[Congressional Record Volume 148, Number 103 (Thursday, July 25, 2002)]
[Senate]
[Pages S7327-S7332]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        GREATER ACCESS TO AFFORDABLE PHARMACEUTICALS ACT OF 2001

  The PRESIDING OFFICER. Under the previous order, the Senate will 
resume consideration of S. 812, which the clerk will report.
  The legislative clerk read as follows:

       A bill (S. 812) to amend the Federal Food, Drug, and 
     Cosmetic Act to provide greater access to affordable 
     pharmaceuticals.

  Pending:

       Reid (for Dorgan) amendment No. 4299, to permit commercial 
     importation of prescription drugs from Canada.
       Rockefeller amendment No. 4316 (to amendment No. 4299), to 
     provide temporary State fiscal relief.
       Gramm point of order that the emergency designation in 
     section C of Rockefeller

[[Page S7328]]

     amendment No. 4316 (to amendment No. 4299), listed above, 
     violates section 205 of H. Con. Res. 290, 2001 Congressional 
     Budget Resolution.
       Reid motion to waive section 205 of H. Con. Res. 290, 2001 
     Congressional Budget Resolution, with respect to the 
     emergency designation in section C of Rockefeller amendment 
     No. 4316 (to amendment No. 4299), listed above.

  The PRESIDING OFFICER. Under the previous order, there will be 1 hour 
of debate on the motion to waive the Budget Act to be equally divided 
and controlled by the Senator from West Virginia, Mr. Rockefeller, and 
the Senator from Texas, Mr. Gramm.
  Who yields time?
  The Senator from West Virginia is recognized.
  Mr. ROCKEFELLER. Madam President, this is an extremely important 
vote. It is very important because in the Congress we worry not only 
about the Nation as a whole, but as a nation of its individual parts, 
that is made up of 50 different States, all of whom are getting 
clobbered by something called a loss of Medicaid money.
  We have a chance with the amendment before us to adjust that 
situation. We felt so strongly about the situation and the loss of 
Medicaid money for our most vulnerable citizens, and also the damage it 
does in the aggregate to our hospitals, nursing homes, and every part 
of our health infrastructure. Whether you are in an urban or rural 
area--and the Presiding Officer's State includes both urban and rural--
you are faced with hospitals and other facilities that depend 
overwhelmingly on Medicaid.
  The States now have an enormous shortfall in their budgets. In fact, 
there are deficits of $40 billion to $50 billion. No State, with the 
exception of Vermont, can go into deficit financing like we do in the 
Federal Government. They have to balance their budgets. So what happens 
if they get to a situation where they don't have money? I was a 
Governor for 8 years, and I was in that situation for a full 5 years, 
where we actually had to lower moneys because the revenue was less than 
the previous year. We had to lay off people and the other things 
Governors have to do.
  We are in a position to help now. We have done nothing on health 
care, basically, except the children's health insurance program, which 
affects 2 million children, but it needs to affect many more. We have 
done nothing about universal health care, prescription drugs, or this 
Medicaid problem, and about virtually all of the areas of health care 
that we talk about all the time and simply do not perform on.
  So this is a real test for the 100 people who will come here to vote 
on whether they want to see their States drown in debt and have to cut 
Medicaid and hurt not only children but families and hospitals and 
nursing homes and home health--all the aspects of where Medicaid makes 
a difference.
  We felt so strongly about this after September 11, which was an 
enormous day in the history of the world, that we included this in the 
stimulus package. We did that prior to last Christmas, which was a long 
time ago. We did it and we decided it was so important to do, even at 
that time, it being a worse situation now, that we would treat it in an 
emergency fashion and not require it to be offset. Some people say you 
need to offset that. When you get into economic times like we have 
now--much worse than they were then--the underpinnings are weaker in 
general, and now we really do have to act.
  So what I am going to do is not use up all of our time, but wait for 
some colleagues to come down to speak on this amendment and why it is 
important that we waive the Budget Act and that we do the right thing 
by States and Medicare. This is an extremely important vote; it is a 
test vote about whether the Senate is really willing to do anything for 
the States and for health care. So far, we have failed on all fronts. 
