Congressional Record, Volume 149 Issue 120 (Thursday, September 4, 2003)

[Congressional Record Volume 149, Number 120 (Thursday, September 4, 2003)]
[Senate]
[Pages S11100-S11107]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS ACT, 2004--Continued

The PRESIDING OFFICER. The Senator from Ohio.
Mr. DeWine. Madam President, my colleague from New York and other
Members who are on the Senate floor have several amendments that I ask
unanimous consent to have set aside. I anticipate speaking probably for
about 10 minutes.
Mr. SPECTER. Madam President, will the Senator from Ohio yield for an
announcement?
Mr. DeWINE. I yield.
Mr. FRIST. Madam President, just for the information of our
colleagues, we will have no more rollcall votes tonight. The plan at
this juncture is that most likely we will have two stacked rollcall
votes in the morning. That is subject to change. People should stay in
touch with the cloakrooms. But for tonight, there will be no more
rollcall votes.
We will continue with amendments, and I ask Members to come to the
floor so we can prepare for tomorrow. We will have stacked votes in the
morning.
The PRESIDING OFFICER. The Senator from Ohio.

Amendment No. 1561 to Amendment No. 1542

Mr. DeWINE. Madam President, I call up my amendment numbered 1561.
The PRESIDING OFFICER. Without objection, the pending amendments will
be set aside and the clerk will report.
The assistant legislative clerk read as follows:

The Senator from Ohio [Mr. DeWine] proposes an amendment
numbered 1561 to amendment No. 1542.

Mr. DeWINE. Madam President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To provide funds to support graduate medical education
programs in children's hospitals)

On page 61, between lines 14 and 15, insert the following:
Sec. __. (a) In General.--To carry out programs to support
graduate medical education programs in children's hospitals
under section 340E of the Public Health Service Act (42
U.S.C. 256e et seq.), there are appropriated a total of
$305,000,000, including amounts otherwise made available in
this Act for such programs.
(b) Offset.--Amounts appropriated under title III under the
heading ``Program Administration'' shall be reduced by
$15,000,000.

Mr. DeWINE. Madam President, this amendment would increase the amount
of pediatric graduate medical education funding to $305 million--up
from the $290 million currently in the bill.
I remind my colleagues that a sense-of-the-Senate amendment was
attached to this year's budget resolution which indicated that
children's graduate medical education should be funded at $305 million.

[[Page S11101]]

This amendment would mirror the sense-of-the-Senate resolution which
we have already adopted. That is all it would do. But I believe it is
important that we provide these additional dollars.
This funding for pediatric graduate medical education is truly a
vital part of our efforts to protect children's health in this country.
To date, children's hospitals, though they represent only 1 percent
of all hospitals in the country, train 30 percent of all pediatricians
and 50 percent of all pediatric specialists. They also provide hospital
care to almost 50 percent of all seriously ill children in this
country.
Furthermore, children's hospitals serve as the health care safety net
for low-income children in their respective communities and are often
the sole regional providers of many critical pediatric services.
These children's hospitals are often the only source of many
pediatric specialty services, and it is their graduate training
programs that make these services possible. Funding for pediatric
graduate medical education helps provide our Nation with highly
qualified pediatricians, pediatricians who can properly treat and care
for our children when they are sick.
Clearly, funding for GME in children's hospitals is a sound
investment in children's health and provides stability for the future
of the pediatric workforce. I urge my colleagues to join me in
providing this additional $15 million in funding for graduate medical
education in children's hospitals.
Anyone who has had the occasion to take their child to a children's
hospital, as I have, and to see the magical work these children's
hospitals do, I think can appreciate the need for this amendment. To
see the specialists descend on your child when you are concerned about
that child's safety, maybe that child's life, is just something you
really cannot describe.
The children's hospitals will tell you that this graduate medical
education money has been a lifesaver for them. It is essential that we
provide this money through the appropriations process, frankly, because
of a quirk in the law. It is a quirk in the law that we have to do it
through the appropriations process because they do not automatically
get the money through the entitlement process because, obviously, they
do not serve many Medicare patients. So it does not come to them
automatically, as it does all the other hospitals in the country. So
every year we have to go through this process.
I am simply asking that the funds be increased to $305 million. It is
the right thing to do. It is the proper thing to do. I ask my
colleagues to support this very simple amendment.
Madam President, I ask unanimous consent that this amendment be set
aside for the time being.
The PRESIDING OFFICER (Ms. Collins). Without objection, it is so
ordered.

