Congressional Record, Volume 146 Issue 45 (Tuesday, April 11, 2000)

[Congressional Record Volume 146, Number 45 (Tuesday, April 11, 2000)]
[Senate]
[Pages S2527-S2545]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

By Mr. GRAHAM:
S. 2383. A bill to amend the Immigration and Nationality Act to
provide temporary protected status to certain unaccompanied alien
children, to provide for the adjustment of status of aliens unlawfully
present in the United States who are under 18 years of age, and for
other purposes; to the Committee on the Judiciary.

alien children protection act of 2000

Mr. GRAHAM. Mr. President, for many weeks, we have been dealing with
the tragedy of Elian Gonzalez. If this tragedy teaches us anything, it
is that the U.S. immigration laws have not been constructed in a manner
that accounts for the special needs of our Nation's most precious
resource--I also say our world's most precious resource--our children.
Yesterday, CNN-USA Today released a Gallup Poll on the Elian Gonzalez
tragedy. That poll said by a 2-to-1 margin Americans believe Elian
Gonzalez should live with his father in Cuba rather than with relatives
in the United States. But that same poll, also by a 2-to-1 margin,
found that Americans disapprove of the way the Government has handled
this case. That disapproval of the way in which the Government has
handled this case could be a disapproval of hundreds of cases if they
had the same notoriety as Elian.
I come this afternoon to introduce legislation that will require the
Federal Government to dramatically improve its treatment of the
thousands of unaccompanied children who arrive in the United States
each year.
Many of us are parents. I personally have been blessed with four
beautiful daughters and 10 wonderful grandchildren. We all know the
special joy a child brings to our lives. We know that bond across
generations that relationship between a parent or a grandparent and a
child brings. We all want to pour all of the history, all of our
personal experience into safeguarding and into paving the way in the
best interests of our children.
The Bible tells us to take this responsibility seriously. In the book
of Proverbs, it imparts this wisdom:

Train up a child in the way he should go, and when he is
old he will not depart from it.

We all have that responsibility to train up a child.
As that passage from Proverbs suggests, we have a responsibility to
protect and nurture all of our children. Their future--our planet's
future--depends on it.
Unfortunately, U.S. law prevents us from carrying out that
responsibility with respect to some of this planet's most vulnerable
children.
Each year, there are about 5,000 unaccompanied children who are
detained by the U.S. Immigration and Naturalization Service. Some
children come to this country seeking asylum, others hope to be
reunified with families, and others seek nothing but a better life.
While many of these children ultimately are deported or voluntarily
returned home, some have legitimate claims which merit our attention.
Regardless of the outcome of their cases, in most instances, these
children must endure the rigors of an immigration system that is
anything but child friendly. Unfortunately, many children in INS
custody end up spending time in jail-like settings while their cases
are pending. They have no one to guide them through complex immigration
law and procedure.
Moreover, immigration laws are technical and inflexible and do not
permit compassion or frequently even common wisdom to enter into the
equation when determining the fate of a child.
I will give some examples. Six Chinese children were detained by the
INS last year in Oregon. Though charged with no crime, they were sent
to a juvenile detention facility for 8 months where they were exposed
to violent youthful offenders who had committed crimes such as murder
and drug trafficking. One of the group, a 15-year-old girl, was forced
to remain at the jail for several weeks after she had been granted
asylum, even though she had relatives living in New York.

Such innocent children should not have to endure exposure to hardened
juveniles and criminals as part of their experience with the U.S.
immigration process.
Equally compelling is the story of a Kosovar Albanian boy who was
suffering from severe depression. He was held in a juvenile
correctional facility for over 6 months during his immigration
proceedings. The INS provided psychiatric care but by a professional
who spoke only English. After a mental episode, the boy was placed in
the maximum security section of the jail rather than being provided
with appropriate care. The INS even balked at placing the boy in foster
care after he was granted asylum, thus further delaying his stay in an
inappropriate facility.
The Federal Government's insensitivity to child immigrants is also
illustrated by a recent case of two children from the Caribbean. Their
mother is a legal, permanent resident in the United States, but she had
left her minor children behind with the belief they would soon follow.
The mother promptly applied for visas for her children. Yet the
children were required to wait in their home country for months and, in
some cases, even years before they could even get an interview at the
local U.S. Embassy to pave the way for reunification with their mother.
These are just three examples of children who were improperly treated
as a result of our current immigration laws. Many of these cases are
the result of INS's inherent conflict of interest: Children are
detained and frequently deported by the same agency that is responsible
for caring for them and protecting their legal rights. This system does
not work well enough, and it needs improvement. Children are entitled
to receive care from child welfare authorities who will act in their
best interest and who are trained to protect children's rights.
Indeed, there is an irony. The Federal Government requires States to
place

[[Page S2528]]

children in facilities that are separate and apart from adult
correctional facilities. The INS should at least abide by the same
standard with respect to alien children.
To address these problems, my legislation takes four actions: First,
it requires that INS place children in its custody in a facility
appropriate for children; in other words, no jails. These facilities
are required to provide for the health, welfare, and educational needs
of children.
Two, provide children in INS custody with a guardian ad litem to
champion that child's best interest. Notably, this guardian would not
be associated with the INS in order to eliminate any conflict of
interest.
Three, give the Attorney General the flexibility and the authority in
extraordinary cases to evaluate a child's case on the basis of what is
in the best interest of the child.
Four, to direct the General Accounting Office to conduct a study and
report back to Congress regarding whether and to what extent U.S.
diplomatic officials are fulfilling their obligation to reunify on a
priority basis children in foreign countries whose parents are legally
present in the United States.
With these changes in the law, children will no longer be forced to
struggle through the immigration process alone under the adverse
conditions to which they are currently exposed. The INS will have the
flexibility to treat children in its custody with greater compassion
and common sense.
I hope the recent attention which has and will continue to surround
the Elian Gonzalez tragedy will encourage us to shield all our children
from the vagaries of U.S. immigration law. Our future generations
deserve to be protected, not persecuted or prosecuted. They deserve to
be inspired, not incarcerated. They deserve to have decisions about
their future made consistent with what is in their best interest, not
confused by conflicts of interest.
I conclude with hope that this Congress will give attention to an
issue which affects not one child but thousands of children who are in
the custody of the United States and whose treatment reflects our
fundamental American values of justice and concern for their rights.
Mr. President, I ask unanimous consent that the bill and three
newspaper articles and editorials on the subject of ``INS Treats
Children Shamefully'' be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

S. 2383

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

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Alien Children Protection
Act of 2000''.

SEC. 2. USE OF APPROPRIATE FACILITIES FOR THE DETENTION OF
ALIEN CHILDREN.

(a) In General.--Except as provided in subsection (b), in
the case of any alien under 18 years of age who is awaiting
final adjudication of the alien's immigration status and who
does not have a parent, guardian, or relative in the United
States into whose custody the alien may be released, the
Attorney General shall place such alien in a facility
appropriate for children not later than 72 hours after the
Attorney General has taken custody of the alien.
(b) Exception.--The provisions of subsection (a) do not
apply to any alien under 18 years of age who the Attorney
General finds has engaged in delinquent behavior, is an
escape risk, or has a security need greater than that
provided in a facility appropriate for children.
(c) Definition.--In this section, the term ``facility
appropriate for children'' means a facility, such as foster
care or group homes, operated by a private nonprofit
organization, or by a local governmental entity, with
experience and expertise in providing for the legal,
psychological, educational, physical, social, nutritional,
and health requirements of children. The term ``facility
appropriate for children'' does not include any facility used
primarily to house adults or delinquent minors.

SEC. 3. ADJUSTMENT TO PERMANENT RESIDENT STATUS.

Section 245 of the Immigration and Nationality Act (8
U.S.C. 1255) is amended by adding at the end the following:
``(l)(1) The Attorney General may, in the Attorney
General's discretion, adjust the status of an alien under 18
years of age who has no lawful immigration status in the
United States to that of an alien lawfully admitted for
permanent residence if--
``(A)(i) the alien (or a parent or legal guardian acting on
the alien's behalf) has applied for the status; and
``(ii) the alien has resided in the United States for a
period of 5 consecutive years; or
``(B)(i) no parent or legal guardian requests the alien's
return to the country of the parent's or guardian's domicile,
or with respect to whom the Attorney General finds that
returning the child to his or her country of origin would
subject the child to mental or physical abuse; and
``(ii) the Attorney General determines that it is in the
best interests of the alien to remain in the United States
notwithstanding the fact that the alien is not eligible for
asylum protection under section 208 or protection under
section 101(a)(27)(J).
``(2) The Attorney General shall make a determination under
paragraph (1)(B)(ii) based on input from a person or entity
that is not employed by or a part of the Service and that is
qualified to evaluate children and opine as to what is in
their best interest in a given situation.
``(3) Upon the approval of adjustment of status of an alien
under paragraph (1), the Attorney General shall record the
alien's lawful admission for permanent residence as of the
date of such approval, and the Secretary of State shall
reduce by one the number of visas authorized to be issued
under sections 201(d) and 203(b)(4) for the fiscal year then
current.
``(4) Not more than 500 aliens may be granted permanent
resident status under this subsection in any fiscal year.''.

SEC. 4. ASSIGNMENT OF GUARDIANS AD LITEM TO ALIEN CHILDREN.

(a) Assignment.--Whenever a covered alien is a party to an
immigration proceeding, the Attorney General shall assign
such covered alien a child welfare professional or other
individual who has received training in child welfare matters
and who is recognized by the Attorney General as being
qualified to serve as a guardian ad litem (in this section
referred to as the ``guardian''). The guardian shall not be
an employee of the Immigration and Naturalization Service.
(b) Responsibilities.--The guardian shall ensure that--
(1) the covered alien's best interests are promoted while
the covered alien participates in, or is subject to, the
immigration proceeding; and
(2) the covered alien understands the proceeding.
(c) Requirements on the Attorney General.--The Attorney
General shall serve notice of all matters affecting a covered
alien's immigration status (including all papers filed in an
immigration proceeding) on the covered alien's guardian.
(d) Definition.--In this section, the term ``covered
alien'' means an alien--
(1) who is under 18 years of age;
(2) who has no lawful immigration status in the United
States and is not within the physical custody of a parent or
legal guardian; and
(3) whom no parent or legal guardian requests the person's
return to the country of the parent's or guardian's domicile
or with respect to whom the Attorney General finds that
returning the child to his or her country of origin would
subject the child to physical or mental abuse.

SEC. 5. SENSE OF CONGRESS.

Congress commends the Immigration and Naturalization
Service for its issuance of its ``Guidelines for Children's
Asylum Claims'', dated December 1998, and encourages and
supports the Service's implementation of such guidelines in
an effort to facilitate the handling of children's asylum
claims.

SEC. 6 GENERAL ACCOUNTING OFFICE REPORT.

The General Accounting Office shall prepare a report to
Congress regarding whether and to what extent U.S. Embassy
and consular officials are fulfilling their obligation to
reunify, on a priority basis, children in foreign countries
whose parent or parents are legally present in the United
States.
____

[From the St. Petersburg Times, Mar. 8, 2000]

INS Treats Children Shamefully

Reaching the U.S. mainland usually is no easy feat for
illegal immigrants fleeing their homelands. Whether crossing
the ocean by boat or trudging miles across desert, immigrants
nearly always face a journey that is dangerous and traumatic.
For the children of these immigrants, who often have no say
in their parents' decision to flee to the United States, that
trauma too often is compounded once they arrive--by an
American immigration system that treats kids like criminals.
The Immigration and Naturalization Service says children
detained by the agency must be moved to a safe, kid-friendly
environment within 72 hours of their initial detention,
unless they are suspected criminals or considered a flight
risk. Advocates for these children say that rule rarely is
enforced. Instead, immigrant children typically are separated
from their loved ones and locked in juvenile detention
facilities, often before the INS has a chance to determine
the family's status.
Because of a worsening space crunch at INS facilities,
nearly 1,000 of the 4,000 children detained by the INS within
the past year have been remanded to secure, jail-like
facilities where many have remained for months. The children
typically wear prison uniforms, and many are forced to mingle
with the teenage convicts also housed in the facilities.
Unlike the convicts, immigrant children get no legal
representation, and no adult guardians are appointed to
protect their interests.
This shameful treatment of children is a symptom of the
broader problems plaguing U.S. immigration policy. It is a
system that

[[Page S2529]]

allows legal U.S. residents to be detained indefinitely on
the basis of secret evidence. It is a system that no longer
gives judges discretion in deportation cases. And it is a
system that even the INS's own chief has described as slow,
inefficient and poorly managed.
The INS is expected to issue new rules that will require
jails housing non-criminal INS detainees to meet specific
standards of care. Immigrant advocates hope the new rules
will give detainees the right to make phone calls, meet with
lawyers and prevent guards from subjecting them to arbitrary
strip searches.
Even if those rules pass, they should be only the first of
many reforms initiated by the INS and Congress to ensure that
all detainees--especially children--are treated more humanely
by the U.S. government.
____

[From the Seattle Post-Intelligencer, Mar. 21, 2000]

Immigration Law Busts Up Families

(By Llewelyn G. Pritchard)

Llewelyn G. Pritchard is a Seattle attorney at Helsell
Fetterman. He is chairman of the American Bar Association
Advisory Committee to the Immigration Pro Bono Development
and Bar Activation Project. He is a former member of the
boards of the Washington State Bar Association and the
American Bar Association.
Lately we have been bombarded with media stories about
immigrant families being ripped apart due to draconian
measures undertaken by the U.S. Immigration and
Naturalization Service.
There is the Atlanta story about the German mother of two
who, having applied for citizenship, faces deportation
instead because years ago she admitted to pulling another
girl's hair over the affections of a boy.
There is the Falls Church, Va., mom who called police after
repeatedly being beaten by her husband. She was arrested for
biting him after he sat on her. She faces deportation and
separation from her children, all of whom were born in the
United States.
But we don't have to look beyond he boundaries of
Washington to hear terrible tales.
There is the case of Emma Hay. This Puyallup mother of
four--all U.S. citizens--is being deported. Her crime was to
answer the telephone for a visiting relative who said he
didn't speak English well enough to talk to the caller.
By simply saying her relative ``couldn't help the caller
today, but could help tomorrow,'' Hay was caught in a drug
sting and charged with ``using a communications facility to
facilitate the distribution of cocaine.'' Although she
claimed she wasn't aware of her cousin's activities, she
pleaded guilty and was convicted on federal drug charges. She
got no jail time, and was placed on probation for three
years, which she successfully completed.
After living in our state for more than 20 years and
running a restaurant, Hay now faces deportation. While the
original incident earned her a probationary sentence because
she agreed to plead guilty, it has now become a deportable
offense.
Hay was grabbed by the INS upon returning from a vacation,
all because the tough 1996 Illegal Immigration Reform and
Immigrant Responsibility Act has tipped the legal scales
against non-citizens * * *. This draconian law reclassifies
past infractions and makes them deportable offenses even in
cases where no prison time has been served or where there is
evidence of rehabilitation.
This law also widely expanded the definition of aggravated
felony. Non-citizens convicted of ``aggravated felonies'' are
now not only deportable, but are also ineligible for a waiver
from deportation or even judicial review.
Woe to the immigrant who applies to become a citizen only
to be trapped in the INS web, as in the case of the German
mother in Atlanta, or who seeks to re-enter the country as
Hay did.
So now Hay sits in a Louisiana jail, thousands of miles
away from her lawyer and her children, awaiting deportation.
Her 20-year-old daughter has quit school to support the
family.
What's the benefit of justice to her, her family or our
country? There is none under this new act.
The INS has the fastest growing prison population in the
United States. There are more than 17,000 immigrants
detained, with predictions of 23,000 by year's end. Most
detainees do not have legal representation, even though the
INS adopted standards in 1998 allowing lawyer access in
federal INS facilities.
The majority, or 60 percent, are warehoused in state and
local jails, at great cost to our overburdened prison budget.
Those folks are far away from immigration lawyers and have no
guarantee of legal access. Even those in federal INS
facilities are in remote areas and access is often difficult.
We should be outraged. This can't be happening in America.
Newcomers live in all our communities, work at our sides,
attend our churches and our schools. They are our neighbors
and our friends.
But there is some good news.
The 60,000 member American Bar Association Section of
Litigation, which will meet in Seattle in early April,
announced that it will adopt our ABA immigration project as
one of its pro bono efforts, pairing up with lawyers with
detainees around the country.
Their efforts will help some of the most defenseless in our
country. I applaud and welcome them in this worthy fight.
We must make certain that the basic premise and promise of
our country is not forgotten: ``Justice for all.''
____

