[Congressional Record Volume 145, Number 83 (Monday, June 14, 1999)]
[Senate]
[Pages S6929-S6939]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    WORK INCENTIVES IMPROVEMENT ACT

  Mr. KENNEDY. Mr. President, as all of us understand, we are 
considering a very important appropriations bill. The floor managers, 
Senator Domenici and Senator Reid, have a responsibility to see that we 
meet the responsibilities of the Senate and the appropriations 
procedures by making sure this legislation is considered and that 
Members have an opportunity to address it and move towards conclusion. 
I respect that, and I have great respect and friendship for the two 
Members.
  I rise today to raise an issue which is not related to the underlying 
measure but is related to a very significant issue that is affecting 
many individuals across this country, and that is the issue of whether 
we are going to free members of our community, referred to as the 
disability community, who are facing some physical or mental challenge, 
whether or not we are going to free them from the kinds of governmental 
policies that discourage them from employment but really, beyond 
employment, from living a full and constructive and positive and 
independent existence,  which I think all of us want to be able to 
achieve.

  Mr. DOMENICI. Will the Senator yield for a question?
  Mr. KENNEDY. Yes.
  Mr. DOMENICI. Mr. President, I know the bill. I am a cosponsor. I 
hope it gets passed soon this year. I understand you are going to file 
a bill but not call it up because meetings are taking place and we will 
want to pursue those.
  Mr. KENNEDY. The Senator is correct. I have talked to the majority 
leader today, as well as our own leaders, Senator Domenici and Senator 
Reid, and Senator Gramm of Texas, who had effectively put a hold on the 
legislation and had indicated that request, that we file the 
legislation so it would conform to the request of the floor managers. 
It would be at the desk.
  It is at least my impression that, given the agenda that has been 
announced by the majority leader, we would not conclude this 
legislation today and we will be moving on to the Y2K, and what they 
call the Social Security lockbox, later in the week, and we would have 
an opportunity and a good-faith effort to see if there could

[[Page S6930]]

be an agreement to consider this legislation independently--which, as 
the Senator from New Mexico understands, is desirable for a number of 
different reasons--but to do it with a precise time for the scheduling. 
That, I believe, is the preferable way to do it. But we didn't want to 
foreclose our opportunity, if we were unable to do so, to at least be 
able to exercise some judgment and move ahead with the legislation.
  Mr. REID. Will the Senator yield?
  Mr. KENNEDY. Yes, I am glad to yield to the Senator.
  Mr. REID. The possibility is not remarkably good, but there is a 
possibility that we can finish this before the Y2K vote tomorrow 
morning, according to what happens with amendments coming in today.
  Mr. KENNEDY. I would like to take this one step at a time, and I 
think there is very little reason, given the expressions of the 
majority leader and the Senator from Texas, why the Senate--not only 
the Senator from Massachusetts, but Senator Roth, Senator Jeffords and 
Senator Moynihan, and myself, who are the principal cosponsors, be 
given assurance that this would be ready. We are quite available 
through the afternoon to be able to take that. I want to say at this 
time that I would like to proceed in that way, without indicating 
exactly what our course of action would be.
  There is no reason why we should be denied further opportunity to 
consider this legislation. I personally would be inclined to move ahead 
with a short timeframe for consideration of the amendment. But I am 
hopeful, as I said, that we may be able to work this out. So that is my 
intention. I am going to file this, if I may, at the desk and conform 
to the request of the floor managers.
  Mr. President, I raise this issue, and it is a rather unusual process 
and procedure. I know the Senate has its responsibilities, but there is 
also a responsibility to the millions of Americans with disabilities. 
They have been waiting for some period of time as well. The fact is 
that this legislation has 78 cosponsors. I don't know of a piece of 
legislation that is before the Senate that has that degree of support 
from Republican and Democrat alike, and from over 300 organizations. We 
have a variety of different important pieces of legislation, but for my 
money, this legislation was more important to consider than Y2K or, 
with respect, the legislation that we have before us even at the 
present time, because it has such overwhelming support. There is no 
reason why we should not move ahead on this legislation. Millions of 
Americans are waiting for us to take action. The overwhelming majority 
of the Members of this body feels strong support for this, and that is 
a compelling reason to move forward with the legislation.
  Mr. President, we have seen this legislation pass out of the Finance 
Committee 16-2, and one of the Members who had expressed  opposition 
has since indicated that the changes that have been made in the 
legislation sent to the desk have effectively addressed those concerns. 
So here we have the overwhelming, overwhelming, overwhelming sentiment 
of those on the Finance Committee in favor of it. It is virtually 
unanimous in the House Commerce Committee. We don't have pieces of 
legislation like this. We have had differences on some pieces of 
legislation between Republicans and Democrats but not on this one, 
because the legislation is so compelling. We ought to be moving 
forward, and we ought to be moving forward now.

  There are 175 cosponsors in the House of Representatives. The reason 
this legislation has such incredible support is because the 
legislation, perhaps more than any legislation I have seen in recent 
times, is really a reflection of the grassroots efforts to address this 
problem. The overwhelming majority of Americans who have some 
disability want to work and have the ability to work. But because of 
the way that the support systems are set up in terms of health 
insurance, they are prohibited from doing so because they will lose the 
health benefits they so desperately need. They are effectively 
disincentivized from going to work. This legislation understands that 
particular dilemma and addresses it. It is one of the most important 
pieces of legislation we are going to have in this Congress.
  At the outset, I want to pay tribute to my friend and colleague, the 
Senator from Vermont, Senator Jeffords. He has been an enormously 
important leader in this body on issues involving the disabled. I 
welcome the opportunity to work with him on this and other legislation. 
We have a number of members on our committee who have taken special 
interest in the care of the needy and disabled; Senator Harkin and 
Senator Frist come to mind, as do others. We have had the overwhelming 
support of the members of our committee, most of whom were very much 
involved 9 years ago in the passage of the Americans with Disabilities 
Act to strike down the walls of discrimination which had existed and 
exist even today in our society against those who have some disability. 
We have made monumental progress in terms of knocking down the walls of 
discrimination.
  As I will show in a few moments, even though we have had some success 
in knocking down the walls of discrimination, we still see that many of 
those who have disabilities are unable to go back to work because of 
the loss of any health insurance, and it has been because of that 
particular dilemma that this legislation was developed. We will get 
into the sound reasons for doing so,  and the most compelling reason; 
and that is to let all Americans know that if someone has a disability 
it does not mean that they are not able to perform and live 
independently in so many instances, and be constructive, positive, and 
contributing members of our society. We will go through why and how 
this legislation does that.

  I want to indicate at this time that the leadership of our 
colleagues--Senator Roth on the Finance Committee and Senator Moynihan 
on the Finance Committee--was essential in getting that legislation 
through. We worked very closely together. The legislation itself is 
really a reflection of their strong work and their strong commitment, 
as well as that of Senator Jeffords.
  It seems to me this is the time to act. We will hopefully get some 
agreement by the leadership to call this legislation up. The 
appropriate way to have this legislation called up would be with our 
good colleagues and friends, Senator Roth and Senator Jeffords, to 
offer this as independent legislation. We will move forward and pass it 
at that time. That is what I am hopeful we will be able to do. But 
quite frankly, we have been unable to get those kinds of assurances.
  I think the delay in bringing this legislation to the floor has gone 
on long enough. We ought to be about the business of the substance of 
this legislation. We know there can be those who are opposed to it, or 
are concerned about it. But I believe we need a time for accounting. We 
need a time for yeas and nays. That is what this business is ultimately 
about. It is about choices. It is about priorities. It is about whether 
we are going to take action.
  We strongly believe we should take action, and we should take action 
now. We have waited now some 2\1/2\ weeks since we had the 
understanding that this was going to be called up. Then it was 
temporarily shelved and put aside.
  We have waited and waited for those who have been concerned about it 
to express their concern. We have tried to work through some of their 
concern. One of their concerns is about the offsets. We tried to work 
through that, but it is time to take action. This is the vehicle by 
which we can at least get action by the Senate of the United States. I 
believe we should move ahead.
  Former majority leader Bob Dole stated in eloquent testimony before 
the Finance Committee that this issue is about people going to work--
``it is about dignity and opportunity and all of the things we talk 
about when we talk about being Americans.'' Senator Dole has been a 
strong supporter of this legislation, and we welcome his support for 
this program.
  We know a large portion of the 54 million disabled men and women in 
this country want to work and are able to work. But they are denied the 
opportunity to do so. The Nation is denied their talents and their 
contributions to our community.
  These are the results of a Lou Harris 1998 poll of the 54 million 
Americans with disabilities:
  Seventy-two percent of working-age people with disabilities who are 
not