Amendment No. 1560 To Amendment No. 1542

Mr. DeWINE. Madam President, I now call up amendment No. 1560.
The PRESIDING OFFICER. The clerk will report.
The assistant legislative clerk read as follows:

The Senator from Ohio [Mr. DeWine] proposes an amendment
numbered 1560 to amendment No. 1542.

Mr. DeWINE. Madam President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To provide funds to support poison control centers)

On page 61, between lines 14 and 15, insert the following:
Sec. __. (a) In General.--To provide funding for poison
control centers under the Poison Control Enhancement and
Awareness Act (42 U.S.C. 14801 et seq.), there are
appropriated a total of $27,600,000, including amounts
otherwise made available in this Act for such centers.
(b) Offset.--Amounts appropriated under title III under the
heading ``Program Administration'' for building alterations
and related expenses for relocation shall be reduced by
$5,300,000.

Mr. DeWINE. Madam President, the amendment I am now offering would
fully fund poison control centers at $27.6 million. That is an increase
of $5 million from what the bill currently funds at $22.3 million.
Members of the Senate, there are currently over 70 poison control
centers nationwide. These centers have fielded over 1 million phone
calls since January 2002, answering questions about poisonings, drug
abuse, product contents, substance identification interactions, and
adverse reactions. They can answer questions and concerns about what
would typically be called poison products--things such as cleaners,
bleaches, anything you would find in your home, any emergency a family
might face. This is the most common poison exposure for children,
children who typically ingest household products such as cosmetics and
personal care products, cleaning substances, pain relievers, foreign
bodies, and plants.
Our Nation's poison control centers handle an average of one poison
call every 15 seconds. Clearly, these centers provide a vital service
to the parents and family members.
The money we provide in this bill will go toward the continuation of
the centers' work, as well as the maintenance of the toll-free
nationwide poison control hotline. That number, of course, is 1-800-
222-1222. Let me repeat that: 1-800-222-1222. That is a number that
anybody in this country now can call. Wherever you are, if you are on
vacation, if you are in your own home, if you are visiting someone, you
can pick up the phone and call that number, and you will go onto a
poison control hotline.
I have used it. My daughter has used it for her children. It is
something that is so very valuable for a parent, anyone who has
children. And certainly it is not just for somebody with children. It
is for anybody who is in a position to be around someone who has
ingested something and they don't know what it is.
As anyone who has visited poison control centers can tell you, it is
also now particularly important in a day and age when we worry about
terrorism. Poison control centers have a particular meaning for us
today.
With the funding in the bill, and with the additional funding that
would be provided by my amendment, we are not just making an investment
in poison control; rather, we are making it easier to keep our
children, our friends, and ourselves safe and healthier.
I therefore urge my colleagues to support this very modest investment
in our health. And I might say, the Federal Government is only a small
partner in the poison control centers. When you go and visit the poison
control centers around the country, what you will find is that they are
funded many times by the local hospitals that pay for them themselves.
They are funded by State and local government units. The money we
provide is a small part of the overall money, but it is a very crucial
and very important part of that contribution to keep these poison
control centers going.
This is a very modest amendment, but it is a very important
amendment. I urge my colleagues to support it when we do, in fact, vote
on the amendment.
Madam President, I ask unanimous consent that this amendment be set
aside.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 1555 To Amendment No. 1542

Mr. DeWine. Madam President, I call up amendment No. 1555.
The PRESIDING OFFICER. The clerk will report the amendment.
The assistant legislative clerk read as follows:

The Senator from Ohio [Mr. DeWine] proposes an amendment
numbered 1555 to amendment No. 1542.

