[Congressional Record Volume 147, Number 81 (Tuesday, June 12, 2001)]
[Senate]
[Pages S6129-S6140]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. BUNNING (for himself and Mr. Harkin):
  S. 1014. A bill to amend the Social Security Act to enhance privacy 
protections for individuals, to prevent fraudulent misuse of the Social 
Security account number, and for other purposes; to the Committee on 
Finance.
  Mr. BUNNING. Mr. President, I rise today to re-introduce legislation 
that is designed to protect the privacy of all Americans from identity 
theft caused by theft or abuse of an individual's Social Security 
number, SSN.
  Identity theft is the fastest growing financial crime in the Nation, 
affecting an estimated 500,000 to 700,000 people annually. Allegations 
of fraudulent Social Security number use for identity theft increased 
from 62,000 in 1999 to over 90,000 in 2000--this is a 50 percent 
increase in just one year.
  It's no wonder why, in Wall Street Journal poll last year, 
respondents ranked privacy as their number one concern in the 21st 
century, ahead of wars, terrorism, and environmental disasters.
  All to often, the first clue someone has that their identity has been 
stolen comes when retail stores, banks, or credit card companies send 
letters wanting payment on bad checks or overdue bills that the 
individual hadn't written or knew nothing about.
  More than 75 percent of the time identity theft cases that take place 
are ``true name'' fraud. That is when someone uses your social security 
number to open new accounts in your name. The common criminal can apply 
for credit cards, buy a car, obtain personal, business, auto, or real 
estate loans, do just about anything in your name and you may not even 
know about it for months or even years. Across the country there are 
people who can tell you about losing their life savings or having their 
credit history damaged, simply because someone had obtained their 
Social Security number and fraudulently assumed their identity.
  This bill prohibits the sale of Social Security numbers by the 
private sector, Federal, State and local government agencies. This bill 
strengthens existing criminal penalties for enforcement of Social 
Security number violations to include those by government employees. It 
amends the Fair Credit Reporting Act to include Social Security number 
as part of the information protected under the law, enhances law 
enforcement authority of the Office of Inspector General, and allows 
Federal courts to order defendants to make restitution to the Social 
Security trust funds.
  This bill would also prohibit the display of Social Security numbers 
on drivers licenses, motor vehicles registration, and other related 
identification records, like the official Senate ID Card.
  This new legislation reflects a small number of fair and appropriate 
modifications, including the following: Since the Federal Trade 
Commission does not have jurisdiction over financial institutions, our 
bill would now authorize the U.S. Attorney General to issue regulations 
restricting the sale and purchase of Social Security numbers in the 
private sector; similar to our provisions affecting the public sector, 
we make explicit our intent that the prohibition of sale, purchase, or 
display of Social Security numbers in the private sector would not 
apply if Social Security numbers are needed to enforce child support 
obligations; to help prevent other individuals from suffering the same 
tragic fate as Amy Boyer, we include a new provision that prohibits a 
person from obtaining or using another person's Social Security number 
in order to locate that individual with the intent to physically injure 
or harm the individual or use their identity for an illegal purpose; 
and we have clarified the provision that would prohibit businesses from 
denying services to individuals an exception for those businesses that 
are required by Federal law to submit the individual's Social Security 
number to the Federal Government.
  I think that it is high time that we get back to the original purpose 
of the social security number. Social Security numbers were designed to 
be used to track workers and their earnings so that their benefits 
could be accurately calculated when a worker retires--nothing else.
  I urge my colleagues to cosponsor this very important piece of 
legislation.
                                 ______
                                 
      By Mr. LEVIN (for himself, Ms. Stabenow, and Mr. Durbin):
  S. 1015. A bill to require the Secretary of Transportation to issue 
regulations to address safety concerns and to minimize delays for 
motorists at railroad grade crossings; to the Committee on Commerce, 
Science, and Transportation.
  Mr. LEVIN. Mr. President, today I am pleased to introduce the 
Railroad Crossing Delay Reduction Act with Senator Stabenow and Senator 
Durbin. This legislation requires the Secretary of Transportation to 
issue regulations within one year to address the safety concerns that 
arise when trains block traffic at railroad crossings.
  Sixteen States and many more municipalities have passed statutes and 
ordinances limiting the amount of time a train is allowed to stop at 
and thus block a railroad grade crossing. There are specific safety 
reasons for limiting the time roadways can be blocked by trains. 
However, the U.S. District Court for the Eastern District of Michigan 
struck down a Michigan statute regulating the length of time that a 
train may block a roadway, opening up the safety issues that my bill 
will address. The ordinance in question prohibited trains from 
obstructing free passage of any street for longer than five minutes in 
order to minimize safety problems within communities.
  The court concluded that the ordinance was preempted by the Federal 
Railway Safety Act, FRSA. Unfortunately, there is no Federal regulation

[[Page S6130]]

addressing the length of time a train may block a grade crossing. That 
means the State of Michigan and all of its political subdivisions are 
now without the authority to provide this regulation and have no other 
remedy. They are urging the passage of Federal legislation to regulate 
the length of time a train may block a roadway in the interest of 
public health and safety. They are calling for Federal action to give 
them relief from the 45 minutes or more that trains are currently 
sitting in railway crossings and blocking their roadways.
  Believe it or not, trains actually stop in the middle of 
intersections for 45 minutes or longer at a time. I have been given 
examples of trains in Michigan that have sat for hours at crossings. 
You can imagine the ramifications of major intersections being 
completely blocked for so long.
  This nationwide problem is amplified in Southeast Michigan because of 
the number of rail lines in the region. For example, this lack of 
regulation is causing a lot of problems for some of the older 
municipalities in Michigan as train tracks literally cris-cross their 
cities. For instance, in Trenton, MI, there is an entire neighborhood 
that is bordered on one side by water on two sides by train tracks, 
forming a triangle. If two trains block the tracks at the same time, 
which has happened, the residents are literally trapped. Worse than the 
residents being trapped is the fact that ambulances, police and fire 
trucks are trapped out of town, or delayed in getting to their 
emergency destinations.
  Unless we take action and require the FRA to act, communities with 
rail crossings are vulnerable. The problems range from the problem of 
traffic congestion and delays to the literal inability of emergency 
vehicles to get in or out of a community. Many Michigan cities have 
railroad crossings at a number of important intersections that, when 
closed by trains, severely limits their ability to provide emergency 
service to its residents. Medical emergency crews in Michigan have 
specifically complained to me that they face the daily problem of 
trains blocking road traffic. They tell me this has the potential to 
put in jeopardy their patients best chance of recovery. As we all 
understand, time is of the essence in emergency situations.
  Trains blocking railroad crossings also pose a threat for pedestrians 
and children who may be tempted to crawl under or between rail cars 
during long waits in order get to or from school. Vehicles may also be 
tempted to speed around a train before it gets to the crossing in order 
to avoid long delays. Both situations unnecessarily put lives in 
danger.
  Michigan businesses have also complained to me that trains have 
blocked important roads for extensive periods of time during plant 
shift changes. This has resulted in unnecessary lost wages and lost 
production when employees cannot get to work.
  Dozens of Michigan's towns and cities have pleaded for Federal action 
to resolve this intolerable situation and have even passed resolutions 
in support of this legislation. They include: Charter Township of 
Huron, City of Lincoln Park, City of Plymouth, City of Riverview, City 
of Rockwood, City of Southgate, City of Trenton, City of Westland, to 
name only a few. Our community leaders believe it is essential to the 
public health, safety and welfare of the residents of their cities that 
blocked crossings be kept to a reasonable minimum, so that emergency 
vehicles may have ready access to their citizens.
  The legislation I am introducing today will give the Federal Railroad 
Administration the push it needs to enact much needed regulations to 
address this safety problem.
  My bill would simply require the Secretary of Transportation to issue 
regulations addressing these safety concerns. It is a reasonable 
approach with nothing controversial or complicated about it. 
Congressman Dingell has sponsored an identical bill in the House.
  We need to stop the delays and remove potentially dangerous 
situations by minimizing how long trains can stop at grade crossings. 
Its time to address this lingering safety concern and reduce the risk 
to motorists, pedestrians, and citizens at large. This is a very simple 
bill that aims to stop the abuse of trains unnecessarily blocking 
railroad crossings. It simply directs the FRA, the agency tasked with 
overseeing railroad safety, to take action in this area. I hope this 
legislation will be enacted quickly.
  The Railroad Crossing Delay Reduction Act has the support of local 
mayors, fire and police departments and emergency organizations. There 
is currently no Federal limit to how long trains can sit and block 
railroad crossings. This bill would require that one be instituted, in 
the name of the public's safety.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1015

       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 ``Railroad Crossing Delay 
     Reduction Act''.

     SEC. 2. REGULATIONS.

       Not later than one year after the date of enactment of this 
     Act, the Secretary of Transportation shall issue regulations 
     regarding trains that block traffic at railroad grade 
     crossings to address safety concerns and to minimize delays 
     encountered by motorists that are caused by such trains.

  Ms. STABENOW. Mr. President, I am proud to join my colleague from 
Michigan, Senator Levin, in introducing the ``Railroad Crossing Delay 
Reduction Act of 2001.''
  Trains needlessly blocking traffic at railroad grade crossings is a 
longstanding nationwide problem, that puts lives and property at grave 
risk. When trains unnecessarily block vital intersections, it can cost 
police, firefighters and emergency medical workers, critical minutes 
when responding to an emergency situation. They also increase train-
automobile accidents, because many motorists dangerously speed through 
railroad crossing intersections, in an attempt to avoid being delayed 
for an extended period by an oncoming train. Train blockage also 
prevents pedestrians, often young children on the way to and from 
neighborhood schools, from crossing a railroad intersection resulting 
in pedestrians climbing through trains to reach the other side.
  Across the country, there are reports that fire trucks, ambulances, 
and police vehicles have been unnecessarily delayed at train crossings. 
The loss of a few minutes in an emergency situation can mean the 
difference between life and death. A fire in a home or business can 
double in size every 20 seconds, and a person suffering from a heart 
attack can die after only six minutes without oxygen. In my home State 
of Michigan, fire and EMS units in Delta Township were blocked by a 
train for a few extra minutes as a boy burned to death on the other 
side of the railroad crossing.
  Last year, a Federal judge in Michigan struck down a State law 
limiting the amount of time a train can block a crossing on the grounds 
that it was a Federal issue and involved interstate commerce under the 
Commerce Clause of the U.S. Constitution. Over 30 communities in 
Michigan alone have passed resolutions asking for Congress to act on 
this important safety issue.
  The ``Railroad Crossing Delay Reduction Act of 2001'' addresses this 
important national problem by requiring the Department of 
Transportation to issue regulations to address these serious safety 
concerns with respect to trains blocking traffic at railroad grade 
crossings, and to minimize delays to automobile traffic resulting from 
these blockages. I urge my Senate colleagues to support this 
legislation and help address this critical railroad safety issue.
                                 ______
                                 
      By Mr. BINGAMAN (for himself, Mr. Lugar, Mr. McCain, Mr. Corzine, 
        and Mrs. Lincoln):
  S. 1016. A bill to amend titles XIX and XXI of the Social Security 
Act to improve the health benefits coverage of infants and children 
under the medicaid and State children's health insurance program, and 
for other purposes; to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today to introduce bipartisan 
legislation with Senators Lugar, McCain, Corzine, and Lincoln. This 
legislation is entitled the ``Start Healthy, Stay Healthy Act of 
2001.'' The purpose of the legislation is to significantly reduce the 
number of uninsured children

