[Congressional Record Volume 146, Number 94 (Wednesday, July 19, 2000)]
[Senate]
[Pages S7229-S7245]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. WELLSTONE:
S. 2888. A bill to guarantee for all Americans quality, affordable,
and comprehensive health insurance coverage; to the Committee on
Finance.
health security for all americans act
Mr. WELLSTONE. Mr. President, today I want to talk about an issue
that is of the utmost importance: Health Security.
First I want to talk about the problem: Health insecurity. Then I
want to talk about the solution: The Health Security for All Americans
Act. And finally I want people around the country to hear what they can
do to wake up Congress and make Health Security for All Americans a
reality.
This year has been a hard one for me. Two months ago, we buried one
of my dear friends, Mike Epstein. Mike's sons came to be with him for
the last few weeks of his struggle with cancer. Devoted sons, they
spoke glowingly about their father at a memorial service for him in the
Capitol. As any of you who has sat with a dying parent knows, emotions
overflow, coping is difficult, and the grief is profound. The last
thing a son or daughter, a parent or spouse, needs is to have the
additional burden of wondering where will the next dollar for ever
mounting health care bills come from; to worry about going into debt;
to worry about going bankrupt because of a loved ones health care
needs. Mike's sons did not have to worry about that because Mike had
health care coverage as good as Congress gets.
[[Page S7230]]
The wife of my health policy advisor, John Gilman, battled cancer for
two and a half years before succumbing one month ago. She had required
innumerable sessions of radiation therapy, plus chemotherapy and
surgery. John had his hands full with work plus taking care of his
wife, both physically and emotionally. It is draining, but can you
imagine how much worse it would be if John and his wife, June, had no
health insurance. John didn't have to worry about how to pay for the
next medical bill because John and his wife had health care coverage as
good as Congress gets.
People do get ill. As hard as we try and as much as we pray, we can't
always cure them. But we certainly can make sure they all have access
to high quality, affordable care with dignity. There is no reason why
all Americans can't have health insurance as good as everyone of us who
serves in the United States Senate.
The idea of procuring health security for all Americans is not a new
one. Franklin Delano Roosevelt recognized the need for universal health
care in the 1930s when we were in the depths of the depression; Harry
Truman fought for it in the 1940s when the troops came home from World
War II; John Kennedy envisioned it in the midst of the cold war;
Richard Nixon had it high on his agenda before events overtook his
Presidency.
What these 20th century Presidents all understood is that there is a
basic human drive for good health, and the good health of the American
people is what drives this country and its economy. By 1992 it was far
past due for us to recognize that all Americans should have a basic
right to quality affordable health care. We had the opportunity in 1993
and 1994 to confer that right on to all of our people--and we lost it,
because of differences and failures to compromise, and obstructionists
and nay sayers, and failing to keep our eye on the ball: Universal,
quality, affordable health care for every American.
I began introducing bills to provide universal health care in this
country shortly after I arrived in the Senate in 1991. Back then people
were aware of the problems of the uninsured--it wasn't being swept
under the rug. Do you remember back in 1992, we were coming out of a
recession, unemployment was at 7.5 percent, the national debt was
increasing each year and 36 million Americans were uninsured, and
everyone was talking about some form of health insurance for all.
Eight years later, we're told the economy's humming along,
unemployment is the lowest its been in 30 years, and there is a
budgetary surplus. But despite the fact that there are 45 million
Americans without health insurance--10 million more than there were 10
years ago--nobody in Washington is talking seriously about doing
anything about it. Incremental change may keep some people from losing
their insurance, and may insure some people who would otherwise be
uninsured, but incrementalism has not stopped the steady rise in the
number of uninsured in America which will soar to 55 million people by
2008.
We need to change that. I don't think the fact that 140 million
Americans own stocks today should make us forget that 45 million
Americans don't have health insurance. And that millions more can't
make ends meet because their health insurance is simply too expensive.
Make no mistake about it: Not having health insurance has its
consequences. And I know some of you know it personally too well. There
are some myths out there about not having health insurance that need to
be debunked:
The first myth is that the uninsured can easily get the care they
need. But the fact is: Uninsured Americans needlessly suffer because
they don't have access to the care they need. For example, the
uninsured are four times more likely to go without needed medical care
and to delay seeking care; and are up to four times more likely to
experience an avoidable hospitalization and emergency hospital care.
The uninsured are more likely to be in fair or poor health and have a
higher probability of in-hospital death than the privately insured.
The second myth is that the lack of health insurance is usually a
temporary condition and that most people get their coverage back
quickly. But the fact is otherwise: Nearly 60 percent of people who are
uninsured have been uninsured for at least two years. Or put another
way: 6 out of 10 people who lose their health insurance this month will
still be uninsured in July 2002!
Employers used to do more to help assure their workers of coverage.
In 1985, nearly two-thirds of businesses with 100 or more workers paid
the full cost of health coverage. Last year only one-fourth of
businesses did. In 1988, employers asked workers to pay on average 20
percent of the cost through payroll deductions. By 1998, they had
raised the average worker's share to 27 percent. Three-fourths of the
working uninsured are not offered or eligible for any coverage through
their workplace.
The third myth is that most people don't have health insurance
because they are not working. But the fact is: 75 percent of uninsured
Americans hold down full-time jobs or are the dependents of someone who
does, and nine out of ten come from working families. What's also a
fact is that low wage workers frequently aren't offered insurance at
all through their employment or if they are, it is at an unaffordable
price.
The fourth myth is that most people who don't have insurance could
afford it but just choose not to buy it. But the fact is: The high cost
of health insurance premiums is the main reason that half the uninsured
don't have health insurance. Only 3 percent of people without insurance
say the most important reason is because they don't think they need it.
Going without health insurance means living in poorer health. Most
uninsured adults have no regular source of health care. Most postpone
getting care. Three in ten go without needed medical care. A quarter
forego getting the medicine they need because they cannot afford to
fill their medical prescriptions. Uninsured children are 30 percent
more likely to fall behind on well-child care and 80 percent more
likely to never have routine care at all.
The uninsured are three to four times more likely to have problems
getting the health care they feel the need. Uninsured children are at
least 70 percent more likely not to get medical care for common
conditions--like asthma--that if left untreated can lead to more
serious health problems.
Uninsured Americans are more likely to end up hospitalized for
conditions--like uncontrolled diabetes--that they could have avoided
with better health care. In the end, uninsured patients are more likely
to die while hospitalized than privately insured patients with the same
health problems.
Partly because they are less likely to get regular mammograms,
uninsured women are nearly 50 percent more likely to die of breast
cancer. Our system takes its toll in senseless, random pain and
suffering.
Without insurance, the medical bills mount quickly. More than one in
three uninsured adults have problems paying their medical bills. The
uninsured are three times more likely to have problems with their
medical bills than the insured. Eight out of ten uninsured people
receive absolutely no reduced charge or free health services. The
crushing weight of bankruptcy looms on the horizon. One out of four
people filing for bankruptcy identified an illness or injury as a major
reason for filing; 1 out of 3 had substantial medical bills; and almost
50 percent had both.
Even with insurance, low- and middle-income families frequently find
themselves in a financial straight jacket. Families with annual incomes
of $30,000 or less are spending an inordinate, unaffordable share of
their income on health care expenses. And the average family with an
income under $10,000 is paying well over 20 percent of its annual
income on health care costs. These families can least afford to make
that kind of payment.
For families with annual incomes of $30,000 or more, the average
amount of that income spent on premiums, deductibles and co-pays drops
to below 5 percent on average. But these are just averages: many
families at every income level spend more than 10 percent of their
family income on health care, especially if someone in the family has a
serious illness. That is not affordable. That is not fair.
Since coming to the Senate, my number one priority has been achieving
universal, affordable, comprehensive, quality care for all Americans.
That is
[[Page S7231]]
why I am proud to be introducing today the Health Security for All
Americans Act.
Let me digress and tell you how I arrived at this legislation.
When I was first elected to the Senate and Bill Clinton was elected
president two years later, I believed the political winds and tides
were aligned for a decade of progressive change for America. I thought
I had been elected at just the right time to be a part of this change.
When President Clinton, in his State of the Union speech, announced he
would veto any health care legislation that did not provide universal
coverage, that every citizen must be covered, I jumped to my feet and
cheered. This was why I came to Washington, to make this kind of
change, and this was a fight I thought we could win.
But I had some quick learning to do. When I spoke about my interest
in a ``single-payer'' health care plan, similar to the Canadian system
where doctors and hospitals remain in the private sector, but where
there is just one insurer or payer, I was told by a senior colleague
that my plan might be the best proposal. ``But it does not have a
chance. The insurance industry hates it and it will go nowhere. It is
just not realistic.''
I was completely disillusioned. I could not accept then, and I do not
accept now, the proposition that even before the American people have
the opportunity to be informed or included, a good proposal is ``dead
on arrival'' because the insurance industry opposes it. That isn't
supposed to happen in a representative democracy!
In spite of the advice, I did introduce the single payer plan with
Jim McDermott, a congressman and physician from the state of
Washington. I thought first you start with the most desirable, and
later on in the process you'll find out what is politically feasible. I
refused to admit defeat before we had even begun to fight. And I was
hoping that our legislation would pull the debate in a more progressive
direction.
What happened was just the opposite. The trillion dollar health care
industry, led by the insurance companies, went on the attack, not
against our plan which ``wasn't realistic'' but against the President's
plan which ``was''. ``Harry and Louise'' ads cried out against the
horrors of ``government medicine.'' Intensive and expensive lobbying
efforts expounded on the same theme.
Media coverage, which should have been about the nuts and bolts of
different proposals shifted now to focus on strategy rather than
substance and head counts rather than hard information. So ordinary
citizens no longer had a source of knowledge to form opinions and
inform their elected leaders.
But the problems were not limited to the insurance lobby and the
media. The only way we could have beaten the health care industry would
have been with dramatic and effective citizen politics. It never
happened. Progressives didn't organize a constituency to fight for
health care reform, and the Administration didn't have the political
will to stand up to powerful interests and therefore never asked the
American people to take on this fight. They tried to win with ``inside
politics,'' cutting deals and making compromises with different
economic interests.
With each accommodation to private power, the President's plan became
hopelessly complicated. As a constituent told me at the time, ``How can
you be for something you don't understand?'' What started as a noble
effort by the President to fill a crucial national need became instead
an object of derision.
Over the years, as I traveled around the country talking about the
need for Universal Health Care and the Single Payer model, I found
people turning off--not to the need for health insurance for all, but
to the specific mechanism I favored. They wanted universal health care,
but they didn't want a national single payer system or they didn't
think one was possible here, so they stopped listening.
The mood of the country has changed since the early 1990s. In 1990,
there were 34 million uninsured. Ten years later, today, there are 45
million, and the number is growing by 100,000 people per month.
Numerous polls show that the large majority of Americans want universal
affordable comprehensive health care coverage and that they are willing
to pay higher taxes for everyone to be covered.
The people and the States are ahead of the Federal politicians on
this issue. The people want a big change; not an incremental change. In
Massachusetts and Washington state, people are pushing for ballot
referendums in the fall on universal coverage. Massachusetts and
Maryland have already received commissioned cost studies of alternative
universal coverage plans. California this past fall legislated a task
force to investigate options for universal coverage.
Governor Howard Dean (D) of VT (also a physician), whose state
presently covers 93.5 percent of its citizens, says it well: ``It is my
view that health insurance ought to be universal, the right of every
citizen in Vermont.'' And there is bipartisan support in Vermont.
``Health care is not a partisan issue in Vermont,'' state Sen. John
Bloomer (R) said, adding that ``it's a bipartisan goal to expand health
care access and affordability.''
The Health Security for All Americans Act is a plan for a big change.
It builds on the momentum going on in the states of this great Nation.
So I decided that rather than trying to tell people how I thought the
system should work, what I needed to do was first, to set out what I
have found are the common goals of the American people: universal
affordable comprehensive health coverage; and second to provide federal
matching funds for each state to reach those goals in the way that best
fits the needs of that state.
So, let me tell you about the Health Security for All Americans Act.
First, it is based on the premise that every American--not just
everyone in this chamber, but every American--is entitled to have
health care coverage as good as the Congress gets. Every Federal
employee has that right. Why shouldn't every other American?
Second, it is based on the premise that good health care must be
affordable. Americans should not go broke trying to keep their bodies
fixed. From my experience traveling around the country, Americans all
across the income spectrum are willing to be responsible for an
affordable fair share of the cost of coverage and care, and a growing
number of polls show that a majority of Americans are willing to pay
higher taxes so that all Americans will have health coverage. Under the
Health Security for All Americans Act, a family's financial
responsibilities for health care is based on a percentage of family
income. At the lowest end of the income scale, families would be
responsible for no more than one-half of 1 percent of family income, so
they can have quality health care, and a roof over their head, and 3
square meals a day. While at the higher end of the income scale,
families would be responsible for no more than 5 percent or 7 percent
of family income. For example, under the Health Security for All
Americans Act, a family of four with an annual income of $25,000 would
be responsible for no more than $11 a month in total health care costs,
while a family of four with $50,000 in annual income would have the
security of knowing that its total out-of-pocket health care spending
(premiums and cost sharing) could not exceed 5 percent of family income
or $2500 per year.
Third, it's based on the premise that you have to have access to care
when you or your family needs it. That is why the Health Security for
All Americans Act includes the Norwood-Dingell Patient Bill of Rights
that has been endorsed by over 300 health care organizations.
Fourth, it's based on the premise that good health care delivery
doesn't just happen. It depends on a well trained, well compensated
health care workforce that doesn't have to constantly worry about where
the next dollar is coming from. And I am referring to doctors and
nurses and orderlies and home health workers, and nursing home
workers--all health care workers. If we are going to deliver humane
dignified health care to everyone in this country, we need to start by
treating the health care workforce with dignity and respect and that
starts with affordable health care for all workers. That is why the
Health Security for All Americans Act includes health care quality,
patient safety, and workforce standards.
[[Page S7232]]
My experience has taught me that Americans agree with these premises.
They want high quality, affordable health care as good as Congress
gets, but they are not sure the best way to get there. That is why the
Health Security for All Americans Act is a federal state partnership
that says here is what Americans want; you--the states--design the plan
you want to get your state there; and we the federal government will
provide the majority of the funds you need to reach that goal in the
manner you chose.