[[Page S6931]]

working now say they want to work. There is a great desire for work by 
those individuals, but still they are effectively denied in a practical 
way the opportunity to do so.
  Removing these barriers to work will help large numbers of disabled 
Americans to achieve self-sufficiency. We are a better and stronger and 
fairer country when we open the golden door of opportunity to all and 
enable them to be equal partners in the American dream. For millions of 
Americans with disabilities, this bill can make the American dream come 
true. When we say ``equal opportunity for all,'' it will be clear that 
we truly mean all.
  How large are the gaps? This chart is the comparison between persons 
with and without disabilities on ``indicator'' measures in 1998.
  Employment: Working either full time or part time, persons with 
disabilities, 29 percent. Persons with no disabilities, approximately 
80 percent. The gap between those with disabilities and without 
disabilities who work is some 50 percent.
  If we look at the income for households, you will see that of those 
persons with disabilities who are working, many of them are working in 
low-income jobs--34 percent have incomes of $15,000 or less compared to 
only 12 percent of those persons with no disabilities. Again we find 
the extraordinary disparity.
  It is long past time to banish the mind-set that the disabled are 
unable. In fact, they have enormous talents and abilities, and America 
cannot afford to waste an ounce of it.
  For too long, Americans with disabilities have faced a series of 
unbearable penalties if they take jobs or go to work. They are in 
danger of losing their medical coverage, which can mean the difference 
between life and death. They are in danger of losing their cash 
benefits, even if they earn only modest amounts from work. No disabled 
American should face the harsh choice between buying a decent meal and 
buying the medication they need.
  The Work Incentives Improvement Act will begin to remove these unfair 
barriers facing people with disabilities who are able to work and who 
want to work.
  It will continue to make health insurance available and affordable 
when a disabled person goes to work or develops a significant 
disability while working.
  It will gradually phase out the loss of cash benefits as income 
rises--instead of the unfair sudden cut-off that so many workers with 
disabilities face today. We have the important demonstration program in 
here that will effectively see the phasing out of the kind of income 
these individuals are entitled to--the phasing out of 50 cents for 
every new dollar they make over a period of time. They would be able to 
increase their income, and we would see a diminution of the amounts 
actually being contributed by the States and Federal Government as they 
continue in the employment.
  This would, obviously, be an incentive for them to move ahead on the 
economic ladder, rather than being the disincentive that it is now, 
which would have a termination of benefits which they receive once they 
move above $500, which effectively locks the disabled into part-time 
jobs and jobs that pay very little.
  It makes a good deal of common sense. It places work incentive 
planners in communities rather than in bureaucracies, and helps workers 
with disabilities learn how to access employment services and support 
the services by help and assistance to the States and communities. The 
States and communities themselves would have some flexibility in being 
able to raise some fees in the administration of these programs. We 
provide a very modest amount for that.

  Finally, all Americans get a fiscally responsible bill. This is based 
on the Joint Committee on Taxation estimates which incorporate CBO 
estimates that S. 331 would cost $838 million over 5 years, to be 
offset by the bill's revenue provisions totaling $906 million, for a 
net savings of $68 million over the 5 years. This does not even begin 
to take into consideration two very important factors; that is, what 
will actually be paid in, in terms of taxes to the Federal Treasury, in 
terms of revenues that the taxpayers will pay, and also the basic 
savings that will be there under the Social Security trust fund.
  This chart shows where we are. We have 7.5 million individuals that 
qualify for Federal participation in some disability program--
individuals who are eligible for some kind of payment. One-half of 1 
percent now are. If, out of the 7.5 million, we are able to get 210,000 
working, we would save the trust fund $1 billion a year. That does not 
come through CBO or OMB because of the way the Budget Act works. This 
is the extrapolation we have in terms of working with the Social 
Security agency. It represents $1 billion saved with 210,000 working 
instead of the 70,000 that are working a year. Ours is $800 million 
over 5 years.
  This makes a good deal of sense. We believe it is economically sound. 
These are savings we will have. When we hear about costs of the bill, 
these are the savings we will have. As I mentioned, it does not even 
take into consideration what will actually be paid in, in terms of 
taxes for those individuals, which will be certainly more than those 
figures.
  We worked very assiduously with a lot of the different groups on this 
program. When we think of citizens with disabilities, we tend to think 
of men, women and children who are disabled from birth. However, fewer 
than 15 percent of all people with disabilities are born with their 
disabilities. A bicycle accident or a serious fall or a serious illness 
can suddenly disable the healthiest and most physically capable person. 
This is enormously important. This legislation is not just for our 
fellow Americans that may be born with some disability, but for all 
Americans.
  In the long run, this legislation may be more important than any 
other action we will take in this Congress. It offers a new and better 
life to large numbers of our fellow citizens. Disability need no longer 
end the American dream. That was the promise of the Americans with 
Disabilities Act a decade ago, and this legislation dramatically 
strengthens our fulfillment of that promise.
  I will not take the time this afternoon to go through a diary I have, 
``A Day in the Life of People Who Want To Work.'' We have broken down 
by States and included letters from individuals who have written about 
what this particular legislation means in terms of their lives today, 
how their lives would be changed, how their lives would be altered with 
this particular legislation. It is enormously powerful and moving.
  If necessary, if we have to convince our colleagues about this 
legislation, I will take some time and go through some of the letters.
  I will mention very briefly the human aspect of this legislation. 
This legislation is for Alice in Oklahoma who is disabled because of 
multiple sclerosis and receives SSDI benefits. She needs personal 
assistance to live and work in her community. But to do so, she must 
use all of her savings and half or all of her wages to pay for personal 
assistance and prescription drugs. As a result, she is left in poverty.
  This bill is for Tammy in Indiana who has cerebral palsy and uses a 
wheelchair. She works part-time at Wal-Mart, but her hours are 
restricted because if she works too much she will lose her health 
benefits. Her goal of becoming a productive citizen is denied by the 
unfair danger of losing the health care she needs.
  This is for Jay in Minnesota on SSDI who wants to work. However, the 
job he is qualified for offers no health care. If he accepts the job, 
he will join the ranks of the uninsured.
  This bill is for Abby in Massachusetts who is only 6 years old and 
has mental retardation. Her parents are very concerned about her future 
and her ability to work and still have health insurance. Already she 
has been denied coverage by two insurance firms because of the 
diagnosis of mental retardation. Without Medicaid, her parents would be 
bankrupted by her medical bills today. If Abby eventually enters the 
workforce, she will have to live in poverty or lose Medicaid coverage 
under current law. Under this bill, all that would change. She and her 
parents will have a chance to dream of a future that includes work and 
prosperity, rather than a future of government handouts.
  This bill is for many other citizens whose stories are told in this 
diary.

[[Page S6932]]

 This diary alone should be enough to shock and shame the Senate into 
action.
  Our goal in this legislation is to banish the stereotypes, to reform 
and improve the existing disability programs so that they genuinely 
encourage and support every disabled person's dream to work and live 
independently and be a productive and contributing member of the 
community. That goal should be the birthright of all Americans. With 
this legislation, we are taking a giant step toward that goal.
  A story from the debate on the Americans With Disabilities Act 
illustrates the point. A postmaster in a town was told he must make his 
post office accessible. The building had 20 steps leading to a 
revolving door at the entrance. The postmaster questioned the need to 
make such costly changes. He said, ``I've been here for 35 years and in 
all that time I have yet to see a single customer come in here in a 
wheelchair.'' As the Americans With Disabilities Act shows, if you 
build the ramp, people will come and they will find their field of 
dreams. This bill expands the field.
  The road to economic prosperity and the right to a decent wage must 
be more accessible to all Americans, no matter how many steps stand in 
the way. That is our goal in this legislation. It is the right thing to 
do. It is the cost-effective thing to do, and now is the time to do it. 
For too long, our fellow disability citizens have felt left out and 
left behind. A new and brighter day is on the horizon for them and 
today we finally will make it a reality.
  I will describe a few other reasons for the importance of this 
legislation, including the cost of this legislation and what is 
happening currently. I will refer to the work in the Work Incentive 
Improvement Act and a report.
  7.5 million disabled receive cash payments from SSI and SSDI. 
Disability benefit spending totals $73 billion a year. That is what we 
are spending at the present time under this program--$73 billion a 
year, making disability programs the fourth largest entitlement 
expenditure in the Federal Government. If only 1 percent, or 75,000, of 
the 7.5 million were to become employed, Federal savings in disability 
programs would total $3.5 billion over the worklife of the 
beneficiaries.
  Do we hear that? If we get to 1 percent, we will be effectively 
saving $3.5 billion over the life of those beneficiaries. That is if we 
just get to 1 percent, let alone the goal of those of us who believe in 
independent living.
  I will quote from the General Accounting Office:

       The two largest Federal programs providing cash and medical 
     assistance for people with disabilities grew rapidly between 
     1985 and 1994, with the enrollment of working age people 
     increasing 59 percent from 4 million to 6.3 million.

  The figures I just read are the most current figures--7.5.

       . . . the inflation-adjusted cost of cash benefits growing 
     by 66 percent. Administered by SSA, DI and SSI paid over $50 
     billion in cash benefits to people with disabilities in 1994.

