Congressional Record, Volume 146 Issue 86 (Friday, June 30, 2000)

[Congressional Record Volume 146, Number 86 (Friday, June 30, 2000)]
[Senate]
[Pages S6186-S6220]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS, 2001

The PRESIDING OFFICER. Under the previous order, the Senate will now
resume consideration of H.R. 4577, which the clerk will report.
The legislative clerk read as follows:

A bill (H.R. 4577) making appropriations for the
Departments of Labor, Health and Human Services, and
Education, and related agencies for the fiscal year ending
September 30, 2001, and for other purposes.

Pending:

Helms amendment No. 3697, to prohibit the expenditure of
certain appropriated funds for the distribution or provision
of, or the provision of a prescription for, postcoital
emergency contraception.
Wellstone amendment No. 3698, to provide for a limitation
on the use of funds for certain agreements involving the
conveyance of licensing of a drug.
Harkin amendment No. 3699, to fully fund the programs of
the Individuals with Disabilities Education Act.

Mr. SPECTER. Mr. President, one item came up in the course of the
consideration of the bill on which I commented I would respond to
regarding the increase in this bill over last year's bill.
This year's bill contains a program level of $104.5 billion for
fiscal year 2001. This is a $7.9 billion increase over fiscal year
2000, which had a program level of $96.6 billion. When assertions have
been made that the bill has grown by 20.4 percent--that is over 20
percent--that is not correct. That calculation is made by comparing the
fiscal year 2001 program level of $104.5 billion with the fiscal year
2000 budget authority level of $86.5 billion. That is not an accurate
comparison.
When you compare the 2001 actual program level to the 2000 program
level, the real increase is 8.2 percent.
This question has come up with some frequency. I thought it would be
useful to make that explanation.
Mr. President, I think we are now prepared to proceed to the
Wellstone amendment.
Mr. WELLSTONE. Mr. President, before we proceed, could I ask my
colleague, is it 2 minutes equally divided or 4 minutes equally divided
on each amendment?
Mr. SPECTER. Mr. President, the Senator from Minnesota is correct.
Each side has 1 minute, and then we go to the vote.
Mr. WELLSTONE. I thank the Senator.

Amendment No. 3698

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes for explanation prior to a vote on Wellstone amendment No.
3698.
Mr. WELLSTONE. Mr. President, this amendment reinstates the Bush
administration's policy of requiring a reasonable pricing clause in the
NIH drug patent licensing agreements and cooperative research
agreements with pharmaceutical companies unless waived on public
interest grounds. It does not apply to universities. A very similar
amendment passed by a 2-to-1 margin in the House of Representatives.
All this says is, when it is our public dollars--taxpayer money, our
constituents' money--we expect that the drug companies, when they
benefit from all this, will agree to charge our constituents a
reasonable price.
I think this is an amendment that should command widespread support.
I have offered this amendment with Senator Johnson. It has support from
the National Council of Senior Citizens, Families USA, and the
Committee to Preserve Social Security and Medicare.
I also want to say that I think Senator Levin, last night, hit the
nail on the head when he said: It is bad enough that we have exorbitant
prices. It is worse when we actually subsidize the research, and then
we do not ask anything in return from these companies.
The PRESIDING OFFICER. The Senator from Pennsylvania.
Mr. SPECTER. Mr. President, the objective of the Wellstone amendment
is laudable in trying to have reasonable prices. The difficulty is that
this was tried 7 or 8 years ago and was found to be very
counterproductive. Instead of encouraging tests and development of
pharmaceutical products, it discouraged them. We have already adopted
the Wyden amendment which provides for a study on this issue.
There are some very important matters raised by the Senator from
Minnesota. Our subcommittee will hold hearings on this subject shortly
upon our return in July to try to find out whether the NIH ought to
have a share of the patents or what would be a fair approach. There has
been substantial experience with what the Senator from Minnesota
suggests in the 1992, 1993, 1994 range, and it was counterproductive.
That is why, although the objective is laudable, I am forced to oppose
the amendment.
I move to table the Wellstone amendment and ask for the yeas and
nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion to table the Wellstone
amendment No. 3698. The clerk will call the roll.
The assistant legislative clerk called the roll.
Mr. NICKLES. I announce that the Senator from Utah (Mr. Hatch), is
necessarily absent.
I further announce that, if present and voting, the Senator from Utah
(Mr. Hatch), would vote ``yes.''
Mr. REID. I announce that the Senator from California (Mrs. Boxer),
the Senator from Hawaii (Mr. Inouye), the Senator from Vermont (Mr.
Leahy), and the Senator from New York (Mr. Moynihan) are necessarily
absent.
The result was announced--yeas 56, nays 39, as follows:

[Rollcall Vote No. 168 Leg.]

YEAS--56

Abraham
Allard
Ashcroft
Bennett
Biden
Bond
Breaux
Brownback
Bunning
Burns
Campbell
Cochran
Collins
Coverdell
Craig
Crapo
DeWine
Dodd
Domenici
Enzi
Fitzgerald
Frist
Gorton
Gramm
Grams
Hagel
Helms
Hutchinson
Hutchison
Inhofe
Kerrey
Kyl
Landrieu
Lautenberg
Lieberman
Lott
Lugar
Mack
McCain
McConnell
Murkowski
Nickles
Roberts
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
Torricelli
Warner

NAYS--39

Akaka
Baucus
Bayh
Bingaman
Bryan
Byrd
Chafee, L.
Cleland
Conrad
Daschle
Dorgan
Durbin
Edwards
Feingold
Feinstein
Graham
Grassley
Gregg
Harkin
Hollings
Jeffords
Johnson
Kennedy
Kerry
Kohl
Levin
Lincoln
Mikulski
Murray
Reed
Reid
Robb
Rockefeller
Roth
Sarbanes
Schumer
Voinovich
Wellstone
Wyden

NOT VOTING--5

Boxer
Hatch
Inouye
Leahy
Moynihan
The motion to table was agreed to.
Mr. SPECTER. Mr. President, I move to reconsider the vote.
Mr. McCONNELL. I move to lay that motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 3697

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes for explanation prior to the vote on the Helms amendment No.
3697.
Mr. SPECTER. Mr. President, I ask unanimous consent that the next
votes in this series be limited to 10 minutes each.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senate will be in order. There are a considerable number of votes
to come.
Mr. BYRD. Mr. President, I thank the Chair for trying to get order.
Will Senators please respect the Chair.
Mr. ROBB. Mr. President, lest there be any confusion on the vote we
are about to cast, it is my understanding that minors who seek a
prescription drug from a school-based health clinic can do so only
after receiving consent from a parent or guardian. Given that this
standard is already in place, I don't believe it is the place of the
federal government to instruct states and localities what specific
services can or cannot be offered in these clinics--I trust communities
to decide for themselves what services should be offered

[[Page S6187]]

in their school-based clinics, based on their values and priorities.
The PRESIDING OFFICER. When the conversations in the well have
concluded, we will be able to continue.
The Senator from North Carolina is recognized for 1 minute.
Mr. HELMS. Mr. President, I thank the Chair.
I ask unanimous consent that it be in order for me to make my remarks
from my chair.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. HELMS. I thank the Chair.
Mr. President, a basic question--and I think a significant one--
pending with this amendment is: Should the taxpayers be required to pay
for the controversial ``morning-after pill''--which is identified as an
abortifacient--to be distributed to schoolgirls on school property? The
answer, Mr. President, is absolutely not.
But as CRS reported to me, federal law does, indeed, permit the
``morning-after pill'' to be distributed at school-health clinics.
I urge my colleagues to prohibit funds from the Labor, HHS, and
Education appropriations bill to be used to distribute the ``morning-
after pill'' on school property.
The PRESIDING OFFICER. All time has expired. Who seeks recognition in
opposition? The Senator from Iowa.
Mr. HARKIN. How much time remains?
The PRESIDING OFFICER. One minute.
Mr. HARKIN. Mr. President, let's make it clear. We are not talking
about an abortion bill. What we are talking about is a contraceptive
pill a young woman would get, the morning after she may have been the
victim of rape or incest. This amendment does not deal with RU-486, it
clearly states it is about denying contraceptive services, and it has
no exception for young victims of rape or incest.
Right now, under existing law, some localities have chosen to provide
minors access to contraceptive pills through community health centers
and other programs that are based in the school. The decision to
provide school-based contraceptive services is a local decision under
current law. A local decision. Not a federal one. But this amendment
would change that.
This amendment says if a young woman has unprotected sex, or even if
she is the victim of rape or incest, and is panic stricken the next
morning, she cannot take a contraceptive pill the next morning, not
knowing whether she is pregnant or not, in order to prevent a pregnancy
from occurring.
That is what this is about.
And I want to reiterate that the Helms amendment has no exception for
the victims of rape or incest.
The PRESIDING OFFICER. The time of the Senator is expired.
Mr. SPECTER. I move to table the amendment, and I ask for the yeas
and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to table the Helms amendment (No. 3697).
The clerk will call the roll.
The legislative clerk called the roll.
Mr. NICKLES. I announce that the Senator from Utah (Mr. Hatch) is
necessarily absent.
I further announce that, if present and voting, the Senator from Utah
(Mr. Hatch) would vote ``no.''
Mr. REID. I announce that the Senator from California (Mrs. Boxer),
the Senator from Hawaii (Mr. Inouye), the Senator from Vermont (Mr.
Leahy), and the Senator from New York (Mr. Moynihan) are necessarily
absent.
The result was announced--yeas 41, nays 54, as follows:

[Rollcall Vote No. 169 Leg.]

YEAS--41

Akaka
Baucus
Bayh
Biden
Bingaman
Bryan
Byrd
Campbell
Chafee, L.
Cleland
Collins
Daschle
Dodd
Durbin
Edwards
Feingold
Feinstein
Graham
Harkin
Hollings
Jeffords
Kennedy
Kerrey
Kerry
Landrieu
Lautenberg
Levin
Lieberman
Lincoln
Mikulski
Murray
Reid
Robb
Rockefeller
Sarbanes
Schumer
Snowe
Specter
Torricelli
Wellstone
Wyden

NAYS--54

Abraham
Allard
Ashcroft
Bennett
Bond
Breaux
Brownback
Bunning
Burns
Cochran
Conrad
Coverdell
Craig
Crapo
DeWine
Domenici
Dorgan
Enzi
Fitzgerald
Frist
Gorton
Gramm
Grams
Grassley
Gregg
Hagel
Helms
Hutchinson
Hutchison
Inhofe
Johnson
Kohl
Kyl
Lott
Lugar
Mack
McCain
McConnell
Murkowski
Nickles
Reed
Roberts
Roth
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Stevens
Thomas
Thompson
Thurmond
Voinovich
Warner

NOT VOTING--5

Boxer
Hatch
Inouye
Leahy
Moynihan
The motion was rejected.
Mr. HELMS. Mr. President, I move to reconsider the vote.
Mr. SANTORUM. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. SPECTER. Mr. President, on behalf of Senator Helms, I ask
unanimous consent to vitiate the yeas and nays.
The PRESIDING OFFICER. Without objection, it is so ordered.
The question is on agreeing to amendment No. 3697.
The amendment (No. 3697) was agreed to.
Mr. SANTORUM. Mr. President, I move to reconsider the vote.
Mr. GRAMM. I move to lay that motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 3699

The PRESIDING OFFICER. Under the previous order, there will be 2
minutes for explanation prior to a vote on Harkin amendment No. 3699.
The Senator from Iowa is recognized for 1 minute.
Mr. HARKIN. Mr. President, this is a simple amendment. It fully funds
the Individuals With Disabilities Education Act. As far as I know, this
is the first time we in the Senate have had a chance to vote directly
on whether to take the action to fully fund IDEA.
I cannot say it any better than our colleague from Vermont, Senator
Jeffords, said it Wednesday night:

This body has gone on record in vote after vote that we
should fully fund IDEA. If we can't fully fund IDEA now with
the budget surpluses and the economy we have, when will we do
it? I do not believe anyone can rationally argue that this is
not the time to fulfill that promise.

I could not have said it any better. This is the first time I know of
the Senate has ever gone on record. This is the vote to fully fund
IDEA. We have the surpluses. We have the money. Let's meet our goal.
The PRESIDING OFFICER. The Senator from Pennsylvania.
Mr. SPECTER. Mr. President, the education budget now is $4.5 billion
over last year. We have increased IDEA by $1.3 billion. Sometimes we
talk about big spenders. Adding $8.75 billion is going to put a burden
on the biggest spenders in this Chamber to support this kind of an
increase. I want to see a lot more funding in a lot more places,
including IDEA, but this is just over the top. I say that with great
respect for my esteemed colleague.
Mr. President, I raise a point of order under 302(f) of the Budget
Act that this amendment would exceed the subcommittee's 302(b)
allocation and is not in order.
Mr. HARKIN. Mr. President, I move to waive the applicable sections of
that act for the consideration of the pending amendment, and I ask for
the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to the motion. The clerk will call the
roll.
The assistant legislative clerk called the roll.
Mr. NICKLES. I announce that the Senator from Utah (Mr. Hatch) is
necessarily absent.
I further announce that if present and voting, the Senator from Utah
(Mr. Hatch) would vote ``no.''
Mr. REID. I announce that the Senator from California (Mrs. Boxer),
the Senator from Hawaii (Mr. Inouye), the Senator from Vermont (Mr.
Leahy), and the Senator from New York (Mr. Moynihan), are necessarily
absent.
The yeas and nays resulted--yeas 40, nays 55, as follows:

[Rollcall Vote No. 170 Leg.]

YEAS--40

Akaka
Baucus
Bayh
Biden
Bingaman
Breaux
Bryan
Chafee, L.
Cleland
Collins
Daschle
Dodd

[[Page S6188]]

Dorgan
Durbin
Edwards
Feinstein
Harkin
Hollings
Jeffords
Johnson
Kennedy
Kerrey
Kerry
Kohl
Landrieu
Lautenberg
Levin
Lieberman
Lincoln
Mikulski
Murray
Reed
Reid
Robb
Rockefeller
Sarbanes
Snowe
Torricelli
Wellstone
Wyden

NAYS--55

Abraham
Allard
Ashcroft
Bennett
Bond
Brownback
Bunning
Burns
Byrd
Campbell
Cochran
Conrad
Coverdell
Craig
Crapo
DeWine
Domenici
Enzi
Feingold
Fitzgerald
Frist
Gorton
Graham
Gramm
Grams
Grassley
Gregg
Hagel
Helms
Hutchinson
Hutchison
Inhofe
Kyl
Lott
Lugar
Mack
McCain
McConnell
Murkowski
Nickles
Roberts
Roth
Santorum
Schumer
Sessions
Shelby
Smith (NH)
Smith (OR)
Specter
Stevens
Thomas
Thompson
Thurmond
Voinovich
Warner

NOT VOTING--5

Boxer
Hatch
Inouye
Leahy
Moynihan
The PRESIDING OFFICER. On this vote, the yeas are 40, the nays are
55. Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected. The point of order is
sustained, and the amendment falls.
The Senate will be in order.
Mr. SPECTER addressed the Chair.
The PRESIDING OFFICER. The Senator will be recognized when the well
is cleared.
The Senator from Pennsylvania.

Amendments Nos. 3700 Through 3731, En Bloc

Mr. SPECTER. Mr. President, I now ask for the adoption of the
managers' package which has been cleared on both sides.
The PRESIDING OFFICER. The clerk will report.
The assistant legislative clerk read as follows:

The Senator from Pennsylvania [Mr. Specter], for himself
and Mr. Harkin, proposes amendments numbered 3700 through
3731, en bloc.

The amendments Nos. 3700 through 3731, en bloc, are as follows:

amendment no. 3700

(Purpose: To provide grants to develop and expand substance abuse
services programs for homeless individuals)

On page 34, on line 13, before the colon, insert the
following: ``, $10,000,000 shall be used to provide grants to
local non-profit private and public entities to enable such
entities to develop and expand activities to provide
substance abuse services to homeless individuals.''.

Ms. COLLINS. Mr. President, I rise today in support of the Collins-
Reed amendment to the Labor HHS Appropriations bill which will increase
the availability of funds to provide substance abuse treatment services
for our Nation's homeless men and women.
I would like to extend my thanks to Senator Jack Reed who has joined
as a cosponsor of this amendment and who has made increased funding for
services to benefit the homeless one of his highest priorities. I would
also like to extend my thanks to Senators Domenici, Feinstein,
Mikulski, Sarbanes, Jeffords, Kennedy, Bingaman, Wellstone, Lincoln
Chafee, Dodd, Leahy, Durbin, Snowe, Edwards and Moynihan, all of whom
cosigned a letter to appropriators which I and Senator Reed sent
earlier this year calling for an increase in funding for mental health
and substance abuse treatment for the homeless.
Like all Americans, homeless men and women need decent shelter, but
in many cases, homeless people also need treatment to address the
underlying problem which has kept them on the street. An estimated 25
percent to 40 percent of homeless people need programs to help them
recover from drug and alcohol abuse illnesses. Despite the prevalence
of these illnesses among our nation's homeless, very limited funds are
available to serve their specific treatment needs.
For a variety of reasons, addicted homeless people often have
difficulty accessing mainstream treatment services. For example, many
substance abuse service providers are not equipped to handle the
complex social and health issues that homeless persons present, and may
reject them or provide ineffective care. In addition, the reality of
life on the street may significantly complicate the receipt of
effective treatment. For example, homeless men and women may have
difficulty in adhering to treatment schedules or may lack
transportation to and from outpatient services.
Comprehensive programs which link treatment to other health, housing,
social and maintenance services often provide the best opportunity for
the homeless to adhere to treatment programs and ultimately achieve
stability in their lives. The funding addressed in my amendment will
provide grants which will assist communities in providing treatment
services tailored to best serve the needs of their own homeless
population.
I thank the Chairman of the Committee, who has been tireless in his
efforts to increase substance abuse treatment services for all
Americans in need, and who has been so receptive to this amendment and
the needs of our Nation's homeless men and women.
Thank you, Mr. President. I yield the floor.

amendment no. 3701

(Purpose: To provide funds for the Web-Based Education Commission)

On Page 68, line 23 before the colon, insert the following:
``, of which $250,000 shall be for the Web-Based Education
Commission''.
____

amendment no. 3702

(Purpose: To provide funds for the purchase of automated external
defibrillators and the training of individuals in basic cardiac life
support)

On page 24, line 1, strike ``and''.
On page 24, line 7, insert before the colon the following:
``, and of which $4,000,000 shall be provided to the Rural
Health Outreach Office of the Health Resources and Services
Administration for the awarding of grants to community
partnerships in rural areas for the purchase of automated
external defibrillators and the training of individuals in
basic cardiac life support''.

Ms. COLLINS. Mr. President, I am pleased that the managers have
accepted the amendment that I introduced with my colleague from
Wisconsin. I thank the distinguished Chairman and Ranking Member of the
Labor-HHS Appropriations Subcommittee for their assistance and support.
Our amendment will improve access to automated external defibrillators,
or AEDs, in rural areas, where they are sorely needed to increase the
chance that individuals in these communities who suffer cardiac arrest
will survive. Joining us in cosponsoring this amendment are Senators
Jeffords, Biden, Enzi, Murray, Abraham, Wellstone, Bingaman, Robb,
Kerry and Reed.
Heart disease is the leading cause of death both in the State of
Maine and the United States. According to the American Heart
Association, an estimated 250,000 Americans die each year from cardiac
arrest. Many of these deaths could be prevented if automated external
defibrillators were more accessible. AEDs are computerized devices that
can shock a heart back into normal rhythm and restore life to a cardiac
arrest victim. They must, however, be used promptly. For every minute
that passes before a victim's normal heart rhythm is restored, his or
her chance of survival falls by as much as 10 percent.
According to the American Heart Association, making AEDs standard
equipment in police cars, fire trucks, ambulances and other emergency
vehicles and getting these devices into more public places could save
more than 50,000 lives a year. Cities across America have begun to
recognize the value of fast access to AEDs and are making them
available to emergency responders. In many small rural communities,
however, limited budgets and the fact that so many rely on volunteer
organizations for emergency services can make acquisition and
appropriate training in the use of these life-saving devices
problematic. Our amendment will increase access to AEDs and trained
local responders for smaller towns and rural areas in Maine and
elsewhere where those first on the scene may not be paramedics or
others who would normally have AEDs.
I am pleased to be joined by my colleague from Wisconsin who has led
this effort to increase access to AEDs in rural areas.
Mr. FEINGOLD. Thank you. I would like to commend my friend and
colleague from Maine for her leadership in passing this amendment that
will help improve cardiac arrest survival rates across rural America by
making AEDs more accessible.
I recently visited DeForest, Wisconsin, where the area's citizens and
businesses recently finished a fund-

[[Page S6189]]

raising effort that resulted in the purchase of three new
defibrillators. When I visited with the DeForest police department,
they provided a real life example of why we must increase the
availability of defibrillators: since they were purchased just three
months ago, two people have been saved by these devices.
They helped show me that cardiac arrest victims are in a race against
time, and unfortunately, for those in many rural areas, Emergency
Medical Services have simply too far to go to reach people in need, and
time runs out for victims of cardiac arrest. It is simply not possible
to have EMS units next to every farm and small town across the nation.
This amendment will begin to address this problem.
Just so my colleagues are aware, I would like to ask my friend from
Maine to describe how these grants will be made.
Ms. COLLINS. These grants will be awarded on a competitive basis by
the Health Resources and Services Administration to community
partnerships in rural areas that are composed of local emergency
response entities, such as community training facilities, local
emergency responders, fire and rescue departments, police, community
hospitals, and local non-profit entities and for-profit entities
concerned about cardiac arrest survival rates. Our amendment will
provide $4 million through the Health Resources and Services
Administration for the awarding of grants to community partnerships in
rural areas to purchase automated external defibrillators and to train
individuals in basic cardiac life support. These rural partnerships
will also be required to evaluate the local community emergency
response times to assess whether they meet the standards established by
national public health organizations such as the American Heart
Association and the American Red Cross. They must also submit to the
Secretary of Health and Human Services an application at such time, in
such manner, and containing such information as the Secretary may
require. I would like to ask my colleague from Wisconsin if he would
like to add any additional comments.
Mr. FEINGOLD. Thank you. I would also like to stress that these
grants are intended for community partnerships in rural areas, as
determined by the Secretary of Health and Human Services. This
amendment has been endorsed by both the American Heart Association and
the American Red Cross as a means of expanding access to these
lifesaving devices across rural America, and I join my colleague from
Maine in thanking the managers of the bill for their cooperation and
support.

amendment no. 3703

(Purpose: To support medication management for seniors)

On page 43, line 9, before the colon, insert the following:
``, of which $5,000,000 shall be available for activities
regarding medication management, screening, and education to
prevent incorrect medication and adverse drug reactions''.
____

amendment no. 3704

On page 50, line 20, after the dash insert the following:
``Except as provided by subsection (e)''.
On page 51, line 1 strike ``December 15, 2000'' and insert
in lieu thereof: ``March 1, 2001''.
On page 52, line 2, strike ``2000'' and insert in lieu
thereof ``2001''.
On page 52, after line 2, insert the following new section
``(e) Territories.--None of the funds appropriated by this
Act may be used to withhold substance abuse funding pursuant
to section 1926 from a territory that receives less than
$1,000,000.''
____

amendment no. 3705

(Purpose: To provide for the conduct of a study and report on
unreimbursed health care provided to foreign nationals)

On page 54, between lines 10 and 11, insert the following:
Sec. . (a) Study.--The Secretary of Health and Human
Services shall conduct a study to examine--
(1) the experiences of hospitals in the United States in
obtaining reimbursement from foreign health insurance
companies whose enrollees receive medical treatment in the
United States;
(2) the identity of the foreign health insurance companies
that do not cooperate with or reimburse (in whole or in part)
United States health care providers for medical services
rendered in the United States to enrollees who are foreign
nationals;
(3) the amount of unreimbursed services that hospitals in
the United States provide to foreign nationals described in
paragraph (2); and
(4) solutions to the problems identified in the study.
(b) Report.--Not later than March 31, 2001, the Secretary
of Health and Human Services shall prepare and submit to the
Committee on Health, Education, Labor, and Pensions of the
Senate, and the Committee on Appropriations, a report
concerning the results of the study conducted under
subsection (a), including the recommendations described in
paragraph (4) of such subsection.

Mr. GRAHAM. Mr. President, last year, on October 7, during the
consideration of the FY 2000 Labor-HHS-Education Appropriations bill,
Senators Ron Wyden, Gordon Smith and I offered an amendment which was
accepted as part of the legislation that passed.
It directed the Department of Labor to send to Congress its
suggestions, or a plan, to improve the day-to-day lives of farmworkers.
We are here again. The Labor-HHS Appropriations bill is being
debated, and we are still awaiting answers to concerns raised in the
last debate.
In fairness, I should mention that the Secretary of Labor has
indicated that this report is underway and that we can expect it later
this year. But yet another year has slipped by without the
Administration designing a plan to improve the lives of those who do so
much to provide for us.
The purpose of our amendment and speech last year was to outline the
three previous years of frustration in our efforts to secure this plan
from the Department of Labor. We sought legislatively what we had not
been able to obtain in personal meetings and phone calls. Now, we are
here again, on this same bill, asking for the same assistance.
For the past several years I have worked with several of our
colleagues to develop a comprehensive strategy to improve the lives of
our Nation's farmworkers.
Almost everyone agrees that the status quo is unacceptable. GAO
estimates that at least 50 percent of agricultural workers in the
United States do not have documented status. This is a conservative
estimate since these are workers who have admitted their illegal
status, the actual number without work authorization is likely much
higher.
I respect the fact that the Department of Labor has concerns about
our bipartisan legislation. What we have asked, year after year, is
that they improve it, modify it, or offer their own alternate
comprehensive plan.
I commend the work that the Department has done up to this point to
respond to us, but I urge Secretary Herman to finish work on this
proposal and submit it to Congress at the earliest possible
opportunity. The legislative calendar is short this year, and we have
no time to waste.
Mr. WYDEN. Mr. President, in October, 1999, I came to the Senate
floor to speak about an important amendment to the Labor, Health and
Human Services Appropriations Bill for Fiscal Year 2000 concerning farm
workers. I have worked on this issue for over three years. I worked
with my friend, Senator Smith of Oregon, as well as my colleague
Senator Graham of Florida, to have our bipartisan amendment adopted by
the managers of the bill, Senator Specter and Senator Harkin.
I come to the floor today as the Senate completes debate on the
Labor, Health and Human Services appropriations bill for fiscal year
2001 to again ask the administration to get serious about addressing
the very real problems in the current farm worker system.
The amendment that was adopted into last year's Labor HHS
appropriations bill required the Department of Labor to report to
Congress with plans to improve compensation, working conditions, and
other benefits for farm workers in the United States. The adopted
amendment became report language in the Labor HHS Conference Report
directing the Department of Labor to deliver the administration's farm
worker plan to Congress as soon as possible.
It is almost ten months since that directive was adopted by the
entire Congress--and almost three years since I was first promised by
Secretary of Labor Herman that such a plan was being devised--and still
the administration has delivered no plan. As we enter the busiest time
of the year for American farms, once again I am

[[Page S6190]]

forced to point out the ineptitude of the Administration in dealing
with this critical issue.
The General Accounting Office completed a report in 1997 on the farm
worker situation in our country. They said there are enough farm
workers. But they came to that conclusion only by counting illegal farm
workers.
Today's agricultural labor program is a disaster for both farm
workers and farmers. Estimates are that well over half of the farm
workers in this country are here illegally. They are smuggled into the
United States by people called ``coyotes.'' Because they are here
illegally, these farm workers have no power--they cannot vote. The
illegal, but much needed, farm worker is often subjected to the worst
possible living and working conditions imaginable. This situation is
nothing short of immoral.
At the same time, the growers, who need a dependable supply of
workers to pick our crops, are also in a completely untenable
situation. Senator Smith and I represent Oregon farmers who literally
have no where to turn to find legal farm workers. The current situation
turns those farmers who want to do the right thing into people who have
to make a Hobbesian choice: do they become felons by hiring illegal
farm workers or do they go bankrupt.
It bears repeating: Well over half of the farm workers in the United
States are illegal immigrants.
Oregon farmers have told me that in meetings, with the Immigration
and Naturalization Service and the Department of Justice, the
Administration has admitted that they know farmers must become felons
by hiring illegal workers. It is deplorable that farmers are greeted by
the Administration with winks and nods--not a legal farm worker system.
In 1998, in the second session of the 105th Congress, Senator Graham,
Senator Smith, and I put together a bipartisan proposal to change this
wholly unacceptable system. We tried to create a new system for dealing
with agricultural labor that would be in the interest of both the farm
worker and the farmer. Under our bill, workers who were legal would get
a significant increase in their benefits and farmers would be assured a
consistent, legal work force.
But after 67 Senators passed our bill, the administration refused to
work with us to hammer out badly needed H2A reform legislation.
At that point, Senators Graham, Smith, and I started alternatively
waiting for and asking for the Administration to produce their plan for
a new agricultural worker system that would address the legitimate
concerns of both farm workers and farmers.
In the spirit of comity and a desire to reach agreement with the
executive branch, we have been waiting to see the Administration's
plan. Mr. President, to date, after meetings, phone calls and
congressional directives, we have been kept waiting for more than three
years to see the administration's proposal.
By its inaction, the Administration is perpetuating a system that is
a disaster for both the farm-worker and the farmer. It is a system that
is totally broken--a system that has condemned the vast majority of
farm workers to some of the most terrible and immoral conditions
imaginable. It is a system that has made it impossible for farmers who
want to do the right thing.
Our bipartisan effort was not a good enough solution for the
administration. Well, the administration's inaction is not a good
enough solution for me.
All of us--farm workers and growers, Senators Graham, Smith, and I--
continue to wait. It is time for the administration to get off the
sidelines. They should do what they promised to do well over two years
ago and what we, as Congress, required them to do over 10 months ago.

amendment no. 3706

(Purpose: To ensure that those students at risk of dropping out of
school receive appropriate attention and to ensure that all students
are given the support necessary to graduate from high school)

On Page 59, line 12, before the period insert the
following: ``: Provided further, That of the amount made
available under this heading for activities carried out
through the Fund for the Improvement of Education under part
A of title X, $10,000,000 shall be made available to enable
the Secretary of Education to award grants to develop and
implement school dropout prevention programs.''.