[[Page S6131]]

and pregnant women by improving outreach to and enrollment of children 
and by expanding coverage to pregnant women through Medicaid and CHIP.
  An estimated 11 million children under age 19 were without health 
insurance in 1999, including 129,000 in New Mexico, representing 15 
percent of all children in the United States and 22 percent of children 
in New Mexico. Unfortunately, due to variety of factors, including the 
lack of knowledge by families about CHIP and bureaucratic barriers to 
coverage such as lengthy and complex applications, an estimated 6.7 
million of our Nation's uninsured children are eligible for but 
unenrolled in either Medicaid or CHIP.
  In addition, an estimated 4.3 million, or 32 percent, of mothers 
below 200 percent of poverty are uninsured. According to the March of 
Dimes, ``Over 95 percent of all uninsured pregnant women could be 
covered through a combination of aggressive Medicaid outreach, 
maximizing coverage for young women through [CHIP], and expanding CHIP 
to cover income-eligible pregnant women regardless of age.''
  It is a travesty that our Nation ranks 25th in infant mortality and 
21st in maternal mortality in the world, which is the worst among 
developed nations. Our legislation would address the problems related 
to these issues.
  Giving children a healthy start: The legislation provides States with 
an enhanced Medicaid matching rate to ensure that children eligible for 
Medicaid or CHIP leave the hospital insured and remain so through the 
first year of life. The legislation provides States with the option to 
further extend coverage to pregnant women through Medicaid and CHIP to 
reduce infant and maternal mortality and low birthweight babies.
  Helping children stay healthy: The legislation provides States with 
an enhanced Medicaid matching rate to reduce the barriers to care for 
children to keep them healthy throughout their childhood. And, the 
legislation provides States with the option to increase CHIP 
eligibility from 200 percent of federal poverty level to 250 percent 
and to extend coverage to children through age 20.
  As an example of an imposed barrier to health coverage, as of March 
of this year, eight States continued to impose an asset test on 
children and their families prior to receiving Medicaid coverage. This 
results in a rather burdensome and complicated application in each of 
these States. For example, in Colorado, the Denver Department of Human 
Services received 15,330 application for Medicaid and 3,700 were denied 
for having an asset, such as a car, in 1999. As the Denver Post pointed 
out, ``Acquire an asset more than $1,500, such as a car, and you've 
traded in health insurance for your children.''
  In addition to creating a high percentage of denials, the imposition 
of an assets test significantly complicates the Medicaid or CHIP 
enrollment applications. For example, some States require reporting on 
everything from whether anyone in the household has any resource such 
as a checking account, life insurance, burial insurance, a saving 
account, or any personal items above a certain amount to documenting 
things such as work income, alimony, child support, interest from 
savings, CD's, etc. over a period of time, including several months in 
the past.
  This can be a nightmare for some families. In Colorado, of the 
families that do attempt to fill out the Medicaid or CHIP application, 
it is estimated that 37 percent of all families are denied coverage 
because the application is incomplete. In Texas, Medicaid applicants 
can face a 17-page application, up to 14 forms and up to 20 
verifications of those forms.
  As a story in last Friday's Washington Post entitled ``Health 
Coverage for Kids Low-Cost but Little Used,'' it was noted that about 
100 students from Yale Medical School, likely some of our Nation's best 
and brightest, filled out applications forms as part of their training 
to enroll families and that not one was able to complete the form 
adequately. If Yale Medical School students cannot fill out the forms 
properly, is it any wonder that families across the country are having 
a difficult time with the bureaucratic paperwork?
  Fortunately, New Mexico eliminated its assets test a few years ago in 
an effort to simplify its Medicaid application and make it easier for 
families to apply. According to a recent report by the Kaiser Family 
Foundation, States that have eliminated the asset test from Medicaid 
have been able to streamline the eligibility determination process, 
adopt automated eligibility determination systems, improve the 
productivity of eligibility workers, establish Medicaid's identity as a 
health insurance program distinct from welfare, make the enrollment 
process for families friendlier and more accessible, and achieve 
Medicaid administrative cost savings.
  In addition, the State of Texas has enacted legislation in recent 
days that seeks to simplify its enrollment process.
  And yet, there are also reports from other States such as Kentucky 
and Idaho that are moving to impose additional bureaucratic barriers to 
coverage.
  As the Denver Rocky Mountain News writes, ``The logic of erecting 
such paperwork obstacles escapes us. Government doesn't have to offer 
insurance to the children of the working poor, but having made the 
decision to do so, it's hardly fair then to smother the program beneath 
layers of red tape.''
  There are also problems related to the poor coordination between 
government agencies that are supposed to serve low-income families.
  My good friend, Senator Lugar, recognized this very point and 
successfully passed language in the ``Agricultural Risk Protection Act 
of 2000'' to improve the coordination between the school lunch program 
and both Medicaid and CHIP. His language makes it easier to disclose 
information from the school lunch program application to Medicaid and 
CHIP agencies. Since children that qualify for the school lunch program 
are almost certainly eligible for either Medicaid or CHIP, this simple 
but important language is already having an important impact on the 
enrollment of children into Medicaid or CHIP.
  According to a report by Covering Kids, the Albuquerque Public 
Schools have successfully worked to improve coordination between 
Medicaid and the school lunch program. As the report reads, ``The 
team's record of success shows that a well-designed process and 
dedicated staff can make [Medicaid enrollment] work. In August and 
September of 2000, Albuquerque Public Schools determined 386 children 
to be presumptively eligible for health coverage. Of these, 371 were 
enrolled and only 15 were denied. That's a 96 percent acceptance rate. 
And the numbers are growing.''
  This coordination between Medicaid and the school lunch program is 
being replicated across the country as a result of Senator Lugar's 
language. However, we still have a number of problems with regard to 
coordination between Medicaid and CHIP across the states that this bill 
seeks to address.
  Why is this important? Why should we make additional efforts to 
reduce the number of uninsured children? According to the American 
College of Physicians--American Society of Internal Medicine, uninsured 
children, compared to the insured, are: up to 6 times more likely to 
have gone without needed medical, dental or other health care; 2 times 
more likely to have gone without a physician visit during the previous 
year; up to 4 times more likely to have delayed seeking medical care; 
up to 10 times less likely to have a regular source of medical care; 
1.7 times less likely to receive medical treatment for asthma; and, up 
to 30 percent less likely to receive medical attention for any injury.
  This is equally true of expanded coverage to children and pregnant 
women in government health programs. In fact, one study has ``estimated 
that the 15 percent rise in the number of children eligible for 
Medicaid between 1984 and 1992 decreased child mortality by 5 
percent.'' This expansion of coverage for children occurred, I would 
add, during the Reagan and Bush Administrations, so this is clearly a 
bipartisan issue that deserves further bipartisan action.
  We, as a Nation, should be doing much better by our children. It 
should be unacceptable to all of us that the United States ranks 25th 
in infant mortality and 21st in maternal mortality in the world.
  Therefore, in addition to seeking to improve health insurance 
coverage

[[Page S6132]]

among children, the bill builds off legislation sponsored in the last 
Congress by Senator Lincoln entitled the ``Improved Maternal and 
Children's Health Coverage Act'' and makes an important change to CHIP 
to allow pregnant women to be covered. Thus, the first two words of our 
bill, ``Start Healthy.''
  Throughout our Nation's history, there has been long-standing Federal 
policy linking programs for pregnant women and infants, including 
Medicaid, WIC, and the Maternal Child Health Block Grant. CHIP, 
unfortunately, failed to provide coverage to pregnant women beyond the 
age of 18. As a result, it is more likely that children eligible for 
CHIP are not covered from the moment of birth, and therefore, miss 
those first critical months of life until their CHIP application is 
processed. They are also more likely not to have had prenatal care.
  By expanding coverage to pregnant women in the Children's Health 
Insurance Program, this legislation recognizes the importance of 
prenatal care to the health and development of a child. As Dr. Alan 
Waxman of the University of New Mexico School of Medicine notes, 
``Prenatal care is an important factor in the prevention of birth 
defects and the prevention of prematurity, the most common causes of 
infant death and disability. Babies born to women with no prenatal care 
or late prenatal care are nearly twice as likely to [be] low 
birthweight or very low birthweight as infants born to women who 
received early prenatal care.''
  Unfortunately, according to a recent report by the Centers for 
Disease Control and Prevention, New Mexico ranked worst in the nation 
in the percentage of mothers receiving late or no prenatal care last 
year. The result is often quite costly, both in terms of the health of 
the mother and child but also in terms of long-term expenses since the 
result can be chronic, lifelong health problems.
  In fact, according to the Agency for Healthcare Research and Quality, 
``four of the top 10 most expensive conditions in the hospital are 
related to care of infants with complications (respiratory distress, 
prematurity, heart defects, and lack of oxygen).'' As a result, in 
addition to reduced infant mortality and morbidity, the provision to 
expand coverage of pregnant women and prenatal care can be cost 
effective.
  The Start Healthy, Stay Healthy Act also eliminates the unintended 
Federal incentives through CHIP that covers pregnant women only through 
the age of 18 and cut off that coverage once the women turn 19 years of 
age. Should the government tell women that they are more likely to 
receive prenatal care coverage only if they become pregnant as a 
teenager?
  I certainly think not, and certainly it is unlikely there is a single 
Senator that would think it wise to send such a message. This 
legislation corrects this unfortunate and unintentional policy 
by allowing pregnant women to be covered through CHIP regardless of 
age.

  And finally, this legislation imposes no Federal mandates on States 
to achieve these goals. Rather, through financial incentives, States 
that adopt ``best practices'' and less cumbersome enrollment processes 
for children would be rewarded.
  The budget resolution contains $28 billion over 10 years to reduce 
the number of uninsured in this country. Although the Congress passed 
CHIP in 1997, 11 million children remain uninsured. It is time we 
finish the job of ensuring that we, as the President says, ``leave no 
child behind.''
  This bipartisan legislation has already received the endorsement of 
the following organizations: the March of Dimes, the American Academy 
of Pediatrics, the American College of Obstetricians and Gynecologists, 
the American Academy of Family Physicians, the American Academy of 
Pediatric Dentistry, the American Academy of Child and Adolescent 
Psychiatry, the National Association of Community Health Centers, the 
American Hospital Association, the National Association of Children's 
Hospitals, the Federation of American Health Systems, the National 
Association of Public Hospitals and Health Systems, Catholic Health 
Association, Premier, Family Voices, the Association of Maternal and 
Child Health Programs, the National Health Law Program, the National 
Association of Social Workers, Every Child By Two, and the United 
Cerebral Palsy Associations. I urge its passage as soon as possible.
  I ask unanimous consent that the text of the bill and a fact sheet be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 1016

       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 ``Start 
     Healthy, Stay Healthy Act of 2001''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

                         TITLE I--START HEALTHY

Sec. 101. Enhanced Federal medicaid match for States that opt to 
              continuously enroll infants during the first year of life 
              without regard to the mother's eligibility status.
Sec. 102. Optional coverage of low-income, uninsured pregnant women 
              under a State child health plan.
Sec. 103. Increase in SCHIP income eligibility.