Now we have a chance to reverse ourselves on a small, but important, 
aspect of it.
  We have, as I say, so many cosponsors that I will not even take the 
time to read them. But it is very bipartisan, with 35 cosponsors, 
including 8 Republicans. We should, in fact, prevail on this and get 
the 60 votes that we want because it is good. This is an emergency, I 
say to the Presiding Officer. This is important now even more so 
because Medicaid bears all of the brunt of the rising cost of 
prescription drugs because it is only Medicaid and the Veterans' 
Administration that pays for prescription drugs. This is not Medicare, 
this is Medicaid, and it is suffering terribly. This is an emergency. 
We deemed it such after 9/11. The situation is worse now. We have a 
chance to do something about it.
  I yield the floor and reserve the remainder of my time.
  The PRESIDING OFFICER (Ms. Stabenow). The Senator from Texas is 
recognized.
  Mr. GRAMM. Madam President, one of the reasons I love this job is 
that you never reach a situation where you are able to say I have heard 
it all before. In much of life, as you live longer and longer, you get 
to the point where there is nothing new under the sun, where any new 
event had so many precedents for it that you understand it and you know 
it and you expect it. The wonderful thing about this job is that there 
is always a new proposal, always a new approach, always a new way of 
doing things that you would have never, ever thought of, and that you 
would have never believed that anyone else would have thought of.
  I have spent 18 years in the Senate trying to deal with deficit 
spending. It has been a long, sometimes fruitful, sometimes not so 
fruitful, battle. I would have to say in the last year and a half, it 
has been a very unfruitful battle from my point of view because we 
started out with a surplus which literally burned a great big hole in 
our pocket. We literally could not spend the money fast enough.
  Now, interestingly enough, we have a deficit. The last projection by 
the Congressional Budget Office is that we are going to spend, this 
year, $165 billion more than we take in. That deficit seems to grow 
every time there is a new projection. Yet our behavior is totally 
unchanged. In fact, I can say that in almost 25 years of service in the 
House and in the Senate, I have never seen the urge to spend money more 
unchecked in Congress than it is today. To me, it is a very frightening 
prospect as to what this is going to mean when all these bills come 
due.
  Let me try to respond to the proposal before us because in so many 
ways, it is extraordinary. The logic of it is pretty straightforward. 
The States are in a position that, because of the state of the economy, 
many States are beginning to have deficits that used to have surpluses. 
In fact, it is projected now that unless something happens very 
positive and very dramatic in the next few months, that as many as 40 
States will run deficits next year, or at least will face the prospects 
of deficits because many States, like my own, have to balance their 
budget. They will have to come into session in January, and they will 
have to make hard choices.
  We don't make hard choices in Congress, but they will have to make 
hard choices in the legislature. When you add up the cumulative 
projected deficits for all 40 States that are looking at potentially 
being in the red, that accumulated aggregate deficit projection is 
about $40 billion.
  Now, the proposal before us extraordinarily says let's declare an 
emergency so that we can spend another $9 billion that we don't have, 
every penny of which will come out of the Social Security trust fund; 
but let's go ahead and borrow that money now. Let's take it out of the 
Social Security trust fund and spend it so that States will not be 
required to make tough choices. The only problem is, our projected 
deficit is four times as great as the aggregate sum of all the deficits 
of all the States in the Union combined.
  In fact, it would have made more sense--I would not have supported it 
but it would have made more sense had our dear colleagues proposed that 
we reduce Medicaid reimbursement because the States have a better 
financial situation than we do and, therefore, they are in a better 
position to deal with this problem.
  I would not have supported that proposal because I do not think we 
want to beggar our neighbor in terms of imposing our problems on the 
States, but at least it could have been argued, with a deficit 
projected to be four times as big as all the State deficits combined, 
that we cannot be as generous as we wanted to be. That argument would 
make sense at Dicky Flatt's Print Shop in Mexia, TX. People would 
understand that argument in Oklahoma.