Mr. BINGAMAN. Mr. President, I want to take a moment to thank
Senators Specter and Harkin for agreeing to include my amendment
dedicating $10,000,000 from the Fund for the Improvement of Education
to support proven dropout prevention programs in the managers' package.
As my colleagues know, I filed an amendment on behalf of myself and
Senators Reid, Collins, and DeWine seeking $20 million for this
purpose. While both of these amounts fall short of the $150,000,000
level authorized in an amendment passed by the Health, Education,
Labor, and Pensions Committee to the ending ESEA reauthorization bill,
this $10,000,000 is an important first step in supporting local efforts
to develop, implement, and disseminate effective dropout prevention
programs. It is my hope that in future years we will be able to grow
the funds for this crucial effort in order to ensure that all schools
with high dropout rates have the resources and information that they
need to curb the high incidence of students dropping out of school.
Today, the lack of a high school education is a greater barrier than
ever to employment, income, and advancement opportunities; though we
frequently talk about how strong the economy is in the United States,
we simply cannot overlook the fact that there are millions of working
Americans who have never finished high school, and they earn less than
a third of what their peers with a college degress earn.
High school completion rates remain distressingly low in many locales
around the country--over 3,000 young people drop out of our high
schools and middle schools each school day. Not surprisingly, the
problem is disproportionately great along racial, ethnic and
socioeconomic lines; Hispanic youth for instance, are nearly three
times more likely to drop out than their white classmates, and African
American students are still dropping out at a rate higher than their
white peers as well. As The Hispanic Dropout Project found, widespread
misunderstandings of the underlying causes of dropouts, combined with a
lack of familiarity with effective programs, has prevented increased
school completion for some groups.
It is my hope that when ESEA is reauthorized, we will be able to
further extend the critical support that is needed to help our at-risk
students complete high school with the skills necessary for the
workplace or continued education. In the meantime, this commitment to
funding is an important step towards ensuring that all students who are
at risk of dropping out of school receive the appropriate attention and
support they need to further their learning and graduate from high
school. I thank my colleagues for working with me on this important
effort.
Mr. REID. Mr. President, those who drop out of high school are at a
greater risk of being unemployed or holding a position with no career
advancement opportunities. These individuals also earn less, are more
likely to be poverty stricken, and received public assistance.
To address the dropout problem, the Department of Education
administers 11 programs. These programs resulted in a downward trend in
the national dropout rate. Nonetheless, we have what we could call the
``dropout divide''--dropout rates in 1998 were higher for Hispanic
(9.4%) than blacks (5.2%) and whites (3.9%).
This holds true in Nevada, where Hispanic students dropped out of
school at a higher rate than other racial/ethnic groups. In the 1996-97
school year, the Hispanic dropout rate is 15.7 percent while White and
Asian/Pacific Islander students had the lowest dropout rates at 8.3%
each.
It is unacceptable that we allow students--of any race--to dropout.
In our new high-tech economy, education is more important than ever. It
is the key to a happy and secure future, and we must work harder to
make sure that our children don't lose this valuable chance to get an
education. We must convince them to stay in school.
For Nevada, the latest numbers show that 17 percent of our school
students will drop out before they get their degrees. Almost one in
five students in the 12th grade (19.4%) dropped out of school during
the 1996-97 school year,

[[Page S6191]]

compared with a dropout rate for 9th grade students of 3.5 percent.
As a member of the HELP Committee, Senator Bingaman has been a strong
advocate for dropout prevention programs and funding. I am pleased that
the Bingaman/Reid amendment--adding $10 million of funding for dropout
program grants--was accepted.
Our role is to provide needed resources to carry out innovate
programs tailored to the specific circumstances encountered. This money
goes to states and local school districts, in grants, to finance new
dropout prevention programs.
Dropout prevention programs must remain a priority for educators,
parents, and policymakers. All students deserve an opportunity to
receive a quality and complete education.

amendment no. 3707

(Purpose: To revise the purpose of the National Institute of Child
Health and Human Development relating to gynecologic health)

At the appropriate place, insert the following:

national institute of child health and human development

Sec. . Section 448 of the Public Health Service Act (42
U.S.C. 285g) is amended by inserting ``gynecologic health,''
after ``with respect to''.
____

AMENDMENT NO. 3708

(Purpose: To increase funding for children's asthma programs
administered by the Centers for Disease Control and Prevention)

On page 26, line 25, before ``of which'' insert the
following: ``of which $20,000,000 shall be made available to
carry out children's asthma programs and $4,000,000 of such
$20,000,000 shall be utilized to carry out improved asthma
surveillance and tracking systems and the remainder shall be
used to carry out diverse community-based childhood asthma
programs including both school- and community-based grant
programs, except that not to exceed 5 percent of such funds
may be used by the Centers for Disease Control and Prevention
for administrative costs or reprogramming, and''.

Mr. DURBIN. Mr. President, I rise today today with my colleagues,
Senators DeWine, Fitzgerald, Kerry, Bingaman, Schumer and Abraham to
offer this critical amendment to increase funding for childhood asthma
programs at the Centers for Disease Control and Prevention.
For the next 15 minutes imagine breathing through a tiny straw the
size of a coffee stirrer, never getting enough air. Now imagine
suffering through the process three to six times a day. This is asthma.
``America is in the middle of an asthma epidemic--an epidemic that is
getting worse, not better.'' So says the PEW environmental Health
Commission in its most recent report on asthma.
The prevalence of asthma continues to rise at astounding rates--every
region of the country and across all demographic groups, whether
measured by age, race or sex. In America today, no chronic disease is
increasing faster than asthma. And asthma is considered the worst
chronic health problem plaguing this nation's children. Among those
four years old, it has mushroomed by 160 percent over the last 2
decades.
Asthma affects nearly 15 million Americans. That figure includes more
than 700,000 Illinoisans, of whom 213,000 are children under the age of
18. Chicago has the dubious distinction of having the second highest
rate of childhood asthma in the country. According to a study published
by the Annals of Allergy, Asthma & Immunology, of inner-city school
children in Chicago, researchers found that the prevalence of diagnosed
asthma was 10.8 percent, or twice the 5.8 percent the federal Centers
for Disease Control and Prevention estimates in that age group
nationally. The study also found that most of the children with
diagnosed asthma were receiving medical care, but it may not be
consistent with what asthma care guidelines recommend.
If rates continue unchecked, a child born a generation from now will
be twice as likely to develop asthma as a child born today. By the end
of this decade, if no action is taken to reverse this trend and it
continues at its current pace, the PEW Commission calculates that 22
million Americans will suffer from asthma--eight million more than at
present. That's one in 14 Americans and one in every five families
forced to live with the disease. By 2020, the Commission estimates that
the number could increase to 29 million--more than twice the current
number.
These figures are staggering. At the current rate of growth, that
means that the number of asthma cases in 2020 will exceed the projected
population of New York and New Jersey combined. If by chance all asthma
suffers lived in one state, it would be the second most populous in the
country. Put another way, if all those with asthma stood side by side,
they would stretch the distance between LA, California and Washington
DC, over four times.
If general rates of asthma are high and getting higher, the rates are
even worse for society's most vulnerable. Asthma disproportionately
attacks them. A recent New York Times article described a study in the
Brooklyn area where it was found that an astounding 38 percent of
homeless children suffer from asthma. Some of the factors known to
contribute to asthma such as poor living circumstances, exposure to
cockroach feces, stress, exposure to dampness and mold are all
experienced by homeless children. They are also experienced by children
living in poor housing or exposed to urban violence. There are other
factors such as exposure to second hand smoke and smog that also
exacerbate or trigger asthma attacks.

Not only is asthma itself on the rise but it is becoming more deadly.
For minorities, asthma is particularly deadly. The asthma death rate
for African-Americans is more than twice as high as it is for other
segments of the population. Nationwide, the childhood asthma-related
death rate in 1993, was 3 to 4 times higher for African-Americans
compared to Caucasian Americans. The hospitalization rate for asthma is
almost three times as high among African-American children under the
age of 5 compared to their white counterparts. Illinois has the highest
asthma related deaths in the country for African-American men. The
increased disparity between death rates compared to prevalence rates
has been partially explained by decreased access to health care
services for minority children.
However, even though asthma rates are particularly high for children
in poverty, they are also rising substantially for suburban children.
Overall the rates are increasing for all groups. Everyone of us knows a
child whether our own, a relatives' or a friends' who suffers from
asthma.
In an effort to stem the tide of this epidemic, Senator DeWine and I
along with 23 other Senators submitted a request to the Labor HHS
appropriators to ask for $50 million for childhood asthma programs at
CDC. One fifth of the money would be available for improved tracking
and surveillance efforts for asthma, as suggested by the PEW commission
for environmental health. Currently, the bill does mention a specific
allocation for asthma.
The amendment, which has been agreed to, provides $20 million for
state and community-based organizations to support asthma screening,
treatment, education and prevention programs and for a new surveillance
and tracking system as called for recently by the PEW Environmental
Health Commission in their report ``Attack Asthma.'' Again, one fifth
of the amount, in this case $4 million would be available for new
surveillance and tracking.
The amendment also states that these community funds may be used by
both health and school-based services. Many school districts, including
the Chicago Public Schools are involved in screening children for
asthma and for seeing to it that they get treatment and management to
deal with their asthma. CDC should see to it that these new funds are
used to coordinate local efforts and to link both school based and
health facility based asthma programs. With additional resources, CDC
should diversify the types of programs that they fund, so that
evaluations can be done to measure the effectiveness of these different
programs. Furthermore, programs need to be tailored to the individual
needs of localities with coordination of local services and local
efforts to combat childhood asthma.
The amendment also includes a restriction on the amount that CDC may
use for administration or reprogramming including the 1 percent Public
Health Service evaluation. Both Senator DeWine and I believe that
asthma

[[Page S6192]]

should be a high priority for CDC and that CDC should not seek to
reprogram this money or use it for other purposes. Last year, CDC chose
to disproportionately allocate rescissions to the asthma program. We
strongly object to that decision. At a time of an asthma epidemic, we
believe that this program should be protected from such cuts.
Therefore, this year we have included language that states that only 5
percent of the total amount allocated for childhood asthma programs may
be used for administration, evaluations, or other activities.
Let me tell you why we need this money. Despite the best efforts of
the health community, childhood asthma is becoming more common, more
deadly and more expensive and the effects of asthma on society are
widespread.
Most children who have asthma develop it in their first year, but it
often goes undiagnosed. Many of you may be surprised to learn that
asthma is the single most common reason for school absenteeism. Parents
miss work while caring for children with asthma. Beyond those missed
days at school and parents missing work, there is the huge emotional
stress suffered by asthmatic children. It is a very frightening event
for a small child to be unable to breathe. A recent US News article
quoted an 8-yr old Virginian farm girl, Madison Benner who described
her experience with asthma. She said ``It feels like something was
standing on my chest when I have an asthma attack.'' This little girl
had drawn a picture of a floppy-eared, big footed elephant crushing a
frowning girl into her bed.
In many urban centers, over 60 percent of childhood admissions to the
emergency room are for asthma. There are 1.8 million emergency room
visits each year for asthma. Yet the emergency room is hardly a place
where a child and the child's parents can be educated in managing their
asthma.
During a recent visit to Children's Memorial Hospital in Chicago, I
met a wonderful little boy whose life is a daily fight against asthma.
He told me he can't always participate in gym class or even join his
friends on the playground. Fortunately, Nicholas is receiving the
medical attention necessary to manage his asthma. Yet for millions of
children, this is not the case. Their asthma goes undiagnosed and
untreated, making trips to the emergency room as common as trips to the
grocery store.
However, we do have treatments that work for most people. Early
diagnosis, treatment and management are key to preventing serious
illness and death. The National Institutes of Health is home to the
National Asthma Education and Prevention board. This is a large group
of experts from all across the fields involved in health care and
asthma. They have developed guidelines on both treating asthma and
educating children and their parents in prevention. It is very
important that when we spend money on developing such guidelines that
they actually get out of communities so that they can take advantage of
this research.
CDC has been working in collaboration with NIH to make sure that
health professionals and others get the most up to date information. My
amendment could further help this effort by providing grantees with
this information.
One interesting new model that appears to work is the ``breathmobile'
program in Los Angeles that was started 2 years ago. This program
provides a van that is equipped with medical personnel, asthma
education materials, and asthma treatment supplies. It goes out to
areas that are known to have a high incidence of childhood asthma and
screens children in those areas. Children are also enrolled in the
Children's Health Program if they are income eligible. We have all
heard of how slow enrollment in the children's health program has been
and anything that we can do to speed enrollment up, I think it vitally
important. This ``Breathmobile'' program has reduced trips to the
emergency room by 17 percent in the first year of operation. I hope
that we can be as successful in Illinois and other parts of the
country.
In Illinois, the Mobile CARE Foundation is setting up a program in
Chicago based on the Los Angeles initiative. In addition, the American
Association of Chest Physicians has joined with other groups to form
the Chicago Asthma Consortium to provide asthma screening and
treatment. Efforts like these need our amendment.

In West Virginia, a Medicaid ``disease management'' program which
seeks to coordinate children with asthma's care so that they get the
very best care has been found to be very cost effective. It has reduced
trips to the emergency room by 30 percent.
This Childhood Asthma Amendment would expand these programs to help
ensure that no child goes undiagnosed and every asthmatic child gets
the treatment he or she needs.
Last year, an additional $10 million was dedicated to start this
program for a total of $11.3 million. CDC will be putting out a request
for proposals this summer. The $20 million agreed to here today is a
good start and I hope that we will be able to do better by increasing
it to $50 million in conference. This $50 million level of funding is
supported by the American Lung Association, the Asthma and Allergy
Foundation, Mothers of Asthmatics, the National Association for
Children's Hospitals and Research Institutions, the Academy of
Pediatrics, the Asthma and Allergy Foundation of America and others who
support children's health.
No child should die from asthma. We need to make sure that people
understand the signs of asthma and that all asthmatic children have
access to treatment and information on how to lessen their exposure to
things that trigger asthma attacks. Funding for this program is
critical.
I am delighted that my colleague Senator Specter has agreed to accept
this amendment to nearly double the funding level for this important
public health effort. I hope that he will work with me in conference to
increase this level of funding to as close as possible to the $50
million originally requested by myself and 23 of my Senate colleagues.
Again I thank my colleagues Specter and Harkin for recognizing the
importance of this issue to the nation's children.

AMENDMENT NO. 3709

(Purpose: To increase funding for the Centers for Disease Control and
Prevention to provide for the adequate funding of State and local
immunization infrastructure and operations activities)

On page 54, between lines 10 and 11, insert the following:
Sec. ___. In addition to amounts otherwise appropriated
under this title for the Centers for Disease Control and
Prevention, $37,500,000, to be utilized to provide grants to
States and political subdivisions of States under section 317
of the Public Health Service Act to enable such States and
political subdivisions to carry out immunization
infrastructure and operations activities: Provided, That of
the total amount made available in this Act for
infrastructure funding for the Centers for Disease Control
and Prevention, not less than 10 percent shall be used for
immunization projects in areas with low or declining
immunization rates or areas that are particularly susceptible
to disease outbreaks, and not more than 14 percent shall be
used to carry out the incentive bonus program: Provided, That
amounts made available under this Act for the administrative
and related expenses of the Department of Health and Human
Services, the Department of Labor, and the Department of
Education shall be further reduced on a pro rata basis by
$37,500,000.

Mr. DURBIN. Mr. President, I rise today to offer an amendment
regarding childhood immunization. Remarkable advances in the science of
vaccine development and widespread immunization efforts have led to a
substantial reduction in the incidence of infectious disease. Today, as
you know, national vaccination coverage is at record high levels.
Smallpox has been eradicated; polio has been eliminated from the
Western Hemisphere; and cases of measles have been reduced to record
lows.
Still, the job is not done and it is important that we remain
vigilant. Every day, nearly 11,000 infants are born and each baby will
need up to 22 doses of vaccine by age two. New vaccines continue to
enter the market. And although a significant proportion of the general
population may be fully immunized at a given time, coverage rates in
the United States are uneven and life-threatening disease outbreaks do
occur. In fact, recent data from the CDC indicate that coverage rates
may be leveling off and that in many areas of the country, including
Chicago, Houston, Delaware, North Dakota, South Dakota and New Mexico,
they are actually declining.
At the same time, funding to states and localities for immunization
delivery activities has also been dramatically reduced over the past
five years.

[[Page S6193]]

States are now struggling to maintain immunization rates and have
implemented severe cuts to immunization activities. Many have already
reduced clinic hours, canceled contracts with providers, suspended
registry development and implementation, limited outreach efforts and
discontinued performance monitoring.
Last week, the Institute of Medicine issued a landmark report on the
state of our Nation's immunization infrastructure. This report
confirmed that the situation requires immediate attention. The IOM in
its report stated:

The combination of new challenges and reduced resources has
led to instability in the public health infrastructure that
supports the U.S. immunization system. Many states have
reduced the scale of their immunization programs and
currently lack adequate strength in areas such as data
collection among at-risk populations, strategic planning,
program coordination, and assessment of immunization status
in communities that are served by multiple health care
providers. If unmet immunization needs are not identified and
addressed, states will have difficulty in achieving the
national goal of 90 percent coverage by year 2010 for
completion of childhood vaccination series for young
children. Furthermore, state and national coverage rates,
which reached record levels for vaccines in widespread use
(79 percent in 1998), can be expected to decline and
preventable disease outbreaks may occur as a result,
particularly among persons who are vulnerable to vaccine-
preventable disease because of their undervaccination status.

The amendment I am offering today with my colleagues Senator Kay
Bailey Hutchison, Senator Jack Reed, Senator Patty Murray, and Senator
John Kerry addresses the recommendations of the IOM and responds to the
issues raised by state and local immunization program administrators
who are struggling to reach underserved children. The provision does
three things: First, it provides a $37.5 million increase in
immunization grant funding to state and local programs for immunization
infrastructure activities in FY 2001, bringing the total funding for
infrastructure up from $139 million to $176.5 million. Second, it
limits to 14 percent the amount of the total that can be spent for
incentive grants to states. Third, it targets 10 percent of the total
infrastructure funding to areas with low or declining immunization
rates and areas susceptible to outbreaks.
While $37.5 million is a good start, additional funding is needed.
The IOM recommends a $75 million increase in the annual federal share
of funding to states for immunization programs. This number was derived
from 3 calculations: (1) annual state expenditure levels during the
mid-1990's; (2) the level of spending necessary to provide additional
resources to states with high levels of need without reducing current
award levels for each state; and (3) additional infrastructure
requirements associated with adjusting to anticipated changes and
increased complexity in the immunization schedule. Dozens of
organizations support this level of funding, including Research.
America, the American Academy of Pediatrics, the March of Dimes, the
Children's Defense Fund, the Association of State and Territorial
Health Officials, Every Child by Two, and many others.
I intend to work with my colleagues on the Committee and in the
Senate to increase this funding level by an additional $37.5 million in
FY 2002 in order to reach the level recommended by the IOM.
The 317 immunization grant program to states and localities for
``infrastructure and operations'' is the sole source of Federal support
for many critical activities, including: immunization registries;
outreach efforts to educate parents about the value and importance of
vaccines as well as the risks and possible side effects; training and
education of providers to ensure timely vaccinations and keep them
updated about the routine schedule including changes resulting from the
addition of new vaccines; outbreak control and monitoring and
investigating disease occurrence; identifying under immunized children
and development of strategies to overcome barriers to vaccination;
linking immunization activities with other public health services such
as the WIC program; and evaluations of immunization strategies to
determine what works.
While overall funding to the Centers for Disease Control's
immunization program has actually seen slight increases, the grant
program to States and localities has dramatically declined over the
past 5 years. Actual appropriations levels have gone from $271 million
in FY1995 to $208 million in FY 96 to $139 million in FY2000. But the
story is even worse. The measles outbreak of the late 1980's and early
1990's prompted Congress to give states hefty funding increases.
Unfortunately, the states were not immediately prepared for the influx
of funds. Money was ``carried over'' from one year to the next as they
worked through barriers such as computer acquisitions, legislative
approvals and hiring freezes. This carryover has compensated for the
dramatic reductions in funding that followed. Now there is no more
carryover money to pick up the slack. So while actual appropriations
have declined by about $68 million since 1996, states are experiencing
reductions of 50 percent or more in the same time period. As a result,
states are struggling to maintain immunization rates and have
implemented severe cuts to immunization activities. Many have already
reduced clinic hours, canceled contracts with providers, suspended
registry development and implementation, limited outreach efforts and
discontinued performance monitoring. An increase of $75 million will
barely get states back up to the funding levels they were experiencing
in 1998.
The amendment also limits the amount that can be allocated for
incentive grants to 14 percent of the total infrastructure funding.
Historically, Senate report language has included a formula to reward
areas that achieved high coverage levels and set aside $33 million out
of the state infrastructure money to pay for this incentive. When this
was first put in place in 1994, this amount represented approximately
14 percent of all grant funding available. Now, because the total
funding has decreased, the percentage is equal to about 25 percent of
the total. Because the overall base funding has decreased (from $271
million in FY95 to $139 million), the incentive allocation is eating up
a greater share of total infrastructure funding pulling money away
from project areas that have lower immunization rates. In addition,
because immunization rates have gone up, nearly every state gets some
incentive money--but it is no longer considered an ``incentive'' by the
states. Rather, states use the money to offset recent decreases in 317
federal grant funding. As a result, this ``incentive'' that has
historically been included in the Senate Appropriations report is no
longer achieving its intended effect. Quite simply, the advantage of
awarding funds as incentives, rewarding successful immunization
programs, has decreased as total funding has decreased. Those grantees
with the lowest coverage levels and most in need are receiving less
funding than those who have already achieved high coverage levels.

To address this issue, this amendment would limit the percentage of
total funding that can be used for incentive money to the percentage it
represented when it was first implemented. No state will experience a
reduction in funds.
I also want to note that the House Labor-HHS-Education Appropriations
report included language, which I strongly support, asking the CDC to
report back to Congress regarding the utility of this incentive program
and recommending a mechanism to phase it out if it is not found to be
achieving its intended purpose. It is my hope that the Senate will
agree to this language in conference.
The amendment also targets 10 percent of total infrastructure funding
to areas of the country with low or declining immunization rates. Even
with significant gains in national immunization rates, subpopulations
of underimmunized children still exist. Rates in many of the Nation's
urban areas, including Chicago and Houston, are unacceptably low and
getting lower. These pockets of need create pools of susceptible
children and increase the risk of dangerous disease outbreaks. The IOM
report highlights the fact that disparities in levels of immunization
coverage still exist. National surveys reveal a gap of 9 percentage
points between children above and below the federal poverty level.
Targeting just 10 percent of the total amount, as IOM recommends, will
help CDC respond to unexpected outbreaks, gaps in immunization
coverage, or other exceptional circumstances within the states.

[[Page S6194]]

I urge my colleagues to support this amendment. It will provide
additional funds to every single state. No state loses money. In this
day and age, it is simply not acceptable that more than one million
children have not been adequately vaccinated. Vaccines are one of the
most cost-effective tools we have in preventing disease. For every
dollar spent on vaccines, society saves up to $24 in medical and
societal costs. Controlling vaccine-preventable disease has been one of
the most significant public health accomplishments of the 20th Century.
But current success does not guarantee future success. And there is
still much work to be done.
Mr. REED. Mr. President, I am pleased to join my colleague Senator
Durbin on an amendment to restore funding to one of our most
accomplished public health initiatives, our national immunization
program.
The purpose of the amendment is quite simple--it seeks to strengthen
and enhance the operations and infrastructure grants administered by
the Centers for Disease Control and Prevention's Section 317
immunization program.
These monies fund a variety of essential programs and services within
the immunization program for children, including outreach efforts to
educate parents about the immunization schedule, training and education
of providers about new vaccines and outbreak control when cases of
infectious diseases arise. The CDC's operation and infrastructure
grants also support vital initiatives to identify under-immunized
children, provide resources necessary to implement and maintain state-
based immunization registries and allow the state immunization program
to forge linkages with other public health services, such as WIC and
Head Start, since these places are often points of entry for low-income
children who may lack all or some of the recommended vaccinations.
Originally, Senator Durbin and I had intended to offer an amendment
that would add a total of $75 million for the CDC Section 317
operations and infrastructure grant program. We have modified our
amendment so that it now calls for a $37.5 million increase in funding
for these grants this year with the understanding that Chairman Specter
has agreed to work to provide additional $37.5 million in FY 2002 for
this grant program. I would thank the Chairman and the Ranking Member
for agreeing to accept this important amendment.
Numerous public health and provider groups including the National
Association of County and City Health Officials (NACCHO), the
Association of State and Territorial Health Officials (ASTHO), the
American Academy of Pediatrics and every Child by Two, just to name a
few support our amendment.
Since the advent of the polio vaccine in 1955, the United States has
invested in a national immunization campaign to rid the population of
devastating diseases such as smallpox, polio, diphtheria and measles.
The CDC Section 317 program has been an integral part of our national
immunization initiative. The Section 317 program can be broken down
into two main categories--(1) vaccine purchase and (2) infrastructure
to facilitate the delivery and monitoring of vaccines. The Section 317
program is the only source of critical federal funding to support the
infrastructure necessary to administer immunizations to children in
communities throughout the country.
A little over a week ago, the Institute of Medicine released their
report on immunization finance policies and practices. This report was
conducted at the request of the Senate Appropriations Committee and
more specifically by our colleague Senator Dale Bumpers, a long-time
champion of the immunization program.
This landmark report offers us many important insights into the
complex federal-state-local partnership that makes up our national
immunization initiative. The report found that although average
immunization coverage levels are at record highs, several problems
continue to plague the program, while even greater challenges lie
ahead. The issues threaten the great success we have achieved in
essentially eradicating deadly and debilitating diseases that were
prevalent in this country a relatively short time ago. Many of these
same diseases continue to strike children in developing nations
throughout the world.

According to the IOM report, one of the greatest challenges currently
facing our immunization program is the persistent disparities in
coverage that exist among and within states, as well as within major
cities.
The 1998 National Immunization Survey (NIS) found a gap of between 7
and 8.6 percent between the immunization rates for non-Hispanic white
children and those of Hispanic and African-American children for one of
the most important series of immunizations. Disparities in immunization
levels also fall along the poverty line. For the same series, National
Immunization Survey found a 9 percentage point difference between the
immunization rates for children living below the poverty level compared
to those at or above the poverty line.
These disparities in coverage are often found in concentrations of
un-immunized and under-immunized children who typically reside in urban
areas as well as in certain rural areas. These areas are also referred
to as `pockets of need'.
Our investments in the immunization program thus far have yielded
great benefits in terms of improving the health of children, as well as
producing significant health care cost savings. For example, for every
dollar spent on the Measles, Mumps, Rubella (MMR) vaccine, $10.30 in
savings were captured in terms of direct medical costs and $13.50 in
indirect societal costs, such as lost work time, disability and death.
While great progress has been made in boosting immunization coverage
nationally, we are at a point where it will require additional
resources in order to reach those remaining children who have not been
immunized. In other words, reaching these remaining un-immunized and
under-immunized children in `pockets of need' areas, will require more
effort and more resources.
Another significant problem outlined in the IOM report is the, ``The
repetitive ebb and flow cycles in the distribution of public resources
for immunization programs . . .'' Federal funding for the immunization
program has been volatile, particularly over the past decade.
To give my colleagues some background, the federal government began
to pay greater attention to the need to support and strengthen our
immunization program after a measles outbreak struck several parts of
the U.S. in 1989-1990. Following the epidemic, the CDC launched a
national initiative designed to strengthen state immunization programs
and provide resources for a broad array of direct services and
outreach. The goal of this effort was to strengthen and enhance our
capacity to monitor immunization levels and improve our ability to
respond to disease outbreaks.
During that period, federal funding for infrastructure grants
increased seven-fold from a total of $37 million in 1990 to $271
million in 1995. However, states were not immediately prepared for the
dramatic funding increases and the expansion of immunization delivery
systems at the state level took time. As a result, funds were ``carried
over'' from one year to the next as states prepared to make the capital
investments necessary to strengthen critical areas of
their immunization program, such as vaccine delivery, outreach into
underserved areas and improvements in monitoring through the
development of state-based immunization registries.

