[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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