[[Page S7329]]

They might not like it. They might oppose it, but they would understand 
it. They would say it made sense, but I do not believe people at Hesser 
Drug Coffee Bar in Ennis, TX, or people anywhere in any State in the 
Union, would find logic in the Federal Government borrowing another $9 
billion we do not have, taking the money out of the Social Security 
trust fund because every penny of this surplus is Social Security 
surplus. I do not think they would understand us declaring an emergency 
to spend this $9 billion to give it to States, that if we added up 
their total deficit is not one-fourth of the deficit that we are 
running right now.
  So we basically are down to a question that we have to ask ourselves: 
Are we willing to declare an emergency to run a new deficit of $9 
billion--spend $9 billion today, and in doing so, take $9 billion out 
of the Social Security trust fund? Are we willing to do that because 
States are running a cumulative deficit that is one-fourth as big as 
the deficit we are running? That basically is the question that is 
before us. It is easy for one to say this is a compassionate decision 
because they do not want their State to have to make a tough decision, 
but compassion is what one does with one's own money, not what one does 
with somebody else's money. This money is coming out of the Social 
Security trust fund. This money is coming from, ultimately, the 
taxpayer who is going to have to pay it back, plus interest.
  If the proponents of this amendment were anteing up out of their own 
pockets, we could say they are compassionate about their States; they 
are worried about what will happen in States that have deficits. But it 
is not compassion when it is somebody else's money. The idea that we 
would run a $9 billion deficit today, that we would take $9 billion out 
of Social Security today to give to States that are running a deficit, 
that when added up among all the States in the Union is not one-fourth 
as big as the deficit we are running, it makes absolutely no sense.
  I think, at least where I am from, and maybe where I am from is 
different than where other people are from, but in my State that would 
make absolutely no sense.
  Finally, every time we talk about letting people keep more of what 
they earn, every time we have a debate about letting working families 
keep more of what they earn, many of our colleagues stand up and say we 
cannot afford it. We would like not to force families to sell their 
business or sell their farm when pappa dies so the Government can get 
55 cents out of every dollar they have accumulated in their whole 
lifetime, even though they have paid taxes on every penny of it. Our 
colleagues tell us we do not like doing that but we do not have any 
choice because we do not have the money; we are running a deficit now.
  When we talk about making the repeal of the marriage penalty 
permanent so we do not penalize people for the simple act of falling in 
love and getting married, both of them good things it seems to me, we 
are told that we would like to do that but we do not have enough money 
because we are now running a deficit.
  Why is it we never, ever have enough money to let people keep more of 
what they earn but we always have enough money to spend? Why is there 
this huge difference? I would assert basically because deep down many 
Members of the Senate believe they can spend money better than families 
can spend money.
  I have raised a point of order against this amendment, and I want to 
be sure my colleagues understand what the point of order is about. This 
amendment will force the Government to take $9 billion out of the 
Social Security trust fund and give it to the States at a time when all 
the States combined have a deficit that is not one-quarter the deficit 
of the U.S. Government. This is a very bad decision. I can see how it 
would be popular in the legislatures, but it cannot be good public 
policy to do this. So I urge my colleagues to sustain this budget point 
of order.
  If our colleagues want to come back and say, look, this is important, 
we want to do this, and we are willing to take $9 billion away from 
something else that is not as important, then depending on what they 
take it away from I might be willing to support it. To simply say we 
want to give this money away, even though we do not have it, I do not 
believe that is a responsible position. As a result, I have raised the 
budget point of order.
  I hope my colleagues who constantly talk about protecting the Social 
Security trust fund, I hope my colleagues who constantly talk about the 
fiscal irresponsibility of letting working people keep more of what 
they earn through tax cuts, will apply that standard today when we are 
gratuitously taking $9 billion out of the Social Security trust fund, 
borrowing it knowing we are going to have to pay it back plus interest. 
This is irresponsible policy. It should be stopped, and I urge my 
colleagues to sustain this budget point of order.
  I reserve the remainder of our time.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. ROCKEFELLER. I yield 5 minutes to the distinguished Senator from 
Nebraska.
  The PRESIDING OFFICER. The Senator from Nebraska.
  Mr. NELSON of Nebraska. I thank my colleague from West Virginia. He 
has done such an able job in this challenge of finding a way to make 
the partnership between the States and the Federal Government on the 
Medicaid Program work in difficult times.
  I respect a great deal my friend and colleague from Texas, who makes 
a very important point about spending in the Senate. If we were only 
talking about spending, then I think that argument might stand, but 
what we are really looking at is a partnership that was created between 
the Federal Government and the States and it is called the Medicaid 
Program, a joint partnership. The Federal Government underfunded it 
because it said we will have a match and our match will vary based on 
our particular situation as well as the situation of the States.
  I remember as Governor of Nebraska when the Federal budget was being 
balanced and the Federal match was reduced. At the State level, my 
particular portion had to increase. So the Federal Government balanced 
its budget on the basis of my budget and at the expense at times of my 
budget.
  Now we are looking at a situation in reverse. We have the States 
being challenged by growing red ink, and the Senator's comment about a 
budget of 40 States with deficits of somewhere around $40 billion, in a 
news article in the Chicago Tribune this morning, it was pointed out 
that the gap in those States may be about $58 billion rather than $40 
billion.
  The point is, this is a partnership, a federally mandated program 
partially funded under the idea that the State would have a 
responsibility and the Federal Government would have a responsibility. 
This is not about giving away money, this is about stopping the 
reduction in the Federal match for a period of 18 months and increasing 
it for a period of 18 months. It is not giving away money, it is 
assisting our partners in the process they are going through as they 
make difficult choices.
  It has been suggested that this will keep them from making difficult 
choices. They have already cut education funding. They have already cut 
funding in many other programs. The cutting has only begun. We are 
hopeful that the cutting in the area of Medicaid and/or in social 
services will not cause the gains that have been made in having people 
go from welfare reform to work reverse themselves and start a spiral 
downward where the gains made can be lost.
  All we are saying to the Federal Government is, do not reduce our 
portion right now and require, then, the States to make that choice 
about increasing theirs, which they cannot do; or cutting eligibility 
for Medicaid and causing, most likely, a downward spiral as they face 
the Medicaid uncertainties.
  In addition to recognizing this is a responsibility we created--I was 
not here, but collectively the Federal Government created this under 
this Federal program--I think we have a responsibility. We are facing 
that responsibility. Yes, we are having some difficult times, but we 
need to share the difficult times together rather than stand on the 
sideline and say it is up to the States to make the difficult choices 
and see them make choices that will have adverse, and maybe in some 
cases draconian, results at the State level.
  I understand the importance of trying to develop offsets. How can 
anyone

