[Congressional Record Volume 148, Number 14 (Thursday, February 14, 2002)]
[Senate]
[Pages S854-S864]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. JOHNSON (for himself, Mr. Hagel, Mr. Reed, and Mr. Enzi):
  S. 1945. A bill to provide for the merger of the bank and savings 
association deposit insurance funds, to modernize and improve the 
safety and fairness of the Federal deposit insurance system, and for 
other purposes; to the Committee on Banking, Housing, and Urban 
Affairs.
  Mr. JOHNSON. Mr. President, I rise to introduce S. 1945, the Safe and 
Fair Deposit Insurance Act of 2002, together with my good friends and 
colleagues, Senator Hagel, Senator Reed and Senator Enzi. This 
important legislation would help to ensure that deposit insurance, 
which is the bedrock of our banking system, maintains its strength even 
when faced with economic weakness.
  S. 1945 is the culmination of many years of my involvement in the 
issue of deposit insurance reform. I would like to recognize the 
banking community in South Dakota for their critical role in the 
process, from explaining how elements of the current system endanger 
local banks throughout that great State, to helping to craft solutions 
that make sense to the average American depositor.
  The current deposit insurance system is dangerously pro-cyclical, and 
in a softening economy, banks are at real risk of having to absorb 
severe insurance premiums when they can least afford them. In the last 
month alone, four banks have failed, putting pressure on the insurance 
funds.
  In addition, deposit insurance coverage was last adjusted in 1980, 
and its real value has eroded over the decades. S. 1945 proposes an 
increase in coverage, and ensures that in the future, coverage keeps 
pace with inflation through periodic indexing. We also increase the 
level of coverage for our municipalities' deposits, to reduce the risk 
that a bank failure will wipe out a town's financial base, as happened 
just last week in Ohio, and also to free up much needed capital to lend 
to cash-starved communities.
  Our bill pays special attention to the needs of our retirees. We 
propose that retirement savings be covered up to $250,000, to allow our 
retirees to keep their money safe without being forced to search for a 
bank outside of their trusted communities.
  So many of our retirees have spent their lives saving to make sure 
they can remain independent in their later years, especially given some 
uncertainty about the long-term health of Social Security. Many have 
put those savings to work in a variety of investments through tax-
deferred accounts and have watched those balances mount.
  Over the last few months, however, we have been reminded that while 
equity markets can provide unparalleled opportunities for economic 
growth, those opportunities come with volatility. And while many 
younger investors have enough time to ride out ups and downs, those of 
us who are closer to retirement age have to make sure we have enough 
savings in secure investments to provide for a comfortable retirement.
  Our bill also merges the two deposit insurance funds, and gives the 
FDIC additional flexibility to manage the fund balance through regular 
insurance premiums. Since 1996, 93 percent of all insured depositories 
have paid nothing for their insurance coverage, which simply doesn't 
make sense. Under the bill, the FDIC would be permitted to resume 
premium assessments; however, they would also be required to keep the 
fund ratio within a range, with a goal of minimizing sharp swings in 
those assessments. FDIC is also charged with the task of building the 
fund up in good times, so in bad times, banks will avoid the economic 
pressure of steep charges that could precipitate a downward spiral.
  Finally, we provide a one-time assessment credit so that institutions 
that have paid their fair share into the insurance funds don't end up 
subsidizing new entrants and fast growers. The credit will also defer 
premium payments for up to several years in some cases.
  Before I close, I would like to comment on the remarkable bipartisan 
process that has allowed this bill to take shape. Partisan politics has 
no place in discussions of deposit insurance reform, which is so 
critical to America's economic foundation. Senators Hagel, Reed, Enzi 
and I have worked together on S. 1945, and I am proud of the results of 
this teamwork. This is just one more example proving that the best laws 
are those that are built on solid principles by bipartisan teams.
  Finally, I thank FDIC Chairman Don Powell for his leadership on this 
issue. He has recognized the importance of reform, and it has been a 
pleasure working with him and his talented team at the FDIC.
                                 ______
                                 
      By Mr. LOTT (for Mr. Campbell (for himself, Mr. Domenici, Mr. 
        Bingaman, and Mr. Allard)):
  S. 1946. A bill to amend the National Trails Systems Act to designate 
the Old Spanish Trail as a National Historic Trail; to the Committee on 
Energy and Natural Resources.
 Mr. CAMPBELL. Mr. President, today I am introducing 
legislation to designate the Old Spanish Trail for addition to the 
National Trails System.
  In 1995, I worked to commission a study of the Old Spanish Trail to 
assess its historic significance and determine whether it should be 
included in the National Trails System. That recently published study 
discussed the Trail in great detail, recognizing it as a benchmark of 
the Old West.
  I would like to commend the Department of the Interior and National 
Park Service's scholarship in producing the ``National Historic Trail 
Feasibility Study and Environmental Assessment'' of the Old Spanish 
Trail.
  The Old Spanish Trail has been called the ``longest, crookedest, most 
arduous pack mule route in the history of America.'' Linking two quaint 
pueblo outposts, Villa Real de Sante Fe de San Francisco, now known as 
Santa Fe, and El Pueblo de Nuestra Senora La Reina de Los Angeles, 
present day Los Angeles. This 1,200 mile route was a critical 
crossroads in trade and culture 150 years ago.
  American Indians lived for thousands of years throughout the American 
Southwest, carving out a network of trade and travel routes. The Utes, 
Paiutes, Comanches, and Navajo peoples used what was known as the Old 
Spanish Trail.
  The Old Spanish Trail played a crucial role as a crossroads for the 
diverse cultures in the West. Indian Tribes, Spaniards, Mexicans, Anglo 
settlers, including the Mormons, and other immigrants used the route 
extensively.
  The traded commodities along the Trail were as diverse as those who 
used it. The Old Spanish Trail supported the fur, mule, horse, sheep, 
and textile trades. Demand for sheep grew dramatically in California 
after the Great Gold Rush. In 1849, a gold-seeker named Roberts bought 
500 sheep in New Mexico for $250, and sold them in California for 
$8,000.
  Beyond traditional commerce, Old Spanish Trail traders also traded in 
American Indian slaves. Tribes would raid weaker tribes and sell 
captives to the Spanish, and later to the Mexicans. The Indian slave 
trade continued as late as the 1860s.

[[Page S855]]

  The trail's rich history marks important events in our nation's 
westward expansion. For example, in 1848, Lt. George B. Brewerton 
recorded his journey over the Spanish Trail and the northern branch. 
The young lieutenant accompanied a party of thirty men including the 
noted scout, Kit Carson. Carson was carrying mail from Los Angeles to 
the East Coast. The party left Los Angeles on May 4 and reached Santa 
Fe via Taos on June 14, forty-one days later. Carson proceeded east, 
reaching Washington, DC in mid-August, bringing news of the discovery 
of gold in California. Carson's news effectively fired the starting gun 
for the great gold rush.
  The study includes numerous accounts of other expeditions, 
experiences, and events marking our Nation's history. Thanks to a 
variety of public and private partnerships, we are learning more about 
the history of the Trail and the region everyday.
  In Colorado, the Bureau of Land Management has worked on documenting 
and interpreting the route with local communities, such as Mesa County 
and the City of Grand Junction. Interested private groups have sprung 
up to recognize the significance of the Trail and work to preserve it 
for generations to come. One such group, the Old Spanish Trail 
Association, founded in Colorado, studies the trail to raise the 
public's awareness of our country's diverse cultural heritage in the 
region. The association has already located wagon ruts and other 
vestiges of the trail's heyday.
  The time has come to acknowledge the national historical importance 
of the Old Spanish Trail.
  This bill designates the Old Spanish Trail for addition to the 
National Trails System to promote the recognition, protection and 
interpretation of our history in the West. By introducing this 
legislation today, we pay tribute to the cultures of the West that have 
enriched our nation and to an important period in American history.
  I urge my colleagues to support swift passage of this legislation.
  I ask that the text of the bill be printed in the Record.
  The bill is as follows:

                                S. 1946

       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 ``Old Spanish Trail 
     Recognition Act of 2002''.

     SEC. 2. AUTHORIZATION AND ADMINISTRATION.

       Section 5(a) of the National Trails System Act (16 U.S.C. 
     1244(a)) is amended--
       (1) by redesignating the second paragraph (21) as paragraph 
     (22); and
       (2) by adding at the end the following:
       ``(23) Old spanish national historic trail.--
       ``(A) In general.--The Old Spanish National Historic Trail, 
     an approximately 3,500 mile long trail extending from Santa 
     Fe, New Mexico, to Los Angeles, California, that served as a 
     major trade route between 1829 and 1848, as generally 
     depicted on the map contained in the report prepared under 
     subsection (b) entitled ``Old Spanish Trail National Historic 
     Trail Feasibility Study'', dated July 2001.
       ``(B) Map.--A map generally depicting the trail shall be on 
     file and available for public inspection in the office of the 
     Director of the National Park Service.
       ``(C) Administration.--The trail shall be administered by 
     the Secretary of the Interior, acting through the Director of 
     the National Park Service (referred to in this paragraph as 
     the `Secretary').
       ``(D) Land acquisition.--The United States shall not 
     acquire for the trail any land or interest in land outside 
     the exterior boundary of any federally-managed area without 
     the consent of the owner of the land or interest in land.
       ``(E) Consultation.--The Secretary shall consult with other 
     Federal, State, local, and tribal agencies in the 
     administration of the trail.
       ``(F) Additional routes.--The Secretary may designate 
     additional routes to the trail if--
       ``(i) the additional routes were included in the Old 
     Spanish Trail National Historic Trail Feasibility Study, but 
     were not recommended for designation as a national historic 
     trail; and
       ``(ii) the Secretary determines that the additional routes 
     were used for trade and commerce between 1829 and 1848.''.