States that submit plans early and achieve universal coverage are
rewarded with increased federal dollars for their efforts. But all
states must have plans in force within four years and coverage for all
their residents within five years. States could reach these goals in a
variety of ways: with an employer mandate, with a combination of public
and private initiatives, with single payer, or some other method. I
think this is a good approach because it allows the states flexibility,
but it clearly sets out a fair and just goal: Universal coverage;
comprehensive benefits as good as Congress gets; quality care
guaranteed with patient protections; real income protections; and
honoring of health care workers. I am proud today to be introducing the
Health Security for All Americans Act and I am proud that this
legislation has the backing and support of the Service Employees
International Union, America's largest health care union.
To my colleagues I say, together we can put universal health care
back on the front burner where it belongs.
We all know that in 1994, the effort to bring health care coverage to
all Americans failed. All of us have heard the reasons why. But what we
haven't answered is why did we give up when we knew this was the right
thing to do? Why have we become so timid? Why have we only been willing
to take half steps?
We must not shrink from the task at hand! America's doctors and
nurses know how to cure disease better than anywhere else in the world.
Well, now it is time to treat America's worst malady--45 million
uninsured Americans, and millions more underinsured Americans who are
spending far too much of their monthly pay check on health care costs.
Martin Luther King, Jr. rightly said, ``Of all the forms of
inequality, injustice in health care is the most shocking and
inhumane.'' All the doctors and all the nurses and all the other health
care providers in America cannot solve this problem nor right this
injustice, but we in the Congress can.
This is a problem that isn't going away on its own, but there is a
solution. So to my colleagues, I say, ``Join me in sponsoring the
Health Security for All Americans Act.'' And to members of the American
public who are listening, I ask you to join thousands of your fellow
citizens who have already written to Members of Congress, and call and
write your Senators and Representatives and ask them to join in
bringing quality, affordable health care coverage to all Americans.
Mr. President, I ask unanimous consent that the bill and additional
material be printed in the Record.
There being no objection, the materials were ordered to be printed in
the Record, as follows:
S. 2888
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Health
Security for All Americans Act''.
(b) Table of Contents.--The table of contents of the Act is
as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I--HEALTH SECURITY FOR ALL AMERICANS--EXPANSION PHASE (PHASE I)
Sec. 101. Expansion phase (phase I) voluntary State universal health
insurance coverage plans.
``TITLE XXII--HEALTH SECURITY FOR ALL AMERICANS
``Part A--Expansion Phase (Phase I) Plans
``Sec. 2201. Purpose; voluntary State plans.
``Sec. 2202. Plan requirements.
``Sec. 2203. Coverage requirements for expansion phase (phase I) plans.
``Sec. 2204. Allotments.
``Sec. 2205. Administration.
``Sec. 2206. Definitions.''.
TITLE II--HEALTH SECURITY FOR ALL AMERICANS--UNIVERSAL PHASE (PHASE II)
Sec. 201. Universal phase (phase II) State universal health insurance
coverage plans.
``Part B--Universal Phase (Phase II) Plans
``Sec. 2211. Purpose; mandatory State plans.
``Sec. 2212. Plan requirements.
``Sec. 2213. Coverage requirements for universal phase (phase II)
plans.
``Sec. 2214. Requirements for employers regarding the provision of
benefits.
``Sec. 2215. Allotments.
``Sec. 2216. Administration; definitions.''.
Sec. 202. Consumer protections.
``Part C--Consumer Protections
``Sec. 2221. Home care standards.
``Sec. 2222. Consumer protection in the event of termination or
suspension of services.
``Sec. 2223. Consumer protection through disclosure of information.''.
``Sec. 2224. Consumer protection through notice of changes in health
care delivery.''.
TITLE III--PATIENT PROTECTIONS
Sec. 301. Incorporation of certain protections.
TITLE IV--HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS
Sec. 401. Health Care Quality, Patient Safety, and Workforce Standards
Institute.
Sec. 402. Health Care Quality, Patient Safety, and Workforce Standards
Advisory Committee.
TITLE V--IMPROVING MEDICARE BENEFITS
Sec. 501. Full mental health and substance abuse treatment benefits
parity.
Sec. 502. Study and report regarding addition of prescription drug
benefit.
TITLE VI--LONG-TERM AND HOME HEALTH CARE
Sec. 601. Studies and demonstration projects to identify model
programs.
TITLE VII--MISCELLANEOUS
Sec. 701. Nonapplication of ERISA.
Sec. 702. Sense of Congress regarding offsets.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) The health of the American people is the foundation of
American strength, productivity, and wealth.
(2) The guarantee of health care coverage and access to
quality medical care to all Americans is a fundamental right
and is essential to the general welfare.
(3) 45,000,000 Americans, more than 11,000,000 of whom are
children, have no health insurance, and that number will grow
to more than 54,000,000 by 2007 even if the economy remains
strong.
(4) Health insurance coverage is unstable; less than \1/2\
of all adults have been in their current health plan for 3
years.
(5) The average American will hold at least 7 jobs during
their life, risking lack of health coverage every time they
change or are between jobs.
(6) In 1998, annual health care expenditures in the United
States totaled $1,150,000,000,000, or $4,094 per person.
National health expenditures are projected to total
$2,200,000,000,000 by 2008.
(7) In 1998, health care expenditures represented 13.5
percent of the gross domestic product in the United States
and grew at the rate of 5.6 percent while the gross domestic
product grew only at the rate of 4.9 percent. By 2008, health
care expenditures are projected to reach 16.2 percent of
gross domestic product. Growth in health spending is
projected to average 1.8 percentage points above the growth
rate of the gross domestic product for the period beginning
with 1998 and ending with 2008.
(8) Although the United States spends considerably more in
health care per person than any other nation, it ranks only
fifteenth among countries worldwide on an overall index
designed to measure a range of health goals according to the
World Health Organization.
(9) One of 4 adults, about 40,000,000 people, say they have
gone without needed medical care because they couldn't afford
it.
(10) Nearly 31,000,000 Americans face collection agencies
annually because they owe money for medical bills.
(11) The average American worker is paying 3 times more for
family coverage than 10 years ago, and more than 4 times more
for employee-only coverage.
(12) Because many individuals do not have health insurance
coverage, they may incur health care costs which they do not
fully reimburse, resulting in cost-shifting to others.
(13) As a consequence of the piecemeal health care system
in the United States, administrative overhead costs
approximately $1,000 per person annually, while other Western
industrialized nations with universal health care systems
spend approximately $200 per person annually for
administrative overhead.
(14) The United States should adopt national goals of
universal, affordable, comprehensive health insurance
coverage and should provide generous matching grants to
[[Page S7233]]
the States to achieve those goals within 5 years of the date
of enactment of this Act.
TITLE I--HEALTH SECURITY FOR ALL AMERICANS--EXPANSION PHASE (PHASE I)
SEC. 101. EXPANSION PHASE (PHASE I) VOLUNTARY STATE UNIVERSAL
HEALTH INSURANCE COVERAGE PLANS.
The Social Security Act (42 U.S.C. 301 et seq.) is amended
by adding at the end the following:
``TITLE XXII--HEALTH SECURITY FOR ALL AMERICANS
``PART A--EXPANSION PHASE (PHASE I) PLANS
``SEC. 2201. PURPOSE; VOLUNTARY STATE PLANS.
``(a) Purpose.--The purpose of this part is to provide
funds to participating States to enable those States to
ensure universal health insurance coverage by establishing
State administered systems.
``(b) Expansion Phase (Phase I) Plan Required.--A State is
not eligible for a payment under section 2205(a) unless the
State has submitted to the Secretary a plan that--
``(1) sets forth how the State intends to use the funds
provided under this part to ensure universal, affordable, and
comprehensive health insurance coverage to eligible residents
of the State consistent with the provisions of this part; and
``(2) has been approved under section 2202(d).
``SEC. 2202. PLAN REQUIREMENTS.
``(a) In General.--Every expansion phase (phase I) plan
shall include provisions for the following:
``(1) Information on the level of health insurance
coverage.--
``(A) The level of health insurance coverage within the
State as determined under subsection (b).
``(B) The base coverage gap for the year involved as
determined under subsection (b)(4).
``(C) State efforts to provide or obtain health insurance
coverage for uncovered residents of the State, including the
steps the State is taking to identify and enroll all
uncovered residents of the State who are eligible to
participate in public or private health insurance programs.
``(2) Details of, and timelines for, expansion phase (phase
i) plan.--
``(A) Use of funds; coordination.--The activities that the
State intends to carry out using funds received under this
part, including how the State will coordinate efforts under
this part with existing State efforts to increase the health
insurance coverage of individuals.
``(B) Timelines.--Consistent with subsection (c), the
manner in which the State will reduce the base coverage gap
for the year involved, including a timetable with specified
targets for reducing the base coverage gap by--
``(i) 50 percent within 2 years after the date of approval
of the expansion phase (phase I) plan; and
``(ii) 100 percent within 4 years after such date.
``(3) Maintenance of effort.--The manner in which the State
will ensure that--
``(A) employers within the State will continue to provide
not less than the level of financial support toward the
health insurance premiums required for coverage of their
employees as such employers provided as of the date of
enactment of this title; and
``(B) the State will continue to provide not less than the
level of State expenditures incurred for State-funded health
programs as of such date.
``(4) State outreach programs; access.--The manner in
which, and a timetable for when, the State will--
``(A) institute outreach programs; and
``(B) ensure that all eligible residents of the State have
access to the health insurance coverage provided under this
part.
``(5) Assurance of coverage of essential services.--An
assurance that the State program established under this part
will comply with the requirements of section 1867 (commonly
referred to as the `Emergency Medical Treatment and Active
Labor Act').
``(6) Representation on boards and commissions.--The manner
in which the State will ensure that all Boards and
Commissions that the State establishes to administer the plan
will include, among others, representatives of providers,
consumers, employers, and health worker unions.
``(7) Disclosure of information to the public.--The manner
in which the State will ensure that, with respect to entities
and individuals that provide services for which reimbursement
is provided under this part--
``(A) financial arrangements between insurers and providers
and between providers and medical equipment suppliers are
disclosed to the public; and
``(B) ownership interests and health care worker
qualifications and credentials are disclosed to the public.
``(8) Consumer protections.--The manner in which the State
will ensure compliance with sections 2221, 2222, 2223, and
2224.
``(9) Public review.--The manner in which the State will
provide for the public review of institutional changes in
services provided, markets and regions covered, withdrawal or
movement of services, closures or downsizing, and other
actions that affect the provision of health insurance under
the plan.
``(10) Services in rural and underserved areas; cultural
competency.--The manner in which the State will ensure--
``(A) coverage in rural and underserved areas; and
``(B) that the needs of culturally diverse populations are
met.
``(11) Purchasing pools.--The manner in which the State
will encourage the formation of State purchasing pools that
provide choice of health plans, control costs, and reduce
adverse risk selection.
``(12) Limitation on administrative expenditures.--The
manner in which the State will ensure that all qualified
plans in the State expend at least 90 percent (or, during the
first 2 years of the plan, 85 percent) of total income
received from premiums on the provision of covered health
care benefits (excluding all costs for marketing,
advertising, health plan administration, profits, or capital
accumulation) to individuals.
``(13) Self-employed and multiemployed.--The manner in
which the State will address self-employed individuals and
multiwage earner families.
``(14) Medicaid wraparound coverage.--The manner in which
the State will ensure that individuals who are eligible for
medical assistance under title XIX and who receive benefits
under the expansion phase (phase I) plan shall receive any
items or services that are not available under the expansion
phase (phase I) plan but that are available under the State
medicaid program under title XIX through `wraparound
coverage' under such program.
``(15) Other matters.--Any other matter determined
appropriate by the Secretary.
``(b) Current Level of Coverage.--
``(1) In general.--The Secretary shall develop a survey
approach that provides timely and up-to-date data to
determine the percentage of the population of each State that
is currently covered by a health insurance plan or program
that provides coverage that meets the requirements of section
2203(a).
``(2) Biannual survey.--The Secretary shall provide for the
conduct of the survey developed under paragraph (1) not less
than biannually to make coverage determinations for purposes
of paragraph (1).
``(3) Use of alternative system.--The Secretary shall
permit a State to utilize an alternative population-based
monitoring system to make determinations with respect to
coverage in the State for purposes of paragraph (1) if the
Secretary determines that such system meets or exceeds the
methodological standards utilized in the survey developed
under paragraph (1).
``(4) Base coverage gap.--For purposes of subsection
(a)(1)(A), the base coverage gap for a State shall be equal
to 100 percent of the eligible individuals and families in
the State for the year involved, less the current level of
coverage for those individuals and families for such year as
determined under paragraph (1) or (3).
``(c) Reducing the Level of Uninsured Individuals.--
``(1) In general.--To be eligible to receive funds under
this part, a State shall agree to administer an expansion
phase (phase I) plan with a goal of providing health
insurance coverage for 100 percent of the eligible residents
of the State by not later than 4 years after the date of
approval of the State's expansion phase (phase I) plan.
``(2) Permissible activities.--A State may use amounts
provided under this part for any activities consistent with
this part that are appropriate to enroll individuals in
health plans and health programs to meet the targets
contained in the State plan under subsection (a)(2)(B),
including through the use of direct payments to health plans
or, in the case of a single State plan, directly to providers
of services.
``(d) Process for Submission, Approval, and Amendment of
Expansion Phase (Phase I) Plan.--The provisions of section
2106 apply to an expansion phase (phase I) plan under this
part in the same manner as they apply to a State plan under
title XXI, except that no expansion phase (phase I) plan may
be effective earlier than January 1, 2001, and all expansion
phase (phase I) plans must be submitted for approval by not
later than December 31, 2002.
``SEC. 2203. COVERAGE REQUIREMENTS FOR EXPANSION PHASE (PHASE
I) PLANS.
``(a) Required Scope of Health Insurance Coverage.--Health
insurance coverage provided under this part shall consist of
at least the benefits provided under the Federal Employees
Health Benefits Program standard Blue Cross/Blue Shield
preferred provider option service benefit plan, described in
and offered under section 8903(1) of part 5, United States
Code, including mental health and substance abuse treatment
benefits parity.