[[Page S7330]]

ever be against offsets? Let me state a few things that have flown in 
the face of asking for offsets--except where maybe you are not 
interested in seeing the program move forward. We passed yesterday the 
supplemental at a $28.9 billion total cost, $2 billion offset. A few of 
the things included $14.4 billion for defense--no one argues with 
that--or $6.7 billion for homeland security. How can anyone argue with 
that? Or $5.5 billion for New York, how can anyone argue with that? No 
request for specific offset for New York, no specific offset for 
homeland security, for defense. Or $1 billion for Pell grants, $417 
million for veterans medical care, and $400 million for improvements to 
State and local election procedures, we all know how important those 
are. Or $205 million for Amtrak, we also know how important that is. 
But $2 billion worth of offset to $28.9 billion worth of budget.
  I am not saying these are not important any more than anyone else is. 
I am suggesting that while they are important, so is this.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. ROCKEFELLER. Madam President, I happily yield 5 minutes to the 
distinguished Senator from Maine.
  Ms. COLLINS. Madam President, let's put the budget point of order of 
the Senator from Texas against our fiscal relief amendment into some 
context. The Senator's point of order, in essence, claims that the 
fiscal relief provided by our bipartisan amendment is somehow not 
emergency spending.
  Let's look at the facts. Let's look at the situation. The Budget 
Enforcement Act of 1990 established statutory limits on discretionary 
spending and a pay-as-you-go requirement for new direct spending and 
tax legislation. But it also exempted from the caps all discretionary 
spending designated by the President and the Congress as an emergency 
requirement.
  The law does not further define what is an emergency requirement. 
That is up to us. One place we can look for guidance, however, is to 
the criteria developed by the Office of Management and Budget for the 
President to use when determining whether or not a spending provision 
qualifies for emergency treatment. The Office of Management and Budget 
determined that an emergency spending provision is ``sudden, urgent, 
necessary, unforeseen, and not permanent.'' The funds that the 
amendment allocates to the States is all of those things. They meet the 
criteria precisely for emergency spending.
  First, our amendment addresses a sudden and unforeseen problem. That 
is the unexpected drop in revenues States have experienced. Indeed, 39 
States were forced to reduce their already enacted budgets for fiscal 
year 2002 by reducing essential programs, tapping rainy day funds, 
furloughing employees, and cutting important services. In short, the 
budget crisis was clearly a sudden and unexpected development for our 
partners as States.
  The second relief our amendment provides is needed to address an 
urgent situation, another criterion. The latest figures show that 46 
States are facing an aggregate budget shortfall exceeding $50 billion. 
Many have already cut or are considering cutting their Medicaid and 
social service programs.
  Finally, the relief provided by our amendment is not permanent, it is 
short-term relief, narrowly tailored to address a fiscal crisis that 
the States are experiencing now.
  In short, our amendment is a textbook example of the definition of 
``emergency'' spending. It addresses a sudden, unforeseen, urgent 
crisis, and provides temporary but much needed relief.
  Finally, we should not forget as we debate this issue what this is 
really all about. It is about protecting health care and other 
essential social services for the neediest and most vulnerable citizens 
in this country. Medicaid provides health insurance to approximately 40 
million low-income Americans, including 21 million children and young 
adults, 11 million elderly and disabled individuals, and 8.6 million 
adults in families, most of whom are single women. Without this 
critical safety net, millions of low-income men and women and their 
families would be left with no health insurance.