  Mr. DOMENICI. Mr. President, last year I introduced a bill that would 
have designated the Old Spanish Trail as a National Historic Trail. 
When I introduced that bill, we were waiting for the Administration to 
complete its work on a final study. Additionally, Senator Campbell 
wrote a personal note to me asking that I work with him on a new bill 
that incorporates the new study. Today, we introduce that bill. As with 
my original bill this legislation will amend the National Trails System 
Act and designate the Old Spanish Trail; which originates in Santa Fe, 
New Mexico and continues to Los Angeles, California as a National 
Historic Trail.
  Today, more than 150 years after the first settlers embarked on their 
western journeys via the Old Spanish Trail, we honor its historic 
significance and recognize its importance to our past, present and 
future. I am proud to introduce legislation that will help preserve the 
route of the trail--much of which has remained relatively unchanged 
since the trail period.
  The United States of America has a rich history and an exciting part 
of that is the movement of civilization westward. Citizens who settled 
in the West came from all walks of life and have deep rooted cultural 
and historic ties to land throughout the west. Since 1829, The Old 
Spanish Trail has served many, from trade caravans to military 
expeditions. For twenty plus years the Old Spanish Trail was used as a 
main route of travel between New Mexico and California.
  The Old Spanish Trail is also a vital part of Native American 
history. We know that numerous Indian pueblos were situated along the 
Old Spanish Trail serving as trading forums for the trail's many 
travelers. The majority of these pueblos are still occupied by 
descendants whose ancestors contributed to the labor and goods that 
constituted commerce on the Old Spanish Trail.
  The Old Spanish Trail is a symbol of cultural interaction between 
various ethnic groups and nations. Further, it is a symbol of the 
commercial exchange that made development and growth popular, not only 
in the West, but throughout the country.
  The National Trails System was established by the National Trails 
System Act of 1968 ``to promote the preservation of, public access to, 
travel within, and enjoyment and appreciation of the open air, outdoor 
areas and historic resources of the Nation.'' Designating the Old 
Spanish Trail as a National Historic Trail would allow for just what 
the act has intended, preservation, access, enjoyment and appreciation 
of the historic resources of our Nation.
  The Old Spanish Trail has been significant in many respects to many 
different people and its rich history is something that should be 
included in our National Trails System. The intent of this legislation 
is to protect this historic route and its historic remnants for public 
use and enjoyment indefinitely.
                                 ______
                                 
      By Mrs. CARNAHAN:
  S. 1947. A bill to amend title XIX of the Social Security Act to 
clarify the circumstances under which a hold harmless provision does 
not exist with respect to a broad-based health care related tax; to the 
Committee on Finance.
  Mrs. CARNAHAN. Mr. President, in late October, I came to the Senate 
floor to address a dispute between the state of Missouri and the Health 
Care Financing Agency, now known as the Centers for Medicare and 
Medicaid Services, or CMS. I felt compelled to discuss the matter 
because of what was at stake, the future of Missouri's Medicaid 
program.
  Medicaid is a partnership between the Federal Government and the 
States to provide healthcare services to our most vulnerable citizens--
low-income children and seniors. Unfortunately, the Federal partner, 
CMS, is behaving irresponsibly.
  Since I last spoke about this issue on the Senate floor, CMS 
Administrator Tom Scully escalated the dispute to an unprecedented 
level. Not only unprecedented, but dangerous.
  On November 29, he sent a harshly toned letter to Governor Holden 
that called Missouri's tax on hospitals illegal and threatened to 
withhold $1.6 billion from the State.
  I am here today to call attention to an agency that is out of 
control. At a time when States are struggling to maintain service due 
to the recession, this agency has threatened to devastate Missouri's 
health care safety net. At a time when States and the Federal 
Government should be working for the common good, CMS is ignoring its 
own laws and regulations.

[[Page S856]]

  After our delegation appealed to top Administration officials, 
finally negotiations began on a long-term solution to the Medicaid 
funding issue. But just this weekend, reports emerged that CMS expects 
to pressure Missouri into accepting changes to the program due to its 
threatened legal action. I am all in favor of negotiations. But I want 
a bargaining table to be completely level. Our State should be free to 
act in the best interest of Missouri's citizens without a $1.6 billion 
lawsuit hanging over its head. That is why I am also introducing 
legislation today that seeks to put an end to this dispute once and for 
all.
  Governor Holden has stated that one of his top Federal priorities is 
to clarify that Missouri's provider tax is fully consistent with 
Federal law. That is what my bill does.
  Before I explain my legislative proposal, I want to describe the 
events that have brought us to this point in time. The subject of the 
disagreement is Missouri's provider assessment program, which is a tax 
on hospitals. States use the money generated from these taxes as their 
``match'' for Federal Medicaid dollars. Over ten years ago, Congress 
became concerned that States were using provider taxes improperly to 
increase the Federal contributions to Medicaid programs. In response, 
Congress enacted a law in 1992 that placed limitations on provider 
assessment programs.
  One specific limitation is that a provider assessment must not 
contain a ``hold harmless'' provision. This means that States may not 
guarantee that a hospital will receive back from Medicaid the amount of 
funds it paid to the State in provider taxes.
  In 1992, under the leadership of Governor John Ashcroft, now the 
Attorney General, Missouri complied with the federal law by enacting 
the Federal Reimbursement Allowance Program law. This law created a tax 
on hospitals, but contained no ``hold harmless'' provision. Governor 
Ashcroft signed the bill into law. Governor Carnahan continued the 
program, and Governor Holder is continuing it.
  For almost a decade, the program has been operating under the 
auspices of HCFA, now CMS. During this time, 100 percent of the 
revenues generated by the tax have been dedicated to Missouri's 
Medicaid program. The program has made Missouri a national model for 
using Federal, State, and private resources to provide health care to 
as many needy citizens as possible. This long-standing legal tax has 
assisted Missouri in creating a strong healthcare safety net for its 
children, pregnant women, and most vulnerable seniors.
  Much of Missouri's success can be attributed to expanded enrollment 
of eligible citizens in Medicaid. During the 1990's, the number of 
Missourians covered by Medicaid more than doubled, increasing from 
364,000 in 1990 to 839,000 in 2001. The number of children enrolled in 
Medicaid has grown at an even faster rate, increasing from 180,000 in 
1990 to 474,000 in 2001.
  An important step in covering more children was the enactment of the 
state's Children's Health Insurance Program, also known as MC Plus. 
Under the leadership of Governor Carnahan, MC Plus was designed to 
cover children up to 300 percent of the poverty level. It is a national 
model. Due to MC Plus, uninsured working parents could secure this 
previous health coverage for their children. The MC Plus program has 
made a difference in the lives of 75,000 children in Missouri.
  This combination of initiatives has sharply reduced the number of 
Missouri citizens that lack health insurance. In 1999, Missouri had the 
fourth lowest percentage of uninsured citizens in the country.
  These tremendous accomplishments, however, could be completely 
undermined because of a bureaucratic crusade to overturn Missouri's 
provider tax, a crusade that is not based on law.
  Let me explain. The letter CMS Administrator Scully sent to Missouri 
on November 29 was significant for several reasons.
  First, it was the first formal declaration from CMS that the agency 
found Missouri's State provider tax impermissible.
  Second, the letter included a draft audit that outlined the agency's 
case and claimed that it would seek to take back $1.6 billion from the 
State.
  Third, the letter opens the door for CMS to actually try to take back 
the money.
  Until this the draft audit was sent, CMS had only threatened action 
against the state. Now, this letter has made it abundantly clear that 
the CMS case is based on a flawed legal theory.
  The Federal statute says that there is a hold harmless provision with 
respect to the provider tax if the Secretary can determine that, and I 
quote from the statute: ``The State or other unit of government 
improving the tax providers--directly or indirectly--for any payment, 
offset, or waiver that guarantees to hold taxpayers harmless for any 
portion of the costs of the tax.''
  In the draft audit, Mr. Scully asserts that Missouri indirectly holds 
hospitals harmless. This leads one to ask the question, how is an 
``indirect guarantee'' defined under the law? The answer exists, but 
unfortunately Mr. Scully's letter does not include it. You can find the 
answer in the Federal regulations that govern how the Federal provider 
tax law should be implemented.
  On September 13, 1993, almost ten years ago, the U.S. Department of 
Health and Human Services issued final regulations for the new law. The 
regulations established an objective test to determine whether a 
government had an indirect guarantee. The regulations provide that if 
the tax on health care providers is less than 6 percent of the 
taxpayer's revenues, ``the tax or taxes are permissible.''
  Missouri's provider tax on hospitals has always been less than 6 
percent. Case closed.
  The bill that I am introducing today essentially codifies this 
regulation into law. If CMS were willing to abide by its own 
regulations, then this bill would not be necessary. But I am concerned 
from the actions the agency has taken and its responses to my inquiries 
on the subject, that CMS is pursuing an ideological agenda, not fair 
even-handed enforcement of the law.
  There is nothing wrong with the State law former Governor Ashcroft 
signed a decade ago. There has been no ``indirect guarantees'' to 
anyone. CMS should back off and allow Missouri to do what it has been 
doing well for over a decade, providing healthcare to its citizens.
  I encourage my colleagues to take a close look at my bill and support 
its passage.
                                 ______
                                 