  So we are up now to $77 billion. In 1994 it was $50 billion. Now, 
this last year, in a period of 4 years it is up to $77 billion. That is 
a $27 billion increase. The flow line of these expenditures is going 
right up through the roof without any further indication of effectively 
reducing their unemployment, improving the ability of these 
individuals--who want to work and who have the ability to work if they 
are able to continue with their health insurance--to be contributing 
members of the community. It can have a dramatic, significant impact in 
lowering the continued escalation in expenditures under this fund.
  For those individuals here who fail to understand what we are doing, 
what is happening, I hope they will refer to an excellent GAO report.
  I ask unanimous consent to have it printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  Social Security: Disability Programs Lag in Promoting Return to Work

       Mr. Chairman and Members of the Committee: You asked us to 
     discuss today ways to improve the Disability Insurance (DI) 
     and Supplemental Security Income (SSI) programs by helping 
     people with disabilities return to work. Each week the Social 
     Security Administration (SSA) pays over $1 billion in cash 
     payments to people with disabilities on DI and SSI. While 
     providing a measure of income security, these payments for 
     the most part do little to enhance the work capacities and 
     promote the economic independence of these DI and SSI 
     recipients. Yet societal attitudes have shifted toward goals, 
     as embodied in the Americans With Disabilities Act (ADA), of 
     economic self-sufficiency and the right of people with 
     disabilities to full participation in society.
       At one time, the common business people was to encourage 
     someone with a disability to leave the workforce. Today, 
     however, a growing number of private companies have been 
     focusing on enabling people with disabilities to return to 
     work. Moreover, medical advances and new technologies provide 
     more opportunities than ever for people with disabilities to 
     work.
       We found that the DI and SSI programs are out of sync with 
     these trends. The application process places a heavy emphasis 
     on work incapacity, and it presumes that medical impairments 
     preclude employment. And SSA does little to provide the 
     support and assistance that many people with disabilities 
     need to work. Our April 1996 report shows, in fact, that 
     program design and implementation weaknesses hinder 
     maximizing beneficiary work potential.\1\ Not surprisingly, 
     these weaknesses also yield poor return-to-work outcomes. 
     Other work we are doing for you highlights strategies from 
     the private sector and other countries that SSA could use to 
     develop administrative and legislative solutions to improve 
     return-to-work outcomes. Indeed, if an additional 1 percent 
     of the 6.3 million working-age SSI and DI beneficiaries were 
     to leave SSA's disability rolls by returning to work, 
     lifetime cash benefits would be reduced by an estimated $2.9 
     billion.\2\
---------------------------------------------------------------------------
     See footnotes at end of article.
---------------------------------------------------------------------------
       With this in mind, today I would like to focus on how the 
     current program structure impedes return to work and how 
     strategies from other disability systems could help 
     restructure DI and SSI to improve return-to-work outcomes. To 
     develop this information, we surveyed people in the private 
     sector generally recognized as leaders in developing 
     disability management programs that focus on return-to-work 
     efforts. We also interviewed officials in Germany and Sweden 
     because the experiences of their social insurance programs 
     show that return-to-work strategies are applicable to a broad 
     and diverse population with a wide range of work histories, 
     job skills, and disabilities. We also conducted focus groups 
     with people receiving disability benefits and convened a 
     panel of disability experts.


                               background

       DI and SSI the two largest federal programs providing cash 
     and medical assistance to people with disabilities--grew 
     rapidly between 1985 and 1994, with the enrollment of 
     working-age people increasing 59 percent, from 4 million to 
     6.3 million, and the inflation-adjusted cost of cash benefits 
     growing by 66 percent. Administered by SSA, DI and SSI paid 
     over $50 billion in cash benefits to people with disabilities 
     in 1994. To be considered disabled by either program, an 
     adult must be unable to engage in any substantial gainful 
     activity because of any medically determinable physical or 
     mental impairment that can be expected to result in death or 
     that has lasted or can be expected to last at least 1 year. 
     Moreover, the impairment must be of such severity that a 
     person not only is unable to do his or her previous work, 
     but, considering his or her age, education, and work 
     experience, is unable to do any other kind of substantial 
     work that exists in the national economy.
       Both programs use the same definition of disability but 
     differ in important ways. DI, established in 1956, is an 
     insurance program funded by payroll taxes paid by workers and 
     their employers into a Social Security trust fund. The 
     program is for workers who, having worked long enough and 
     recently enough to become insured under DI, have lost their 
     source of income because of disability. Medicare coverage is 
     provided to DI beneficiaries after they have received cash 
     benefits for 24 months. Almost 4 million working-age people 
     (aged 18 to 64) received about $34 billion in DI cash 
     benefits in 1994.\3\
       In contrast, SSI is a means-tested income assistance 
     program for disabled, blind, or aged individuals regardless 
     of their participation in the labor force. Established in 
     1972 for individuals with low income and limited resources, 
     SSI is financed from general revenues.\4\ In most states, 
     SSI entitlement ensures an individual's eligibility for 
     Medicaid benefits. In 1994, about 2.36 million working-age 
     people with disabilities received SSI benefits. Federal 
     SSI benefits paid to SSI beneficiaries with disabilities 
     in 1994 equaled $18.9 billion.\5\


              caseloads have changed since the mid-1980's

       The composition of the DI and SSI caseloads has undergone 
     many changes during the last decade. Between 1985 and 1994, 
     DI and SSI experienced an increase in the proportion of 
     beneficiaries with impairments--especially mental 
     impairments--that keep them on the rolls longer than in the 
     past. By 1994, 31 percent of DI beneficiaries and 57 percent 
     of SSI working-age beneficiaries had mental impairments--
     conditions that have one of the longest anticipated 
     entitlement periods (about 16 years for DI). In addition, the 
     beneficiary population has become, on average, modestly but 
     steadily younger since the mid-1980s. The proportion of 
     working-age beneficiaries who are middle aged (aged 30 to 49) 
     has steadily increased--from 30 to 40 percent for DI, and 
     from 36 to 46 percent for

[[Page S6933]]

     SSI--as the proportion who are older has declined.


          Statute Provides for Returning Beneficiaries to Work

       The Social Security Act states that as many individuals 
     applying for disability benefits as possible should be 
     rehabilitated into productive activity. To this end, people 
     applying for disability benefits are to be promptly referred 
     to state vocational rehabilitation (VR) agencies for services 
     intended to prepare them for work opportunities. To reduce 
     the risk a beneficiary faces in trading guaranteed monthly 
     income and premium-free medical coverage for the 
     uncertainties of competitive employment, the Congress also 
     established various work incentives to safeguard cash and 
     medical benefits while a beneficiary tries to return to work.
       Dispite congressional attention to employment as a way to 
     reduce dependence, few beneficiaries leave the rolls to 
     return to work. During each of the past several years, not 
     more than 1 of every 500 DI beneficiaries has been terminated 
     from the rolls because they returned to work.


     Technological Advances and Social Change Foster Return to Work

       While DI and SSI return-to-work outcomes have been poor, 
     many technological and medical advances have created more 
     opportunities for some individuals with disabilities to 
     engage in work. Electronic communications and assistive 
     technologies--such as scanners, synthetic voice systems, 
     standing wheelchairs, and modified automobiles and vans--have 
     given greater independence to some people with disabilities, 
     allowing them to tap their work potential. Advances in the 
     management of disability--like medication to control mental 
     illness or computer-aided prosthetic devices--have helped 
     reduce the functional limitations associated with some 
     disabilities. These advances may have opened new 
     opportunities, particularly for some people with physical 
     impairments, in the growing service sector of the economy.
       Social change has promoted greater inclusion of and 
     participation by some people with disabilities in the 
     mainstream of society, including children in school and 
     adults at work. For instance, over the past 2 years, people 
     with disabilities have sought to remove environmental 
     barriers that impede them from fully participating in their 
     communities. Moreover, ADA supports the full participation of 
     people with disabilities in society and fosters the 
     expectation that people with disabilities can and have the 
     right to work. ADA prohibits employers from discriminating 
     against qualified individuals with disabilities and requires 
     employers to make reasonable workplace accommodations, unless 
     it would impose an undue hardship on the business.


            current program structure impedes return to work

       The cumulative impact of weaknesses in the design and 
     implementation of the disability programs is to understate 
     beneficiaries' work capacity and impede efforts to improve 
     return-to-work outcomes. Despite a changing beneficiary 
     population and advances in technology and medicine that have 
     increased the potential for some beneficiaries to work, the 
     disability programs have remained essentially frozen in time. 
     Weaknesses in the design and implementation of the DI and SSI 
     programs, summarized in table 1, have impeded identifying and 
     encouraging the productive capacities of those who might 
     benefit from rehabilitation and employment assistance.

    TABLE 1.--SUMMARY OF PROGRAM DESIGN AND IMPLEMENTATION WEAKNESSES
------------------------------------------------------------------------
               Program area                           Weakness
------------------------------------------------------------------------
Disability determination.................  ``Either/or'' decision gives
                                            incentive to promote
                                            inabilities and minimize
                                            abilities.
                                           Lengthy application process
                                            to prove one's disability
                                            can erode motivation and
                                            ability to return to work.
Benefit structure........................  Cash and medical benefits
                                            themselves can reduce
                                            motivation to work and
                                            receptivity to VR and work
                                            incentives, especially when
                                            low-wage jobs are the likely
                                            outcome.
                                           People with disabilities may
                                            be more likely to have less
                                            time available to work,
                                            further influencing a
                                            decision to opt for benefits
                                            over work.
Work incentives..........................  ``All-or-nothing'' nature of
                                            DI cash benefits can make
                                            work at low wages
                                            financially unattractive.
                                           Risk of losing medical
                                            coverage when returning to
                                            work is high for many
                                            beneficiaries.
                                           Loss of other federal and
                                            state assistance is a risk
                                            for some beneficiaries who
                                            return to work.
                                           Few beneficiaries are aware
                                            that work incentives exist.
                                           Work incentives are not well
                                            understood by beneficiaries
                                            and program staff alike.
VR.......................................  Access to VR services through
                                            Disability Determination
                                            Service (DDS) referrals is
                                            limited: restrictive state
                                            policies severely limit
                                            categories of people
                                            referred by DDSs; the
                                            referral process is not
                                            monitored, reflecting its
                                            low priority and removing
                                            incentive to spend time on
                                            referrals; VER counselors
                                            perceive beneficiaries as
                                            less attractive VR
                                            candidates than other people
                                            with disabilities, making
                                            them less willing to accept
                                            beneficiaries as clients;
                                            and the success-based
                                            reimbursement system is
                                            ineffective in motivating VR
                                            agencies to accept
                                            beneficiaries as clients.
                                           Applicants are generally
                                            uninformed about VR and
                                            beneficiaries are not
                                            encouraged to seek VR,
                                            affording little opportunity
                                            to opt for rehabilitation
                                            and employment.
                                           Studies have questioned the
                                            effectiveness of state VR
                                            agency services since long-
                                            term, gainful work is not
                                            necessarily the focus of VR
                                            agency services.
                                           Delayed VR intervention can
                                            cause a decline in
                                            receptiveness to participate
                                            in rehabilitation and job
                                            placement activities, as
                                            well as a decline in skills
                                            and abilities.
                                           The monopolistic state VR
                                            structure can contribute to
                                            lower quality service at
                                            higher prices, and recent
                                            regulations allowing
                                            alternative VR providers may
                                            not be effective in
                                            expanding private sector VR
                                            participation.
------------------------------------------------------------------------