                         TITLE II--STAY HEALTHY

Sec. 201. Enhanced Federal medicaid match for increased expenditures 
              for medical assistance for children.
Sec. 202. Increase in SCHIP appropriations.
Sec. 203. Optional coverage of children through age 20 under the 
              medicaid program and SCHIP.

                         TITLE I--START HEALTHY

     SEC. 101. ENHANCED FEDERAL MEDICAID MATCH FOR STATES THAT OPT 
                   TO CONTINUOUSLY ENROLL INFANTS DURING THE FIRST 
                   YEAR OF LIFE WITHOUT REGARD TO THE MOTHER'S 
                   ELIGIBILITY STATUS.

       (a) State Option.--Section 1902(e)(4) of the Social 
     Security Act (42 U.S.C. 1396a(e)(4)) is amended by adding at 
     the end the following new sentence: ``A State may elect 
     (through a State plan amendment) to apply the first sentence 
     of this paragraph without regard to the requirements that the 
     child remain a member of the woman's household and the woman 
     remains (or would remain if pregnant) eligible for medical 
     assistance.''.
       (b) Enhanced FMAP.--The first sentence of section 1905(b) 
     of the Social Security Act (42 U.S.C. 1396d(b)) is amended--
       (1) by inserting ``(A)'' after ``only''; and
       (2) by inserting ``, or (B) on the basis of a State 
     election made under the third sentence of section 
     1902(e)(4)'' before the period.
       (c) Effective Date.--The amendments made by this section 
     apply to medical assistance provided on or after October 1, 
     2001.

     SEC. 102. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED PREGNANT 
                   WOMEN UNDER A STATE CHILD HEALTH PLAN.

       (a) In General.--Title XXI of the Social Security Act (42 
     U.S.C. 1397aa et seq.) is amended by adding at the end the 
     following new section:

     ``SEC. 2111. OPTIONAL COVERAGE OF LOW-INCOME, UNINSURED 
                   PREGNANT WOMEN.

       ``(a) Optional Coverage.--Notwithstanding any other 
     provision of this title, a State child health plan (whether 
     implemented under this title or title XIX) may provide for 
     coverage of pregnancy-related assistance for targeted low-
     income pregnant women in accordance with this section, but 
     only if the State has established an income eligibility level 
     under section 1902(l)(2)(A) for women described in section 
     1902(l)(1)(A) that is 185 percent of the income official 
     poverty line.
       ``(b) Definitions.--For purposes of this section:
       ``(1) Pregnancy-related assistance.--The term `pregnancy-
     related assistance' has the meaning given the term child 
     health assistance in section 2110(a) as if any reference to 
     targeted low-income children were a reference to targeted 
     low-income pregnant women, except that the assistance shall 
     be limited to services related to pregnancy (which include 
     prenatal, delivery, and postpartum services) and to other 
     conditions that may complicate pregnancy.
       ``(2) Targeted low-income pregnant woman.--The term 
     `targeted low-income pregnant woman' has the meaning given 
     the term targeted low-income child in section 2110(b) as if 
     any reference to a child were deemed a reference to a woman 
     during pregnancy and through the end of the month in which 
     the 60-day period (beginning on the last day of her 
     pregnancy) ends.
       ``(c) References to Terms and Special Rules.--In the case 
     of, and with respect to, a State providing for coverage of 
     pregnancy-related assistance to targeted low-income pregnant 
     women under subsection (a), the following special rules 
     apply:
       ``(1) Any reference in this title (other than subsection 
     (b)) to a targeted low income child is deemed to include a 
     reference to a targeted low-income pregnant woman.
       ``(2) Any such reference to child health assistance with 
     respect to such women is deemed a reference to pregnancy-
     related assistance.
       ``(3) Any such reference to a child is deemed a reference 
     to a woman during pregnancy and the period described in 
     subsection (b)(2).

[[Page S6133]]

       ``(4) The medicaid applicable income level is deemed a 
     reference to the income level established under section 
     1902(l)(2)(A).
       ``(5) Subsection (a) of section 2103 (relating to required 
     scope of health insurance coverage) shall not apply insofar 
     as a State limits coverage to services described in 
     subsection (b)(1) and the reference to such section in 
     section 2105(a)(1) is deemed not to require, in such case, 
     compliance with the requirements of section 2103(a).
       ``(6) There shall be no exclusion of benefits for services 
     described in subsection (b)(1) based on any pre-existing 
     condition and no waiting period (including any waiting period 
     imposed to carry out section 2102(b)(3)(C)) shall apply.
       ``(d) No Impact on Allotments.--Nothing in this section 
     shall be construed as affecting the amount of any initial 
     allotment provided to a State under section 2104(b).
       ``(e) Application of Funding Restrictions.--The coverage 
     under this section (and the funding of such coverage) is 
     subject to the restrictions of section 2105(c).
       ``(f) Automatic Enrollment for Children Born to Women 
     Receiving Pregnancy-Related Assistance.--Notwithstanding any 
     other provision of this title or title XIX, if a child is 
     born to a targeted low-income pregnant woman who was 
     receiving pregnancy-related assistance under this section on 
     the date of the children's birth, the child shall be deemed 
     to have applied for child health assistance under the State 
     child health plan and to have been found eligible for such 
     assistance under such plan (or, in the case of a State that 
     provides such assistance through the provision of medical 
     assistance under a plan under title XIX, to have applied for 
     medical assistance under such title and to have been found 
     eligible for such assistance under such title) on the date of 
     such birth and to remain eligible for such assistance until 
     the child attains 1 year of age. During the period in which a 
     child is deemed under the preceding sentence to be eligible 
     for child health or medical assistance, the child health or 
     medical assistance eligibility identification number of the 
     mother shall also serve as the identification number of the 
     child, and all claims shall be submitted and paid under such 
     number (unless the State issues a separate identification 
     number for the child before such period expires).''.
       (b) State Option To Use Enhanced FMAP and SCHIP Allotment 
     for Coverage of Additional Pregnant Women under the Medicaid 
     Program.--Section 1905 of the Social Security Act (42 U.S.C. 
     1396d) is amended--
       (A) in the fourth sentence of subsection (b), by inserting 
     ``and in the case of a State plan that meets the condition 
     described in subsections (u)(1) and (u)(4)(A), with respect 
     to expenditures described in subsection (u)(4)(B) for the 
     State for a fiscal year'' after ``for a fiscal year,''; and
       (B) in subsection (u)--
       (i) by redesignating paragraph (4) as paragraph (5); and
       (ii) by inserting after paragraph (3) the following new 
     paragraph:
       ``(4)(A) The condition described in this subparagraph for a 
     State plan is that the plan has established an income level 
     under section 1902(l)(2)(A) with respect to individuals 
     described in section 1902(l)(1)(A) that is 185 percent of the 
     income official poverty line.
       ``(B) For purposes of subsection (b), the expenditures 
     described in this paragraph are expenditures for medical 
     assistance for women described in section 1902(l)(1)(A) whose 
     income exceeds the income level established for such women 
     under section 1902(l)(2)(A)(i) as of the date of the 
     enactment of this paragraph but does not exceed 185 percent 
     of the income official poverty line.''.
       (c) No Waiting Periods or Cost-Sharing.--
       (1) No waiting period.--Section 2102(b)(1)(B) of the Social 
     Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--
       (A) by striking ``, and'' at the end of clause (i) and 
     inserting a semicolon;
       (B) by striking the period at the end of clause (ii) and 
     inserting ``; and''; and
       (C) by adding at the end the following new clause:
       ``(iii) may not apply a waiting period (including a waiting 
     period to carry out paragraph (3)(C)) in the case of a 
     targeted low-income pregnant woman, if the State provides for 
     coverage of pregnancy-related assistance for such women in 
     accordance with section 2111.''.
       (2) No cost-sharing for pregnancy-related benefits.--
     Section 2103(e)(2) of such Act (42 U.S.C. 1397cc(e)(2)) is 
     amended--
       (A) in the heading, by inserting ``and pregnancy-related 
     services'' after ``preventive services''; and
       (B) by inserting before the period at the end the 
     following: ``or for pregnancy-related services, if the State 
     provides for coverage of pregnancy-related assistance for 
     targeted low-income pregnant women in accordance section 
     2111''.
       (d) Presumptive Eligibility.--
       (1) In general.--Section 1920A(b)(3)(A)(i)(III) of the 
     Social Security Act (42 U.S.C. 1396r-1a(b)(3)(A)(i)(III)) is 
     amended by inserting ``a child care resource and referral 
     agency,'' after ``a State or tribal child support enforcement 
     agency,''.
       (2) Application to presumptive eligibility for pregnant 
     women under medicaid.--Section 1920(b) of the Social Security 
     Act (42 U.S.C. 1396r-1(b)) is amended by adding at the end 
     after and below paragraph (2) the following flush sentence:
     ``The term `qualified provider' includes a qualified entity 
     as defined in section 1920A(b)(3).''.
       (3) Application under title xxi.--
       (A) In general.--Section 2107(e)(1)(D) of the Social 
     Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as 
     follows:
       ``(D) Sections 1920 and 1920A (relating to presumptive 
     eligibility).''.
       (B) Exception from limitation on administrative expenses.--
     Section 2105(c)(2) of the Social Security Act (42 U.S.C. 
     1397ee(c)(2)) is amended by adding at the end the following 
     new subparagraph:
       ``(C) Exception for presumptive eligibility expenditures.--
     The limitation under subparagraph (A) on expenditures shall 
     not apply to expenditures attributable to the application of 
     section 1920 or 1920A (pursuant to section 2107(e)(1)(D)), 
     regardless of whether the child or pregnant woman is 
     determined to be ineligible for the program under this title 
     or title XIX.''.
       (e) Program Coordination With the Maternal and Child Health 
     Program (Title V).--
       (1) In general.--Section 2102(b)(3) of the Social Security 
     Act (42 U.S.C. 1397bb(b)(3)) is amended--
       (A) in subparagraph (D), by striking ``and'' at the end;
       (B) in subparagraph (E), by striking the period and 
     inserting ``; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(F) that operations and activities under this title are 
     developed and implemented in consultation and coordination 
     with the program operated by the State under title V in areas 
     including outreach and enrollment, benefits and services, 
     service delivery standards, public health and social service 
     agency relationships, and quality assurance and data 
     reporting.''.
       (2) Conforming medicaid amendment.--Section 1902(a)(11) of 
     such Act (42 U.S.C. 1396a(a)(11)) is amended--
       (A) by striking ``and'' before ``(C)''; and
       (B) by inserting before the semicolon at the end the 
     following: ``, and (D) provide that operations and activities 
     under this title are developed and implemented in 
     consultation and coordination with the program operated by 
     the State under title V in areas including outreach and 
     enrollment, benefits and services, service delivery 
     standards, public health and social service agency 
     relationships, and quality assurance and data reporting''.
       (3) Effective date.--The amendments made by this subsection 
     take effect on January 1, 2002.
       (f) Application of Annual Aggregate Cost-Sharing Limit.--
     Section 2103(e)(3)(B) of the Social Security Act (42 U.S.C. 
     1397cc(e)(3)(B)) is amended by adding at the end the 
     following new sentence: ``In the case of a targeted low-
     income pregnant woman provided coverage under section 2111, 
     or the parents of a targeted low-income child provided 
     coverage under this title under an 1115 waiver or otherwise, 
     the limitation on total annual aggregate cost-sharing 
     described in the preceding sentence shall be applied to the 
     entire family of such woman or parents.''.
       (g) Effective Date.--Except as provided in subsection (e), 
     the amendments made by this section take effect on the date 
     of the enactment of this Act and apply to expenditures 
     incurred on or after that date.