``(b) Limitations on Premiums and Cost-Sharing.--
``(1) Description; general conditions.--An expansion phase
(phase I) plan shall include a description, consistent with
this subsection, of the amount (if any) of premiums, cost-
sharing, or other similar charges imposed. Any such charges
shall be imposed pursuant to a public schedule.
``(2) Limitations on premiums and cost-sharing.--
``(A) Individuals and families with income below 150
percent of poverty line.--In the case of an individual or
family whose income is at or below 150 percent of the poverty
line--
``(i) the State plan may not impose a premium; and
``(ii) the total annual aggregate amount of cost-sharing
imposed by a State with respect to all individuals in a
family may not exceed 0.5 percent of the family's income for
the year involved.
[[Page S7234]]
``(B) Individuals and families with income between 150 and
300 percent of poverty line.--In the case of an individual or
family whose income exceeds 150 percent but does not exceed
300 percent of the poverty line--
``(i) the State plan may not impose a premium that exceeds
an amount that is equal to--
``(I) 20 percent of the average cost of providing benefits
to an individual (or a family) under this part in the year
involved; or
``(II) 3 percent of the family's income for the year
involved; and
``(ii) the total annual aggregate amount of premiums and
cost-sharing (combined) imposed by a State with respect to
all individuals in a family may not exceed 5 percent of the
family's income for the year involved.
``(C) Individuals and families with income above 300
percent of poverty line.--In the case of an individual or
family whose income exceeds 300 percent of the poverty line--
``(i) the State plan may not impose a premium that exceeds
20 percent of the average cost of providing benefits to an
individual (or a family of the size involved) under this part
in the year involved; and
``(ii) the total annual aggregate amount of premiums and
cost-sharing (combined) imposed by a State with respect to
all individuals in a family may not exceed 7 percent of the
family's income for the year involved.
``(D) Self-employed individuals.--The State shall establish
rules for self-employed individuals based on individual and
family income.
``(3) Collection.--The State shall establish procedures for
collecting any premiums, cost-sharing, or other similar
charges imposed under this part. Such procedures shall
provide for annual reconciliations and adjustments.
``(c) Application of Certain Requirements.--
``(1) Restriction on application of preexisting condition
exclusions.--The expansion phase (phase I) plan shall not
permit the imposition of any preexisting condition exclusion
for covered benefits under the plan.
``(2) Choice of plans.--
``(A) In general.--Except as provided in subparagraph (B),
the expansion phase (phase I) plan shall offer eligible
individuals and families a choice of qualified plans from
which to receive benefits under this part. At least 1 plan
shall be a preferred provider option plan.
``(B) Waiver.--The Secretary--
``(i) may waive the requirement under subparagraph (A) if
determined appropriate; and
``(ii) shall waive such requirement in the case of a State
that establishes a single State plan.
``SEC. 2204. ALLOTMENTS.
``(a) State Allotments.--
``(1) In general.--With respect to a fiscal year, the
Secretary shall allot to each State with an expansion phase
(phase I) plan approved under this part the amount determined
under paragraph (2) for such State for such fiscal year.
``(2) Determination of cost of coverage.--The amount
determined under this paragraph is the amount equal to--
``(A) the product of--
``(i) the Federal participation rate for the State as
determined under subsection (b) or, if applicable, the
enhanced Federal participation rate for the State, as
determined under subsection (c);
``(ii) the estimated cost for the minimum benefits package
required to comply under section 2203, not to exceed the sum
of--
``(I) the total annual Government and employee
contributions required for individual or self and family
health benefits coverage under the Federal Employees Health
Benefits Program standard Blue Cross/Blue Shield preferred
provider option service benefit plan, described in and
offered under section 8903(1) of title 5, United States Code
(adjusted for age, as the Secretary determines appropriate);
and
``(II) the estimated average cost-sharing expense for an
individual or family; and
``(iii) the estimated number of residents to be enrolled in
the expansion phase (phase I) plan; less
``(B) the sum of--
``(i) the individual or family health insurance
contribution and cost-sharing payments to be made in
accordance with section 2203(b); and
``(ii) any applicable employer contribution to such
payments.
``(b) Federal Participation Rate.--For purposes of
subsection (a)(2)(A)(i), the Federal participation rate for a
State shall be equal to the enhanced FMAP determined for the
State under section 2105(b).
``(c) Enhanced Federal Participation Rate.--
``(1) In general.--For purposes of subsection (a)(2)(A)(i),
the enhanced Federal participation rate for a State shall be
equal to the Federal participation rate for such State under
subsection (b), as adjusted by the Secretary based on the
decrease in the base coverage gap in the State.
``(2) Amount of adjustment and application.--
``(A) Amount of adjustment.--The Federal participation rate
under subsection (b) with respect to a State shall be
increased by--
``(i) 1 percentage point if the base coverage gap of the
State has decreased by at least 50 percent within 2 years
after the date of approval of the expansion phase (phase I)
plan, as determined by the Secretary; and
``(ii) 3 percentage points if the base coverage gap of the
State has decreased by 100 percent within 4 years after the
date of approval of the expansion phase (phase I) plan, as
determined by the Secretary.
``(B) Application.--The increase described in--
``(i) subparagraph (A)(i) shall only apply to a State for
the period beginning with the month of the determination
under such subparagraph and ending with the month preceding
the month of the determination under subparagraph (A)(ii) (if
any), but in no event for more than 24 months; and
``(ii) subparagraph (A)(ii) shall apply to a State for any
year (or portion thereof) beginning with the month of the
determination under such subparagraph.
``(3) Full coverage.--For purposes of this part, a State
shall be deemed to have decreased its base coverage gap by
100 percent if the Secretary determines that--
``(A) 98 percent of all eligible residents of the State are
provided health insurance coverage under the expansion phase
(phase I) plan; and
``(B) the remaining 2 percent of such residents are served
by alternative health care delivery systems as demonstrated
by the State.
``(d) Grants to Indian Tribes, Native Hawaiian
Organizations, and Alaska Native Organizations.--
``(1) In general.--Out of funds appropriated under
subsection (e), the Secretary shall reserve an amount, not to
exceed 1 percent of the total allotments determined under
subsection (a) for a fiscal year, to make grants to Indian
tribes, Native Hawaiian organizations, and Alaska Native
organizations for development and implementation of universal
health insurance coverage plans for members of such tribes
and organizations.
``(2) Plan.--To be eligible to receive a grant under
paragraph (1), an Indian tribe, Native Hawaiian organization,
or Alaska Native organization shall submit a universal health
insurance coverage plan to the Secretary at such time, in
such manner, and containing such information, as the
Secretary may require.
``(3) Regulations.--The Secretary shall issue regulations
specifying the requirements of this part that apply to Indian
tribes, Native Hawaiian organizations, and Alaska Native
organizations receiving grants under paragraph (1).
``(e) Appropriation.--
``(1) In general.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to carry out
this title such sums as may be necessary for fiscal year 2001
and each fiscal year thereafter.
``(2) Budget authority.--Paragraph (1) constitutes budget
authority in advance of appropriations Acts and represents
the obligation of the Federal Government to provide States,
Indian tribes, Native Hawaiian organizations, and Alaska
Native organizations with the allotments determined under
this section and the grants for administrative and outreach
activities under section 2205.
``SEC. 2205. ADMINISTRATION.
``(a) Payments.--
``(1) In general.--
``(A) Quarterly.--Subject to subparagraph (B) and
subsection (b), the Secretary shall make quarterly payments
to each State with an expansion phase (phase I) plan approved
under this part, from its allotment under section 2204.
``(B) Funding for administration and outreach.--
``(i) Authority to make grants.--In addition to the
allotments determined under section 2204, the Secretary may
make grants to States, Indian tribes, Native Hawaiian
organizations, and Alaska Native organizations for
expenditures for administrative and outreach activities.
``(ii) Amounts.--
``(I) In general.--A grant awarded under this subparagraph
shall not exceed the applicable percentage (as determined
under subclause (II)) of the total amount allotted to the
State, Indian tribe, Native Hawaiian organization, or Alaska
Native organization under section 2204.
``(II) Applicable percentage.--For purposes of subclause
(I), the applicable percentage is--
``(aa) 14 percent during the first 2 years an expansion
phase (phase I) plan is in effect and complies with the
requirements of this title;
``(bb) 12 percent during the third, fourth, and fifth years
that such plan, or a universal phase (phase II) plan added by
an addendum to an expansion phase (phase I) plan, is in
effect and complies with the requirements of this title; and
``(cc) 10 percent during any year thereafter such plan (or
universal phase (phase II) plan added by an addendum to such
plan) is in effect and complies with the requirements of this
title.
``(2) Advance payment; retrospective adjustment.--The
Secretary may make payments under this part for each quarter
on the basis of advance estimates by the State and such other
investigation as the Secretary may find necessary, and may
reduce or increase the payments as necessary to adjust for
any overpayment or underpayment for prior quarters.
``(3) Flexibility in submittal of claims.--Nothing in this
subsection shall be construed as preventing a State from
claiming as expenditures in the quarter expenditures that
were incurred in a previous quarter.
[[Page S7235]]
``(b) Authority for Blended Rate for Health Security,
Medicaid, and SCHIP Funds.--The Secretary shall establish
procedures for blending the payments that a State is entitled
to receive under this title, title XIX, and title XXI into 1
payment rate if--
``(1) the State requests such a blended payment; and
``(2) the Secretary finds that the State meets maintenance
of effort requirements established by the Secretary.
``(c) Limitations on Federal Payments Based on Cost
Containment.--
``(1) Determination of baseline.--Each year (beginning with
2001), the Secretary shall establish a baseline projection
for the national rate of growth in private health insurance
premiums for such year.
``(2) Requirement.--Beginning with fiscal year 2002 and
each fiscal year thereafter, any payment made to a State
under section 2204 shall not exceed the amount paid to the
State under such section for the preceding fiscal year,
adjusted for changes in enrollment and a premium inflation
adjustment that is 0.5 percent below the baseline projection
determined under paragraph (1) for the year.
``(d) Other Limitations On Use of Funds.--
``(1) In general.--A State participating under part A, and,
effective January 1, 2005, all States under part B, shall
ensure that any payments received by the State under section
2205 or 2116(a) are not used by any individual or entity,
including providers or health plans that contract to provide
services herein, to finance directly or indirectly, or to
otherwise facilitate expenditures to influence health care
workers of such individual or entity with respect to issues
related to unionization.
``(2) Construction.--Nothing in this subsection shall be
construed to limit expenditures made for the purpose of good
faith collective bargaining or pursuant to the terms of a
bona fide collective bargaining agreement.
``(e) Waiver of Federal Requirements.--A State may request
(and the Secretary may grant) a waiver of any provision of
Federal law that the State determines is necessary in order
to carry out an approved expansion phase (phase I) plan under
this part.
``(f) Report.--Not later than January 1, 2002, and each
January 1 thereafter, the Secretary, in consultation with the
General Accounting Office and the Congressional Budget
Office, shall prepare and submit to the appropriate
committees of Congress a report on the number of States
receiving payments under this part for the year for which the
report is being prepared as well as the level of insurance
coverage attained by each such State.
``SEC. 2206. DEFINITIONS.
``In this title:
``(1) Cost-sharing.--The term `cost-sharing' has the
meaning given such term under the Federal Employees Health
Benefits Program standard Blue Cross/Blue Shield preferred
provider option service benefit plan described in and offered
under section 8903(1) of part 5, United States Code, and
includes deductibles, copayments, coinsurance, as such terms
are defined for purposes of such plan.
``(2) Eligible residents of a state.--
``(A) In general.--The term `eligible residents of a State'
means an individual or family who--
``(i) is (or consists of) a resident of the State involved;
``(ii) except as provided in subparagraph (B), has a family
income that does not exceed 300 percent of the poverty line;
``(iii) is (or consists of) a citizen of the United States,
a legal resident alien, or an individual otherwise residing
in the United States under the authority of Federal law; and
``(iv) in the case of an individual, is not eligible for
benefits under the medicare program under title XVIII or for
medical assistance under the medicaid program under title XIX
(other than under the application of section
1902(a)(10)(A)(ii)(XIV)).
``(B) Option to provide coverage for individuals and
families with higher income.--If approved by the Secretary, a
State may increase the percentage described in subparagraph
(A)(ii), or eliminate all income eligibility criteria in
order to provide coverage under this part to more individuals
and families.
``(3) Expansion phase (phase i) plan.--The term `expansion
phase (phase I) plan' means the State universal health
insurance coverage plan submitted under section 2201(b).
``(4) Health care services.--The term `health care
services' includes medical, surgical, mental health, and
substance abuse services, whether provided on an in-patient
or outpatient basis.
``(5) Health care worker.--The term `health care worker'
means an individual employed by an employer that provides--
``(A) health care services; or
``(B) necessary related services, including administrative,
food service, janitorial, or maintenance service to an entity
that provides such health care services.
``(6) Health plan.--The term `health plan' includes health
insurance coverage, as defined in section 2791(b)(1) of the
Public Health Service Act (42 U.S.C. 300gg-91(b)(1)) and
group health plans, as defined in section 2791(a) of such Act
(42 U.S.C. 300gg91(b)(1)).
``(7) Mental health and substance abuse treatment benefits
parity.--
``(A) In general.--The term `mental health and substance
abuse treatment benefits parity' means the same level of
parity for such benefits as is required under the Federal
Employees Health Benefits Program standard Blue Cross/Blue
Shield preferred provider option service benefit plan,
described in and offered under section 8903(1) of part 5,
United States Code, as of January 1, 2001.
``(B) Exception.--Notwithstanding subparagraph (A), there
shall be no limit on parity benefits for patients who do not
substantially follow their treatment plans unless such limits
also are imposed on all medical and surgical benefits.
``(8) Poverty line.--The term `poverty line' has the
meaning given such term in section 673(2) of the Community
Services Block Grant Act (42 U.S.C. 9902(2)), including any
revision required by such section.
``(9) Premium.--The term `premium' includes any enrollment
fees and other similar charges.
``(10) Qualified plan.--The term `qualified plan' means a
health plan that satisfies the coverage requirements
described under section 2203 and participates in an expansion
phase (phase I) plan.''.