[From the Miami Herald, Jan. 9, 2000]

The Littlest Refugees Merit Better Treatment From INS

Immigration and Naturalization Service Commissioner Doris
Meissner projects uncommon compassion. ``Both U.S. and
international law recognize the unique relationship between
parent and child,'' she said in announcing her decision to
return 6-year-old Elian Gonzalez to his father in Cuba.
``Family reunification has long been a cornerstone of both
American Immigration law and INS practice.''
Unfortunately her agency doesn't always practice what she
preaches. Case in point: Two children, ages 8 and 10, were
repatriated to Haiti while their mother, desperate with worry
not knowing what had happened to them, was brought to Miami
for medical care.
Yvena Rhinvil and her children were among some 400
passengers on the boat from Haiti that ran aground off Key
Biscayne on New Years Eve. They were trying to enter the
United States illegally. Both the Coast Guard and INS now say
that they didn't know about the children. Had it known, INS
says it would have tried to keep the kids with their mother.
But Ms. Rhinvil says she spoke of her kids both to an
interpreter before being taken off the ship and once again on
land. What mother wouldn't?

kids don't come first

If indeed the INS didn't know, it should have known before
it sent the children back. Nobody asked, which is
inexcusable. Fortunately an aunt watched Ms. Rhinvil's
children. But who knows if there were other unaccompanied
youths aboard that boat?
The problem is that the INS is not equipped either by
mission or staffing to look out for the welfare of children.
First and foremost it is an enforcement agency, charged with
protecting our borders. Both policy and practice reflect it.
Another case: A 15-year-old Chinese girl remained in a
Portland, Ore., juvenile jail more than six weeks after being
granted asylum and after an uncle in New York had agreed to
take her. She and five other teens fled China in April, only
to spend eight months in a criminal facility.
Unfortunately, locking up minors such as these teens is not
an exception. That's because INS practices regarding children
vary widely by their nationality and INS district. Even
though international law and common decency dictate that
refugee children be detained only as a last measure and only
for a short time, detention in criminal juvenile facilities
happens regularly in some districts. Without caretakers and
most often without legal advisers, what hope can detained
children have of knowing or demanding their legal rights?

little protection

For the most part, the Florida INS District treats minors
better than most. Unaccompanied children without U.S.
relatives are often placed with Catholic Charities facilities
such as Boystown. Children who arrive with parents are
typically placed in a hotel until the family is deported or
released from detention.
Ideally all minors could be released to caring relatives,
and the INS frequently does this. Yet without the
intervention of child-welfare authorities, there is little
protection from abuse. The INS mandates such intervention
only when the child is from China or India because of the
track record of child servant-slaves. Yet Haitian children,
too, have been known to be sold into servitude.
Capricious and inconsistent treatment of children simply is
unacceptable when last year alone the INS had some 5,300
minors in its custody.
______

By Mrs. FEINSTEIN (for herself, Mrs. Hutchison, Mr. Baucus, Mr.
Murkowski, Mr. Cleland, Mr. Durbin, Ms. Landrieu, Mr. Smith of
Oregon, Mr. Lautenberg, Mr. Johnson, Mr. Kennedy, Mr. Edwards,
Mr. Campbell, Mr. Abraham, Mr. Kerry, Mr. Feingold, Mr.
Santorum, Mr. Leahy, Mr. Inhofe, Mr. Wellstone, Mr. Bingaman,
Mr. Moynihan, Mr. Hatch, Ms. Snowe, Mr. Hagel, Mr. Biden, Mr.
Mack, Mr. Grassley, Mr. Ashcroft, Mr. Bryan, Mrs. Murray, Mrs.
Boxer, Ms. Mikulski, Mr. Reid, Mr. Breaux, Mr. Dodd, Mr.
Lieberman, Mr. Kerrey, Mr. Daschle, Mr. Jeffords, and Mr.
Roth):
S. 2386. A bill to extend the Stamp out Breast Cancer Act; to the
Committee on Governmental Affairs.

breast cancer research stamp reauthorization act of 2000

Mrs. FEINSTEIN. Mr. President, I rise to introduce the bill entitled
the Breast Cancer Research Stamps Reauthorization Act of 2000. I am
pleased that Senator Kay Bailey Hutchison has joined me as the lead
cosponsor.
The Breast Cancer Research stamp is the first stamp in our nation's
history

[[Page S2530]]

dedicated to raising funds for a special cause. Since the stamp's
issuance in the summer of 1998, the U.S. Postal Service has sold 164
million Breast Cancer Research stamps--raising over $12 million for
breast cancer research. In addition, the stamp has focused public
awareness on the devastating disease and has stood out as a beacon of
hope and strength around which breast-cancer survivors can rally.
Unfortunately, without congressional action, the Breast Cancer
Research stamp will expire on July 28, 2000. The Breast Cancer Research
Stamp Reauthorization Act of 2000 would permit the sale of the Breast
Cancer Research stamp for 2 additional years. The stamp would continue
to cost 40 cents and sell as a first class stamp. The extra money
collected will be directed to breast cancer research at the National
Institutes of Health and the Department of Defense.
A Breast Cancer Research stamp remains just as necessary today as 2
years ago. Breast cancer is the most commonly diagnosed cancer among
women in every major ethnic group in the United States. More than 2
million women are living with breast cancer in America, 1 million of
whom have yet to be diagnosed.
Breast cancer continues to be the number one cancer killer of women
between the ages of 15 and 54. This year alone, 182,800 women will be
diagnosed with breast cancer, and 40,800 women will die from the
disease. The disease claims another woman's life every 15 minutes in
the United States.
Thanks to breakthroughs in cancer research, more and more people are
becoming cancer survivors rather than cancer victims. According to the
American Association for Cancer Research, 8 million people are alive
today as a result of cancer research. The bottom line is that every
dollar we continue to raise will save lives.
I am pleased to report that this reauthorization bill has over 39
original cosponsors and broad support within the health community.
Let me just repeat a couple of the glowing comments from the many
groups in support of this bill. It shows the truly astounding impact of
this stamp.
The Susan G. Komen Foundation writes:

The Breast Cancer Research stamp has not only raised
millions of dollars by providing a convenient and innovative
mechanism for public participation in the [battle against
breast cancer], but it has also focused public awareness on
this devastating disease.

Betsy Mullen of Women's Information Network--Against Breast Cancer
adds:

This bill, if passed will provide an innovative, simple and
now proven way for individuals to make a substantial
contribution to fund federal cancer research and to continue
to be a part of what has become an effective public-private
partnership.

The American Association of Health Plan attests:

We've heard from our physicians about women who have
scheduled examinations or mammograms after purchasing the
stamp or receiving a card or letter posted with it.

Oliver Goldsmith, chairman of the Southern California Permanente
Medical Group, writes:

The Breast Cancer Research stamp captures the essence of
innovation, volunteerism and partnership that are such an
integral aspect of our country's history and spirit. This
vital legislation will give all of us the opportunity to
continue to work together to eradicate breast cancer. The
American people can realistically continue to raise millions
of dollars a year to fund cutting edge research to end this
rampant disease that claims the lives of all too many breast
cancer victims in this country and around the world.

Other supporters of the Breast Cancer Stamp Reauthorization Act of
2000 include the American Cancer Society, the American Medical
Association, the Y-Me National Breast Cancer Organization, Leadership
America, the National Association of Women's Health, the American
Cancer League, the American College of Surgeons, Friends of Cancer
Research, the California Nurses Association, the Association of
Reproductive Health Care Professionals, and many others.
I urge my colleagues to join me in enacting this important
legislation.
______

By Mr. LEAHY (for himself, Mr. Jeffords, Mr. Kennedy, Mr. Kerry,
Mr. Durbin, and Mr. Wellstone):
S. 2387. A bill to improve global health by increasing assistance to
developing nations with high levels of infectious disease and premature
deaths, by improving children's and women's health and nutrition, by
reducing unintended pregnancies, and by combating the spread of
infectious diseases, particularly HIV/AIDS, and for other purposes; to
the Committee on Foreign Relations.

GLOBAL HEALTH ACT OF 2000

Mr. LEAHY. Mr. President, today the Foreign Operations Subcommittee
held its third hearing on global health since 1997. Our first hearing
was the first of its kind in the Congress, when we highlighted how
disease outbreaks and impoverished public health systems half a world
away directly threaten Americans. Since then, the interest in these
issues in the Congress, the Administration, the media and the public
has skyrocketed.
Today, there are about a dozen pieces of legislation pending which
deal with some aspect of global health, the President has proposed
major increases in funding and policy initiatives to encourage the
pharmaceutical companies to invest in new vaccines against HIV/AIDS,
malaria, TB, and other major killers, and the World Health Organization
is setting the pace for us all to tackle these challenges with new
energy and new resources.
This sea change is a reflection of the magnitude of the challenges
and opportunities, as well as a recognition of the essential role the
United States must play in global health.
There is no need to recite at length what has spurred this interest,
but I do want to cite a couple of illustrative facts:
In America, each year we spend over $4,000 per person on health care.
In the countries where 2 billion of the world's people live in
desperate poverty, only $3 to $5 per person per year is spent on health
care.
It would cost just $15 per person per year to address most of the
urgent health needs of those 2 billion people.
With that $15 per person, we could prevent or cure the many millions
of deaths caused by tuberculosis, malaria, pneumonia, diarrheal
diseases, measles, HIV/AIDS, and pregnancy related diseases.
That is the challenge we face. The benefits to the world, and to the
United States, should be obvious. In an increasingly interdependent
world, reducing the threats posed by infectious diseases and poor
reproductive health, and the social and economic consequences of
poverty and disease, is absolutely key to our own future security and
prosperity.
The Congress has become increasingly seized with these issues.
However, while I strongly support most of the bills that have been
introduced--and I am a cosponsor of Senator Kerry's ``Vaccines for the
New Millennium Act,'' they have tended to focus narrowly on the
eradication of specific diseases and the development of new vaccines.
These are admirable and important goals, but I have always believed
that global health consists of a broader set of issues that must be
addressed together. Our primary challenge is to provide the resources
to enable developing countries to build the capacity--both human and
infrastructure, to support effective public health systems. That was
the motivation for my infectious disease initiative three years ago,
which since then has provided an additional $175 million to support
programs in surveillance, anti-microbial resistance, TB, and malaria.
Today, in an effort to build on that initiative, I am introducing new
legislation to authorize an additional $1 billion to support five key
components of global health. The ``Global Health Act of 2000,'' targets
HIV/AIDS; other deadly infectious diseases such as TB, malaria, and
measles; children's health; women's health; and family planning.
Together, these five groups of issues account for over 80 percent of
the disproportionate burden of disease and death borne by the 2 billion
people living in the world's poorest countries. This legislation, an
identical version of which Congressman Joseph Crowley has introduced in
the House, has the strong support of the Global Health Council, the
world's largest consortium of private and public companies and
organizations, agencies and governments, involved in public health.

[[Page S2531]]

We have the technology to do this. The key missing ingredient is
political will, and resources.
We can, and we must, recognize that we need to think in terms of far
larger amounts of money if we are serious about global health. Every
dollar of the additional $1 billion called for in my legislation, which
is approximately double the amount we currently spend on these
activities, is justified and urgently needed. And the payoff would be
enormous, both in terms of lives saved and in future health care cost
savings.
Senator McConnell, the chairman of the Foreign Operations
Subcommittee, has been a strong supporter of global health, and I will
be working in the Appropriations Committee to obtain the funds we need
to achieve these goals.
______

By Mr. ROTH;
S. 2389. A bill to provide additional assistance for fire and
emergency services, and for other purposes; to the Committee on
Environment and Public Works.

21st century fire and emergency services act of 2000

Mr. ROTH. Mr. President, firefighters and EMS personnel are
truly our nation's first responders. When the tragic images of natural
or manmade disasters flash across our TV screens, there is one image
that stands alone. The American firefighter is always there to rescue
the family from a burning building, always there in the wake of a
natural disaster, and is always there should a terrorist strike in our
nation's heartland. These scenes are played out around our country on a
daily basis. And while we see these images on TV as just a part of our
society today, what is not realized is the cost our first responders
bear.
The 1.2 million men and women that serve in our nation's 32,000 fire
departments do so with little fanfare, and often with little or no pay.
Our nation's first responders ask very little of us, but, thankfully,
they are always there when we need them.
That is why I have introduced the 21st Century Fire and Emergency
Services Act which is a companion to the House-passed legislation. This
legislation is an important step forward for the fire and EMS
community.
Every year I hear from fire departments in Delaware who are looking
to acquire state-of-the-art equipment to enhance their performance on a
fire scene, or attempting to secure funding to train personnel in arson
detection. I also hear from fire personnel seeking funds to create all-
important fire prevention programs at local elementary schools. These
are just a few examples. The point is that for all too many
departments, after the general operating expenses are calculated, there
is no funding for this equipment or special program. Funds raised
through chicken dinners, bingo and bake sales can only go so far.
Back home, the Delaware Volunteer Firemen's Association is sending
out the call for help. My legislation establishes two grant programs at
the Federal Emergency Management Agency. The first is an $80 million
competitive grant program for volunteer and paid fire and emergency
services departments. With these 50/50 matching grants, I believe this
legislation will give departments throughout our country an opportunity
to have the thermal imaging camera or the health and wellness program
needed to help them do their jobs even better.
Second, this bill establishes a $10 million burn research grant
program through FEMA. Under this program, safety organizations,
hospitals, and governmental and nongovernmental entities that are
responsible for burn research, prevention, or treatment are eligible
for competitive grants to continue their important work.
Finally, this bill recognizes the contributions of volunteer
firefighters by providing $10 million to fully fund the USDA's
Volunteer Fire Assistance Program. This program allows the nearly
28,000 rural fire departments nationwide to apply for cost-share grants
for training, equipping and organizing their personnel. These rural
fire departments represent the first line of defense for rural areas
coping with fires and other emergencies.
Personally, I am excited about the technology that is available to
first responders today, and I am committed to working to ensure that
every department in Delaware and throughout the country has the tools
it needs to make us all safer in our homes and communities. Let's not
wait for the next disaster to hear the call.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 2389

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

SECTION 1. SHORT TITLE.

This Act may be cited as the ``21st Century Fire and
Emergency Services Act of 2000''.

SEC. 2. DEFINITIONS.

In this Act:
(1) Agency.--The term ``Agency'' means the Federal
Emergency Management Agency.
(2) Burn program.--The term ``burn program'' means the Burn
Services Grant Program established by section 3(a).
(3) Director.--The term ``Director'' means the Director of
the Agency.
(4) Fire program.--The term ``fire program'' means the
``Fire Services Grant Program'' established under section
4(a).

SEC. 3. BURN SERVICES GRANT PROGRAM.

(a) Establishment.--There is established within the Agency
a grant program to be known as the ``Burn Services Grant
Program''.
(b) Competitive Grants.--The Director may make a grant
under the burn program, on a competitive basis, to--
(1) a safety organization that has experience in conducting
burn safety programs, for the purpose of assisting the
organization in conducting or augmenting a burn prevention
program;
(2) a hospital that serves as a regional burn center, for
the purpose of conducting acute burn care research; or
(3) a governmental or nongovernmental entity, for the
purpose of providing after-burn treatment and counseling to
individuals that are burn victims.
(c) Program Office.--The Director shall establish within
the Agency an office to--
(1) establish criteria for use by the Director in awarding
grants under the burn program; and
(2) administer grants awarded under the burn program.
(d) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $10,000,000, to
remain available until expended.

SEC. 4. FIRE SERVICES GRANT PROGRAM.