     SEC. 103. INCREASE IN SCHIP INCOME ELIGIBILITY.

       (a) Definition of Low-Income Child.--Section 2110(c)(4) of 
     the Social Security Act (42 U.S.C. 42 U.S.C. 1397jj(c)(4)) is 
     amended by striking ``200'' and inserting ``250''.
       (b) Effective Date.--The amendment made by subsection (a) 
     applies to child health assistance provided, and allotments 
     determined under section 2104 of the Social Security Act (42 
     U.S.C. 1397dd), for fiscal years beginning with fiscal year 
     2002.

                         TITLE II--STAY HEALTHY

     SEC. 201. ENHANCED FEDERAL MEDICAID MATCH FOR INCREASED 
                   EXPENDITURES FOR MEDICAL ASSISTANCE FOR 
                   CHILDREN.

       (a) Enhanced FMAP.--Section 1905(b) of the Social Security 
     Act (42 U.S.C. 1396d(b)) is amended by adding at the end the 
     following new sentence: ``Notwithstanding the first sentence 
     of this subsection, in the case of a State plan that meets at 
     least 7 of the conditions described in subsection (x)(1) (as 
     determined by the Secretary in consultation with States 
     (including the State agencies responsible for the 
     administration of this title and title V), beneficiaries 
     under this title, providers of services under this title, and 
     advocates for children), with respect to expenditures 
     described in subsection (x)(2) for the State for a fiscal 
     year, the Federal medical assistance percentage is equal to 
     the percentage determined for the State under subsection 
     (x)(3).''.
       (b) Conditions and Expenditures Described.--Section 1905 of 
     the Social Security Act (42 U.S.C. 1396d) is amended by 
     adding at the end the following new subsection:
       ``(x)(1) For purposes of subsection (b), the conditions 
     described in this subsection are the following:
       ``(A) Highest schip income eligibility.--The State has a 
     State child health plan under title XXI which (whether 
     implemented under such title or under this title) has the 
     highest income eligibility standard permitted under title XXI 
     as of January 1, 2001, does not limit the acceptance of 
     applications, and provides benefits to all children in

[[Page S6134]]

     the State who apply for and meet eligibility standards.
       ``(B) Uniform, simplified application form.--With respect 
     to children under age 19 (or such higher age as the State has 
     elected under section 1902(l)(1)(D)) who are eligible for 
     medical assistance under section 1902(a)(10)(A), the State 
     uses the same uniform, simplified application form 
     (including, if applicable, permitting application other than 
     in person) for purposes of establishing eligibility for 
     benefits under this title and also under title XXI.
       ``(C) Coordinated enrollment process.--The State has an 
     enrollment process that is coordinated with that under title 
     XXI so that a family need only interact with a single agency 
     in order to determine whether a child is eligible for 
     benefits under this title or title XXI, and that allows for 
     the transfer of enrollment, without a gap in coverage, for a 
     child whose income eligibility status changes but who remains 
     eligible for benefits under either title.
       ``(D) Same verification and redetermination policies; 
     automatic reassessment of eligibility.--With respect to 
     children under age 19 (or such higher age as the State has 
     elected under section 1902(l)(1)(D)) who are eligible for 
     medical assistance under section 1902(a)(10)(A), the State 
     provides for initial eligibility determinations and 
     redeterminations of eligibility using the same verification 
     policies (including with respect to face-to-face interviews), 
     forms, and frequency as the State uses for such purposes 
     under title XXI, and, as part of such redeterminations, 
     provides for the automatic reassessment of the eligibility of 
     such children for assistance under this title and title XXI.
       ``(E) No asset test.--The State does not impose an asset 
     test for eligibility under section 1902(l) or title XXI with 
     respect to children.
       ``(F) 12-month continuous enrollment.--The State has 
     elected the option of continuing enrollment under section 
     1902(e)(12) and has elected a 12-month period under 
     subparagraph (A) of such section.
       ``(G) Compliance with outstationing requirement.--The State 
     is providing for the receipt and initial processing of 
     applications of children for medical assistance under this 
     title at facilities defined as disproportionate share 
     hospitals under section 1923(a)(1)(A) and Federally-qualified 
     health centers described in subsection (l)(2)(B) of this 
     section consistent with the requirements of section 
     1902(a)(55).
       ``(H) No waiting period longer than 6 months.--The State 
     does not impose a waiting period for children who meet 
     eligibility standards to qualify for assistance under such 
     plan that exceeds 6 months (and may impose a shorter period 
     or no period) for purposes of complying with regulations 
     promulgated under title XXI to ensure that the insurance 
     provided under the State child health plan under such title 
     does not substitute for coverage under group health plans.
       ``(I) Sufficient provider payment rates.--The State 
     demonstrates that it is meeting the requirements of section 
     1902(a)(30)(A) through payment rates sufficient to enlist 
     enough providers so that care and pediatric, obstetrical, 
     gynecologic, and dental services are available under the plan 
     at least to the extent that such care and services are 
     available to the general population in the geographic area.
       ``(2)(A) For purposes of subsection (b), the expenditures 
     described in this paragraph are expenditures for medical 
     assistance for children described in subparagraph (B) for a 
     fiscal year, but only to the extent that such expenditures 
     exceed the base expenditure amount, as defined in 
     subparagraph (C).
       ``(B) For purposes of subparagraph (A), the children 
     described in this subparagraph are--
       ``(i) individuals who are under 19 years of age (or such 
     higher age as the State may have elected under section 
     1902(l)(1)(D)) who are eligible and enrolled for medical 
     assistance under this title; and
       ``(ii) individuals who--
       ``(I) would be described in clause (i) but for having 
     family income that exceeds the highest income eligibility 
     level applicable to such individuals under the State plan; 
     and
       ``(II) would be considered disabled under section 
     1614(a)(3)(C) (determined without regard to the reference to 
     age in that section but for having earnings or deemed income 
     or resources (as determined under title XVI for children) 
     that exceed the requirements for receipt of supplemental 
     security income benefits.
       ``(C) For purposes of subparagraph (A), the term `base 
     expenditure amount' means the total expenditures for medical 
     assistance for children described in subparagraph (B) for 
     fiscal year 1996.
       ``(3) For purposes of subsection (b), the Federal medical 
     assistance percentage with respect to expenditures described 
     in paragraph (2) for a fiscal year is equal to the following:
       ``(A) In the case of a State that meets 7 of the conditions 
     described in paragraph (1), the Federal medical assistance 
     percentage (as defined in the first sentence of subsection 
     (b)) for the State increased by a number of percentage points 
     equal to 50 percent of the number of percentage points by 
     which (1) such Federal medical assistance percentage for the 
     State is less than (2) the enhanced FMAP for the State 
     described in section 2105(b).
       ``(B) In the case of a State that meets 8 of the conditions 
     described in paragraph (1), the Federal medical assistance 
     percentage (as so defined) for the State increased by a 
     number of percentage points equal to 75 percent of the number 
     of percentage points by which (1) such Federal medical 
     assistance percentage for the State is less than (2) the 
     enhanced FMAP for the State (as so described).
       ``(C) In the case of a State that meets all of the 
     conditions described in paragraph (1), the enhanced FMAP (as 
     so described).''.
       (c) Collection of Data.--The Secretary of Health and Human 
     Services shall modify such data collection and reporting 
     requirements under title XIX of the Social Security Act as 
     are necessary to determine the expenditures and base 
     expenditure amount described in section 1905(x)(2) of that 
     Act (as added by subsection (b)), particularly with respect 
     to expenditures and the base expenditure amount related to 
     children described in section 1905(x)(2)(B)(ii) of that Act.
       (d) Effective Date.--The amendments made by subsections (a) 
     and (b) apply to medical assistance provided on or after 
     October 1, 2001.

     SEC. 202. INCREASE IN SCHIP APPROPRIATIONS.

       Section 2104(a) of the Social Security Act (42 U.S.C. 
     1397dd(a)) is amended by striking paragraphs (5) through (9) 
     and inserting the following:
       ``(5) for fiscal year 2002, $3,500,000,000;
       ``(6) for fiscal year 2003, $4,000,000,000;
       ``(7) for fiscal year 2004, $4,300,000,000;
       ``(8) for fiscal year 2005, $4,500,000,000;
       ``(9) for fiscal year 2006, $4,500,000,000; and''.

     SEC. 203. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE 20 UNDER 
                   THE MEDICAID PROGRAM AND SCHIP.

       (a) Medicaid.--
       (1) In general.--Section 1902(l)(1)(D) of the Social 
     Security Act (42 U.S.C. 1396a(l)(1)(D)) is amended by 
     inserting ``(or, at the election of a State, 20 or 21 years 
     of age)'' after ``19 years of age''.
       (2) Conforming amendments.--
       (A) Section 1902(e)(3)(A) of such Act (42 U.S.C. 
     1396a(e)(3)(A)) is amended by inserting ``(or 1 year less 
     than the age the State has elected under subsection 
     (l)(1)(D))'' after ``18 years of age''.
       (B) Section 1902(e)(12) of such Act (42 U.S.C. 
     1396a(e)(12)) is amended by inserting ``or such higher age as 
     the State has elected under subsection (l)(1)(D)'' after ``19 
     years of age''.
       (C) Section 1920A(b)(1) of such Act (42 U.S.C. 1396r-
     1a(b)(1)) is amended by inserting ``or such higher age as the 
     State has elected under section 1902(l)(1)(D)'' after ``19 
     years of age''.
       (D) Section 1928(h)(1) of such Act (42 U.S.C. 1396s(h)(1)) 
     is amended by inserting ``or 1 year less than the age the 
     State has elected under section 1902(l)(1)(D)'' before the 
     period at the end.
       (E) Section 1932(a)(2)(A) of such Act (42 U.S.C. 1396u-
     2(a)(2)(A)) is amended by inserting ``(or such higher age as 
     the State has elected under section 1902(l)(1)(D))'' after 
     ``19 years of age''.
       (b) Title XXI.--Section 2110(c)(1) of such Act (42 U.S.C. 
     1397jj(c)(1)) is amended by inserting ``(or such higher age 
     as the State has elected under section 1902(l)(1)(D))''.
       (c) Effective Date.--The amendments made by this section 
     take effect on October 1, 2001, and apply to medical 
     assistance and child health assistance provided on or after 
     such date.
                                  ____


          Fact Sheet--Start Healthy, Stay Healthy Act of 2001

       Sens. Jeff Bingaman (D-NM), Richard Lugar (R-IN), John 
     McCain (R-AZ), Jon Corzine (D-NJ), and Blanche Lincoln (D-AR) 
     introduced the ``Start Healthy, Stay Healthy Act of 2001'' on 
     June 12, 2001. The legislation would significantly reduce the 
     number of uninsured children and pregnant women by improving 
     outreach to and enrollment of children and by expanding 
     coverage to pregnant women through Medicaid and the State 
     Children's Health Insurance Program (CHIP).
       An estimated 11 million children under age 19 were without 
     health insurance in 1999, representing 15% of all children in 
     the United States. Due to a variety of factors, including 
     governmental barriers to coverage, such as bureaucratic ``red 
     tape,'' and the lack of knowledge of families about CHIP, an 
     estimated 6.7 million of our nation's uninsured children are 
     eligible for but are unenrolled in either Medicaid or CHIP.
       In addition, an estimated 4.3 million, or 32%, of mothers 
     below 200% of poverty are uninsured. According to the March 
     of Dimes, ``Over 95 percent of all uninsured pregnant women 
     could be covered through a combination of aggressive Medicaid 
     outreach, maximizing coverage for young women through [CHIP], 
     and expanding CHIP to cover income-eligible pregnant women 
     regardless of age.''
       The legislation would reduce the number of uninsured 
     children and pregnant women by:
     Start healthy
       Providing states with an enhanced Medicaid matching rate to 
     ensure that children eligible for Medicaid or CHIP leave the 
     hospital insured and remain so through the first year of 
     life.
       Providing states with the option to further extend coverage 
     to pregnant women through Medicaid and CHIP to reduce infant 
     and maternal mortality and low birthweight babies.
     Stay healthy
       Providing states with an enhanced Medicaid matching rate to 
     reduce the barriers to care for children to keep them healthy 
     throughout their childhood.