However, as the threat of another disease outbreak faded, carry-over
fund balances grew and pressure to reduce federal discretionary
spending intensified here in Congress. What happened as a result was an
almost 50 percent decline in funding, and for the past two years, the
CDC infrastructure grant program has been level funded at $139 million.
For the past few years, states have been using remaining carry-over
funds to cover expenses that could not be met by their new award. The
estimated FY 2001 figures indicate that most states have exhausted
their carry-over funding and must rely solely on their new grant award
to finance their operations.
This cut has seriously eroded states' ability to develop and
implement program innovations and threatened their capacity to
administer vaccines. These reductions over the past several years

[[Page S6195]]

have also forced states to scale back on other important activities
such as community outreach, parental and physician education and the
development and operation of registries.
This reduction in the operations and infrastructure grant awards has
had a significant impact on my home state of Rhode Island. My state has
gone from a high of approximately $3 million to a low of $500,000 in
just four years. These kinds of swings in funding make it virtually
impossible for a state to administer its program, let alone plan ahead
for the future.
And these dramatic declines have not only happened in my state--they
have happened in virtually every state in the country.
Fortunately, my state has been extremely successful thus far in
expanding immunization coverage rates in the nation (89%). However,
continued vigilance is necessary to maintain coverage rates in states
like Rhode Island, while additional effort and resources are required
to bring up immunization rates in areas like Chicago (69%) and Houston
(56%).
Mr. President, we must remain diligent and focused on our
immunization goals and invest in the tools necessary to protect our
children. This additional funding will help to achieve that end by
restoring immunization grant awards to a level that will enable states
to carry out critical program activities. As I mentioned before, our
amendment would add $37.5 million over two years to the CDC operations
and infrastructure grant program.
The IOM report makes clear that our immunization system is at a
critical juncture, and I am pleased that Chairman Specter and Ranking
Member Harkin have agreed to accept our amendment because we should not
wait for a serious outbreak to a vaccine-preventable disease to address
the shortfall in the CDC immunization program.

amendment no. 3710

(Purpose: To require that contracts for the care of research NIH
chimpanzees be awarded to contractors that comply with the Animal
Welfare Act)

At the appropriate place, add the following: ``None of the
funds appropriated under this Act shall be expended by the
National Institutes of Health on a contract for the care of
the 288 chimpanzees acquired by the National Institutes of
Health from the Coulston Foundation, unless the contractor is
accredited by the Association for the Assessment and
Accreditation of Laboratory Animal Care International or has
a Public Health Services assurance, and has not been charged
multiple times with egregious violations of the Animal
Welfare Act.''.

Mr. SMITH of New Hampshire. Mr. President, I thank the Senate
managers for including my amendment in the managers' package. This
amendment relates to the Request for Proposals (RFP) recently issued by
the National Institutes of Health for the care of 288 chimpanzees
recently acquired by NIH from The Coulston Foundation. The Coulston
Foundation, an animal research facility in Alamogordo, New Mexico, has
a very troubling record of animal care, and has been investigated and
charged by the U.S. Department of Agriculture numerous times for
egregious violations of the Animal Welfare Act relating to the deaths
of several chimpanzees and other primates. At least 14 chimpanzees and
4 monkeys have died at the lab in the past seven years, due to
negligence and a lack of appropriate veterinary care.
Last August, following the deaths of several chimpanzees at Coulston,
USDA ordered the lab to halve its chimpanzee colony, leading to the
transfer of 288 chimps to NIH. However, the transfer was in title only.
For the time being, the chimpanzees will remain in Coulston's physical
possession, in direct defiance of the spirit and intent of the USDA
order.
I am eager, therefore, for NIH to proceed with its RFP to secure the
services of an entity that can provide high quality care for the 288
chimpanzees. The easiest way to ensure this is to insist that bidders
for the contract be accredited by the Association for the Assessment
and Accreditation for Laboratory Animal Care, International, or AAALAC.
AAALAC is a private, internationally recognized accrediting body. Its
stamp of approval guarantees that a laboratory provides high standards
of care to its animals. AAALAC accreditation is often required in
Public Health Service (PHS) contracts and, in fact, is strongly based
on strict compliance with NIH's own Guide for the Care and Use of
Laboratory Animals. In 1994, NIH made a site visit to The Coulston
Foundation, and recommended that Coulston achieve AAALAC accreditation
within 3-5 years. That was six years ago, and Coulston is still not
accredited by this international organization, despite applying.
Although I would expect that any entity selected by NIH to receive
this contract would be highly qualified and therefore AAALAC-
accredited, bidders for the contract that are not accredited may
demonstrate their qualifications by holding a valid PHS Animal Welfare
Assurance. In theory, an Animal Welfare Assurance shows that a
laboratory is compliant with the federal Animal Welfare Act and PHS
policy on animal care. Sometimes these assurances are restricted. For
instance, Coulston's assurance is restricted because of its poor animal
care record. However, it is still considered valid.
I think it is important to stress that the recipient of NIH's
contract should have a good record of animal welfare and should be
compliant with federal animal welfare laws. As such, I have included
language in my amendment which states that NIH cannot give its contract
to a facility that has been charged multiple times with egregious
violations of the Animal Welfare Act, as is the case with The Coulston
Foundation. These animals can live to 50, even 60 years of age, and are
very similar to humans in many ways. We should make certain that they
receive the level of care appropriate to them. The amendment which I am
offering will address these concerns. I would like to thank the
managers for working out this language and for supporting my amendment.

AMENDMENT No. 3711

(Purpose: To Provide an additional $800,000 for technology and media
services and to provide an offset)

At the end of title III, insert the following:

SEC. __. TECHNOLOGY AND MEDIA SERVICES.

Notwithstanding any other provision of this Act--
(1) the total amount appropriated under this title under
the heading ``Office of Special Education and Rehabilitative
Services'' under the heading ``special education'' to carry
out the Individuals with Disabilities Education Act shall be
$7,353,141,000, of which $35,323,000 shall be available for
technology and media services; and
(2) the total amount appropriated under this title under
the heading ``Departmental Management'' under the heading
``program administration'' shall be further reduced by
$800,000.

Mr. DODD. Mr. President, I thank the chairman, Senator Spector, and
the Ranking member, Senator Harkin, for accepting an amendment I have
proposed to S. 2553, the Labor, Health and Human Services, and
Education, and related agencies appropriation bill for fiscal year
2001. This amendment provides an additional $800,000 for the Technology
and Media Services section of the Department of Education
appropriation. The funds allocated to Technology and Media Services are
crucially important because they are used to make competitive awards to
support the development, demonstration, and use of technology and
education media activities of value to children with disabilities.
In that regard, the National Theatre of the Deaf (NTD) has a long and
worthy history as an organization dedicated to helping deaf and hard-
of-hearing children and adults achieve their fullest potential. In
1967, the NTD was created with the assistance of the Department of
Education to support educational and artistic programs for the deaf
community. With strong and enduring support from the Congress, the NTD
has developed an innovative training program and seasonal workshop
series to foster the growth of a unique form of theater. Presented in
both American Sign Language and spoken English, NTD performance have
expanded the boundaries of theatrical expression and made an original
contribution to professional theater while simultaneously building
bridges between the hearing and non-hearing communities. The NTD has
repeatedly won recognition for it's work over the last 33 years,
including a Tony Award. The NTD has touched over 3.5 million people
through local, national and international live performances, and
millions more through televised specials. As a result of the massive
success of the NTD , more than 40 similar Theaters of the Deaf have
sprung up worldwide.

[[Page S6196]]

Unfortunately, in fiscal year 2000, the NTD was not funded by the
Department of Education, an unintended consequence of modifications
made by Congress to the Individuals with Disabilities Education Act in
1997. I have no reason to believe that the Congress is any less
supportive of the National Theater of the Deaf today than it has been
for the last 33 years. It is the intent of the amendment that I offer
today to provide the Department of Education with sufficient means to
fund an additional competitive grant from the Special Education
Technology and Media Services program.
Once again, I am grateful to the Chairman and Ranking Member for
accepting this amendment and, I think I speak for our colleagues in
thanking them for their continued support for the deaf and hard-of-
hearing community in our country.
Mr. SPECTER. I would like to commend the Senator from Connecticut for
bringing this amendment to our attention. While the amount requested in
this amendment is a modest sum, it will make a major difference to an
important community in this country. I look forward to working with the
Senator from Connecticut as this matter moves to conference.
Mr. HARKIN. I would like to associate myself with the remarks of my
Chairman and that of the Senator from Connecticut, particularly with
regard to the important role that the National Theater of the Deaf has
played over the last 33 years. I pledge to do what I can to ensure the
conference agreement carriers out the intent of the Senator from
Connecticut.

amendment no. 3712

In amendment No. 3633, as modified, strike ``$78,200,000''
and insert ``$35,000,000'' in lieu thereof.
____

amendment no. 3713

(Purpose: To provide grants to states for high schools to improve
academic performance and provide technical skills training and grants
to elementary and secondary schools to provide physical education and
improve physical fitness)

On page 69, line 2, after the colon insert the following
proviso: ``Provided further, That of the funds appropriated
$5,000,000 shall be made available for a high school state
grant program to improve academic performance and provide
technical skills training, $5,000,000 shall be made available
to provide grants to enable elementary and secondary schools
to provide physical education and improve physical fitness''.
____

amendment no. 3714

(Purpose: To provide grants to states and local government for early
childhood learning for young children)

On page 41, at the beginning of line 12 insert the
following: ``$5,000,000 shall be made available to provide
grants for early childhood learning for young children, of
which''.
____

amendment no. 3715

(Purpose: To increase funding for the Office of Civil Rights of the
Department of Health and Human Services)

On page 45, line 4, insert before the period the following:
``: Provided, That an additional $2,500,000 shall be made
available for the Office for Civil Rights: Provided further,
That amounts made available under this title for the
administrative and related expenses of the Department of
Health and Human Services shall be reduced by $2,500,000''.

Mr. LEAHY. Mr. President, I want to thank my colleagues
Senator Specter and Senator Harkin for including an amendment I have
offered to increase funding for the Office of Civil Rights (OCR) at the
Department of Health and Human Services (HHS) as part of the managers'
package. My amendment would provide an increase of $2.5 million for the
Office of Civil Rights to protect the civil rights of Americans. I want
to take a moment to explain why I believe this funding increase is so
important.
The Office of Civil Rights at HHS has the responsibility to enforce
civil rights laws in the health and human service setting throughout
the United States. What does this mean? Essentially, the Office of
Civil Rights oversees anyone who receives funding from HHS--hospitals,
managed care organizations, nursing homes, and social service agencies
among others--to ensure they are complying with civil rights statutes.
Although it enforces a wide array of civil right laws, the bulk of
OCR's efforts center around enforcement of Title VI of the Civil Rights
Act of 1964, which addresses discrimination in federally funded
programs, and the Americans with Disabilities Act.
The civil rights challenges that confront OCR continue to grow. A few
of the issues the office is focusing on include racial and ethnic
disparities in health; ensuring that individuals with disabilities
avoid unnecessary institutionalization and can live in their
communities; and fighting discrimination among minorities and
individuals with disabilities in managed care.
It seems to me that this office already has a pretty big workload.
Well, it is about to become much larger. In addition to the important
efforts the OCR currently works on, this office will soon be
responsible for implementing and enforcing the proposed medical privacy
regulations. The administration has been required to establish
safeguards to protect personal medical information of Americans because
this Congress missed its own self-imposed deadline. If we're not going
to do our job in Congress, we should at least support the Office that
will have to do it for us.
In 1996, Congress passed the Health Insurance Portability and
Accountability Act (HIPAA). This legislation set a self-imposed
deadline for Congress to pass comprehensive medical privacy legislation
by August 1999. If Congress was unable to meet the deadline, the
Secretary of the Department of Health and Human Services was required
by law to establish medical privacy protection through regulation.
Secretary Shalala issued her draft regulations last fall and there was
a public comment period that extended until this past February.
Currently, HHS is working to finalize the draft regulations which
should be issued later this year.
I have been on this Senate floor countless times to talk about the
need to establish privacy protections for personal medical information.
It angers me that this Congress could not even move privacy protections
through the committee process, let alone, to actually have a debate on
this critical issue before the full Senate. We couldn't do the job on
our own and we have instead shifted the responsibility to the
administration. This Congress has the responsibility to protect the
privacy of Americans--and that includes the protection of their medical
records. The place for these protections is in legislation--not
regulation. But that's not the issue right now. The issue before us is
the need to adequately fund the office that will have the sole
responsibility for enforcing these essential privacy protections.
The FY 2000 Budget for the Office of Civil Rights is $22 million.
This figure has remained unchanged since 1980. I find this hard to
believe. The Office has seen its enforcement responsibilities increase
dramatically with the passage of the Americans with Disabilities Act
and other major legislation. Add the impending implementation of the
medical records privacy regulation and it becomes clear that this
budget must come in line with the current times and allow the Office to
do what they must--protect the civil rights of Americans.
This additional funding provided in this amendment will help the
Office of Civil Rights do the job we have asked them to do. I do not
think this increase is nearly enough. However, I recognize that we have
limited funds for a wide range of important programs. I am hopeful that
this will be the first of many steps to increase the resources for this
office. Again, I want to thank my colleagues for their support of this
amendment and for their support of the important work of this
office.
Mr. HARKIN. Mr. President, I rise to support the increase in funding
for the Office of Civil Rights at the Department of Health and Human
Services. The Office of Civil Rights (OCR) enforces civil rights laws
in health and human services settings. OCR oversees hospitals, managed
care organizations, nursing homes, social service agencies--literally
any state, local, or private agency that receives HHS funding, to
ensure compliance with civil rights laws.
In the next year, OCR will be responsible for enforcing several
initiatives of real importance to me and to health care consumers
across America. First, OCR will be responsible for enforcing the
landmark health information privacy regulations. These regulations will
provide consumers with protections against the inappropriate disclosure
of their health information. Indeed, Americans are concerned about

[[Page S6197]]

who gets to see and use their personal medical information. Privacy is
the first defense against discrimination on the basis of health
status--an issue I know a lot about through my work on the Americans
with Disabilities Act.
One of OCR'S other top priorities in the coming year is to enforce
the Americans with Disabilities Act (ADA) by working with states and
advocates to develop programs to enable people with disabilities to
live in community-based settings, as required by the Supreme Court's
Olmstead decision. Just last year, in L.C. v. Olmstead, the Supreme
Court held that state Medicaid programs must comply with the ADA's
integration mandate. The Court held that under the ADA, people with
disabilities have the right to be included in our communities, not
segregated behind the closed doors of institutions and excluded from
the mainstream. This decision means that unjustified isolation now
properly is regarded as discrimination when it is based on disability.
The Department of Health and Human Services has already taken steps
to ensure that states comply with the Supreme Court's decision. The
Department sent a letter to state Medicaid directors and others
emphasizing the Court's suggestion that states develop a comprehensive
plan for placing qualified individuals with disabilities in less
restrictive settings and ensure that their waiting lists for community-
based services move at a reasonable pace that is not controlled by the
state's endeavors to keep its institutions fully populated.
This so-called ``Olmstead Letter'' is a great first step. However, a
law is only as effective as its enforcement, and that is why OCR is so
important to the civil rights of people with disabilities. This new
funding will help OCR to ensure that as we approach the ADA's 10th
anniversary next month, the ADA will continue to have a very real
effect on the daily lives of people with disabilities and their ability
to live and participate in their communities.

Amendment No. 3716

(Purpose: To increase the amount of funds made available for activities
that improve the quality of infant and toddler child care)

On page 40, line 5, strike ``$60,000,000'' and insert
``$100,000,000''.
____

Amendment No. 3717

(Purpose: To increase funding to provide assistance for poison
prevention and to stabilize the funding of regional poison control
centers)

On page 54, between lines 10 and 11, insert the following:
Sec. __. (a) In addition to amounts made available under
the heading ``Health Resources and Services Administration-
Health Resources and Services'' for poison prevention and
poison control center activities, there shall be available an
additional $20,000,000 to provide assistance for such
activities and to stabilize the funding of regional poison
control centers as provided for pursuant to the Poison
Control Center Enhancement and Awareness Act (Public Law 106-
174).
(b) Amounts made available under this Act for the
administrative and related expenses of the Department of
Health and Human Services, the Department of Labor, and the
Department of Education shall be reduced further on a pro
rata basis by $20,000,000.

Mr. DeWINE. Mr. President, I rise today to thank the Chairman of the
Labor, Health, and Education Appropriations Subcommittee, Senator
Specter, and the Ranking Member, Senator Harkin, for their support of
our Nation's poison control centers. Because of their help, the
appropriations bill we pass will contain a sound investment in these
centers.
Mr. President, many of us--as parents--have experienced the
terrifying situation when a child accidently swallows something
potentially toxic. Fortunately, poison control centers are in place to
field poison-related phone calls and to offer parents and everyone
valuable medical advice when these types of emergencies arise.
Additionally, the professionals at the centers provide education and
training to the public to help prevent poisonings. Without a doubt,
poison control centers offer vital health services.
Earlier this year, Congress passed legislation that I sponsored along
with 34 of my colleagues--and the President signed it into law--which
authorizes $27.6 million to be used to fund a national toll-free number
to ensure access to poison control center services; a nationwide media
campaign to educate the public and health care providers about poison
prevention; and a grant program to: (1) Help certified regional poison
control centers achieve financial stability; (2) Prevent poisonings;
(3) Provide treatment recommendations for poisonings; and (4) Improve
poison control center services.
Last year, I worked with Senator Specter, to include $3 million in
FY2000 for the Health Resources and Services Administration (HRSA) and
Centers for Disease Control and Prevention (CDC) to initiate planning
for the national toll-free number and to begin assisting the local
poison control centers' other efforts. Because of that initial
investment, the national toll-free number will be fully operational by
September 30th of this year. The new toll-free number will provide easy
access to poison control services no matter where you are in the
country by directing calls to the local poison control center closest
to you.
To ensure that the local centers can maintain current operations and
handle increases in calls resulting from the new toll-free number, the
centers must be funded at an adequate level. The investment this bill
makes will help poison control centers continue providing essential
services to parents and to the public now and in the future.
Investing in poison control centers just makes good economic sense.
Do you realize that for every dollar spent on poison control center
services, we can save $7 dollars in medical costs? The average cost of
a poisoning exposure call to a poison control center is $31.28. The
average cost of using other health care system options, like emergency
room services, for example, is $932 dollars.
Each year, the Central Ohio Poison Center handles more than 66,000
calls, and the Cincinnati Poison Center handles about 78,000 calls.
According to Dr. Marcel Casavant--medical director for the Central Ohio
Poison Center and emergency department physician at Columbus Children's
Hospital--the Central Ohio Poison Center refers callers to their
doctors or to an emergency department about 10 percent of the time. The
other 90 percent of cases don't usually require a trip to the emergency
room and can be treated and monitored right at home with treatment
advice provided by poison control professionals. Poison control centers
save lives and save money by offering immediate treatment advice. They
help keep patients from calling 911 or going to emergency rooms
unnecessarily, while offering immediate treatment advice to callers.
Throughout the United States each year, more than two million
poisonings are reported to poison control centers. More than 90 percent
of these poisonings happen in the home, and over 50 percent of
poisoning victims are children younger than six years of age. My own
personal experience with poison control centers occurred two years ago,
when our granddaughter, Isabelle, who was two years old at the time,
fell into a bucket of bubble solution as we were wrapping up our annual
Ice Cream Social at our home in Cedarville, Ohio. We feared that
Isabelle may have swallowed some of the solution, since she was covered
with it from head to toe.
My sister-in-law, who is a nurse, immediately called the poison
control center to determine whether Isabelle had swallowed a poisonous
substance. We were very lucky. The professional at the local poison
control center told us immediately what to do and explained that we
needed to rinse Isabelle off and have her drink several glasses of
water to flush the solution through her system. But for the quick
response of that local poison control center, we would probably have
ended up taking Isabelle to the emergency room needlessly.
My friend and colleague from Michigan, Senator Abraham, also had his
own personal experience with a poison center. In 1999, he and his wife
were at home and spotted their toddler son, Spencer, with an open
bottle of allergy medicine. They immediately called the poison center.
The Abrahams, too, were very lucky. As it turned out, little Spencer
hadn't swallowed more than an ounce, so the poison center staff
recommended that his parents just monitor him at home through the
night.
While poisonings very often affect children, adults also face
situations necessitating information and help from

[[Page S6198]]

poison control centers. The centers provide services for adults who
have been exposed to potentially poisonous or toxic substances. Take
the example of what occurred in Marysville, Ohio. Thirty workers in a
manufacturing plant in Marysville were victims of gas exposure. Twenty
of these workers went to Union Memorial Hospital. The hospital
contacted the poison center, after which these patients were given
oxygen and later discharged that same day. Ten others went to a
different hospital which did not call a poison center. These patients
were not released until the next day, even though their symptoms did
not differ from the other 20 workers.
Because the local poison centers cover a lot of area and handle a
large number of exposure cases, they can help identify trends and
patterns of exposure which might not otherwise be recognized by
individual health care providers. The organized network of poison
centers facilitates instant communication of public health concerns, as
well as effective methods of treatment. For example, in 1993, an Oregon
Poison Center staff member noticed a cluster of symptomatic callers who
had all used an aerosol leather protector. Subsequent investigation
revealed similar cases in the preceding four days. Immediate
notification of other centers confirmed cases in other states. Contact
with the manufacturer and subsequent product removal occurred within
only four hours.
Here's another example: On January 28, 1998, there was a nationwide
recall of a popular snack cake due to possible asbestos contamination.
This recall resulted in about 1000 calls to one poison center in Ohio,
with similar numbers of calls to poison centers in Illinois, Indiana,
and Missouri. The poison centers were able to reassure callers about
the low toxicity of small oral ingestion of asbestos and referred
callers to the company's customer service number.
Despite their obvious value, poison control centers have been
seriously under-funded. The centers have been financed through unstable
arrangements from a variety of public and private sources. Over the
last two decades, there has been a steady decline in the number of
poison control centers in the United States. In 1978, there were more
than 600 poison control centers nationwide. Today, there are fewer than
75--of which, only 53 are certified. Since 1991, six centers in Ohio
have closed, leaving only three in current operation.
This trend has jeopardized the ability of the remaining poison
control centers nationwide to provide immediate, around-the-clock
service to all Americans. As a result, more emergency rooms are likely
to be visited by anxious parents who fear their children were
accidentally poisoned. This is a trend that is increasing the total
cost of treating poisonings and increasing the risk of accidental
injury or death.
Mr. President, I am pleased that my colleagues have agreed to take
things to the next level and are providing a substantial investment in
these centers. This investment will help bring stability to our
nation's poison control centers and bring peace of mind to parents.
I thank the Chair and yield the floor.

AMENDMENT NO. 3718

(Purpose: To increase funds for the National Program of Cancer
Registries)

On page 27, line 24, before the period insert the
following: ``: Provided further, That in addition to amounts
made available under this heading for the National Program of
Cancer Registries, an additional $15,000,000 shall be made
available for such Program and special emphasis in carrying
out such Program shall be given to States with the highest
number of the leading causes of cancer mortality: Provided
further, That amounts made available under this Act for the
administrative and related expenses of the Centers for
Disease Control and Prevention shall be reduced by
$15,000,000''.

AMENDMENT NO. 3719

(Purpose: To protect the rights of residents of certain health care
facilities)

On page 92, between lines 4 and 5, insert the following:
Sec. __. Title V of the Public Health Service Act (42
U.S.C. 290aa et seq.) is amended by adding at the end the
following:

``PART G--REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS OF CERTAIN
FACILITIES

``SEC. 581. REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS
OF CERTAIN FACILITIES.

``(a) In General.--A public or private general hospital,
nursing facility, intermediate care facility, residential
treatment center, or other health care facility, that
receives support in any form from any program supported in
whole or in part with funds appropriated to any Federal
department or agency shall protect and promote the rights of
each resident of the facility, including the right to be free
from physical or mental abuse, corporal punishment, and any
restraints or involuntary seclusions imposed for purposes of
discipline or convenience.
``(b) Requirements.--Restraints and seclusion may only be
imposed on a resident of a facility described in subsection
(a) if--
``(1) the restraints or seclusion are imposed to ensure the
physical safety of the resident, a staff member, or others;
and
``(2) the restraints or seclusion are imposed only upon the
written order of a physician, or other licensed independent
practitioner permitted by the State and the facility to order
such restraint or seclusion, that specifies the duration and
circumstances under which the restraints are to be used
(except in emergency circumstances specified by the Secretary
until such an order could reasonably be obtained).
``(c) Definitions.--In this section:
``(1) Restraints.--The term `restraints' means--
``(A) any physical restraint that is a mechanical or
personal restriction that immobilizes or reduces the ability
of an individual to move his or her arms, legs, or head
freely, not including devices, such as orthopedically
prescribed devices, surgical dressings or bandages,
protective helmets, or any other methods that involves the
physical holding of a resident for the purpose of conducting
routine physical examinations or tests or to protect the
resident from falling out of bed or to permit the resident to
participate in activities without the risk of physical harm
to the resident; and
``(B) a drug or medication that is used as a restraint to
control behavior or restrict the resident's freedom of
movement that is not a standard treatment for the resident's
medical or psychiatric condition.
``(2) Seclusion.--The term `seclusion' means any separation
of the resident from the general population of the facility
that prevents the resident from returning to such population
if he or she desires.

``SEC. 582. REPORTING REQUIREMENT.

``(a) In General.-- Each facility to which the Protection
and Advocacy for Mentally Ill Individuals Act of 1986 applies
shall notify the appropriate agency, as determined by the
Secretary, of each death that occurs at each such facility
while a patient is restrained or in seclusion, of each death
occurring within 24 hours after the patient has been removed
from restraints and seclusion, or where it is reasonable to
assume that a patient's death is a result of such seclusion
or restraint. A notification under this section shall include
the name of the resident and shall be provided not later than
7 days after the date of the death of the individual
involved.
``(b) Facility.--In this section, the term `facility' has
the meaning given the term `facilities' in section 102(3) of
the Protection and Advocacy for Mentally Ill Individuals Act
of 1986 (42 U.S.C. 10802(3)).''.

``SEC. 583. REGULATIONS AND ENFORCEMENT.

``(a) Training.--Not later than 1 year after the date of
enactment of this part, the Secretary, after consultation
with appropriate State and local protection and advocacy
organizations, physicians, facilities, and other health care
professionals and patients, shall promulgate regulations that
require facilities to which the Protection and Advocacy for
Mentally Ill Individuals Act of 1986 (42 U.S.C. 10801 et
seq.) applies, to meet the requirements of subsection (b).
``(b) Requirements.--The regulations promulgated under
subsection (a) shall require that--
``(1) facilities described in subsection (a) ensure that
there is an adequate number of qualified professional and
supportive staff to evaluate patients, formulate written
individualized, comprehensive treatment plans, and to provide
active treatment measures;
``(2) appropriate training be provided for the staff of
such facilities in the use of restraints and any alternatives
to the use of restraints; and
``(3) such facilities provide complete and accurate
notification of deaths, as required under section 582(a).
``(c) Enforcement.--A facility to which this part applies
that fails to comply with any requirement of this part,
including a failure to provide appropriate training, shall
not be eligible for participation in any program supported in
whole or in part by funds appropriated to any Federal
department or agency.''.
____

AMENDMENT NO. 3720

(Purpose: To provide funding for certain activities of the Occupational
Safety and Health Administration with respect to all employers)

On page 13, line 20, strike ``Provided'' and insert the
following: ``: Provided, That of the amount appropriated
under this heading that is in excess of the amount
appropriated for such purposes for fiscal year 2000, at least
$22,200,000 shall be used to carry out education, training,
and consultation activities as described in subsections (c)
and (d) of section 21 of the Occupational Safety and Health
Act of 1970 (29 U.S.C. 670(c) and (d)): Provided further,''.

[[Page S6199]]

____
AMENDMENT NO. 3721

(Purpose: To express the sense of the Senate that the Health Care
Financing Administration should consider current systems that provide
better, more cost-effective emergency transport before promulgating any
final rule regarding the delivery of emergency medical services)

On page 54, between lines 10 and 11, insert the following:

SEC. __. SENSE OF THE SENATE REGARDING THE DELIVERY OF
EMERGENCY MEDICAL SERVICES.