      Work Capacity of DI and SSI Beneficiaries May Be Understated

       The Social Security Act requires that the assessment of an 
     applicant's work incapacity be based on the presence of 
     medically determinable physical and mental impairments. SSA 
     maintains a Listing of Impairments for medical conditions 
     that are, according to SSA, ordinarily severe enough in 
     themselves to prevent an individual from engaging in any 
     gainful activity. About 70 percent of new awardees are 
     eligible for disability because their impairments meet or 
     equal the listings. But findings of studies we reviewed 
     generally agree that medical conditions are a poor predictor 
     of work incapacity.\6\ As a result, the work capacity of DI 
     and SSI beneficiaries may be understated.
       While disability decisions may be more clear-cut in the 
     case of people whose impairments inherently and permanently 
     prevent them from working, disability determinations may be 
     much more difficult for those who may have a reasonable 
     chance of work if they receive appropriate assistance and 
     support. Nonmedical factors may play a crucial role in 
     determining the extent to which people in this latter group 
     can work.


  Program Weaknesses Impede Efforts to Improve Return-to-Work Outcomes

       The ``either/or'' nature of the disability determination 
     process creates an incentive for applicants to overstate 
     their disabilities and understate their work capacities. 
     Because the result of the decision is either full award of 
     benefits or denial of benefits, applicants have a strong 
     incentive to promote their limitations to establish their 
     inability to work and thus qualify for benefits. Conversely, 
     applicants have a disincentive to demonstrate any capacity to 
     work because doing so may disqualify them for benefits. 
     Furthermore, the documentation involved in establishing one's 
     disability can, many believe, create a ``disability mind-
     set,'' which weakens motivation to work. Compounding this 
     negative process, the length of time required to determine 
     eligibility can erode skills, abilities, and habits necessary 
     to work.

                           *   *   *   *   *

       Intervene as soon as possible after a disabling event;
       Identify and provide necessary return-to-work services and 
     manage cases; and
       Structure cash and medical benefits to encourage return to 
     work.
       The practices underlying these strategies are summarized in 
     table 2.
       Disability managers we interviewed emphasized that these 
     return-to-work strategies are not independent of each other 
     and work most effectively when integrated into a 
     comprehensive return-to-work program. Return-to-work 
     strategies and practices may hold potential both for 
     improving federal disability programs by helping people with 
     disabilities return to productive activity in the workplace 
     and, at the same time, for reducing program costs.

 TABLE 2: STRATEGIES AND PRACTICES IN THE DESIGN OF RETURN-TO-WORK PROGRAMS OF THE U.S. PRIVATE SECTOR AND OTHER
                                                    COUNTRIES
----------------------------------------------------------------------------------------------------------------
                                  Strategies                                                Practices
----------------------------------------------------------------------------------------------------------------
Intervene as early as possible after an actual or potentially disabling event.  Address return-to-work goals
                                                                                 from the beginning of an
                                                                                 emerging disability.
                                                                                Provide return-to-work services
                                                                                 at the earliest appropriate
                                                                                 time.
                                                                                Maintain communication with
                                                                                 workers who are hospitalized or
                                                                                 recovering at home.
Identify and provide necessary return-to-work assistance effectively..........  Assess each individual's return-
                                                                                 to-work potential and needs.
                                                                                Use case management techniques
                                                                                 when appropriate to help
                                                                                 workers with disabilities
                                                                                 return to work
                                                                                Offer transitional work
                                                                                 opportunities that enable
                                                                                 workers with disabilities to
                                                                                 ease back into the workplace.
                                                                                Ensure that medical service
                                                                                 providers understand the
                                                                                 essential job functions of
                                                                                 workers with disabilities.
Structure cash and medical benefits to encourage return to work...............  Structure cash benefits to
                                                                                 encourage workers with
                                                                                 disabilities to rejoin the
                                                                                 workforce.
                                                                                Maintain medical benefits for
                                                                                 workers with disabilities who
                                                                                 return to work.
                                                                                Include a contractual provision
                                                                                 that can require the worker
                                                                                 with disabilities to cooperate
                                                                                 with return-to-work efforts.
----------------------------------------------------------------------------------------------------------------


[[Page S6934]]

             Early Intervention Critical to Return to Work

       Disability managers we surveyed stressed the importance of 
     early intervention in returning workers with disabilities to 
     the workplace. Advocates of early intervention believe that 
     the longer an individual stays away from work, the less 
     likely return to work will be. Studies show that only one in 
     two workers with recently acquired disabilities who are out 
     of work 5 months or more will ever return to work. Disability 
     managers believe that long absences from the workplace can 
     reduce motivation to attempt work.
       Setting return-to-work goals soon after the onset of 
     disability and providing timely rehabilitation services are 
     believed to be critical in encouraging workers with 
     disabilities to return to the workplace as soon as possible. 
     Contacting a hospitalized worker soon after an injury or 
     illness and then continuing to communicate with the worker 
     recovering at home, for instance, helps reassure the worker 
     that there is a job to return to and that the employer is 
     concerned about his or her recovery.


     Identifying and Providing Return-to-Work Services Effectively

       Another common strategy is to effectively identify and 
     provide return-to-work services. This approach involves 
     investing in services tailored to individual circumstances 
     that help achieve return-to-work goals for workers with 
     disabilities while avoiding unnecessary expenditures.
       In an effort to provide appropriate services, many in the 
     private sector strive to identify the individuals who are 
     likely to be able to return to work and then identify the 
     specific services they need. In doing so, each individual 
     should be functionally evaluated after his or her medical 
     condition has stabilized to assess potential for returning to 
     work. When appropriate, the private sector uses case 
     management techniques to coordinate the identification, 
     evaluation, and delivery of disability-related services to 
     individuals deemed to need such services to return to work. 
     Transitional work allows workers with disabilities to ease 
     back into the workplace in jobs that are less physically or 
     mentally demanding than their regular jobs.
       The private sector also stresses the need to ensure that 
     physicians and other medical service providers understand the 
     essential job functions of workers with disabilities. Without 
     this understanding, the worker's return to work could be 
     delayed unnecessarily. Also, if an employer is willing to 
     provide transitional work opportunities or other job 
     accommodations, the treating physician must be aware of and 
     understand these accommodations.


               Work Incentives Facilitate Return to Work

       Finally, disability managers responding to our survey 
     generally offered incentives through their programs' cash and 
     medical benefit structure to encourage workers with 
     disabilities to return to work. Disability managers believe 
     that a program's incentive structure can affect return-to-
     work decisions. The level of cash benefits paid to workers 
     with disabilities can affect their attitudes toward returning 
     to work because, if disability benefits are too generous, the 
     benefits can create a disincentive for participating in 
     return-to-work efforts. Disability managers also believe 
     employer-sponsored medical benefits can provide an incentive 
     to return to work if returning is the way that workers with 
     disabilities in the private sector can best ensure that they 
     retain medical benefits.
       Although the structure of benefits plays a role in return-
     to-work decisions, disability managers emphasized that well-
     structured incentives are not sufficient in themselves for a 
     successful return-to-work program. Incentives must be 
     integrated with other return-to-work practices. Disability 
     managers also generally advocated including a contractual 
     requirement for cooperation with a return-to-work plan as a 
     condition of eligibility for benefits. They believed such a 
     requirement helps motivate individuals with disabilities to 
     try to return to work.