[[Page S6135]]

       Providing states with the option to increase CHIP 
     eligibility from 200% of federal poverty level to 250% and to 
     extend coverage to children through age 20.
       As a result of these provisions, the legislation would 
     achieve the following additional objectives:
       Reduces Infant and Maternal Mortality: The United States 
     ranks 25th in infant mortality and 21st in maternal 
     mortality, the worst among developed nations. Studies with 
     respect to the previous expansions of Medicaid coverage to 
     pregnant women and children during the Reagan and Bush 
     Administrations indicate those expansions reduced infant 
     mortality and improved child health (GAO, ``Insurance and 
     Health Care Access,'' November 1997). By reducing the number 
     of uninsured children and pregnant women in this country, the 
     legislation would also reduce infant and maternal mortality 
     as well.
       Eliminates Bureaucratic Barriers to Coverage and Promotes 
     Best Practices by States: Building on the successful 
     enactment of Senator Lugar's amendment to the ``Agricultural 
     Risk Protection Act of 2000'' to make it easier to disclose 
     information from the school lunch program application to 
     Medicaid and CHIP agencies, this legislation seeks to further 
     improve coordination between Medicaid, CHIP, and the Maternal 
     and Child Health (MCH) Block Grant in order to expand health 
     insurance coverage to eligible but unenrolled children. The 
     bill also provides states financial incentives to remove 
     bureaucratic barriers to health insurance coverage in 
     Medicaid and CHIP for children. These provisions reward 
     states for ``best practices'' and also eliminates the 
     negative incentive for states to enroll children improperly 
     in CHIP (with the higher matching rate, higher cost sharing, 
     and reduced benefits) rather than Medicaid (with a lower 
     matching rate, reduced cost sharing, and increased benefits).
       Addresses the ``CHIP Dip'': There is a ``dip'' in federal 
     funding, known as the ``CHIP dip'' in fiscal years 2002 
     through 2006 that states have complained will cause them to 
     limit their CHIP programs out of fear of not having enough 
     funding in those years. The bill addresses that problem by 
     raising CHIP funding levels in fiscal years FY 2002 through 
     2006.
       Eliminates Unintended Federal Incentives Regarding Teenage 
     Pregnant Women: Current federal law allows pregnant women to 
     receive coverage through CHIP through age 18--creating a 
     perverse federal incentive of covering only teenage pregnant 
     women and cutting off that coverage once they turn 19 years 
     of age. This legislation would eliminate this problem by 
     allowing states to cover pregnant women through CHIP, 
     regardless of age. This also eliminates the unfortunate 
     separation between pregnant women and infants that has been 
     created through CHIP, which has been contrary to long-
     standing federal policy through programs such as Medicaid, 
     WIC, MCH, etc.
       Imposes No Mandates on States: This legislation imposes no 
     mandates on states. However, states would, just as we have 
     done in the Temporary Assistance for Needy Families (TANF), 
     be provided financial incentives and accountability for the 
     additional money this legislation provides in return for 
     reducing governmental barriers to coverage for children and 
     pregnant women.
       Remains Within the Budget Framework: The budget provides 
     for $28 billion over 10 yeas for the purpose of reducing the 
     number of uninsured. This proposal will meet those budgetary 
     limits.
       This bipartisan legislation has received the endorsement of 
     the following organizations: the March of Dimes, the American 
     Academy of Pediatrics, the American College of Obstetricians 
     and Gynecologists, the American Academy of the Family 
     Physicians, the American Academy of Pediatric Dentistry, the 
     American Academy of Child and Adolescent Psychiatry, the 
     National Association of Community Health Centers, the 
     American Hospital Association, the National Association of 
     Children's Hospitals, the Federation of American Health 
     Systems, the National Association of Public Hospitals and 
     Health Systems, Catholic Health Association, Premier, Family 
     Voices, the Association of Maternal and Child Health 
     Programs, the National Health Law Program, the National 
     Association of Social Workers, Every Child by Two, and the 
     United Cerebral Palsy Associations.


                          legislative summary

       This legislation is split into two titles:
     Title I: Start healthy
       Provides states through Medicaid with the CHIP enhanced 
     matching rate if they choose the option to continuously 
     enroll infants from birth through the first year of life, as 
     allowed under current law, regardless of the woman's status 
     during that year.
       Provides states with an option to further cover pregnant 
     women through Medicaid and CHIP (above 185% of poverty up to 
     the full CHIP eligibility levels) in order to reduce infant 
     mortality and the delivery of low birthweight babies.
     Title II: Stay healthy
       Provides states through Medicaid with the CHIP enhanced 
     matching rate for children above a certain base expenditure 
     level such as a state's spending on children in 1996) if they 
     choose to meet the following conditions: States must expand 
     coverage to children up to the full extent that is allowed 
     under CHIP (to 200% of poverty or 50 percentage points above 
     where the coverage levels were prior to passage of Title 
     XXI); adoption of a simplified, joint mail-in application; 
     adoption of application procedures (e.g., verification and 
     face-to-face interview requirements) that are no more 
     extensive, onerous, or burdensome in Medicaid than in CHIP, 
     elimination of assets test; adoption of 12-month continuous 
     enrollment; adoption of procedures that simplify the 
     redetermination/coverage renewal process by allowing families 
     to establish their child's continuing eligibility by mail 
     and, in states with separate CHIP programs, by establishing 
     effective procedures that allow children to be transferred 
     between Medicaid and the separate program without a new 
     application a gap in coverage when a child's eligibility 
     status changes; compliance with the OBRA-89 outstationed 
     workers requirement, which provide for outstationed 
     eligibility workers in Medicaid DSH hospitals and community 
     health centers, impose waiting periods no longer than 6 
     months for children seeking to enroll in CHIP (ensure 
     flexibility for states to impose shorter periods, if at all); 
     and demonstrate that the State has adopted payments rates 
     sufficient to enlist enough providers so that care and 
     pediatric, obstetrical/gynecologic and dental services are 
     available at least to the extent such care and services are 
     available to the general population in the geographic area.
       States meeting these conditions would receive the full 
     enhanced CHIP matching rate. If a state meets 8 of these 
     conditions, it would receive 75% of the difference between 
     the regular Medicaid matching rate and the CHIP enhanced 
     matching rate. If a state meets 7 of the conditions, it would 
     receive 50% of the difference.
       Expand CHIP eligibility to 250% of poverty for children and 
     pregnant women.
       Expand CHIP eligibility up to age 21 (adding 19 and 20 
     year-olds).
       The legislation also increases the CHIP allotments in FY 
     2002 to $3.5 billion, in FY 2003 to $4 billion, in FY 2004 to 
     $4.3 billion in FY 2005 to $4.5 billion, and in FY 2006 to 
     $4.5 billion.
                                 ______
                                 
      By Mr. DODD (for himself, Mr. Chafee, Mr. Leahy, Mr. Lugar, Mr. 
        Roberts, Mr. Baucus, Mr. Levin, Mrs. Boxer, Mr. Jeffords, Mr. 
        Kennedy, Mr. Akaka, Mr. Wellstone, Mr. Dorgan, Mr. Bingaman, 
        Mr. Durbin and Mr. Hagel):
  S. 1017. A bill to provide the people of Cuba with access to food and 
medicines from the United States, to ease restrictions on travel to 
Cuba, to provide scholarships for certain Cuban nationals, and for 
other purposes; to the Committee on Foreign Relations.
  Mr. DODD. Mr. President, last year 26 Senators cosponsored 
legislation to help the Cuban people and American farmers and 
businesses by allowing sales of food and medicine to Cuba. Later, with 
passage of the FY2001 Agriculture Appropriations Bill, the 106th 
Congress approved the issuance one year licenses for the sale of food 
and medicine to Cuba, but placed restrictions on the financing of these 
sales. This was a beginning, and now we need to expand on this small 
success by continuing to move forward in constructing bridges to the 
Cuban people.
  Toward that end, I am today joined by a bipartisan group of my 
colleagues in introducing the Bridges to the Cuban People Act, an 
expanded version of the legislation that was passed last year. Among 
those joining as original cosponsors are Senators Chafee, Leahy, Lugar, 
Roberts, Baucus, Levin, Boxer, Jeffords, Kennedy, Akaka, Wellstone, 
Dorgan, Bingaman, and Durbin. This bill comprehensively updates U.S. 
policy toward Cuba by increasing humanitarian trade between Cuba and 
the United States, increasing our people-to-people contacts, and 
enhancing the flexibility of the President with respect to our foreign 
policy towards Cuba. I would like to take a few moments to outline the 
various sections of this bill, and to explain to my colleagues the 
reasons why enactment of this legislation is so vital.
  First, let me be clear. This new legislation will not end the embargo 
on Cuba. Rather, this bill creates specific exceptions to the embargo 
that will allow American farmers and businesses to sell food, medicine, 
and agricultural equipment to Cuba without the burden of securing 
annual licenses and will allow our farmers and businesses to use 
American banks and American financing to conduct these sales. Both of 
these changes, along with the lifting of shipping restrictions, are 
designed to allow sales to move forward in a way that is less 
burdensome to American farmers and businesses. Additionally, this bill 
would mandate that the President submit a report to Congress each year 
describing the number and types of sales to Cuba so that we will have 
some official record of these sales.