(a) Establishment.--The Director shall establish within the
Agency a grant program known as the ``Fire Services Grant
Program'' to award grants to volunteer, paid, and combined
volunteer-paid departments that provide fire and emergency
medical services.
(b) Use of Funds.--A grant awarded under the fire program
may be used to--
(1) acquire--
(A) personal protective equipment required for firefighting
personnel by the Occupational Safety and Health
Administration; and
(B) other personal protective equipment for firefighting
personnel;
(2) acquire additional firefighting equipment, including
equipment for communication and monitoring;
(3) establish wellness and fitness programs for
firefighting personnel to reduce the number of injuries and
deaths related to health and conditioning problems;
(4) promote professional development of fire code
enforcement personnel;
(5) integrate computer technology to improve records
management and training capabilities;
(6) train firefighting personnel in--
(A) firefighting;
(B) emergency response; and
(C) arson prevention and detection;
(7) enforce fire codes;
(8) fund fire prevention programs and public education
programs on--
(A) arson prevention and detection; and
(B) juvenile fire setter intervention; and
(9) modify fire stations, fire training facilities, and
other facilities to protect the health and safety of
firefighting personnel.
(c) Applications.--An applicant for a grant awarded under
the fire program shall submit to the Director an application
that includes--
(1) a demonstration of the financial need of the applicant;
(2) evidence of a commitment by the applicant to provide
matching funds from non-Federal sources for the project that
is the subject of the application in an amount that is at
least equal to the amount of funds requested in the
application;
(3) a cost-benefit analysis linking the funds requested to
improvements in public safety; and
(4) a commitment by the applicant to provide information to
the National Fire Incident Reporting System for the period
for which the grant is received.
(d) Audits.--The Director shall conduct audits of grant
recipients to ensure that grant funds are used for the
purposes for which the grant is awarded.
(e) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $80,000,000, to
remain available until expended.

[[Page S2532]]

SEC. 5. COOPERATIVE FORESTRY ASSISTANCE.

The Secretary of Agriculture shall use the funds,
facilities, and authorities of the Commodity Credit
Corporation to carry out paragraphs (1) through (3) of
section 10(b) of the Cooperative Forestry Assistance Act of
1978 (16 U.S.C. 2106(b)), not to exceed $10,000,000, to
remain available until expended.
______

By Mr. DeWINE (for himself, Mr. Warner, Mr. Hutchinson, Mr.
Sessions, Mr. Helms, and Mr. Abraham):
S. 2390. A bill to establish a grant program that provides incentives
for States to enact mandatory minimum sentences for certain firearms
offenses, and for other purposes; to the Committee on the Judiciary.

project exile: the safe streets and neighborhoods act of 2000

Mr. DeWINE. Mr. President, I come to the floor today because I
am troubled. Guns are falling into the wrong hands. It's killing our
children. It's killing our friends and our neighbors. It's creating
mayhem in communities across America. That's why I'm introducing
Project Exile: The Safe Streets and Neighborhoods Act of 2000.
It's no secret that gun control measures are very controversial and
are subject to a great deal of debate--as they should be. But, in the
heat of that debate, we must not lose sight of the real issue--gun
violence. There is nothing controversial about protecting our children,
our families and our communities by keeping guns out of the wrong
hands--the hands of armed criminals--not law-abiding citizens, Mr.
President, but criminals.
The Safe Streets and Neighborhoods Act offers a simple, commonsense
approach to fighting gun violence. My bill would provide $100 million
in grants over 5 years to those states agreeing to impose mandatory
minimum 5-year jail sentences on criminals who use or possess an
illegal gun. As an alternative, a state can also qualify for the grants
by turning armed criminals over for federal prosecution under existing
firearms laws. Therefore, a state has the option of having armed felons
prosecuted in state or federal courts. Qualifying states can use their
grants for any purpose that would strengthen the ability of their
criminal or juvenile justice systems to deal with violent criminals.
Back in 1991, the Federal Government implemented a program to aim
antigun violence efforts at the root of the problem--at criminals. This
program--known as project Triggerlock--directed every U.S. attorney to
coordinate with federal, state, and local investigators to bring
federal weapons charges against armed criminals. Sentences for these
prosecutions wee generally more severe than they would have been under
state laws. The program was hugely successful. In fact, simply by
making gun prosecutions a federal priority, starting in 1991, Project
Triggerlock took away over 2,000 guns from violent felons in just 18
months.
Tragically, Mr. President, despite the success of Project
Triggerlock, the current administration has not aggressively prosecuted
all armed criminals. Between 1992 and 1998, for example, the number of
gun cases filed for prosecution dropped from 7,048 to about 3,807--
that's a 46-percent decrease. As a result, the number of federal
criminal convictions for firearms offenses have fallen dramatically.
Even worse, some federal firearms laws are almost never enforced by
this administration. While Brady law background checks have stopped
nearly 300,000 prohibited purchasers of firearms from buying guns, less
than one-tenth of one percent have been prosecuted. Similarly, federal
criminal prosecutions for possession of a firearm on school grounds
numbered just eight in 1998, despite the fact that 6,000 individuals
were caught carrying guns to school. There's something wrong with this
picture, Mr. President, something terribly wrong.
I believe most Americans would agree that we should take guns out of
the hands of armed criminals. I believe that most Americans would agree
that criminals who possess a firearm or use a firearm during the
commission of a violent crime or a serious drug trafficking offense
should face severe penalties. And, Mr. President, I also believe that
most Americans would favor legislation that offers a single,
noncontroversial, commensense approach to fighting gun violence.

So, today, I, along with my colleagues, introduce Project Exile: The
Safe Streets and Neighbors Act, which builds on the previous success of
programs like Project Triggerlock and offers the kind of practical
solution we need to thwart gun crimes.
This approach works, Mr. President. For example, in 1997, Virginia
revived Project Triggerlock under the name ``Project Exile.''
Specifically, the city of Richmond and the U.S. attorney implemented a
program based on one simple principle: any criminal caught with a gun
serves a minimum mandatory sentence of 5 years in federal prison.
Period. End of story. As a result, gun-toting criminals are being
prosecuted six times faster, and serving sentences up to four times
longer than they otherwise would under state law. Moreover, the
homicide rate in Richmond already has dropped 40 percent.
It is clear that programs like Project Triggerlock and Virginia's
Project Exile work, while at the same time being very simple. But
still, federal gun prosecutions have declined considerably during this
administration because it has not emphasized these programs. Why? I
have repeatedly questioned Attorney General Reno and her deputies about
this decline, and their standard response is that the Department of
Justice is focusing on so-called ``high-level'' offenders, instead of
``low-level'' offenders who commit a crime with a gun. With all due
respect, I consider that response to be bureaucratic nonsense. One
thing I learned as Greene County Prosecutor in my home state of Ohio is
that any criminal who commits a crime with a gun is a high-level
offender. And, I'm willing to bet that any citizen who has ever been a
victim of a gun-crime would agree.
Furthermore, the idea that there are a lot of so-called ``low-level''
offenders, who commit only one crime with a gun, is just plain wrong.
The average armed criminal commits 160 crimes a year; that is an
average of three crimes per week. These people are, by themselves,
walking crime waves.
Along the same lines, Attorney General Reno recently said that she
would aggressively prosecute armed criminals, but only if they commit a
violent crime. Again, that type of law enforcement policy just does not
make sense. Current law prohibits felons from possessing guns--we
should enforce the law. We should aggressively prosecute armed
criminals before they use those guns to injure and kill people.
We need to take all of these armed criminals off the streets. That is
how we will prevent crime and save lives. Why wait for armed criminals
to commit more heinous crimes before we prosecute them to the full
extent of the law? Why wait when we can do something that will make a
difference now, before another Ohioan--or any American--becomes a
victim of gun violence.
Every state should have the opportunity to implement Project Exile in
their high-crime communities. The bill that we are introducing today
will make this proven, commonsense approach to reducing gun violence
available to every state. Programs like Project Triggerlock and Project
Exile will take guns out of the hands of violent criminals. They will
make our neighborhoods safer. They will save lives.
We can take concrete steps toward making our streets and
neighborhoods safer from armed criminals by passing the ``Safe Streets
and Neighborhoods Act.'' I urge my colleagues on both sides of the
aisle to support and pass this legislation. It's time to protect our
children and our families. It's time to get guns out of the wrong
hands. It's time we take back our neighborhoods and our communities
from the criminals and take action to stop gun crimes.
______

By Mr. ROTH:
S. 2391. A bill to suspend temporarily the duty on (S)-6-chloro-3,4-
dihydrol - 4 - cyclopropyethynyl-4-trifluoromethyl-2(1H)-quinazolinone;
to the Committee on Finance.
S. 2392. A bill to suspend temporarily the duty on (S)-6-chloro-3,4-
dihydro-
4E-cyclopropyethynyl - 4 - trifluoro-methyl-2(1H)-quinazolinone; to the
Committee on Finance.

legislation to temporarily reduce tariffs on hiv-combating drugs

Mr. ROTH. Mr. President, I rise today to introduce two bills, each of

[[Page S2533]]

which would temporarily suspend the tariff collected on imports of two
HIV-combating drugs, thus lowering their price for HIV-infected
consumers in the United States.
The two drugs are DPC 961 and DPC 083. They have been selected from
hundreds of candidates to have superior attributes relative to
currently marketed similar drugs. As such, their combined potency,
excellent resistance profile, lower protein binding, and longer plasma
half life increases the probability that these drugs will successfully
treat both HIV patients who have not previously had a similar treatment
as well as those HIV patients who have already developed resistance to
currently available agents. According to publicly available
information, there is no other HIV treatment in clinical trials that is
expected to be able to treat most patients with resistance to currently
available agents. DPC 961 and DPC 083 are also expected to have the
advantage of once daily therapy.
In addition, it is my expectation that the revenue impact of these
measures will be determined by the Congressional Budget Office to be de
minimus. There is no manufacturer of these drugs in the United States.
It is my hope that these measures will win the unanimous support of my
colleagues.
______

By Mr. DURBIN (for himself and Mr. Feingold):
S. 2393. A bill to prohibit the use of racial and other
discriminatory profiling in connection with searches and detentions of
individuals by the United States Customs Service personnel, and for
other purposes; to the Committee on Finance.

the reasonable search standards act

Mr. DURBIN. Mr. President, I rise today to introduce the
Reasonable Search Standards Act. This act prohibits racial or other
discriminatory profiling by Customs Service personnel. Representative
John Lewis from Georgia has introduced similar legislation in the
House.
Two years ago, I requested a GAO study of the U.S. Customs Service's
procedures for conducting inspections of airport passengers. The need
for this study grew out of an investigation report by Renee Ferguson of
WMAQ-TV in Chicago and several complaints from African-American women
in my home state of Illinois who were strip-searched at O'Hare Airport
for suspicion of carrying drugs. No drugs were found and the women felt
that they had been singled out for these highly intrusive searches
because of their race. These women, approximately 100 of them, have
filed a class action suit in Chicago.
The purpose of the GAO study was to review Customs' policies and
procedures for conducting personal searches of airport passengers and
to determine the internal controls in place to ensure that airline
passengers are not inappropriately targeted or subjected to personal
searches.
Approximately 140 million passengers entered the United States on
international flights during fiscal years 1997 and 1998. Because there
is no data available on the gender, race and citizenship of this
traveling population, GAO was not able to determine whether specific
groups of passengers are disproportionately selected to be searched.
However, once passengers are selected for searches, GAO was able to
evaluate the likelihood that people with various race and gender
characteristics would be subjected to searches that are more personally
intrusive, such as strip-searches and x-rays, rather than simply being
frisked or patted down.
The GAO study revealed some very troubling patterns in the searches
conducted by U.S. Customs Service inspectors.
GAO found disturbing disparities in the likelihood that passengers
from certain populations groups, having been selected for some form of
search, would be subjected to the more intrusive searches including
strip-searches or x-ray searches. Moreover, that increased likelihood
of being intrusively searched did not always correspond to an increased
likelihood of actual carrying contraband.
Because of the intrusive nature of strip-searches and x-ray searches,
it is important that the Customs Service avoid any discriminatory bias
in forcing passengers to undergo these searches.
GAO found that African-American women were much more likely to be
strip-searched than most other passengers. This disproportionate
treatment was not justified by the rate at which these women were found
to be carrying contraband. Certain other groups also experienced a
greater likelihood of being strip-searched relative to their likelihood
of being found carrying contraband.
Specifically, African-American women were nearly 3 times as likely as
African-American men to be strip-searched, even though they were only
half as likely to be found carrying contraband. Hispanic-American and
Asian-American women were also nearly 3 times as likely as Hispanic-
American and Asian-American men to be strip-searched, even though they
were 20 percent less likely to be found carrying contraband.
In addition, African-American women were 73 percent more likely than
White-American women to be strip-searched in 1998 and nearly 3 times as
likely to be strip-searched in 1997, despite only a 42 percent higher
likelihood of being found carrying contraband. Moreover, among non-
citizens, White men and women were more likely to be strip-searched
than Black and Hispanic men and women, despite lower rates of being
found carrying contraband.
As with strip-searches, x-rays are personally intrusive and it is of
particular concern that the Customs Service avoid any discriminatory
bias in requiring x-ray searches of passengers suspected of carrying
contraband.
GAO found that African-Americans and Hispanic-Americans were much
more likely to be x-rayed than other passengers. This disproportionate
treatment was not justified by the rate at which these passengers were
found to be carrying contraband.
Specifically, GAO found that African-American women were nearly 9
times as likely as White-American women to be x-rayed even though they
were half as likely to be carrying contraband. African-American men
were nearly 9 times as likely as White-American men to be x-rayed, even
though they were no more likely than White-American men to be carrying
contraband. Moreover, Hispanic-American women and men were nearly 4
times as likely as White-American women and men to be x-rayed, even
though they were only a little more than half as likely to be carrying
contraband. And among non-citizens, Black women and men were more than
4 times as likely as White women and men to be x-rayed, even though
Black women were only half as likely and Black men were no more likely
to be found carrying contraband.
For these reasons, I am introducing the Reasonable Search Standards
Act. This bill is a direct response to the concerns raised by the GAO
report. The bill prohibits Customs Service personnel from selecting
passengers for searches based in whole or in part on the passenger's
actual or perceived race, religion, gender, national origin, or sexual
orientation.
To ensure that a sound reason exists for selecting someone to be
searched, the bill requires Customs Service personnel to document the
reasons for searching a passenger before the passenger is searched. The
only exception to this requirement is when the Customs official
suspects that the passenger is carrying a weapon.
The bill also requires all Customs Service personnel to undergo
periodic training on the procedures for searching passengers, with a
particular emphasis on the prohibition on profiling. The training shall
include a review of the reasons given for searches, the results of the
searches and the effectiveness of the criteria used by Customs to
select passengers for searches.
Finally, the bill calls for an annual study and report on detentions
and searches of individuals by Customs Service personnel. The report
shall include the number of searches conducted by Customs Service
personnel, the race and gender of travelers subjected to the searches,
the type of searches conducted--including pat down searches and
intrusive non-routine searches--and the results of these searches.
With this proposed legislation, I call on the Congress of the United
States to act, to make a commitment giving all persons entering and
leaving our borders, regardless of gender, race, color,

[[Page S2534]]

religion, or ethnic background, the right to be treated fairly.
Lyndon B. Johnson once said, ``I am a free man, an American, a United
States Senator, and a Democrat, in that order.'' I am also all of
these, in that order.
As a man, I am saddened that, in this new millennium, women and
minorities are disproportionately selected for intrusive searches at
our nation's borders.
As an American, I am deeply troubled by the thought that any citizen,
or non-citizen, might be detained and stripped or x-rayed because of
their gender or the color of their skin.
As a United States Senator, I am proposing legislation to prohibit
racial or other inappropriate profiling and establish statutory
procedures to track and prevent disproportionate search rates. This
approval reflects our nation's basic posture of common sense and common
justice.
I implore my colleagues to examine this issue from the viewpoint of
the nation and its entire people. In the immortal words of John F.
Kennedy, ``The rights of every man are diminished when the rights of
one man are threatened.''
______

(By Mr. MOYNIHAN (for himself, Mr. Kennedy, Mr. Schumer, Mr.
Helms, Mr. Kerrey, Mrs. Boxer, Mr. Inouye, Mr. Santorum, Mr.
Torricelli, Mr. Johnson, Mrs. Feinstein, Mr. Smith of Oregon,
Mr. Kerry, Mr. DeWine, Mr. Edwards, Mr. Cleland, Mr. Lieberman,
Mr. Levin, Mr. Sarbanes, Mr. Wellstone, Mr. Reed, Mrs. Murray,
Ms. Mikulski, and Mr. Specter):
S. 2394. A bill to amend title XVIII of the Social Security Act to
stabilize indirect graduate medical education payments; to the
Committee on Finance.