TITLE II--HEALTH SECURITY FOR ALL AMERICANS--UNIVERSAL PHASE (PHASE II)
SEC. 201. UNIVERSAL PHASE (PHASE II) STATE UNIVERSAL HEALTH
INSURANCE COVERAGE PLANS.
Title XXII of the Social Security Act, as added by section
101, is amended by adding at the end the following:
``PART B--UNIVERSAL PHASE (PHASE II) PLANS
``SEC. 2211. PURPOSE; MANDATORY STATE PLANS.
``(a) Purpose.--The purposes of this part are to--
``(1) require States to establish and implement State-
administered systems to ensure universal health insurance
coverage; and
``(2) provide funds to States for the establishment and
implementation of such systems.
``(b) Universal Phase (Phase II) Plan Required.--
``(1) In general.--Except as provided in paragraph (2), not
later than January 1, 2004, a State shall submit to the
Secretary a plan that sets forth how the State intends to use
the funds provided under this part to ensure universal,
affordable, and comprehensive health insurance coverage to
eligible residents of the State consistent with the
provisions of this part.
``(2) States with phase i plans.--
``(A) In general.--Not later than January 1, 2004, a State
with a phase I State plan shall submit an addendum to such
plan that provides assurances to the Secretary that such plan
conforms to the requirements of this part.
``(B) Conversion to universal phase (phase ii) plan.--If an
addendum to an expansion phase (phase I) plan is approved by
the Secretary--
``(i) the plan shall be automatically converted to a
universal phase (phase II) plan; and
``(ii) section 2214 and any provision of part A that is
inconsistent with this part shall not apply to the plan.
``(3) Failure to submit plan or addendum.--If a State fails
to submit a plan as required in paragraph (1) (or an addendum
as required in paragraph (2)), or fails to have such plan or
addendum approved by the Secretary, such State shall be in
violation of this part; and any residents of such a State may
bring a cause of action against the State in Federal district
court to require the State to comply with the provisions of
this part.
``SEC. 2212. PLAN REQUIREMENTS.
``(a) In General.--A universal phase (phase II) plan shall
include a description, consistent with the requirements of
this part, of the following:
``(1) Details of the universal phase (phase ii) plan.--The
activities that the State intends to carry out using funds
received under this part to ensure that all eligible
residents of the State have access to the coverage provided
under this part, including how the State will coordinate
efforts under the program under this part with existing State
efforts to increase to 100 percent the health insurance
coverage of eligible residents of the State by January 1,
2006.
``(2) Requirements for employers.--The manner in which the
State will ensure that employers within the State will comply
with the requirements of section 2214.
``(3) Part a provisions.--The following provisions apply to
a universal phase (phase II) plan under this part in the same
manner as such provisions apply to an expansion phase (phase
I) plan under part A:
``(A) State outreach programs; access.--Section 2202(a)(4).
``(B) Assurance of coverage of essential services.--Section
2202(a)(5).
``(C) Representation on boards and commissions.--Section
2202(a)(6).
``(D) Disclosure of information to the public.--Section
2202(a)(7).
``(E) Consumer protections and workforce standards.--
Section 2202(a)(8).
``(F) Public review.--Section 2202(a)(9).
``(G) Services in rural and underserved areas; cultural
competency.--Section 2202(a)(10).
``(H) Purchasing pools.--Section 2202(a)(11).
``(I) Limitation on administrative expenditures.--Section
2202(a)(12).
``(J) Self-employed and multiemployed.--Section
2202(a)(13).
[[Page S7236]]
``(K) Medicaid wraparound coverage.--Section 2202(a)(14).
``(4) Other matters.--Any other matter determined
appropriate by the Secretary.
``(b) Permissible Activities.--A State may use amounts
provided under this part for any activities consistent with
this part that are appropriate to enroll individuals in
health plans to ensure that all eligible residents of the
State are provided coverage under this part, including
through the use of direct payments to health plans or
providers of services.
``(c) Cost Containment; Competitive Bidding.--
Notwithstanding subsection (b), State purchasing pools shall
solicit bids from health plans at least annually.
``(d) Process for Submission, Approval, and Amendment of
Universal Phase (Phase II) Plan.--Section 2106 applies to a
universal phase (phase II) plan under this part in the same
manner as such section applies to a State plan under title
XXI, except that no universal phase (phase II) plan may be
effective earlier than January 1, 2005, and all such plans
must be submitted for approval by not later than January 1,
2004.
``SEC. 2213. COVERAGE REQUIREMENTS FOR UNIVERSAL PHASE (PHASE
II) PLANS.
``(a) Required Scope of Health Insurance Coverage.--Section
2203(a) applies to a universal phase (phase II) plan under
this part.
``(b) Universal Coverage.--All States shall ensure that by
January 1, 2006, 100 percent of eligible residents of the
State have health insurance coverage that meets the
requirements of section 2203(a).
``(c) Limitations on Premiums and Cost-Sharing.--Section
2203(b) applies to a universal phase (phase II) plan under
this part.
``(d) Application of Certain Requirements.--Section 2203(c)
applies to a universal phase (phase II) plan under this part.
``SEC. 2214. REQUIREMENTS FOR EMPLOYERS REGARDING THE
PROVISION OF BENEFITS.
``(a) Requirements.--Subject to subsection (c)(2)(B), an
employer in a State shall comply with the following
requirements:
``(1) Employers with less than 500 employees.--
``(A) In general.--An employer with less than 500 employees
shall enroll each employee in a State-designated purchasing
pool.
``(B) Contributions.--
``(i) In general.--Notwithstanding subparagraph (A) and
subject to clause (ii), the employer shall make a
contribution on behalf of each employee for health insurance
coverage that is equal to at least 80 percent of the total
premiums for such coverage for employees and their families
if the employee elects dependent coverage.
``(ii) Limitation.--An employer shall not be liable under
subparagraph (B) for more than 10 percent of each employee's
annual wages.
``(2) Employers with at least 500 employees.--
``(A) In general.--An employer with at least 500 employees,
a majority of whose wages fall below an amount equal to 300
percent of the poverty line applicable to a family of the
size involved, shall comply with the requirements applicable
to an employer under paragraph (1).
``(B) Other employers.--
``(i) In general.--An employer with at least 500 employees
that is not described in subparagraph (A) shall, at the
option of the employer, either--
``(I) comply with the requirements applicable to an
employer under paragraph (1); or
``(II) provide health insurance coverage to all employees
and their families (if the employee elects dependent
coverage) that meets the requirements of section 2213 and the
employer contribution required under paragraph (1)(B).
``(ii) Additional employer contribution.--An employer that
elects to comply with clause (i)(I) shall contribute an
additional 1 percent of payroll into the State-designated
purchasing pool in which it participates.
``(3) Rule of construction.--Nothing in this title shall be
construed as prohibiting a labor organization from
collectively bargaining for an employer contribution that is
greater than the contribution that is required under
paragraph (1)(B) or, as applicable, for health insurance
benefits that are greater than the coverage required under
paragraph section 2203(a).
``(4) Part-time employees.--An employer shall be
responsible for meeting the requirements under this
subsection for all employees of the employer.
``(5) Multiemployer families.--In the case of a family with
more than 1 employer, the employers of individuals within the
family shall apportion their contributions in accordance with
rules established by the State.
``(b) Nonapplicability.--This section shall not apply--
``(1) to any State that establishes a single payor system;
or
``(2) to any State that established a universal phase
(phase II) plan through an approved addendum to an expansion
phase (phase I) plan.
``(c) Private Cause of Action.--
``(1) Liability.--An employer that fails to comply with the
requirements of subsection (a) or otherwise takes adverse
action against an employee for the purpose of interfering
with the attainment of any right to which the employee may be
entitled to under this title, shall be liable to the employee
affected.
``(2) Amount.--The amount of the liability described in
paragraph (1) shall be an amount equal to--
``(A) the contributions that otherwise would have been made
by the employer on behalf of the employee under this section;
``(B) an additional amount as liquidated damages; and
``(C) consequential damages for reasonably foreseeable
injuries resulting from such action.
``(3) Jurisdiction; equitable relief.--
``(A) Jurisdiction.--An action under this subsection may be
maintained against any employer in any Federal or State court
of competent jurisdiction by any 1 or more employees.
``(B) Equitable relief.--In addition to the damages
described in paragraph (2), a court may enjoin any act or
practice that violates this title.
``(4) Attorney's fees.--If a plaintiff or plaintiffs
prevail in an action brought under this subsection, the court
shall, in addition to any judgment awarded to the plaintiff
or plaintiffs, award the reasonable attorney's fees and costs
associated with the bringing of the action.
``SEC. 2215. ALLOTMENTS.
``(a) State Allotments.--Subsections (a) and (b) of section
2204 apply to a universal phase (phase II) plan under this
part in the same manner as such subsections apply to an
expansion phase (phase I) plan under part A.
``(b) Special Rule for Expansion Phase (Phase I) Plans.--A
State that operated an expansion phase (phase I) plan and
converted such plan to a universal phase (phase II) plan
pursuant to section 2211(b)(2)(B) shall continue to be
eligible for the enhanced Federal participation rate
determined under section 2204(c).
``(c) Grants to Indian Tribes, Native Hawaiian
Organizations, and Alaska Native Organizations.--Section
2204(d) applies to a universal phase (phase II) plan under
this part.
``(d) Appropriation.--
``(1) In general.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to carry out
this title such sums as may be necessary for fiscal year 2005
and each fiscal year thereafter.
``(2) Budget authority.--Paragraph (1) constitutes budget
authority in advance of appropriations Acts and represents
the obligation of the Federal Government to provide States,
Indian tribes, Native Hawaiian organizations, and Alaska
Native organizations with the allotments determined under
this section and the grants for administrative and outreach
activities under section 2205(a)(1)(B) (as applied to this
part under section 2216(a)).
``SEC. 2216. ADMINISTRATION; DEFINITIONS.
``(a) Administration.--The provisions of section 2205
(other than subsection (c) of such section) apply to a
universal phase (phase II) plan under this part in the same
manner as such provisions apply to an expansion phase (phase
I) plan under part A.
``(b) Definitions.--
``(1) Application of section 2206.--The definitions set
forth in section 2206 apply to a universal phase (phase II)
plan under this part in the same manner as such provisions
apply to an expansion phase (phase I) plan under part A
except that for purposes of this part, the definition of
`eligible residents of a State' set forth in section 2206(2)
shall be applied without regard to subparagraphs (A)(ii) and
(B).
``(2) Universal phase (phase ii ) plan.--In this title, the
term `universal phase (phase II) plan' means the State
universal health insurance coverage plan submitted under
section 2211(b).''.
SEC. 202. CONSUMER PROTECTIONS.
Title XXII of the Social Security Act, as amended by
section 201, is amended by adding at the end the following:
``PART C--CONSUMER PROTECTIONS
``SEC. 2221. HOME CARE STANDARDS.
``In order to ensure that home care services are provided
in a consumer-directed manner, a State participating under
part A, and, effective January 1, 2005, all States under part
B, shall satisfy the Secretary that any health plan that
provides home care services under this title creates, or
contracts with, a viable entity other than the consumer or
individual provider to provide effective billing, payments
for services, tax withholding, unemployment insurance, and
workers compensation coverage, and to serve as the statutory
employer of the home care provider. Recipients of such
services shall retain the right to independently select,
hire, terminate, and direct the work of the home care
provider.
``SEC. 2222. CONSUMER PROTECTION IN THE EVENT OF TERMINATION
OR SUSPENSION OF SERVICES.
``A State participating under part A, and, effective
January 1, 2005, all States under part B, shall satisfy the
Secretary that any health plan providing services under this
title shall ensure that enrollees will receive continued
health services in the event that the plan's health care
services are terminated or suspended, including as the result
of the plan filing for bankruptcy relief under title 11,
United States Code, or the failure of the plan to provide
payments to providers, lockouts, work stoppages, or other
labor management problems.
``SEC. 2223. CONSUMER PROTECTION THROUGH DISCLOSURE OF
INFORMATION.
``(a) In General.--A State participating under part A, and,
effective January 1, 2005,
[[Page S7237]]
all States under part B, shall satisfy the Secretary that any
health care provider that provides services to individuals
under this title shall provide to the State information
regarding the identity, employment location, and
qualifications of health care workers providing services
under--
``(1) the licensure of the provider; or
``(2) a contract between the provider and a health plan or
the State.
``(b) Availability to Public.--A health care provider shall
make the information described in subsection (a) available to
the public.''.
``SEC. 2224. CONSUMER PROTECTION THROUGH NOTICE OF CHANGES IN
HEALTH CARE DELIVERY.
``A State participating under part A, and, effective
January 1, 2005, all States under part B, shall describe how
the State will provide, at a minimum, the following
protections:
``(1) Adequate advance notice to the public, the affected
health care workers, and labor organizations representing
such workers, of a pending--
``(A) facility or operating unit closure;
``(B) sale, merger, or consolidation of a facility or
operating unit;
``(C) transfer of work from 1 facility or entity to another
facility or entity; or
``(D) reduction of services.
``(2) A right of first refusal for similar vacant positions
with--
``(A) the resulting entity, in the case of a health care
worker whose position was eliminated following a merger of
the worker's original employer with a new entity; or
``(B) the contractor, in the case of a health care worker
whose position was eliminated following the contracting out
of the work the worker formerly performed.''.
TITLE III--PATIENT PROTECTIONS
SEC. 301. INCORPORATION OF CERTAIN PROTECTIONS.
(a) Incorporation.--The provisions of the following bills
are hereby enacted into law:
(1) H.R. 2723 of the 106th Congress (other than section
135(b)), as introduced on August 5, 1999.
(2) H.R. 137 of the 106th Congress, as introduced on
January 6, 1999.
(b) Publication.--In publishing this Act in slip form and
in the United States Statutes at Large pursuant to section
112, of title 1, United States Code, the Archivist of the
United States shall include after the date of approval at the
end appendixes setting forth the texts of the bills referred
to in subsection (a) of this section.
TITLE IV--HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS
SEC. 401. HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE
STANDARDS INSTITUTE.
(a) Establishment.--
(1) Institute.--There is established within the Agency for
Healthcare Research and Quality, an institute to be known as
the Health Care Quality, Patient Safety, and Workforce
Standards Institute (in this section referred to as the
``Institute'').