    Return-to-Work Outcomes Could Be Improved Through Restructuring

       Return-to-work strategies used in the U.S. private sector 
     and other countries reflect expectations that people with 
     disabilities can and do return to work. The DI and SSI 
     programs, however, are out of sync with this return-to-work 
     focus. Improving the DI and SSI return-to-work outcomes 
     requires restructuring these programs to better identify and 
     enhance beneficiary return-to-work capacities. While there is 
     opportunity for improvement, it should be acknowledged that 
     many beneficiaries will be unable to return to work. In fact, 
     almost half of the people receiving benefits are not likely 
     to become employed because of their age or because they are 
     expected to die within several years. For others, work 
     potential is unknown; but research suggests that successful 
     transitions to work may be more likely for younger people 
     with disabilities and for those who have greater motivation 
     and more education.\7\
       Studies have shown that a meaningful portion of DI and SSI 
     beneficiaries possess such characteristics. The DI and SSI 
     disability rolls have been increasingly composed of a 
     significant number of younger individuals. Among working-age 
     SSI and DI beneficiaries, one out of three is under the age 
     of 40 \8\ In addition, in 1993, 35 percent of 84,000 DI 
     beneficiaries expressed an interest in receiving 
     rehabilitation or other services that could help them return 
     to work, an indication of motivation. Moreover, a substantial 
     portion--almost one in two--of a cohort of DI beneficiaries 
     had a high school degree or some years of education beyond 
     high school.\9\ The literature also suggests that lack of 
     work experience is a significant barrier to 
     employability.\10\ A promising sign is that about one-half of 
     DI and one-third of SSI working-age beneficiaries had some 
     attachment to the labor force during the 5 years immediately 
     preceding the year of benefit award.\11\
       Even those who may be able to return to work will face 
     challenges. For example, some may need to learn basic skills 
     and work habits and build self-esteem to function in the 
     workplace. Moreover, the nature of some disabilities may 
     limit full-time work, while others may cause logistical 
     obstacles, such as transportation difficulties. Finally, 
     employer resistance to hiring people with disabilities and 
     tight labor market conditions, particularly for low-wage 
     positions, could constrain employment opportunities.
       Nevertheless, there are compelling reasons to try new 
     approaches. As mentioned, our review of the disability 
     determination process shows that the work capacity of an 
     individual found eligible for DI and SSI benefits may be 
     understated. And this country has experienced medical, 
     technological, and societal advances over the past several 
     years that foster return to work. But weaknesses in the 
     design and implementation of the DI and SSI programs mean 
     that little has been done to identify and encourage the 
     productive capacities of beneficiaries who might be able to 
     benefit from these advances.
       Restructuring of the DI and SSI programs should consider 
     the return-to-work strategies employed by the U.S. private 
     sector and social insurance programs in Germany and Sweden. 
     Lessons from these other disability programs argue for 
     placing greater priority on assessing return-to-work 
     potential soon after individuals apply for disability 
     benefits. The priority in the DI and SSI programs, however, 
     is to determine the eligibility of applicants to receive cash 
     benefits, not to assess their return-to-work potential. In 
     conjunction with making an early assessment of return-to-work 
     potential, the programs should place greater priority on 
     identifying and providing, at the earliest appropriate time, 
     the medical and vocational rehabilitation services needed to 
     return to work. But under the current program design, medical 
     and vocational rehabilitation services are provided too late 
     in the process. Finally, the programs should be designed to 
     ensure that cash and medical benefits encourage beneficiaries 
     to return to work. Presently, however, cash and medical 
     benefits can make it financially advantageous to remain on 
     the disability rolls, and many beneficiaries fear losing 
     their premium-free Medicare or Medicaid benefits if they 
     return to work.
       Although SSA faces constraints in applying the return-to-
     work strategies of other disability programs, opportunities 
     exist for better identifying and providing the return-to-work 
     assistance that could enable more of SSA's beneficiaries to 
     return to work. Even relatively small gains in return-to-work 
     successes offer the potential for significant savings in 
     program outlays.


                              conclusions

       In our April 1996 report, we recommended that the 
     Commissioner take immediate action to place greater priority 
     on return to work, including designing a more effective means 
     to identify and expand beneficiaries' work capacities and 
     better implementing existing return-to-work mechanisms. In 
     line with placing greater emphasis on return to work, we 
     believe that the Commissioner needs to develop a 
     comprehensive return-to-work strategy that integrates, as 
     appropriate, earlier intervention, earlier identification and 
     provision of necessary return-to-work assistance for 
     applicants and beneficiaries, and changes in the structure of 
     cash and medical benefits. As part of that strategy, the 
     Commissioner needs to identify legislative changes that would 
     be required to implement such a program.
       \1\ This testimony is based on SSA Disability: Program 
     Redesign Necessary to Encourage Return to Work(GAO/HEHS-96-
     62, Apr. 24, 1996) and a forthcoming GAO report on return-to-
     work strategies in the U.S. private sector, Germany, and 
     Sweden.
       \2\ The estimated reductions are based on fiscal year 1994 
     data provided by SSA's actuarial staff and represent the 
     discounted present value of the cash benefits that would have 
     been paid over a lifetime if the individual had not left the 
     disability rolls by returning to work.
       \3\ Included among the 3.96 million DI beneficiaries are 
     671,000 who were dually eligible for SSI disability benefits 
     because of the low level of their income and resources.
       \4\ Reference to the SSI program throughout this testimony 
     addresses blind or disabled, not aged recipients. General 
     revenues include taxes, customs duties, and miscellaneous 
     receipts collected by the federal government but not 
     earmarked by law for a specific purpose.
       \5\ The 2.36 million SSI beneficiaries do not include 
     individuals who were dually eligible for SSI and DI benefits. 
     The $18.9 billion consists of payments to all SSI blind and 
     disabled beneficiaries regardless of age.
       \6\ For example, S.O. Okpaku and others, ``Disability 
     Determinations for Adults With

[[Page S6935]]

     Mental Disorders: Social Security Administration vs. 
     Independent Judgments.'' American Journal of Public Health, 
     Vol. 84, No. 11 (Nov. 1994), pp. 1791-95; and H.P. Brehm and 
     T.V. Rush, ``Disability Analysis of Longitudinal Health Data: 
     Policy Implications for Social Security Disability 
     Insurance,'' Journal of Aging Studies, Vol. 2, No. 4 (1988), 
     pp. 379-99.
       \7\ For example, J.C. Hennessey and L.S. Muller, ``The 
     effect of Vocational Rehabilitation and Work Incentives on 
     Helping the Disabled Worker Beneficiary Back to Work,'' 
     Social Security Bulletin, Vol. 58, No. 1 (spring 1995), pp. 
     15-28; R.J. Butler, W.G. Johnson, and M.L. Baldwin, 
     ``Managing Work Disability: Why First Return to Work Is Not a 
     Measure of Success,'' Industrial and Labor Relations Review, 
     Vol. 48, No. 3 (Apr. 1995), pp. 452-67; and R.V. Burkhauser 
     and M.C. Daly, ``Employment and Economic Well-Being Following 
     the Onset of a Disability: The Role for Public Policy,'' 
     paper presented at the National Academy of Social Insurance 
     and the National Institute for Disability and Rehabilitation 
     Research Workshop on Disability, Work, and Cash Benefits 
     (Santa Monica, Calif.: Dec. 1994).
       \8\ Annual Statistical Supplement, 1995 to the Social 
     Security Bulletin (Aug. 1995).
       \9\ J.C. Hennessey and L.S. Muller, ``Work Efforts of 
     Disabled Worker Beneficiaries: Preliminary Findings From the 
     New Beneficiary Followup Survey,'' Social Security Bulletin, 
     Vol. 57, No. 3 (fall 1994), pp. 42-51.
       \10\ Berkeley Planning Associates and Harold Russell 
     Associates, ``Private Sector Rehabilitation: Lessons and 
     Options for Public Policy,'' prepared for the U.S. Department 
     of Education. Office of Planning, Budget, and Evaluation 
     (Dec. 31, 1987).
       \11\ M.C. Daly, ``Characteristics of SSI and SSDI 
     Recipients in the Years Prior to Receiving Benefits: Evidence 
     From the PSID,'' presented at SSA's conference on Disability 
     Programs: Explanations of Recent Growth and Implications for 
     Disability Policy (Sept. 1995).
  Mr. KENNEDY. In the GAO report is an analysis of this program. But 
they also looked at U.S. private and social insurance programs to find 
out, are there American companies that are trying to deal with this 
with employees, and are there other States trying to do it?
  Look at this. We can look at the percentages of working-age persons 
with disabilities. We will see West Virginia is 12.6; then 11, in 
Louisiana; 10 in Maine; Oklahoma, 10.2; Oregon, 10.
  Now, take the percent working and the percent not working. The 
percent working is 20 percent--24, 28, 23, 23. Maine has 37 percent 
working; Oklahoma, 34; and Oregon has 42 percent working--42 percent 
working.
  Then we look at the percent not working--57 percent. Some other 
States are almost 80 percent.
  Don't you think we ought to look at the States that have large 
numbers of people with disabilities who are working and find out how 
they are getting people to work? And find out what is not happening in 
States where they are not getting them to work? That is what we did in 
this legislation. What we are finding out is, in those States, in the 
private sector, they are maintaining the insurance aspects of the 
health care and also providing the financial incentives to be able to 
go to work. That is just in some of our States.
  We are hopeful we can move with these incentives to get to every 
State. Some States are making dramatic improvements, and others are 
not. The lessons are very clear, and we have included that in the 
legislation. If we look at what is happening in other countries, in two 
countries we find the absolutely extraordinary results they have from 
having similar incentives and disincentives that we have tried to 
incorporate in this legislation and that are referred to by the GAO as 
being very successful.
  I would like to believe the importance of this is to make sure those 
Americans with some disability are going to be included in the great 
American dream, that we decided as a nation we not only are not going 
to discriminate but we are going to encourage policies that will make 
it possible for those with disabilities to be part of the American 
dream. What we are attempting is to do it in ways that have 
demonstrated effectiveness.
  The principal reasons they have been effective are along these lines. 
They have been happening because we have seen new medical technology 
which has been very helpful when carefully and effectively pursued. I 
think we all understand the costs of medical technology. In this 
particular area, there are some great opportunities for people, by the 
use of medical technology, to get back to work. It is working, and it 
is effective; it is cost effective.
  We are also finding, for one reason or another--I will not take the 
time now--a number of those going on the disability rolls have been 
younger individuals than we were considering probably 20 years ago.
  Another interesting corollary is, most of those individuals have a 
higher achievement in completion of high school and college, for 
reasons I will not bother taking up the time of the Senate with at this 
time. We are talking about younger individuals who are more adaptable 
for these training programs, newer kinds of technology out there, and 
where that is accessible, more effective training programs such as we 
passed last year with our one-stop shopping and incentive programs, 
with financial incentives in the private sector that are going to be 
effective programs getting people working. We have brought all of these 
elements together. We followed the examples that have been pointed out 
to us as effective and incorporated those in this legislation.
  We believe this will have a dramatic and positive impact, most 
importantly on the ability of individuals to go to work and be useful 
and productive, constructive members of our society and live happier 
lives in their own personal situations and the members of their family, 
be more productive in the general economy, in what they are able to add 
to the economy, without these false disincentives out there, reducing 
the financial burden on the trust funds which are paying out to the 
community, and ultimately seeing a dramatic reduction in burden to the 
States' financial situation for funding as well as to the Federal 
Government. This, we believe, is a win-win-win situation all the way 
along the line.
  I could take further time. I know there are others who want to speak 
to the underlying measure. But we believe very deeply in this 
legislation, which has been carefully thought through by individuals 
who will be most affected by it. That has been enormously important. 
Very often we draft and shape legislation in a way we think is best, 
but this is legislation that has emerged from the grassroots level. We 
understand the difficulty of getting everyone to agree to different 
proposals.
  We have harmony among the community that represents 300 different 
organizations. It is an extraordinary initiative, an extraordinary 
result that is so powerful in terms of what we hope to achieve.
  This is really a service to the country. We want the kind of America 
that is going to say to those individuals who are faced with some 
physical or mental challenges that we will make sure they will be able 
to participate to the extent their abilities, their interest, their 
courage, and their determination permit them. We want to eliminate or 
knock down those barriers which one way or the other inhibit their 
ability to move forward.
  We have been attempting to do that in a number of ways, but there is 
nothing that is going to do more in opening up the dreams and the hopes 
of these individuals and their families than this piece of legislation.
  The Americans With Disabilities Act is important in trying to 
eliminate discrimination against the disabled. The Work Incentives 
Improvement Act will do the job in terms of eliminating the significant 
financial disincentives out there that basically inhibit so many of our 
fellow citizens, who have the ability and dedication and commitment and 
desire, from moving forward. That is why this legislation is so 
important.
  At another time, I will go through some of the other provisions of 
the legislation.