  That is the bottom line in this debate. We need to help the States so 
they can continue to provide essential health care to the most 
vulnerable citizens in our society. We are not taking the States off 
the hook. They are still going to have to make many tough choices in 
order to balance their budgets. But we can provide this meaningful 
relief. We must do so now in order to preserve that critical safety net 
for the most vulnerable in our society.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. ROCKEFELLER. How much time is remaining to this side?
  The PRESIDING OFFICER. There are 14 minutes 20 seconds.
  Mr. ROCKEFELLER. I yield to the Senator from Nebraska 4 minutes.
  Mr. NELSON of Nebraska. Madam President, how much time was yielded?
  The PRESIDING OFFICER. Four minutes was yielded.
  Mr. ROCKEFELLER. We have 14 minutes left; is that correct?
  The PRESIDING OFFICER. Four minutes was yielded to the Senator from 
Nebraska.
  Mr. NELSON of Nebraska. Thank you, Madam President, and I thank my 
colleague from West Virginia.
  I have never been to Dicky Flatt's and I hope my good friend from 
Texas will take me to Dicky Flatt's one of these days because it is, 
obviously, quite a place.
  I imagine the folks in Dicky Flatt's, though, will be interested in 
what came from the supplemental--$22.9 million to upgrade port 
surveillance and vessel tracking capability in the ports in Port 
Arthur, TX, Houston, and New York City, NY, and $12.6 million to the 
Pantex Plant in Texas for increased safeguards and security needs.
  The point is, folks in Dicky Flatt's or Elm Creek, NB, or other small 
communities and/or locations around the country, understand why some 
spending is necessary. They understand also that when you have a 
Federal program that is put together, as the Medicaid Program has been, 
that both parties have some responsibility to make sure it is viable so 
when times get difficult, one partner doesn't say to the other partner: 
Good luck, I hope you are able to make it.
  Because now we have an opportunity to say this is our program 
together, at the Federal level and at the State level; we have an 
interest in seeing that the people who are the most vulnerable in our 
society are appropriately served; that the nursing homes do not cease 
to be able to provide services or that childcare provisions are not 
eliminated, which are transitional benefits to get, in many cases, 
single parents off welfare and into the workforce.
  So as we think about offsets, I think it is important that we 
recognize that one person's offset is another person's idea of 
eliminating or destroying or in some way obstructing getting something 
accomplished.
  What we have to do is make sure offsets are, in fact, included 
wherever we can possibly include them. But one of the reasons emergency 
spending issues and funding issues have not generally required offsets 
is because it is very difficult to be able to match it at the time. We 
cannot wait on this and we cannot fight out every offset people would 
like to talk about. That is why emergency disaster relief, in this case 
emergency spending--to go to our States for our share of the program 
for a period of time--just simply provides the opportunity to continue 
something and it has to be done immediately and the process then, I 
take it, is there for them.
  We only seem to talk about offsets when it is convenient, or where we 
do talk about it and they are appropriate, it is when there is enough 
time to be able to put them together and get them accomplished.
  The economic stimulus plan, when this was a part of it last year, did 
not have an offset. There was not a lot of discussion about offsets at 
that time. Unfortunately, this particular provision did not get 
included in the stimulus package that was passed earlier this year, 
although it should have been. If it had been, it would not have 
involved an offset.
  It seems to me we have the opportunity to move forward as a partner 
with our States and to be able to assist them in very important policy 
matters and programs that I think will benefit the people of our 
country and will benefit our economy. That is why this was