      By Ms. COLLINS (for herself, Mr. Feingold, Mr. Kohl, and Mr. 
        Dayton):
  S. 1948. A bill to establish demonstration projects under the 
Medicare program under title XVIII of the Social Security Act to reward 
and expand the number of health care providers delivering high-quality, 
cost-effective health care to Medicare beneficiaries; to the Committee 
on Finance.
  Ms. COLLINS. Mr. President, I am pleased to join my colleague and 
dear friend from Wisconsin, Senator Feingold, in introducing a 
``Medicare Fairness'' package of bills that will ensure that the 
Medicare system rewards rather than punishes states like Maine and 
Wisconsin that deliver high-quality, cost-effective Medicare services 
to our elderly and disabled citizens.
  The good people of Maine pay the same payroll taxes to Medicare, and 
our seniors pay the same premiums, deductibles and copayments as 
Medicare beneficiaries in other parts of the country. Yet Maine's 
patients, physicians, hospitals and other providers receive far less 
from the program in return when it comes to Medicare payments.
  According to a recent study published in the Journal of the American 
Medical Association, Maine ranks third in the Nation when it comes to 
the quality of care delivered to our Medicare beneficiaries. Yet we are 
11th from the bottom when it comes to per-beneficiary Medicare 
spending.
  The fact is that Maine's Medicare dollars are being used to subsidize 
higher reimbursements in other parts of the country. Maine's Medicare 
patients receive, on average, $3,856 worth of Medicare services per 
year, far below the national average of $5,034. By way of contrast, in 
the District of Columbia, Medicare patients receive about $15,620 in 
Medicare payments a year. Moreover, these dramatically higher payments 
have not bought any better

[[Page S857]]

care for the District's Medicare beneficiaries. According to the 
Journal of the American Medical Association, the District is ranked 
34th out of 52, in the bottom third, when it comes to quality.
  This simply is not fair. Medicare's reimbursement systems have 
historically tended to favor urban areas and failed to take the 
special needs of rural States into account. Ironically, Maine's low 
payment rates are also the result of its long history of providing 
high-quality, cost-effective care. In the early 1980s, Maine's lower 
than average costs were used to justify lower payment rates. Since 
then, Medicare's payment policies have only served to widen the gap 
between low and high-cost states.

  As a consequence, Maine's hospitals, physicians and other providers 
have experienced a serious Medicare shortfall, which has forced them to 
shift costs on to other payers in the form of higher charges. This 
Medicare shortfall is one of the reasons that Maine has among the 
highest health insurance premiums in the nation. Small businesses, for 
example, are facing increases of 20 to 30 percent, jeopardizing their 
ability to provide coverage for their employees.
  Moreover, the fact that Medicare underpays our hospitals and nursing 
facilities has significantly handicapped Maine's providers as they 
compete for nurses and other health care professionals in an 
increasingly tight labor market.
  As a recent study by Dr. John Wennberg of the Dartmouth Medical 
School points out, more Medicare spending does not necessarily buy 
better quality health care. According to the Dartmouth study, Medicare 
beneficiaries in high-cost states don't live any longer or enjoy better 
quality care. High cost states simply provide more care. They rely on 
inpatient and specialist care more than outpatient and primary care, 
and they tend to treat the chronically ill and those near death much 
more aggressively, with possible adverse effects on their quality of 
life. According to the Dartmouth study, this pattern of practice is 
driven not by medical evidence, but instead by community practice 
patterns and the availability of hospital beds.
  The legislative package we are introducing today will reform the 
current Medicare reimbursement system by reducing regional inequities 
in Medicare spending and providing incentives to hospitals and 
physicians to encourage the delivery of high-quality, cost-effective 
care.
  The first bill, the Physician Wage Fairness Act of 2001, will promote 
fairness in Medicare payments to physicians and other health 
professionals by eliminating the outdated geographic physician work 
adjustor in the physician fee schedule that has resulted in a 
significant differential in payment levels to urban and rural health 
care providers.
  We are concerned that the current formula does not accurately measure 
the cost of providing services. As a consequence, Medicare pays rural 
providers far less than it should for equal work. We also don't think 
that it makes sense to pay physicians more for their work in areas like 
New York City, which tend to have an oversupply of physicians, and pay 
physicians less for the same services in areas that are more likely to 
experience shortages. Eliminating the georgraphic physician work 
adjustor will bring an estimated $1 million a year in Medicare payments 
to physicians and other providers in Southern Maine and $3 million more 
to providers in the rest of Maine.

  The second bill, the Medicare Value and Quality Demonstration Act of 
2002, will authorize a series of demonstration programs to encourage 
high-quality, low-cost health care to Medicare beneficiaries. These 
programs would reward hospitals and physicians who deliver high quality 
care at a lower cost. It would also require that the states chosen for 
the pilot projects create a plan to increase the number of providers 
who deliver high-quality, cost-effective care to Medicare 
beneficiaries.
  A third bill, the Graduate Medical Education Demonstration Act, will 
allow the Secretary of Health and Human Services to use existing 
Graduate Medical Education funds to create a program to encourage 
hospitals in underserved areas to host clinical rotations to encourage 
more medical students to practice in these areas when they graduate.
  And finally, the Skilled Nursing Facility Wage Information 
Improvement Act will promote fairness in Medicare payments to nursing 
homes by collecting and using accurate nursing home wage data rather 
than, as is the current practice, using the inaccurate hospital wage 
data that discriminates against States like Maine.
  As Congress works to modernize Medicare, we must also restore basic 
fairness to the program and find ways to reward, rather than penalize, 
providers of high-quality, cost-effective care. This is what our 
legislation will do, and I encourage all of our colleagues to join us 
as cosponsors.
                                 ______
                                 
      By Mr. FRIST (for himself, Mr. Dodd, Mr. Hutchinson, Mr. 
        Jeffords, and Mr. Enzi):
  S. 1949. A bill to amend the Public Health Service Act to promote 
organ donation, and for other purposes; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. FRIST. Mr. President, on this Valentine's Day, National Donor 
Day, I rise to speak on the critical issue of organ donation. It is 
with great pleasure that I join with my colleagues Senators Dodd, 
Hutchinson, Jeffords, and Enzi to introduce the Organ Donation and 
Recovery Improvement Act.
  This far-reaching, comprehensive legislation includes a number of new 
steps intended to improve organ donation and recovery efforts 
nationwide and increase the number of organs available for transplants 
each year. This legislation is further complemented by a resolution 
that I, and a number of my colleagues are introducing today to 
commemorate today as National Donor Day and call attention to the 
important issue of organ donation.
  This year, more than twenty-two thousand Americans will receive an 
organ transplant. This is due to the rapid and tremendous advancements 
in our knowledge and in the science of organ transplantation. As a 
heart and lung transplant surgeon before coming to the Senate, I have 
had the opportunity to watch the field develop tremendously over the 
past three decades. I remember my own experiences, of conducting some 
of the first transplants using hearts and lungs, and know the 
tremendous progress that has been made since that time. And I know the 
hundreds of my own patients who have benefitted from improved lives due 
to advances in transplantation.
  Advances in our knowledge and the science have allowed us to 
transplant individuals who were once not considered candidates. But 
such advances have meant a staggering increase in the number of 
patients waiting for a transplant, while the number of donated organs 
has failed to keep pace. In fact, there are almost 80,000 patients 
waiting for a transplant today, a four-fold increase from just over a 
decade ago. Many of them may die before they can receive a transplant.
  More needs to be done. We must look for other ways to improve organ 
donation, to identify eligible organs and work with families to help 
them better understand the value of donation.
  Secretary Thompson already has made great progress in this area. I 
commend him for making organ donation a top priority at the Department 
of Health and Human Services. His initiative holds great promise. In 
particular, I applaud his call to recognize donor families through a 
medal of honor, something I have long supported through my own 
legislation, the Gift of Life Congressional Medal Act. I also welcome 
the Secretary's commitment to more closely scrutinize the role that 
organ donor registries play in the donation process.
  The legislation I am introducing today builds on these efforts 
through a broad range of initiatives intended to improve organ donation 
and recovery, enhance our knowledge base in these fields, and encourage 
novel approaches to this growing problem.
  The Organ Donation and Recovery Improvement Act is designed to 
improve the overall process of organ donation and recovery. The bill 
also seeks to remove potential barriers to donation, while identifying 
and focusing on best practices in organ donation.
  Let me briefly highlight a few key provisions of the legislation. 
First, the bill establishes a grant program for demonstration projects 
intended to improve donation and recovery rates and