Mr. DeWINE. Madam President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To express the sense of the Senate concerning the Pediatric
Research Initiative)

[[Page S11102]]

Pensions of the Senate and the Committee on Energy and
Commerce of the House of Representatives on the status of the
Pediatric Research Initiative, including--
(A) the extent of the total funds obligated to conduct or
support pediatric research across the National Institutes of
Health, including the specific support and research awards
allocated by the Office of the Director through the
Initiative;
(B) the activities of the cross-institute committee on
pediatric research in assisting the Director in considering
requests for new or expanded pediatric research to be funded
through the Initiative;
(C) how the Director plans to budget dollars toward the
Initiative for fiscal year 2004;
(D) the amount the Director has expended to implement the
Initiative since the enactment of the Initiative;
(E) the status of any research conducted as a result of the
Initiative;
(F) whether that research is translational research or
clinical research;
(G) how the Initiative interfaces with the Off-Patent
research fund of the National Institutes of Health; and
(H) any recommended modifications that Congress should
consider in the authority or structure of the Initiative
within the National Institutes of Health for the optimal
operation and success of the Initiative.

Amendment No. 1555, As Modified

Mr. DeWINE. Madam President, further, I ask unanimous consent that
the amendment be modified on page 2, line 8, to include the Senate and
House Appropriations Committees.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The amendment, as modified, is as follows:

On page 61, between lines 14 and 15, insert the following:
Sec. __. To demonstrate the appreciation that the Senate
has for, and to further encourage, the efforts of the
Director of the National Institutes of Health in implementing
the Pediatric Research Initiative under section 409D of the
Public Health Service Act, it is the sense of the Senate
that--
(1) the Director should continue the Initiative and
emphasize the importance of pediatric research, particularly
translational research; and
(2) not later than January of 2004, the Director should
continue to report to the Committee on Health, Education,
Labor, and Pensions of the Senate, the Committee on Energy
and Commerce of the House of Representatives, the Senate
Committee on Appropriations and the House Committee on
Appropriations on the status of the Pediatric Research
Initiative, including--
(A) the extent of the total funds obligated to conduct or
support pediatric research across the National Institutes of
Health, including the specific support and research awards
allocated by the Office of the Director through the
Initiative;
(B) the activities of the cross-institute committee on
pediatric research in assisting the Director in considering
requests for new or expanded pediatric research to be funded
through the Initiative;
(C) how the Director plans to budget dollars toward the
Initiative for fiscal year 2004;
(D) the amount the Director has expended to implement the
Initiative since the enactment of the Initiative;
(E) the status of any research conducted as a result of the
Initiative;
(F) whether that research is translational research or
clinical research;
(G) how the Initiative interfaces with the Off-Patent
research fund of the National Institutes of Health; and
(H) any recommended modifications that Congress should
consider in the authority or structure of the Initiative
within the National Institutes of Health for the optimal
operation and success of the Initiative.

Mr. DeWINE. Madam President, this amendment is a sense-of-the-Senate
amendment expressing the importance of pediatric research at NIH.
Specifically, this amendment says we should continue the work of the
Pediatric Research Initiative. This is an effort I worked on with
several of my colleagues and was included in the Children's Public
Health Act of the year 2000.
This initiative helps ensure that more funds can be dedicated to
children's health research within the National Institutes of Health.
Mr. SPECTER. Madam President, will the Senator yield for a question?
Mr. DeWINE. I yield.
Mr. SPECTER. Will the Senator from Ohio be willing to take a voice
vote, at this point, accepting this amendment?
Mr. DeWINE. I would be more than happy to do that.
Mr. SPECTER. Madam President, I urge adoption of the amendment.
The PRESIDING OFFICER. If there is no further debate, without
objection, the amendment, as modified, is adopted.
The amendment (No. 1555), as modified, was agreed to.
Mr. SPECTER. I thank my distinguished colleague from Ohio and I thank
the Chair.

Amendment No. 1578 To Amendment No. 1542

Mr. DeWINE. Madam President, at this point I call up amendment No.
1578.
The PRESIDING OFFICER. Without objection, the clerk will report the
amendment.
The assistant legislative clerk read as follows:

The Senator from Ohio [Mr. DeWine], for himself, Mr.
Alexander, Ms. Stabenow, Mr. Grassley, and Mr. Voinovich,
proposes an amendment numbered 1578 to amendment No. 1542.

Mr. DeWINE. Madam President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To provide funding for the Underground Railroad Education and
Cultural Program)

On page 74, line 1, strike ``$409,863,000, of which
$13,644,000'' and insert ``$406,863,000, of which
$10,644,000''.
On page 76, between lines 11 and 12, insert the following:
Sec. __. For necessary expenses for the Underground
Railroad Education and Cultural Program, there are
appropriated $3,000,000.