(a) Findings.--The Senate finds the following:
(1) Several States have developed and implemented a unique
2-tiered emergency medical services system that effectively
provides services to the residents of those States.
(2) These 2-tiered systems include volunteer and for-profit
emergency medical technicians who provide basic life support
and hospital-based paramedics who provide advanced life
support.
(3) These 2-tiered systems have provided universal access
for residents of those States to affordable emergency
services, while simultaneously ensuring that those persons in
need of the most advanced care receive such care from the
proper authorities.
(4) One State's 2-tiered system currently has an estimated
20,000 emergency medical technicians providing ambulance
transportation for basic life support and advanced life
support emergencies, over 80 percent of which are handled by
volunteers who are not reimbursed under the medicare program
under title XVIII of the Social Security Act.
(5) The hospital-based paramedics, also known as mobile
intensive care units, are reimbursed under the medicare
program when they respond to advanced life support
emergencies.
(6) These 2-tiered State health systems save the lives of
thousands of residents of those States each year, while
saving the medicare program, in some instances, as much as
$39,000,000 in reimbursement fees.
(7) When Congress requested that the Health Care Financing
Administration enact changes to the emergency medical
services fee schedule as a result of the Balanced Budget Act
of 1997, including a general overhaul of reimbursement rates
and administrative costs, it was in the spirit of
streamlining the agency, controlling skyrocketing health care
costs, and lengthening the solvency of the medicare program.
(8) The Health Care Financing Administration is considering
implementing new emergency medical services reimbursement
guidelines that would destabilize or eliminate the 2-tier
system that have developed in these States.
(b) Sense of the Senate.--It is the sense of the Senate
that the Health Care Financing Administration should--
(1) consider the unique nature of 2-tiered emergency
medical services delivery systems when implementing new
reimbursement guidelines for paramedics and hospitals under
the medicare program under title XVIII of the Social Security
Act; and
(2) promote innovative emergency medical service systems
enacted by States that reduce reimbursement costs to the
medicare program while ensuring that all residents receive
quick and appropriate emergency care when needed.
____

AMENDMENT NO. 3722

(Purpose: To provide additional funds for the Perkin's loan
cancellation program, with an offset)

On page 71, after line 25, add the following:
Sec. __. (a) In addition to any amounts appropriated under
this title for the Perkin's loan cancellation program under
section 465 of the Higher Education Act of 1965 (20 U.S.C.
1087ee), an additional $30,000,000 is appropriated to carry
out such program.
(b) Notwithstanding any other provision of this Act,
amounts made available under titles I and II, and this title,
for salaries and expenses at the Departments of Labor, Health
and Human Services, and Education, respectively, shall be
further reduced on a pro rata basis by $15,000,000.
____

AMENDMENT NO. 3723

(Purpose: To provide for a study evaluating the extent to which funds
made available under part A of title I of the Elementary and Secondary
Education Act of 1965 are targeted to schools and local educational
agencies with the greatest concentrations of school-age children from
low-income families)

On page 71, after line 25, insert the following:
Sec. 305. The Comptroller General of the United States,
shall evaluate the extent to which funds made available under
part A of title I of the Elementary and Secondary Education
Act of 1965 are allocated to schools and local educational
agencies with the greatest concentrations of school-age
children from low-income families, the extent to which
allocations of such funds adjust to shifts in concentrations
of pupils from low-income families in different regions,
States, and substate areas, the extent to which the
allocatiion of such funds encourage the targeting of state
funds to areas with higher concentrations of children from
low-income families, the implications of current distribution
methods for such funds, and formula and other policy
recommendations to improve the targeting of such funds to
more effectively serve low-income children in both rural and
urban areas, and for preparing interim and final reports
based on the results of the study, to be submitted to
Congress not later than February 1, 2001, and April 1, 2001.
On page 70, line 7, strike ``$396,672,000'' and insert
``$396,671,000''.
____

amendment no. 3724

(Purpose: To provide assistance to Tribal Colleges or Universities for
construction and renovation projects under section 316 of the Higher
Education Act of 1965, with an offset)

At the end of title III, insert the following:

SEC. .

The amount made available under this title under the
heading ``Office of Postsecondary Education'' under the
heading ``higher education'' to carry out section 316 of the
Higher Education Act of 1965 is increased by $5,000,000,
which increase shall be used for construction and renovation
projects under such section; and the amount made available
under this title under the heading ``Office of Postsecondary
Education'' under the heading ``higher education'' to carry
out part B of title VII of the Higher Education Act of 1965
is decreased by $5,000,000.

Mr. BINGAMAN. Mr. President, on behalf of the cosponsors of this
amendment I thank Senators Specter and Harkin for dedicating $5,000,000
from the Fund for the improvement of Postsecondary Education for
desperately-needed construction and renovation projects at the 32
Tribal Colleges and Universities that comprise the American Indian
Higher Education Consortium.
These institutions serve students from over 250 federally recognized
Tribes in some of the most impoverished parts of the country. Anyone
who has ever visited one has seen the overcrowding and the poor
condition of the facilities; crumbling foundations, leaky roofs,
exposed wiring, and many other safety hazards were in fact recently
estimated to require $120 million in repairs.
The $5,000,000 supplemental to the Title III Strengthening Tribal
Colleges and Universities funding recommended by the committee will
provide some relief to the inadequate and unsafe conditions at many of
the Tribal Colleges and Universities and hopefully will help the
institutions leverage additional private funds. However, we know the
needs are extremely great, and hope that the Congress will sustain and
expand this commitment of federal resources to aid these schools which
play such a key role in the education of our Native American
populations.

AMENDMENT NO. 3725

(Purpose: To express the sense of the Senate regarding the impacts of
the Balanced Budget Act of 1997)

On page 54, between lines 10 and 11, insert the following:

SEC. __. SENSE OF THE SENATE REGARDING IMPACTS OF THE
BALANCED BUDGET ACT OF 1997.

(a) Findings.--The Senate makes the following findings:
(1) Since its passage in 1997, the Balanced Budget Act of
1997 has drastically cut payments under the medicare program
under title XVIII of the Social Security Act in the areas of
hospital, home health, and skilled nursing care, among
others. While Congress intended to cut approximately
$100,000,000,000 from the medicare program over 5 years,
recent estimates put the actual cut at over $200,000,000,000.
(2) A recent study on home health care found that nearly 70
percent of hospital discharge planners surveyed reported a
greater difficulty obtaining home health services for
medicare beneficiaries as a result of the Balanced Budget Act
of 1997.
(3) According to the Medicare Payment Advisory Commission,
rural hospitals were disproportionately affected by the
Balanced Budget Act of 1997, dropping the inpatient margins
of such hospitals over 4 percentage points in 1998.
(b) Sense of Senate.--It is the sense of the Senate that
Congress and the President should act expeditiously to
alleviate the adverse impacts of the Balanced Budget Act of
1997 on beneficiaries under the medicare program under title
XVIII of the Social Security Act and health care providers
participating in such program.
____

AMENDMENT NO. 3726

(Purpose: To state the sense of the Senate regarding funds for programs
for early detection and treatment regarding childhood lead poisoning at
sites providing Early Head Start programs)

At the end of title V, add the following:
Sec. __. It is the sense of the Senate that each entity
carrying out an Early Head Start program under the Head Start
Act should--
(1) determine whether a child eligible to participate in
the Early Head Start program has received a blood lead
screening test, using a test that is appropriate for age and
risk factors, upon the enrollment of the child in the
program; and

[[Page S6200]]

(2) in the case of an child who has not received such a
blood lead screening test, ensure that each enrolled child
receives such a test either by referral or by performing the
test (under contract or otherwise).
____

AMENDMENT NO. 3727

(Purpose: To allocate appropriated funds for programs for early
detection and treatment regarding childhood lead poisoning at sites
providing Early Head Start programs)

On page 27, line 24, strike the period and insert the
following: ``: Provided further, That the funds made
available under this heading for section 317A of the Public
Health Service Act may be made available for programs
operated in accordance with a strategy (developed and
implemented by the Director for the Centers for Disease
Control and Prevention) to identify and target resources for
childhood lead poisoning prevention to high-risk populations,
including ensuring that any individual or entity that
receives a grant under that section to carry out activities
relating to childhood lead poisoning prevention may use a
portion of the grant funds awarded for the purpose of funding
screening assessments and referrals at sites of operation of
the Early Head Start programs under the Head Start Act.''.
____

amendment no. 3728

(Purpose: To provide for a study into sexual abuse in schools)

At the appropriate place add the following:
(a) Whereas sexual abuse in schools between a student and a
member of the school staff or a student and another student
is a cause for concern in America;
(b) Whereas relatively few studies have been conducted on
sexual abuse in schools and the extent of this problem is
unknown;
(c) Whereas according to the Child Abuse and Neglect
Reporting Act, a school administrator is required to report
any allegation of sexual abuse to the appropriate
authorities;
(d) Whereas an individual who is falsely accused of sexual
misconduct with a student deserves appropriate legal and
professional protections;
(e) Whereas it is estimated that many causes of sexual
abuse in schools are not reported;
(f) Whereas many of the accused staff quietly resign at
their present school district and are then rehired at a new
district which has no knowledge of their alleged abuse;
(g) Therefore, it is the Sense of the Senate that the
Secretary of Education should initiate a study and make
recommendations to Congress and state and local governments
on the issue of sexual abuse in schools.''.
____

amendment no. 3729

(Purpose: To provide increased funding for school construction under
the Impact Act program, with an offset)

On page 58, line 3, strike ``25,000,000'' and insert
``35,000,000''.
Amounts made available under this Act for the
administrative and related expenses of the Department of
Health and Human Services, the Department of Labor, and the
Department of Education shall be further reduced on a pro
rata basis by $10,000,000.
____

amendment no. 3730

(Purpose: To increase funding for adoption incentives)

On page 41, lines 11 and 12, strike ``$7,881,586,000, of
which $41,791,000'' and insert ``$7,895,723,000, of which
$55,928,000''.
Amounts made available under this Act for the
administrative and related expenses of the Department of
Health and Human Services, the Department of Labor, and the
Department of Education shall be further reduced on a pro-
rata basis by $14,137,000.
____

amendment no. 3731

On page 69 on line 24 insert the following: ``Provided
further, That of the amount made available under this heading
for activities carried out through the Fund of the
Improvement of Education under part A of title X, $50,000,000
shall be made available to enable the Secretary of Education
to award grants to develop, implement and strengthen programs
to teach American history (not social studies) as a separate
subject within school curricula''.

loss of america's civic memory

Mr. LIEBERMAN. Mr. President, I come today to the floor of this
Chamber, which is so rich with history, which has been the setting of
some of the most determinative moments for our democracy, to talk about
the state of our civic memory.
Thomas Jefferson once famously said, ``If a nation expects to be
ignorant and free, it expects what never was and never will be.'' I am
saddened to say that this Nation, the guardian of the Jeffersonian
ethic, seems well on the way today to testing his proposition.
Or so the findings of a recent survey of America's college graduates
would suggest. That survey reveals that our next generation of leaders
and citizens is leaving college with a stunning lack of knowledge of
their heritage and the democratic values that have long sustained our
country.
The University of Connecticut's Roper Center found that 81 percent of
seniors from America's elite institutions of higher education received
a grade of D or F on history questions drawn from a basic high school
examination. Many seniors could not identify Valley Forge, words from
the Gettysburg Address, or even the basic principles of the U.S.
Constitution. By comparison, 99 percent of them knew who Beavis and
Butthead were and 98 percent knew who the rapper Snoop Doggy Dogg was.
The Roper survey also shows that most major colleges no longer
require their students to study history, which helps to explain why
historical illiteracy is growing in this country. Students can now
graduate from 100 percent of the top colleges and universities without
taking a single course in American history. And students at 78 percent
of those institutions are not required to take any form of history at
all.
The American Council of Trustees and Alumni, a nonprofit group
dedicated to the pursuit of academic freedom, has compiled and analyzed
these findings in a provocative report entitled ``Losing America's
Memory: Historical Illiteracy in the 21st Century.'' I would encourage
my colleagues to examine this report, a copy of which has been sent to
every Member's office. I ask unanimous consent to have the report
printed in the Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
(See exhibit 1.)
Mr. LIEBERMAN. I do so because I believe all of us--elected
officials, educators, parents, the whole of our citizenry--should be
alarmed by findings, by the Nation's growing ignorance of our past and
what it implies for America's future. When we lose the memory of our
past, when we lose our understanding of the remarkable individuals,
events, and values that have shaped this Nation, we are losing much of
what it means to be an American. We are losing touch with the civic
glue that binds our diverse Nation into a single people with a common
purpose. And, I fear, we are losing sight of the lessons our history
teaches us and the fundamental responsibilities we share as citizens in
a free democracy.
Earlier this week I had the privilege of joining with my colleague
from Washington, Senator Gorton, Congressman Tom Petri of Wisconsin,
the leaders of the ACTA, and assemblage of distinguished historians at
a press conference to underscore the import of this report. With the
Fourth of July in the offing, we wanted to seize the opportunity of
this moment of patriotism to in a sense play Paul Revere, and to begin
ringing the alarm bells about the growing ignorance of the
contributions that Revere and many other great men and women made to
this Nation.
Among the scholars who attended were: Gordon Wood, Professor of
History at Brown University; John Patrick Diggins, Distinguished
Professor of History, The Graduate Center, City University of New York;
James Rees, Director of George Washington's Mount Vernon; Jeffrey
Wallin, president, American Academy for Liberal Education; and Paul
Reber, Executive Director of Decatur House, National Trust for Historic
Preservation. With us, in spirit if not in body, were David McCullough,
the prize-winning author of the illuminative biography of Harry Truman,
and the great Oscar Handlin, Professor Emeritus at Harvard.

Each of these historians, as well as several others, issued
statements expressing their concerns about the consequences of losing
America's memory. I ask unanimous consent to have a collection of these
statements printed in the Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
(See exhibit 2.)
Mr. LIEBERMAN. I will read a few excerpts, because I think they
uniquely speak to the ramifications of the problem.
Gordon Wood explained: ``We Americans have a special need to
understand our history, for our history is what makes us a nation and
gives us our sense of nationality. A people like us, made up of every
conceivable race, ethnicity, and religion in the world, can never be a
nation in the usual sense of the term. . . . Up until recently almost
every American, even those who were new immigrants possessed some sense
of America's past, however rudimentary and unsophisticated. Without

[[Page S6201]]

some such sense of history, the citizens of the United States can
scarcely long exist as a united people.''
Theodore Rabb, Professor of History at Princeton, and Chairman of the
National Council for History Education, quoting historian Kenneth T.
Jackson, added: `` `Our binding heritage is a democratic vision of
liberty, equality, and justice. If Americans are to preserve that
heritage and bring it to daily practice, it is imperative that all
citizens understand how it was shaped in the past . . .' Indeed, the
office of citizen cannot be properly filled in today's democratic
society without an understanding of American history.''
Stephen H. Balch, President of the National Association of Scholars,
concluded: ``More than most nations, America is defined by shared
memories. Great deeds, stirring moments, inspiring heroes, hard-won
victories, occasional defeats, and, most significantly, lofty ideals--
declared, attacked, and ultimately vindicated--map our collective
identity. ACTA's study, `Losing America's Memory,' thus strongly
suggests that were also in danger of losing America itself. Its
findings should be a wake-up call for our educators who have been
clearly shirking their responsibilities.''
And David McCullough issued this succinct condemnation: ``The place
given to history in our schools is a disgrace, and the dreadful truth
is very few of those responsible for curriculum seem to care, even at
the highest level of education.''
These wise men have more than convinced me that this is a national
problem deserving national attention. In that spirit, Senator Gorton
and I today are introducing a resolution that we hope will help call
public attention to America's growing historical illiteracy and ideally
begin to mobilize a national response. This bipartisan resolution,
which is cosponsored by Senators Byrd, Gordon Smith, and Cleland,
reaffirms the value we place on our truly exceptional history and makes
an appeal to begin work immediately on rebuilding our historical
literacy.
Our call goes out primarily to America's colleges and universities to
recommit themselves to the teaching of history, particularly America's
national history. Specifically, it urges college trustees,
administrators, and State higher education officials around the country
to review their curricula and reinstate requirements in U.S. history.
It also encourages students to select colleges with history
requirements and to take college courses in history whether required or
not.
We also cannot ignore the role of our public schools in contributing
to this historical ignorance, so we must ask educators at all levels to
redouble their efforts to bolster our children's knowledge of U.S.
history and help us restore the vitality of our civic memory. This
point was reinforced at our press conference by Mount Vernon Director
James Rees, who noted with despair that George Washington's presence in
elementary school curricula has been gradually disappearing. As an
example, he related that the textbook being used today at the
elementary school he attended contained 10 times fewer references to
the father of our country than the textbook he used in his youth.
Mr. President, I hope our colleagues will join us in supporting and
adopting this resolution and making an unequivocal statement. As we
prepare to celebrate the Fourth, I can think of no finer birthday
present to the Nation, no better way to honor the anniversary of
America's independence, than for us first to remember what moved that
determined band of patriots to lay down all for liberty, what has
sustained our democracy for these many years, and for us to act so that
our children and those who follow them will never forget.

Exhibit 1

Losing America's Memory--Historical Illiteracy in the 21st Century

[Issued for Presidents' Day, February 21, 2000--Prepared by Anne D.
Neal and Jerry L. Martin, American Council of Trustees and Alumni]

``If a nation expects to be ignorant and free, it expects
what never was and never will be.''--Thomas Jefferson.
``[W]e cannot escape history.''--Abraham Lincoln.

introduction

Who are we? What is our past? Upon what principles was
American democracy founded? And how can we sustain them?--
These are the questions that have inspired, motivated,
perplexed since the beginning. And they are questions which
still elude our full understanding. Yet they underscore a
belief that a shared understanding, a shared knowledge, of
the nation's past unifies a people and ensures a common civic
identity. Indeed, the American system is uniquely premised on
the need for an educated citizenry. Embarking on the
experiment of a democratic republic, the founders viewed
public education as central to the ability to sustain a
participatory form of government. ``If a nation expects to be
ignorant and free,'' Thomas Jefferson said, ``it expects what
never was and never will be.''
But the importance of a shared memory appears to have lost
its foothold in American higher education. As we move forward
into the 21st century, our future leaders are graduating with
an alarming ignorance of their heritage--a kind of collective
amnesia--and a profound historical illiteracy which bodes ill
for the future of the republic.
There is a widespread, though unspoken assumption that, if
not all citizens, at least college graduates--certainly those
from the elite institutions--have a basic understanding of
this country's history and founding principles. Colleges
themselves rarely, if ever, test this assumption. The
American Council of trustees and Alumni (ACTA) decided to do
so. What do seniors at the nation's best colleges and
universities know and not know about the history of this
nation? What grade would they receive if tested?
ACTA commissioned the Roper organization--The Center for
Survey Research and Analysis at the University of
Connecticut--to survey college seniors from the nation's best
colleges and universities as identified by the U.S. News &
World Reports annual college rankings. The top 55 liberal
arts colleges and research universities were sampled during
December 1999. (For a list, see Appendix A.)
The questions were drawn from a basic high school
curriculum. In fact, many of the questions had been used in
the National Assessment of Educational Progress (NAEP) tests
given to high school students.
How did seniors from our nation's top colleges and
universities do? They flunked. Four out of five--18%--of
seniors from the top 55 colleges and universities in the
United States received a grade of D or F. they could not
identify Valley Forge, or words from the Gettysburg Address,
or even the basic principles of the U.S. Constitution.
Scarcely more than half knew general information about
American democracy and the Constitution.
Only 34% of the students surveyed could identify George
Washington as an American general at the battle of Yorktown,
the culminating battle of the American Revolution.
Only 42% were able to identify George Washington as ``First
in war, first in peace, first in the hearts of his
countrymen.''
Less than one quarter (23%) correctly identified James
Madison as the ``father of the Constitution.''
Even fewer--22% of the college seniors--were able to
identify ``Government of the people, by the people, and for
the people'' as a line from the Gettysburg Address--arguably
one of the three most important documents underlying the
American system of government.
Over one-third were unable to identify the U.S.
Constitution as establishing the division of power in
American government.
Little more than half (52%) knew George Washington's
Farewell Address warned against permanent alliances with
foreign governments.
What do they know? They get an A+ in contemporary popular
culture.
99% know who the cartoon characters Beavis and Butthead
are.
98% can identify the rap singer Snoop Doggy Dogg.
Beavis and Butthead instead of Washington and Madison;
Snoop Doggy Dogg instead of Lincoln? How did it come to this?
Students and parents are paying $30,000 a year at elite
institutions. For what?
What Happened to American History?
To find out what our nation's top colleges and universities
demand of students in the area of American history, ACTCA
conducted a study of graduation requirements at the same 55
colleges and universities surveyed by the Roper
organization. These are the institutions, such as Harvard
and Amherst, which set the standard for all the rest. (See
Appendix B.)
For each school, the most recent undergraduate course
catalog or Internet course listing was used to define the
graduation requirements and to determine what history or
American history courses are required of students before they
graduate.
The results are worse than could have been imagined.
Students can now graduate from 100% of the top colleges
without taking a single course in American history.
Novelist Milan Kundera once said that, if you want to
destroy a country, destroy its memory. If a hostile power
wanted to erase America's civic heritage, it could hardly do
a better job--short of actually prohibiting the study of
American history--than America's elite colleges and
universities are doing.
More shocking still is that, at 78% of the institutions,
students are not required to take any history at all. The
best that can be said is that they are permitted to take
history to satisfy other requirements in such

[[Page S6202]]

areas as social sciences or diversity. Only the fact that
many students find history useful and interesting saves the
subject from extinction.
It is not surprising that college seniors know little
American history. Few students leave high school with an
adequate knowledge of American history and even the best
colleges and universities do nothing to close the ``knowledge
gap.''
The abandonment of history requirements is part of a
national trend. In 1988, the National Endowment for the
Humanities publicized the first troubling indication that
America was losing its historic memory. NEH issued a report
concluding that more than 80% of colleges and universities
permitted students to graduate without taking a course in
American history while 37% of those institutions allowed
students to avoid history altogether. Now, thirteen years
later, as outlined in Appendix B, standards have fallen
further--100% do not require American history, and 78%
require no history at all.
The problem is not limited to history. In 1996, the
National Association of Scholars issued another seminal
report, The Dissolution of General Education, which concluded
that, during the last thirty years, the commitment of
American higher education to providing students with a broad
and rigorous exposure to major areas of knowledge has
virtually vanished. In its stead, students pick and choose
from a smorgasbord of courses that are too often on narrow,
specialized topics. As the widely-acclaimed study by the
Association of American Colleges, Integrity in the College
Curriculum, concluded in 1990: ``As far as what passes as
college curriculum, almost anything goes.'' Is it any wonder
that students end up with an understanding that is equally
narrow, fragmented, and less than the sum of its parts?
In the country that gave birth to Jefferson's conception of
an educated citizenry, colleges and universities are failing
to provide the kind of general education that is needed for
graduates to be involved and educated citizens.
Why Does American History Matter?
Other than our schools, no institutions bear greater
responsibility for the transmission of our heritage than
colleges and universities. They educate almost two-thirds of
our citizens, including all our school teachers, lawyers,
doctors, journalists, and public leaders. They set the
admissions and curricular requirements that signal to
students, teachers, parents, and the public what every
educated citizen in a democracy must know.
What happens in higher education thus relates directly to
what happens in K-12. If colleges and universities no longer
require their students to have a basic knowledge of American
civilization and its heritage, we are all in danger of losing
a common frame of reference that has sustained our free
society for so many generations.
As ACTA chairman and former NEH chairman Lynne V. Cheney
observes, in Telling the Truth, ``[I]t is from our colleges
and universities that messages radiate--or fail to radiate to
schools, to legal institutions, to popular culture, and to
politics about the importance of reason, of trying to
overcome bias, of seeking truth through evidence and
verification.'' If our graduates leave school without knowing
the foundations of American society, children they teach will
certainly do no better.
It is sometimes said that historical facts do not matter.
But citizens who fail to know basic landmarks of history and
civics are unlikely to be able to reflect on their meaning.
They fail to recognize the unique nature of our society, and
the importance of preserving it. They lack an understanding
of the very principles which bind our society--namely,
liberty, justice, government by the consent of the governed,
and equality under the law.
As Lynne Cheney has also written, ``Knowledge of the ideas
that have molded us and the ideals that have mattered to us
functions as a kind of civic glue. Our history and literature
give us symbols to share; they help us all, no matter how
diverse our backgrounds, feel part of a common undertaking.''
What Should Be Done?
Immediate steps must be taken to ensure that the memory of
our great nation and its remarkable past is passed on to the
next generation. The following actions should be taken by
colleges and universities, students and their families,
alumni and donors, state and federal governments, and
accrediting agencies.
By colleges and universities
Colleges and universities should make improving students'
historical memory and civic competence an urgent priority.
Boards of trustees and state agencies with higher education
oversight should take steps to ensure that institutions of
higher education have adequate requirements in American
history and history in general. Faculty, whose personal
interest often draws them to specialized topics, should teach
what students need to know, not what faculty desire to teach.
The most direct solution is a strong core curriculum, with
a broad-based, rigorous course on American history required
of all students. The course should include the breadth of
American history from the colonial period to the present, and
the long struggle to defend liberty against all foes domestic
and foreign and to expand democratic rights at home and
abroad. Students should be required to study the great civic
documents of the nation, beginning with the Declaration of
Independence, Constitution, the Bill of Rights, the
Federalist papers, and the Gettysburg Address. Such a course
gives students a sense not only of where the country has
been, but what it has meant.
By students and their families
The first challenge for students and their families is
selecting a college. Some colleges have strong core curricula
that ensure that every graduate will be well-grounded in the
full range of basic subjects, including American history.
Most have loose cafeteria-style requirements that let the
students choose for themselves. Some no longer even offer
traditional, broad-based courses in American history.
Before selecting a college, students and their families
should look at catalogues, examining requirements and course
descriptions and ideally accessing course syllabi on the web.
College is a big investment, and it deserves as much research
as any other major purchase. A hot reputation and fancy
student center are no guarantee of a solid academic program.
Students who are already attending a college can make up
for colleges' deficiencies by selecting for themselves those
courses, including American history, that will prepare them
for successful participation in our civic as well as economic
life. Parents should help their students understand that
trendy courses that may strike their short-term fancy will
not well serve their long-term needs.
By alumni and donors
Alumni should take an active interest in whether their alma
maters have strong requirements in American history and other
basic subjects. They should not allow their degrees to be
devalued by a decline in college standards.
Those who give can be especially helpful, since it is
possible to target gifts to outstanding programs and projects
in American history and civic understanding. The American
Council of Trustees and Alumni has established a program, the
Fund for Academic Renewal (FAR), that assists donors, free of
charge, in identifying outstanding programs and directing
their gifts to support them.
By State and Federal Governments and accrediting agencies
Consumers in the higher education market cannot make wise
choices if they have no information. Most college guides and
rankings give little or no information about the curriculum.
The U.S. Department of Education--and state government for
institutions in their states--should publish and disseminate
a national report on collegiate standards, listing which
colleges require such basic subjects as English, history,
mathematics, and science, and which do not.
Federal and state governments should target some of the
funds from existing grant programs to support outstanding
core curricula that include American history and civics.
Accrediting agencies, which have so often neglected issues
of academic quality, should include adequate requirements in
American history and other basic disciplines among their
criteria for assessing colleges and universities.

Conclusion

On this Presidents' Day 2000, it is indeed ironic that
many--if not most--of our college seniors are unfamiliar with
and ignorant about the individuals we celebrate. The time is
ripe for citizens, parents, families and policymakers to
demand a renewed exploration and examination of our history.
It is not too late to restore America's memory.

Exhibit 2

statements submitted in conjunction with the congressional press
conference on historical illiteracy in america--june 27, 2000

David McCullough, Historian, West Tisbury, MA:
The place given to history in our schools is a disgrace,
and the dreadful truth is very few of those responsible for
curriculum seem to care, even at the highest level of
education. Anyone who doubts that we are raising a generation
of young Americans who are historically illiterate needs only
to read Losing America's Memory.

Oscar Handlin, University Professor Emeritus, Harvard
University:
History is a discipline in decline. There is a profound
ignorance not only among students but among their teachers as
well. This study [Losing America's Memory] confirms that.

Lynne V. Cheney, Former Chairman, National Endowment for the
Humanities:
It is regrettable that over the last decade we have seen a
continuing decline in emphasis at the college level on core
subjects such as literature, math, and history. ACTA's recent
report, ``Losing America's Memory: Historical Illiteracy in
the 21st Century,'' confirms this disturbing trend and
underscores a profound historical illiteracy amongst our
future leaders that bodes ill for the future of the Republic.
Sen. Lieberman and Cong. Petri deserve our praise for raising
this important issue. We must begin to restore America's
memory. If our best and brightest are graduating without a
grounding in the past, we are on our way to losing the
understanding that makes us all feel part of a

[[Page S6203]]

common undertaking, no matter how diverse our backgrounds.

John Patrick Diggins, Distinguished Professor of History, The
Graduate Center, City University of New York:
``We cannot escape history,'' Abraham Lincoln warned
Americans more than a century ago. According to the American
Council of Trustees and Alumni report, students have escaped
it and remain happily ignorant of their own ignorance in an
educational establishment that has surrendered its mission to
popular culture.