[[Page S7331]]

included earlier in the economic stimulus package. There was a 
recognition it was part of the economic stimulus. I hope we will today 
recognize it, not only as the right thing and fair thing to do with our 
partners, the States, but also recognize that this has been considered 
part of the economic stimulus package.
  I ask unanimous consent an article by Judith Graham entitled 
``States' Budgetary Shortfalls Deepen'' be printed in the Record, and I 
yield the floor.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

               [From the Chicago Tribune, July 25, 2002]

                  States' Budgetary Shortfalls Deepen

                           (By Judith Graham)

       Denver.--Concerned state legislators gathered here for 
     their yearly meeting received sobering news Wednesday: State 
     budget deficits have widened dramatically over the last 
     several months, and the worst may be yet to come. Budget gaps 
     are projected to reach $57.9 billion for the fiscal year that 
     began July 1, up from the $35.9 billion deficit recorded 
     during the previous 12-month period, according to a report by 
     the National Conference of State Legislatures.
       While states have plugged these holes by reducing spending 
     and, in some cases, raising taxes, these solutions may not be 
     enough. With turnoil roiling Wall Street, investors in a 
     state of shock and costs for health-care programs such as 
     Medicaid escalating sharply, ``We've anticipating deficits 
     are going to grow even larger in the months ahead,'' said 
     Corina Eckl, the group's fiscal affairs director. Consumers 
     are feeling the bite of the states' financial woes in the 
     form of higher tuition for public colleges, fewer services 
     for at-risk kids, less help for elderly people trying to live 
     independently in their homes, larger elementary school class 
     sizes, as well as higher taxes.
       States including Illinois are being hit particularly hard 
     by the stock market's troubles, which have taken a big bite 
     out of personal incomes and shaken consumer confidence. On 
     average, more than one-third of state tax revenues comes from 
     personal income taxes, with another sizable chunk coming from 
     sales taxes. The falloff has been widespread: 26 states 
     collected less money during their just-ended fiscal years 
     than they did the year before, according to the conference's 
     new study. ``For many states, this is the first time this has 
     ever happened,'' said Arturo Perez, a budget analyst with the 
     legislative group.
       Reflecting a sense of pessimism, 46 percent of legislators 
     polled at a Wednesday morning meeting said they thought 
     revenues would remain flat or decline in the year ahead. 
     Virtually all states are legally required to balance budgets. 
     If so, hard choices may become even more difficult.
       This past year, 19 states tapped into rainy day funds and 
     12 turned to tobacco settlement funds to make up for lower-
     than-expected revenues and keep spending cuts in check. But 
     those reserves are now substantially smaller, leaving states 
     with fewer options and more pressure to cut programs, said 
     William Pound, the executive director of the National 
     Conference of State Legislatures. One state facing acute 
     pressure is Iowa, where revenues slid nearly 9 percent last 
     year and spending was slashed nearly 6 percent below the 
     previous year's levels. ``If you're a parent and you walk 
     into the human services department and ask for help, you'll 
     be told no services are available,'' said state Rep. Dave 
     Heaton, co-chairman of the Iowa House's human services 
     appropriations subcommittee. ``The most we can do is try to 
     help existing clients.''
       Among other budget-saving measures, Iowa has raised tuition 
     at public colleges by nearly 20 percent, and instituted a 
     hiring freeze for child protection services. With the number 
     of workers down because of attrition and retirements, 
     ``caseloads continue to rise and, to be honest, the attitude 
     out there in the field is very stressful,'' said Heaton, a 
     Republican from Mt. Pleaasant. ``I can tell you staffing at 
     our boys' school and juvenile home, as well as our mental 
     health facilities, is critical because of the cuts we've had 
     to make,'' he said. ``No matter how small you want government 
     to be, there are still things government has to do. And the 
     problem I see now is we're getting to the point where we 
     can't afford to do them.''
  Ms. SNOWE. Mr. President, a particular problem facing not only the 