(2) Director.--The Secretary of Health and Human Services
shall appoint a director of the Institute. The director shall
administer the Institute and carry out the duties of the
director under this section subject to the authority,
direction, and control of the Secretary.
(b) Mission.--The mission of the Institute is to--
(1) demonstrate how patient safety issues and workplace
conditions are linked to quality patient care and the
reduction of the incidence of medical errors; and
(2) reduce the incidence of medical errors and improve
patient safety and quality of care.
(c) Duties.--In carrying out the mission of the Institute,
the director of the Institute shall--
(1) work closely with the director of the Agency for
Healthcare Research and Quality to ensure that issues related
to workplace conditions are reflected in the activities
conducted by such agency in order to reduce the incidence of
medical errors and improve patient safety and quality of
care, including--
(A) the establishment of national goals;
(B) the development and implementation of a research
agenda;
(C) the development and promotion of best practices;
(D) the development of performance and staffing standards
in consultation with the Health Care Financing Administration
and other Federal agencies, as appropriate; and
(E) the development and dissemination of information,
educational and training materials, and other criteria as it
relates to the delivery of quality care;
(2) provide recommendations to the Secretary of Health and
Human Services and other Federal agencies with responsibility
for health care quality and the development of standards that
impact on the delivery of quality patient care on standards
related to workplace conditions and patient safety;
(3) support the activities of the Health Care Financing
Administration related to the development of new or revised
conditions of participation under the medicare and medicaid
programs and subsequent rulemaking on issues related to
workplace conditions, medical errors, and patient safety and
quality of care; and
(4) conduct other activities determined appropriate by the
director of the Institute.
(d) Workplace Conditions.--For purposes of this section,
the term ``workplace conditions'' shall include issues
related to--
(1) health care worker staffing;
(2) hours of work;
(3) confidentiality and whistleblower protections;
(4) employee participation in decisionmaking roles that
contribute to improved quality of care and the reduction of
the incidence of medical errors;
(5) workforce training; and
(6) the impact of health care delivery restructuring on
communities and health care workers.
(e) Definition of Health Care Worker.--
(1) In general.--In this section, the term ``health care
worker'' means an individual employed by an employer that
provides--
(A) health care services; or
(B) necessary related services, including administrative,
food service, janitorial, or maintenance service to an entity
that provides such health care services.
(2) Health care services.--In paragraph (1), the term
``health care services'' includes medical, surgical, mental
health, and substance abuse services, whether provided on an
in-patient or outpatient basis.
(f) Authorization of Appropriations.--There are authorized
to be appropriated to the Institute such sums as may be
necessary to carry out the purposes of this section.
SEC. 402. HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE
STANDARDS ADVISORY COMMITTEE.
(a) Establishment of Committee.--There is established a
Health Care Quality, Patient Safety, and Workforce Standards
Committee (in this section referred to as the ``Committee'').
(b) Functions of Committee.--
(1) Advice to institute.--The Committee shall provide
advice to the Director of the Health Care Quality, Patient
Safety, and Workforce Standards Institute established under
section 401 on issues related to the duties of the Director.
(2) Initial report.--Not later than December 31, 2001, the
Committee shall submit an initial report to the Secretary
that contains--
(A) recommendations regarding minimal workforce standards
that are critical for improved health care quality and
patient safety; and
(B) recommendations regarding additional ways to reduce the
incidence of medical errors and to improve patient safety and
quality of care.
(3) Final report.--Not later than December 31, 2002, the
Committee shall submit a final report to the Secretary of
Health and Human Services regarding the recommendations
contained in the initial report required under paragraph (2),
including any modifications of such recommendations.
(c) Structure and Membership of the Committee.--
(1) Structure.--The Committee shall be composed of the
Director of the Health Care Quality, Patient Safety, and
Workforce Standards Institute established under section 401
and 15 additional members who shall be appointed by the
Secretary of Health and Human Services.
(2) Membership.--
(A) In general.--The members of the Committee shall be
chosen on the basis of their integrity, impartiality, and
good judgment, and shall be individuals who are, by reason of
their education, experience, and attainments, exceptionally
qualified to perform the duties of members of the Committee.
(B) Specific members.--In making appointments under
paragraph (1), the Secretary of Health and Human Services
shall ensure that the following groups are represented:
(i) Health care providers and health care workers,
including labor unions representing health care workers.
(ii) Consumer organizations.
(iii) Health care institutions.
(iv) Health education organizations.
(d) Chairman.--The Director of the Health Care Quality,
Patient Safety, and Workforce Standards Institute established
under section 401 shall chair the Committee.
TITLE V--IMPROVING MEDICARE BENEFITS
SEC. 501. FULL MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT
BENEFITS PARITY.
Notwithstanding any provision of title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.), beginning January 1,
2001, each individual who is entitled to benefits under part
A or enrolled under part B of the medicare program, including
an individual enrolled in a Medicare+Choice plan offered by a
Medicare+Choice organization under part C of such program,
shall be provided full mental health and substance abuse
treatment parity under the medicare program established under
such title of such Act consistent with title XXII of the
Social Security Act (as added by this Act).
SEC. 502. STUDY AND REPORT REGARDING ADDITION OF PRESCRIPTION
DRUG BENEFIT.
Not later than January 1, 2003, the Director of the
Institute of Medicine shall study and report to Congress and
the President legislative recommendations for adding a
comprehensive, accessible, and affordable prescription drug
benefit to the medicare program established under title XVIII
of the Social Security Act (42 U.S.C. 1395 et seq.).
[[Page S7238]]
TITLE VI--LONG-TERM AND HOME HEALTH CARE
SEC. 601. STUDIES AND DEMONSTRATION PROJECTS TO IDENTIFY
MODEL PROGRAMS.
The Secretary of Health of Human Services shall--
(1) conduct studies and demonstration projects, through
grant, contract, or interagency agreement, that are designed
to identify model programs for the provision of long-term and
home health care services;
(2) report regularly to Congress on the results of such
studies and demonstration projects; and
(3) include in such report any recommendations for
legislation to expand or continue such studies and projects.
TITLE VII--MISCELLANEOUS
SEC. 701. NONAPPLICATION OF ERISA.
The provisions of section 514 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1144) shall not apply
with respect to health benefits provided under a group health
plan (as defined in section 733(a) of that Act (29 U.S.C.
1191b(a))) qualified to offer such benefits under an
expansion phase (phase I) plan under title XXII of the Social
Security Act (as added by this Act) or under a universal
phase (phase II) plan under such title.
SEC. 702. SENSE OF CONGRESS REGARDING OFFSETS.
It is the sense of Congress that any sums necessary for the
implementation of this Act, and the amendments made by this
Act, should be offset by--
(1) general revenues available as a result of an on-budget
surplus for a fiscal year;
(2) direct savings in health care expenditures resulting
from the implementation of this Act; and
(3) reductions in unnecessary Federal tax benefits
available only to individuals and large corporations that are
in the maximum tax brackets.
____
GROWTH IN THE NUMBER OF UNINSURED AMERICANS: 1988-98
[Millions of nonelderly uninsured]
------------------------------------------------------------------------
Year
------------------------------------------------------------------------
1988....................................................... 33.6
1989....................................................... 34.3
1990....................................................... 35.6
1991....................................................... 36.3
1992....................................................... 38.3
1993....................................................... 39.3
1994....................................................... 39.4
1995....................................................... 40.3
1996....................................................... 41.4
1997....................................................... 43.1
1998....................................................... 43.9
1999....................................................... \1\ 45.0
2000....................................................... \2\ 55.0
------------------------------------------------------------------------
\1\ Approximate.
\2\ Projected.
Source: Employee Benefits Institute, 2000.
Data: Current Population Surveys (March) 1989-1999 Health Insurance
Association of America (HIAA).
MOST IMPORTANT REASONS FOR NOT HAVING HEALTH INSURANCE, 2000
------------------------------------------------------------------------
Percent
------------------------------------------------------------------------
It is too expensive.......................................... 47
Your job doesn't offer coverage.............................. 15
You are between jobs or unemployed........................... 15
You can't get coverage or were refused....................... 5
You don't think you need it.................................. 3
Other........................................................ 15
------------------------------------------------------------------------
Source: The NewsHour with Jim Lehrer/Kaiser Family Foundation National
Survey on the Uninsured, 2000.
______
___
By Mr. DURBIN:
S. 2889. A bill to amend the Federal Cigarette Labeling and
Advertising Act and the Comprehensive Smokeless Tobacco Health
Education Act of 1986 to require warning labels for tobacco products;
to the Committee on Commerce, Science, and Transportation.
the stronger tobacco warning labels to save lives act
Mr. DURBIN. Mr. President, today I am introducing the Stronger
Tobacco Warning Label to Save Lives Act. This legislation would replace
the current cigarette warning label on tobacco products with larger,
more direct messages that will have an impact on current smokers and
potential smokers who are usually children. The Stronger Tobacco
Warning Label to Save Lives Act will require a new series of warning
labels modeled after new, more effective warning labels in Canada.
On January 19, 2000, Canadian Health Minister Allan Rock unveiled new
and larger health warning labels for tobacco products which include
color graphics and images that illustrate the damage that cigarettes do
to the health of smokers and those around them. These warning labels
will cover 50% of the front and back panels of tobacco products--one
side in English and the other in French--and provide more information
on the harmful ingredients in tobacco products. These new warning
labels apply to all tobacco products. They will take effect on January
1, 2001.
After the U.S. Surgeon General publicly announced the dangers of
tobacco use in 1965, the U.S. became the first country to impose
mandatory health warning labels on all cigarette packs. In 1984, the
U.S. replaced that label with a system of four rotating warning labels.
Since then, the U.S. cigarette warning labels have become stale and
ineffective. Many smokers have memorized all of the current warning
labels. Others never notice the warnings because they are placed
inconspicuously the side of the pack.
Other countries have since taken the lead and required stronger
health warning labels. These labels have been effective in reducing
smoking rates. For example, in South Africa, tobacco consumption
decreased by 15% between 1994 and 1997 due to a combination of radio
advertising campaigns, increased excise taxes on cigarettes, and new
health warning labels. Fifty-eight percent of smokers said that the
cigarette warning labels made them want to quit, cut down on smoking,
or at least change to a lighter cigarette. Among non-smokers, 38% said
that the warnings made them glad they had never started smoking.
The tobacco industry's massive expenditures on tobacco product
promotion and public relations have ensured that, over time, Americans
have seen more positive than negative imagery surrounding tobacco. The
Stronger Tobacco Warning Label to Save Lives Act will ensure that every
time someone lights up, the first thing that comes to mind is the
health consequences--not the alluring lifestyle images associated with
tobacco industry marketing. Too many young people smoke because they
are led to believe it's cool and glamorous, when the truth is that
tobacco kills.
Because tobacco products are highly addictive for many users, and
because most users start using tobacco at a very young age, the
standard of warning for tobacco must be much higher than for other
products. The warning labels should at least be as prominent in selling
the health message as the industry's design is effective in promoting
the product. This is not about banning or regulating a legal product,
this is about providing the consumer with the appropriate information
so they can make an informed decision.
Mr. President, I urge my colleagues to join me in cosponsoring this
important legislation to ensure that every time someone lights up, the
first thing that comes to mind are the health consequences--not the
alluring lifestyle images associated with tobacco industry marketing. I
ask unanimous consent that a copy of the legislation be printed in the
Congressional Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 2889
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Stronger Tobacco Warning
Labels to Save Lives Act''.
SEC. 2. AMENDMENT TO FEDERAL CIGARETTE AND LABELING
ADVERTISING ACT.
(a) Amendment.--The Federal Cigarette Labeling and
Advertising Act (15 U.S.C. 1331 et seq.) is amended by
striking section 4 and inserting the following:
``SEC. 4. LABELING.
``(a) Label.--
``(1) In general.--It shall be unlawful for any person to
manufacture, package, or import for sale or distribution
within the United States any cigarettes the package of which
fails to bear, in accordance with the requirements of this
section, a warning label.
``(2) Regulations.--Not later than 1 year after the date of
enactment of this section, the Secretary shall promulgate
regulations describing the warning label required by
paragraph (1).
``(3) Content of label.--The regulations promulgated under
paragraph (2) shall ensure that the text of each warning
label addresses one of the following:
``(A) Diseases or fatal health conditions caused by
cigarette smoking.
``(B) Any physical addiction that results from cigarette
smoking.
``(C) The influence that cigarette smoking by adults has on
young children and teenagers and the consequences of such
use.
``(D) The health hazards of secondhand smoke from
cigarettes.
``(4) Graphics.--
``(A) In general.--The regulations promulgated under
paragraph (2) shall ensure that each warning label contains a
color graphic or picture that illustrates or emphasizes to
the greatest practicable extent the message of the text of
the corresponding warning label.
``(B) Contents.--The graphics described in subparagraph (A)
shall enhance the message of the text of the warning label
and may include a color picture of one of the following:
[[Page S7239]]
``(i) A diseased lung, heart, or mouth.
``(ii) An individual suffering from addiction.
``(iii) Children watching an adult smoke a cigarette.
``(iv) An individual adversely affected by secondhand smoke
from a cigarette, including pregnant women or infants.
``(b) Advertising.--It shall be unlawful for any
manufacturer or importer of cigarettes to advertise or cause
to be advertised within the United States any cigarette
unless the advertising bears, in accordance with the
requirements of this section, one of the warning label
statements required by subsection (a).
``(c) Requirements for Labeling.--
``(1) Location.--Each label statement required by
subsection (a) shall be located on the upper portion of the
front panel of the cigarette package (or carton) and occupy
not less than 50 percent of such front panel.
``(2) Type and color.--Each label statement required by
subsection (a) shall be printed in at least 17 point type
with adjustments as determined appropriate by the Secretary.
All the letters in the label shall appear in conspicuous and
legible type, in contrast by typography, layout, or color
with all other printed material on the package, and be
printed in a black-on-white or white-on-black format as
determined appropriate by the Secretary.
``(d) Requirements for Advertising.--
``(1) Location.--Each label statement required by
subsection (b) shall occupy not less than 50 percent of the
area of the advertisement involved.