Gordon Wood, Professor of History, Brown University:
We Americans have a special need to understand our history,
for our history is what makes us a nation and gives us our
sense of nationality. A people like us, made up of every
conceivable race, ethnicity, and religion in the world, can
never be a nation in the usual sense of the term. Instead, we
have only our history to hold us together; McDonald's can
never do it. It's our history, our heritage, that makes us a
single people. Up until recently almost every American, even
those who were new immigrants, possessed some sense of
America's past, however rudimentary and unsophisticated.
Without some such sense of history, the citizens of the
United States can scarcely long exist as a united people.

Theodore K. Rabb, Chairman, National Council for History
Education, Professor of History, Princeton University:
Since the focus of the National Council for History
Education (NCHE) is on the improvement of history education
in the schools--indeed, our one postsecondary initiative has
been to recommend that teachers of history be certified only
if they have a college major or at least a minor in the
subject--we are not in a position to comment on the findings
of Losing America's Memory except to add our voice to those
who are concerned about the growing problem of historical
illiteracy in the United States. We have long argued that
history should occupy a large and vital place in the
education of both the private person and the public citizen.
As historian Kenneth T. Jackson has written, ``Unlike many
people of other nations, Americans are not bound together by
a common religion or a common ethnicity. Instead, our binding
heritage is a democratic vision of liberty, equality and
justice. If Americans are to preserve that vision and bring
it to daily practice, it is imperative that all citizens
understand how it was shaped in the past, what events and
forces either helped or obstructed it, and how it has evolved
down to the circumstances and political discourse of our
time.'' Indeed, the office of citizen cannot be filled
property in today's democratic society without an
understanding of American history, nor can students afford to
go into the twenty-first century ignorant of the history and
culture of other nations.

Eugene W. Hickock, Secretary of Education, Commonwealth of
Pennsylvania:
ACTA's recent study, Losing America's Memory, is deeply
troubling for many reasons. The findings suggest to me that
the teaching of our nation's history has taken a back seat
in our elementary and secondary schools, likely replaced
by failed fads or trends that have permeated our education
system for decades. But, we cannot expect K-12 education
to take full responsibility; our higher education
institutions often have replaced the study of our American
culture with watered down programs and curricula that
focus more on our popular culture. It is time for
Americans from all walks of life--parents, educators,
students, and local, state, and national leaders--to step
up their efforts to reverse this disturbing trend and to
make sure our nation's history is a key part of the
curriculum at every level. I applaud Senator Lieberman and
Congressman Petri for their strong commitment and bold
efforts to reverse this trend and to make sure every
student knows and appreciates our Republic's rich history.

James C. Rees, Executive Director, Historic Mount Vernon:
With each year that passes, it becomes more and more
evident that the people entering our gates at Mount Vernon
know next to nothing about the real George Washington. They
usually recognize his image from the dollar bill, and
sometimes they're familiar with the age-old myths about the
cherry tree and the silver dollar toss across the
Rappahannock River. But when it comes to even the most
rudimentary facts--what war he was in and when he was
president--it is incredible how many people draw a blank. And
it's not just the kids in grade school who have somehow lost
touch with George Washington. It is their parents as well.
This most recent survey of college students confirms our
worst fear: that the next generation of parents will continue
this trend of ignorance. To put it as simply as possible, it
would be naive to think that George Washington could be first
in the hearts of this generation, because it simply doesn't
know and appreciate his remarkable leadership and character.

Walter A. McDougall, Pulitzer prize-winning professor of
history, University of Pennsylvania:
The findings of this excellent ACTA report are deemed
``shocking.'' In fact, they are all too predictable, which is
why they deserve the widest dissemination. Americans simply
cannot expect rigorous history instruction in their K-12
schools so long as the nation's elite colleges and
universities delete history from their curricula.

Thomas Egan, Chairman of the Board, State University of New
York:
ACTA's recent report ``Losing America's Memory,'' is
alarming proof that our graduates are failing to receive a
strong grounding in their past. At SUNY, we are pleased to be
among the vanguard of university boards to require U.S.
history as part of a core curriculum demanded of our
graduates. Congressional action today confirms what we have
already concluded: students must be familiar with their
history in order to be engaged participants in the civic
life of our nation.

Stepeh H. Balch, President, National Association of Scholars:
More than most nations, America is defined by shared
memories. Great deeds, stirring moments, inspiring heroes,
hard-won victories, occasional defeats, and, most
significantly, lofty ideals--declared, attacked, and
ultimately vindicated--map our collective identity. ACTA's
study, ``Losing America's Memory,'' thus strongly suggests
that we are also in danger of losing America itself. Its
findings should be a wake-up call for our educators who have
been clearly shirking their responsibilities.

Candace de Russy, Member of the Board, Chairman, Academic
Standards Committee, State University of New York:
As part of their duty to ensure the academic excellence of
their institutions, the nation's higher-education governing
boards are beginning to promote U.S. history requirements. We
trustees of the State University of New York have
accomplished this by mandating the study of American history
as part of a larger core curriculum which all SUNY
undergraduates must now pursue. This mandate is consonant
with our determination to raise academic standards. It also
reflects our commitment to help ground students in the
fundamental norms and ideals we as citizens need to hold in
common in order that this free society endures.

Dr. Balint Vazsonyi, Founder and Director, Center for the
American Founding:
Having grown up in Hungary, in turn under German National
Socialist and Russian International Socialist terror, I have
learned the absolute need of socialists to erase the national
memory as a precondition for disseminating their own
fictitious history. The so-called National Standards for U.S.
History demonstrate that the second stage of this process is
already under way. Alone clear identification of the ideology
that mandates the erasure of national memory can provide a
meaningful response to the crisis. It is then up to the
advocates of that ideology whether they desire continued
identification with it. Incorporating more of the current,
mostly fraudulent histories in the curriculum only serves
those who have created the crisis in the first place.

Marc Berley, President, Foundation for Academic Standards &
Tradition:
While students may not know as much as they should about
American history, they do know what they're missing. And they
want their colleges to do exactly what Senator Joseph I.
Lieberman and Congressman Thomas E. Petri are urging. In
``Student Life,'' a national survey of 1005 randomly selected
college students conducted by Zogby International and
released last week by the Foundation for Academic Standards
and Tradition, 8 out of 10 college students said their
schools need to ``do a better job teaching students the basic
principles of freedom in America.''

Michael C. Quinn, Executive Director, James Madison's
Montpelier:
America is forgetting its heritage, and it does matter. The
American Council of Trustees and Alumni has recently taken a
survey of college seniors, and has exposed the failure of our
universities to teach our nation's history. Only 23 percent
of the college seniors surveyed could correctly identify
James Madison as the ``Father of the Constitution.'' Why does
this matter? It matters because the American nation exists
through its heritage. Americans have only one thing that
unites them as citizens: a shared vision of democracy.
Citizens of almost every other country are united by a shared
language, a shared religion, a shared geography, or a shared
ethnicity. In America, we join together as a people because
of nothing more than an idea. Yet the idea we share as a
people--the constitutional democracy pioneered by James
Madison and other founding fathers--is one of the most
powerful ideas on earth. No other form of government has
guaranteed so much individual liberty and economic
opportunity to its citizens. The failure to teach American
history, with its lessons of struggle and idealism, of
inspiring leaders like James Madison, is failing our nation.
Each generation has an obligation to instill the shared idea
of democracy into the next generation. And American history--
the story of the birth and success of that vision of
democracy--makes our shared idea a lasting, meaningful part
of every new citizen's life.

The PRESIDING OFFICER. The question is on agreeing to the managers'
amendments Nos. 3700 through 3731.
The amendments (Nos. 3700 through 3731), en bloc, were agreed to.
Mr. SPECTER. Mr. President, if there is any issue about the pendency
of the Baucus amendment, I think it is in the managers' package. I ask
unanimous consent to vitiate the request for

[[Page S6204]]

the yeas and nays on the Baucus amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. SPECTER. Mr. President, parliamentary inquiry. Are we now ready
for third reading?
Mr. GRAMM. Mr. President, I renew my point of order.
The PRESIDING OFFICER. The Senator from Texas raises his point of
order. The point of order is sustained.

training needs for appropriate use of seclusion and restraint

Mr. LIEBERMAN. Will the Chairman of the Labor Health and Human
Services Appropriations Subcommittee yield for a question?
Mr. SPECTER. I will be pleased to yield for a question from the
Senator from Connecticut.
Mr. LIEBERMAN. First, I want to compliment the chairman and the
ranking member, Mr. Harkin for bringing this bill to the Senate in a
very timely way and for the committee's attention to the several health
programs funded by this Bill that very broadly benefit the entire
Nation.
I also want to compliment the chairman and the ranking member for the
committee's report language from last year that urged the Department of
Health and Human Services to address the inappropriate use of seclusion
and restraint in mental health facilities across the Nation that has
resulted in tragic and unnecessary deaths and injuries. The committee's
language has helped focus attention on this matter and progress has
been made. For example, the Health Care Financing Administration (HCFA)
has issued interim ``conditions of participation'' rules governing the
use of restraints and seclusion in facilities receiving Medicare and
Medicaid reimbursement. I thank the committee for its assistance in
making progress on this matter.
Mr. President, what we have learned from the National Mental Health
Association, the Child Welfare League, and my own states Klingberg
Center is that a significant obstacle to making further progress is the
high turnover rate in many of the mental health facilities across the
country and the recurring need to provide training to new personnel in
these facilities on the appropriate use of seclusion and restraint. To
address this national problem, would the Chairman support funding a
demonstration project for model training and education programs for the
appropriate use of restraints?
Mr. SPECTER. I thank both Senators Dodd and Lieberman for their work
in bringing this matter to our attention and I would certainly support
such a demonstration.
Mr. LIEBERMAN. I thank the Chairman for his continuing leadership on
this matter.
Mr. DODD. I would like to also thank the Chairman and the Ranking
Member for their assistance on this issue which has been of particular
concern in my state. In fact, I worked to develop legislation last
year, S. 976, the Compassionate Care Act, cosponsored by Senator
Lieberman, that recognizes the critical need for adequate training in
restraint use and alternatives to their use. The Compassionate Care Act
was passed by the Senate unanimously last year as part of the
reauthorization of the Substance Abuse and Mental Health Services
Administration (SAMHSA) legislation and it is my hope that the House of
Representatives will soon act on this important legislation.
Meanwhile, however, it would appear to me that there are nationally
based consumer organizations that could make an important contribution
to the development of model training and education programs that could
effectively serve to lessen the inappropriate use of restraint and
seclusion.
Mr. SPECTER. Yes. It seems to me that such groups would be strong
competitors for an education and training demonstration grant.

medicare contractor funding

Mr. CRAIG. I am concerned about the funding level for Medicare
contractors. The Senate committee mark reduces the FY 2001 funding
level by $57 million below the President's Budget recommendation. I
believe that this funding reduction will adversely impact fee-for-
service claims processing activities and the ability of contractors to
provide critical beneficiary and providers services.
In the recent past, we have seen the effect inadequate funding levels
can have on services. In 1998 payments were slowed down, and
beneficiaries and providers were forced to deal with more voice mail
rather than human beings when they called their contractors with
questions about claims. We need to fund this program adequately to
ensure beneficiaries get the service they deserve.
Mr. DORGAN. I want to make it clear that funding to assure the timely
and accurate processing of Medicare claims also is a high priority for
me and the beneficiaries in my state.
I am concerned that HCFA projects a 3.5 percent increase in claims
volume next year and yet our budget flatlined funding for Medicare
contractors. However, I am even more concerned that the House has cut
the Medicare contractor budget by $79 million from current levels. The
Senate, at the very least, must assure that this important program is
not cut. Additionally, I would like to work with Senator Craig to
secure additional funding for the Medicare contractors, if funds become
available.
Mr. SPECTER. I understand the issues both Senators are raising and
the importance of adequately funding the Medicare contractor program. I
will work with my two colleagues to try to keep the Senate funding
level is kept intact and that no funding cut is made to the Medicare
contractor program.

hcfa coverage change

Mr. HOLLINGS. Mr. President, I rise today to discuss an issue of
importance to the people of South Carolina with my colleagues from
Pennsylvania and Iowa.
In January of 1999, South Carolina enhanced its Medicaid drug program
to provide eligible adults with four prescriptions a month instead of
three. This was a much needed change that HCFA had encouraged South
Carolina to make over a number of years. Unfortunately, South Carolina
improperly notified HCFA of the coverage change. Instead of filing a
State Plan amendment, South Carolina distributed a Medicaid Bulletin to
relevant parties--including three officials at HCFA's Atlanta regional
office, believing that to be sufficient. The South Carolina Department
of Health and Human Services brought their oversight to HCFA's
attention. South Carolina and HCFA are currently involved in
discussions regarding whether South Carolina should receive federal
funds for 4th prescription expenditures that occurred between January
1, 1999 and September 30, 1999.
At this time, a legislative remedy does not appear necessary to allow
HCFA to impose suitable fines on states that provide notice of Medicaid
coverage changes but do not properly file State Plan amendments. I am
encouraged by the response officials in South Carolina have received
from HCFA and hopeful that a resolution can be reached in a manner
agreeable to all parties. Nevertheless, I wanted to bring this matter
to the attention of the distinguished chairman and ranking member of
the subcommittee and inform them that I may revisit this issue at a
later date if necessary.
Mr. SPECTER. I thank my colleague from South Carolina for bringing
this matter to my attention. I too hope that South Carolina and HCFA
can resolve their difference, but would be willing to discuss the
matter in the future if an agreement cannot be reached.
Mr. HARKIN. I agree with the comments of the chairman.
Mr. HOLLINGS. I thank the distinguished chairman and ranking member
of the subcommittee for their attention to this matter and will keep
them appraised of future developments.

medicare integrity program

Mr. HARKIN. I am very concerned about the proposed $50 million
funding cut to the Medicare Integrity Program (MIP) approved by the
House Appropriations LHHS Subcommittee. The Senate has recommended that
MIP be funded at $680 million, the amount authorized in HIPAA.
In 1999, Medicare contractors saved the Medicare Trust Funds nearly
$10 billion in inappropriate payments--about $18 for every dollar
invested. Any funding cut to MIP is tantamount to the government
throwing money out a window. In fact, I believe, because of the
tremendous need to reduce an estimated $14 billion in Medicare waste,
we

[[Page S6205]]

should increase MIP funding. Therefore, I will work hard to ensure that
the Senate funding level for this important program is not compromised.
It should be higher, not lower.
Mr. GRASSLEY. I've long been committed to the effective and efficient
management of the Medicare program, specifically the detection of fraud
and abuse. I supported the creation of the MIP program, established
under HIPAA, to provide a stable and increasing funding source for
fraud and abuse detection efforts. Prior to MIP, Medicare contractor
funding for anti-fraud and abuse activities was often reduced because
of other spending priorities in the annual appropriations process. MIP
was created to prevent that from happening again. The House
Appropriations Committee recommendation is in clear disregard of
congressional intent.
Additionally, I am concerned about the Senate Appropriations
Committee recommendation to flatline the Medicare contractor budget.
HCFA requested a $57 million increase to the Medicare contractor
budget, in part to ensure implementation of certain balanced budget
amendment provisions. Without this money, I am told by HCFA, that the
final provisions of BBA will not be implemented. It doesn't make much
sense to pass laws, if we don't provide the funding to ensure their
implementation.
Mr. SPECTER. Please rest assured that during conference, I will try
to keep MIP funding at the Senate recommended level of $680 million. I
understand the importance of the MIP program to the integrity of the
Medicare Trust Funds and will work with my colleagues to ensure full
funding of this program.
Regarding the Medicare contractor budget, I am committed to the
Senate Appropriations Committee funding recommendation of $1.244
billion and will work in conference to keep the Senate's funding level.

outreach services

Mr. DeWINE. Mr. President, as Chairman of the Aging Subcommittee I
would like to take this opportunity to compliment the Chairman of the
Labor, Health and Human Services, Education Appropriations
Subcommittee, Senator Specter, for his efforts to address the needs of
America's aging population. At this time, I would like to engage the
distinguished chairman in a colloquy.
Mr. President, there is a lack of understanding of what constitutes
the best outreach and professional services for our elderly population.
I am pleased to report that Ohio is taking the lead in providing
quality health care professionals to the provider community. In
particular, the Geriatric Nursing Program at the University of Akron
has been recognized as the top such program in the United States. They
are most interested in identifying and developing best practices in
elder care that can be disseminated nationally for use by other
institutions and health care providers. Would you agree that such a
program would help improve the overall quality of care of our elderly
population?
Mr. SPECTER. Mr. President, I would like to thank the Senator from
Ohio for his kind remarks and his dedication on this most important
matter. I, too, would agree that such an initiative would be most
valuable.
Mr. DeWINE. Mr. President, I appreciate the comments from the
gentleman from Pennsylvania and would ask that the Chair support the
program in the upcoming conference with the House of Representatives.
Mr. SPECTER. Mr. President, I consider the interests of older
Americans, particularly the issue of ensuring quality health care, to
be among the most important matters that come before the subcommittee.
The gentleman from Ohio has my commitment to support the project in
conference.

huntington's disease

Ms. MIKULSKI. Mr. President, I rise today with the Chairman of the
Senate Appropriations Subcommittee on the Departments of Labor, Health
and Human Services, and Education to discuss a fatal brain disorder
called Huntington's disease. This genetic ailment, which has no cure,
has afflicted approximately 30,000 Americans, and over 150,000 more
people in our country are at risk. In my state alone, it is estimated
that over 500 people have Huntington's, and another 4,742 are at risk.
Also known as ``HD,'' the illness is like a cross between Alzheimer's
disease and Parkinson's disease. Everybody with the defective gene will
become ill, slowly losing the ability to walk, talk, eat, and reason
and eventually dying from choking, infection, or heart failure. HD
strikes both sexes, all ethnicities, and sometimes even children. In
addition, each child of a parent with HD has a 50/50 chance of
inheriting the gene.
One family that has been struck by the terrible realities of
Huntington's disease is the Mason family of Baltimore, Maryland. Troy
Mason was once the agile quarterback on his high school football team.
Today at age 36, Mr. Mason uses a wheelchair and can only walk a bit
and speak some words. His wife, Rosemary, is his full time caregiver.
Troy and Rosemary's two children have a 50/50 chance of inheriting the
HD gene. Not only does Mrs. Mason care for her husband, but she also
cares for her mother who suffers from HD. This means that Mrs. Mason
also has a 50/50 chance of inheriting the HD gene. Mrs. Mason not only
has to face the incredible daily stresses and strains of caregiving,
but must also face the possibility that she and her children may
someday have Huntington's disease themselves. This Baltimore family is
courageously fighting Huntington's disease, but they need our help.
Mr. SPECTER. I am familiar with the horrible effects of Huntington's
disease. In my state, 1,200 people are affected. But I am optimistic
about a cure. HD research is advancing rapidly and could be the Rosetta
stone to treatments for Alzheimer's Parkinson's, and other
neurodegenerative disorders that together strike millions of people and
their families.
I am also hopeful that through public and private medical research
funding, we will soon approach a better understanding of, and perhaps
even a cure for, this terrible disease. Researchers at the University
of Pennsylvania are part of this effort. The federal government clearly
has a significant role to play in this struggle. In Fiscal Year 1999,
the National Institute of Neurological Disorders and Stroke at the
National Institutes of Health (NIH) dedicated $62.5 million to
Huntington's Disease research. Also commendable is the commitment of
the Huntington's Disease Society of America (HDSA), which this year
will allocate an estimated $2.8 million to research in this area.
Ms. MIKULSKI. The people of Maryland appreciate this support by the
NIH and laud your and Senator Harkin's leadership in doubling the NIH
budget over five years. I am very pleased to join you in this worthy
endeavor. We are proud to have an HDSA Center of Excellence in
Maryland, at Johns Hopkins University and Johns Hopkins Hospital. Johns
Hopkins also receives funding from NIH to conduct Huntington's disease
research. However, I believe additional resources are needed to fund
important HD research. I am concerned that the current health
appropriations bill does not provide guidance to the NIH on HD funding
and research priorities.
Mr. SPECTER. I understand the Senator's concerns. The Committee has
included nearly $1.2 billion in this year's appropriations bill for the
National Institute of Neurological Disorders and Stroke, NINDS. This is
a significant increase over the FY00 level. I believe that the NINDS,
and the NIH generally, devote additional resources to Huntington's
disease research in FY 2001. I also believe that the NINDS could
increase support for the centers of excellence and other programs
developed by the Huntington's Disease Society for the care of HD
patients.
Ms. MIKULSKI. I thank the Chairman for his attention to Huntington's
disease. To eliminate this horrible illness and others like it we must
build and strengthen the partnership between the federal government,
academia, and private organizations. I wish to thank the Distinguished
Senator from Pennsylvania for his assistance. I yield the floor.

strategic plan for pkd

Mr. SANTORUM. Mr. President, I wonder if my distinguished colleague,
the senior senator from Pennsylvania, would answer a few questions on
funding for research regarding polycystic kidney disease?
Mr. SPECTER. I would be happy to answer questions on this issue.
Mr. SANTORUM. I thank the Chairman. I know that you are very much

[[Page S6206]]

aware of the devastation caused by polycystic kidney disease, better
known as PKD. Our colleagues may be interested to know that this
disease afflicts over 600,000 Americans, which is more than the
combined total of cystic fibrosis, Huntington's disease, sickle cell
anemia, hemophilia, muscular dystrophy and Down's syndrome. That
translates into an average of almost 1400 sufferers in each
congressional district, or 12,000 in each state.
PKD is the most prevalent life-threatening genetic disease, and is
the third leading cause of kidney failure, resulting in almost $2
billion spent every year to treat end-stage renal disease requiring
dialysis or transplantation. End-Stage Renal Disease is the fastest
growing part of Medicare, and I know we are all looking for ways to
strengthen that important program.
Mr. President, I would like to ask the Chairman if, in the context of
the funding provided to the National Institutes of Health in this bill,
could he tell us your intentions with regard to PKD research?
Mr. SPECTER. As the Senator knows, we are entering the third year of
a bipartisan effort to double funding for the NIH. Within that budget,
we have been able to provide significant increases in the budget for
the National Institute of Diabetes and Digestive and Kidney Diseases.
It is my hope and intention that, with these additional funds, NIDDK
will fully implement the Strategic Plan for PKD put forward by a panel
of blue-ribbon experts which they convened in 1998. These expert
scientists and doctors have stated that, with a total PKD research
budget of $20 million, which we provide in this bill, they are
confident that a treatment for PKD can be achieved in the very near
future. In fact, I am very heartened by recent reports indicating that
a drug currently used to treat cancer has been shown to actually stop
the progression of PKD in laboratory animals. This discovery, coupled
with statements from our leading genetic researchers to the effect that
PKD is the most rapidly advancing area of genetic research, convinces
me that the additional funds provided in this bill will allow NIDDK to
produce a treatment and eventual cure for this devastating disease.
May I say to my colleague that I intend to do everything in my power
to ensure that NIDDK implements the Strategic Plan for PKD. This bill
provides the budgetary means to do that, and I will be following up
with NIDDK on the disposition of those funds.
Mr. SANTORUM. I thank my esteemed colleague for his help in this
matter.

ocular albinism

Mr. BROWNBACK. I rise today to bring to the attention of the senate
the serious disease Ocular Albinism. Ocular Albinism is an x-linked
genetic disorder affecting 1 in 50,000 American children, mostly males.
Affected patients show photophobia, nystagmus, strabimus, a loss of
three dimensional vision and a severe reduction in visual acuity, due
to the abnormal development of the retina and optic pathways. There are
five diseases relating to Ocular Albinism including Fundus
Hypopigmentations, Macular Hypoplasia, Iris Transillumination, Visual
Pathway Misrouting and Nystagmus
Mr. SPECTER. Ocular Albinism is one of the many diseases being
researched by the NIH. This is why I have been pressing for a doubling
of funding for NIH and have included a $2.7 billion increase in funding
in this bill.
Mr. BROWNBACK. In consideration of the severity of this disease and
the paucity of current NIH sponsored research I would certainly hope
that the NIH will develop and fund a research initiative in cooperation
with the National Eye Institute in to the causes of the treatments for
Ocular Albinism and related Disorders.
Mr. SPECTER. I agree with my colleague and thank him for brining it
to the attention of the Senate.
Mr. BROWNBACK. I thank the Chairman of the Subcommittee and commend
him for his understanding of the importance of this issue.

federal family statistics

Mr. BROWNBACK. Mr. President, I rise today to engage in a brief, but
important colloquy with the distinguished chairman of the Labor-HHs
subcommittee of the Appropriations Committee, Senator Specter. I
appreciate his willingness to engage in this colloquy, and his
commitment to ensuring that the federal government does the best
possible job in gathering vital information on family structure and
function.
It has been said that the family is the cornerstone of civilization.
Certainly, the evidence we have suggests that family structure is one
of the most fundamental indicators of child health and well-being.
Strong families are positively linked to child physical, emotional and
psychological health, social adjustment, academic competence, and
positive behavior. In fact, the more we study family structure and
function, the more information we glean about children's health risks,
and challenges to their well-being and development.
Unfortunately, there is vital data that is not currently being
gathered relating to family structure and function. This is not merely
my opinion, but the statement of the Federal Inter-Agency Forum on
Child and Family Statistics, which declares that important information
on child living arrangements, family structure, and family interaction,
is falling through the cracks, and recommends expanded and enhanced
data-gathering in these areas. Without such data, we are at a
disadvantage in determining the root causes of both youth well-being,
and youth challenges, and addressing them effectively.
It is therefore vital that we encourage the National Center of Health
Statistics, the Agency for Health Care Policy and Research, the
National Institute of Child Health and Human Development,
Administration for Children and Families, Maternal and Child Health
Bureau, Office of the Assistant Secretary for Planning and Evaluation,
and Bureau of Labor Statistics to enhance research in this area.
According to the Inter-Agency Forum on Child and Family Statistics, of
which all these agencies are a member of, regularly collected data are
needed that describe children's living arrangements, and interactions
with parents and guardians, including non-residential parents. In
addition, regularly-collected data are needed on how many children live
with biological parents, step-parents, and adoptive parents, or with no
parent or guardian.
Mr. SPECTER. Senator Brownback, I appreciate the work that you have
put into this, and look forward to working with you on appropriate
language which may be included in the Labor-HHS conference report.
Mr. BROWNBACK. I thank the subcommittee chairman. Mr. Chairman, I
should add that there are many sources of information that only the
federal government has the means and resources to tap effectively.
Gathering this data may also prove helpful in reducing health care
costs, strengthening families, and improving the health and well-being
of children.
Mr. SPECTER. I thank my colleague from Kansas for his work on this
issue.
Mr. BROWNBACK. I thank the Chairman.

strengthen our sisters

Mr. TORRICELLI. Mr. President, I rise to ask the distinguished
managers of the bill if they would consider a request I have concerning
the conference.
Mr. SPECTER. I would be happy to consider a request from by colleague
from New Jersey.
Mr. TORRICELLI. I rise in support of Strengthen Our Sisters, a non-
profit, tax-exempt shelter in West Milford, New Jersey that has
provided homeless and battered women and children with safe shelter and
supportive services since 1988. The mission of Strengthen Our Sisters
is to help women and children break the cycle of domestic violence and
homelessness, which, if unchecked, is passed from one generation to the
next. To date, Strengthen Our Sisters has experienced great success in
fulfilling its mission as evidenced by its remarkable growth. While in
1988, Strengthen Our Sisters started with an annual budget of less than
$36,000, this year's budget stands at $1.3 million. Strengthen Our
Sister's continued growth is a result of their demonstrated expertise
in management and dedicated and knowledgeable staff.
As a way to help more women, Strengthen Our Sisters would like to
expand the service their program offers for older women. In 1998,
Strengthen Our Sisters served four women over age fifty-five, a number
that jumped to fourteen in the span of less than a

[[Page S6207]]

year. The older women they serve often arrive with long histories of
abuse that requires special services related to domestic violence, drug
and alcohol addictions, unemployment and mental health. Indeed, the
need for assistance naturally increases as we grow older. And, adding
life changing circumstances such as abuse, homelessness and physical
challenges to the equation increases the need for assistance
exponentially. Thus, Strengthen Our Sisters would like to expand the
services its program offers to address the needs of senior women in a
comprehensive and integrative manner that focuses on helping them
attain appropriate shelter, resources and advocacy services.
The work of Strengthen Our Sisters is an appropriate focus for the
Committee because domestic violence is a national epidemic. Expanding
the Strengthen Our Sisters program to help senior women could be a
model for shelters across the country that are confronting similar
problems and population trends.
Mr. SPECTER. In the past, we have faced difficult choices in making a
determination of funding priorities and this year promises to be no
exception. We are aware of the request by Strengthen Our Sisters and
commend their efforts toward expanding its program to serve more women
in need. In conference, we will keep in mind your request as well as
those with similar meritorious characteristics and goals.
Mr. TORRICELLI. I thank my distinguished colleague for his assistance
with this matter. I am thankful for the Committee's acknowledgment of
the expertise and dedication that Strengthen Our Sisters brings to
helping our most vulnerable population and I hope that funding for this
important organization can be found in conference.

comprehensive school reform funding in labor hhs appropriations bill

Mr. BINGAMAN. Senator Lugar, I know you're aware of the tremendous
good that the Comprehensive School Reform program (CSRD) has introduced
to many struggling schools with high proportions of disadvantaged
students, and the potential that the program offers for the numerous
schools that desire to implement comprehensive reform in their
buildings. While I recognize the considerable task of Chairman Spector
and Ranking Member Harkin in accommodating the great number of
priorities funded in the FY'01 Labor-HHS-Education appropriations bill,
it concerns me that the bill before us provides no funds for the CSRD--
a tremendously popular and effective program.
Mr. LUGAR. I agree that few areas of our education funding can have a
more positive impact on education in America than the CSRD. This
program is a key tool for helping struggling schools adopt important
reforms. Good reform programs are a bargain for our schools and our
children when we compare their costs to that of retention, special
education and illiteracy. In fact, I filed an amendment to S. 2,
legislation crafted to reauthorize the Elementary and Secondary
Education Act, that would have more than doubled funding for this
important program. Unfortunately, this bill has been set aside.
Mr. BINGAMAN. The notion of systematic, comprehensive reform is
inherently appealing because rather than piecing together discordant or
incompatible pieces of change, these approaches provide a holistic and
coordinated plan of action to improve student achievement and outcomes.
I know that a number of research-based models of comprehensive school
reform have been developed in recent years, and one that I am familiar
with and which has spurred great progress across New Mexico is the
Success for All program.
Success for All is serving about 1550 elementary schools in 48
states, and is also assisting related projects in five other countries.
Fifty schools in New Mexico have adopted this program with great
results.
Mr. LUGAR. Success for All is an exemplary research-based reform
program. I have spent time with Dr. Slavin, who developed this program
at Johns Hopkins, and I have been visiting Success for All schools in
Indiana. The results in these schools are so promising that I have
written to every superintendent in Indiana urging them to take a look
at the program.
The discipline and accountability of Success for All greatly reduce
the possibility that students will fail. By teaching children to read
in the early grades, our schools can avoid holding students back,
promoting them with insufficient ability or transferring them out of
the normal curriculum to special education courses. Referrals to
special education in Success for All schools have been shown to
decrease by approximately 50 percent. In schools where Success for All
is taught, students learn to read by the end of the third grade. By the
fifth grade, students in these schools are often testing a full grade
level ahead of students in other schools.
Mr. BINGAMAN. It is clear that as we seek ways to assist resource-
poor and failing schools, we should increase support for research-based
proven programs like Success for All. The House bill included the
amount requested by the Administration--$240,000,000--for this program
and I know that Senators Specter and Harkin are supporters of the
program. So, I'd like to encourage the Senators to include funding for
it as the bill moves to conference. Funding at this level would allow
approximately 2,250 schools to receive new grants and continue support
for 1,025 schools currently using such funds to carry out research-
based school reforms. It is my hope that we can work together as the
bill moves through the appropriations process to fund this successful
program.
Mr. SPECTER. Senators Lugar and Bingaman make some very valid points
with respect to the comprehensive school reform program. In conference
with the House, I will make every effort to work with the Conferees to
provide adequate resources for the CSRD.
Mr. HARKIN. I agree that the comprehensive school reform program has
had a positive impact in many of our schools. As the bill moves to
conference, I will work with Chairman Specter to restore funding for
this program.