[[Page S858]]

ensures that the projects' results will be evaluated quickly and 
disseminated broadly. The bill also provides for the placement and 
evaluation of organ donation coordinators in hospitals, a model that 
has worked with success in other countries.
  In addition, the legislation expands the authority of the Agency for 
Healthcare Research and Quality to conduct important research, 
including research on the recovery, preservation and transportation of 
organs and tissues. As we all know, the science of organ 
transplantation has been improved and refined over and over again since 
its inception. Yet all too often organ donation efforts are conducted 
under the same conditions and understandings as they were twenty years 
ago. This must change, and the legislation Senator Dodd and I are 
introducing today will help establish a strong evidence-based approach 
to enhance organ donation and recovery and improving our understanding 
of this process.
  The bill also includes several important provisions affecting living 
organ donation. First, it attempts to reduce potential financial 
disincentives toward serving as a living donor by allowing for the 
reimbursement of travel and other expenses incurred by living donors 
and their families.
  Importantly, the bill also takes steps towards evaluating the long-
term health effects of serving as a living donor by asking the 
Institute of Medicine to report on this issue, as well as through the 
establishment of a living donor registry intended to track the health 
of individuals who have served as living organ donors. There remain 
important questions surrounding how this registry should be structured, 
and I look forward to working with my colleagues and the experts in the 
field to finalize the details before any legislation is enacted.
  Finally, I would like to address the issue of prospective organ donor 
registries. I am supportive of donor registries and feel they have an 
important role to play in improving organ donation rates. Moreover, I 
am pleased by the actions taken by some states to establish and enhance 
such registries. However, I am concerned that too great a focus has 
been placed on registries at a time when a number of questions 
surrounding registries remain unanswered and their effectiveness has 
not been fully evaluated. Therefore, the bill establishes an advisory 
committee to study this question and to report to Congress on the 
usefulness and success of organ donor registries and potential roles 
for the federal government to play in encouraging and improving such 
programs.
  The Frist-Dodd Organ Donation and Recovery Improvement Act is 
supported by a wide range of patient and organ transplantation 
organizations. I am pleased that the bill is supported by the American 
Society of Transplantation, National Kidney Foundation, American Liver 
Foundation, North American Transplant Coordinators Organization, 
Patient Access to Transplantation Coalition, TN Donor Services, New 
Mexico Donor Services, and Golden State Donor Services. I thank them 
for their hard work and dedication to this issue.
  Organ donation is one of the most important issues before us today. 
Each year, thousands of donors and families make the important decision 
to give consent and give the gift of life. We must recognize and honor 
their sacrifice, and, in so honoring, work to increase donation rates 
and allow more families to receive this gift of life each year. 
Hundreds of my own patients are alive today because of this gift. Let 
us work together to allow more patients and families to experience this 
miracle.
  I thank Senators Dodd, Hutchinson, Jeffords and Enzi for joining me 
in this effort, and look forward to working with them and my other 
colleagues to pass this important legislation this year.
  Mr. DODD. Mr. President, most of us know February 14 as Valentine's 
Day, but for the past few years, it has shared that date with another 
vitally important, and unfortunately less well-known, event: National 
Donor Day.
  Thanks to the selflessness of thousands, February 14 has become our 
Nation's largest one-day donation event. On a day that celebrates 
giving the gift of life, we should make a commitment to increasing our 
donation rates and saving even more lives.
  Today, I am pleased to introduce legislation with Senator Bill Frist 
to do just that. The Organ Donation and Recovery Improvement Act will 
bring attention to this critical public health issue by increasing 
resources and coordinating efforts to improve organ donation and 
recovery. I am proud to be working with my friend and colleague, 
Senator Frist, whose leadership and professional experience as a heart 
and lung transplant surgeon has been critical in making this issue a 
priority.
  At this very moment, more than 80,000 people are waiting for an organ 
transplant, and one person is added to this list every thirteen 
minutes. This has increased from 19,095 people on waiting lists a 
decade ago. Unfortunately, the discrepancy between the need and the 
number of available of organs is growing exponentially. From 1999 to 
2000 transplant waiting list grew by 10.2 percent, while the total 
increase in donation grew by 5.3 percent. Tragically, in 2000, 
approximately 5,500 wait-listed patients died waiting for an organ.
  Undoubtedly, the task before us seems daunting. However, each person 
who makes the decision to donate can save as many as three lives. These 
are our mothers, fathers, brothers, sisters, friends. None of us wants 
to imagine the anguish of watching a family member or a friend wait for 
an organ transplant hoping that their name reaches the top of the list 
before their damaged organ fails or having to bear the emotional, 
physical, or financial costs of undergoing a transplant procedure. For 
those that do, and for all of those that will, we must improve and 
strengthen our systems of organ donation and recovery. We must also 
work to remove the barriers that stand in a donor's way as he or she 
seeks to help another person continue life. States need the resources 
to determine for themselves how best to increase donations and a vital 
part of increasing donations lies in education and public awareness 
initiatives.
  We must work to improve the science of donation and recovery and 
address legal issues relating to donation, including consent. More than 
20 states currently have registries that may prove indispensable in 
ensuring that we honor a donor's wishes. We should study the benefits, 
and potential shortcomings, of these arrangements and work to create a 
national sense of urgency that matches the national need for donors.
  I would like to recognize the invaluable support and guidance we 
received, in drafting this bill, from the American Society of 
Transplantation, the American Liver Foundation, the Patient Access to 
Transplantation Coalition, North American Transplant Coordinators 
Organization, and the National Kidney Foundation. I would be remiss not 
to mention the Association of Organ Procurement Organizations and the 
OPOs nationwide that have worked so tirelessly to bridge the gap 
between the immense need and the inadequate supply. In my home state of 
Connecticut, we are well served by the tremendous work of the Northeast 
Organ Procurement Organization and the New England Donor Bank.
  Finally, I look forward to working with my colleagues, including 
Senator Kennedy, Senator Gregg and Senator Durbin, whose commitment to 
this issue has been unparalleled. I urge Congress to take swift action 
on bipartisan legislation aimed at increasing organ donation and saving 
lives.
  Mr. JEFFORDS. Mr. President, today, Valentine's Day, provides a 
wonderful opportunity for me to offer my support for the Organ Donation 
and Recovery Improvement Act. I commend my colleagues, Senator Frist of 
Tennessee and Senator Dodd of Connecticut, for their leadership and 
commitment to this important issue. Organ transplantation provides 
perhaps the clearest example where scientific research has been 
translated and applied to modern medicine. Not too many years ago organ 
transplantation was associated with inconsistent success and numerous 
complications. Today these procedures have advanced to the point where 
success is commonplace. Not only the duration of life, but the quality 
of life, is improved.
  I have carried an organ donor card in my wallet for more than twenty-
five years, and I am a long-time organ donation supporter. In my home 
State of

[[Page S859]]

Vermont, Representative Johannah Donovan has introduced a bill to allow 
for the creation of a donor registry through the Department of Motor 
Vehicles. It is an excellent example of trying to make the organ donor 
process easier and more efficient. So, I am proud to join my colleagues 
as an original sponsor in this effort to increase organ donation at the 
national level. Even though great strides have been made in organ 
procurement and distribution, problems remain, and those issues are 
addressed by this legislation. This proposal would establish a federal 
inter-agency task force to coordinate organ donation efforts and 
transplant research; expand the Federal organ-donation grant authority 
and provide funds to educate lay professionals in issues surrounding 
organ donation; expand the Agency for Healthcare Research and Quality 
authority to review and improve organ recovery, preservation, and 
transplantation; provide for two important Institute of Medicine 
studies to review and document issues associated with live organ 
donation; and establish an advisory committee to make recommendations 
regarding costs, benefits, expansion, availability, and other issues 
involving transplantation.
  In Vermont, we are fortunate to have Fletcher Allen Medical Center. 
This state-of-the-art institution provides quality transplantation 
services to the residents of my state and surrounding areas. However, 
despite a wonderful facility and a well-trained and experienced staff 
of health professionals, Fletcher Allen is limited, like all similar 
institutions, by the high demand for donor organs and the limited 
supply. This legislation will move us closer to the day when all 
individuals who would benefit from transplantation are able to receive 
appropriate care in a timely manner. I urge all of my colleagues to 
join me in supporting this important legislation.
                                 ______
                                 