[[Page S6136]]

  The Building Bridges to the Cuban People Act would also lift the 
embargo on the exports of goods or services intended for the exclusive 
use of children. No embargo should include children as its victims, and 
this provision would allow us to give special attention to children in 
Cuba.
  This bill also modernizes our approach to Cuba's medical exports. 
Cuba is currently involved in the development of some medicines that 
are not available in the United States, such as the Meningitis B 
vaccine, but that could save American lives. This legislation would 
allow Cuba, with the approval of the Secretary of Health and Human 
Services, to export to the United States medicines for which there is a 
medical need in the United States, provided the medicine is not 
currently being manufactured in our country. In this way we can build 
on the strong tradition of medical research in Cuba and encourage the 
free exchange of ideas and experiments between scholars.
  In addition, this bill will lift restrictions on travel to Cuba. Cuba 
does not now pose a threat to individual Americans, and it is time to 
permit our citizens to exercise their constitutional right to travel to 
Cuba. Surely we do not ban travel to Cuba out of concern for the safety 
of Americans who might visit the island Nation. Today Americans are 
free to travel to Iran, the Sudan, Burma, Yugoslavia, and North Korea, 
but not to Cuba. This is a mistake. American influence, through person-
to-person and cultural exchanges, was one of the prime factors in the 
evolution of our hemisphere from a hemisphere ruled predominantly by 
authoritarian and military regimes to one where democracy is the rule. 
Our current policy toward Cuba limits the United States from using our 
most potent weapon in our effort to combat totalitarianism, and that is 
our own people. They are some of the best ambassadors we have ever sent 
anywhere, and the free exchange of ideas between Americans and the 
Cuban people is one of the best ways to encourage democracy and build 
bridges between the American and Cuban people.
  Another provision in this new legislation would allow us to reach out 
to Cuban students. Under this legislation, scholarships would be 
provided for Cubans who would like to pursue graduate study in the 
United States in the areas of public health, public policy, economics, 
law, or other fields of social science. Throughout our history, 
educational and cultural exchanges have proven to be valuable tools 
that lead to understanding and friendship. This scholarship program is 
a concrete example of the true people-to-people dialogue we should be 
trying to foster with Cuba.
  Nor does this legislation ignore the struggle of the Cuban-American 
population in the United States. Cuban-Americans here have always had 
the ability to send money to their families in Cuba, but the government 
imposes restrictions on the total amount of money that can be sent. 
This legislation would lift these limitations so that Americans would 
be free to provide whatever assistance they wished to their loved ones.
  And, finally, this bill would modernize the way our policies toward 
Cuba are codified. At the present time, the President has the authority 
to waive Title III of the Helms/Burton Act. This legislation would 
extend the President's authority so that he could also waive Title I, 
Title II, and Title IV of the Helms/Burton Act, at his discretion. When 
Helms/Burton was enacted it contained a provision that codified all 
existing Cuban embargo Executive Orders and regulations, but did not 
provide for presidential waivers. This lack of waivers severely ties 
the hands of the Administration if a decision is made to make changes 
in our policy towards Cuba. The President should have the tools he 
needs to conduct and modify our foreign policy, and this legislation 
would give the President the flexibility to shape our relationship with 
Cuba in a more positive way.
  In conclusion, I believe that this bill will streamline our Cuban 
policy so that it deals with the realities of the modern age, addresses 
the needs of our American farmers, patients, and children, while 
imposing the fewest restrictions on American citizens who wish to have 
contact with the people of Cuba. The people of Cuba are not our enemy. 
Our government's quarrel is with Fidel Castro, and our policies should 
reflect that reality. Without doubt, the Castro regime has denied 
rights to its citizens, but in our efforts to isolate him, we have 
built walls that are hampering our goal of bringing democracy to the 
Cuban people. As a measure that tears down those walls and replaces 
them with bridges, this legislation is a good starting point for a 
serious debate about how we can change U.S. policy in order to foster a 
peaceful transition to democracy on the island of Cuba while 
alleviating the hardship that our current policy has caused for the 11 
million people who reside there. I hope to hold hearings in the near 
future and will be discussing with the committee leadership dates for 
the markup of this important legislation. Congressmen Serrano, Leach 
and more than eighty of their House colleagues have introduced a 
companion bill in the House today as well. I urge the rest of my 
colleagues to join us in this endeavor.
  Mr. BINGAMAN. Mr. President, I rise today in support of the Bridges 
to Cuban People Act of 2001. As many of my colleagues know, I have been 
vocal in my support of legislation that removes sanctions against the 
Cuban people. I have supported such legislation for several reasons. 
First, sanctions ultimately hurt the very people we proclaim we are 
trying to help. It is obvious by now that barriers that either hinder 
or prohibit the flow of food and medicine to Cuba do not impact the 
Castro regime, but rather harms innocent men, women, and children. 
Second, sanctions are counterproductive to our goal of bringing about 
change in Cuba. There is no empirical evidence whatsoever that our 
continued efforts to isolate Cuba has brought about any transformation 
in the way the Castro regime sees or reacts to the world. Finally, 
sanctions prevent U.S. firms from exporting to Cuba, allow their 
counterparts in other countries to make sales our firms cannot, and 
thus harm the U.S. economic interest.
  I am convinced engagement on all fronts--social, economic, and 
political--will make a substantial difference in Cuba, and it is way 
past time that we begin that process. The bill today represents another 
dramatic step forward in our policy in this regard. After considerable 
debate over the years, we are now seeing consensus emerge among my 
colleagues on this issue, as indicated by the bi-partisan support for 
this bill. The components of this legislation--the unrestricted sales 
of food, farm equipment, agricultural commodities and medicine, the 
removal of restrictions on travel, the authorization of scholarships 
for Cuban students to study in the United States, among others--are in 
fact the humanitarian, responsible, and appropriate way to approach 
Cuba at this time.
  Let me emphasize today, as I have in the past, that the elimination 
of sanctions on Cuba and the creation of new opportunities for the 
Cuban people does not imply that I, or the Senate as a whole, agree 
with the policies and politics of the Castro regime. Quite the 
contrary. I believe the Castro regime to be distinctly out of touch 
with current trends in the international system and their own people. I 
personally deplore the Castro regime's oppressive tactics. The lack of 
freedom and opportunity in that country stands in direct contrast to 
most of the countries in the Western Hemisphere and throughout the 
world. Cuba now stands alone in its inability to allow the growth of 
democracy, to establish the protection of individual rights, and create 
a semblance of economic security. It is a political system that should 
be condemned at every opportunity.
  But as a practical matter this legislation suggests that we cannot 
effectively punish authoritarian regimes through their own people. Cuba 
is ripe for change, and the best way to achieve positive change is to 
allow Americans to communicate and associate with the Cuban people on 
an intensive and ongoing basis, to re-establish cultural activities, 
and to rebuild economic relations. To allow the Cuban system to remain 
closed does little to assert United States influence over policy in 
that country and it does absolutely nothing in terms of creating the 
foundation for much-needed political economic transformation. The 
spread of democracy comes from interaction, not isolation.
  So, I strongly support this bill, and I urge my colleagues to do so 
as well.

[[Page S6137]]

                                 ______
                                 
      By Mr. LEVIN (for himself, Ms. Snowe, Mrs. Murray, Mr. Schumer, 
        Ms. Stabenow, and Ms. Cantwell):
  S. 1018. A bill to provide market loss assistance for apple 
producers; to the Committee on Agriculture, Nutrition, and Forestry.
  Mr. LEVIN. Mr. President, I am today introducing a bill that seeks to 
provide much needed assistance to our Nation's apple farmers. In the 
past four years, due to weather related disasters, disease and the 
dumping of Chinese apple juice concentrate, our Nation's apple 
producers have lost over $1.4 billion dollars in revenue. This has left 
many growers on the brink of financial disaster.
  In the past three years, Congress has assisted America's farmers by 
providing substantial assistance to agricultural producers. The U.S. 
apple industry boasts a long history of self-sufficiency and has long 
operated without relying upon federally funded farm programs. Last 
year, Congress, recognized the problems facing apple growers and for 
the first time ever, provided direct market loss assistance to apple 
growers.
  Even with this aid, a significant percentage of apply growers are 
expected to go out of the business this year. Without some type of 
financial relief, the numbers could indeed be staggering. Studies by 
economists at Michigan State University estimated U.S. apple growers 
will lose nearly $500 million this year alone. Such losses threaten to 
devastate the entire U.S. apple industry. The Michigan Farm Bureau 
states that the number of those leaving the business in some States is 
running as high as 30 percent. Assistance is desperately needed to help 
stabilize not only the production sector but entire communities and 
subsidiary businesses that are dependent on the apple industry, not 
only in Michigan, but nationwide.
  The $250 million in assistance we are proposing will help those who 
depend on the apple industry for their livelihood, and ensure that 
American apple growers will be able to provide the United States and 
the world with a quality product that is second to none.
  Mrs. MURRAY. Mr. President, I rise today to express my strong support 
for legislation to provide $250 million in emergency payments to apple 
growers. I would like to thank Senators Levin and Snowe for their 
leadership on this issue.
  Rural communities and agricultural producers have not enjoyed 
America's recent economic prosperity. Around the Nation, nearly all 
commodity producers are enduring low prices and trade challenges. In 
Washington State, these problems are compounded by a severe drought, an 
energy crisis, and fish listings under the Endangered Species Act.
  The combined impact is devastating. Apple growers in my State, from 
Okanogan County to Walla Walla County, are going bankrupt. Many family 
farmers have given up hope. On land that has produced high quality 
fruit for generations, farmers are tearing out orchards. Farmer 
cooperatives and other businesses that have been a part of rural 
communities for decades have closed up shop. Local governments have 
seen tax revenue decline. And non-farm businesses have struggled as 
consumers no longer have the cash to buy their goods and services.
  In the 106th Congress, we responded. Last year, I worked with my 
colleagues to pass a $100 million emergency package for apple growers. 
In 1999, I worked with the Clinton Administration to end the dumping by 
Chinese companies of non-frozen apple juice concentrate. And on a host 
of smaller issues, from fighting pests in abandoned orchards, to 
securing research funding, to breaking down trade barriers, I worked 
with the industry and other stakeholders to build a stronger foundation 
for the future.
  We can be proud of what we accomplished. But we still have more to do 
in the 107th Congress.
  If signed into law, this new legislation will provide $250 million in 
emergency payments to apple growers nation-wide. This emergency 
legislation will not save every producer. It will give the industry the 
financial support it needs to get through another year of disastrous 
prices. It will also give us the time we need to develop long-term 
solutions as part of the next farm bill for apple and other specialty 
crop growers.
  I urge my colleagues to support this legislation. And I urge the 
Senate Agriculture Committee and the Senate Appropriations Committee to 
work with the sponsors of this bill to provide meaningful assistance to 
all apple growers.
                                 ______
                                 