RELIEF FOR DISPLACED COAL WORKERS IN INDIANA COUNTY, PENNSYLVANIA

Mr. SANTORUM. Mr. President, I have sought recognition to discuss
with Chairman Specter the plight of nearly 1,000 displaced coal workers
in southwestern Pennsylvania. As Senator Specter is aware, these
employees of Consol Coal have recently lost their jobs and have sought
federal assistance to provide a wide variety of adjustment assistance
services including occupational skills training, career plan
development, and job search assistance.
As my colleague knows, the Commonwealth of Pennsylvania had requested
over $12 million in an emergency grant application that was submitted
to the U.S. Department of Labor. In addition to the services already
mentioned, needs-related payments were requested in order to provide
income support to workers who participated in retraining activities.
These payments are essential as they provide a modest source of income
for the workers while they are pursuing additional skills and education
in order to prepare for a new vocation. Unfortunately, the Department
of Labor only funded a portion of the request, indicating that needs-
related payments could not exceed 25 percent of the total application.
However, in the past the Department has not held similar applications
to the same standard. In fact, I have been made aware of a grant award
for mine workers who requested needs-related payments in excess of 70
percent of the total grant application.
Knowing of the need of these displaced coal workers and the
inconsistency of the Department of Labor in awarding funds, I ask that
Chairman Specter work with me in the coming weeks to identify
appropriate funds in the Department of Labor's budget to support these
workers as they prepare for new careers.
Mr. SPECTER. Mr. President, I want to thank my friend, the Senator
from Pennsylvania, for his comments. He has been a tireless advocate of
the coal workers in Indiana County, and I applaud his efforts on their
behalf.
I, too, am well aware of the situation being faced by the former
employees of Consol Coal and wrote to the Department of Labor on
January 31, 2000 to urge that federal retraining funds be made
available. As my colleagues are aware, we face tight budget constraints
in this legislation. I will continue working with my colleague from
Pennsylvania in the coming weeks in an effort to identify sources of
funding that may be available for this purpose.

[[Page S6208]]

graduate medical education program

Mr. MACK. Will the Chairman of the Labor, Health and Human Services
and Education Appropriations Subcommittee yield for a question?
Mr. SPECTER. I will be pleased to yield to the Senator from Florida
for a question.
Mr. MACK. I was most pleased to see that the Senate report
accompanying this bill urged the Department to act in a timely manner
to issue a Notice of Proposed Rule Making to include psychology into
the Graduate Medical Education program. As you know, the Senate Finance
Committee and the House Ways & Means Committee have been working with
the Department of Health and Human Services on this matter since 1997.
Both the Conference Report on the Balanced Budget Act of 1997 (Report
105-217 issued on July 30, 1997) and the Conference Report on last
year's Omnibus bill (Report 106-479 issued on November 18, 1999) urged
the Department to act favorably on this matter. In fact last year's
Conference Report urged the Secretary to issue Notice of Rule Making to
accomplish this modification before June 1, 2000.
Mr. President, we thank you for including language in your report--
Report 106-292--to further support this effort. I am saddened to report
that the advice the Appropriations Committee has given the Secretary is
being given little notice, just like all the previous requests to her
on this matter. Mr. President, at this point, I would request unanimous
consent that a letter I wrote to Secretary Shalala, along with Senator
Graham, Congressman Shaw, and Congresswoman Thurman on April 27, 1998
be published in the Record, following this colloquy.
Mr. President, many letters have been written to the Secretary and
Nancy Ann Min DeParle, the Administrator of the Health Care Financing
Administration, on this subject. Language has been included in two
Finance/Ways & Means Conference Reports on this subject. Language has
been included in the L-HHS Report. Despite all of these urgings, the
desired result has not been produced. Would the Chairman of the
Subcommittee consider including bill language in the final bill
mandating this action if the Department has not issued the Notice of
Proposed Rule Making by the time the Subcommittee goes to Conference
with the House.
Mr. SPECTER. I would be pleased to look at this matter between now
and the time of Conference.
Mr. GRAHAM. I understand that the Health Care Financing
Administration has now cleared the NPRM, but there are other
Departmental Agencies who now have questions about issuing the NPRM. I
also concur with my colleague Senator Mack, that this issue has
remained unresolved for too long, and I also believe it would be
appropriate to include language to mandate this change.
Mr. MACK. I thank the Chairman for his response to our inquiry.
There being no objection, the letter was ordered to be printed in the
Record, as follows:

Congress of the United States,

Washington, DC, April 27, 1998.
Hon. Donna Shalala,
Secretary of Health and Human Services,
Washington, DC.
Dear Secretary Shalala: The purpose of this letter is to
bring to your attention report language included in the
Balanced Budget Act of 1997 (P.L. 105-33) and to request
implementation of the language at the earliest possible date.
The language stated: ``With regard to graduate medical
education payments, the Committee also notes that the
Secretary reimburses for the training of certain allied
health professionals, and urges the Secretary to include
physician assistants and psychologists under such
authority.''
The Graduate Medical Education (GME) program currently
supports the training of 13 allied health professions
including hospital administration, medical records, x-ray
technology, dietetic internships and inhalation therapy. We
believe the cost of including two additional health
professions in the GME program, as recommended by the Senate
Finance Committee and the House Ways and Means Committee,
would be small and offset by the additional benefits to
patient care.
In our view, including psychologists and physicians
assistants in the GME program would be of significant benefit
to Medicare patients. For example, there is an excellent
program at the University of Florida where clinical
psychologists, working in Shands Teaching Hospital, treat a
variety of individuals with medical and psychological
disorders. This program operated at and supported financially
by Shands University Hospital contributes significantly to
patient care and is the kind of program the Conference
Committee considered appropriate for GME reimbursement.
We look forward to hearing from you regarding early
implementation of the Conference language.
Sincerely,
Hon. Connie Mack,
U.S. Senator.
Hon. Bob Graham,
U.S. Senator.
Hon. E. Clay Shaw,
Member of Congress.
Hon. Karen L. Thurman,
Member of Congress.

child health institute of the university of medicine and dentistry of
new jersey-robert wood johnson medical school

Mr. TORRICELLI. I rise for the purpose of engaging the Chairman, Mr.
Specter, in a colloquy.
Mr. SPECTER. I'd be happy to join my colleague from New Jersey in a
colloquy.
Mr. TORRICELLI. I would like to take this opportunity to express my
support for a very important initiative to both myself, the State of
New Jersey, and the Nation. The University of Medicine and Dentistry of
New Jersey (UMDNJ)-Robert Wood Johnson Medical School has developed the
Child Health Institute (CHI) of New Jersey--a comprehensive biomedical
research center focused on the development, growth and maturation of
children. The mission of the Institute is to improve the health and
quality of life of children by fostering scientific research that will
produce new discoveries about the causes of many childhood diseases as
well as the treatments for these diseases. Researchers will direct
their efforts toward the prevention and cure of environmental, genetic
and cellular diseases of infants and children.
The hospitals in central New Jersey birth nearly 20,000 babies each
year. The founding of the Child Health Institute has created an
extraordinary health care resource for these hospitals and the patients
they serve. The new Children's Hospital at Robert Wood Johnson
University Hospital is scheduled to open in 2000 and the Child Health
Institute in 2001. Together these institutions will provide state of
the art clinical and scientific research and treatment complex to serve
children and their families, not only in New Jersey, but throughout the
nation with cutting edge care and the latest scientific developments.
At maturity, the Child Health Institute is also expected to attract
between $7 and $9 million of new research funding annually with the
total economic impact on the New Brunswick area estimated to be $50 to
$60 million per year. This facility has also already attracted the
private funding of two endowed professorships designed to allow
recruitment of world-class faculty.
Mr. President, funding for the University of Medicine and Dentistry's
Child Health Institute in this bill would be entirely appropriate under
the Health Resources and Services Administration account. It would be
money well spent. I ask the Chairman to consider providing $5 million
for the completion of the Child Health Institute.
Mr. SPECTER. I thank my colleague for his comments. We have received
numerous requests for funding of health facilities. In the past, we
have faced difficult choices in making a determination of funding
priorities and this year promises to be no exception. We are aware of
the request by the Child Health Institute and commend their efforts
toward enhancing its research and service capacity. In Conference, we
will keep in mind your request as well as those with similar
meritorious characteristics and goals.

antimicrobial resistance

Mr. COCHRAN. It is my understanding that, in view of the pressing
need to deal with both infectious diseases and antimicrobial resistant
diseases, the Chairman will agree that in conference there will be a
total of at least $25 million in new funds to deal with the problem of
antimicrobial resistance and that the total to deal with other
infectious diseases will be at least at the level included in the
Senate bill prior to the amendment.
Mr. SPECTER. That is correct.
Mr. KENNEDY. I commend my colleagues, Senator Specter and Senator
Cochran, for their leadership in having reached agreement on this
important issue. The resources provided under this agreement are an
important first

[[Page S6209]]

step in addressing the critical problem of antimicrobial resistance. I
look forward to continuing to work with my colleagues on this important
issue as the Senate considers the legislation on infectious diseases,
antimicrobial resistance and bioterrorism that I have introduced with
my colleague, Senator Frist.

least toxic pesticides policies

Mrs. BOXER. Mr. President, last March, the Senate passed an
amendment I offered to the Education Savings Accounts bill that said
schools receiving federal funds must notify parents prior to the
application of toxic pesticides on school buildings and grounds. It
also required the distribution of the Environmental Protection Agency's
manual that guides schools in establishing a least toxic pesticide
policy.
I offered that amendment for a simple reason. Toxic pesticides hurt
our kids, and that hurts the education of our kids. The National
Academy of Sciences has found that up to 25 percent of childhood
learning disabilities may be attributable to a combination of exposure
to toxic chemicals like pesticides and genetic factors. Yet, current
EPA pesticide standards are not protective of children, and schools
across America--where our children spend 6 or 7 or more hours a day--
routinely use toxic pesticides. My amendment sought to lessen the
impact of toxic pesticides on our children by urging schools to use the
kinds of products that will harm children the least and to let parents
know when toxic pesticides are going to be used.
Again, my amendment was added to the Education Savings Accounts bill.
However, that bill has not gone anywhere since the Senate passed it on
March 2. I could offer my amendment to the Elementary and Secondary
Education Act bill, but it, too, appears dead.
So, I drafted an amendment to the Labor-HHS Appropriations bill to
provide $100,000 for the Department of Education, in conjunction with
the Environmental Protection Agency, to encourage school districts
across the country to establish a least toxic pesticide policy--which
is the policy in several school districts in California--and to notify
parents prior to the use on school grounds of pesticides that the EPA
has identified as a known or probable carcinogen, a category I or II
acute nerve toxin, or a pesticide of the organophosphate, carbamate, or
organochlorine class.
At the suggestion of my friend from Iowa, the Ranking Member of the
Labor-HHS Appropriations Subcommittee, I will not offer that amendment
because I understand that the managers will work to add language in the
conference report that would accomplish the same thing. May I ask the
Chairman and Ranking Member if that is correct?
Mr. HARKIN. Mr. President, I thank the Senator from California for
bringing this issue before the Senate. I support what she is trying to
do, and I think we can accomplish it through language in the conference
report rather than as an amendment to the bill itself. I assure her
that I will work to include such language in the report.
Mr. SPECTER. Mr. President, I will also work to see that language is
included in the conference report encouraging the Department of
Education to urge schools to adopt a least toxic pesticide policy and
to provide the information and support necessary to do so.
Mrs. BOXER. I thank my collegues.

employment and training grants for dislocated worker employment and
training activities

Mr. DOMENICI. Mr. President, I would like to raise the issue of how
the United States Department of Labor is administering Grants for
Dislocated Worker Employment and Training Activities.
Both the FY 1999 and 2000 Labor-HHS Appropriations Bill contained
earmarks critically important to New Mexico's economic well-being. The
earmarks were directed toward training workers for the State's rapidly
growing technology-based call center industry.
In fact, the industry is generating in excess of 450 jobs per month
that pay approximately $11 per hour with substantial benefits in New
Mexico. These grants would allow for the continued expansion of this
industry by allowing the New Mexico Consortium to create a training
curriculum that will lead to employment in the call center industry
with an emphasis on the placement of hard-to-employ individuals.
However, the Department of Labor's actions regarding these earmarks
has left me deeply distressed by the ill treatment New Mexico has
received, especially in light of the priority placed on this issue by
not only me but, the Committee as well.
It is also my understanding the current program year for the
Department of Labor ends this Friday, June 30th and that there may be
unobligated funds left over at that time. It is also my further
understanding that in the event there are such unobligated funds the
Department could provide some of these funds to a deserving program,
like the training program in New Mexico.
Mr. SPECTER. I understand the concerns raised by the distinguished
Senator from New Mexico in ensuring the Department of Labor properly
funds the projects specified by this Committee.
I would concur with my colleague from New Mexico in the importance of
funding the program to train workers for the State's rapidly growing
technology-based call center industry. In the event there are
unobligated funds left over at the end of the Department's current
program year, I would also urge the Secretary of Labor to consider
allocating funding for the training program in New Mexico.
Mr. DOMENICI. I thank the distinguished Chairman for his
consideration and support for this important matter.

low-income home energy assistance program

Mr. WELLSTONE. I rise in hope that Chairman Specter and Ranking
Member Harkin of the Labor-HHS Appropriation Subcommittee will engage
in a colloquy with myself and Senator Jeffords, Chairman of the Health,
Education, Labor and Pensions Committee, on the importance of advance
funding for the Low Income Home Energy Assistance Program (LIHEAP).
I had initially planned to offer an amendment, with Senators
Jeffords, Kohl, Lieberman, Levin, Schumer, Reed, Dodd, Kennedy, and
Leahy, that would restore advance funding for this essential program.
However, since it is my understanding that my colleagues will work in
the conference to ensure that the House provision for advance LIHEAP
funding is included in the final appropriation bill, I will withdraw my
amendment.
As my colleagues know, there is broad bipartisan, multi-regional
support for LIHEAP. This year, 46 Senators signed a letter in support
of the program. Specifically, we asked for $1.4 billion in regular
LIHEAP funding, along with $300 million in emergency funding. In
addition, we urged $1.5 billion in advance LIHEAP funding for fiscal
year 2002. It is the lack of this advance funding in the Senate Labor-
HHS appropriation bill that causes me great concern.
As many of my colleagues know, Minnesota is often called the ice-box
of the nation, where bitterly cold weather is the norm. In fact,
Minnesota is the third coldest state, in terms of heating degree days,
in the country, after Alaska and North Dakota. Especially in cold-
weather states like Minnesota, funding for LIHEAP is critical to
families with children and vulnerable low-income elderly persons, who
without it could be forced to choose between food and heat.
As we saw several years ago, when the Federal government shut down,
piecemeal funding approved for LIHEAP had an extremely disruptive
effect on the operation of the energy programs in the states.
Congressional delay and enactment of appropriations bills after October
1 severely hampers states abilities to effectively plan their energy
assistance programs. States operating year-round programs or those that
begin in September are particularly threatened. Therefore, advance
appropriations enable the creation of administrative systems for more
efficient program management, allowing for orderly planning of state
LIHEAP programs.
Will the Chairman work in conference to include this critical advance
funding appropriation in the final Labor-HHS appropriation bill?
Mr. SPECTER. As you know, this is a very difficult year for
appropriators. The budget caps are very tight, and this bill contains
many valuable programs. I recognize and appreciate that the House-
passed Labor-HHS bill provides $1.1 billion in FY2002 advance

[[Page S6210]]

LIHEAP funding. I have been a strong supporter of the LIHEAP program,
and will work in conference to attempt to include the House provision
for advance LIHEAP funding in the final appropriation bill.
Mr. JEFFORDS. First, Mr. Chairman, let me thank you for your hard
work on this appropriation bill, and your dedication to the LIHEAP
program. Next, I would just like to emphasize the importance of the
forward funding provision contained in the 1990 reauthorization
statute--the Augustus F. Hawkins Human Services Reauthorization Act.
This provision responds to the states' need to budget and plan their
LIHEAP programs in advance of the fall/winter heating season, allowing
them to effectively meet their obligations under the law. Timely energy
assistance in the form of consistent advance LIHEAP funding is critical
to the success of LIHEAP. For planning purposes, the states have come
to rely on the predictability that your advance funding mark provides
them.
Our Northeast-Midwest region has experienced extreme fuel price
spikes during the last six months, highlighting the vulnerability of
our low income energy consumers. With fuel prices projected to be even
higher this winter than last, we need an effective LIHEAP program more
now than ever. It is the most effective tool we have to ensure the
safety of our low income households during severe weather conditions.
Mr. HARKIN. I agree that the importance of LIHEAP advance funding has
been demonstrated this past year as many states have faced extreme
temperatures and high fuel costs. LIHEAP advance funding is an
effective tool that allows states to determine eligibility, establish
the size of the benefits, determine the parameters of the crisis
programs and enable the states to properly budget for staffing needs. I
will work with Chairman Specter to attempt to include the House
provision for $1.1 billion in FY2002 advance LIHEAP funding in the
final appropriation bill.
Mr. WELLSTONE. Thank you, Mr. Chairman, Ranking Member Harkin and
Senator Jeffords. I appreciate your commitment to work in conference on
behalf of LIHEAP, and I withdraw the amendment.

centers for independent living

Mr. BENNETT. I would like to thank the subcommittee chairman for
including a $10 million increase for Centers for Independent Living,
part C. However, because of the formula in current law, eighteen states
do not receive any increase in funding. I understand that many of the
smaller states have not received an increase since 1992. It is not my
intention to change the funding formula in an appropriations bill, but
I believe this problem needs to be addressed.
Mr. SPECTER. I appreciate the Senator bringing this to my attention,
and am willing to hear the solution the Senator from Utah proposes.
Mr. BENNETT. The National Council on Independent Living and
individuals in my own state of Utah, are concerned about individuals
with disabilities who reside in underserved areas. NCIL has proposed
changing the formula for Centers for Independent Living, part C. Under
their proposal, fifty percent of funding will be distributed equally
among the states, and fifty percent will be divided among the states
based on population.
Instead of amending the Rehabilitation Act in this bill to
permanently change the formula on this appropriations bill, I propose
$5 million of the $10 million increase included in H.R. 4577, be
divided equally among the states. The remaining $5 million would be
distributed based on current law. Thus every state will receive a
funding increase. In small states, this small amount translates to
roughly $94,000. Based on letters and phone calls I have received, it
appears that the coalition of Independent Living Centers across the
country are amenable to this proposal--even the larger states.
Mr. SPECTER. I thank the Senator. I appreciate the Senator's
sensitivity to changing authorizing language in this bill. I also share
his concerns about the needs of individuals with disabilities in
underserved areas, and I will address this issue as we proceed through
the appropriations process.
Mr. BENNETT. I appreciate the chairman's consideration. It is my hope
that we can reach an agreement that will increase the ability for
Centers for Independent Living to serve the needs of individuals with
disabilities not only in large states, but in smaller, underserved
area.

vocational rehabilitation

Mr. SCHUMER. First, Mr. President, I would like to thank Senator
Specter and Senator Harkin for their leadership and continued funding
of the Vocational Rehabilitation program, which is so important to the
disabled men and women in New York State and across the country.
I would like to take a moment to engage my colleague in a colloquy.
Mr. HARKIN. I thank the Senator for his kind words and would be happy
to engage in a colloquy with him.
Mr. SCHUMER. In Fiscal Year 2000, Congress provided a 1.2 percent
inflationary increase to the Vocational Rehabilitation State Grants
program, which is distributed through a statutory formula using
population and per capita income data. In October of 1999, the Bureau
of Economic Analysis released new estimates of per capita income
resulting in a drastic change in the funding allocation to states.
Under these comprehensive revisions, New York, Massachusetts, Colorado,
Minnesota, Texas, and the District of Columbia lost funding to a level
below that of their Fiscal Year 1999 funding. This shift was both
unexpected and severe, leaving these states' agencies unable to assist
hundreds of physically or mentally disabled men and women needing
assistance toward gainful employment. In my own state of New York, we
lost $1.6 million from our initially expected amount.
Mr. President, I wish to thank Senator Harkin for committing to add
report language during the conference committee negotiations of the
Departments of Labor, Health and Human Services, and Education Bill for
Fiscal Year 2001 that will enable the Department of Education to give
priority status under Fiscal Year 2000 re-allotment funds to States who
received less under the formula in Fiscal Year 2000 than in Fiscal Year
1999, and who are able to meet the criteria outlined in Section
110(b)(2) of the Rehabilitation Act.
Mr. HARKIN. I am pleased to help the Senator from New York and his
colleagues from the other affected states and the District of Columbia.
Mr. SPECTER. I thank the Senator from New York for his effort on this
issue and will do my best to resolve this situation in conference.
Mr. SCHUMER. I thank the Chair.

advanced placement funding

Mr. BINGAMAN. Senators Specter and Harkin, I'd like to express my
appreciation to you and your committee members for agreeing on the
importance of the Advanced Placement (AP) Incentive Program by
recommending that it be funded at $20,000,000--a $5,000,000 increase
over last year's appropriation. As you know, the AP program provides
rigorous instruction to high school students by teachers who have had
additional, intensive professional development. While historically it
was the well-to-do elite that had access to these courses--which not
only cover advanced material but enable students to gain college credit
and advanced standing--today the AP program continues to expand its
reach, so that over half of all high schools in the nation offer AP
courses in a variety of subject areas. The fact of the matter is that
in this era of focus on high standards and improving student
achievement, the AP program offers proven impact on student outcomes in
high school, and there is even research that shows that regardless of
the grade attained, a student who has access to more rigorous course
work in high school is more likely to complete college.
As you know, the AP Incentive Program helps ensure that AP classes
are within reach of low income students by subsidizing the cost of
taking the AP test. These tests cost about $100 and many low income
students would have to pass up the opportunity to take it due to
expense. The program also supports activities designed to expand access
to AP courses, particularly in low income areas. Many schools do not
yet have AP programs and schools with large minority and low income
populations are less likely to offer AP courses. This can be tragic for
many students, as many colleges and universities consider whether a
student has

[[Page S6211]]

taken AP classes when making admissions decisions. Every student--
regardless of socioeconomic background--should have the opportunity to
attend college and to take challenging curriculum in high school. This
program helps to ensure both.
Mr. HARKIN. I agree wholeheartedly with you on the importance of
ensuring that all students are exposed to challenging courses that lead
them on a positive track towards further education, and that teach
critical skills that can be practically applied even if the student
does not continue their education immediately. While it is certainly
just one piece of the puzzle when it comes to strengthening the
academic offerings and outcomes for all students, including
disadvantaged students, the AP program is something I think we should
all be able to agree on supporting.
Mr. BINGAMAN. I also want to share my thanks for the Committee's
attention to the benefits of Internet-based AP programs, particularly
in rural and Native American areas of the country. As technological
capacities at schools increase, there is every reason to utilize such
tools to deliver high-quality programs like AP courses through distance
methods, especially in schools where the student population is too
small or location is too remote to sustain a great deal of variety on-
site. I look forward to working with you and the Administration to
expand support for these kinds of innovative means of advanced
instructional delivery to our rural and Native American schools.
Mr. SPECTER. I agree that Advanced Placement programs can be
extremely valuable in raising standards in high schools and helping
high school students to be better prepared for postsecondary education.
I am glad that we were able to provide an increase in funding for this
program and, in conference with the House, I will make every effort to
work with the Conferees to maintain funding for this program.

smaller learning communities funding in labor hhs appropriations bill

Mr. BINGAMAN. Mr. President, I wanted to take a moment to reiterate
my hope that the conferees on the Appropriations Committee will
consider restoring funding for the Smaller Learning Communities program
under the Fund for the Improvement of Education. Last 7ear $45 million
was appropriated for what has been a very important initiative an the
President has requested $120 million for FY2001. I strongly believe
that we must continue--and indeed increase--our support for this
program. As this appropriations bill goes to conference, I hope that
you and your fellow committee members will decide to meet the
President's request.
A number of research studies in recent years have documented the
value of small schools and smaller learning communities, and the Bank
Street College of Education just last week release a new study called
``Small Schools: Great Strides,'' which unequivocally confirms what we
knew from earlier research--namely, that small schools help students
succeed. This particular study examined the 150 or so small schools
that were founded between 1990 and 1997 in Chicago, and tracks their
progress through 1999. In these elementary schools of fewer than 350
students and these high schools of fewer than 400 students, the
positive trends encompass everything from diminished violence to higher
grade point averages and attendance rates. Of course, small size alone
does not translate into these positive changes, but it certainly does
foster the atmosphere of closeness and community that is conducive to
the kinds of progress that our parents, teachers, and students are
seeking.
Based on studies of high school violence, researchers have concluded
that the first step in ending school violence must be to break through
the impersonal atmosphere of large high schools by creating smaller
communities of learning within larger structures, where teachers and
students can come to know each other well. We really cannot wait for
more tragedies of students shooting students or teachers before we act
to fix the situation.
And just as important, particularly in our search for what works to
improve student achievement, is that smaller school size also
positively impacts learning. Research demonstrates that small schools
outperform large schools on every measure of student outcomes,
including grades, test scores, attendance, and graduation rates. In the
Bank Street study, nearly twice as many students enrolled in smaller
learning communities contained within larger high schools scored at or
above national norms in reading compared to their peers. This impact is
even greater for ethnic minority and low-income students.
In addition, smaller learning communities enhance the school
experience for both teachers and students--research shows that smaller
schools generate greater community and parental involvement, and a more
engaged and enthusiastic staff. Research also shows that students at
smaller schools are more likely to participate in extracurricular
activities, and in a greater variety of activities--because everyone is
needed to fill out the teams, clubs, and offices, even shy and less
able students are more likely to participate and develop a sense of
belonging.
Furthermore, contrary to what some may think, small schools can be
created cost effectively. Larger schools can be more expensive because
their sheer size requires more administrative support, and because
small schools have higher graduation rates, the actual cost per
graduating student is lower than at large schools.
I certainly hope that we do not turn our backs on this initiative,
which we already know from research is a worthwhile investment that has
real impact on school climate and student safety, as well as on student
morale and achievement.
Mr. HARKIN. I thank the Senator for sharing your knowledge on this
research-proven method of educational reform. As we make the difficult
decisions about what should be funding priorities for the Federal
government in the vast expanse of options, we certainly do need to be
acutely aware of what has been demonstrated as having measurable
positive impact on real students. As we move to conference on this
appropriations bill, I will encourage everyone to consider the good
that smaller learning communities can do for all students, including
those for whom just a little extra attention and sense of belonging can
mean the difference between violent outbursts as a cry for help and
successful completion of high school with goals for the future.
Mr. SPECTER. Senator Bingaman has made some very valid points with
respect to the research on small schools. In conference with the House,
I will make every effort to work with the Conferees to provide adequate
resources for the smaller learning communities program.