      By Mrs. FEINSTEIN (for herself, Ms. Cantwell, Mr. Wyden, and Mrs. 
        Boxer):
  S. 1951. A bill to provide regulatory oversight over energy trading 
markets, and for other purposes; to the Committee on Agriculture, 
Nutrition, and Forestry.
  Mrs. FEINSTEIN. Mr. President, I am pleased to introduce this bill 
today with Senators Cantwell and Wyden to make sure that all energy 
transactions are transparent and subject to regulatory oversight. With 
passage of this legislation, we can reinstate regulatory oversight to 
the marketplace and help ensure there is not a repeat of the energy 
crisis that had such a devastating impact on California and the West.
  The Enron bankruptcy has uncovered many gaping holes in our 
regulatory structure, everything from accounting and investment 
practices to on-line energy transactions. Congress must take a look at 
all of this. The bill we are introducing today is a first step. The 
exemptions and exclusions to the 2000 Commodity Futures Modernization 
Act essentially gave EnronOnline, and the entire energy sector, the 
ability to operate a bilateral electronic trading forum absent any 
regulatory oversight or price transparency.
  Let me give you an example of what that lack of transparency meant to 
California: On December 12, 2000, the price of natural gas on the spot 
market was $59 in southern California while it was $10 in nearby San 
Juan, NM. We know it costs less than $1 to transport gas from New 
Mexico to California because this was the cost when these 
transportation routes were transparent and regulated. So there was $48 
unaccounted for that undoubtedly found its way into someone's pocket.
  This problem lasted from November, 2000 to April, 2001, and all this 
time no one knew where all this money was going. The Senate Energy 
Committee looked at this issue last year but was not able to piece 
together all of what happened. In the wake of Enron's bankruptcy, 
however, we are beginning to learn a lot more. By controlling a 
significant number of energy transactions affecting California, some 
traders estimate that Enron controlled up to 50-70 percent of the 
natural gas transactions into southern California, and by trading in 
secret, Enron had the unique ability to manipulate prices and gouge 
customers. And the consumes, particularly those in California, 
ultimately bore the brunt of the costs. In fact, through the course of 
the crisis in California, the total cost of electricity soared from $7 
billion in 1999 to $27 billion in 2000 and $26.7 billion in 2001.
  A market does not function properly without transparency. 
Additionally, regulators need the authority and the tools to step in 
and do their jobs when markets have gone awry. This bill, then, is 
intended to close the regulatory loopholes that allowed EnronOnline to 
operate unregulated trading markets in secret. The Commodity Futures 
Modernization Act provided a regulatory exemption for bilateral 
transactions between sophisticated parties in nonagriculturual and 
nonfinancial commodities. This exclusion includes energy products and 
electronic trading forums. Because many of the EnronOnline transactions 
did not involve physical delivery, there was also no oversight by the 
Federal Energy Regulatory Commission. In determining which agency, FERC 
or the CFTC should have the proper authority, we are faced with two 
challenges: 1. FERC does not have the necessary expertise in derivative 
transactions; and 2. CFTC does not have the necessary expertise to 
protect consumers from out-of-control energy prices.
  This bill tries to utilize the unique talents of each agency.
  In summary, our legislation: 1. Repeals exemptions and exclusions 
provided for by the Commodity Futures Modernization Act of 2000; 2. 
ensures that energy dealers in derivatives markets (such as 
EnronOnline) cannot escape federal regulation; 3. makes sure that all 
multilateral markets and dealer markets in energy commodities are 
subject to registration, transparency, disclosure and reporting 
obligations; 4. gives FERC regulatory oversight authority over 
bilateral transactions not subject to CFTC oversight. Although CFTC 
would have antimanipulation authority over these transactions; 5. 
expands FERC jurisdiction to include derivatives transactions, which 
are defined to include transactions based on the cost of electricity or 
natural gas and include futures, options, forwards and swaps unless 
such transactions are under the jurisdiction of the CFTC or the state; 
and 6. Ensures that entities running on-line trading forums must 
maintain sufficient capital to carry out its operations and maintain 
open books and records for investigation and enforcement purposes.

  This last point is also very important. Enron saw its future as a 
``virtual'' company. As such it sold off many of its physical assets 
over the past few years. Investors lost confidence in Enron's ability 
to back up its trades since Enron did not have enough assets to back up 
its trades. This was a contributing factor in Enron's final spiral into 
bankruptcy.
  Energy trading has gotten extremely arcane and complex over the last 
three decades. Very few people fully understand how swaps and other 
derivatives actually work. Without adequate transparency, regulatory 
oversight, and a regulatory agency willing to do its job, the 
likelihood is that consumers will pay the price. This is what happened 
in the California Energy Crisis and has happened with Enron. It would 
be unconscionable not to do everything we can to prevent the same thing 
from happening again.
                                 ______
                                 
      By Mrs. BOXER (for herself, Ms. Landrieu, Mrs. Feinstein, and Mr. 
        Breaux):
  S. 1952. A bill to reacquire and permanently protect certain leases 
on the Outer Continental Shelf off the coast of California by issuing 
credits for new energy production in less environmentally sensitive 
areas in the Western and Central Planning Areas of the Gulf of Mexico; 
to the Committee on Energy and Natural Resources.
  Mrs. BOXER. Mr. President, for decades, Californians have opposed oil 
and gas drilling along their coasts. Nothing sharpened this concern 
more than the horrific tanker spill that occurred off the coast of 
Santa Barbara in 1969. Californians are still living with the 
ecological implications of that spill and the myriad other spills and 
leaks associated with the rigs that are currently along our coast.
  Unfortunately, 36 more leases off our coast remain eligible for oil 
and gas development and four additional leases remain in legal limbo.
  That is the last thing Californians want or need.

[[Page S860]]

  California is now in a pitched legal battle with the Department of 
Interior over whether the State has the ability to deny these leases. I 
strongly support the State in this effort and have joined 
Representative Capps in filing an amicus brief in the case.
  Every State should have the right to deny oil and gas development off 
their shores, as offshore activities inevitably impact the people and 
resources that are onshore. Last year, I reintroduced legislation, the 
Coastal States Protection Act, to place a moratorium on new drilling 
leases in Federal waters that are adjacent to State waters that have a 
drilling moratorium. That bill, however, addresses only the issue of 
future leases.
  With regard to the existing leases off of California's coast, I am 
not completely confident that the courts will solve the problem. We 
must therefore act now to eliminate the threat, the threat to 
California's natural resources and the threat to our economy through 
losses in the tourism and fishing industries.
  It is for this reason that I am proud to introduce today with my 
colleague Senator Landrieu, the California Coastal Protection and 
Louisiana Energy Enhancement Act.
  Our bill would end the seemingly endless battle over the California 
leases and would permanently protect those areas from oil, gas, and 
mineral development.
  Here's how it would work. Within 30 days of enactment, the Secretary 
of Interior would provide the oil companies holding the 40 California 
leases with a swap of equivalent value in the Gulf of Mexico. If all of 
the companies holding the California leases agree to this offer and 
agree to drop all pending litigation regarding those leases, then the 
California leases will be canceled, and the lessees will receive a 
credit equal to the amount paid for the leases plus the amount already 
spent to develop them.
  These credits could be used only in the central and western Gulf, an 
area already open to drilling and open to further leasing. They could 
be used for bidding on new leases in that area or to pay royalty 
payments for existing drilling activities in that area.
  The 40 tracts off of California's coast would then be converted to an 
ecological preserve, thus permanently protecting the areas from future 
mineral leasing and development. The tracts would be managed for the 
protection of traditional fishing activities as well as conservation, 
scientific, and recreational benefits.
  I am very proud of this legislation, and this very promising proposal 
to end the imminent threat of additional drilling off California's 
coast. We have been very careful to make sure that these credits are 
designed in a way that will not promote new drilling in environmentally 
sensitive areas. Instead, these credits can only be used in non-
controversial areas that have already been set aside for future 
development.
  We have also been very careful to ensure that the Federal Government, 
and in turn, the Federal taxpayer are protected from any future claims 
by these companies regarding these leases.
  And, I am very pleased to say that we have worked to ensure that the 
40 California tracts will never again be threatened by offshore 
development.
  In short, we get rid of unwanted drilling in California and 
permanently protect these sensitive areas. The oil companies are freed 
from a protracted legal battle and allowed to take their business 
elsewhere. And, the Federal Government is protected from expensive 
litigation that the companies are currently pursuing.
  I believe that we have hit upon the proverbial win-win situation. And 
I look forward to having this bill became a reality soon.
                                 ______
                                 
      By Mr. FEINGOLD (for himself, Ms. Collins, Mr. Kohl, and Mr. 
        Dayton):
  S. 1953. A bill to amend title XVIII of the Social Security Act to 
eliminate the geographic physician work adjustment factor from the 
geographic indices used to adjust payments under the physician fee 
schedule; to the Committee on Finance.
                                 ______
                                 
      By Mr. FEINGOLD (for himself, Ms. Collins, Mr. Kohl, and Mr. 
        Dayton):
  S. 1954. A bill to establish a demonstration project under the 
Medicare program under title XVIII of the Social Security Act to 
provide the incentives necessary to attract educators and clinical 
practitioners to underserved areas; to the Committee on Finance.
                                 ______
                                 