                         Privilege Of The Floor

  Mr. KENNEDY. I ask unanimous consent that Connie Garner be given the 
privilege of the floor during the consideration of the energy and water 
appropriations bill.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REID. Will the Senator yield for a question?
  Mr. KENNEDY. I will be glad to yield.
  Mr. REID. In listening to the remarks of the Senator from 
Massachusetts, I am struck by the fact that the people this legislation 
is attempting to help are people who do not have voices here to 
represent their interests; is that not generally the case?

[[Page S6936]]

  Mr. KENNEDY. The Senator is correct. I like to believe there is a 
greater understanding and awareness of the challenges that disabled 
Americans have faced in more recent years than there had been for the 
first 200 years of our country. Over the last 8 or 10 years, we have 
had some important changes in attitude on these issues.
  By and large, the Senator is correct that this has not been an issue 
that has been in the forefront of legislative or executive action.
  Mr. REID. I also say there have been some people of good will joining 
together around the country attempting to advocate for the disabled, 
but the people we deal with on a daily basis are usually people who 
come representing institutions or entities and who are, in effect, well 
paid. They are people who have vast amounts of money tied up in Federal 
programs.
  The disabled people the Senator is attempting to help with this 
legislation are people who have--the Senator is absolutely right--
joined together in the last decade recognizing the disabled need help. 
But these are volunteer groups and people, as I said, of good will 
around the country trying to help people who have no representation; is 
that basically true?
  Mr. KENNEDY. The Senator is correct. It was not that long ago when we 
had 5.5 million children who were disabled who never went to schools in 
our country. We have made some progress in opening up the schools of 
our country. We debated the issue of trying to give help and assistance 
to local communities. I am a strong supporter of it. I know the Senator 
from Nevada is. I know there are others on both sides of the aisle who 
feel that way as well.
  We have made some progress on other issues. I cannot speak further 
without recognizing the good work of the Senator from New Mexico in 
regard to mental illness. For many years, those afflicted by the 
challenges of mental illness were kept aside in our own communities, 
and in terms of debate and discussion, there has been a general 
reluctance to talk about some of their special needs.

  The Senator is quite correct. The willingness to talk about these 
issues has been in a more recent time. I can even speak of that with 
regard to my own family with a sister who is mentally retarded and 
having seen the evolution and the changes which have taken place in how 
people react and respond to those who are mentally retarded.
  We have come a long way, but the Senator is quite correct, by and 
large, these individuals and the communities are hard pressed with the 
day-to-day activities and do not have a great deal of time to come 
here, although I note both Senator Reid and Senator Domenici would say 
that when they do come here and when they do speak, there are a few 
more eloquent voices and compelling voices for the cause of social 
justice.
  Mr. REID. I want to say one additional thing while the Senator is on 
the floor, and that is, the community of disabled persons around the 
country have been very fortunate to have Senator Kennedy as a 
spokesperson on their behalf. But I also want to mention something in 
which your family has been involved. It certainly has shown to me, 
having been involved in a number of Special Olympic programs in my own 
State, how the disabled enjoy life just as much as anyone else. There 
is no example better than athletics. I commend and applaud the Senator 
and his family for the great work they have done with the Special 
Olympics program, which is now a worldwide program.
  Mr. KENNEDY. I thank the Senator. I appreciate that. As a matter of 
fact, they are having the International Special Olympics on June 27 and 
28 in North Carolina this year. There will be more than 130 countries 
participating in those games. That cause still goes on.
  It is a great tribute not only to the athletes but to the parents, 
the teachers, to the volunteers, and States all over the country that 
have been supportive of that program. I know the Senator has been a 
supporter of the program, and I think any of those individuals who 
watch those programs cannot leave the field without feeling an 
extraordinary sense of inspiration. That is, I believe, enormously 
moving.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Is the Senator from Massachusetts finished?
  Mr. KENNEDY. I am finished. I thank the Senator.
  Mr. DOMENICI. I say to Senator Kennedy, I commend him for what he is 
doing. I remind the Senate that the last time I looked, this bill had 
33 Republicans on it and was led on the Senate side by the chairman of 
the Finance Committee. He is one of the leaders, not just Senator 
Jeffords from the Health, Education, Labor, and Pensions Committee.
  Frankly, what has happened is, though we pass laws with reference to 
helping people who are disabled, either because of physical 
disabilities or mental disabilities, a lot of our terribly mentally 
handicapped do participate in disability programs.  What they do not 
participate in very well is the training programs for them. We are just 
getting that started.

  But essentially we pass laws saying let's help them. Then we forget 
about them for about 15 or 20 years, which is what happened here. We 
find that in many respects the law has arbitrary finalization of 
benefit dates that hurt instead of help. Instead of encouraging that a 
person who is disabled go to work, if anybody is experienced with the 
old law, before we change it, what the people will be telling them is: 
Be careful, because if you try to go to work and get off, they take you 
off so quick and for such a tiny amount of earnings that sometimes that 
job finishes because the disabled do not have the propensity to have 6-
year-long jobs; sometimes it is 6 months, 5 months.
  In the case of the mentally ill, sometimes a schizophrenic works 1 
month. This program, unless we change it, does not work for them, 
because they get taken off the benefit list too quickly. Then it is 
hard to get back on. So a parent may say: Let's just not ask Jimmy to 
go to the Green Door and get trained over here to get a job. They say: 
Let's just leave that alone and talk to him about volunteering, not 
earning money. But I tell you, to the extent we are encouraging that, 
we are doing a very bad thing for disabled people.
  You will find across the board, for the disabled people, young or 
old, the most important thing going is for them to get a job. You 
cannot imagine how important it is for them to get a paycheck. It is 
among the most intriguing psychological things that happens to a 
disabled person--when they earn their own money--that you have ever 
seen.
  Why should we have laws that help them but at the same time 
discourage them from getting a job because they may get kicked off the 
rolls too quickly, or they cannot get on quickly enough after they get 
unemployed? Let's change that and make it common sense.
  I understand these laws are good laws, the ones we are changing. They 
put America in the vanguard when we passed them. They are good. But in 
the meantime, we are finding that nothing is as good as a job. These 
jobs do not pay a lot but pay just enough to qualify people under the 
old law to get off the rolls. So it is not as if it is rich people who 
are getting on and off the rolls, people earning $100,000; it is people 
earning minimum wage. In some instances, they even have youth jobs that 
are at less than minimum wage, and all of a sudden they qualify--no 
more aid--and they are worse off than they were before. That is what 
this is; the essence of it is to try to fix those things. We ought to 
fix them.
  It does not belong on this bill that Senator Reid and I are managing. 
Senator Kennedy has not said it does. But, look, if you cannot resolve 
it, we are going to do what has to happen here. I hope the Republican 
leadership would get together--actually, they are in the forefront. I 
am assuming that the chairman of the Finance Committee is not here 
today. He would probably be here. He wants to make sure it is done 
right. He has to find offsets, does he not? There are offsets.
  This bill is going to be neutral budgetwise. We are going to pay for 
it. It is not that we are going to add to the debt, or use up the 
surplus or use the Social Security trust fund--none of those.
  Frankly, I am very hopeful that our bill has served a purpose. There 
has been a nice debate. There is nobody here who needs the Senate any 
more