THE TEACHING HOSPITAL PRESERVATION ACT OF 2000

Mr. MOYNIHAN. Mr. President, today I am introducing a bill--
The Teaching Hospital Preservation Act of 2000--that would provide much
needed financial support for America's 144 accredited medical and
osteopathic schools and 1,250 graduate medical education (GME) teaching
institutions. Teaching hospitals are national treasures; these
institutions are the very best in the world. Yet, today they find
themselves in a precarious financial situation as market forces reshape
the health care delivery system in the United States.
Markets do not provide for public goods such as teaching hospitals.
Everyone benefits from public goods but no one has any incentive to
pay. It follows, therefore that for the most part teaching hospitals
have to be paid for by the public either indirectly through tax
exemption or directly through expenditure.
The legislation I am introducing is similar to S. 1023--The Graduate
Medical Education Payment Restoration Act of 1999--a bill I introduced
during the first session. Congressman Rangel is introducing an
identical bill in the House today.
My particular interest in this subject began in 1994, when the
Finance Committee took up the President's Health Security Act. I was
Chairman of the Committee at the time. In January of that year, I asked
Dr. Paul Marks, M.D., President of Memorial Sloan-Kettering Cancer
Center in New York City, if he would arrange a ``seminar'' for me on
health care issues. He agreed, and gathered a number of medical school
deans together one morning in New York.
Early on in the meeting, one of the seminarians remarked that the
University of Minnesota might have to close its medical school. In an
instant I realized I had heard something new. Minnesota is a place
where they open medical schools, not close them. How, then, could this
be? The answer was that Minnesota, being Minnesota, was a leading state
in the growth of competitive health care markets, in which managed care
organizations try to deliver services at lower costs. In this
environment, HMOs and the like do not send patients to teaching
hospitals, absent which you cannot have a medical school.
We are, my friends, in the midst of a great era of discovery in
medical science--an era which might end prematurely if we are not
careful with our finances. It is certainly not a time to close medical
schools. This great era of medical discovery is occurring right here in
the United States, not in Europe like past ages of scientific
discovery. And it is centered in New York City. Progress over the past
60 years has been remarkable: images of the inside of the human body
based on the magnetic resonance of bodily tissues; laser surgery; micro
surgery for reattaching limbs; and organ transplantation, among other
wonders. Physicians are now working on a gene therapy that might
eventually replace bypass surgery. I can hardly imagine what might be
next.
The growth of managed for-profit care, which does not fund public
goods, combined with reductions in Medicare support for GME, is having
a deleterious effect on the financial position of teaching hospitals.
The Medicare program is the nation's largest explicit financier of GME,
with annual payments of about $5.4 billion in 1999. However, because of
payment reductions set forth by the Balanced Budget Act (BBA) of 1997,
Medicare support is eroding as well--down from $6.3 billion in 1997.
According to the Medicare Payment Advisory Commission, between 1997 and
1998, the margins for major teaching hospital have been slashed by more
than half, and are at their lowest point of the century. And this is an
average; individual hospitals have fared far worse.
With declining margins and many hospitals operating in the red, the
mission of these fine institutions is in jeopardy. The teaching
hospitals that we know and depend on today--including those in my state
of New York-- may not be able to continue their work, or even to
survive. If this is to happen, we could face what Walter Reich has
called ``the dumbing down of American medicine.''
Last year, we forestalled some cuts enacted in the BBA by passing the
Balanced Budget Refinement Act (BBRA) of 1999, however, this
legislation provided only short-term relief and does not go for enough.
To ensure that this precious public resource is maintained and the
United States continues to lead the world in quality health care, my
bill, the Teaching Hospital Preservation Act of 2000 would maintain
critically required funding.
The Teaching Hospital Preservation Act of 2000, with a total of 23
cosponsors, would freeze the scheduled reductions to the indirect
portion of GME funding. Under the BBA, the indirect payment adjustor
was scheduled to be reduced from 7.7 percent to 5.5 percent by FY 2001.
Last year, the BBRA slowed the cuts by holding the indirect payment
adjuster at 6.5 percent in FY 2000, 6.25 percent in FY 2001 and 5.5
percent in FY 2002 and thereafter. BBRA restored about $500 million--
over 5 years--in funding for teaching hospitals. The bill I introduce
today would maintain the indirect payment adjuster at 6.5 percent. In
total, this bill restores about another $2 billion over 5 years in GME
funding for teaching hospitals.
This bill would protect our nation's teaching hospitals and ensure
that the United States will continue to be in the forefront of
developing new cures, new medical technology, and training of the
worlds finest medical professionals. Without this bill, the state of
our nation's teaching hospitals and the delivery of health care will
remain in jeopardy.
I ask unanimous consent that the text of the bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 2394

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

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Teaching Hospital
Preservation Act of 2000''.

SEC. 2. REVISION OF REDUCTION OF INDIRECT GRADUATE MEDICAL
EDUCATION PAYMENTS.

Section 1886(d)(5)(B)(ii) of the Social Security Act (42
U.S.C. 1395ww(d)(5)(B)(ii)) (as amended by section 111(a) of
the Medicare, Medicaid, and SCHIP Balanced Budget Refinement
Act of 1999 (113 Stat. 1501A-329), as enacted into law by
section 1000(a)(6) of Public Law 106-113) is amended--
(1) in subclause (IV), by adding ``and'' at the end; and
(2) by striking subclauses (V) and (VI) and inserting the
following:
``(V) on or after October 1, 2000, `c' is equal to
1.6.''.

[[Page S2535]]

Mr. KENNEDY. Mr. President, the Teaching Hospital Preservation
Act that we are introducing today will restore much-needed support for
the nation's teaching hospitals by freezing the Medicare Indirect
Medical Education adjustment at 6.5 percent. The so-called IME payments
under Medicare go to teaching hospitals to help defray their added
costs of caring for the sickest patients, training physicians, and
providing an environment in which clinical research can flourish. Under
current law, the IME payments will be reduced from their current level
of 6.5 percent to 6.25 percent for fiscal year 2001 and 5.5 percent for
fiscal year 2002 and future years. If these reductions take place, they
will have a devastating impact on the nation's teaching hospitals.
Enactment of this relief is essential to complete the task we began
last year in the Balanced Budget Restoration Act of 1999. Across the
country, teaching hospitals continue to suffer severe financial losses.
According to the Association of American Medical Colleges, even with
enactment of last year's measure, the typical teaching hospital will
still lose more that $40 million in Medicare payments between 1998 and
2002. At the most recent meeting of the Medicare Payment Advisory
Committee, it was reported that the margins of major teaching hospitals
dropped from 5.1 percent in 1997 to 2.3 percent in 1998.
Notwithstanding major efforts by the leadership of this institutions to
reduce their costs, there is every reason to believe this ominous trend
is continuing.
In Boston, teaching hospitals lost $22 million just in the first
quarter of the current fiscal year, and Boston is far from alone. The
financial problems of the nation's pre-eminent teaching hospitals
around the country are well-known. Cutbacks in care for patients,
research, and teaching have already been implemented by many of these
respected institutions, and are being considered by many others. These
teaching hospitals are the backbone of our health care system, and
Congress should not stand silent in the face of these distressing
developments.
Teaching hospitals are facing substantially higher costs for drugs,
labor, medical devices and new technologies. The tight labor market is
pushing wages higher and higher. Despite these heavy financial
pressures. Medicare is scheduled to impose serious cutbacks in its
reimbursements to teaching hospitals. The result of this shortfall may
well be disastrous for these indispensable institutions.
A significant part of the problem was caused by the excessive and
unintended Medicare reductions required by the Balanced Budget Act of
1997. Last year's Balanced Budget Restoration Act delayed reductions in
the IME adjustment. That relief was an important first step, but it was
only a first step. The legislation we are introducing today will ensure
that Medicare support for teaching hospitals remains at its current
level.
The pre-eminence of American academic medicine is at stake. The
nation's teaching hospitals provide the highest quality health care to
the sickest patients. They ensure the highest quality physicians
training, and an unparalleled research capability. In addition,
teaching hospitals are the safety net for 44 percent of the uninsured,
despite comprising only 6 percent of all hospitals. They perform a vast
array of services to their communities, from neighborhood health
programs to drug treatment programs to well baby clinics. All of these
programs are in jeopardy if the currently scheduled cutbacks take
place. We cannot afford to let teaching hospitals fail. I urge my
colleagues to join us in enacting this important bill this
year.
______

By Mr. BENNETT:
S. 2396. A bill to authorize the Secretary of the Interior to enter
into contracts with the Weber Basin Water Conservancy District, Utah,
to use Weber Basin Project facilities for the impounding, storage, and
carriage of nonproject water for domestic, municipal, industrial, and
other beneficial purposes; to the Committee on Energy and Natural
Resources.

legislation regarding the weber basin water conservancy district

Mr. BENNETT. Mr. President, I am pleased to take a step in addressing
the long-term water needs of Summit County, Utah. The bill I am
introducing today, to make a necessary technical correction, authorizes
the Secretary of the Interior to enter into contracts with the Weber
Basin Water Conservancy District. This legislation would permit non-
federal water intended for domestic, municipal, industrial, and other
uses to utilize federal facilities of the original Weber Basin Project
for various purposes such as storage and transportation.
In this case, the Smith Morehouse Dam and Reservoir was constructed
by the Weber Basin Water Conservancy District in the early 1980's using
local funding resources in order to create a supply of non-federal
project water. However, it has been determined that there is currently
a need to deliver approximately 5,000 acre feet of this non-federal
Smith Morehouse water in conjunction with approximately 5,000 acre feet
of federal Weber Basin project water to the Snyderville Basin area of
Summit County, Utah and to Park City, Utah.
In 1996, the Weber Basin Water Conservancy District entered into
aMemorandum of Understanding and Agreement to deliver this water
approximately 14 miles from Weber Basin Weber River sources within a
certain time frame and dependent upon the execution of an Interlocal
Agreement with Park City and Summit County. The Warren Act requires
that legislation be enacted to enable the District to move ahead with
this agreement with Summit County and Park City to deliver the water
utilizing Weber Basin Project facilities built by the Bureau of
Reclamation.
There is an immediate need for the delivery of water to this area.
The Utah State Engineer halted the approval of new groundwater
developments in the area last year. At the same time, Summit County is
experiencing tremendous growth; in fact it is one of the highest growth
areas in the state. Within the areas to be served, taxed by the Weber
Basin District, there is a definite public need for an adequate,
reliable, and cost effective water delivery project in order to meet
the future demands of this area.
Since there is precedent allowing the wheeling of non-federal water
through federal facilities, my colleagues should realize that this is a
non-controversial piece of legislation. Therefore, I hope that Congress
will move quickly to pass this legislation next session and I look
forward to working closely with my colleagues on the Committee on
Energy and Natural Resources to move it quickly.
______

By Mr. FITZGERALD (for himself, Mr. Schumer, Mr. Durbin, Mr.
Santorum, Mr. Specter, Ms. Mikulski, Mr. Sarbanes, and Mr.
Kerrey):
S. 2398. A bill to amend the Public Health Service Act to revise and
extend the programs relating to organ procurement and transplantation;
to the Committee on Health, Education, Labor, and Pensions.

organ transplantation fairness act of 2000

Mr. FITZGERALD. Thank you, Mr. President.
Mr. President, I rise today to introduce the Organ Transplantation
Fairness Act of 2000.
I thank my original cosponsors on this bill: Senators Schumer,
Durbin, Santorum, Specter, Mikulski, Sarbanes, and Kerrey.
Our Nation's organ procurement and transplant system is in serious
need of change.
We could be saving more lives through organ transplants in this
country than we are at the present time.
The purpose of our bill and the goals of our bill are threefold.
First, we want to increase the amount of organs that are being
donated all across the country.
There are many more people who need to receive organs to remain
alive. They need organ transplants, and there are not a sufficient
number of people donating those organs. This bill attempts to address
that issue.
Second, we want to bring greater fairness to how we allocate scarce
organs after they are donated.
Right now those organs are not allocated in the best possible way.
And because of problems in our allocation system, people are dying
unnecessarily. We could be saving more lives.
The third goal of the bill is to seek to implement many of the
recommendations of the Institute of Medicine in

[[Page S2536]]

their 1999 report entitled ``Organ Procurement and Transplantation.''
In attempting to improve the system of organ procurement transplants
in this country, we have picked out many of the Institute of Medicine's
recommendations, and we tried to enact them into law. Our system is
saving many more lives than it used to.
Organ transplantation is fairly new to this country. If you go back
20 years or so, there were very few organs being transplanted. But now
many more people are benefiting and going on to live healthy lives
thanks to people who have donated organs, and thanks to successful
transplants. But as many lives as our system has saved, we are not
saving as many lives as we could.
I have a chart to demonstrate this. As of today, there are over
68,000 American patients waiting for a life-saving organ transplant.
In 1998, the most recent statistics available, over 4,800 people died
while on that organ transplant waiting list.
That means about 13 people a day are dying in this country while
waiting to get an organ that can be transplanted into their bodies.
I said earlier that we are not saving as many lives as we could save.
Let me demonstrate why that is the case, and why we know we are not
saving enough lives.
According to the Department of Health and Human Services, in 1998,
some 71 percent of livers were transplanted to patients in the least
urgent medical status categories. But at the same time that we were
transplanting those livers into patients in the least urgent medical
status categories, in the same year, 1,300 patients died while waiting
for a liver.
How can it be that we are transplanting livers into patients who
aren't in the most critically ill categories, while at the same time
people in the most critical condition were dying for lack of a liver
transplant?
The reason for that is we have a system in our country that is based
on where you live. Whether you live or die because of an organ
transplant may depend not on how sick you are but on where you live in
this country.
Let's examine this a little bit more closely.
There is a private not-for-profit corporation in this country that
has been given the authority to be in charge of our Nation's organ
transplant and procurement network. They have set up a series of
regions. They divided the whole country into regions. There are organs
that are available within those regions. But if you live outside one of
the regions where an organ is available, you are not liable to get one
of the organs when it comes up.

As a Senator from Illinois, I think the simplest thing for me to do
in illustrating this problem is to use Illinois as an example. Most of
Illinois is in organ procurement organization district 29. You can have
a patient who lives in northern Illinois, just a few miles from the
border of Wisconsin, and this patient could need a liver transplant. He
or she could be in status 1 medical condition, which means he or she is
in the most critical category and in need of a liver transplant
immediately. A liver may become available just over the border in
region 37, the Wisconsin network. But that liver can't be sent to the
person in Illinois because that person in Illinois is in region 29--not
37.
If a liver becomes available from a donor in Wisconsin, they will
first look to see if they have a very critically ill person who needs a
liver transplant in region 37. If they don't find such a person, then
they will go to somebody who is in a less urgent situation who doesn't
need the liver as quickly as that other person in Illinois. Thus,
somebody who may be in status 2, or even what they call status 3
medical condition, which isn't as critical as status 1, could get the
liver transplant up in Wisconsin. But that person a few miles south of
the border who needs the liver immediately, because he or she happens
to live in Illinois, cannot get it. If an organ doesn't become
available in that region in which he or she lives, that person may not
survive.
There is a saying in the real estate industry by the real estate
brokers and agents. When you go to them, they always tell you that
everything and the value of your home depends on ``location, location,
location.'' I bet not many Americans realize that in some cases if you
are in need of a liver transplant or a heart transplant, your chances
of survival are going to depend on your location, your location, your
location.
The purpose of our bill is to try to open this system up, and instead
of directing the organs to the people depending on where they live,
instead of determining whether people are going to live or die simply
based on accidents of geography, we try to bring sense to this whole
system. We try to get organs to people in the most critical need of
those organs as soon as possible. We would hope to get those to the
sickest people as soon as possible--the sickest people who have the
chance of going on and having a successful transplant.
There comes a point when your organs are so damaged and you are so
sick that it could be that a transplant would no longer help you.
Certainly, we have to be careful to make sure that we get the organs to
those who are the sickest but who still have a good chance of surviving
an organ transplant.
In addition, attempting to get the organs to the sickest patients
first, making that our Nation's public policy, we would like to
encourage a broader sharing of organs.
The Institute of Medicine's report suggested that each of these areas
should contain at least 9 million people. That is the minimum level for
optimal sharing to get the organs out and save the most lives. We want
to make sure we broaden these networks.