      By Mr. FEINGOLD (for himself, Ms. Collins, Mr. Kohl, and Mr. 
        Dayton):
  S. 1955. A bill to amend title XVIII of the Social Security Act to 
require that the area wage adjustment under the prospective payment 
system for skilled nursing facility services be based on the wages of 
individual's employed at skilled nursing facilities; to the Committee 
on Finance.
  Mr. FEINGOLD. Mr. President, I rise today to join with my colleague 
from Maine to introduce legislation to restore fairness to the Medicare 
program. This package of legislation will reduce regional inequalities 
in Medicare spending and support providers of high-quality, low-cost 
Medicare services.
  Just about a month ago, I met with representatives of Wisconsin's 
hospitals, doctors, and seniors, who spoke passionately about how 
Medicare inequities have a real and serious impact on the lives of 
Wisconsin seniors, and on health care providers in my State. Wisconsin 
seniors and providers came to me with these concerns, and this 
legislation is a direct result of their advocacy. I thank them for 
their efforts.
  I also want to thank my colleague from Maine, who has joined me on a 
number of health care initiatives that address the mutual concerns of 
our constituents. I am grateful for her efforts on health care issues 
that concern both of our States, such as home health care, access to 
emergency services, and this legislation on Medicare fairness.
  The Medicare program should encourage the kind of high-quality, cost-
effective Medicare services that we have in Wisconsin and Maine. But 
unfortunately, that's not the case.
  To give an idea of how inequitable the distribution of Medicare 
dollars is, imagine identical twins over the age of 65. Both twins 
worked at the same company all their lives, at the same salary, and 
paid the same amount to the Federal Government in payroll taxes, the 
tax that goes into the Medicare Trust Fund. But if one twin retired to 
another part of the country and the other retired in Wisconsin, they 
would have vastly different health care options under the Medicare 
system.
  The high Medicare payments in some areas allow Medicare beneficiaries 
a wide array of options, they can choose between an HMO or traditional 
fee-for-service plan, and, because area health care providers are 
reimbursed at such a high rate, those providers can afford to offer 
seniors a broad range of health care services. The twin in Wisconsin, 
however, would not have the same access to care, there is no option to 
choose an HMO, and there are fewer health care agencies that can afford 
to provide care under the traditional fee-for-service plan.
  How can two people with identical backgrounds, who paid the same 
amount in payroll taxes, have such different options under Medicare?
  They do, because the distribution of Medicare dollars among the 50 
States is grossly unfair to Wisconsin, and many other states around the 
country. Too many Americans in Wisconsin and other States like it pay 
just as much in taxes as everyone else, but the Medicare funds they get 
in return don't come close to matching the money they pay in to the 
program.

  Wisconsin has a lot of company in this predicament. More than 35 
States are below the national average in terms of per beneficiary 
Medicare spending. In some States, such as Wyoming and Idaho, Medicare 
spends almost $2,000 less per beneficiary than the national average.
  While there are different reasons for this wide range in Medicare 
payments, their result is often the same, higher private sector 
insurance costs and a loss of access to care. In Milwaukee WI, there 
are reports that lower Medicare reimbursement rates often causes costs 
to shift to the private sector. In rural parts of Wisconsin, these low 
reimbursement rates jeopardize access to health care services.
  In the case of my home State of Wisconsin, low payment rates are in 
large part a result of health care proviers' historically high-quality, 
cost-effective health care. In the early 1980s, Wisconsin's lower-than-
average cost were used

[[Page S861]]

to justify lower payment rates. Since that time, Medicare's payment 
policies have only widened the gap between low- and high-cost States.
  This package of legislation will take us a step in the right 
direction by reducing the inequities in Medicare payments to hospitals, 
physicians, and skilled nursing facilities that the majority of States 
across the country now face.
  At the same time, our proposal would establish pilot programs to 
encourage high-quality, cost-effective Medicare practices. Our proposal 
would reward providers who deliver higher quality at lower cost. It 
would also require that the pilot States create a plan to increase the 
amount of providers providing high quality, cost-effective care to 
Medicare beneficiaries.
  This legislation would also help to address the unique workforce 
needs of urban and very rural areas by encouraging clinical rotations 
in those areas. These rotations could help focus a workforce on the 
specific challenges facing these areas, so that they can deliver care 
that serves the unique needs that they have.
  Congress must modernize Medicare. But it must also restore basic 
fairness to the Medicare program.
  My legislation demands Medicare fairness for Wisconsin and other 
affected States, plain and simple. Medicare shouldn't penalize high-
quality providers of Medicare services, and most of all Medicare should 
stop penalizing seniors who depend on the program for their health 
care. They have worked hard and paid into the program all their lives, 
and in return they deserve full access to the wide range of benefits 
that Medicare has to offer.
  I look forward to working with my colleagues to move this legislation 
forward. I believe that we can rebalance the budget, while at the same 
time encouraging efficient, quality enhancing services, and that's what 
my legislation sets out to do.
  Mr. KOHL. Mr. President, I rise today in strong support of the 
Medicare Value and Quality Demonstration Act, the Physician Wage 
Fairness Act, the Graduate Medical Education Demonstration Act, and the 
Skilled Nursing Facility Wage Information Improvement Act. I am proud 
to cosponsor this package of legislation that will finally begin to 
address the grossly distorted Medicare reimbursement system, which 
penalizes health care providers in States like Wisconsin for being 
efficient as they provide high-quality care, and penalizes seniors in 
Wisconsin by delivering fewer benefits than seniors in other States 
receive. I want to commend Senator Feingold and Senator Collins for 
their hard work and commitment to fixing this problem, and I am proud 
to join them as an original cosponsor in this effort.
  This issue points to a basic question of fairness. The current 
Medicare reimbursement system is extremely unfair for Wisconsin. 
Because Wisconsin has been successful in holding down health care 
costs, current Medicare payment rates are very low in comparison to 
higher cost States, like Florida and California. In other words, the 
current system effectively punishes Wisconsin providers for being more 
efficient, and puts Medicare beneficiaries in Wisconsin at an unfair 
disadvantage compared to beneficiaries in other States.
  This system has to change. My constituents in Wisconsin pay the same 
Medicare payroll tax as people in other States. They suffer from the 
same illnesses; they need the same treatments; they see the same types 
of health providers. Yet Wisconsin Medicare beneficiaries receive on 
average $3,795 in Medicare benefits per year, the eighth lowest in the 
country. That's 25 percent below the national average of $5,034. A 
study conducted by the Rural Wisconsin Health Cooperative found that 
this costs Wisconsin nearly a billion dollars each year in Medicare 
dollars lost.
  There is simply no logical reason why Wisconsin doctors, hospitals, 
nursing homes, and ultimately, Wisconsin beneficiaries, should receive 
less reimbursement and fewer Medicare benefits than other States 
receive. And there is no logical reason why Medicare tax dollars paid 
by Wisconsinites should instead be used to pay higher rates to 
providers and greater benefits to beneficiaries in other States.
  And this system isn't just bad for seniors on Medicare. The current 
system also has major consequences for businesses and non-Medicare 
patients in Wisconsin. When Medicare reimbursement to hospitals or 
nursing homes or doctors is inadequate, somebody has to make up the 
difference in order for these providers to stay afloat. This means that 
Wisconsin employers who provide health insurance for their employees, 
and patients who pay all or part of their health care bills, must pay 
higher prices and premiums to make up the shortfall. This is unfair to 
all of Wisconsin's citizens and exacerbates the problem of rising 
health care costs.
  We should all be outraged by a system that treats seniors in some 
States like second-class citizens. Congress must stop sanctioning the 
current system, which penalizes Medicare beneficiaries based on where 
they live, penalizes providers for being efficient, and rewards 
providers that do not do their part to hold the line on costs. This 
backward system simply makes no sense.
  The package of bills introduced today will finally begin to turn this 
system around and ensure that health care providers in Wisconsin and 
similarly affected States are adequately reimbursed and rewarded for 
providing high quality, cost-effective care. It will eliminate outdated 
and inaccurate data that is currently used to determine Medicare's 
flawed payment rates. And most importantly, it will help level the 
playing field for seniors in Wisconsin by helping to ensure that they 
have access to the same benefits as seniors in other States.
  First, the Skilled Nursing Facility Wage Information Improvement Act 
will create a reimbursement system for nursing homes that is actually 
based on accurate nursing home data. This would seem to be common 
sense; yet the current formula for determining Medicare nursing home 
payments is based on hospital wage data that is inaccurate and 
discriminates against many States like Wisconsin. The Centers for 
Medicare and Medicaid Services, CMS, is now compiling nursing home wage 
data but as of yet has not finalized a plan to utilize it. This bill 
would set October 1, 2002 as the date for which CMS must incorporate 
the nursing home data.
  Second, the Medicare Value and Quality Demonstration Act would begin 
to reverse the backward incentive structure in today's Medicare system. 
Medicare currently penalizes low-cost, high-quality States and health 
care providers by delivering inadequate reimbursement for their 
services. It just makes no sense to penalize providers who are working 
hard to be cost-effective and provide high-quality care at the same 
time. This second bill would create 4 demonstration projects to provide 
bonus incentive payments to high-quality, low-cost hospitals and 
doctors in the demonstration States. These States would also have to 
implement a plan to encourage more of their providers to deliver low-
cost, high-quality care.
  Third, the Physician Wage Fairness Act would correct a flaw in the 
payment system for physicians. The current physician payment formula 
includes a geographic adjustor that is outdated. Many studies now point 
to the fact that the labor market for health professionals is actually 
a national labor market and therefore, a geographic adjustor simply 
does not match today's reality. This bill would eliminate the 
geographic adjustor and bring the physician payment formula up to date. 
Wisconsin's physicians stand to gain $8 million more in Medicare 
reimbursement with passage of this legislation.
  Finally, the Graduate Medical Education Demonstration Act would help 
address the issue of shortages of health professionals in underserved 
areas. It allows the HHS Secretary to use Medicare Graduate Medical 
Education funds to create a program to give providers in underserved 
areas financial incentives to attract educators and clinical 
practitioners.
  This package of legislation is not the end of the story when it comes 
to fixing Medicare's current flawed payment system. In addition to this 
package, for the past 2 years I have been a cosponsor of the Medicare 
Fairness in Reimbursement Act, introduced by Senators Harkin and Craig. 
This bill also works to level the playing field between high payment 
States and low payment

[[Page S862]]