      By Mrs. FEINSTEIN:
  S. 1019. A bill to provide for monitoring of aircraft air quality, to 
require air carriers to produce certain mechanical and maintenance 
records, and for other purposes; to the Committee on Commerce, Science, 
and Transportation.
  Mrs. FEINSTEIN. Mr. President, today I am proud to introduce the 
Aircraft Clean Air Act of 2001. The bill is designed to encourage 
airlines to keep records of airplane cabin air quality complaints, as 
well as complaints of illnesses that may be a result of poor air 
quality.
  Airlines are not required to maintain records of passenger and 
crewmember complaints regarding cabin air quality, even if the 
passenger or crewmember reports an illness as a result of poor air 
quality.
  As a result, potentially valuable information is lost to researchers 
studying cabin air quality.
  The Aircraft Clean Air Act allows passengers and crewmembers to 
submit their complaints directly to the Federal Aviation Administration 
and requires that the Administration record the complaint and pass it 
on to the appropriate airline.
  The bill requires airlines to maintain records of complaints for ten 
years.
  If a passenger or crewmember requests mechanical or maintenance 
records with regard to their complaint, and the passenger or crewmember 
has had a health care professional verify their symptoms, this 
legislation requires that the airline provide the requested information 
within 15 days. If the airline does not comply with the request, it is 
subject to a civil penalty of $1,000 for each day it does not produce 
the records.
  Airlines must be ready to provide maintenance records of all 
chemicals used in or on the plan, from cleaning solvents to hydraulic 
fluids.
  The traveling public should have access to any chemicals to which 
they may be exposed.
  The Aircraft Clean Air Act addresses another issue, as well: aircraft 
pressurization.
  Planes are currently pressurized to 8,000 feet while in the air. That 
means that even though the plane is flying at 30,000 feet, the cabin 
has the same air pressure as it would at 8,000 feet.
  Airplane manufacturers arrived at the 8,000 figure in the 1960s when 
commercial air travel was booming. They agreed on the figure after 
testing the effects of different pressurizations on young, healthy 
pilots.
  Because oxygen is absorbed into the blood at a much lower rate in 
high altitudes, there is speculation that some illnesses experienced 
during flight are a result of the 8,000 feet pressurization. Commonly 
reported symptoms such as shortness of breath and numbness in the limbs 
may be a direct result of the high altitude.
  The Aircraft Clean Air Act directs the Federal Aviation 
Administration to sponsor an aeromedical research project to determine 
what cabin altitude limit should provide enough oxygen to passengers 
and crew.
  The bill allows universities to compete to conduct the study, and the 
National Academy of Sciences' Committee on Air Quality in Passenger 
Cabins of Commercial Aircraft to select the winner.
  Researchers will examine the oxygen saturation in people of different 
ages, weights, and body types at 5,000 feet through 8,000 feet. The 
bill directs researchers to determine which altitude provides enough 
oxygen to ensure that individuals' health is not adversely affected 
either in the short-term or long-term.
  It is unacceptable that airlines do not maintain records of air 
quality complaints on their commercial flights. I hope my colleagues 
will join me in this effort to protect the traveling public and the 
hardworking men and women who make air travel possible.
                                 ______
                                 
      By Mr. HARKIN (for himself, Mr. Craig, Mr. Bingaman, Mrs.

[[Page S6138]]

        Murray, Mr. Feingold, Mr. Kohl, and Mr. Leahy):
  S. 1020. A bill to amend title XVIII of the Social Security Act to 
improve the provision of items and services provided to Medicare 
beneficiaries residing in rural areas; to the Committee on Finance.
  Mr. HARKIN. Mr. President, I am pleased to be joined today by my 
colleagues, Senator Craig, Senator Bingaman, Senator Murray, Senator 
Feingold, and Senator Kohl to introduce the Medicare Fairness in 
Reimbursement Act of 2001. This legislation addresses the terrible 
unfairness that exists today in Medicare payment policy.
  According to the latest Medicare figures, Medicare payments per 
beneficiary by State of residence ranged from slightly less than $3,000 
to well in excess of $7,000. For example, in Iowa, the average Medicare 
payment was $2,985, nearly 45 percent less than the national average of 
$5,364. In Idaho, the average payment is $3,592, only 66 percent of the 
national average.
  This payment inequity is unfair to seniors in Iowa and Idaho, and it 
is unfair to rural beneficiaries everywhere. The citizens of my home 
State pay the same Medicare payroll taxes required of every American 
taxpayer. Yet they get dramatically less in return.
  Ironically, rural citizens are not penalized by the Medicare program 
because they practice inefficient, high cost medicine. The opposite is 
true. The low payment rates received in rural areas are in large part a 
result of their historic conservative practice of health care. In the 
early 1980's rural States' lower-than-average cost were used to justify 
lower payment rate, and Medicare's payment policies since that time 
have only widened the gap between low- and high-cost States.
  Two years ago I wrote to the Health Care Financing Administration 
(HCFA) and I asked them a simple question. I asked their actuaries to 
estimate for me the impact on Medicare's Trust Funds, which at that 
time were scheduled to go bankrupt in 2015, if average Medicare 
payments to all states were the same as Iowa's.
  I've always thought Iowa's reimbursement level was low. But HCFA's 
answer surprised even me. The actuaries found that if all States were 
reimbursed at the same rate as Iowa, Medicare would be solvent for at 
least 75 years, 60 years beyond their projections.
  I'm not suggesting that all States should be brought down to Iowa's 
level. But there is no question that the long-term solvency of the 
Medicare program is of serious national concern. And as Congress 
considers ways to strengthen and modernize the Medicare program, the 
issue of unfair payment rates needs to be on the table.
  The bill we are introducing today, the Medicare Fairness in 
Reimbursement Act of 2001 sends a clear signal. These historic wrongs 
must be righted. Before any Medicare reform bill passes Congress, I 
intend to make sure that rural beneficiaries are guaranteed access to 
the same quality health care services of their urban counterparts.
  Our legislation does the following: requires HCFA to improve the 
fairness of payments under the original Medicare fee-for-services 
system by adjusting payments for items and services so that no State is 
greater than 105 percent above the national average, and no State is 
below 95 percent of the national average. An estimated 31 States would 
benefit under these adjustments, based on the Health Care Financing 
Administration's projections of the 1999 payment data.

  Requires HCFA to improve the fairness of payments to rural 
practitioners who bill under Medicare Part B by narrowing the range of 
the Geographic Payment Classification Indices, GPCIs. Currently, there 
are dramatic geographic differences in payments for physician services 
with little scientific data to support the disparity. Providers in 
rural areas are under-compensated. This act would restrict the range 
for each GPCI so that no GPCI is greater than 1.05 or less than .95 of 
the standard index of 1.00. Practitioners who work in rural areas will 
benefit from this change in geographic adjusters.
  It ensures that beneficiaries are held harmless in both payments and 
services, ensures budget neutrality, and automatically results in 
adjustment of Medicare managed care payments to reflect increased 
equity between rural and urban areas.
  This legislation simply ensures basic fairness in our Medicare 
payment policy. I urge my Senate colleagues, no matter what State 
you're from, to consider our bill and join us in supporting this 
commonsense Medicare reform.
                                 ______
                                 
      By Mr. LUGAR (for himself, Mr. Biden, Mr. Chafee, Mr. Craig, Mr. 
        Kerry, Mr. Leahy, Mr. Lieberman, Mr. Murkowski, Mr. Reed, and 
        Mr. Roberts):
  S. 1021. A bill to reauthorize the Tropical Forest Conservation Act 
of 1998 through fiscal year 2004; to the Committee on Foreign 
Relations.
  Mr. LUGAR. Mr. President, Senator Biden and I are today introducing a 
bill to reauthorize appropriations for the Tropical Forest Conservation 
Act of 1998 for the Fiscal Years 2002, 2003 and 2004. We are joined in 
this effort by Senators Chafee, Craig, Kerry, Leahy, Lieberman, 
Murkowski, Reed and Roberts.
  The United States has a significant national interest in protecting 
tropical forests in developing countries. Tropical forests regulate the 
hydrological cycle on which world agriculture depends. The genetic 
diversity contained in tropical forests is important for plant 
breeding. Twenty-five percent of prescription drugs come from tropical 
forests. Tropical forests also serve as carbon sinks, storing carbon to 
mitigate the potential effects of the increase in greenhouse gases on 
the world's climate. Avoiding tropical deforestation is essential to 
mitigating the threat of climate change.
  Worldwide, there is a net loss of thirty million acres of forests 
every year. The heavy debt burden of many developing countries 
encourages them to engage in unsustainable exploitation of natural 
resources in order to generate revenue to service external debt. At the 
same time, these poor governments tend to have few resources available 
to set aside and protect key areas.
  The Tropical Forest Conservation Act addresses the economic pressures 
on developing countries through ``debt for nature'' mechanisms that 
reduce foreign debt while leveraging scarce funds available for 
international conservation. Specifically, the Act authorizes the 
President to reduce certain bilateral government debt owed to the 
United States through three distinct mechanisms: debt buybacks; debt 
restructuring and reduction; or debt swaps. In return, eligible 
developing countries with significant tropical forests must establish 
and place local currencies in tropical forest funds. These funds are 
managed primarily by local, non-governmental organizations and make 
grants for projects that are designed to protect or restore tropical 
forests or to promote their sustainable economic use.
  The debt for nature mechanisms in the Act effectively leverage the 
limited funds available for international conservation. Under the 
Tropical Forest Conservation Act, the host country places currencies in 
its tropical forest fund, the value of which typically exceeds the cost 
to the U.S. Treasury of the debt reduction agreement. Furthermore, 
because these tropical forest funds have integrity and are broadly 
supported within the host country, conservation organizations are 
interested in contributing their own money to them, producing an 
additional leverage of federal conservation dollars.
  Our bill would reauthorize appropriations for the Act for three 
years, with funding levels of $50 million in Fiscal Year 2002, $75 
million in Fiscal year 2003 and $100 million in Fiscal Year 2002.
  President Bush has indicated his strong support for the Tropical 
Forest Conservation Act, which is modeled upon President George Herbert 
Walker Bush's Enterprise for the Americas program as well as upon the 
Biden-Lugar Global Environmental Protection Assistance Act of 1989. 
These programs have helped to foster the development of responsible, 
community-based conservation organizations that are capable of 
addressing environmental problems at the local level and ensuring 
successful program implementation.
  The Tropical Forest Conservation Act encourages the repayment of debt 
owed to the United States government, addresses the cash flow problems 
of poorer nations, promotes cooperation

[[Page S6139]]

between governmental and local conservation organizations and helps to 
save the world's outstanding tropical forests, which are disappearing 
at an alarming rate.
  It is my understanding that Congressmen Rob Portman and Tom Lantos 
are introducing identical legislation in the House of Representatives. 
Senator Biden and I plan to work with our colleagues in the House and 
Senate toward speedy passage of this three year reauthorization bill.
  I ask unanimous consent that the text of the bill and a summary be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 1021

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

     SECTION 1. AUTHORIZATION OF APPROPRIATIONS TO SUPPORT 
                   REDUCTION OF DEBT UNDER THE FOREIGN ASSISTANCE 
                   ACT OF 1961 AND TITLE I OF THE AGRICULTURAL 
                   TRADE DEVELOPMENT AND ASSISTANCE ACT OF 1954.

       (a) Reauthorization.--Section 806 of the Tropical Forest 
     Conservation Act of 1998 (22 U.S.C. 2431d) is amended by 
     adding at the end the following new subsection:
       ``(d) Authorization of Appropriations for Fiscal Years 
     After Fiscal Year 2001.--For the cost (as defined in section 
     502(5) of the Federal Credit Reform Act of 1990) for the 
     reduction of any debt pursuant to this section or section 
     807, there are authorized to be appropriated to the President 
     the following:
       ``(1) $50,000,000 for fiscal year 2002.
       ``(2) $75,000,000 for fiscal year 2003.
       ``(3) $100,000,000 for fiscal year 2004.''.
       (b) Conforming Amendment.--Section 808(a)(1)(D) of the 
     Tropical Forest Conservation Act of 1998 (22 U.S.C. 
     2431f(a)(1)(D)) is amended by striking ``to appropriated 
     under sections 806(a)(2) and 807(a)(2)'' and inserting ``to 
     be appropriated under sections 806(a)(2), 807(a)(2), and 
     806(d)''.