It isn't possible in all cases for all organs to be shared
nationally. With the heart, for example, a heart cannot last much more
than 4 hours after it has been given by a donor. It has to be
transplanted quickly. Other organs, such as kidneys, my understanding
is we can preserve them for over 24 hours, or even longer, and in that
circumstance it would be possible to have more nationwide sharing to
get those organs allocated to the people who need them the most.
Another important provision of our legislation is to take a strong
stand for the proposition that the private not-for-profit corporation
that now runs the whole Nation's organ procurement and transplant
network should have some public accountability. Members may have heard
that a bill passed by the House of Representatives provides no public
accountability for this private corporation that has life or death
control over at least 68,000 Americans. There is no accountability in
that bill. They wouldn't be accountable to elected officials. They
could not be regulated by the Department of Health and Human Services.
If people had a complaint with how that organization was being run,
there would be little or no recourse. I guess you could knock on their
doors at their corporate headquarters in Richmond, VA, and ask them to
listen to you, but they wouldn't have to. They are private not-for-
profit corporations with no responsibility to make sure the best public
policy goals of this country are achieved.
I don't think that is right. I think we want this corporation to be
publicly accountable to make sure that it is meeting the objectives of
the laws that are on the books and serving the public interest.
In addition, the Organ Transplantation Fairness Act of 2000 would
create a national organ transplant advisory board. It implements the
recommendations of the Institute of Medicine in this regard by creating
an advisory board that reviews the organ procurement and
transplantation network policies and advises the Secretary of our
Department of Health and Human Services.
We also put in place a process, based on sound medical criteria, for
the certification and recertification of what they call OPOs--organ
procurement organizations. It requires the OPOs that fail to meet
performance criteria to file a corrected plan, and they will have 3
years to implement such a plan. We have to have a way of making sure
the organ procurement organizations in this country are doing a good,
professional job. There has to be some accountability of those
organizations.
One of the most important issues, of course, is encouraging more
organ donations. Earlier this morning I had the opportunity to meet in
my office with several individuals who had actually been the recipients
of donated organs. Those transplants they had had saved

[[Page S2537]]

their lives. One of them was a constituent of mine. His name was Kent
Schlink from Peoria, IL. When Kent was in his late twenties, he had to
have a heart transplant to correct a defect he had in his heart dating
from his early childhood. He was very sick. He was on the waiting list
for quite some time. He ultimately had a heart transplant at St.
Francis Hospital in Peoria, IL, that saved his life. His life was saved
at a time when he had a 6-month-old child. He has gone on to have
another child. To see him talk about the joy to be with his young kids
drives home what a gift people who donate organs make--a gift of life.
We also had the opportunity to meet in my office with Britney Green,
a young girl whom I believe is 13 years old. She had a liver transplant
when she was 3 years old. She is currently on a waiting list for a new
heart. She has had a very tough road to hoe, but she is a bright and
cheerful young lady. She is very supportive and hopes we can improve
the system in this country.
Finally, I wish to mention one other young man who impressed me. His
name is Danny Canal. Danny is 14 years old, and he is an incredibly
bright, wonderful young man. He is a transplant recipient who actually
had a four-organ transplant, if you can believe that. Not only did he
have four organs transplanted, he actually had two sets of those organs
before the third set began functioning properly. This wonderful young
kid who has been saved by these organ transplants probably wouldn't
have had to have so many organs transplanted into him, because he
originally only needed a transplant of a small intestine.
Unfortunately, it took so long, he was on the waiting list for the
transplant of that intestine so long that his other organs started to
fail, to the point where he had to have his pancreas and other organs
replaced. Then there were problems and it took three times before they
got that right. He is a wonderful young man. It was a very moving
experience to hear his story.

We need to encourage more people to donate organs so there can be
more Danny Covals and Kent Schlinks and Britney Greens whose lives can
be saved in this country. Our bill does a lot to address that. We seek
to establish a grant program to assist organ procurement organizations
and other not-for-profit organizations in developing and expanding
programs aimed at increasing organ donation rates.
We create a congressional donor medal to honor living organ donors
and organ donor families, and give credit to the tremendous gift they
are giving by giving an organ. We establish a system of support for
State programs to increase organ donation, and we provide some
financial support to pay for nonmedical travel expenses of living
donors.
We have long had a transplant policy in this country that it was
against public policy, against the law to pay people for donating
organs. That creates many medical and ethical issues. I agree with that
prohibition against paying people for donating organs. Everybody who
does it is doing it just for the internal reward of helping somebody
else. They are not doing it for any financial gain. However, I think it
is appropriate that we could at least help defray some of the
nonmedical travel expenses of the living donors. Most health insurance
policies do, in fact, now in this country cover the medical expenses
associated with donating the organ.
The bill also bans lobbying by the organ procurement and transplant
network administrator. That is the private not-for-profit corporation
in Richmond, VA. We prohibit that firm which administers the program
under contract with the Department of Health and Human Services from
using fees that it collects from transplant patients to lobby Members
of Congress. That firm is collecting, I believe, $375 from every person
who is on an organ donor waiting list in the country. We want to make
sure those fees are helping to match organs with patients so that more
people can be saved. We do not think they need to be using those funds
to lobby Members of Congress.

Finally, one of the things the bill does is it actually comes in and
abolishes State laws that are on the books in several States that are
referred to as organ hoarding laws. Several States now, I regret to
say, have enacted laws saying organs donated within their State borders
cannot be given to people outside of their States. One of those States
is the State of Wisconsin, that borders on my State of Illinois.
I love Wisconsin. I think it is one of the most beautiful States in
our country. Every summer my family and I go up and we vacation in
northern Wisconsin. We enjoy their fishing and beautiful forests and
the wildlife there. But I disagree with the law they have on the books
that says if somebody in Wisconsin donates an organ, it cannot save a
life in Illinois. I know Walter Payton, if he could have had an organ
donated from a Green Bay Packer fan, would have gladly accepted it.
We do not need to be engaging in the Balkanization of our country. We
do not need to have these kinds of barriers erected between States. We
are, in the end, one nation, one giant state. This Balkanization has no
place in our country. A report from the Institute of Medicine and other
reports have indicated the statutes on the books in these several
States greatly diminish the effectiveness and equity of a national
organ transplant policy. We need to make sure that is no longer
allowed.
The other thing I point out is many of the people from Wisconsin may
come down and get listed on a transplant list at a hospital in Chicago.
Then the effect of that law, passed by the Wisconsin legislature, would
be to deny their own resident of the State of Wisconsin the ability to
get the transplant at maybe a very renowned hospital in Chicago, or
even one they go to in New York or another big State. That is
inappropriate. It is not good public policy. Our bill would very firmly
say that those laws would no longer be allowed in the States, and I
think we would be on our way toward developing a much better national
policy.
With that, Mr. President, I ask unanimous consent that the text of my
bill be printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 2398

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

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Organ Transplantation
Fairness Act of 2000''.

SEC. 2. FINDINGS.

(a) In General.--Congress makes the following findings:
(1) It is in the public interest to maintain and
continually improve a national network to ensure the fair and
effective distribution of organs among patients on the
national waiting list irrespective of their place of
residence or the location of the transplant program with
which they are listed, and to ensure quality and facilitate
collaboration among network members and individual medical
practitioners participating in the network activities.
(2) The Organ Procurement and Transplantation Network
(referred to in this section as the ``Network'') was created
in 1984 by the National Organ Transplant Act (Public Law 98-
507) in order to facilitate an equitable allocation of organs
among all patients on a national basis.
(3) The Federal Government should continue to provide
Federal oversight of the Network and is responsible for
protecting the public's health care interest and ensuring
that the policies of the Network meet the goals established
by this Act.
(4) The responsibility for developing, establishing, and
maintaining medical criteria and standards for organ
procurement and transplantation should be a function of the
Network, and the Secretary of Health and Human Services
should provide oversight to ensure compliance with this Act
and other applicable laws.
(5) The network should be operated by a private
organization under contract with the Department of Health and
Human Services.
(6) The Federal Government is responsible for ensuring that
the efforts of the Network serve patients and donor families
in the procurement and distribution of organs.
(7) The Federal Government should take immediate action to
improve organ donation rates and increase the number of
organs available for transplantation.
(8) There is a significant disparity between the number of
organ donors and the number of individuals waiting for organ
transplants, and it is in the public's best interest to have
a system of organ allocation that ensures that transplant
candidates with similar severity of illness have similar
likelihood of transplantation irrespective of their place of
residence or the location of the transplant program with
which they are listed.
(b) Sense of Congress Regarding Organ Donation.--It is the
sense of Congress that--
(1) the factors that impact organ donation rates are
complex and require a multifaceted approach to increase organ
donation rates;
(2) the Federal Government should lead the national effort
to increase organ donation

[[Page S2538]]

and develop programs with the transplant community to
research and implement a best practices approach to
increasing organ donation; and
(3) a generous contribution has been made by each
individual who has donated an organ to save a life.

SEC. 3. ORGAN PROCUREMENT ORGANIZATIONS.

Section 371 of the Public Health Service Act (42 U.S.C.
273) is amended to read as follows:

``SEC. 371. ORGAN PROCUREMENT ORGANIZATIONS.

``(a) Authority of the Secretary.--The Secretary may make
grants to, and enter into contracts with, qualified organ
procurement organizations described in subsection (b), and
other nonprofit private entities, for the purpose of carrying
out special projects designed to increase the number of organ
donors.
``(b) Qualified Organizations.--
``(1) Requirements.--A qualified organ procurement
organization for which grants may be made under subsection
(a) is an organization that, as determined by the Secretary,
will carry out the functions described in paragraph (2), and
that--
``(A) is a nonprofit entity;
``(B) has accounting and other fiscal procedures (as
specified by the Secretary) necessary to ensure the fiscal
stability of the organization;
``(C) has an agreement with the Secretary to be reimbursed
under title XVIII of the Social Security Act for the
procurement of kidneys;
``(D) notwithstanding any other provision of law, has met
the other requirements of this subsection and has been
certified or recertified by the Secretary as meeting the
performance standards to be a qualified organ procurement
organization through a process that--
``(i) granted certification or recertification within the
previous 4 years with such certification in effect as of
October 1, 2000, and remaining in effect through the earlier
of--

``(I) January 1, 2002; or
``(II) the completion of recertification under the
requirements of clause (ii); or

``(ii) is set forth in regulations prescribed by the
Secretary not later than January 1, 2002, that--

``(I) require recertifications of qualified organ
procurement organizations not more frequently than once every
4 years;
``(II) rely on outcome and process performance measures
that are based on available, practical empirical evidence of
organ donor potential or other related factors in each
service area of qualified organ procurement organizations;
``(III) use multiple outcome measures as part of the
certification process;
``(IV) provide for the filing and approval of a corrective
action plan by a qualified organ procurement organization if
the Secretary notifies the organ procurement organization
that it has failed to meet the performance measures after the
first 2 years of the 4 year certification period, which
corrective action plan shall apply for the 3 years following
approval of such plan;
``(V) provide for a qualified organ procurement
organization to appeal a decertification to the Secretary on
substantive and procedural grounds;

``(E) has procedures to obtain payment for nonrenal organs
provided to transplant centers;
``(F) has a defined service area that is of sufficient size
to assure maximum effectiveness in the procurement of organs;
``(G) has a director and other such staff, including the
organ donation coordinators and organ procurement specialists
necessary to effectively obtain organs from donors in its
service area; and
``(H) has a board of directors or an advisory board that--
``(i) is composed of--

``(I) members who represent hospital administrators,
intensive care or emergency room personnel, tissue banks, and
voluntary health organizations in its service area;
``(II) members who represent the public residing in such
area;
``(III) a physician with knowledge, experience, or skill in
the field of histocompatibility or an individual with a
doctorate degree in biological science with knowledge,
experience, or skill in the field of histocompatibility;
``(IV) a physician with knowledge or skill in the field of
neurology; and
``(V) from each transplant center in its service area, a
member who is a surgeon who has practicing privileges in such
center and who performs organ transplant surgery;

``(ii) has the authority to recommend policies for the
procurement of organs and the other functions described in
paragraph (2); and
``(iii) has no authority over any other activity of the
organization.
``(2) Functions.--An organ procurement organization shall--
``(A) have effective agreements, to identify potential
organ donors, with all of the hospitals and other health care
entities in its service area that have facilities for organ
donation;
``(B) conduct and participate in systematic efforts,
including professional education, to acquire all usable
organs from potential donors;
``(C) arrange for the acquisition and preservation of
donated organs and provide quality standards for the
acquisition of organs which are consistent with the standards
adopted by the Organ Procurement and Transplantation Network
under section 372(b)(2)(F), including arranging for testing
with respect to preventing the acquisition of organs that are
infected with the etiologic agent for acquired immune
deficiency syndrome;
``(D) arrange for the appropriate tissue typing of donated
organs;
``(E) assist the Organ Procurement and Transplantation
Network in the equitable distribution of organs among
patients on a national basis;
``(F) provide or arrange for the transportation of donated
organs to transplant centers;
``(G) have arrangements to coordinate its activities with
transplant centers in its service area;
``(H) participate in the Organ Procurement and
Transplantation Network established under section 372;
``(I) have arrangements to cooperate with tissue banks for
the retrieval, processing, preservation, storage, and
distribution of tissues as may be appropriate to assure that
all usable tissues are obtained from potential donors;
``(J) evaluate annually the effectiveness of the
organization in acquiring potentially available organs; and
``(K) assist hospitals in establishing and implementing
protocols for assuring that all deaths and imminent deaths
are reported to the appropriate organ procurement
organization.''.

SEC. 4. ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK.

Section 372 of the Public Health Service Act (42 U.S.C.
274) is amended to read as follows:

``SEC. 372. ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK.