States, with a particular emphasis on improving reimbursement rates for 
rural areas. And I look forward to continuing to work with Senator 
Feingold and Senator Collins on additional legislation that will deal 
with the complicated problems of hospital reimbursement and Medicare + 
Choice.
  But these bills are an important first step toward fixing a system 
that is not just unfair to my State; it is inaccurate, outdated, and 
creates perverse incentives for inefficient providers.
  Many of us in the Congress are working to update Medicare and 
modernize its structure to fit today's health care system. It is 
critical that we add a prescription drug benefit for seniors so they 
don't have to choose between taking their medicine and eating their 
next meal. It makes sense to add more preventive benefits to keep 
seniors healthy at the start rather than only treating illnesses when 
they become more serious. I strongly support these efforts and hope 
that Congress will act this year. But if we don't also fix the 
inequities in Medicare's payment system, these new benefits could also 
turn out to be inequitable for Wisconsin's seniors. This is an issue 
that must be addressed if Congress is serious about passing real 
Medicare reform.
  Again, I want to commend Senators Feingold and Collins for their hard 
work on this package. I look forward to working with them as Medicare 
reform moves forward.
                                 ______
                                 
      By Mr. KOHL (for himself, Mr. Hatch, Mr. Schumer, and Ms. 
        Cantwell):
  S. 1956. A bill to combat terrorism and defend the Nation against 
terrorist attacks, and for other purposes; to the Committee on the 
Judiciary.
  Mr. KOHL. Mr. President, I rise today to introduce the Safe 
Explosives Act. This legislation will help prevent the criminal use and 
accidental misuse of explosive materials.
  The events of September 11 have tragically demonstrated how good 
terrorists are at seeking out loopholes in our Nation's defenses. Law 
enforcement, now more than ever, must be several steps ahead of these 
criminals.
  Most Americans would be stunned to learn that in some States it is 
easier to get enough explosives to take down a house than it is to buy 
a gun, get a drivers' license, or even obtain a fishing license. 
Currently, it is far too easy for would-be terrorists and criminals to 
obtain explosive materials. Although permits are required for 
interstate purchases of explosives, there are no current uniform 
national limitations on the purchase of explosives within a single 
state by a resident of that State. As a result, a patchwork quilt of 
State regulations covers the intrastate purchase of explosive 
materials. In some States, anyone can walk into a hardware store and 
buy plastique explosives or a box of dynamite. No background check is 
conducted, and no effort is made to check whether the purchaser knows 
how to properly use this deadly material. In at least 12 States, there 
are little to no restrictions on the intrastate purchase of explosives.
  Since September 11, the threat of a terrorist attack involving 
explosives is more real than ever. As Richard Reid, the so-called 
``shoe bomber,'' recently demonstrated when he tried to take down a 
Boeing 767 en route from Paris to Miami, terrorists are actively trying 
to use explosives in pursuit of their aims. We must be more vigilant in 
overseeing the purchase and possession of explosives if we ever hope to 
prevent future potential disasters.
  The Safe Explosives Act would close the deadly loophole in our 
current laws by requiring people who want to acquire and possess 
explosive materials to obtain a permit. This measure would 
significantly reduce the availability of explosives to terrorists, 
felons, and others prohibited by current federal law from possessing 
dangerous explosives.
  Let me elaborate on what the proposal does. As I said, under current 
law anyone who is involved in interstate shipment, purchase, or 
possession of explosives must have a Federal permit. This legislation 
creates the same requirement for intrastate purchases. It calls for two 
types of permits for these intrastate purchasers: user permits and 
limited user permits. The user permit lasts for 3 years and allows 
unlimited explosives purchases. The limited user permit also expires 
after 3 years, but only allows six purchases per year. We created this 
two-tier system so that low-volume users would not be burdened by 
regulations. The limited permit, like the user permit, imposes 
commonsense rules such as a background check, monitoring of explosives 
purchases, secure storage, and report of sale or theft of explosives. 
However, the Safe Explosives Act does not subject the limited user to 
the record keeping requirements currently required for full permit 
holders.

  In addition to creating the permit system, our measure makes some 
commonsense addition to the classes of people who are barred from 
buying or possessing explosives. Current Federal explosives law 
prohibits certain people from purchasing or possessing explosives. The 
list of people barred is roughly parallel to those prohibited by 
Federal firearms law. For example, convicted felons are not allowed to 
buy guns or explosives. However, while current law bars nonimmigrant 
aliens from buying guns, they are not prohibited from buying 
explosives. That makes no sense. The Safe Explosives Act would stop 
nonimmigrant aliens from being able to buy explosives. Since we now 
know that several of the September 11 terrorists were nonimmigrant 
aliens, and that sleeper terrorist cells made up of nonimmigrant aliens 
have been operating within U.S. borders for number of years, this 
provision is especially important.
  In addition, the Safe Explosives Act improves the public's safety by 
requiring permit holders to adhere to proper storage and safety 
regulations. These provisions will help ensure the safety of explosives 
handlers and prevent accidental or criminal detonation of explosives. 
Sadly, each year, many people are seriously injured or killed by misuse 
and criminal use of explosives. For example, in 1997, there were 4,777 
explosives incidents, killing 27 and injuring 164 people, and resulting 
in more than $7.3 million in property damage. Our proposal will help 
reduce these numbers.
  This measure strikes a reasonable balance between stopping dangerous 
people from getting explosives and helping legitimate users obtain and 
possess explosives. Most large commercial users already have explosives 
permits because they engage in interstate explosives transport. These 
users would not be significantly affected by our legislation. The low-
volume users will be able to quickly and cheaply get a limited permit. 
And high-volume intrastate purchasers who are running businesses that 
require explosives should easily be able to get an unlimited user 
permit. Also, the measure will not affect those who use black or 
smokeless powder for recreation, as the legislation does not change 
current regulations on those particular materials.
  Our goal is simple. We must take all possible steps to keep deadly 
explosives out of the hands of dangerous individuals seeking to 
threaten our livelihood and security. The Safe Explosives Act is 
critical legislation, supported by the administration. It is designed 
solely to the interest of public safety. It will significantly enhance 
our efforts to limit the proliferation of explosives to would be 
terrorists and criminals. It will close a loophole that could 
potentially cause mass destruction of property and life. I hope my 
colleagues will support our efforts to pass this vital law. Thank you.
  I ask unanimous consent that the text of the bill be printed in the 
Record.

                                S. 1956

       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 referred to as the ``Safe Explosives Act''.

      SEC. 2. PERMITS FOR PURCHASERS OF EXPLOSIVES.

       (a) Definitions.--Section 841(j) of title 18, United States 
     Code, is amended to read as follows:
       ``(j) `Permittee' means any user of explosives for a lawful 
     purpose, who has obtained either a user permit or a limited 
     permit under the provisions of this chapter.''.
       (b) Permits for Purchase of Explosives.--Section 842 of 
     title 18, United States Code, is amended--
       (1) in subsection (a)(2), by striking ``and'' at the end;
       (2) by striking subsection (a)(3) and inserting the 
     following:
       ``(3) other than a licensee or permittee knowingly--
       ``(A) to transport, ship, cause to be transported, or 
     receive any explosive materials; or

[[Page S863]]

       ``(B) to distribute explosive materials to any person other 
     than a licensee or permittee; or
       ``(4) who is a holder of a limited permit--
       ``(A) to transport, ship, cause to be transported, or 
     receive in interstate or foreign commerce any explosive 
     materials; or
       ``(B) to receive explosive materials from a licensee or 
     permittee, whose premises are located within the State of 
     residence of the limited permit holder, on more than 6 
     separate occasions, pursuant to regulations implemented by 
     the Secretary.'';
       (3) by striking subsection (b) and inserting the following:
       ``(b) It shall be unlawful for any licensee or permittee 
     knowingly to distribute any explosive materials to any person 
     other than--
       ``(1) a licensee;
       ``(2) a holder of a user permit; or
       ``(3) a holder of a limited permit who is a resident of the 
     State where distribution is made and in which the premises of 
     the transferor are located.''; and
       (4) in the first sentence of subsection (f), by inserting 
     ``, other than a holder of a limited permit,'' after 
     ``permittee''.
       (c) Licenses and User Permits.--Section 843(a) of title 18, 
     United States Code, is amended--
       (1) by inserting ``or limited permit'' after ``user 
     permit'' in the first sentence;
       (2) by inserting before the period at the end of the first 
     sentence the following: ``, including the names of and 
     appropriate identifying information regarding all employees 
     who will handle explosive materials, as well as fingerprints 
     and a photograph of the applicant (including, in the case of 
     a corporation, partnership, or association, any individual 
     possessing, directly or indirectly, the power to direct or 
     cause the direction of the management and policies of the 
     corporation, partnership, or association)''; and
       (3) by striking the third sentence and inserting ``Each 
     license or user permit shall be valid for no longer than 3 
     years from the date of issuance and each limited permit shall 
     be valid for no longer than 1 year from the date of issuance. 
     Each license or permit shall be renewable upon the same 
     conditions and subject to the same restrictions as the 
     original license or permit and upon payment of a renewal fee 
     not to exceed one-half of the original fee.''.
       (d) Criteria for Approving Licenses and Permits.--Section 
     843(b) of title 18, United States Code, is amended--
       (1) in paragraph (4), by striking ``and'' at the end;
       (2) in paragraph (5), by striking the period at the end; 
     and
       (3) by adding at the end the following:
       ``(6) none of the employees of the applicant who will 
     possess explosive materials in the course of their employment 
     with the applicant is a person whose possession of explosives 
     would be unlawful under section 842(i) of this chapter; and
       ``(7) in the case of a limited permit, the applicant has 
     certified in writing that the applicant will not receive 
     explosive materials on more than 6 separate occasions during 
     the 12-month period for which the limited permit is valid.''.
       (e) Inspection Authority.--Section 843(f) of title 18, 
     United States Code, is amended--
       (1) in the first sentence--
       (A) by striking ``permittees'' and inserting ``holders of 
     user permits''; and
       (B) by inserting ``licensees and permittees'' before the 
     words ``shall submit''; and
       (2) in the second sentence, by striking ``permittee'' the 
     first time it appears and inserting ``holder of a user 
     permit''.
       (f) Posting of Permits.--Section 843(g) of title 18, United 
     States Code, is amended by inserting ``user'' before 
     ``permits''.
       (g) Effective Date.--The amendments made by this section 
     shall take effect 180 days after the date of enactment of 
     this Act.