American people but also the States themselves--and that certainly 
includes my home State of Maine--is the rising cost of health care.
  Today, Medicaid is the fastest growing component of State budgets, 
accounting for up to 20 percent of the average State budget, as costs 
increased by 11 percent last year and are expected to increase by 
another 13.4 percent this year. One of the components of this increase 
has been a corresponding increase in prescription drug costs as many 
states have discount prescription drug programs through Medicaid.
  In addition, the economic downturn has left many families out of a 
job and without their health insurance, forcing them to turn to 
Medicaid. This put an enormous strain on the States, which were already 
facing tough budget decisions. In an effort to address their budgetary 
obligations, 22 States have cut Medicaid spending and 16 have cut 
programs that help low-income people.
  The situation strained further by the fact that the Fiscal Year 02 
FMAP allocations did not reflect the economic downturn and the 
resulting upswing in people needing assistance. In fact, due to the 
formula used to determine the match, 29 States found themselves with a 
smaller Federal match than in Fiscal Year 01.
  As a result, many states have scaled back eligibility, reduced 
benefits, increased beneficiary cost-sharing, and cut or delayed 
payments to providers. Additional reductions in health care assistance, 
as well as cuts in other State-funded programs that serve many of those 
affected by the economic downturn, are expected. At this point in 
Maine's financial crisis, savings have been found elsewhere in the 
budget. However, my Governor has already made a call for a special 
session of the State legislature, which adjourned back on April 25 of 
this year, so that they can hammer out a solution to the ballooning 
deficit.
  I am particularly concerned about the impact the State budget crunch 
will have on the Medicaid Program and the low-income children and 
families who rely on this program for essential health coverage. Last 
year, the House passed the Senate Centrists Economic Stimulus bill that 
I developed along with Senator Breaux and others, and that proposal 
contained about $4.5 billion in emergency Medicaid funding to the 
States. Unfortunately, we could not get a vote on the proposal in the 
Senate.
  In January, I voted to support an amendment by Senator Harkin to the 
compromise economic stimulus bill that would have increased the FMAP by 
3 percent for all States and 1.5 percent for States with higher than 
average unemployment rates, but the amendment was defeated.
  Passage of this Rockefeller-Collins amendment would mean the infusion 
of about $54 million into my State of Maine--$36 million under the FMAP 
provisions alone. Maine is currently staring down the barrel of a $180 
million budget shortfall. Many States face similar circumstances and 
still others face a figure many times that amount.
  We do not want, and we certainly do not need, our States to reduce 
essential health care and social services to people in need in order to 
balance their budgets. The low-income families and seniors of this 
Nation should be able to rely on the continuation of these programs on 
which they have come to depend. The states should receive the help they 
need to continue their programs offering prescription drugs to seniors 
and low-income individuals and families. During these difficult fiscal 
times, our States need more federal assistance in providing health care 
services through Medicaid, not less.
  I want to thank the Senator from West Virginia, Mr. Rockefeller, and 
my colleague, Ms. Collins, for offering this amendment and I urge my 
colleagues to support our States and this amendment.
  The PRESIDING OFFICER. Who yields time? The Senator from West 
Virginia.
  Mr. ROCKEFELLER. Madam President, I ask to retain 5 minutes to close 
debate on this side.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ROCKEFELLER. I yield 2 minutes or so to the distinguished Senator 
from Maine.
  The PRESIDING OFFICER (Mr. Carper). The Senator from Maine.
  Ms. COLLINS. I thank the Senator from West Virginia. It has been a 
pleasure to work with him and the Senator from Nebraska, as well as the 
Senator from Oregon, on this important amendment.
  The Senator from Nebraska raised a very good point. This amendment 
has implications for all of our health care providers and that is why 
it enjoys such strong support of our nursing homes, of our hospitals--
our rural hospitals are struggling with inadequate reimbursements--from 
disability advocates and the Visiting Nurse Associations.
  But let's talk about what this means. We have talked about it being 
necessary to protect the most vulnerable