Mr. DeWINE. Madam President, the amendment I offer now, along with
Senators Alexander, Stabenow, Grassley, and Voinovich, will provide $3
million in funding for the Underground Railroad Education and Cultural
Act, a 1998 law that Senator Collins and I wrote together. The
Underground Railroad Education and Cultural Act was designed to assist
in establishing programs to research, display, interpret, and collect
artifacts and other items relating to the history of the underground
railroad. The bill before us now has unfortunately zero-funded this
program. I believe we must correct that.
Our amendment would provide $3 million for this program. As my
colleagues know, the history of the underground railroad is a vital
part of the history of our great country. In the 20 years or so prior
to the Civil War, it is estimated--of course, no one will ever know
what the true figure is--that more than 40,000 slaves used this
underground railroad, as we refer to it, as a pathway to their ultimate
freedom. It is a great story in the history of our country. It is a
great story every schoolchild in America should know about.
More than 150 underground railroad sites have been identified in my
State of Ohio alone. But Ohio is not unique. All the States that border
along the Ohio River and were actually considered to be border States
have sites on the underground railroad. There were people all along on
both sides who helped slaves escape. African Americans helped slaves
escape. White Americans helped slaves escape. There were so many
heroes.
Their stories need to be told. There are many more other sites out
there that frankly need to be identified, and their stories need to be
told as well. These sites symbolize freedom for thousands and thousands
of enslaved Americans. When I visit these sites, as I have with my
family--in fact, I had the opportunity this August during our recess to
visit several of them--it makes me pause and think about the sacrifice
that was made by so many people. It reminds us of the history of this
country. It reminds us of the horror of slavery, a part of our history
that simply has to be told. But it also reminds us of the good part of
that history; that is, the sacrifice made by so many people so others
could be free.
This program is very important. I urge my colleagues to join me in
support of this funding request. This funding request will enable this
story to be told and told in a better way.
Madam President, I ask unanimous consent at this point that the
amendment be set aside.
The PRESIDING OFFICER. Without objection, it is so ordered.

International HIV Initiative

Mr. DeWINE. Madam President, I will at some point, as I indicated
this morning, be coming to the floor and offering an amendment
concerning President Bush's International Mother and Child Prevention
of HIV initiative. As I indicated this morning, unfortunately the bill
before us does fall short by $60 million what the President requested.

[[Page S11103]]

The President requested $150 million in regard to the amount of money
to be provided for this initiative. I will be talking about this later
and will be offering an amendment concerning it. This is the most cost-
effective way to save lives.
A number of my colleagues went with Senator Bill Frist to Africa. We
returned just last week. We saw firsthand the good this program is
already doing. For as little as $3, a pregnant woman can be given the
help, the drugs she needs to ensure that her child will not be born HIV
positive.
The statistics are staggering. For a mother who is HIV positive, the
odds are approximately 30 percent that she, untreated, will give birth
to a child who will be HIV positive. We all know what that means, what
horrible tragedy that is. In countries we visited such as Namibia and
South Africa, there are now ongoing programs. Many of them, because of
the initiative of President Bush and this Congress, are good people
working, reaching out to these pregnant mothers who are HIV positive.
They have reduced that percentage now down to 5 or 10 percent. If that
mother can be given a drug prior to the birth of that child--as I said,
it now costs as little as $2, $3, maybe $4--we can reduce the odds from
30 percent to giving birth to a child who is HIV positive down to as
little as 10 percent and possibly as low as 5 percent.
That is why it is so very important that we restore the funding in
this bill to the $150 million requested by President Bush. I will be
coming to the floor later on as we debate this bill and offering an
amendment to restore the funding to the level President Bush requested.
I will be back on the floor later on to do so.
I yield the floor.
The PRESIDING OFFICER. The Senator from New York.
Mrs. CLINTON. Madam President, I commend and thank my colleague from
Ohio who is always looking out for the children. This has been a
mission of his, year in and year out. I thank him for the amendments he
has just discussed because every one of them concerns the well-being of
our children. I look forward to supporting these amendments. I
particularly thank the Senator for amendment 1561 to restore the money
for pediatric graduate medical education.