[[Page S6937]]

than we do right now. Nobody is offering amendments. We are waiting. It 
is all right with me if they do not. It is a fine discussion.
  I thank the Senator. It is good to get an opportunity to comment.
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER (Ms. Collins). The Senator from Massachusetts.
  Mr. KENNEDY. Madam President, I will not take much time.
  The Senator has it absolutely right. We built in the program the 
ability to provide the medical and some income for people who have the 
disabilities and said that if they make over $500, they lose the 
insurance and they lose the additional kind of insurance, that they 
would be able to receive income, and they are just dropped out.
  Very few of the families can be assured they can get a job after a 
training program where they would be able to offset their total medical 
expenses if they are able to get health insurance. They probably are 
not able to get it because they have a disability. The fact of the 
matter is, the insurance companies, by and large, do not include them.
  I have a son who lost his leg to cancer and is a very healthy young 
person, but there is not a chance in the world he can get insurance. He 
has insurance only as a part of a much larger group. That happens to 
individuals who have any kind of disability. So they are out behind the 
8-ball.
  What we are saying is, continue their health care. OK, we can phase 
out or eliminate their income. They would be willing to take a chance 
on that. They will go out and try to pull their own weight. They are 
glad to do it. They will do it, and they will do it very well.
  They have a desire to do it and the ability to do it. We have 
provided these incentives and training programs to enable them to be 
more creative to do it. There are more examples in a number of the 
States about how to do it. There are a number of examples in different 
countries on how to do it. We are going to do it in ways that are 
financially responsible.
  The Senator made an excellent statement. I thank him for his 
sponsorship, as well as the Senator from Nevada.
  I yield the floor.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Madam President, before Senator Kennedy leaves the 
floor, I will just make a comment. He mentioned those disabled because 
of severe mental illnesses: manic depression, schizophrenia, severe 
chronic depression.
  I say to the Senator, I introduced the parity bill with Senator 
Wellstone to try to get more insurance coverage resources applied to 
these serious illnesses. I want to share with the Senator, since we are 
talking about disabilities, a notion that came to me with reference to 
severely mentally ill people.
  I said, what would happen if the United States, by definition, had 
decided we would not cover, under health insurance, illnesses of the 
heart because we did not want to cover illnesses of the brain? The 
complicated vessels are the heart and the brain. What if 30 years ago, 
as we produced the list of coverable illnesses, we said no coverage for 
heart conditions. Guess what would have happened. None of the 
breakthroughs in treating the heart would have ever occurred because 
there would not have been enough resources going into it for the 
researchers and the doctors to make the breakthroughs.
  As a matter of fact, we would not have invented angioplasty and all 
those other significant techniques. What would have happened in the 
meantime is that hundreds of thousands of Americans would be dying 
earlier than they should. That would be along with what I just said.
  When we say insurance companies should not cover schizophrenics, who 
have a brain disease, diagnosable and treatable, that we should not 
cover them, then are we not saying the same thing about a very serious 
physical frailty that hits between 5 and 15 million Americans during 
any given year, from the very young to the very old, with the highest 
propensity between 17 and 25 years of age for schizophrenia, manic 
depression, and the like?
  It seems to me that sooner or later, if we are going to call 
something ``health insurance,'' it ought to cover those who are sick, 
wouldn't you think?
  Mr. KENNEDY. Absolutely.
  Mr. DOMENICI. Why do we call health insurance ``health insurance'' 
and leave out a big chunk of the American population? Because the 
definition chooses to will away an illness. You define it so it does 
not exist, right? No. It exists. Families go broke. Their kids are in 
jails instead of hospitals. Because once they get one of these 
diseases, there is no way to help them, because there are no systems, 
because there are not enough resources. The resources come from the 
mass coverage by insurance. That is what puts resources into illnesses 
and cures.
  So I just want to assure you, we are going to proceed this year. We 
are going to proceed with this parity bill. We are going to have a vote 
here. I do not know which bill yet, but we are going to have a good 
debate. We are asking the business community to get the price tag. We 
do not want to hear any of this business that it is going to break us.
  We want to know, based on history, what is it going to cost? Then we 
are going to let the Senators and the public decide: Is that too much? 
What if it isn't too much in the minds of most Americans and Senators? 
Then it seems to me the marketplace will have to adjust to it.
  Obviously, if I have a chance, I would like to talk about this. I 
would like to do it on the floor of the Senate so a lot of other 
Americans hear about it. I would like to do it when somebody is here to 
talk about the significance of this.
  This is important business, the disabled in this country, whether 
they are disabled physically or disabled mentally. If we are going to 
have a real society that is proud of being free--and we have put so 
much emphasis on that--then we cannot leave out big chunks of the 
public with arbitrary laws or a failure to have insurance companies 
take care of the responsibilities of health coverage for disabled 
Americans.
  I yield the floor.
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. As the good Senator knows, we have such coverage for all 
Members of the Senate. Federal employees have it, over 11 million have 
it, and other groups have that as well. We find that it is suitable for 
Members of Congress and for the administration, other Federal 
employees.
  I underline that I do not think we have health insurance worth its 
name if it doesn't meet the standard that the Senator from New Mexico 
has outlined here. I think it is basic and fundamental. There may have 
been troubles with the Clinton health insurance program, but the 
President has recently announced that he will issue an executive order 
to provide mental health parity.
  I say to the good Senator, my friend--I have heard him speak 
eloquently, as well as our friend Senator Wellstone, and others speak 
on this issue--I pledge to him that I look forward to working with him. 
I think it is enormously important. I commend the Senator for what was 
initiated previously when we were dealing with this issue in related 
form on the Kassebaum-Kennedy legislation a few years ago. We want to 
see that and other legislation actually implemented. I commend him and 
look forward to working with him.
  Finally, I would like to state my support for the efforts of my good 
friend and colleague from Nevada, Senator Reid, who has long been a 
champion of the need for better and more comprehensive approaches to 
suicide prevention. Suicide claims over 30,000 lives each year in this 
country; it is the eighth leading cause of death overall and the third 
major cause of death amongst teenagers from 15-19. It is an issue 
clearly associated with mental health parity. If better access to 
mental health services were available for all persons who have 
psychiatric conditions, the suicide rate would be dramatically reduced. 
It is time to provide mental health parity and to prevent these 
unnecessary family tragedies.
  I thank the Senator.
  Mr. REID addressed the Chair.
  The PRESIDING OFFICER. The Senator from Nevada.
  Mr. REID. Madam President, even though this is the energy and water

[[Page S6938]]

bill, I am glad we are going to have this conversation this afternoon 
about mental health.
  An area I have worked on that is now receiving more attention is 
suicide. Thirty-one thousand people each year in the United States kill 
themselves. What if 31,000 people were killed in some other manner? We 
would focus a lot of attention on it.
  There are almost as many people killed in car wrecks every year. We 
have airbags and we have speed limits. We do all kinds of things to 
prevent people from being killed in automobile accidents. We have even 
done a much better job in recent years trying to stop people from 
driving under the influence of alcohol.
  Suicide is a very difficult problem in America today. During the time 
we have been on this bill--it is now 3:30 eastern time; we started at 
1--about 12 people in the United States have killed themselves. So it 
is an issue I hope we will spend more time on.
  For the first time in the history of the country we are spending 
money to find out why people commit suicide. We don't know why. An 
interesting fact is that the 10 leading States in the United States for 
suicide are western United States, States west of the Mississippi. We 
don't know why this is, but it is now being studied by the Centers for 
Disease Control. We appropriated money last year to try to focus on 
this.
  Not only is this, of course, terrible for the person who dies, but 
what it does to the victims, the people who are the survivors.
  I am happy to hear the discussion this afternoon about mental health 
generally. I want to talk about suicide specifically. It is an area 
that we really have to focus some attention on and get Members of the 
Congress to agree that we have to do something about this. It is an 
issue that is crying for an answer. I hope that in the years to come we 
can do much more than we have done in the past, which wouldn't take 
very much, but it is an area in which we need to do much more. I hope 
we can do that.
  Madam President, I suggest the absence of a quorum.
  Mr. DOMENICI. Will the Senator withhold?
  Mr. REID. I will withhold.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. I say to my good friend, the ranking member on this 
subcommittee, we have a good, bipartisan bill. I hope we can make the 
point that we worked together to make it bipartisan, because I think 
that is the way we get a bill that we can get through here and can 
sustain.
  Commenting on your last statement and your efforts with reference to 
suicide, that is not unrelated to what I was discussing at all.
  Mr. REID. That is right.
  Mr. DOMENICI. I don't know the numbers, but I am going to guess that 
60 to 70 percent of the suicides are probably found to be caused by a 
mental illness, most of them by severe depression. Frankly, one of the 
reasons we have so many suicides is because we have not created a 
culture among our medical people and among those who help our medical 
people of properly diagnosing such things as depression.
  One of the reasons we don't have a culture that does the diagnosis 
right is because it is not covered by insurance. As a consequence, 
there are not enough resources put in at the grassroots where doctors 
are getting paid for this and universities can do research on it, 
because it is worthwhile to the doctors to become experts in this. We 
are doing a little more than we did in the past but not enough from the 
standpoint of real mass involvement.
  Young people in particular are the majority victims of the suicide 
numbers, which is such a shame. Many of those 21,000 are kids; right?
  Mr. REID. Thirty-one thousand.
  Mr. DOMENICI. Teenagers, 31,000; they are not in the senior citizen 
numbers. There is a small percentage, but the big percentage are in the 
absolute throes of starting a great life. If we could do a better job 
with diagnosing depression, we would have medication and therapy 
preventing many of those 31,000.
  Mr. REID. Will the Senator yield?
  Mr. DOMENICI. Yes, indeed.
  Mr. REID. I think one of the reasons we have made more progress on 
suicide and other mental health problems in recent years is because 
people who have problems with depression, people who are survivors of 
suicides are willing to talk about it. It wasn't many years ago----
  Mr. DOMENICI. That is true.
  Mr. REID.--For example, my father, who committed suicide, wouldn't 
have been able to be buried in the cemetery. My father would have to 
have been buried someplace else because suicide was considered sinful, 
wrong.
  Mr. DOMENICI. Right.
  Mr. REID. So I believe clearly that the Senator is absolutely right. 
The Senator and I, as an example, are willing to talk about some of our 
experiences with mental health problems. As a result of that, it is not 
something people tend to hide as much as they used to. We recognize 
that depression is a medical condition.
  Mr. DOMENICI. You have it.
  Mr. REID. It is no different than if you have pneumonia. Depression 
is like pneumonia. We are learning how to cure depression. We learned 
some time ago how to cure pneumonia. So the more that we talk about 
this, the more people are willing to say: I think I am just depressed. 
I need some help. Is there somebody who can help me.
  The fact of the matter is, as the Senator said, we did some hearings 
on depression and suicide. With suicide, they had really an interesting 
program in the State of Washington where one city developed an outreach 
program with mail carriers. When someone would go to deliver mail, 
especially in areas where there were senior citizens--sometimes the 
only contact a senior would have was with the mail carrier--the mail 
carrier was trained to recognize symptoms of depression and, 
consequently, suicide and saved a lot of people.
  I remember a hearing we had in the Aging Committee; a woman who wrote 
poems came in. She showed us a poem she wrote when she was depressed 
and when she wanted to kill herself and a poem she wrote afterwards. I 
can't remember the poem--I am not like Senator Byrd--but I can remember 
parts of it where she talked about the snow was like diamonds in her 
hair.
  If we could do a better job of recognizing depression, talk about 
that one, mental illness, depression, think of the money we would save. 
We would have a much more productive society. The workforce would be 
more productive. The gross national product would go up as a result of 
that.
  Mr. DOMENICI. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative assistant proceeded to call the roll.
  Mr. WELLSTONE. Madam President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WELLSTONE. I thank the Chair.
  Madam President, having just returned from Minnesota, I want to speak 
on the floor for a few short minutes, first of all, in support of the 
amendment that my colleague, Senator Kennedy, introduced, which is 
really the Work Incentives Improvement Act, S.331, which he has done so 
much work on, along with Senator Jeffords.
  My understanding is--it could be that my colleague, Senator Reid of 
Nevada, spoke about this--Senator Kennedy came to the floor and said: 
``Listen, we want some action on this bill.'' We do want action on 
this. We have 78 Senators who are cosponsors of the Work Incentives 
Improvement
  Seventy-eight consponsors means, by definition, that this is a strong 
bipartisan effort.
  The reason for this bill, with all of its support, is really all 
about dignity. For Senators who talk about self-sufficiency and self-
reliance and people being able to live lives with dignity, that is what 
this is about.
  I am sure the Chair has experienced this, when you are back home and 
you talk to people in the disabilities community over and over again, 
you hear people telling you that they are ready to go to work if only 
they could be sure they wouldn't lose their health insurance--insurance 
they literally need to live. I don't know, but I think the unemployment 
rate among people with disabilities is well above 50 percent; the 
poverty rate is also above 50 percent. The problem is, when people in 
the disabilities community work, they