     SEC. 3. PERSONS PROHIBITED FROM RECEIVING OR POSSESSING 
                   EXPLOSIVE MATERIALS.

       (a) Distribution of Explosives.--Section 842(d) of title 
     18, United States Code, is amended--
       (1) in paragraph (5), by striking ``or'' at the end;
       (2) in paragraph (6), by striking the period at the end and 
     inserting ``or who has been committed to a mental 
     institution;''; and
       (3) by adding at the end the following:
       ``(7) is an alien, other than an alien who is lawfully 
     admitted for permanent residence (as defined in section 101 
     (a)(20) of the Immigration and Nationality Act) or an alien 
     described in subsection (q)(2);
       ``(8) has been discharged from the armed forces under 
     dishonorable conditions; or
       ``(9) having been a citizen of the United States, has 
     renounced the citizenship of that person.''.
       (b) Possession of Explosive Materials.--Section 842(i) of 
     title 18, United States Code, is amended--
       (1) in paragraph (3), by striking ``or'' at the end; and
       (2) by inserting after paragraph (4) the following:
       ``(5) who is an alien, other than an alien who is lawfully 
     admitted for permanent residence (as that term is defined in 
     section 101(a)(20) of the Immigration and Nationality Act) or 
     an alien described in subsection (q)(2);
       ``(6) who has been discharged from the armed forces under 
     dishonorable conditions; or
       ``(7) who, having been a citizen of the United States, has 
     renounced the citizenship of that person.''.
       (c) Definition.--Section 842 of title 18, United States 
     Code, is amended by adding at the end the following:
       ``(q) Provisions Relating to Legal Aliens.--
       ``(1) Definition.--In this subsection, the term `alien' has 
     the same meaning as in section 101(a)(3) of the Immigration 
     and Nationality Act (8 U.S.C. 1101(a)(3)).
       ``(2) Exceptions.--Subsections (d)(7) and (i)(5) do not 
     apply to any alien who--
       ``(A) is in lawful nonimmigrant status, is a refugee 
     admitted under section 207 of the Immigration and Nationality 
     Act (8 U.S.C. 1157), or is in asylum status under section 208 
     of the Immigration and Nationality Act (8 U.S.C. 1158);
       ``(B) is a foreign law enforcement officer of a friendly 
     foreign government entering the United States on official law 
     enforcement business;
       ``(C) is a person having the authority to direct or cause 
     the direction of the management and policies of a 
     corporation, partnership, or association licensed pursuant to 
     section 843(a), and the shipping, transporting, possessing, 
     or receiving of explosive materials relates to that 
     authority; or
       ``(D) is a member of a North Atlantic Treaty Organization 
     (NATO) or other friendly foreign military force (whether or 
     not admitted in a nonimmigrant status) who is present in the 
     United States under military orders for training or other 
     authorized purpose, and the shipping, transporting, 
     possessing, or receiving explosive materials is in 
     furtherance of the military purpose.''.
       ``(3) Waiver.--
       ``(A) Conditions for waiver.--Any individual who has been 
     admitted to the United States under a nonimmigrant visa may 
     receive a waiver from the requirements of subsection (i)(5) 
     if--
       ``(i) the individual submits to the Attorney General a 
     petition that meets the requirements of subparagraph (C); and
       ``(ii) the Attorney General approves the petition.
       ``(B) Petition.--Each petition submitted in accordance with 
     subparagraph (A) shall--
       ``(i) demonstrate that the petitioner has resided in the 
     United States for a continuous period of not less than 180 
     days before the date on which the petition is submitted under 
     this paragraph; and
       ``(ii) include a written statement from the embassy or 
     consulate of the petitioner, authorizing the petitioner to 
     acquire explosives and certifying that the alien would not, 
     absent the application of subsection (i)(5), otherwise be 
     prohibited from such an acquisition under subsection (i).
       ``(C) Approval of petition.--The Attorney General shall 
     approve a petition submitted in accordance with this 
     paragraph if the Attorney General determines that waiving the 
     requirements of subsection (i)(5) with respect to the 
     petitioner--
       ``(i) would be in the interests of justice; and
       ``(ii) would not jeopardize the public safety.''.

     SEC. 4. REQUIREMENT TO PROVIDE SAMPLES OF EXPLOSIVE MATERIALS 
                   AND AMMONIUM NITRATE.

       Section 843 of title 18, United States Code, is amended by 
     adding at the end the following:
       ``(h) Furnishing of Samples.--
       ``(1) In general.--Licensed manufacturers and licensed 
     importers and persons who manufacture or import explosive 
     materials or ammonium nitrate shall, when required by letter 
     issued by the Secretary, furnish--
       ``(A) samples of such explosive materials or ammonium 
     nitrate;
       ``(B) information on chemical composition of those 
     products; and
       ``(C) any other information that the Secretary determines 
     is relevant to the identification and classification of the 
     explosive materials or to identification of the ammonium 
     nitrate.
       ``(2) Reimbursement.--The Secretary may, by regulation, 
     authorize reimbursement of the fair market value of samples 
     furnished pursuant to this subsection, as well as the 
     reasonable costs of shipment.''.

     SEC. 5. DESTRUCTION OF PROPERTY OF INSTITUTIONS RECEIVING 
                   FEDERAL FINANCIAL ASSISTANCE.

       Section 844(f)(1) of title 18, United States Code, is 
     amended by inserting before the word ``shall'' the following: 
     ``or any institution or organization receiving Federal 
     financial assistance,''.

     SEC. 6. RELIEF FROM DISABILITIES.

       Section 845(b) of title 18, United States Code, is amended 
     to read as follows:
       ``(b) Relief from Disabilities.--
       ``(1) In general.--A person who is prohibited from 
     possessing, shipping, transporting, receiving purchasing, 
     importing, manufacturing, or dealing in explosive materials 
     may make application to the Secretary for relief from the 
     disabilities imposed by Federal law with respect to the 
     acquisition, receipt, transfer, shipment, transportation, or 
     possession of explosive materials, and the Secretary may 
     grant that relief, if it is established to the satisfaction 
     of the Secretary that--
       ``(A) the circumstances regarding the disability, and the 
     record and reputation of the applicant are such that the 
     applicant will not be likely to act in a manner dangerous to 
     public safety; and
       ``(B) that the granting of the relief will not be contrary 
     to the public interest.

[[Page S864]]

       ``(2)Petition for judicial review.--Any person whose 
     application for relief from disabilities under this section 
     is denied by the Secretary may file a petition with the 
     United States district court for the district in which that 
     person resides for a judicial review of the denial.
       ``(3) Additional evidence.--The court may, in its 
     discretion, admit additional evidence where failure to do so 
     would result in a miscarriage of justice.
       ``(4) Further operations.--A licensee or permittee who 
     conducts operations under this chapter and makes application 
     for relief from the disabilities under this chapter, shall 
     not be barred by that disability from further operations 
     under the license or permit of that person pending final 
     action on an application for relief filed pursuant to this 
     section.
       ``(5) Notice.--Whenever the Secretary grants relief to any 
     person pursuant to this section, the Secretary shall promptly 
     publish in the Federal Register, notice of that action, 
     together with reasons for that action.''.

     SEC. 7. THEFT REPORTING REQUIREMENT.

       Section 842 of title 18, United States Code, as amended by 
     this Act, is amended by adding at the end the following:
       ``(r) Theft Reporting Requirement.--
       ``(1) In general.--A holder of a limited user permit who 
     knows that explosive materials have been stolen from that 
     user, shall report the theft to the Secretary not later than 
     24 hours after the discovery of the theft.
       ``(2) Penalty.--A holder of a limited user permit who does 
     not report a theft in accordance with paragraph (1), shall be 
     fined not more than $10,000, imprisoned not more than 5 
     years, or both.''.

     SEC. 8. APPLICABILITY.

       Nothing in this Act shall be construed to affect the 
     exception in section 845(a)(4) (relating to small arms 
     ammunition and components of small arms ammunition) or 
     section 845(a)(5) (relating to commercially manufactured 
     black powder in quantities not to exceed 50 pounds intended 
     to be used solely for sporting, recreational, or cultural 
     purposes in antique firearms) of title 18, United States 
     Code.

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