Amendment No. 1565 To Amendment No. 1542

Mrs. CLINTON. Madam President, I ask unanimous consent that amendment
1565 be called up.
The PRESIDING OFFICER. Without objection, the clerk will report.
The assistant legislative clerk read as follows:

The Senator from New York [Mrs. Clinton] proposes an
amendment numbered 1565 to amendment No. 1542.

Mrs. CLINTON. Madam President, I ask unanimous consent that reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To provide additional funding to ensure an adequate
bioterrorism preparedness workforce)

On page 36, line 16, strike the period at the end and
insert ``: Provided further, That the amount $6,252,256,000
under the heading `Health Resources and Services' shall be
deemed to be $6,272,256,000 of which the additional
$20,000,000 shall be available for carrying out sections 765
and 767 of the Public Health Service Act: Provided further,
That the amount $4,588,671,000 under the heading `Disease
Control, Research, and Training' shall be deemed to be
$4,631,871,000: Provided further, That the amount
$1,726,846,000 under the heading `Public Health and Social
Services Emergency Fund' shall be deemed to be
$1,756,846,000: Provided further, That the amount
$1,116,156,000 under the heading `Public Health and Social
Services Emergency Fund' shall be deemed to be $1,146,156,000
Provided further, That the amount $6,895,199,000 in section
305(a)(1) of this Act shall be deemed to be $6,988,399,000:
Provided further, That the amount $6,783,301,000 in section
305(a)(2) of this Act shall be deemed to be $6,690,101,000:
Provided further, That of the funds appropriated in this Act
for the National Institutes of Health, $93,200,000 shall not
be available for obligation until September 30, 2004.

Mrs. CLINTON. Madam President, this amendment is intended to provide
the money that is needed to ensure that at the Federal, State, and
local levels, we have an adequate bioterrorism workforce. In order to
do that, we have to fund the pipeline.
This summer the Partnership for Public Service issued a report
stating that 50 percent of our experts trained to respond to a
biological or chemical attack will retire over the next 5 years. That
puts our country and our public health at risk.
Obviously, every one of us in this body is committed to making our
country safer and providing the bioterrorism funding we have fought for
since 9/11. And I appreciate the great support the Senate has given to
increasing dollars to combat the threat of bioterrorism. But,
unfortunately, our frontline defenders, who are our health
professionals, are decreasing in number when we need them more than
ever.

According to the Office of Personnel Management, more than 2,600
public health professionals in the Federal Government are eligible to
retire in 2008, and that number could soar to more than 8,000 in just
the next few years.
Unfortunately, the shortage in personnel is not just Federal. It is
already being felt at the State and county levels. In county after
county in the public health departments, I have been given reports that
so many of the staff members are being stretched thin and they are
unable to do the work that is required. If we don't find ways to
provide the resources to attract and pay for these professionals, we
are going to be in a terrible dilemma not only if a horrible event or
some kind of biological or chemical attack were to occur, but even with
the outbreak of something like SARS, or something unpredictable that we
may have never encountered before.
The Bioterrorism Preparedness and Response Act that we passed in 2002
does help with workforce training, recruitment and development. But
with respect to what has occurred since 2002, we already know we have
had increased demands on our public health system, and we have
insufficient resources to expand personnel or, as these recent reports
I have referenced indicate, keep pace at current levels.
The CDC and other agencies need to do strategic planning. My
amendment includes $5 million to fund an annual needs assessment, with
a report to Congress, of Federal, State, and local bioterrorism
personnel, conducted by the Institute of Medicine or another competent
and independent authority.
But even while we are looking longer term, we have immediate public
health needs right now. I know that, for example, in New York, two
Centers for Public Health Preparedness are located at SUNY Albany and
Columbia University. They have already trained 10,000 people each year
in bioterrorism preparedness. Many regions don't have these centers of
excellence, and we have to figure out how we can get the resources and
personnel to every part of our country.
According to the Association of Schools of Public Health Preparedness
and Prevention, the 19 nationwide Centers of Public Health Preparedness
have asked the administration for $50 million--nearly double what the
President's budget proposes. I think we should meet those requests, and
my amendment would provide the funds to do that.
My amendment also provides funds, in accordance with the
recommendation of CDC's own National Advisory Committee on Children and
Terrorism, to double the number of outbreak specialists in the Epidemic
Intelligence Service. These EIS specialists are dispatched to respond
to epidemics and bioterrorism.
The resident expertise that we need in State and local public health
departments is also crucial. My amendment would provide $25 million to
the Epidemiology Program Office, the National Center for Infectious
Diseases, and the Public Health Practice Program Office of the CDC to
recruit and train 1,600 epidemiologists, 800 laboratory personnel, 800
public health nurses, and 800 other public health professionals to work
in State and local public health departments nationwide.