[[Page S6939]]

lose the medical assistance they have now.
  What this piece of legislation says is that we want people to be able 
to live at home in as near a normal circumstance as possible, with 
dignity. That is what the Work Incentives Improvement Act is all about.
  I come to the floor to say to my colleague, Senator Kennedy, that if 
he wants to force the issue on this bill that we have before us, the 
Energy and Water Appropriations bill, I am all for that. If we can get 
some kind of a commitment from Senators as to whether we can bring this 
piece of legislation up freestanding, have an up-or-down vote--78 
Senators are cosponsors--then I am for that.
  Those of us who feel strongly about this issue and have met with 
people back home and heard their pleas really want to respond to the 
concerns and circumstances of their lives. It is very moving to meet 
with people in the disabilities community, to have people say to you: 
If you could do this, it would help us so much.
  We are running out of patience; we really are. For colleagues who are 
blocking this and getting in the way of our being able to bring this to 
the floor and having a vote on this, be it unanimous consent, or be it 
78 to 22, or 99 to 1 or whatever the case might be, so be it. I do not 
mind the 1; I have been on the losing end of a couple 99 to 1 votes in 
the last two months. If a Senator feels strongly about that, and it is 
his or her honest opinion that this legislation shouldn't pass, fine. 
He or she has the right to speak out, to try to persuade others and to 
vote his or her conscience. What I don't like is the way in which this 
piece of legislation has been held up so that it is not possible to 
debate it and vote on it at all. That, I think, is unconscionable.
  Mr. REID. Will the Senator yield?
  Mr. WELLSTONE. I will be pleased to yield.
  Mr. REID. As the Senator was traveling here from Minnesota by air, 
Senator Kennedy gave a very moving presentation about the necessity for 
this legislation, which, when he finished, caused the two managers of 
this legislation to talk about some of the work you and Senator Kennedy 
and Senator Domenici and this Senator joined in, dealing with mental 
health parity. It was a very good discussion, stimulated by Senator 
Kennedy's presentation on this legislation, which is so badly needed.
  Senator Kennedy has indicated that he filed this amendment on this 
legislation in the hope of focusing attention on this issue. If we have 
so much support--we have almost 80 Senators supporting this 
legislation--it would seem that we should figure out a way to pay for 
it. That is the problem. I think that will come to be, as Senator 
Kennedy has talked to the majority leader and other people who 
recognize that they control the ebb and flow of legislation on this 
floor. In short, I say to the Senator, I think Senator Kennedy did the 
right thing in filing this amendment on this legislation, or any other 
legislation. If it doesn't work out on this bill, he might have to do 
it on the next bill, but I support the efforts of the Senator from 
Minnesota.
  Mr. WELLSTONE. Madam President, again, I appreciate the comments of 
Senator Reid of Nevada. I think all of us feel strongly about this and 
are prepared to fight it out. We have waited long enough for the men 
and women, the young people and the elderly people with disabilities 
who want to work and who will lose health care coverage. We ought to 
pass this legislation, and the sooner the better.
  I will yield the floor in a moment. I wasn't here for the colloquy or 
the suggestion about our mental health parity legislation. I am looking 
forward to this journey with Senators Domenici, Reid, and Kennedy--and 
maybe I am really being presumptuous, but I hope Senator Collins and 
others as well, because I think the time has come for this idea. I 
think you can make a pretty strong case there that there is entirely 
too much discrimination when it comes to coverage for those struggling 
with mental illness. This cuts across a broad section of the 
population.
  I am extremely hopeful that we will be able to pass this legislation, 
which would make a huge positive difference in the lives of so many 
people. I want to say on the floor that I am also committed to trying 
to do more when it comes to substance abuse treatment. We have the same 
problem there, where people have pretty good coverage for physical 
illnesses, but for somebody struggling with alcoholism, it is a detox 
center 2 or 3 days each time a year, and that is it. You know, a lot of 
these diseases are brain diseases with biochemical connections and 
neurological connections and people's health insurance should cover the 
disease of addiction just like it covers heart disease or diabetes.
  Our policy is way behind; it is outdated and discriminatory. The 
tragedy of it is that so many people in the recovery community can talk 
about the ways in which, when they received treatment, they have been 
able to rebuild their lives and contribute at their place of work, to 
their families, and to their communities. This is nonsensical. So these 
will be separate pieces of legislation on the Senate side. But I am 
very excited about this effort with Senator Domenici, Senator Reid, 
Senator Kennedy, and others as well. I believe we can pass this mental 
health parity legislation. I think what we did in 1996 was a small step 
forward. Now I think we have to do something that will really provide 
people with much more coverage.
  Having said that, let me just make one other point. When we talk 
about this whole issue of parity and trying to end discrimination in 
health insurance coverage, one issue we still don't deal with is what 
happens if people have no coverage at all. When we are saying you ought 
to treat these illnesses the same way we treat physical illnesses, what 
we are not doing is dealing with those that have no coverage 
whatsoever. I still think that a front-burner issue in American 
politics is universal health care coverage and comprehensive health 
care reform.
  I have introduced legislation called the Healthy Americans Act. 
Sometime I would like to bring it out on the floor and have an up-or-
down vote on it. I think we ought to be talking about universal 
coverage. The insurance industry took it off the table a few years ago; 
I think we should put it back on the table and I am going to work as 
hard as I can to do that.
  But right now, I wanted to come to the floor and support Senator 
Kennedy's effort. Hopefully, we will soon have an up-or-down vote on 
the Work Incentives Improvement Act. I hope we don't have to keep 
bringing it out as an amendment on other bills so it gets the attention 
it needs. This is a piece of legislation that deserves an up-or-down 
vote now.
  Finally, also in the spirit of amendments, I will keep bringing back 
the welfare tracking amendment, because the more I look at the studies 
that are coming out and the more I talk to people in the field, the 
more strongly I feel that as policymakers we ought to at least have 
some evaluation of what we have done. I think it is a terrible mistake 
not to do so. My amendment lost by one vote last time. I will bring it 
back, and I hope to get a couple more votes. It does nothing more than 
just say to Health and Human Services let's get from the States data 
every year so we know what is happening to the women and children, so 
we can have a sense of what kind of jobs they have, at what wages, and 
whether there is child care for children. We need to do that. It is a 
terrible mistake not to have that knowledge.
  I want to mention to colleagues that I will be bringing this 
amendment out within the next week--if not this week, next week--and I 
am hoping this time to somehow get a majority vote for it. I think it 
is reasonable and we should do it. I don't think we should turn away 
from this. It is important to know, especially because in the next 
couple of years, by 2002, in every State in the country, benefit 
reductions will have been fully felt. I think we ought to know how we 
are doing before that happens.
  I yield the floor.
  Mr. DOMENICI. I thank the Senator.
  Mr. WELLSTONE. I say to Senator Domenici, I look forward to this work 
on the Mental Health Equitable Treatment Act.

                          ____________________