            Summary of the Tropical Forest Conservation Act

       The Tropical Forest Conservation Act of 1998 (Public Law 
     105-214) helps to protect the world's dwindling tropical 
     forests through ``debt for nature swaps.''
       The TFCA focuses on tropical forest conservation, using the 
     same principles as the 1989 Global Environmental Protection 
     Act, Biden-Lugar, and former President Bush's Enterprise for 
     the Americas Initiative (EAI). The bill extends eligibility 
     for ``Debt for Nature'' swaps under the EAI to lower and 
     middle income countries in Africa and Asia with globally or 
     regionally outstanding tropical forests. It authorizes 
     appropriations to compensate the Treasury Department for 
     revenues foregone when debts with poorer developing nations 
     are restructured at less than their asset value.
       The Tropical Forest Conservation Act of 1998 authorizes the 
     President to reduce certain bilateral government debt owed to 
     the United States under the Foreign Assistance Act of 1981 or 
     Title 1 of the Agricultural Trade Development and Assistance 
     Act of 1954. In exchange, the eligible developing country 
     would place local currencies in a tropical forest fund, which 
     would be used for projects to preserve, restore or maintain 
     its tropical forests. In some instances, debt swaps would 
     occur at no cost to the Federal Treasury since sovereign debt 
     would simply be reduced to its asset value under the Federal 
     Credit Reform Act of 1990. In other instances, poorer nations 
     will be allowed to restructure their debt at an amount 
     somewhat lower than its asset value and Federal 
     appropriations would have to be used to compensate the 
     Treasury for reductions in its anticipated revenue stream. 
     The law also allows private organizations to contribute their 
     funds to help facilitate a debt swap under the terms of the 
     bill.
       To qualify for assistance, eligible countries must meet the 
     criteria established by Congress under EAI: the government 
     must be democratically elected, must not support acts of 
     international terrorism, must cooperate on international 
     narcotics control matters, must not violate internationally 
     recognized human rights, and must institute any needed 
     investment reforms.
       To ensure accountability, an administrative body is 
     established in the beneficiary country. This body will 
     consist of one or more U.S. Government officials, one or more 
     individuals appointed by the recipient country's government, 
     and representatives of environmental, community development, 
     scientific, academic and forestry organizations of the 
     beneficiary country. It is authorized to make grants for 
     projects which would conserve its outstanding tropical 
     forests. Additionally, the existing Enterprise for Americas 
     Initiative Board is expanded by four new members and oversees 
     both the EAI and the Tropical Forest Conservation Act.
       The authorization of appropriations for the 1998 Tropical 
     Forest Conservation Act expires at the end of fiscal year 
     2002. Legislation will be introduced to extend the 
     authorization of appropriations through fiscal years 2002 at 
     a level of $50,000,000 in FY 2002, $75,000,000 in FY 2003 and 
     $100,000,000 in FY 2004.

  Mr. BIDEN. Mr. President, I am pleased to once again join my 
distinguished colleague from Indiana, Senator Lugar, in introducing 
legislation to protect the world's significant tropical forests through 
``debt-for-nature'' mechanisms. We have shared a long and fruitful 
bipartisan relationship on this important issue. I am gratified that we 
have the bipartisan support of our original cosponsors noted by Senator 
Lugar.
  Tropical forests are a cornerstone of the global environment. 
Figuratively speaking, they are the ``lungs'' of our planet, and they 
can help to regulate and mitigate the process of climate change. They 
guide global patterns of rainfall on which agriculture and fisheries 
depend. They harbor pharmaceutical treasures that we are just beginning 
to explore. They are home our planet's widest diversity of plants and 
animals.
  We have a responsibility, a duty, to be good stewards of these 
essential resources, and it is in our direct economic interest to see 
that they flourish.
  In 1989, Senator Lugar and I coauthored the Global Environmental 
Protection Assistance Act, which was enacted into law as title VII A of 
the International Finance and Development Act of 1989 (Public Law 101-
240, December 19, 1989). That Act authorized US AID to use its funds 
for Debt for Nature swaps. Under the authority of this Act, US AID has 
used $95 million of its funds to establish environmental endowments 
totaling $146 million in Costa Rica, Honduras, Indonesia, Jamaica, 
Madagascar, Mexico, Panama and the Philippines.
  President Bush's Enterprise for the Americas Initiative (EAI), 
carried forward this linkage between debt reduction and the generation 
of local funds to protect the environment. The EAI provided $876 
million in debt relief and $154 million in local endowments at a 
federal cost of $90 million in seven countries in Latin America and the 
Caribbean: Argentina, Bolivia, Chile, Columbia, El Salvador, Jamaica 
and Uruguay.
  The Tropical Forest Conservation Act of 1998 extended the debt for 
nature mechanism of the EAI to the protection of significant tropical 
forests in lower and middle income developing countries throughout the 
world, not just those in Latin America and the Caribbean. Furthermore, 
the Tropical Forest Conservation Act (TFCA), authorizes the use of two 
new, no cost ``debt-for-nature'' models, the Buy Back option and Debt 
Swap option.
  The basic premise behind this series of programs has not changed over 
the years. Many of the world's important tropical forests are found in 
countries that do not have the resources to protect them. Their own 
patterns of economic development and their participation in the 
international economy place irresistible pressures on them to turn 
these irreplaceable global resources into quick local cash. One of the 
important contributors to those pressures is too often the debt those 
countries owe to us. That is one thing we can do something about.
  The mechanisms in this bill will allow us to multiply the small 
dollar cost of writing the debt of those countries off of our books, 
leveraging substantially more resources to the cause of preserving 
tropical forests around the world.
  I look forward to taking this bill up in the Foreign Relations 
Committee as soon as possible, and I fully expect it will continue to 
enjoy the strong support it has had in the past. I also look forward to 
working with the Administration to provide the funding that the 
President has called for to implement this program.
                                 ______
                                 
      By Mr. WARNER:
  S. 1022. A bill to amend the Internal Revenue Code of 1986 to allow 
Federal civilian and military retirees to pay health insurance premiums 
on a pretax basis and to allow a deduction for TRICARE supplemental 
premiums; to the Committee on Finance.
  Mr. WARNER. Mr. President, today I am pleased to join my colleague in 
the House of Representatives, Congressman Tom Davis, in introducing 
legislation that will enable Federal and military retirees to take 
advantage of premium conversion. Premium conversion allows individuals 
to pay their health insurance premiums with pre-tax dollars.
  This tax benefit was extended last year under a Presidential 
directive to

[[Page S6140]]

current Federal employees who participate in the Federal Employees 
Health Benefits Program, saving an average of over $400 per year on 
their Federal income taxes. It is a benefit already available to many 
private sector employees, and State and local government employees.
  Although extending this benefit to Federal annuitants has broad 
support, it requires a legislative change in the tax laws. The 
legislation I am introducing today will do just that.
  The Federal Employees Health Insurance Premium Conversion Act will 
provide that the same health insurance premium conversion arrangement 
afforded to employees in the Executive and Judicial branches of the 
Federal government, be made available to Federal annuitants.
  This year, retirees under the Civil Service Retirement System 
received a 3.5 percent cost of living adjustment, and those who receive 
an annuity under the Federal Employees Retirement System received a 2.5 
percent adjustment.
  This increase in benefits is nearly offset by severe increases in 
FEHB premiums. In 2000, health premiums increased by an average of 9.3 
percent. The Office of Personnel Management reports that a similar 
increase is expected again this year.
  I am deeply concerned about increases in Federal Employee Health 
Benefit premiums in recent years. Health care coverage is provided to 
over 9 million Federal employees, retirees and their families under 
FEHBP. Ensuring affordable health care coverage for all Federal 
employees and their dependents must remain a priority for Congress.
  In addition, I am pleased that this bill will also allow uniformed 
services retiree beneficiaries, their family members and survivors to 
pay their TRICARE Prime enrollment fees and TRICARE Standard 
supplemental insurance premiums with pre-tax dollars. TRICARE Standard 
supplemental insurance premiums paid by active duty personnel are also 
covered by the legislation which allows for an above the line deduction 
to benefit active duty personnel and their families.
  This is a critical issue to many retirees, especially those living on 
a fixed income. Extending premium conversion will provide much needed 
relief from the increasing cost of health care insurance. It will help 
to ensure that more Federal retirees are able to afford continued 
coverage under the Federal Employees Health Benefits program.
  I encourage my colleagues to support this critical legislation and 
show their support of these Federal civilian and military retirees for 
their dedicated service. I ask unanimous consent that the text of the 
bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1022

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

     SECTION 1. PRETAX PAYMENT OF HEALTH INSURANCE PREMIUMS BY 
                   FEDERAL CIVILIAN AND MILITARY RETIREES.

       (a) In General.--Subsection (g) of section 125 of the 
     Internal Revenue Code of 1986 (relating to cafeteria plans) 
     is amended by adding at the end the following new paragraph:
       ``(5) Health insurance premiums of federal civilian and 
     military retirees.--
       ``(A) FEHBP premiums.--Nothing in this section shall 
     prevent the benefits of this section from being allowed to an 
     annuitant, as defined in paragraph (3) of section 8901, title 
     5, United States Code, with respect to a choice between the 
     annuity or compensation referred to such paragraph and 
     benefits under the health benefits program established by 
     chapter 89 of such title 5.
       ``(B) TRICARE premiums.--Nothing in this section shall 
     prevent the benefits of this section from being allowed to an 
     individual receiving retired or retainer pay by reason of 
     being a member or former member of the uniformed services of 
     the United States with respect to a choice between such pay 
     and benefits under the health benefits program established by 
     chapter 55 of title 10, United States Code.''
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after the date of the 
     enactment of this Act.

     SEC. 2. DEDUCTION FOR TRICARE SUPPLEMENTAL PREMIUMS.

       (a) In General.--Part VII of subchapter B of chapter 1 of 
     the Internal Revenue Code of 1986 (relating to additional 
     itemized deductions for individuals) is amended by 
     redesignating section 223 as section 224 and by inserting 
     after section 222 the following new section:

     ``SEC. 223. TRICARE SUPPLEMENTAL PREMIUMS OR ENROLLMENT FEES.

       ``(a) Allowance of Deduction.--In the case of an 
     individual, there shall be allowed as a deduction the amounts 
     paid during the taxable year by the taxpayer for insurance 
     purchased as supplemental coverage to the health benefits 
     programs established by chapter 55 of title 10, United States 
     Code, for the taxpayer and the taxpayer's spouse and 
     dependents.
       ``(b) Coordination With Medical Deduction.--Any amount 
     allowed as a deduction under subsection (a) shall not be 
     taken into account in computing the amount allowable to the 
     taxpayer as a deduction under section 213(a).''
       (b) Deduction Allowed Whether or Not Individual Itemizes 
     Other Deductions.--Subsection (a) of section 62 of such Code 
     is amended by inserting after paragraph (18) the following 
     new paragraph:
       ``(19) Tricare supplemental premiums or enrollment fees.--
     The deduction allowed by section 223.''
       (c) Clerical Amendment.--The table of sections for part VII 
     of subchapter B of chapter 1 of such Code is amended by 
     striking the last item and inserting the following new items:

``Sec. 223. TRICARE supplemental premiums or enrollment fees.
``Sec. 224. Cross reference.''

       (d) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after the date of the 
     enactment of this Act.

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