``(a) In General.--The Secretary shall by regulation
provide for the establishment and operation of an Organ
Procurement and Transplantation Network that meets the
requirements of subsection (b).
``(b) Requirements.--
``(1) In general.--The Organ Procurement and
Transplantation Network shall carry out the functions
described in paragraph (2) and shall--
``(A) be operated by a private entity under contract with
the Department of Health and Human Services; and
``(B) have a board of directors--
``(i) not more than 50 percent of which members are
transplant surgeons or transplant physicians;
``(ii) at least 25 percent of which members are transplant
candidates, transplant recipients, organ donors, and family
members; and
``(iii) that includes representatives of organ procurement
organizations, voluntary health associations, and the general
public; and
``(iv) that shall establish an executive committee and
other committees, whose chairpersons shall be selected to
ensure continuity of the board.
``(2) Functions.--The Organ Procurement and Transplantation
Network shall--
``(A) establish and maintain one or more lists derived from
a national list of individuals who need organ transplants;
``(B) establish a national system, through the use of
computers and in accordance with established medical
criteria, to match organs and individuals included on such
lists;
``(C) establish membership criteria for hospitals, for
performing organ transplants, and for individual members;
``(D) maintain a 24-hour telephone service to facilitate
matching organs with individuals included in such lists;
``(E) allocate organs so that transplant candidates with
similar severity of illness have similar likelihood of
receiving a transplant irrespective of their place of
residence or the location of the transplant program with
which they are listed;
``(F) adopt and use standards of quality for the
acquisition and transportation of donated organs, including
standards for preventing the acquisition of organs that are
infected with the etiologic agent for acquired immune
deficiency syndrome;
``(G) prepare and distribute, on a national basis, samples
of blood sera from individuals who are included on such lists
in order to facilitate matching the compatibility of such
individuals with organ donors;
``(H) coordinate, as appropriate, the transportation of
organs from organ procurement organizations to transplant
centers;
``(I) provide information to physicians and other health
professionals and the general public regarding organ
donation;
``(J) collect, analyze, and publish data concerning organ
donation and transplants;
``(K) provide data to the Secretary in order to permit the
Secretary to carry out the Secretary's responsibilities under
this part, and to the Scientific Registry maintained pursuant
to section 373;
``(L) respond in a timely fashion and to the extent
permitted, to requests for data from researchers and
investigators;
``(M) carry out studies and demonstration projects for the
purpose of improving procedures for organ procurement and
allocation;
``(N) work actively to increase the supply of donated
organs;
``(O) submit to the Secretary an annual report containing
information on the comparative costs and patient outcomes at
each transplant center affiliated with the Organ Procurement
and Transplantation Network; and
``(P) submit to the Secretary an annual report containing
such financial information,

[[Page S2539]]

as determined by the Secretary, to be necessary to evaluate
the cost of operating the Organ Procurement and
Transplantation Network.
``(3) Availability of patient listing fees and
participation fees.--
``(A) In general.--Any fees described in subparagraph (B)
that are collected by the Organ Procurement and
Transplantation Network--
``(i) shall be available to the Organ Procurement and
Transplantation Network, without fiscal year limitation, for
use in carrying out the functions of the Organ Procurement
Transplantation Network under this section; and
``(ii) shall not be used for any activity (including
lobbying or other political activity) that is not authorized
under this section.
``(B) Covered fees.--Subparagraph (A) applies with respect
to the following:
``(i) Listing fees.
``(ii) Fees imposed as a condition of being a participant
in the Organ Procurement and Transplantation Network.
``(C) Construction.--No provision of this paragraph may be
construed to prohibit the Organ Procurement and
Transplantation Network from--
``(i) collecting fees other than the fees described in
subparagraph (B); or
``(ii) using fees covered by clause (i) for an activity
covered by subparagraph (A)(ii) or other activity.
``(c) Organ Allocation.--
``(1) Development of policies.--The Organ Procurement and
Transplantation Network shall develop organ-specific policies
(including combinations of organs, such as for kidney-
pancreas transplants), subject to the review of and approval
by the Secretary, for the equitable allocation of cadaveric
organs to individuals on the national waiting list.
``(2) Listing criteria.--Standardized minimum listing
criteria for including individuals on the national list shall
be established and, to the extent possible, shall--
``(A) contain explicit thresholds for the listing of a
patient;
``(B) avoid futile transplants or the wasting of organs;
``(C) be expressed through objective and measurable medical
criteria; and
``(D) be reviewed periodically and revised as appropriate.
``(3) Requirements relating to transplant candidates.--
Where appropriate for the specific organ, transplant
candidates shall--
``(A) be grouped by status categories from most to least
medically urgent with--
``(i) sufficient categories to avoid grouping together
individuals with substantially different medical urgency;
``(ii) explicit thresholds for differentiating among
patients; and
``(iii) explicit standards for the movement of individuals
among the status categories;
``(B) be expressed through objective and measurable medical
criteria; and
``(C) be reviewed periodically and revised as appropriate.
``(4) Requirements for allocation policies and
procedures.--Organ allocation policies and procedures shall
be established in accordance with sound medical judgment and
shall--
``(A) be designed and implemented to allocate organs among
transplant candidates--
``(i) in order of decreasing medical urgency status;
``(ii) over the largest geographic area practicable in a
manner consistent with organ viability so that neither place
of residence nor place of listing shall be a major
determinant; and
``(iii) so as to maintain organ viability and avoid organ
wastage; and
``(B) be reviewed periodically and revised as appropriate.
``(5) Policies where medical urgency is not an appropriate
measurement.--Where medical urgency is not an appropriate
measurement for organ allocation, policies and procedures
shall be established in accordance with sound medical
judgment.
``(d) Authority of the Secretary.--The policies and rules
established by the Organ Procurement and Transplantation
Network that are to be enforceable shall be subject to review
and approval by the Secretary. The Secretary shall--
``(1) in consultation with the Organ Procurement and
Transplantation Network, develop mechanisms to promote and
review compliance with the requirements of this section;
``(2) establish and approve all fees, dues, or similar
costs charged to support the operation of the Organ
Procurement and Transplantation Network;
``(3) establish procedures for receiving from interested
persons critical comments relating to the manner in which the
Organ Procurement and Transplantation Network is carrying out
the duties of the Network under subsection (b); and
``(4) take such action, as determined by the Secretary, to
enforce the requirements of this section as well as the
requirements under title XVIII of the Social Security Act.
``(5) if the Organ Procurement and Transplantation Network
fails to submit a policy on a matter which the Secretary
determines should be enforced under this section or section
1138 of the Social Security Act, or the Organ Procurement and
Transplantation Network submits a policy that the Secretary
determines is inconsistent with the goals of this Act, submit
to the board of directors or advisory board of the Organ
Procurement and Transplantation Network the Secretary's
version of such policy.
``(e) National Transplant Advisory Board.--
``(1) Establishment.--The Secretary shall, by regulation,
provide for the establishment of a National Organ Transplant
Advisory Board (referred to in this subsection as the
`Board').
``(2) Membership.--The Board shall carry out the functions
described in paragraph (3) and shall be comprised of
individuals that--
``(A) include a broad spectrum of representatives of the
medical and scientific community, including transplant
surgeons, transplant physicians, epidemiologists, and health
service researchers, as well as representatives from organ
procurement organizations and the community of transplant
patients, family members and donor families;
``(B) are selected by the Secretary;
``(C) serve terms of not less than 3 years.
``(3) Functions.--The Board shall assist the Secretary in
ensuring that the Organ Procurement and Transplantation
Network is grounded on the best available medical science and
is effective and equitable as possible and shall--
``(A) at the request of the Secretary, review the policies
and rules of the Organ Procurement and Transplantation
Network;
``(B) advise and propose to the Secretary policies, rules,
and regulations affecting organ procurement and
transplantation;
``(C) at the request of the Secretary, review and consider
policies and regulations affecting organ transplantation
developed by the Secretary;
``(D) advise the Secretary with respect to comments
received by the Secretary under subsection (d)(3);
``(E) meet at the request of the Secretary, but not less
than 2 times each year; and
``(F) elect a Chairperson and Vice-chairperson as well as
any other officers as determined appropriate by the Board.
``(4) Authorization of appropriations.--For the purpose of
carrying out this subsection, there are authorized to be
appropriated $1,000,000 for each of the fiscal years 2000
through 2005.''.

SEC. 5. SCIENTIFIC REGISTRY.

Section 373 of the Public Health Service Act (42 U.S.C.
274a) is amended to read as follows:

``SEC. 373. SCIENTIFIC REGISTRY.

``The Secretary shall, by grant or contract, develop and
maintain a scientific registry of the recipients of organ
transplants. The registry shall include such information
concerning patients and transplant procedures as the
Secretary determines to be necessary to an ongoing evaluation
to the scientific and clinical status of organ
transplantation. The registry shall also include such
information concerning both donors and patients in
transplants involving living donors. The Secretary shall
prepare for inclusion in the report under section 376 an
analysis of information derived from the registry.''.

SEC. 6. ADMINISTRATION.

Section 375 of the Public Health Service Act (42 U.S.C.
274c) is amended to read as follows:

``SEC. 375. ADMINISTRATION.

``The Secretary shall designate and maintain an
identifiable administrative unit in the Public Health Service
to--
``(1) administer this part and coordinate with organ
procurement activities under title XVIII of the Social
Security Act;
``(2) administer and coordinate programs, as determined by
the Secretary, to increase organ donation rates;
``(3) provide technical assistance to organ procurement
organizations, the Organ Procurement and Transplantation
Network established under section 372, and other entities in
the health care system involved in organ donations,
procurements, and transplants; and
``(4) provide information--
``(A) to patients, their families, and their physicians
about transplantation; and
``(B) to patients and their families about resources
available nationally and in each State, and the comparative
costs and patient outcomes at each transplant center
affiliated with the Organ Procurement and Transplantation
Network, in order to assist the patients and families with
the costs associated with transplantation.''.

SEC. 7. ADDITIONAL AMENDMENTS.

Part H of title III of the Public Health Service Act (42
U.S.C. 273 et seq.) is amended--
(1) in section 374 (42 U.S.C. 274b)--
(A) in subsection (b)(1), by striking ``and may not exceed
$100,000'' and inserting ``and other organizations for the
purpose of increasing the supply of transplantable organs'';
and
(B) in subsection (b)(2), by striking the second sentence;
(2) in section 376 (42 U.S.C. 274d), by striking
``Committee on Energy and Commerce'' and inserting
``Committee on Commerce''; and
(3) by striking section 377 (42 U.S.C. 274f).

SEC. 8. PAYMENT OF TRAVEL AND SUBSISTENCE EXPENSES INCURRED
TOWARD LIVING ORGAN DONATION.

Part H of title III of the Public Health Service Act (42
U.S.C. 273 et seq.) is amended by inserting after section 376
the following section:

``SEC. 376A. TRAVEL AND SUBSISTENCE PAYMENTS FOR LIVING ORGAN
DONATION.

``(a) In General.--The Secretary may make awards of grants
or contracts to

[[Page S2540]]

States, transplant centers, qualified organ procurement
organizations under section 371, or other public or private
entities for the purpose of--
``(1) providing for the payment of travel and subsistence
expenses incurred by individuals toward making living
donations of their organs (referred to in this section as
`donating individuals'); and
``(2) in addition, providing for the payment of such
incidental nonmedical expenses that are so incurred as the
Secretary determines by regulation to be appropriate.
``(b) Eligibility.--
``(1) In general.--Payments under subsection (a) may be
made for the qualifying expenses of a donating individual
only if--
``(A) the State in which the donating individual resides is
a different State than the State in which the intended
recipient of the organ resides; and
``(B) the annual income of the intended recipient of the
organ does not exceed $35,000 (as adjusted for fiscal year
2002 and subsequent fiscal years to offset the effects of
inflation occurring after the beginning fiscal year 2001).
``(2) Certain circumstances.--Subject to paragraph (1), the
Secretary may in carrying out subsection (a) provide as
follows:
``(A) The Secretary may consider the term `donating
individuals' as including individuals who in good faith incur
qualifying expenses toward the intended donation of an organ
but with respect to whom, for such reason as the Secretary
determines to be appropriate, no donation of the organ
occurs.
(B) The Secretary may consider the term `qualifying
expenses' as including the expenses of having one or more
family members of donating individuals accompany the donating
individuals for purposes of subsection (a) (subject to making
payment for only such types of expenses as are paid for
donating individuals).
``(c) Limitation on Amount of Payment.--
``(1) In general.--With respect to the geographic area to
which a donating individual travels for purposes of section
(a), if such area is other than the covered vicinity for the
intended recipient of the organ, the amount of qualifying
expenses for which payments under such subsection are made
may not exceed the amount of such expenses for which payment
would have been made if such area had been the covered
vicinity for the intended recipient, taking into account the
costs of travel and regional differences in the cost of
living.
``(2) Covered vicinity.--For purposes of this section, the
term `covered vicinity' with respect to an intended recipient
of an organ from a donating individual, means the vicinity of
the nearest transplant center to the residence of the
intended recipient that regularly performs transplants of
that type of organ.
``(d) Relationship to Payments Under Other Programs.--An
award may be made under subsection (a) only if the applicant
agrees that the award will not be expended to pay the
qualifying expenses of a donating individual to the extent
that payment has been made, or can reasonably be expected to
be made, with respect to such expenses--
``(1) under any State compensation program, under an
insurance policy, or under any Federal or State health
benefits program; or
``(2) by an entity that provides health services on a
prepaid basis.
``(e) Definitions.--In this section:
``(1) Covered vicinity.--The term `covered vicinity' has
the meaning given such term in subsection (c)(2).
``(2) Donating individual.--The term `donating individual'
has the meaning indicated for such term in subsection (a)(1),
subject to subsection (b)(2)(A).
``(3) Qualifying expenses.--The term `qualifying expenses'
means the expenses authorized for purposes of subsection (a),
subject to subsection (b)(2)(B).
``(f) Authorization of Appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated $5,000,000 for each of fiscal years 2000 through
2005.''.

SEC. 9. PROGRAMS AND DEMONSTRATION PROJECTS TO INCREASE ORGAN
DONATION.

Part H of title III of the Public Health Service Act (42
U.S.C. 273 et seq.) is amended by inserting after section 377
the following:

``SEC. 377A. INITIATIVES TO INCREASE ORGAN DONATION.

``(a) Public Awareness.--The Secretary shall (directly or
through grants or contracts) carry out a program to educate
the public with respect to organ donation.
``(b) Studies and Demonstrations.--The Secretary may make
grants to public and nonprofit entities for the purpose of
carrying out studies and demonstration projects with respect
to increasing rates of organ donation. The Secretary shall--
``(1) give priority to those studies and demonstration
projects that are founded upon a best practices approach to
increasing organ donation consent rates;
``(2) give priority to those geographic areas with lower
organ donation consent rates, especially among minorities;
``(3) provide assistance to qualified organ procurement
organizations described under section 371 to implement
programs and projects, that as determined by Secretary
through studies and demonstration projects, have proven to be
effective in increasing organ donation rates; and
``(4) provide assistance to the study and consideration of
presumed consent as an opportunity to increase organ donation
rates.
``(c) Grants to States.--The Secretary may make grants to
states for the purpose of carrying out public education and
outreach programs designed to increase the number of organ
donors within the State. To be eligible, each State shall--
``(1) submit an application to the Secretary, in such form
as prescribed by the Secretary; and
``(2) establish yearly benchmarks for improvement in organ
donation rates in the State.
``(d) Congressional Medal.--
``(1) Design.--The Secretary shall design a bronze medal
with suitable emblems, devices, and inscriptions, to be
determined by the Secretary, to commemorate organ donors and
their families.
``(2) Eligibility.--Any organ donor, or the family of any
organ donor, shall be eligible for a medal under this
subsection.
``(3) Requirements.--The Secretary shall direct the Organ
Procurement and Transplantation Network, established under
section 372, to--
``(A) establish an application procedure requiring the
relevant organ procurement organizations, described in
section 371, through which an individual or their family made
an organ donation, to submit documentation supporting the
eligibility of that individual or their family to receive a
medal; and
``(B) determine through the documentation provided, and, if
necessary, independent investigation, whether the individual
or family is eligible to receive a medal.
``(4) Delivery.--The Secretary shall make suitable
arrangements as necessary with the Secretary of the Treasury
to strike and deliver the medals described in paragraph (3).
``(5) Presentation.--The Secretary shall provide for the
presentation to the relevant organ procurement organizations
all medals struck pursuant to this section to individuals or
families that, in accordance with paragraph (3), the Organ
Procurement and Transplantation Network has determined
eligible to receive medals.
``(6) Limitation.--
``(A) in general.--Except as provided in subparagraph (B),
only 1 medal may be presented to a family under paragraph
(5). Such medal shall be presented to the donating family
member, or in the case of a deceased donor, the family member
who signed the consent form authorizing, or who otherwise
authorized, the donation of the organ involved.
``(B) Additional medals.--In the case of a family in which
more than 1 member is an organ donor, an additional medal may
be presented to each such organ donor or their family.
``(7) Duplicates.--The Secretary or the Organ Procurement
and Transplantation Network may provide duplicates of a
medal--
``(A) to any recipient of a medal under paragraph (4) under
such regulation as the Secretary may issue; and
``(B) the cost of which shall be sufficient to cover the
costs of such duplicates.
``(8) National medals.--The medals struck pursuant to this
subsection are national medals for purposes of section 5111
of title 31, United States Code.
``(9) Applicability of provisions.--No provision of law
governing procurement or public contracts shall be applicable
to the procurement of goods or services necessary for
carrying out the provisions of this subsection.
``(10) Funding.--
``(A) Agreements.--The Secretary of the Treasury may enter
into an agreement with the Organ Procurement and
Transplantation Network to collect funds to offset
expenditures relating to the issuance of medals authorized
under this subsection.
``(B) Payment and limitation.--
``(i) Payment.--Except as provided in clause (ii), all
funds received by the Organ Procurement and Transplantation
Network under this paragraph shall be promptly paid to the
Secretary of the Treasury.
``(ii) Limitation.--Not more than 5 percent of any funds
received under this paragraph may be used to pay
administrative costs incurred by the Organ Procurement and
Transplantation Network as a result of an agreement
established under this subsection.
``(C) Deposits and expenditures.--Notwithstanding any other
provision of law--
``(i) all amounts received by the Secretary of the Treasury
under paragraph (10)(A)(i) shall be deposited in the
Numismatic Public Enterprise Fund, as described in section
5134 of title 31, United States Code; and
``(ii) the Secretary of the Treasury shall charge such fund
with all expenditures relating to the issuance of medals
authorized under this subsection.
``(D) Start-up costs.--A one-time amount of not to exceed
$55,000 shall be provided by the Secretary to the Organ
Procurement and Transplantation Network to cover initial
start-up costs to be paid back in full within 3 years of the
date of enactment of this section from funds received under
this subsection.
``(11) Definition.--For the purposes of this section, the
term `organ' means the human kidney, liver, heart, lung,
pancreas, and any other human organ (other than corneas and
eyes) specified by regulation by the Secretary.
``(12) Effective date.--This subsection shall be effective
for the 5-year period beginning on the date of the enactment
of this section.