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in our society. Let's talk about what it means for some individual 
States.
  I mentioned yesterday that this amendment would provide $54 million 
in much needed relief to my home State of Maine. That would help avoid 
the necessity for draconian cuts in essential social service programs 
such as our Medicaid Program. But let's look at a few other States.
  For Alabama, for example, this would mean $92.6 million; for Alaska, 
it would be $32.2 million; for Arizona, $144 million; for Arkansas, $80 
million.
  Let me skip down a bit. For Florida, $359 million; for Georgia, $208 
million; for Hawaii, $28 million; for Idaho, $28.6 million. Indeed, the 
Governor of Idaho, our former colleague, Governor Kempthorne, has 
worked very hard as an advocate for this important legislation.
  In other words, every single State in the Nation would be by this 
amendment provided with much needed relief. That is why we need to act. 
Otherwise, States are going to have no choice but to slash essential 
programs.
  We have new figures coming out today that show the fiscal crisis 
affecting our partners, the States, has widened still further. 
According to the National Conference of State Legislators, States have 
used up two-thirds of their cash on hand. The gap between revenues and 
spending has hit $36 billion and is expected to be $58 billion, 
affecting 46 States. We must act. I urge my colleagues to reject the 
point of order.
  The PRESIDING OFFICER. The Senator has used 2 minutes.
  The Senator from West Virginia.
  Mr. DASCHLE. Would my colleague from West Virginia withhold for a 
moment? If the Senator from West Virginia will yield, I appreciate my 
colleague's courtesy.
  Mr. ROCKEFELLER. Mr. President, I yield.

                          ____________________