rural healthcare needs

Mr. BURNS. I would like to engage my colleagues from Pennsylvania and
Iowa on a couple of issues relating to the Fiscal Year 2001 Labor,
Health and Human Services, and Education Appropriations bill. Access to
healthcare in Montana is often inadequate. I would like to focus on a
couple of projects that must be addressed in the state in order to
address some immediate rural healthcare needs. The first is a mobile
health clinic. St. Vincent Hospital in Billings has partnered with
Ronald McDonald House Charities to operate a mobile health clinic in
Eastern Montana. They hope to begin operating this clinic later this
year. This mobile health clinic will focus on providing preventive
health care to children at no cost in small rural communities. These
communities are in dire need of medical services. Mr. Chairman, Mr.
Harkin, this is no small matter--31 Montana counties are designated as
``medically underserved'' by the Health Resources Services
Administration (HRSA). Twenty-three percent of Montanans lack access to
a primary health care provider.
Mr. SPECTER. I understand the Senator's concerns and agree with him
about the unique healthcare needs and problems with access in rural
areas.
Mr. HARKIN. As a Senator from Iowa, I understand quite well the
challenges to access to care posed in rural states.
Mr. BURNS. The second concern is the fact that there is a need for
additional dental hygienists, but Montana is the only state without a
dental hygiene education program. There are currently 333 active
licensed dental hygienists in Montana. A survey of all Montana dentists
and dental hygienists

[[Page S6212]]

was conducted late in 1996 which indicated a need for additional
hygienists to fill current and future vacancies. The lack of a dental
hygienist in a practice reduces the number of hours the dentist is
available to deliver care only he or she is able to perform. Licensure
as a registered dental hygienist in Montana requires graduation from an
accredited dental hygiene program of either two or four years.
Montana's only dental hygiene education program was closed in 1989 at
Carroll College. Since that time efforts to open a new program have
been unsuccessful, but are ongoing. Montana students desiring hygiene
degrees must travel out of State. Of the current 28 students at
Sheridan Community College in Wyoming, half are from Montana. Montana
has fewer dentists per capita than the U.S. average. Many communities,
especially rural areas, are losing dentists (to retirements and other
factors). A large percentage of Montana dentists are expected to retire
in the coming decade, while the number of available dental school
graduates has been declining. With two-thirds of Montana's active
dentists age 45 years or older and more than a quarter over age 55,
concerns over the effect of retirement in coming years has grown. If a
dental hygiene program were established in Montana, hygiene graduates
would be available to perform hygiene tasks which presently are being
performed by dentists. This would free the dentists to perform
diagnosis and treatment services which only the dentist is trained to
provide. The establishment of this program would be of vital importance
to eliminating the strong prevalence of under-served areas in Montana.
Mr. SPECTER. We have rural states in need of programs which improve
both access and quality of care. I believe these projects are worthy,
and I will consider them during the conference agreement. I appreciate
your bringing these issues of my attention.
Mr. HARKIN. I understand the nature of the problem in Montana
requires attention. I thank the Senator for bringing these issues to my
attention. Chairman Specter and I will give them consideration during
conference.

leap funding

Mr. REED. Mr. President, I rise to engage Senators Specter and Harkin
in a colloquy regarding funding for the Leveraging Educational
Assistance Partnership (LEAP) program.
First, I want to commend Senators Specter and Harkin for numerous
education funding increases in the Labor, Health and Human Services,
and Education Appropriations bill. There are tough budget pressures
facing Senators Specter and Harkin, and they have done tremendous work
on this bill. In particular, I am pleased that they have increased
funding for the Leveraging Educational Assistance Partnership (LEAP)
program to $70 million.
LEAP, a federal-state partnership, is vital to our efforts to help
needy students attend and graduate from college. In fact, without this
important federal incentive, many states would never have established
or maintained their need-based financial aid programs.
Over the past three years, I have worked with Senator Collins and
others in the Senate to restore, revamp, and increase funding for LEAP.
This year, the Senate Labor, Health and Human Services, and Education
Appropriations bill provides $70 million for LEAP. While this funding
level is less than the bipartisan request that I submitted with 32 of
my colleagues, it is a significant increase over current funding and
the President's request. This would be the biggest boost for the
program in some time, and, as such, I decided not to offer an amendment
to further increase funding for LEAP.
However, I am concerned that during Conference with the House, which
has once again zero-funded the program, LEAP will not remain at the
Senate's $70 million funding level. This concern is also shared by the
higher education community, which strongly supports the Senate's $70
million for LEAP. Would the Chairman yield for a question?
Mr. SPECTER. I would yield to the Senator from Rhode Island.
Mr. REED. I thank the Senator. Does the Senator share my concern
about maintaining the Senate's $70 million for LEAP and is the
Senator's intent to fight for this level in Conference?
Mr. SPECTER. I share the Senator's support for our Subcommittee's
funding level for LEAP and will work during Conference to preserve it.
Mr. HARKIN. I would also like to voice my support for preserving the
Subcommittee's funding level for LEAP.
Mr. REED. I thank my colleagues, and I yield the floor.

the role of human factors research in reducing medical errors

Mr. BINGAMAN. Mr. President, will the Chairman yield for a question?
Mr. SPECTER. I will be pleased to yield.
Mr. BINGAMAN. First, I want to compliment the Chairman and the
Ranking Member of the Subcommittee on their hard work in producing this
bill for the consideration of the Senate. I would also compliment the
Committee for addressing the medical errors issue. Medical errors
account for as many as 98,000 deaths each year making it the 5th
leading cause of death in America. It is therefore appropriate that the
Committee has recommended an allocation of $50 million to the Agency
for Healthcare Research and Quality (AHRQ) to focus on ways to reduce
medical errors.
Mr. REID. Mr. President, I also want to express my support for the
efforts outlined in this bill to reduce medical errors. It is my hope
that these measures will set us on the path of constructively
addressing this troubling issue.
Mr. BINGAMAN. In hearings before the Health, Education, Labor and
Pensions Committee we heard expert testimony regarding the contribution
to increased safety made by human factors research in industries such
as defense and aviation. This field of research maximizes the
efficiency and accuracy of the interface of humans with equipment,
technology and the workplace environment.
Does the Chairman view human factors as a field of research that
could make an important contribution toward reducing medical errors?
Mr. SPECTER. I thank the Senator from New Mexico and the Senator from
Nevada for highlighting this matter. Yes, the field of human factors
research clearly is a field that can make an important contribution
toward reducing medical errors. I am also aware that the National
Academy of Sciences has developed an expertise in this field and I
would urge the Agency for Healthcare Research and Quality to call on
the expertise of the National Academy of Sciences as it addresses the
medical errors issue.
Mr. BINGAMAN. I thank the Chairman for his response.
Mr. KENNEDY. Mr. President, I know that Senators Specter and Harkin
worked diligently to craft a bill that could gain broad support. But
during the floor debate, Republicans weakened this bill in critical
ways that shortchange children in their education, subject hundreds of
thousands of American workers to ergonomic injuries, and promote a sham
patients' bill of rights.
I urge the Senate to reject this bill, and I urge the President to
veto it if it reaches his desk. America's schoolchildren, workers,
seniors, and everyone with health needs deserve a much better bill.
Republicans' very first order of business in debating this bill was
to delay the Department of Labor's proposed protections against
ergonomic injuries. Hundreds of thousands of American workers will
continue to suffer these injuries if this bill is enacted. The
companies that Republicans are helping in this bill have had years to
study and respond to the overwhelming evidence that ergonomic standards
improve worker safety. Yet these special interests continue to oppose
these protections. This is unacceptable, and it alone warrants a veto
of this bill.
Debate on many other parts of this bill fell into a regrettable
pattern. Time and again Democrats came to the floor with proposals to
improve schools, improve health care, or improve conditions in the
workplace. Republicans rejected the amendments, because the amendments
didn't allow room for the massive tax breaks they want, and the
amendments were defeated.
Republicans think they've already done enough for the health and
education of the American people. Democrats insist that more can be
done and

[[Page S6213]]

should be done. That is a fundamental difference between the two
parties.
The amendments that Democrats proposed to this bill highlight the
obvious needs that the nation should be meeting.
The health of senior citizens is needlessly at risk, because they
don't have affordable and dependable prescription drug coverage under
Medicare.
Public schools across the country are literally falling apart. They
need help in repairing their crumbling facilities and modernizing their
classrooms.
One of every five children in the nation still lives in poverty. They
lack educational opportunities at every step of the way from birth
through college. They deserve a fair chance to do well in school--to go
to college--to have a productive life and career.
The high-technology training needed to prepare the nation's workforce
for the future economy is out of reach for millions of Americans.
Democrats want to do more to solve these problems. But again and
again, our Republican colleagues refuse to act. Their refusal raises a
fundamental question of priorities that the American people will decide
in November if this impasse continues.
We have a budget surplus of $1.9 trillion over the next ten years. We
can afford more than token efforts to improve education, health care,
and working conditions for the nation's families. We need major
improvements in current law--and we can afford them. They should be a
high priority.
How long will we ignore the 20 percent of the nation's children who
live in poverty? How long will we ignore the third of senior citizens
who have no prescription drug coverage? How long will we send children
to crumbling schools? How long will we refuse to address the hundreds
of thousands of ergonomic injuries suffered by workers each year? Now
is the time to deal with these festering problems.

In fiscal year 2001 alone, a $49 billion surplus is now projected.
All of the priorities I have described can be accommodated for a small
fraction of this amount--and they should be accommodated. If we are
ever going to make serious investments in the education of the nation's
children, now is the time.
The record prosperity we are now enjoying also gives us an
opportunity to save many more lives through better access to health
care. It gives us an opportunity to modernize Medicare by adding a
life-saving prescription drug benefit for senior citizens. It gives us
an opportunity to provide many more children with a decent education
and enable them to become full participants in the new economy. It
gives us an opportunity to make every workplace safer, and to provide
millions of workers with the skills they need in this rapidly growing
high tech economy.
We can do all this, and also provide responsible tax relief for the
vast majority of our citizens. Democrats support targeted tax relief
for the nation's families, not the excessive and irresponsible tax
breaks for the wealthy that our Republican colleagues insist on.
The Republican estate tax relief bill alone would cost $105 billion
in the first ten years, and $50 billion a year after that. It's the
ultimate tax break for the wealthy. Its relief goes to the wealthiest 2
percent of Americans--those who have prospered most in our record-
breaking economy--those who have no trouble affording education for
their children, health care for their families, or the prescription
drugs they need.
Other Republican tax breaks now pending in the Senate would cost a
total of $711 billion over the next ten years, exploding to even higher
costs in the following years. George W. Bush has proposed tax cuts that
would consume the entire $1.9 trillion budget surplus projected over
the next ten years.
If Republicans are willing to give even slightly less to those who
already have the most, we will have more than enough resources to
dramatically improve education and health care for all Americans.
The American people should be very clear on this issue. The
Republican tax breaks are too extreme. They are keeping the nation from
meeting its high priority needs in education, heath care, the workplace
and other vital areas. These needs can be met, if Congress has the will
to meet them. As we head into the final weeks of this year's session, I
urge my colleagues to do a better job of meeting these all-important
priorities.
The anti-labor rider that Republicans attached to this bill on
ergonomics, combined with the failure to fund education priorities in
class size and school construction, would be enough alone for me to
vote against this bill. But yesterday, Republicans added yet another
offensive provision--a sham patients' bill of rights.
Republicans went on record in favor of weak health care protections
for Americans. And even those weak protections cover only a small
fraction of the number of people who need protection. The Republican
plan contains ineffective appeal procedures. These defects are the
reason why the GOP plan is strongly opposed by all medical and nursing
organizations and hundreds of patient groups and consumer groups across
the country. Only the insurance industry supports the Republican plan,
because it's a plan that only an HMO could love.
This flawed bill should be defeated. The American people deserve far
better than this.
Mr. MOYNIHAN. Mr. President, I am pleased to see the New-York
Historical Society mentioned in the Committee Report to the Labor-HHS
Appropriations bill. The Society is a wonderful New York institution
that has outstanding collections and runs outstanding educational
programs. One such program would soon bring to the general public one
of the nation's most extensive collections of Revolutionary War
materials; documents, manuscripts, artifacts, and works of art. Tied to
the collection will be a program that will tie in with social studies
and history classes across the nation.
The key components of this effort are digitization of primary
documents and museum objects to make them available on the World Wide
Web and workshops for teachers to be held at the Historical Society to
show creative approaches to interpreting history using documents and
artifacts. Video conferencing will make teacher workshops available
around the country as well.
Published school curricula and resources kits based on the Society's
Revolutionary collections will be available to teachers as well. There
will also be an interactive web site for teachers and students, a
linkage of the Society's library and museum collection databases,
providing one unified source of information on the collections. The
Society also hopes to develop a 30 minute interactive video in English
and Spanish available in the Society headquarters and on the web.
Finally, hand held scanners will give visitors instant electronic
access to information about the collections as they are viewed and
access to related websites.
Mr. President, the Historical Society has wonderful plans for its
future. I hope we are able to assist with what is truly a project of
national scope when we finalize this bill during the coming
months.
Mr. McCAIN. Mr. President, this appropriation bill contains funding
for many critical and quite frankly, essential programs benefitting
many segments of our society. This appropriation vehicle supplies
important funding directly benefiting American families and senior
citizens while also providing important assistance to our most
important resource, our children.
This appropriation bill provides funding for helping states and local
communities educate our children. Additionally, it provides the
necessary funds for supporting our scientists dedicated to finding
treatments, if not cures, for many of the illnesses which plague our
nation. This bill also provides funds for ensuring our nation's most
vulnerable--our children, seniors and disabled have access to quality
health care. In addition, it provides the monetary support for
important programs assisting working families needing assistance with
child care, adult day care for elderly seniors and Meals on Wheels.
These are many important programs funded through this bill that help
so many vulnerable citizens that I am even more frustrated to find this
bill laden with directives and accounting gimmicks. I am particularly
disappointed that this bill redirects $1.9 billion from the State
Children's Health Insurance Program, S-CHIP, to assist in funding other
programs and

[[Page S6214]]

projects. This is simply wrong and is nothing more than an accounting
gimmick at the expense of the health of America's children. In
addition, I am concerned about the significant reduction in Social
Services Block Grant, SSBG.
I applaud the committee for including very few specific funding
earmarks but am distressed about the extensive list of directives that
have been included. It is apparent that the plethora of directives and
strong committee language are intended to camouflage the number of
specific projects that are being provided special consideration and
bypassing the appropriate competitive funding process. The list of set
asides contained in this bill are so extensive that I will not burden
the chamber with listening to me list each one individually. Instead, I
will highlight just a few of the violations of the appropriate
budgetary review process. These include:

Language encouraging consideration of efforts by the University of
Pittsburgh Medical Center Health System, UPMC-HS, to implement a state-
of-the-art Health System wide project to electronically store and
provide all clinical and administrative information in a secure and
automated manner.
Language encouraging additional funds for the Pine Ridge Indian
Reservation in the southwestern corner of South Dakota which has a high
incidence of alcohol addition.
Language encouraging consideration of a program at the Center Point,
Inc. which provides low-cost, comprehensive drug and alcohol services
to high risk families and individuals in the San Francisco Bay area.
Language directing consideration of sufficient funds to continue West
Virginia's Injury Control Training and Demonstration Center at the same
level as last year.
Language directing consideration of the Lewis and Clark College's
Life of the Mind Education initiative that develop an educational
programming celebrating the 200th anniversary of the Lewis and Clark
expedition and the Louisiana purchase.
The Committee is aware of the following projects that it encourages
the Department of Labor to consider supporting:
Workforce Training and Retraining for dislocated and incumbent
workers in real manufacturing environment--University of Albany, NY.
Workforce Development project to retain older incumbent workers for
Montana workforce--Montana State University, Billings.
University of Alaska/Ketchikan Shipyards training program for
shipyard workers.
State of New Mexico--telecommunications job training for dislocated
workers.
Clemson University, retraining of tobacco farmers.
While each of these programs may be just and deserving of funding it
is appalable that these funds are specifically earmarked and not
subject to the appropriate competitive grant process. I am confident
that there are many facilities, health organizations, and educational
sites around the nation needing financial assistance for their
particular programs who are not fortunate enough to have an advocate in
the Appropriation process to ensure that their funding is earmarked in
this funding bill. This is wrong and does a disservice to all
Americans.
Mr. President, so many important programs including those impacting
the health and education of our nation depends on the support provided
through this bill and yet, we have diluted the positive impact of these
programs by siphoning away funds for specific projects or communities
which are fortunate enough to have representation on the Appropriation
committee.
We must find the courage to discard the spending gimmicks and
earmarks contained in this bill during conference and provide the much
needed financial support for education, work training, children, health
care, research and senior programs.
Mrs. MURRAY. Mr. President, the Labor, Health and Human Services
appropriations bill is meant to address the needs of our nation's most
precious resource, our people. When a Labor, HHS bill is properly
funded, it ensures the health of our families, the education of our
children and the safety of our workers. Unfortunately, the bill before
us falls short and I will vote against it.
In March, I expressed my concerns that the Congressional Majority was
not sufficiently funding this part of the budget.
Today, in June, we can see specifically how those shortcomings will
impact the American people. While this bill does make some specific
gains in key public health programs, the overall picture is lacking.
While I am pleased with some parts of this bill, I am voting against
it because it does not make the necessary commitments to public health,
worker safety, and reducing class sizes. We have a surplus and we can
invest in key programs like education, health care, job training, and
work place, but instead we are guided by a spending plan that places a
greater emphasis on irresponsible tax cuts.
Before I outline the specific reasons for my vote, I do want to thank
the Chairman for his hard work on this bill. He has been given an
impossible task, and he has still been able to make some key
investments in vital health initiatives like the National Institutes of
Health, NIH, our efforts to reduce medical mistakes, and efforts to
expand medical services in rural areas through the use of telemedicine.
When it comes to funding the NIH, the additional $2.7 billion
allocated in this bill is clearly a sound and wise investment.
Unfortunately, we have not made the same investment in other important
health care access and prevention programs, but I am committed to
working with the Chairman to maintain this level for NIH.
We also need to ensure that all public health agencies receive the
same level of commitment and support. Without the work and programs of
CDC, HRSA, and FDA, research funded from NIH will never make it to
patients.
We also need to show the same commitment to prevention programs and
health care access programs that we have shown to NIH. What we
sometimes forget is the number one killer in this country is
cardiovascular disease, a disease that we can do more to prevent.
Another highlight of this bill is its support for innovative
solutions to prevent medical errors. The $50 million to fund new
projects to reduce medical mistakes is essential if we hope to
implement effective, constructive solutions. I believe this new funding
will provide support to hospitals and clinics to automate drug
dispensing to reduce fatal errors from prescription drugs not
administered correctly. It will ensure that we utilize ``best
practice'' standards when implementing automation into hospitals and
will allow the expansion of current efforts at the Veterans
Administration to reduce medical mistakes. The Institute of Medicine's
report on medical errors clearly illustrated what was wrong in our
health care delivery system. Fortunately, this Appropriations bill
provides the funding to help us avoid medical mistakes.

I also want to thank the Chairman for his support of telemedicine
efforts. For rural communities in Washington state, expanding and
enhancing telemedicine is an important part of ensuring access to
quality, affordable health care. I appreciate the Chairman's support of
my request for Children's Hospital in Seattle to support a telemedicine
project.
I would be remiss if I did not congratulate the Chairman and Ranking
member for their efforts on behalf of women's health care. The pending
LHHS Appropriations bill does address many of the gender inequities in
research and access. The Chairman has also provided an increase for the
CDC Breast and Cervical Cancer Treatment Act to expand the Wise Women
program to additional states, including Washington state. This
important screening program would allow for the screening of breast and
cervical cancer as well as heart disease. It builds on the success of
the breast and cervical cancer screening program to offer greater
access for low income women.
Clearly, there are some good elements of this bill. Unfortunately,
the lack of overall investment in public health undermines these
provisions. The bottom line is that the overall commitment made to the
LHHS and Education programs has been short changed in order to provide
massive tax cuts for the few. The priorities of

[[Page S6215]]

the FY01 Budget Resolution simply do not reflect the priorities of
working families.
Another problem with this bill is it does not protect America's
workers. Today, we have one of the lowest unemployment rates in our
nation's post-war economy. We have jobs that cannot be filled, but we
also have workers who cannot find jobs because they lack the training
and necessary skills. Dislocated workers are a resource we simply have
not tapped and the funding levels in this bill do not allow for the
necessary investment in these programs.
This bill also does not allow OSHA to issue an ergonomics standard,
even though ergonomic injuries are the single-largest occupational
health crisis faced by men and women in our work force today.
I am also disappointed that this bill does not fund the President's
efforts to ensure pay equity. This bill does not give the Department of
Labor and the Equal Employment Opportunity Commission the tools it
needs to enforce wage discrimination rules.
In addition, this bill does not guarantee that classrooms across
America will be less crowded next year. While I appreciate the
Chairman's efforts, the funding level is not adequate to meet our goal
of hiring 100,000 new teachers to reduce classroom overcrowding. In
addition, the structure of the funding does not guarantee that the
funds will be used to reduce classroom overcrowding.
This is a national priority, and we should direct this investment to
reducing class size. If we do not continue to honor our commitment to
classroom overcrowding, we will have failed to give students the tools
to learn the basics in disciplined environment.
I also am concerned that we have doomed this bill to failure if we
reject the President's education agenda, which includes a targeted
class size reduction program. Not simply throwing more money at the
problem, but using limited resources to invest in our children. I will
continue to work with the Chairman as I do believe he is trying to work
with difficult spending limitations, but we need to improve our
commitment to reducing class sizes. This bill does not get the job
done.
Finally, Mr. President, I want to express my strong opposition to the
Helms Amendment, which would override the choices of thousands of
communities and would endanger America's students.
Currently, 23 states allow minors access to confidential family
planning and contraceptives. The Helms amendment would override those
laws and--in effect--create a new federal parental consent law. Access
to safe, confidential reproductive health care services for minors is a
major health concern, and various communities have found their own ways
to address it.
This is not just about preventing pregnancy. It's about preventing
fatalities. AIDS and HIV threaten students today. Unfortunately, this
amendment jeopardizes a public health effort to protect these students.
I do want to mention that I was surprised to hear the sponsor of this
amendment talk about access to RU-486 in school-based clinics. I would
remind my colleague that RU-486 has still not been approved for use in
this country. The real issue here is our ability to protect the health
of students across America, and the Helms amendment stands in the way
of that important priority.
When I look at the Labor, HHS bill, I see a bill that fails America's
workers and students. Because this bill does not make the necessary
investments in public health, worker safety and education, I am voting
against it.
Mr. BYRD. Mr. President, I support the Fiscal Year 2001
appropriations bill for the Departments of Labor, Health and Human
Services, Education, and Related Agencies.
This measure increases funding for education programs by $4.6 billion
from $37,924,569,000 to $42,594,646,000. This increase includes funds
to provide for a $350 dollar increase in the maximum Pell Grant award,
up to a maximum of $3,650 dollars. The bill also includes an increase
of $1.3 billion for special education programs, raising the total
appropriations for such purposes from $6,036,196,000 to $7,352,341,000.
Furthermore, for the first time, this bill enables local education
agencies to use Title VI funds for school modernization and class-size
reduction efforts, if they so choose.
I am pleased that the bill contains over $40 million in funding for
the Robert C. Byrd Honors Scholarship program. As the only merit-based
scholarship program funded by the Department of Education, this program
awards scholarships to high school graduates who demonstrate
outstanding academic achievement and have been accepted to attend an
institution of higher learning.
The bill includes nearly a million dollars for the continuation of a
program to identify and provide models of alcohol prevention and
education in higher education. Alcohol abuse is a devastating problem
on college campuses across America, and I hope that this program will
provide incentives and form the basis for colleges and universities to
better address the problem of alcohol abuse on their campuses.
I note that the bill includes a $1.2 billion initiative to address
the problem of youth violence, which is also a major national concern.
This spring, at West Virginia University, I convened a Youth Summit on
Violence that was designed to give young people an opportunity to put
forth their ideas on how to reduce violence among their peers. In
response to the question, ``What would best prevent violence in the
schools?''--the number one response from these young people was to
create safe places where they can gather for social activities after
school. In that regard, I am pleased that the bill includes $600
million for the 21st Century Learning Centers Program. That very
important program supports grants to local education agencies for the
purpose of establishing after-school programs.
The bill contains nearly $250 million for the Mine Safety and Health
Administration, and an increase of $2.5 million above the President's
request for the Mine Health and Safety Academy. This agency is vital
when it comes to protecting the health and safety of our nation's
miners. The measure also contains $6 million for black lung clinics,
which play a critical role in providing medical treatment to coal
miners suffering from black lung disease.
Further, the bill includes more than $200 million for the National
Institute for Occupational Safety and Health (NIOSH). Important
research conducted at NIOSH adds to our understanding of occupation-
related ailments and diseases.
In conclusion, Mr. President, I express my appreciation to the
Chairman and Ranking Member, Senators Specter and Harkin, for their
efforts in putting together this very important funding bill. These two
Senators are vastly experienced and knowledgeable when it comes to
matters under the jurisdiction of the Labor, Health and Human Services
and Education Subcommittee. They have worked on a bipartisan basis
splendidly, as is always the case, preparing this Fiscal Year 2001
appropriations bill.
I also wish to express my appreciation to Senators Specter and Harkin
for facilitating the inclusion of my amendment into the managers'
package. My amendment provides $50 million to the Secretary of
Education to award grants to states to develop, implement, and
strengthen programs that teach American history as a separate subject
within school curricula. The importance of America history is too often
undervalued in our nation's classrooms. Poll after poll in recent years
has alerted us to huge gaps in historical knowledge among our nation's
schoolchildren. It is my hope that this amendment will encourage
teachers and students to take a deeper look at the importance of our
nation's past.
Again, I wish to compliment the two fine managers of the bill and the
Appropriations staff who have assisted them with preparing the bill. I
urge my colleagues to support the bill.
Mr. KOHL. Mr. President, I rise in support of final passage of the FY
2001 Labor, Health and Human Services, Education and Related Agencies
Appropriations bill. Although I have concerns with the funding levels
in some areas, I want to commend Senator Specter and Senator Harkin for
again working under difficult budget constraints to put together a good
bill that addresses many of our nation's needs.
I am pleased that the bill includes significant increases for many
vital