``(2) Type and color.--
``(A) Type.--Each label statement required by subsection
(b) shall be printed in a point type that is not less than
the following types:
``(i) With respect to whole page advertisements on
broadsheet newspaper--45 point type.
``(ii) With respect to half page advertisements on
broadsheet newspaper--39 point type.
``(iii) With respect to whole page advertisements on
tabloid newspaper--39 point type.
``(iv) With respect to half page advertisements on tabloid
newspaper--27 point type.
``(v) With respect to DPS magazine advertisements--31.5
point type.
``(vi) With respect to whole page magazine advertisements--
31.5 point type.
``(vii) With respect to 28cm x 3 column advertisements--
22.5 point type.
``(viii) With respect to 20cm x 2 column advertisements--15
point type.
The Secretary may revise the required type sizes as the
Secretary determines appropriate within the 50 percent
requirement.
``(B) Color.--All the letters in the label under this
paragraph shall appear in conspicuous and legible type, in
contrast by typography, layout, or color with all other
printed material and be printed in an alternating black-on-
white and white-on-black format as determined appropriate by
the Secretary.
``(e) Rotation of Label Statements.--
``(1) In general.--Except as provided in paragraph (2), the
label statements specified in subsections (a) and (b) shall
be rotated by each manufacturer or importer of cigarettes
quarterly in alternating sequence on packages of each brand
of cigarettes manufactured by the manufacturer or importer
and in the advertisements for each such brand of cigarettes
in accordance with a plan submitted by the manufacturer or
importer and approved by the Federal Trade Commission. The
Federal Trade Commission shall approve a plan submitted by a
manufacturer or importer of cigarettes which will provide the
rotation required by this subsection and which assures that
all of the labels required by subsections (a) and (b) will be
displayed by the manufacturer or importer at the same time.
``(2) Application of other rotation requirements.--
``(A) In general.--A manufacturer or importer of cigarettes
may apply to the Federal Trade Commission to have the label
rotation described in subparagraph (C) apply with respect to
a brand style of cigarettes manufactured or imported by such
manufacturer or importer if--
``(i) the number of cigarettes of such brand style sold in
the fiscal year by the manufacturer or importer preceding the
submission of the application is less than \1/4\ of 1 percent
of all the cigarettes sold in the United States in such year;
and
``(ii) more than \1/2\ of the cigarettes manufactured or
imported by such manufacturer or importer for sale in the
United States are packaged into brand styles which meet the
requirements of clause (i).
If an application is approved by the Commission, the label
rotation described in subparagraph (C) shall apply with
respect to the applicant during the 1-year period beginning
on the date of the application approval.
``(B) Plan.--An applicant under subparagraph (A) shall
include in its application a plan under which the label
statements specified in subsection (a) will be rotated by the
applicant manufacturer or importer in accordance with the
label rotation described in subparagraph (C).
``(C) Other rotation requirements.--Under the label
rotation which the manufacturer or importer with an approved
application may put into effect, each of the labels specified
in subsection (a) shall appear on the packages of each brand
style of cigarettes with respect to which the application was
approved an equal number of times within the 12-month period
beginning on the date of the approval by the Commission of
the application.
``(f) Application of Requirement.--Subsection (a) does not
apply to a distributor or a retailer of cigarettes who does
not manufacture, package, or import cigarettes for sale or
distribution within the United States.
``(g) Cigars; Pipe Tobacco.--
``(1) In general.--The Secretary shall promulgate such
regulations as may be necessary to establish warning labels
for cigars and pipe tobacco. Such regulations shall require
content-specific messages regarding health hazards posed by
cigars and pipe tobacco, include graphic illustrations of
such content messages, as is required under subsection (a),
and be formatted in a clear and unambiguous manner, as is
required under subsection (a).
``(2) Definitions.--In this subsection:
``(A) Cigar.--The term `cigar' means any roll of tobacco
wrapped in leaf tobacco or in any substance containing
tobacco (other than any roll of tobacco that is a cigarette
or cigarillo).
``(B) Pipe tobacco.--The term `pipe tobacco' means any
loose tobacco that, because of the appearance, type,
packaging or labeling of such tobacco, is likely to be
offered to, or purchased by, consumers as a tobacco to be
smoked in a pipe.''
(b) Effective Date.--The amendment made by this section
shall take effect 1 year after the date of enactment of this
section.
SEC. 3. AMENDMENT TO THE COMPREHENSIVE SMOKELESS TOBACCO
HEALTH EDUCATION ACT OF 1986.
(a) Amendment.--The Comprehensive Smokeless Tobacco Health
Education Act of 1986 (15 U.S.C. 4401 et seq.) is amended by
striking section 3 and inserting the following:
``SEC. 3. SMOKELESS TOBACCO WARNING.
``(a) General Rule.--
``(1) Label on package.--It shall be unlawful for any
person to manufacture, package, or import for sale or
distribution within the United States any smokeless tobacco
product unless the product package bears, in accordance with
the requirements of this section, a warning label.
``(2) Label in advertisements.--It shall be unlawful for
any manufacturer, packager, or importer of smokeless tobacco
products to advertise or cause to be advertised within the
United States any smokeless tobacco product unless the
advertising bears, in accordance with the requirements of
this Act, one of the labels required by paragraph (1).
``(b) Regulations.--Not later than 1 year after the date of
enactment of this section, the Secretary shall promulgate
regulations describing the warning labels required under
subsection (a).
``(c) Content of label.--The regulations promulgated under
subsection (b) shall ensure that the text of each warning
label addresses one of the following:
``(1) Diseases resulting from use of smokeless tobacco
products.
``(2) Any physical addiction that results from using
smokeless tobacco products.
``(3) The influence that use of smokeless tobacco products
by adults has on young children and teenagers and the
consequences of such use.
``(d) Number of labels.--The regulations promulgated under
subsection (b) shall ensure that not less than 2 warning
labels are created for each subject matter described in
paragraphs (1), (2), and (3) of subsection (c). Such
regulations shall also require that each package of smokeless
tobacco bear 1 warning label that shall be rotated in
accordance with subsection (g).
``(e) Graphics.--
``(1) In general.--The regulations promulgated under
subsection (b) shall ensure that each warning label required
by subsection (a) contains a color graphic or picture that
illustrates or emphasizes to the greatest practicable extent
the message of the text of the corresponding warning label.
``(2) Contents.--The graphics described in paragraph (1)
shall enhance the message of the text of the warning label
and may include a color picture of one of the following:
``(A) A diseased mouth or other physical effect of using
smokeless tobacco products.
``(B) An individual using a smokeless tobacco product.
``(C) Children watching an adult use a smokeless tobacco
product.
``(f) Format.--
``(1) Location.--Each label statement required by
subsection (a)(1) shall be located on the principal display
panel of the product and occupy not less than 50 percent of
such panel.
``(2) Type and color.--Each label statement required by
subsection (a)(1) shall be printed in 17 point type with
adjustments as determined appropriate by the Secretary to
reflect the length of the required statement. All the letters
in the label shall appear in conspicuous and legible type in
contrast by typography, layout, or color with all other
printed material on the package and be printed in an
alternating black on white and white on black format as
determined appropriate by the Secretary.
``(g) Advertising and Rotation.--The provisions of sections
(d) and (e)(1) of the Federal Cigarette Labeling and
Advertising Act (as amended by the Stronger Tobacco Warning
Labels to Save Lives Act) shall apply to advertisements for
smokeless tobacco products required under subsection (a)(2)
and the rotation of the label statements required under
subsection (a)(1) on such products.
[[Page S7240]]
``(h) Application of Requirement.--Subsection (a) does not
apply to a distributor or a retailer of smokeless tobacco
products who does not manufacture, package, or import such
products for sale or distribution within the United States.
``(i) Television and Radio Advertising.--It shall be
unlawful to advertise smokeless tobacco or cigars on any
medium of electronic communications subject to the
jurisdiction of the Federal Communications Commission.''.
(b) Effective Date.--The amendment made by this section
shall take effect 1 year after the date of enactment of this
section.
______
By Ms. SNOWE (for herself and Mr. L. Chafee):
S. 2890. A bill to provide States with funds to support State,
regional, and local school construction; to the Committee on Health,
Education, Labor, and Pensions.
building, renovating, improving, and constructing kids' schools act
Ms. SNOWE. Mr. President, I rise today with my friend and colleague,
Senator Chafee, to introduce a revised version of the ``Building,
Renovating, Improving, and Constructing Kids' Schools (BRICKS) Act''--
legislation that would address our nation's burgeoning need for K-12
school construction, renovation, and repair.
The legislation--which is endorsed by the National Education
Association (NEA) and National PTA, and the National Association of
State Boards of Education (NASBE)--would accomplish this in a fiscally-
responsible manner while seeking to find the middle ground between
those who support a very direct, active federal role in school
construction, and those who are concerned about an expanded federal
role in what has been--and remains--a state and local responsibility.
Mr. President, the condition of many of our nation's existing public
schools is abysmal even as the need for additional schools and
classroom space grows. Specifically, according to reports issued by the
General Accounting Office (GAO) in 1995 and 1996, fully one-third of
all public schools needing extensive repair or replacement.
As further evidence of this problem, an issue brief prepared by the
National Center for Education Statistics (NCES) in 1999 stated that the
average public school in America is 42 years old, with school buildings
beginning rapid deterioration after 40 years. In addition, the NCES
brief found that 29 percent of all public schools are in the ``oldest
condition,'' which means that they were built prior to 1970 and have
either never been renovated or were renovated prior to 1980.
Not only are our nation's schools in need of repair and renovation,
but there is a growing demand for additional schools and classrooms due
to an ongoing surge in student enrollment. Specifically, according to
the NCES, at least 2,400 new public schools will need to be built by
the year 2003 to accommodate our nation's burgeoning school rolls,
which will grow from a record 52.7 million children today to 54.3
million by 2008.
Needless to say, the cost of addressing our nation's need for school
renovations and construction is enormous. In fact, according to the
General Accounting Office (GAO), it will cost $112 billion just to
bring our nation's schools into good overall condition, and a recent
report by the NEA identified $332 billion in unmet school modernization
needs. Nowhere is this cost better understood than in my home state of
Maine, where a 1996 study by the Maine Department of Education and the
State Board of Education determined that the cost of addressing the
state's school building and construction needs stood at $637 million.
Mr. President, we simply cannot allow our nation's schools to fall
into utter disrepair and obsolescence with children sitting in
classrooms that have leaky ceiling or rotting walls. We cannot ignore
the need for new schools as the record number of children enrolled in
K-12 schools continues to grow.
Accordingly, because the cost of repairing and building these
facilities may prove to be more than many state and local governments
can bear in a short period of time, I believe the federal government
can and should assist Maine and other state and local governments in
addressing this growing national crisis.
Admittedly, not all members support strong federal intervention in
what has been historically a state and local responsibility. In fact,
many argue with merit that the best form of federal assistance for
school construction or other local educational needs would be for the
federal government to fulfill its commitment to fund 40 percent of the
cost of special education. This long-standing commitment was made when
the Individuals with Disabilities Education (IDEA) Act was signed into
law more than 20 years ago, but the federal government has fallen
woefully short in upholding its end of the bargain, only recently
increasing its share above 10 percent.
Needless to say, I strongly agree with those who argue that the
federal government's failure to fulfill this mandate represents nothing
less than a raid on the pocketbook of every state and local government.
Accordingly, I am pleased that recent efforts in the Congress have
increased federal funding for IDEA by nearly $2.5 billion over the past
four years, and I support ongoing efforts to achieve the 40 percent
federal commitment in the near future.
Yet, even as we work to fulfill this long-standing commitment and
thereby free-up local resources to address local needs, I believe the
federal government can do more to assist state and local governments in
addressing their school construction needs without infringing on local
control.
Mr. President, the legislation we are offering today--the ``BRICKS
Act''--will do just. Specifically, it addresses our nation's school
construction needs in a responsible fiscal manner while bridging the
gap between those who advocate a more activist federal role in school
construction and those who do not.
First, our legislation will provide $20 billion in federal loans to
support school construction, renovation, and repair at the local level.
By designating that at least one-half of these loan monies must be used
to pay the interest owed to bondholders on new school construction
bonds that are issued through the year 2003, the federal government
will leverage the issuing of new bonds by states and localities that
would not otherwise be made. In addition, by providing that up to one-
half of the monies may be used for state-wide school construction
initiatives, the bill provides needed flexibility to ensure that unique
state and local approaches to school construction will also be
supported, such as revolving loan funds.
Of importance, these loan monies--which will be distributed on an
annual basis using the Title I distribution formula--will become
available to each state at the request of a Governor. While the federal
loans can only be used to support bond issues that will supplement, and
not supplant, the amount of school construction that would have
occurred in the absence of the loans, there will be no requirement that
states engage in a lengthy application process that does not even
assure them of their rightful share of the $20 billion pot.
Second, our bill ensures that these loans are made by the federal
government in a fiscally responsible manner that does not cut into the
Social Security surplus or claim a portion of non-Social Security
surpluses that may prove ephemeral in the future.
Specifically, our bill would make these loans to states from the
Exchange Stabilization Fund (ESF)--a fund that was created through the
Gold Reserve Act of 1934 and has grown to hold more than $40 billion in
assets. The principal activity of the fund--which is controlled solely
by the Secretary of the Treasury--is foreign exchange intervention that
is intended to limit fluctuations in exchange rates. However, the fund
has also been used to provide stabilization loans to foreign countries,
including a $20 billion line of credit to Mexico in 1995 to support the
peso.
In light of the controversial manner in which the ESF has been used,
some have argued that additional constraints should be placed on the
fund. Still others--including former Federal Reserve Board Governor
Lawrence B. Lindsey--have stated that, for various reasons, the fund
should be liquidated.
Regardless of how one feels about exercising greater constraint over
he ESF or liquidating it, I believe that if this $40 billion fund can
be used to bailout foreign currencies, it certainly can be used to help
America's schools.
Accordingly, I believe it is appropriate that the $20 billion in
loans provided by my legislation will be made
[[Page S7241]]
from the ESF--an amount identical to the line of credit that was
extended to Mexico by the Secretary of the Treasury in 1995. Of
importance, these loans will be made from the ESF on a progressive,
annual basis--not in a sudden or immediate manner. Furthermore, these
monies will be repaid to the fund to ensure that the ESF is compensated
for the loans it makes.