[[Page S2541]]

``(e) Annual Report to Congress.--The Secretary shall
submit to the Congress an annual report on the activities
carried out under this section, including provisions
describing the extent to which the activities have affected
the rate of organ donation.
``(f) Authorization of Appropriations.--
``(1) In general.--For the purpose of carrying out this
section, there are authorized to be appropriated $10,000,000
for fiscal year 2000, and such sums as may be necessary for
each of the fiscal years 2001 through 2005. Such
authorization of appropriations is in addition to any other
authorizations of appropriations that are available for such
purpose.
``(2) Public Awareness.--Of the amounts appropriated under
paragraph (1) for a fiscal year, the Secretary may not
obligate more than $2,000,000 for carrying out subsection
(a).''.

SEC. 10. AUTHORIZATION OF APPROPRIATIONS.

Section 378 of the Public Health Service Act (42 U.S.C.
274g) is amended to read as follows:

``SEC. 378. AUTHORIZATION OF APPROPRIATIONS FOR ORGAN
PROCUREMENT AND TRANSPLANTATION NETWORK.

``For the purpose of providing for the Organ Procurement
and Transplantation Network under section 372, and for the
Scientific Registry under section 373, there are authorized
to be appropriated $4,000,000 for fiscal year 2000, and such
sums as may be necessary for each of fiscal years 2001
through 2005.''.

SEC. 11. PREEMPTION.

Part H of title III of the Public Health Service Act (42
U.S.C. 273 et seq.) is amended by inserting after section 378
the following:

``SEC. 378A. PREEMPTION.

``No State or political subdivision of a State shall
establish or continue in effect any law, rule, regulation, or
other requirement that would restrict in any way the ability
of any transplant hospital, organ procurement organization,
or other entity to comply with the organ allocation policies
of the Network under this part.''.

SEC. 12. EFFECTIVE DATE.

The amendments made by this Act shall take effect on
October 1, 2000, or upon the date of enactment of this Act,
whichever occurs later.
______

By Mr. DURBIN (for himself and Mr. Levin):
S. 2399. A bill to amend title XVIII of the Social Security Act to
revise the coverage of immunosuppressive drugs under the Medicare
program; to the Committee on Finance.

comprehensive immunosuppressive drug coverage for transplant patients
act of 2000

Mr. DURBIN. Mr. President, I rise to make a few remarks
concerning this bill I am introducing today, which will help many
Medicare beneficiaries who have had organ transplants.
Every year, over 4,000 people die waiting for an organ transplant.
Currently, over 62,000 Americans are waiting for a donor organ. It is
this scarcity that has fueled the current controversy over organ
allocation.
Given that organs are extremely scarce, Federal law should not
compromise the success of organ transplantation. Yet that is exactly
what current Medicare policy does, because Medicare denies certain
transplant patients coverage for the drugs needed to prevent rejection.
Medicare does this in three different ways. Firstly, Medicare has
time limits on coverage of immunosuppressive drugs. Permanent Medicare
law only provides immunosuppressive drug coverage for 3 years with
expanded coverage totaling 3 years and 8 months between 2000 and 2004.
However, 61 percent of patients receiving a kidney transplant after
someone has died still have the graft intact 5 years after
transplantation. 76.6 percent of patients receiving a kidney from a
live donor still have their transplant intact after 5 years post
transplantation. For livers, the graft survival rate after 5 years is
62 percent. For hearts, the 5 year graft survival rate is 67.7 percent.
So many Medicare beneficiaries lose coverage of the essential drugs
that are needed to maintain their transplant.
Secondly, Medicare does not pay for anti-rejection drugs for Medicare
beneficiaries, who received their transplants prior to becoming a
Medicare beneficiary. So for instance, if a person received a
transplant at age 64 through their health insurance plan, when they
retire and rely on Medicare for their health care they will no longer
have immunosuppressive drug coverage.
Thirdly, Medicare only pays for anti-rejection drugs for transplants
performed in a Medicare approved transplant facility. However, many
beneficiaries are completely unaware of this fact and how it can
jeopardize their future coverage of immunosuppressive drugs. To receive
an organ transplant, a person must be very ill and many are far too ill
at the time of transplantation to be researching the intricate nuances
of Medicare coverage policy.
The bill that I am introducing today, the ``Comprehensive
Immunosuppressive Drug Coverage for Transplant Patients of 2000 Act''
would remove these short-sighted limitations. The bill sets up a new,
easy to follow policy: All Medicare beneficiaries who have had a
transplant and need immunosuppressive drugs to prevent rejection of
their transplant, would be covered as long as such anti-rejection drugs
were needed.
I am introducing this bill on behalf of some of the constituents that
I have met who are unfortunately very adversely affected by the current
gaps in Medicare coverage.
Richard Hevrdejs was a Chicago attorney in private practice until
1993. Unfortunately, he suffered a debilitating heart attack that year,
which left him unable to work and on disability. In 1997, suffering
from congestive heart failure, he was placed on a Heart-Mate machine at
the University of Illinois Medical Center (UIC). In April of 1998, he
received a heart transplant at UIC but because UIC was not at the time
a Medicare approved facility for heart transplants, Medicare will not
cover his immunosuppressive drugs. Richard was near death when he had
his transplant and was in no condition to research the intricacies of
Medicare coverage policies. His drug costs are now around $25,000 per
year. He gets some assistance from the drug company medical assistance
plans and he has a Medigap policy that provides a little assistance.
But for the most part, he is forced to watch all his savings dwindle
because of Medicare's coverage gaps.
Anita Milton is from Morris, Illinois. In 1995, she became so
disabled that she was no longer able to work and was forced onto
disability. The following year, her lungs gave up and she had to have
a bilateral lung transplant. Because Medicare s not available for 2
years after a person becomes eligible for disability, Anita was not on
Medicare when she had the transplant. Today, the huge bills for the
transplant remain at collection agencies. Because Anita was not on
Medicare when she received her transplant, she does not receive
Medicare coverage for the antirejection drugs that she needs. She
receives $940 in disability payments per month. She is now on Medicaid
but due to the spend down requirements in Illinois, she must spend $689
on drug costs to get Medicaid converge for her drugs. In effect, she
gets coverage every month. Anita cannot afford her anti-rejection drugs
and she tried to scale back on them. This caused her to nearly reject
the transplant. Consequently, she has lost a third of her lung capacity
permanently. As Anita said at a Town Hall meeting in Chicago in January
``these Medicare and Medicaid rules make no sense.''

I am introducing this bill on the same day that another bill the
``Organ Transplant Act of 2000'', which I am an original cosponsor is
also being introduced. The ``Organ Transplant Fairness Act'' also seeks
to change another aspect of Federal law to improve the Nation's organ
allocation system. The two bills are good companions. It makes little
sense to improve the organ allocation system to maximize the success of
organ transplantation and increase the number of lives saved, if we do
not at the same time reduce the ways that Medicare jeopardizes
transplants by denying transplant patients the anti-rejection drugs
they need to maintain their transplant.
Mr. President, I ask unanimous consent that a copy of the bill the
``Comprehensive Immunosuppresive Drug Coverage for Transplant Patients
of 2000'' be printed in the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 2399

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

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Comprehensive
Immunosuppressive Drug Coverage for Transplant Patients Act
of 2000''.

SEC. 2. REVISION OF COVERAGE OF IMMUNOSUPPRESSIVE DRUGS UNDER
THE MEDICARE PROGRAM.

(a) Revision.--
(1) In general.--Section 1861(s)(2)(J) of the Social
Security Act (42 U.S.C. 1395x(s)(2)(J))

[[Page S2542]]

(as amended by section 227(a) of the Medicare, Medicaid, and
SCHIP Balanced Budget Refinement Act of 1999 (113 Stat.
1501A-354), as enacted into law by section 1000(a)(6) of
Public Law 106-113) is amended by striking ``, to an
individual who receives'' and all that follows before the
semicolon at the end and inserting ``to an individual who has
received an organ transplant''.
(2) Conforming amendments.--
(A) Section 1832 of the Social Security Act (42 U.S.C.
1395k) (as amended by section 227(b) of the Medicare,
Medicaid, and SCHIP Balanced Budget Refinement Act of 1999
(113 Stat. 1501A-354), as enacted into law by section
1000(a)(6) of Public Law 106-113) is amended--
(i) by striking subsection (b); and
(ii) by redesignating subsection (c) as subsection (b).
(B) Subsections (c) and (d) of section 227 of the Medicare,
Medicaid, and SCHIP Balanced Budget Refinement Act of 1999
(113 Stat. 1501A-355), as enacted into law by section
1000(a)(6) of Public Law 106-113, are repealed.
(3) Effective date.--The amendments made by this subsection
shall apply to drugs furnished on or after the date of
enactment of this Act.
(b) Extension of Certain Secondary Payer Requirements.--
Section 1862(b)(1)(C) of the Social Security Act (42 U.S.C.
1395y(b)(1)(C)) is amended by adding at the end the
following: ``With regard to immunosuppressive drugs furnished
on or after the date of enactment of the Comprehensive
Immunosuppressive Drug Coverage for Transplant Patients Act
of 2000, this subparagraph shall be applied without regard to
any time limitation.''.
______

By Mr. GREGG (for himself and Mr. Kohl):
S. 2401. A bill to provide jurisdictional standards for imposition of
State and local business activity, sales, and use tax obligations on
interstate commerce, and for other purposes; to the Committee on
Finance.

the new economy tax simplification act

Mr. GREGG. Mr. President, I rise today with Senator Kohl to
introduce the New Economy Tax Simplification Act or NETSA. Electronic
commerce is reshaping our society. In many ways, the strong economic
conditions we currently enjoy are a result of the convenience, lower
costs, and global connections provided by the internet. The question
for us as a nation is how to manage this new enterprise so that it
continues to benefit our nation's economy, particularly in regard to
the taxation of e-commerce.
So far, the government's hands-off approach is working. Our nation's
unemployment and inflation rates are at record lows and higher paying
jobs are being created at a tremendous rate. Many financial experts
attribute the record low inflation rates to the Internet. A University
of Texas study found that the Internet economy grew an astounding 68%
rate in the past 12 months.
Another sign of the good times is the surplus revenue flowing into
federal and state treasuries all over the nation. The federal
government's budget is balanced for the first time in a generation and
the 50 states ended 1998 with a collective surplus of $11 billion.
States are seeing revenue increases of more than 5 percent a year
through the 1990's. This hardly seems like a compelling rationale for
levying taxes on the Internet. Yet a heated debate is raging between
those who want to keep the internet free of taxes and state and local
governments who seek to impose widespread taxes on internet sales.
The Advisory Commission on Electronic Commerce (ACEC), set up by
Congress last year to develop recommendations on Internet taxes,
recently concluded its final meeting but failed to reach the required
supermajority to make any formal recommendations. Notably, it did agree
by a simple majority vote to extend the current moratorium on Internet
taxes for five years.
The Commission is set to deliver it's report to Congress tomorrow. It
will recommend that we extend the internet tax moratorium for another
five years and I fully support this. The Commission will also ask
Congress to establish nexus safeguards--to make clear when a State or
municipality has the power to levy taxes. Our legislation establishes
these important nexus safeguards.
Currently, online sales are governed by the very same tax rules that
govern mail order sales. The existing rules of the road are based upon
two prior Supreme Court decisions--National Bellas Hess case in 1967,
and the Quill case in 1992. Both decisions established the power of
state tax authority to be limited by nexus--or the scope of a company's
connection to the taxing state.
Local sales taxes are incredibly complex. There are 7,600 different
tax jurisdictions across the country--within these systems about 600-
700 rate changes occur per year. There are 46 different sets of rules
(45 states and the District of Columbia have state sales tax). If
forced to comply with these rules, companies would be filing 425 tax
returns each month or 5,100 a year.
The Gregg/Kohl bill, the New Economy Tax Simplification Act (NETSA),
codifies these mail order tax rules as outlined in the Quill decision,
updating this decision for the 21st century.
Sales/use tax nexus rules are court-based, and income tax nexus rules
are based upon a 1950s federal statute that applies only to tangible
goods. The Gregg/Kohl plan would codify nexus standards across the
board. This legislation would update and strengthen the nexus standards
for the 21st Century economy--ensuring that intangible sales, web pages
and servers do not cause nexus. It maintains current constitutional
principles and keeps state powers within their jurisdictions, and does
not try to pre-empt a state's tax authority within its own borders.
I ask unanimous consent that the full text of the bill be printed in
the Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:

S. 2401

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

SECTION 1. SHORT TITLE.

This Act may be cited as the ``The New Economy Tax
Simplification Act (NETSA)''.

SEC. 2. JURISDICTIONAL STANDARDS FOR THE IMPOSITION OF STATE
AND LOCAL BUSINESS ACTIVITY, SALES, AND USE TAX
OBLIGATIONS ON INTERSTATE COMMERCE.

Title I of the Act entitled ``An Act relating to the power
of the States to impose net income taxes on income derived
from interstate commerce, and authorizing studies by
congressional committees of matters pertaining thereto'',
approved on September 14, 1959 (15 U.S.C. 381 et seq.), is
amended to read as follows:
``TITLE I--JURISDICTIONAL STANDARDS

``SEC. 101. IMPOSITION OF STATE AND LOCAL BUSINESS ACTIVITY,
SALES, AND USE TAX OBLIGATIONS ON INTERSTATE
COMMERCE.

``(a) In General.--No State shall have power to impose, for
any taxable year ending after the date of enactment of this
title, a business activity tax or a duty to collect and remit
a sales or use tax on the income derived within such State by
any person from interstate commerce, unless such person has a
substantial physical presence in such State. A substantial
physical presence is not established if the only business
activities within such State by or on behalf of such person
during such taxable year are any or all of the following:
``(1) The solicitation of orders or contracts by such
person or such person's representative in such State for
sales of tangible or intangible personal property or
services, which orders or contracts are approved or rejected
outside the State, and, if approved, are fulfilled by
shipment or delivery of such property from a point outside
the State or the performance of such services outside the
State.
``(2) The solicitation of orders or contracts by such
person or such person's representative in such State in the
name of or for the benefit of a prospective customer of such
person, if orders or contracts by such customer to such
person to enable such customer to fill orders or contracts
resulting from such solicitation are orders or contracts
described in paragraph (1).
``(3) The presence or use of intangible personal property
in such State, including patents, copyrights, trademarks,
logos, securities, contracts, money, deposits, loans,
electronic or digital signals, and web pages, whether or not
subject to licenses, franchises, or other agreements.
``(4) The use of the Internet to create or maintain a World
Wide Web site accessible by persons in such State.
``(5) The use of an Internet service provider, on-line
service provider, internetwork communication service
provider, or other Internet access service provider, or World
Wide Web hosting services to maintain or take and process
orders via a web page or site on a computer that is
physically located in such State.
``(6) The use of any service provider for transmission of
communications, whether by cable, satellite, radio,
telecommunications, or other similar system.
``(7) The affiliation with a person located in the State,
unless--
``(A) the person located in the State is the person's agent
under the terms and conditions of subsection (d); and
``(B) the activity of the agent in the State constitutes
substantial physical presence under this subsection.