[[Page S6216]]

health and education programs. We've invested in our youngest children,
by increasing the Child Care & Development Block Grant by $817 million,
and by increasing Head Start by $1 billion. The bill also provides
much-needed increases for elementary and secondary education, including
Title I, Special Education, After-School programs, and Impact Aid. And
the bill ensures that more students will have the opportunity to go to
college by increasing funding for Pell Grants, Work-Study, and TRIO
programs. It is my hope that when we go to conference, we can find more
funds to make an even stronger investment in our children's education.
I am also pleased that the bill makes great strides in ensuring
access to quality health care. The bill includes a $150 million
increase for Community Health Centers, which provide care to many low-
income, uninsured Americans. The bill includes a modest increase for
nursing home inspections to ensure that elderly and disabled patients
receive the highest quality care. And clearly, all Americans will
benefit from the $2 billion increase for the National Institutes of
Health. This increase in funding for biomedical research will lead us
down the path to new treatments and cures for disease.
Despite these important provisions, I have several concerns with the
bill that I believe must be addressed in conference. First, I am deeply
troubled by the cut in the Social Services Block Grant. My State and
counties rely on these funds to provide home care, services for the
disabled, and child welfare programs. In Wisconsin, the vast majority
of SSBG money goes straight to the county level. Without SSBG funds,
our counties have no guarantee they will receive enough money to
provide these critical services. I am heartened that Senator Stevens,
Chairman of the Appropriations Committee, has made a commitment to
restore these funds in conference, and I look forward to working with
him to make that happen.
Second, I believe we must make a stronger investment in programs that
serve our nation's seniors. I am very concerned that programs under the
Older Americans Act--including Supportive Services and Centers and
Nutrition programs--are inadequately funded. I also support the
inclusion of $125 million for the Family Caregiver Support Network,
which provides support and respite to family members caring for a
relative in long-term care. In addition, we must include larger
increases for programs that utilize the unique talents of our nation's
older citizens, such as the Foster Grandparents and Senior Companions
programs. I hope that the conference committee will do what's right and
make the necessary investments in programs that serve the elderly.
Finally, I was also disappointed that a provision blocking OSHA from
pursuing a rule on ergonomics was included in the bill. This move to
include legislative riders on appropriations bills has become a common
effort to circumvent the rule making process. In this case, opponents
wanted to stop the process before we had a chance to see what the final
rule would look like. I believe this effort to halt the rule is
premature. There are almost 1.8 million ergonomic injuries every year
with 300,000 resulting in lost work days. Workers are suffering through
painful injuries every day, and we must do something. OSHA has been
working on this issue for ten years, and we should delay it no longer.
Overall, Mr. President, I believe the Chairman and Ranking Member of
the Appropriations Committee have done an outstanding job in putting
together this bill under difficult circumstances. I am voting for the
bill at this point, despite the concerns I have just outlined, because
I believe we must move this bill through the Appropriations process.
However, let me make clear that these concerns must be addressed before
the bill emerges from Conference. I look forward to working with all of
my colleagues to improve the bill as the process continues.
Mr. SPECTER. Mr. President, I rise today to raise a very important
issue concerning the vital safety-net hospitals in my state of
Pennsylvania. As my colleagues are aware, the Medicare Disproportionate
Share Hospital program consists of special supplemental payments made
to hospitals to offset the costs for providing uncompensated care. I
worked closely over the last few years with Pennsylvania hospitals and
the Health Care Financing Administration to resolve a dispute
concerning the inclusion of a State's General Assistance population as
a part of its Medicare Disproportionate Share Hospital (DSH) payment
calculation. In August 1998, HCFA asserted that Pennsylvania hospitals
were incorrectly including General Assistance (GA) days in their
Medicare DSH calculation, and claimed that they should only have
included Medicaid days. These payments represent a significant portion
of many hospitals' revenues, and any proposed reduction puts the
Commonwealth's neediest populations at risk.
The dispute raised further concerns about how HCFA interpreted its
own rules and regulations. Medicare fiscal intermediaries had been
reimbursing hospitals with the GA days included for the past twelve
years. Yet, beginning in mid-1998, HCFA reversed its own
intermediaries' interpretation and began recouping the so-called
overpayments for certain years, as far back as fiscal year 1993. The
impact to Pennsylvania's hospitals would have totaled in the hundreds
of millions of dollars.
Indeed, I was encouraged when Secretary Shalala and Administrator
DeParle were able to work out a retroactive solution regarding the DSH
calculations. As of October 1, 1998, Pennsylvania hospitals stopped
including the GA days in their DSH calculations, but since the law was
unclear enough for the fiscal intermediaries to have been confused for
twelve years, they did not have to give back any reimbursements. I
understand that 35 other States had been including General Assistance
days in their Medicare DSH calculations, thus the resolution of this
dispute was critical for many safety-net hospitals across the nation.
However, Mr. President, it now appears that Pennsylvania hospitals
are once again at a disadvantage with regard to their Medicare DSH
reimbursements, as HCFA is graying the regulatory area we thought had
been clarified last year.
I understand from Pennsylvania hospitals that HCFA is unfairly
applying the GA days and Medicare DSH calculation policy across States.
Beginning in January of 2000, HCFA began allowing some States which
operate under Medicaid Section 1115 waivers to include the GA
population in the Medicare DSH calculation, thus significantly
increasing those States' DSH reimbursements. Since Pennsylvania
hospitals operate under a Section 1915 waiver rather than Section 1115,
it has been made clear to them that they cannot count GA populations in
their calculations.
I urge my colleagues to join me in my commitment to ensure that HCFA
clarifies once and for all how the GA population should be treated
under the Medicare DSH program, thus assuring that Pennsylvania and all
States will be treated fairly under one uniform and understandable
policy.
Mr. SANTORUM. Mr. President, I rise today to address an issue that
Senator Specter and I have been working on with Pennsylvania hospitals
and the Health Care Financing Administration. Since 1998, we have been
trying to resolve a dispute concerning the inclusion of a state's
General Assistance population as a part of its Medicare
Disproportionate Share Hospital (DSH) payment calculation. HCFA
asserted in 1998 that Pennsylvania hospitals were including General
Assistance (GA) days in their Medicare DSH calculation, when they
should only have included Medicaid days. This issue at the time was an
enormous concern to the hospitals which provide care to the neediest
populations in my state, and this issue remains unresolved today.
Mr. President, this is a matter of fairness and applying the rules
and interpretations equally. Medicare fiscal intermediaries had been
reimbursing hospitals with GA days included for the past twelve years.
In 1998, HCFA reversed its own intermediaries' interpretation and began
recouping the so-called overpayments as far back as fiscal year 1993.
Since then, Pennsylvania hospitals stopped including the GA days in
their DSH calculations.
I now understand that thirty-five other States had been including
General Assistance days in their Medicare DSH calculations, and that
since January of this year, HCFA began allowing some states which
operate under Section 1115 Medicaid waivers to include

[[Page S6217]]

the GA population in the Medicare DSH calculation. Pennsylvania
hospitals operate under a Section 1915 waiver, and it has been made
clear to them that they cannot count GA populations in their
calculations.
Mr. President, HCFA appears to be unfairly applying GA days and
Medicare DSH calculations across states. I am very concerned that
hospitals in Pennsylvania remain at a disadvantage, and I remain
committed to working with HCFA to clarify once and for all how the GA
population should be treated under the Medicare DSH program.
I appreciate the diligence that my colleague from Pennsylvania,
Senator Specter, has shown on this matter, and I will continue to work
with him toward a satisfactory resolution.
Mr. KENNEDY. Mr. President, I strongly support advanced
appropriations for the Low Income Home Energy Assistance Program.
Senator Wellstone's amendment continues the funding practice that has
existed for years in this program. It enables states to plan ahead for
the energy assistance they provide to needy families.
The bill as now written unfortunately ends this current practice. It
introduces needless uncertainty into the funding outlook for the
future. At this time of high energy prices and budget surpluses, we
should strengthen the protection we provide low-income families, not
weaken it.
A third of Massachusetts families rely on home heating oil, which
nearly doubled in price last winter because inventories were too low to
meet the sudden surge in need for heating oil when unseasonably cold
weather suddenly arrived. Many families could not deal with this
expense. But because heat is a basic necessity for families in New
England, they had no choice but to make room in their limited budgets
for the soaring cost of heat.
This year, all indications are that once again, heating oil
inventories are dangerously low throughout the Northeast. The coming
winter may bring price spikes that are even higher than last winter.
Natural gas prices are unusually high this year as well, which may well
increase demand for heating oil.
We should do more to ensure that adequate inventories of heating oil
are maintained in the Northeast. Early in this year, I introduced
legislation to do so. But the Energy Committee has not acted on this
proposal, and the industry steadfastly refuses regulation as a means of
protecting families that rely on oil heat. So we need to focus on other
ways to address the problem.
The best defense for families that need reliable, economical heat to
survive is to plan ahead to meet their needs. Secretary Richardson has
urged consumers to fill their heating oil tanks this summer, while
prices are stable, and I join him in strongly recommending this action.
State governments which distribute LIHEAP funds also need to plan
ahead, but they need an entire fiscal year to properly plan. They need
to plan to set eligibility limits and to distribute benefits. They need
to know what level of federal assistance will be available, so they can
budget their state assistance accordingly. They also need advance
notice so that they can do what most companies do when they buy
commodities that are subject to volatile prices--hedge against price
surges by purchasing options contracts.
The decision to include advanced appropriations in LIHEAP was made
years ago and has been faithfully followed. The current uncertainty in
energy markets is the wrong time to inject further uncertainty in
LIHEAP funding. That is why I join my colleagues from both sides of the
aisle in calling for advance appropriations for this program.
The support made available by this program is literally a matter of
life and death for millions of families in Massachusetts and New
England. Congress should do everything possible to encourage planning
that avoids the supply and price problems that left so many families in
the cold last winter, and that threaten our region's economic health.
Mr. DOMENICI. Mr. President, I rise today to discuss the critical
importance of mental health research.
The human brain is the organ of the mind and just like the other
organs of our body, it is subject to illness. And just as illnesses to
our other organs require treatment, so too do illnesses of the brain.
With this in mind, I think that it is appropriate to be discussing
the benefits of mental health research as we have just concluded the
``Decade of the Brain.'' During this time we witnessed breakthrough
achievements like new medications and brain imaging techniques that
have provided innumerable benefits for so many Americans.
Just last year, I dedicated the National Foundation for Functional
Brain Imaging at the University of New Mexico. The Foundation's purpose
is to advance the development of magneto-encephalography, or MEG,
technology that provides real-time imagery of neurons as they operate
within the human brain.
As we explore functions of ``normal'' brains, as well as brains of
individuals suffering from severe illnesses, we may well be on the
brink of exciting breakthroughs for mental illness treatment.
Moreover, one only needs to look at the amazing research being done
by the National Institute of Mental Health to realize how far we have
really come over the past decade. And finally, the close of the decade
gave us the first ever Surgeon General's Report on Mental Health
entitled, ``Mental Health: A Report of the Surgeon General.''
However, even with these fabulous advances we must still maintain our
vigilance and continue our support for research so even newer and
better breakthroughs are made by our nation's researchers.
For instance, about 5 million individuals in the United State suffer
from a severe and persistent mental illness. Nearly 7.5. million
children and adolescents suffer from one or more types of mental
disorders.
There is a final area I would like to touch upon and that is
children. While researchers have already made fantastic breakthroughs
in the area of mental illness, research for children still remains
incomplete.
We must continue the excellent work already being done, like studies
seeking to understand the basic mechanisms of brain development and
comparisons of effective treatments for specific illnesses.
Additionally, scientists have already established preventive steps
that can be taken that are effective: Genes are identified to see if a
child has a predisposition to a certain illness and if so monitoring
begins. In conjunction with that, a calm environment is sought for the
child and early stage drugs are administered if appropriate.
I would submit the key for not only children, but adults is the
continuation of research that will allow us to realize even greater
breakthroughs that will enable earlier and more accurate diagnoses of a
mental illness. And I firmly believe the key to ensuring continued
discoveries through our research is to continue providing our nation's
researchers with adequate funding.
Mr. KYL. Mr. President, today the Senate is voting on final passage
of the FY2001 Labor, Health and Human Services, and Education
appropriations bill, H.R. 4577.
This measure includes funding for many good and worthwhile programs:
medical research conducted by the National Institutes of Health, a
drug-demand reduction initiative, efforts to combat bioterrorism, Pell
Grants, Impact Aid, and services for older Americans, to name a few.
The amount of funding allocated to this bill is very generous: $97.8
billion in discretionary appropriations, or about 12 percent over last
year's level.
There are very substantial increases provided for particular
programs. For example, there is a 12 percent increase for the
Occupational Safety and Health Administration, a 13 percent increase
for the Ricky Ray Hemophilia Relief Fund, a 15 percent increase for the
National Institutes of Health, a 19 percent increase for Head Start,
and a 13 percent increase for education.
I believe the OSHA increase, for one, is something that can and
should be cut back in conference. If we want to maintain the other
large increases, though, we need to find other programs, of lesser
priority, to cut in order to moderate the total cost of the bill.
My concern is, as we get to conference, there will be pressure to
increase spending even more. We are going to hear a lot, for example,
about the need for more funding for the Social Services Block Grant
program. If

[[Page S6218]]

the amount in the bill for SSBG is going to be increased, we are going
to have to find somewhere else to cut. I hope proponents of these
increases will keep that in mind as we proceed to conference.
The sky is not the limit here. I am going to support this bill today
to get it to conference, but I am not inclined to support a dollar more
in the conference report. We have got to do a better job of
prioritizing, or we will soon find Congress once again raiding the
Social Security surpluses to pay for other government programs.
We just put a stop to that two years ago. We have to honor our
commitment to preserve Social Security surpluses for Social Security.
The question is on the engrossment of the amendments and third
reading of the bill.
The amendments were ordered to be engrossed, and the bill to be read
a third time.
The bill was read a third time.
The PRESIDING OFFICER. The bill having been read the third time, the
question is, Shall the bill, as amended, pass?
Mr. SPECTER. Mr. President, before moving to final passage, I thank
my distinguished colleague, Senator Harkin, for his cooperation, and
our devoted staffs: Bettilou Taylor, Jim Sourwine, Mary Deitrich, Kevin
Johnson, Mark Laisch, Jon Retzlaff, Ellen Murray, Lisa Bernhardt, and
Allison DeKosky.
I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second. The clerk will call the roll.
The legislative clerk called the roll.
Mr. NICKLES. I announce that the Senator from Utah (Mr. Hatch) is
necessarily absent.
I further announce that, if present and voting, the Senator from Utah
(Mr. Hatch) would vote ``yea.''
Mr. REID. I announce that the Senator from California (Mrs. Boxer),
the Senator from Hawaii (Mr. Inouye), the Senator from Vermont (Mr.
Leahy) and the Senator from New York (Mr. Moynihan) are necessarily
absent.
I further announce that, if present and voting, the Senator from
Vermont (Mr. Leahy) would vote ``no.''
The PRESIDING OFFICER (Mr. Frist). Are there any other Senators in
the Chamber desiring to vote?
The result was announced--yeas 52, nays 43, as follows:

{Rollcall Vote No. 171 Leg.}

YEAS--52

Abraham
Ashcroft
Bennett
Bond
Breaux
Burns
Byrd
Campbell
Chafee, L.
Cleland
Cochran
Collins
Coverdell
Craig
Crapo
DeWine
Domenici
Enzi
Fitzgerald
Frist
Gorton
Grassley
Gregg
Hagel
Harkin
Hollings
Hutchison
Hutchison
Inhofe
Jeffords
Kerrey
Kohl
Kyl
Lincoln
Lott
Lugar
Mack
McCain
McConnell
Murkowski
Roberts
Roth
Santorum
Shelby
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
Warner

NAYS--43

Akaka
Allard
Baucus
Bayh
Biden
Bingaman
Brownback
Bryan
Bunning
Conrad
Daschle
Dodd
Dorgan
Durbin
Edwards
Feingold
Feinstein
Graham
Gramm
Grams
Helms
Johnson
Kennedy
Kerry
Landrieu
Lautenberg
Levin
Lieberman
Mikulski
Murray
Nickles
Reed
Reid
Robb
Rockefeller
Sarbanes
Schumer
Sessions
Smith (NH)
Torricelli
Voinovich
Wellstone
Wyden

NOT VOTING--5

Boxer
Hatch
Inouye
Leahy
Moynihan
The bill (H.R. 4577), as amended, was passed.
(The bill will be printed in a future edition of the Record.)
Mr. COVERDELL. Mr. President, I move to reconsider the vote.
Mr. SPECTER. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. HARKIN. Mr. President, I want to say a public thank you to our
chairman, Senator Specter.
The PRESIDING OFFICER. May we have order in the Chamber.
Conversations will please be taken to the back of the Chamber or to the
Cloakroom.
The Senator from Iowa.
Mr. HARKIN. Mr. President, in all the years I have been on this
committee and also on the subcommittee, which now numbers 16, this is
the earliest we have ever gotten this bill finished. If I am not
mistaken, this may be the first time that this was not the last bill to
be acted on, whether it has been Republican leadership or Democratic
leadership.
I thank Senator Specter for his great leadership. I thank him for
working in such an open and bipartisan fashion with us on this side. I
have never had a case where something was done on the Republican side
that I didn't know about and that we weren't consulted with every step
of the way. I want Senator Specter to know how much we really
appreciate that.
The working relationship has been great with our staff: Bettilou
Taylor, Jim Sourwine, Mark Laisch, Mary Dietrich, Jon Retzlaff, Kevin
Johnson, Ellen Murray, and Lisa Bernhardt. Our staff has a great
working relationship.
Again, as we now go into conference with the House, I make a
commitment to my chairman that we will continue to work in a bipartisan
fashion, as we have always, to make sure we can bring back a strong
bill.
I think we can be proud of the amount of money we have in education.
We have more money in this bill for education than asked for by
President Clinton. I believe we are making moves in the right
direction. Maybe we vote and disagree here and there in little bits and
pieces, but, by and large, what is in the bill for education I think
should be a mark and a source of pride for all of us.
I thank Senator Specter for his leadership on that side.
The PRESIDING OFFICER. Does the Senator from New Mexico yield time?
Mr. DOMENICI. I would be glad to yield a minute to Senator Specter.
The PRESIDING OFFICER. The Senator from Pennsylvania.
Mr. SPECTER. Mr. President, I thank my distinguished colleague from
Iowa for those very generous comments. We have a close working
relationship. I learned a long time ago that if you want to get
something done in this town, you have to be willing to cross party
lines.
This bill involving education funding, health funding, and the
Department of Labor with job training and worker safety is a good
bipartisan result.
Mr. HARKIN. Mr. President, if the Senator will yield, I was remiss.
Someone else we have to thank is the chairman of our committee, Senator
Stevens, who worked very hard to get the allocations. When we ran into
some problems, he was able to find ways so we could move ahead with
this bill, and disregarding some of the problems we had so we could get
to conference.
I thank Senator Stevens for his support of this subcommittee.
Mr. SPECTER. Senator Stevens did an extraordinary job as we moved
through this very tough process. Our distinguished ranking member of
the full committee, Senator Byrd, has been a strong stalwart throughout
the entire process.
Other Senators are waiting to speak. I have already enumerated the
great work done by our staff. I pay special tribute to the staff.
Bettilou Taylor has been a very real stalwart.
Mr. STEVENS. Mr. President, I congratulate Senator Specter and
Senator Harkin, on my own behalf, and I am sure I speak for Senator
Byrd also.
The Senate should know this is the largest health services bill in
history. It represents a magnificent contribution and commitment to
increasing funding for medical research in particular, and so many
other things in general. Both of these Senators have done tremendous
work in getting this bill where it is and getting it to the House. I
think they really deserve our total congratulations for keeping our
commitment to doubling the amount of money available for medical
research within 5 years.
Mr. DODD. Mr. President, I rise to express my regret that I was
unable to support the Labor/HHS Appropriation bill that was passed by
the Senate today. I was initially prepared to offer my support when we
began debate on this legislation, however the addition of a number of
troubling amendments during consideration of this bill compels me to
oppose this bill.

[[Page S6219]]

Before I discuss the provisions that caused me to vote against the
legislation, I would like to recognize Senators Specter and Harkin as
well as the rest of the Labor, Health and Human Services, and Education
Appropriations Subcommittee, for their efforts to increase our nation's
investments in a number of critical programs that serve our nation's
children and families. First, this legislation includes an increase of
$817 million for the Child Care and Development Block Grant, bringing
total funding for this program to $2 billion and allowing an additional
220,000 children to be served. In my opinion, this new investment in
child care represents a significant victory for American families and
it is my sincere hope that this provision is retained in conference. I
am also pleased that this legislation provides $4.9 billion for the
Head Start program, as the President had requested. This funding
represents a funding increase of $1 billion over FY 2000.
I also commend Senators Specter and Harkin for providing a $2.7
billion increase for the National Institutes of Health, the largest
increase in history. This increase, coupled with a $2 billion increase
last year, put Congress on the path toward the goal of doubling our
nation's investment in the search for medical breakthroughs over the
next five years.
I also applaud the Appropriations Committee's bipartisan education
funding increase of $4.6 billion, including a record $1.3 billion
increase for special education, as well as increases for Title I grants
to schools, teacher technology training, Impact Aid, Reading
Excellence, vocational education, school counseling, Pell grants, and
other student financial aid programs.
Mr. President, I am particularly pleased that this legislation
includes an initiative I worked to advance last year that will serve to
protect individuals with mental illnesses from the inappropriate use of
seclusion and restraint. I first became aware of the problem
surrounding the misuse of seclusion and restraints in 1998 when the
Hartford Courant published a five-part investigative series outlining
the tragic practice. This series documented 142 deaths over the last
decade nationally that were determined to be directly attributable to
the inappropriate use of restraint and seclusion. Additionally, the
Harvard Center for Risk Analysis estimates that between 50 and 150
restraint-related deaths occur each year nationally, with more than 26
percent of those deaths occurring in children. This initiative will
ensure that physical restraints are no longer used for discipline or
for the convenience of mental health facility staff by extending to the
mental health population a standard that has been shown to be effective
in reducing the use of restraints and seclusion in nursing homes.
Further, this legislation will require that all restraint and seclusion
related deaths be reported to an appropriate oversight agency. In
addition, this legislation would require adequate staffing levels and
appropriate training for staff of facilities that serve the mentally
ill. These safeguards will hopefully prevent further harm to
individuals who may be unable to protect themselves from abuse by those
entrusted with their care.

Yet, while I recommend the overall increase in education funding, I
am concerned about the elimination of funds for critical programs. For
instance, the bill ends the bipartisan commitment to reduce class size
that has now been funded for two years. S. 2553 transfers the class
size funds to Title VI, which eliminates any guarantee that the funds
will be used for this purpose, greatly diluting targeting to high
poverty schools, and severely weakening accountability for how money is
spent. I am also concerned that this bill fails to guarantee funds for
the critical area of school modernization. Instead, it increases the
Title VI program by $1.3 billion, adding renovation and construction of
school facilities as an allowable use of funds. I am pleased that the
bill acknowledges the need for federal assistance in helping states and
schools with their school modernization needs; however, this block
grant approach fails to guarantee that funds will be used for school
modernization, and fails to target funds to schools with the greatest
needs. I also believe this bill does not go far enough to fund Title
I--an important program that provides supplemental programs to enable
educationally disadvantaged children. This bill would only increase
last year's $8 billion appropriation by $400 million. It is estimated
that it would take $24 billion to fully fund this program.
Another area of this bill that is of some concern to me is the
investment in after-school programs. The bill's funding level for 21st
Century Community Learning Centers is $400 million below the
President's request denying 1.6 million children access to before- and
after-school programs in safe, drug-free environments. I am
disappointed that my amendment to increase spending on this crucial
area to $1 billion was not adopted. It is time our funding reflects the
importance that parents place on this national priority. With 5 million
children home alone each week, after-school programs must not be an
afterthought.
I am also very troubled that this legislation now includes a patients
bill of rights proposal that offers only the illusion of patient
protections. This amendment fails to cover all Americans with private
health insurance and fails to offer patients a true right to seek legal
redress when they are harmed by an HMO's refusal to provide care. I am
also disappointed that the majority refused to support an amendment
offered by Senator Dorgan which would have required that any patient
protection legislation passed by the Senate cover all 191 million
privately insured Americans.
Lastly, I am disappointed that this legislation would delay a
proposed ergonomics standard to protect workers from work-related
musculoskeletal disorders. Each year more than 600,000 workers suffer
serious injuries, such as back injuries, carpal tunnel syndrome and
tendinitis as a result of ergonomic hazards. The proposed ergonomics
rule promulgated by OSHA can go a long way toward keeping our workers
productive and our businesses profitable. I hope that common sense will
prevail in conference, and that this and other counter-productive
measures will be remedied.
Mr. ABRAHAM. Mr. President, during the debate on the Labor-Health &
Human Services-Education appropriations bill for Fiscal Year 2001,
Senator Daschle offered an amendment relating to genetic testing and
the potential for genetics-based discrimination in the workplace.
I was thrilled at the recent announcement of the completion of the
human genetic map, and with it, the possibility of the full
identification of the more than three billion nucleotide bases that
comprise the genome. This knowledge will bring with it limitless
possibilities, vastly improving our quality of life and health.
Yet with this knowledge comes great responsibility. For all the good
this information can do for us, there is also the potential of great
harm and misuse. One of the challenges that faces us even now, is to
ensure that genetic information about an individual is not used against
him or herself.
Despite my strong conviction that genetic information must never be
used to discriminate against an individual, I was unable to support the
amendment offered by Senator Daschle relating to genetic discrimination
in the workplace.
Senator Daschle's amendment is, in reality, much more than simply a
technical amendment to an appropriations bill. It is a 5-page, far-
reaching, broadly written, piece of legislation, which would create an
entirely new class of discrimination law, creating inequalities and
conflicting with existing law.
This legislation would usurp the jurisdiction of the Equal Employment
Opportunity Commission and allow genetic discrimination suits to go
directly to the court system. This is highly unusual for discrimination
suits and would afford this form of discrimination preferential
treatment over any other form of discrimination.
In addition, this bill comes into direct conflict with the Americans
with Disabilities Act, ADA. The ADA already captures genetic
discrimination--this has been affirmed by the Secretary of the EEOC and
the Supreme Court. If we pass a separate bill that preempts the
protections already provided for in the ADA, we could potentially be
undermining our support for the people covered by those protections.
Just to highlight the possible inequalities--the Daschle amendment

[[Page S6220]]

would give a genetic marker greater protection than a paraplegic.
Given the drastic and over-reaching changes which would be brought
about by the Daschle amendment, especially in a new area such as
genetic testing, consideration of this legislation must be deliberate
and well-informed.
Yet, there has not been a single hearing on this legislation. In
fact, the amendment language was not available for review until only an
hour or so before the vote. I believe it would be wrong and even
negligent to pass legislation without knowing exactly how it would
affect Americans' lives, now and far into the future.
The Senate Health, Education, Labor and Pensions Committee has
already planned the first hearing on this matter in July. I am
confident, that with careful deliberation and thorough debate, we will
succeed in finding the most effective and appropriate way to ensure
that no one will have their genetic-information used against them. I am
looking forward to the challenge.
Mr. HATCH. Mr. President, today the Senate passed H.R. 4577,
the Labor-HHS-Education Appropriations Act. I would like to
congratulate my colleagues, Senator Specter, Senator Stevens, and
Senator Harkin for working together to pass one of the more contentious
of the annual appropriations bills.
I appreciate the comity and courtesy displayed by the managers of
this bill. I realize that most of my colleagues have specific
priorities they wish to highlight in this measure. I appreciate the
managers' support of the Inhofe amendment regarding the Impact Aid
program. As I have stated in the past, this is a vital program for
Utah.
I also appreciate the fact that the subcommittee has once again
included a provision which would allow school districts adversely
affected by a recalculation of the census to keep their Title I
concentration funds.
According to Utahns who live and work and educate our children in
these districts, this cut would do a huge disservice to Title I
students in these districts. These hardworking Utahns have informed me
that they believe that the census calculations do not adequately
reflect the pockets of poverty that exist in these districts. Some of
the schools in these districts have a poverty rate, when calculated
based on school lunch data, at over 70 percent. I am pleased that the
subcommittee has accepted the recommendation to hold these districts
harmless.
I intend to vote in favor of the Labor-HHS-Education Appropriations
bill, but I would be remiss if I did not take this opportunity to note,
once again, that a crucial provision in the Title I formula remains
unfunded. The Education Finance Incentive Grant Program was authorized
in the 1994 Elementary and Secondary Education Act and is included in
S. 2, the ESEA reauthorization, currently pending before the Congress.
I recently detailed the merits of this program when I spoke about my
intention to offer an amendment to S. 2 that would make EFIG a
mandatory component of Title I. I will briefly review those arguments
here:
EFIG has, as a principal component, an equity factor, which measures
how states distribute resources among school districts. As policy,
equalizing resources among school districts has merit well documented
in academic literature.
Moreover, many States are being compelled by the courts to equalize
resources among school districts. Over 30 states have been taken to
court on the basis of an unequal distribution of resources. My
amendment would provide some relief to states that are currently
required by the courts to equalize resources among school districts by
increasing their share of Title I funds. My amendment would also
provide the incentive to equalize resources to states which may not
have already done so.
The Education Finance Incentive Grant program would be the only part
of the Title I formula that does not use the per-pupil expenditure as a
proxy for a state's commitment to education. There are many ways to
measure a State's commitment to education--the per-pupil expenditure is
merely one. Indeed, one of the most damaging aspects of the Title I
formula is that it is replicated as a means to distribute Federal money
to the states in other programs that have no relation to Title I. The
insertion of another measure of a state's commitment to education is
appropriate.
When EFIG is a factor in the Title I formula, more states do better
than under current law. This was a key factor in the debate over the
1994 reauthorization of the Elementary and Secondary Education Act and
why it was the intent during the enactment of the 1994 reauthorization
that any additional funds directed to Title I go out through the EFIG.
Indeed, it was the reason why a number of Senators voted for the
conference report. It is my strongly held conviction that the intention
of the 1994 act should be realized, and I will continue to pursue this
goal.
I do not believe that the Senate should authorize on an
appropriations measure, which is why I did not offer my amendment
during consideration of this bill. However, I join with many of my
colleagues who have expressed concerns over the possibility that, for
the first time in nearly 30 years, the Congress will fail to
reauthorize vital elementary and secondary education programs. I
sincerely hope that those who have obstructed enactment of S. 2 will
reconsider their position and allow the bill to go forward.
The PRESIDING OFFICER. Under the previous order, the Senator from New
Mexico is recognized to speak as if in morning business.
The Senator from New Mexico.

____________________