Although the ESF will recoup all of the monies it lends, it should
also be noted that my proposal ensures that states and local
governments will not be forced to pay excessive interest, or that they
will be forced to repay over an unreasonable period of time. In fact,
if the federal government fails to substantially increase its share of
IDEA funding, states will incur no interest at all!
Specifically, to encourage the federal government to meet its funding
commitment for IDEA--and to compensate states for the fact that every
dollar in foregone IDEA funding is a dollar less that they have for
school construction or other local needs--our bill would impose no
interest on BRICKS loans during the first five years provided the 40
percent funding commitment is not met.
Thereafter, the interest rate is pegged to the federal share of IDEA:
zero in any year that the federal government fails to fund at least 20
percent of the cost of IDEA; 2.5 percent--the long-term projected
inflation rate--in years that the federal share falls between 20 and 30
percent; 3.5 percent in years the federal share is 30 to 40 percent;
and 4.5 percent in years the full 40 percent share is achieved.
Combined, these provisions will minimize the cost of these loans to
the states, and maximize the utilization of these loans for school
construction, renovation, and repair.
Mr. President, by providing low-interest loans to states and local
governments to support school construction, I believe that our bill
represents a fiscally-responsible, centrist solution to a national
problem.
For those who support a direct, active federal role in school
construction, our bill provides substantial federal assistance by
dedicating $20 billion to leverage a significant amount of new school
construction bonds. For those who are concerned about the federal
government becoming overly-engaged in an historically state and local
responsibility--and thereby stepping on local control--my bill directs
that the monies provided to states will be repaid, and that no onerous
applications or demands are placed on states to receive their share of
these monies.
Mr. President, I urge that my colleagues support the ``BRICKS Act''--
legislation that is intended to bridge the gap between competing
philosophies on the federal role in school construction. Ultimately, if
we work together, we can make a tangible difference in the condition of
America's schools without turning it into a partisan or ideological
battle that is better suited to sound bites than actual solutions.
Thank you, Mr. President. I ask unanimous consent that the letters of
support from the NEA, PTA, NASBE, and Jim Rier, the Chairman of the
Maine State Board of Education, be inserted in the Record following my
statement.
There being no objection, the materials were ordered to be printed in
the Record, as follows:
National Education Association,
Washington, DC, July 13, 2000.
Senator Olympia Snowe,
U.S. Senate,
Washington, DC.
Dear Senator Snowe: On behalf of the National Education
Association's (NEA) 2.5 million members, we would like to
thank you for your leadership in introducing a revised
version of the Building, Renovating, Improving, and
Constructing Kids' Schools (BRICKS) Act.
As you know, our nation's schools are in desperate need of
repair and renovation. Too many students attend classes in
overcrowded buildings with leaky roofs, faulty wiring, and
outdated plumbing. A recently-released NEA study documents
more than $300 billion in unmet infrastructure and technology
needs, nearly three times the level estimated in previous
research by the General Accounting Office.
NEA believes the revised BRICKS Act offers a meaningful
avenue for assisting schools. The bill would make available
$20 billion in guaranteed funding over 15 years to provide
low-interest--and in many cases zero interest--school
modernization loans to states and schools. According to a
preliminary Department of Education analysis, the BRICKS Act
would provide schools with a benefit of $465 for each $1,000
in bonds.
We are pleased that the BRICKS Act would allow up to 50
percent of federal funds to be used for payment of actual
construction costs or the principal portion of loans, as well
as the interest costs. We also appreciate the provision
allowing those states with laws that prohibit borrowing to
pay the interest costs on school bonds to use 100 percent of
their BRICKS loans for state revolving loan funds or other
state administered school modernization programs.
NEA believes it is essential to enact meaningful school
modernization assistance this year. We thank you for your
leadership in this area and look forward to continuing to
work with you toward passage of bipartisan school
modernization legislation.
Sincerely,
Mary Elizabeth Teasley,
Director of Government Relations.
____
National PTA,
Chicago, IL, July 7, 2000.
Hon. Lincoln D. Chafee,
Hon. Olympia J. Snowe,
United States Senate, Washington, DC.
Dear Senators Chafee and Snowe: On behalf of the 6.5
million parents, teachers, students, and other child
advocates who are members of the National PTA, I am writing
to support the Building, Renovating, Improving, and
Constructing Kids' Schools (BRICKS) Act, which you plan to
introduce next week.
We thank you for your leadership in proposing this
initiative, which acknowledges the federal government's
responsibility to help schools repair and renovate their
facilities. As you are aware, the U.S. General Accounting
Office has estimated that the cost of fixing the structural
problems in schools across the nation will cost more than
$112 billion. If new schools are built to accommodate
overcrowding, and if schools' technology, wiring, and
infrastructure needs are added in, this estimate would exceed
$200 billion dollars.
This is a problem schools cannot address without a
partnership with the federal government, and National PTA
supports a variety of approaches to address this growing
crisis. In addition to endorsing the BRICKS bill, National
PTA is supporting the Public School Repair and Renovation
Act, which would provide tax credits to pay the interest on
school modernization bonds and create a grant and loan
program for emergency repairs in high-need districts; and
also the America's Better Classrooms Act, which would provide
$22 billion over two years in zero interest school
construction and modernization bonds.
Under BRICKS, nearly $20 billion would be available over 15
years to provide low interest, and in many cases zero
interest, loans to States for interest payments on their
school modernization bonds. We are pleased that the proposal
will allow increased flexibility in using the federal funds
for interest payments, as well as for other state-
administered programs that assist state entities or local
governments pay for the construction or repair of schools.
National PTA is committed to helping enact a federal school
modernization proposal this Congress. We believe the BRICKS
Act should be promoted as one of the ways the federal
government can assist schools, and we thank you for your
leadership in this area. We look forward to continuing to
work with you toward formulation and passage of bipartisan
school modernization legislation.
Sincerely,
Vicki Rafel,
Vice President for Legislation.
____
National Association of
State Boards of Education,
Alexandria, VA, July 18, 2000.
Hon. Olympia Snowe,
U.S. Senate,
Washington, DC.
Dear Senator Snowe: The National Association of State
Boards of Education (NASBE) is a private nonprofit
association representing state and territorial boards of
education. Our principal objectives are to strengthen state
leadership in education policy-making, promote excellence in
the education of all students, advocate equality of access to
educational opportunity, and assure responsible governance of
public education.
We are writing to applaud your efforts to provide federal
assistance to states for school construction. The
deterioration of America's school infrastructure has reached
crisis proportions. At least one-third of all U.S. schools
are in need of extensive repairs or replacement and 60% have
at least one major building deficiency such as cracked
foundations, leaky roofs, or crumbling walls. We cannot
expect our children to learn much less excel in such decrepit
and unsafe environments.
The more than $112 billion needed to renovate and/or repair
existing school facilities has simply overwhelmed state and
local resources. This national problem demands federal
attention and we are encouraged that your office is
attempting to address this need by proposing a $20 billion
federal loan program.
Your legislation, the Building, Renovating, Improving, and
Construction Kids' Schools Act (BRICKS), will leverage new
school construction expenditures at the state and local
levels and provides flexibility to integrate this assistance
with the variety of solutions
[[Page S7242]]
states have already undertaken, such as revolving funds, to
enhance the financing of school construction.
We appreciate your efforts and attention to address this
critical situation. NASBE is encouraged by your actions and
we look forward to working with your office to foster a
partnership between federal, state and local entities to
improve the learning conditions of American children.
Sincerely,
Brenda Lilienthal Welburn,
Executive Director.
____
State Board of Education,
Augusta, ME, April 29, 2000.
Senator Olympia J. Snowe,
United States Senate,
Washington, DC.
Dear Senator Snowe: The age and condition of our nation's
public schools are an expanding crisis and should be of great
concern to all. Decades of neglect, unfunded maintenance
programs, constrained state and municipal budgets, shifting
populations, technology requirements, and programmatic
changes have combined to weaken the infrastructure of public
education. As you are well aware, a 1995 GAO report estimated
that just repairing existing school facilities would cost
$112 billion. In addition, building new facilities to met the
demands of program and increased enrollments could cost
another $73 billion. We have allowed the condition of our
schools to deteriorate to a point that there are now critical
implications for the health and safety of our students and
staff who occupy those buildings. A number of states have
launched major efforts to address their school facilities
needs. The task is huge and beyond the ability of most local
and even state resources.
Unfortunately, Maine mirrors the nation. A Facilities
Inventory Study, conducted in 1996 by the Department of
Education and the University of Maine's Center for Research
and Evaluation, identified approximately $650 million in
needed facility improvements. Of particular concern was the
need for over $60 million in serious health and safety
related improvements as well as an additional $150 million in
other renovation and upgrades required.
In response to Maine's survey of over 700 buildings,
Governor King appointed a Commission to develop a plan to
address the needs identified. Their report was delivered to
the Maine Legislature in February 1998, and the
recommendations were enacted in April 1998. Maine has
responded to address the identified needs with significant
state and local resources. However, even as we develop policy
and resources to aggressively address those needs, our
concern grows.
Progressing from the condition survey to a detailed
engineering and environmental analysis of the conditions
causes even greater alarm. Roofs that were reported as
leaking in the survey are found to have serious structural
integrity problems with greater safety risks for occupants as
well as more complex and costly solutions. Indoor air quality
problems in the survey grow from increased air exchange
solutions to more complex ones due to mold and microbial
growth in the interior walls. Again, this poses increased
health risk for students and staff. As we learn more about
the problems, our concerns grow and the necessary resources
increase. The critical health and safety needs from the 1996
survey ($60 million) have grown to over $86 million in our
latest project estimates. Many more projects are yet to be
identified.
Applications for Major Capital Construction projects were
received in August of 1999 from over 100 buildings throughout
Maine. Even with a major new commitment of over $200 million
from this Session of the Maine Legislature we will only be
able to address approximately 20 of those projects over the
next two years. More will be applying in the next two-year
cycle that begins in July 2001.
Although school construction and modernization is and
should remain primarily a state and local responsibility,
states and school districts cannot meet the current urgent
needs alone. Federal assistance in the form of reduced or low
interest loans as you have included in S1992, the BRICKS ACT,
responds to the urgent need and could provide a critical
component to a comprehensive but flexible approach to address
Maine's, as well as the nation's, school facilities needs. As
currently proposed, your legislation would allow the
flexibility to address the renovation and upgrade of existing
facilities as well as provide relief for overcrowding and
insufficient program space where major capital construction
is required. It creates an effective local/state/federal
partnership, while leaving decisions about which schools to
build or repair up to states and local school units. In
Maine, that would allow us to strengthen our Revolving
Renovation Fund (created to aid local units in the upgrade
and renovation of existing buildings), and it would enhance
our bonding capacity for long term debt commitment to major
capital construction projects.
Structurally unfit, environmentally deficient, or
overcrowded classrooms impair student achievement, diminish
student discipline, and compromise student safety. Although
not cited often, the learning environment does affect the
quality of education and our ability to help students achieve
high standards.
The National Association of State Boards of Education has
identified school construction as one of its priority issues.
I serve as Vice-Chair of their Governmental Affairs Committee
and would be happy to enlist their help in focusing the
nation's attention on the poor condition of our schools and
the need for comprehensive federal assistance. If you have
questions or need information from NASBE please contact David
Griffith, Director of Governmental Affairs at 703-684-4000.
As Chairman of the Maine State Board of Education and the
governor's School Facilities Commission I am available and
would be pleased to participate in any way you think
appropriate to outline Maine's innovative and comprehensive
school facilities program, and to elaborate on how federal
assistance could best complement state and local efforts to
address our school construction needs.
It was an honor to meet you in March during NASBE's
Legislative Conference. I look forward to working with you in
support of a federal partnership with state and local school
units to provide a safe, healthy, and effective learning
environment for all.
Sincerely,
James E. Rier, Jr.,
Chair.
Mr. L. CHAFEE. Mr. President, I am pleased to join my colleague from
Maine, Senator Snowe, in introducing a revised version of BRICKS--the
Building, Renovating, Improving, and Constructing Kids' Schools Act.
This legislation represents a fresh approach to addressing the
infrastructure problems in our nation's elementary and secondary
schools.
Many thanks to Senator Snowe for her commitment to this issue and for
her leadership; to the National PTA and the NEA, both of whom have
endorsed the proposal; and special thanks to the Rhode Island
Department of Education and Commissioner Peter McWalters for offering
suggestions which I believe helped to improve this proposal.
As some of you may know, Senator Snowe first introduced the BRICKS
proposal at the end of the last session. In January, I joined as a
cosponsor. We had hoped to offer this revised version as an amendment
to S. 2 but were unable to do so. As a result, we are introducing the
revised version of BRICKS today in a form we hope many of our
colleagues will be enthusiastic about cosponsoring.
The BRICKS Act would permit the federal government to provide low, or
no, interest loans to states to address their serious school
infrastructure problems. The National Center for Education Statistics
reports that three quarters of our nation's public schools need to
build, renovate, improve or modernize their facilities. In some cases
the need arises from increased school-age population. In other cases,
school facilities are simply old and in need of repair. Today's
estimated cost of modernizing and improving school facilities
throughout the United States is $127 billion. There is no argument
about whether a serious problem exists. There are differences on how
best to solve this terribly serious problem.
BRICKS recognizes that our nation faces a grave problem. We worry
about whether our children are learning enough to compete in the
international marketplace, yet we send our children to school in
overcrowded classrooms. We tell them to do their best without adequate
air conditioning, heating and plumbing. We expect them to learn in
buildings with leaky roofs and crumbling walls, or we house them in
``temporary'' classrooms in trailers on school parking lots.
In Rhode Island, our schools are old: twenty five percent were built
before 1930; another thirty-six percent were built in the 1940s and
1950s; twenty-three percent were built in the 1960s; and thirteen
percent were built in the recent 1980s. Between 1986 and 1990, our
small State spent about $400 million on school construction projects,
averaging about 11 projects per year, and there is much more to be
done. My State isn't asking the federal government to step in and take
over its school facilities responsibilities or the responsibilities of
local communities. Rather, help is being sought at the federal level to
meet a critical and immediate need.