[[Page S2543]]

``(8) The use of an unaffiliated representative or
independent contractor in such State for the purpose of
performing warranty or repair services with respect to
tangible or intangible personal property sold by a person
located outside the State.
``(b) Domestic Corporations; Persons Domiciled in or
Residents of a State.--The provisions of subsection (a) shall
not apply to the imposition of a business activity tax or a
duty to collect and remit a sales or use tax by any State
with respect to--
``(1) any corporation which is incorporated under the laws
of such State; or
``(2) any individual who, under the laws of such State, is
domiciled in, or a resident of, such State.
``(c) Sales or Solicitation of Orders or Contracts for
Sales by Independent Contractors.--For purposes of subsection
(a), a person shall not be considered to have engaged in
business activities within a State during any taxable year
merely by reason of sales of tangible or intangible personal
property or services in such State, or the solicitation of
orders or contracts for such sales in such State, on behalf
of such person by one or more independent contractors, or by
reason of the maintenance of an office in such State by one
or more independent contractors whose activities on behalf of
such person in such State consist solely of making such
sales, or soliciting orders or contracts for such sales.
``(d) Attribution of Activities and Presence.--For purposes
of this section, the substantial physical presence of any
person shall not be attributed to any other person absent the
establishment of an agency relationship between such persons
that--
``(1) results from the consent by both persons that one
person act on behalf and subject to the control of the other;
and
``(2) relates to the activities of the person within the
State.
``(e) Definitions.--For purposes of this title--
``(1) Business activity tax.--The term `business activity
tax' means a tax imposed on, or measured by, net income, a
business license tax, a business and occupation tax, a
franchise tax, a single business tax or a capital stock tax,
or any similar tax or fee imposed by a State.
``(2) Independent contractor.--The term `independent
contractor' means a commission agent, broker, or other
independent contractor who is engaged in selling, or
soliciting orders or contracts for the sale of, tangible or
intangible personal property or services for more than one
principal and who holds himself or herself out as such in the
regular course of his or her business activities.
``(3) Internet.--The term `Internet' means collectively the
myriad of computer and telecommunications facilities,
including equipment and operating software, which comprise
the interconnected world-wide network of networks that employ
the Transmission Control Protocol/Internet Protocol, or any
predecessor or successor protocols to such Protocol.
``(4) Internet access.--The term `Internet access' means a
service that enables users to access content, information,
electronic mail, or other services offered over the Internet,
and may also include access to proprietary content,
information, and other services as a part of a package of
services offered to users.
``(5) Representative.--The term `representative' does not
include an independent contractor.
``(6) Sales tax.--The term `sales tax' means a tax that
is--
``(A) imposed on or incident to the sale of tangible or
intangible personal property or services as may be defined or
specified under the laws imposing such tax; and
``(B) measured by the amount of the sales price, cost,
charge, or other value of or for such property or services.
``(7) Solicitation of orders or contracts.--The term
`solicitation of orders or contracts' includes activities
normally ancillary to such solicitation.
``(8) State.--The term `State' means any of the several
States, the District of Columbia, or any territory or
possession of the United States, or any political subdivision
thereof.
``(9) Use tax.--The term `use tax' means a tax that is--
``(A) imposed on the purchase, storage, consumption,
distribution, or other use of tangible or intangible personal
property or services as may be defined or specified under the
laws imposing such tax; and
``(B) measured by the purchase price of such property or
services.
``(10) World wide web.--The term `World Wide Web' means a
computer server-based file archive accessible, over the
Internet, using a hypertext transfer protocol, file transfer
protocol, or other similar protocols.
``(f) Application of Section.--This section shall not be
construed to limit, in any way, constitutional restrictions
otherwise existing on State taxing authority.

``SEC. 102. ASSESSMENT OF BUSINESS ACTIVITY TAXES.

``(a) Limitations.--No State shall have power to assess
after the date of enactment of this title any business
activity tax which was imposed by such State or political
subdivision for any taxable year ending on or before such
date, on the income derived for activities within such State
that affect interstate commerce, if the imposition of such
tax for a taxable year ending after such date is prohibited
by section 101.
``(b) Collections.--The provisions of subsection (a) shall
not be construed--
``(1) to invalidate the collection on or before the date of
enactment of this title of any business activity tax imposed
for a taxable year ending on or before such date; or
``(2) to prohibit the collection after such date of any
business activity tax which was assessed on or before such
date for a taxable year ending on or before such date.

``SEC. 103. TERMINATION OF SUBSTANTIAL PHYSICAL PRESENCE.

``If a State has imposed a business activity tax or a duty
to collect and remit a sales or use tax on a person as
described in section 101, and the person so obligated no
longer has a substantial physical presence in that State, the
obligation to pay a business activity tax or to collect and
remit a sales or use tax on behalf of that State applies only
for the period in which the person has a substantial physical
presence.

``SEC. 104. SEPARABILITY.

``If any provision of this title or the application of such
provision to any person or circumstance is held invalid, the
remainder of this title or the application of such provision
to persons or circumstances other than those to which it is
held invalid, shall not be affected thereby.''.
Mr. KOHL. Mr. President, today Senator Gregg and I are introducing
legislation, the New Economy Tax Simplification Act, to ask government
to step out of the way of the growing Internet economy and take a
middle ground approach to taxation of Internet commerce. Our
legislation does not stop any one State from forcing Internet companies
within its borders to collect the sales taxes collected by any other
business within its borders. But it does stop every one of the over
7000 local taxing jurisdictions from imposing every one of their unique
rules, regulations, and rates on every business that sells over the
Internet or through the mail.
We are not here today to ask for special treatment for companies that
sell on the Internet. We simply want to make sure that businesses that
are tackling the market with 21st century technology are not bled to
death by the Byzantine local tax system.
All companies--regardless of whether they now sell over the Internet
or not--benefit from the economic boom and consumer convenience
provided by computer commerce. If you don't sell over the Internet now;
you probably buy there. If you don't work for a company whose economic
fortune is tied to Internet sales or information, your spouse, child,
or neighbor probably does. If you haven't invested in one of these
successful Internet businesses, they have probably invested in you: in
the charities in your community, in the jobs that are growing our
economy everywhere; in the State programs financed by the taxes these
companies rightly pay to the States in which they have a physical
presence.
Our bill provides a clear set of standards for businesses operating
across state lines through mail-order sales or the Internet. And--very
significantly--it also protects the rights of state and local officials
to determine tax policy within their own jurisdictions.
Some have called for a complete ban on sales taxes on Internet goods.
Still others have claimed that companies should collect sales taxes on
all of their products without regard to the point of sale or the state
or residence of the consumer.
We strike a balance between these two extremes. Just as my Wisconsin
constituents should not have to pay local sales taxes for schools and
sewers in Texas, Nebraska, or New York; it also makes sense that a
Wisconsin business should not be forced to collect taxes to support
fire and police protection in the other states. Businesses should
collect the sales taxes that support the government services they
receive.
But the main reason I am here today is to protect against a Federal
red tape nightmare that would prevent the very growth that we all wish
to promote. There are over 7,000 tax jurisdictions in this country, all
with their own tax rates, exemptions, audit requirements and appeals
procedures. Requiring compliance with all those jurisdictions would
mean learning and complying with 46 sets of rules. Under this scenario,
companies would have to file more than 425 tax returns every month.
That amounts to approximately 5100 tax returns every year.
Internet and mail order companies, as well as traditional main street
stores who are developing or using Internet services, serve consumers
who like the convenience of phone or Internet shopping or who are
unable to leave their homes to shop. They offer

[[Page S2544]]

greater convenience and greater choice. And they offer small specialty
businesses the chance to grow into successful big businesses.
Our bill will allow these vital markets to continue to flourish--free
from a tangle of tax red tape. It will also allow state and local
officials to continue to collect taxes as they see fit within their own
jurisdictions. We believe it strikes the proper balance, and we look
forward to convincing our colleagues that it is worthy of their
support.
______

By Mr. CLELAND:
S. 2402. A bill to amend title 38, United States Code, to enhance and
improve educational assistance under the Montgomery GI bill in order to
enhance recruitment and retention of members of the Armed Forces, and
for other purposes; to the Committee on Veterans' Affairs.

helping our professionals educationally (hope) act of 2000

Mr. CLELAND. Mr. President, I come before you today to introduce
legislation that addresses the educational needs of our men and women
in uniform and their families. I call this measure the HOPE Act of
2000: HOPE, Helping Our Professionals Educationally--that is, our
military professionals.
The great Stephen Ambrose, the marvelous historian of World War II,
the author of ``D-Day'' and other books, has said the GI bill is the
single best piece of legislation ever passed by the Federal Government.
Last year, Time magazine named the American GI as the Person of the
Century--how appropriate. That alone is a powerful statement about the
high value of our military personnel. They are recognized around the
world for their dedication and commitment to fight for our country and
for peace in the world. This past century has been the most violent one
in modern memory. The American GI has fought in the trenches during the
first World War, the beaches at Normandy, in the hills of Korea, in the
jungles of Vietnam, in the deserts of the Persian Gulf, and most
recently in the valleys of the Balkans.
During that period, the face of our military and the people who fight
our wars has changed dramatically. The traditional image of the single,
mostly male, drafted, and ``disposable'' soldier is now gone. Today we
are fielding the force for the 21st century. This new force is a
volunteer force, filled with men and women who are highly skilled,
married, and definitely not disposable. Gone are the days when quality
of life for a GI meant a beer in the barracks and a 3-day pass. Now, we
know we have to recruit a soldier but retain a family.
We have won the cold war. This victory has further changed the world
and our military. The new world order has given way to a new world
disorder. United States is responding to crises around the globe--
whether it be strategic bombing or humanitarian assistance--and our
military is often seen as our most effective response and our best
ambassadors. In order to meet these challenges, we are retooling our
forces to be lighter, leaner, and meaner. This is a positive move.
Along with this lighter force, our military professionals must be
highly educated and highly trained.
Our Nation is currently experiencing the longest continuous peacetime
economic growth in our history. This economic expansion has been a boon
for our country. However, there has been a downside to this growing
economy insofar as our Armed Forces are concerned. With the enticement
of quick prosperity in the civilian sector it is more difficult than
ever to recruit and retain our highly skilled forces.
In fiscal year 1999, the Army missed it recruiting goals by 6291
recruits, while the Air Force missed its goal by 1,732 recruits. Pilot
retention problems persist for all services; for fiscal year 1999 the
Air Force ended up 1,200 pilots short and the Navy ended 500 pilots
short. We have other problems. The Army is having problems retaining
captains, while the Navy faces manning challenges for surface warfare
officers and special warfare officers. It is estimated that $6 million
is spent to train a pilot. We as a nation cannot afford to continually
train our people, only to lose them to the private sector. It is
unarguably far better to retain than retrain.
There is hope that we are now beginning to address these challenges.
Last year was a momentous one for our military personnel. The Senate
passed legislation that significantly enhances the quality of life for
our military personnel. I am the Ranking Democrat on the Armed Service,
Committee. The Senate, with my vote and support, passed legislation
that significantly enhances the quality of life for our military
personnel from retirement reform to pay raises. This Congress is on
record supporting our men and women in uniform. However, more must be
done.
In talking with our military personnel on my visits to the military
bases in Georgia and around the world, we know that money alone is not
enough. One of the things I would like to do is focus on education as a
wonderful addition to the positive incentives we offer people to come
into the military and stay in the military. Education, as a matter of
fact, is the No. 1 reason service members come into the military.
Unfortunately it is also the No. 1 reason why its members are leaving.
We have to restructure our educational program in the military. We have
to have a new GI bill. We have to provide hope to our military people,
hope that the military can become the greatest university they will
ever encounter.
Last year the Senate began to address this issue by supporting
improved education benefits for military members and their families but
we encountered some concerns in the House. Since last year, we have
gone back and studied this issue further. In reviewing the current
Montgomery GI bill--named after the wonderful Representative from
Mississippi, Congressman Sonny Montgomery--we found several
disincentives and conflicts among the education benefits offered by the
services. These conflicts make the GI bill, which is actually an earned
benefit, less attractive than it could be.
My legislation will improve and enhance the current educational
benefits and create the GI bill for the 21st century.
One of the most important provisions of my legislation would give the
Service Secretaries the ability to authorize a service member to
transfer his or her basic MGIB benefits, educationally, to family
members. Many service members tell us that they really want to stay in
the service, but do not feel that they can stay and provide an
education for their families. This proposed change will give them an
opportunity to stay in the service and still provide an education for
their spouses and children. It will give the Service Secretaries a very
powerful retention tool by allowing them to authorize transfer of basic
GI bill benefits, that are earned through the service of the service
man or woman, anytime after 6 years of service.
To encourage members to stay longer, the transferred benefits could
not be used until completion of at least 10 years of service. I believe
that the services can use this much like a reenlistment bonus to retain
valuable service members. It can be creatively combined with
reenlistment bonuses to create a very powerful and cost effective
incentive for highly skilled military personnel to stay in the Service.
In talking with service members upon their departure from the military,
we have found that family considerations play a crucial role in the
decision of a member to continue their military career.
I found in discussions with military families and service members
that at the 8- to 10- to 12-year mark when young service members are
beginning to make a choice about whether to stay in the military, that
choice is driven not so much by their own choice to serve the country--
obviously they want to serve the country and stay in the military--that
choice is more and more driven by family needs, whether their spouse is
employed or whether their spouse would like to gain an extra degree or
whether they need to create a college fund for their kids.
Reality dictates that we must address the needs of the family in
order to retain our soldiers, sailors, airmen, and marines.
My legislation would also give the Secretaries the authority to
authorize the Veterans' Educational Assistance Program, known as VEAP.
Those

[[Page S2545]]

VEAP participants and those active duty personnel who did not enroll in
Montgomery GI bill to participate in the current GI bill program. The
VEAP participants would contribute $1,200, and those who did not enroll
in the Montgomery GI bill would contribute $1,500. The services would
pay any additional costs of the benefits of this measure.
Another enhancement made by my proposal to the current GI bill
extends the period in which the members of Reserve Components can
utilize the program. I was shocked to find out that currently, Reserve
members lose their education benefits when they leave the service or
after 10 years of service. Amazing, they have no benefits when they
leave service. My legislation will permit them to use the benefits up
to 5 years after their separation from the military. This will
encourage them to stay in the Reserves for a full career.
It is obvious we are calling upon our reservists and our guards men
and women more and more to fulfill our commitments around the globe.
This will, I think, fulfill this Nation's commitment, certainly to our
reservists, for an improvement in their educational opportunities.
Other provisions of this legislation would allow the Service
Secretaries to pay 100 percent tuition assistance or enable service
members to use the GI bill to cover any unpaid tuition and expenses
when the services do not pay 100 percent of tuition.
This will allow a service member an additional incentive to use the
GI bill in service. Education begets education.
I believe this is a necessary next step for improving education
benefits for our military members and their families. We have to offer
them credible choices. If we offer them such options and treat the
members and their families properly, we will show them our respect for
their service and dedication, which they expect. Maybe then we can turn
around our current sad retention statistics. This GI bill is an
important retention tool for the services.
We must continue to focus our resources on retaining our personnel
based on their actual life needs, particularly their need for an
educational opportunity. This bill gives them hope.

____________________