The legislation which Senator Snowe and I are introducing today,
addresses that need by providing twenty billion dollars in federal
loans to the states. Each state receives funds, based on the Elementary
and Secondary Education Act's Title I distribution formula, at the
request of the Governor. States have until 2003 to request the loans.
Fifty percent of the loans must be used to repay the interest on school
construction bonds. The other fifty percent may be used to support
existing state-administered school construction
[[Page S7243]]
programs. Decisions about the use of these federal dollars are made by
the Governor in consultation with the director of the state education
agency. I am very pleased that the revised legislation encourages the
loans to go to those school districts with the greatest need, but the
final decisions are made by those closest to the problems.
As a former mayor, the person at the local level signing the checks
to pay for my community's education needs, I am very familiar with
educational priorities at the local level. I am deeply committed to
ensuring that the federal government meets its overdue goal of paying
up to forty percent of the cost of educating children with special
needs. Since coming to the Senate, I have made fully-funding IDEA--the
Individuals with Disabilities Education Act--a top priority. This bill
links the interest states and localities will be required to pay to the
federal level of IDEA funding.
Until 2006, there will be zero interest on BRICKS loans. After that,
interest will be determined by the federal funding level for IDEA. If
federal IDEA funding remains, as it is today, below twenty percent, the
loans will remain at zero interest. If the federal spending on IDEA is
between twenty and thirty percent, interest will be 2.5 percent. If
federal spending on IDEA rises to between thirty and forty percent,
interest rises to 3.5 percent. Finally, if the federal government meets
its forty percent goal, interest peaks at 4.5 percent. Taking into
account federal funding of IDEA seems completely appropriate to me. I
hope this linkage of IDEA and spending on school facilities is another
step which encourages Congress to meet the goal of fully funding IDEA.
Our proposal does not ask the federal government to assume
responsibility for building, improving and maintaining school
facilities. States and local school districts already have accepted
that responsibility by spending more than ever before on facilities.
According to the most recent study by the General Accounting Office on
school facilities, issued in March 2000, spending on school
infrastructure increased by 39 percent from 1990 to 1997. But they
cannot do it alone. The federal government can and should help by
providing BRICKS loans.
I hope that Senators who care about this issue will put aside
partisan differences and look carefully at the plan Senator Snowe and I
are proposing. We believe that BRICKS addresses an immediate problem in
a responsible manner that does not usurp the authority or
responsibility of states and school districts. I urge my colleagues to
join as cosponsors of BRICKS.
______
By Mr. REID:
S. 2891. A bill to establish a national policy of basic consumer fair
treatment for airline passengers; to the Committee on Commerce,
Science, and Transportation.
AIR TRAVELERS FAIR TREATMENT ACT OF 2000
Mr. REID. Mr. President, I rise to introduce the Air Travelers' Fair
Treatment Act of 2000.
Air travel is an increasingly unpleasant and stressful experience.
Anyone who flies much at all knows that airports are crowded, flights
too often delayed or canceled without explanation, ticket prices are
unpredictable and hard to figure out, passengers are more unruly and
occasionally violent.
Monday's edition of the Washington Post included a front-page story
reporting that delays and cancellations are at an all-time high.
According to Time Magazine, the number of air-rage incidents reported
by flight crews from 66 in 1997, to 534 last year. It doesn't take a
great leap of faith to see a relationship between the two.
Last year, Congress passed my ``air rage'' bill that increased
penalties on passengers who commit acts that threaten the health or
safety of other passengers or jeopardize the safety of the flight. That
was a good bill, that I think will help passengers and airlines alike
to reduce the amount of stress associated with flying.
But punishing unruly passengers is only half of the solution, because
unruly passengers are not the only source of stress in air travel. Air
rage is not only a cause, but a symptom, of stress.
The airlines have cut corners in recent years in ways that make
traveling by air more and more difficult and unpleasant for customers.
A few weeks ago, the Inspector General of the Department of
Transportation released a study on the performance of the airline
industry. According to the study:
Through the first four months of this year, the number of passenger
complaints to the Department has increased a whopping 74 percent
compared to last year.
Complaints about delays, cancellations, and missed connections were
up 115 percent since last year--in other words, they have more than
doubled in only one year.
And even these numbers may be low, because the Inspector General
estimates that the airlines receive anywhere from 100 to 400 complaints
for every one that is filed with the government.
Last fall, the airlines announced that they would voluntarily
implement their own reforms. They made a great show of implementing
their ``12 Commandments for Customer Service'' last fall.
But this study reveals that things have become worse, not better. The
study cites numerous instances where the airlines have violated their
own so-called ``Commandments.''
For example, one of these so-called Commandments is to notify
customers about delays and cancellations. The Transportation
Department's report indicated that airlines were, in fact, making an
effort to communicate delays and cancellations--but that the
information communicated was, to quote the Inspector General,
``frequently inaccurate, incomplete or unreliable.''
Airlines are often poorly equipped to handle in-flight emergencies--
some carriers have virtually no first-air or medical equipment on their
flights, and the amount of first-aid training that flight crews
received varies widely from carrier to carrier.
And airlines ticket prices are still confusing and arbitrary. Some
carriers have enacted rules that prohibit customers from combining legs
of different tickets to get the best prices.
Now, there are some explanations for the decline in service and the
increase in the number of complaints. Last year, the airlines carried a
total of 635 million passengers, a record number, double the number of
passengers 20 years ago. The average load factor--which refers to the
percentage of passengers compared to available seats--is 71 percent,
also a record.
But crowded airports are no excuse for airlines to violate their own
so-called Commandments for Customer Service.
It's no excuse for providing misleading or inaccurate explanations of
delays or cancellations to air travelers. People make plans around
posted flight schedules, important personal or business plans. If a
flight is canceled or delayed, they should be able to find out what's
going on, so that they can make alternative plans if they need to.
The bill I am introducing today will address some of these concerns.
The bill has seven provisions.
(1) Pricing Policies: Due to the complex way that airlines price
their tickets, in some cases, a trip will be cheaper if a passenger
purchases a ticket to a different destination and gets off during the
layover, leaving the second leg of the ticket unused, rather than
buying a ticket directly to his/her intended destination. Similarly, a
passenger may save money by combining portions of different tickets. To
prevent this and to force passengers to pay the higher prices, airlines
have begun canceling the return ticket if the passenger does not use
the entire ticket, and penalizing travel agents who allow customers to
combine ticket portions this way. The bill would allow passengers to
use all, part or none of a purchased ticket without penalty by the
airline, enabling passengers and travel agents to freely mix-and-match
tickets to get the best price.
(2) Flight Delays: The bill requires air carriers to provide
travelers with accurate and timely explanations of the reasons for a
flight cancellation, delay or diversion from a ticketed itinerary, by
classifying the failure to do so as an unfair business practice.
(3) Right to Exit Aircraft: Where a plane has remained at the gate
for more than 1 hour past its scheduled departure time and the captain
has not been informed that the aircraft can be cleared for departure
within 15 minutes, passengers would have the right
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to exit the plane into the terminal to make alternative travel plans,
or simply to stretch their legs, get something to eat, etc. I believe
this provision will help prevent ``air rage'' incidents when passengers
are forced to sit in parked planes for long periods of time.
(4) Right to In-flight Medical Care: Currently, each airline has its
own policy regarding what kind of medical and first-aid equipment and
training is provided on their flights, so that the available equipment
varies widely, particularly with more expensive equipment like
defibrillators. This bill would direct the Secretary of Transportation
to issue uniform minimum regulations for all carriers regarding the
type of medical equipment each flight must carry, and the kind of
medical training each flight crew should receive.
(5) Access to State Laws: The Federal Courts have split on whether
the Airline Deregulation Act of 1978 pre-empts state consumer
protection and personal injury laws as applied to airlines. The Ninth
Circuit Court of Appeals has held that passengers may sue airlines in
state court for violations of state tort and consumer laws; in
contrast, the Fourth Circuit has held that airlines are immune from
state laws. The Supreme Court has not acted on the issue. The bill
would add a provision making clear that the 1978 Act does not pre-empt
state tort and consumer protection laws.
(6) Termination of Ticket Agents: Travel agencies provide a valuable
service to customers looking for the best prices. Yet airlines have
enormous leverage over what kind of information they can and cannot
provide to customers, because they can withdraw their accounts without
notice from any travel agency for any reason--even if the only reason
is that the travel agency is giving the customer the best rates. The
bill requires carriers to provide written 90-day advance statement of
reasons before canceling a travel agency's account with the airline,
and to give them 60 days to correct the identified deficiencies.
(7) Independent Commission: Finally, the bill would establish an
independent Commission to study the airlines' pricing practices and
their effects on customer choice, on the number of routes available,
and on the quality of service provided by the airlines.
The stress associated with air travel has increased considerably, and
much of that stress is caused by things that airlines do to save money
and maximize profit that hurt customers. I believe that we must look at
unfair and deceptive practices of the airlines that contribute to the
stress of air travel, in a specific, targeted and reasonable manner.
This bill will do that.
______
By Mr. SCHUMER (for himself and Mr. Moynihan):
S. 2892. A bill to designate the Federal building located at 158-15
Liberty Avenue in Jamaica, Queens, New York, as the ``Floyd H. Flake
Federal Building''; to the Committee on Environment and Public Works.
DESIGNATING A FEDERAL BUILDING AS THE ``FLOYD H. FLAKE FEDERAL
BUILDING''
______
By Mr. SCHUMER (for himself and Mr. Moynihan):
S. 2893. A bill to designate the facility of the United States Postal
Service located at 757 Warren Road in Ithaca, New York, as the
``Matthew F. McHugh Post Office''; to the Committee on Government
Affairs.
DESIGNATING A UNITED STATES POSTAL FACILITY AS THE ``MATTHEW F. McHUGH
POST OFFICE''
Mr. SCHUMER. Mr. President, I had the honor and privilege of working
with former Representative Floyd H. Flake during my tenure in the House
and it gives me great pleasure to join Senator Moynihan and my House
colleague Congressman Greg Meeks in introducing a bill to name a
Federal building in Jamaica, Queens, New York, after the man who served
that district with the utmost honor and dedication.
Floyd was elected to the House of Representatives in 1986 to serve
the 6th Congressional District of New York. He served his constituents
admirably for 11 years until his retirement in 1997. He is most
remembered for his service on the Banking and Financial Services
Committee, a committee we served on together.
In the House, Floyd distinguished himself as a leader in the fight
for the revitalization of urban communities. He worked tirelessly to
pass the Community Development Financial Institutions Act of 1993 and
to ensure passage of the Community Reinvestment Act. These two acts,
along with Floyd's countless other efforts to help urban communities,
illustrates his commitment as a true public servant.
Since his retirement, Floyd has continued his service to the public.
He is currently the Pastor of the Allen A.M.E. Church in Queens and has
led a movement to increase church-based non-profit activity in
communities. He has dedicated his life to helping New York City
residents work their way towards a better life through innovative
employment programs, community improvement projects and renewal of
spiritual faith.
Floyd has distinguished himself as a true leader who was able to
combine high morals with government. I can think of no one more
deserving of this honor than Reverend Flake.
______
By Mr. LUGAR (for himself, Mr. Roberts, Mr. Burns, and Mr.
Santorum):
S. 2894. A bill to provide tax and regulatory relief for farmers and
to improve the competitiveness of American agricultural commodities and
products in global markets; to the Committee on Finance.
THE RURAL AMERICA PROSPERITY ACT OF 2000
Mr. LUGAR. Mr. President, I rise today to introduce the Rural America
Prosperity Act of 2000. I am pleased that Senator Roberts, Senator
Santorum, and Senator Burns have joined as cosponsors of this bill.
A Republican controlled Congress in 1996 produced a sweeping reform
of farm programs. Farmers were no longer told by the government what
crops they had to plant. Farmers were no longer forced by the
government to idle part of their land. That farm bill disentangled
farmers from government controls and enabled them to make production
decisions based on market signals.
Freeing farmers from excessive, and often counterproductive,
government controls is an important step, but we should do more to give
farmers the tools they need to succeed. Specifically, we need to work
to open foreign markets for our agricultural commodities and products,
ease the tax and regulatory burden, and provide new risk management
tools for farmers.
There are three tax provisions in this legislation that I have long
advocated as crucial to the financial health of farmers. First is the
repeal of the estate tax. A repeal of this tax, which has prevented
some farms from being passed from one generation to the next, is
essential. We are proposing the same 10-year phase-out of the estate
tax which Congress just passed, and the President has promised to veto.
Excluding capital gains from the sale of farmland would put production
agriculture on the same footing as homeowners who benefit from a
capital gains exclusion for their home. The deduction of health care
insurance costs is needed for farmers and others who are self-employed.
Recently Congress provided over $8 billion to improve the federal
crop insurance program. While crop insurance is an important risk
management tool, today we offer two other risk management tools for
farmers--income averaging and FARRM accounts. Two years ago Congress
made income averaging a permanent risk management tool for farmers when
calculating taxes. Unfortunately, the interaction between income
averaging and the alternative minimum tax has prevented many farmers
from receiving the benefit of income averaging. This bill fixes that
problem. Under this bill, farmers will be able to contribute up to 20
percent of annual farm income into a FAARM account and deduct this
amount from their taxes. This is an excellent tool for managing
financial volatility associated with farming.
We also address regulatory reform in our bill. We are seeking a
review of existing and proposed regulations to determine the cost of
compliance for farmers, ranchers and foresters. We want to determine if
there are more cost-effective ways for farmers, ranchers and foresters
to achieve the objectives of these regulations.
Finally, we must do more to help develop new markets abroad for our
farm commodities and agricultural products. Opportunity lies in
developing
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countries where growing wealth allows for increased demand for meat and
processed commodities. Authorizing fast-track authority for the
President to negotiate international trade agreements may be the single
most important thing we can do to facilitate exports.
We also need to address sanctions. Sanctions that prohibit the export
of U.S. agricultural products into the sanctioned country are often
morally indefensible because they deny necessities to people, not the
offending government. Such sanctions also deny markets for U.S.
agricultural products which are then captured by our competitors.
This legislation represents what I believe is necessary to further
the historic reforms initiated in the farm bill 4 years ago. I urge my
colleagues to cosponsor this bill. I will continue to encourage my
colleagues and the Administration to work to enact these proposals.
____________________