The Council of State and Territorial Epidemiologists estimates that
State and local public health departments need to hire 1,600
epidemiologists over the next 10 years to prevent worsening shortages
of State and local epidemiologists. It costs about $60,000 to train a
public health professional. This proposal would spread that investment
over 10 years.
Finally, the amendment also provides $20 million for carrying out
sections 765 through 769 of the Public

[[Page S11104]]

Health Service Act to title VII to encourage personnel to enter
epidemiology and bioterrorism detection careers.
Title VII has been decimated each of the last 3 years. It has been a
struggle to keep it even flat-funded from year to year. Unfortunately,
the pipeline for epidemiologists and bioterrorism experts has suffered
as a result.
I hope to be able to work this out without the manager of the bill. I
understand completely the many competing considerations he has to
balance, but it is imperative that we start to meet these needs. If we
pass this amendment today and get the money in the pipeline, we can
begin to train and hire the doctors, nurses, and other public health
professionals who are going to be necessary for us to deal with
whatever we face in the future.
Unfortunately, terrorists or epidemics like SARS don't wait while the
retirement notices are stacking up. I don't think we should either.
This $93 million would be money well spent that would make us better
prepared to deal with the incredible challenges that we confront as we
try to ensure that our vigilance and our concern is matched by the
expertise we need to actually deal with any problem that we may
confront.
Madam President, I ask that this amendment be supported, but I ask,
too, that we look for a way to deal with this pipeline problem that is
so critical to actually putting teeth into the preparedness that we
have passed in this body and funded since September 11.
I yield the floor.
The PRESIDING OFFICER. The Senator from Pennsylvania is recognized.
Mr. SPECTER. Madam President, there is no doubt of the tremendous
need for preparation for bioterrorism. During the recess month, I spent
most of it traveling through my State visiting first responders--
essentially fire departments, in conjunction with police departments
and other county organizations that are being set up for response to
potential bioterrorist attacks.
When 9/11 struck, obviously, the U.S. was totally unprepared. I think
the ranking member will recall that we had to have the hearing in the
bowels of this building because we were kicked out of the other hearing
rooms. We brought in the Centers for Disease Control and insisted that
they give us an itemization of the various types of biological attack,
what resources were currently available, and what additional resources
we would need.
We had a very tough time getting information from the Centers for
Disease Control by the time they went through the alphabet soup. They
had to get permission from HHS, and then Health and Human Services had
to get permission from the Office of Management and Budget. Finally, we
got the information informally. We could not get it formally. We got it
informally.
I have just been handed talking points and information and facts by
my staff. The way the Senate functions is that these amendments come
without any significant advanced notice. The Senator from New York was
halfway through her argument before I got a copy of her amendment. I
challenge anybody to read the amendment and follow it.
Well, people can't hear me on C-SPAN because my microphone wasn't on.
The point was that we did get a supplemental appropriations bill for
approximately $3 billion. We had quite an extended discussion in the
living quarters of the White House--something I probably ought not to
talk about. But the President invited a group of us over and we got
into a long discussion. There were those in the administration,
according to an article published a day after Thanksgiving, that wanted
to put it in next year's budget. They wanted to wait until 2002 to put
it in 2003.
Talking directly to the President, a number of us prevailed and put
$3 billion into the budget at that time.
We now have a very extensive itemization of funding. The CDC has $940
million for State and local preparedness. Upgrading CDC capacity:
$143,700,000. Pharmaceutical stockpile: $300 million. Smallpox
vaccine--and it goes down to a full page. I ask unanimous consent that
list be printed in the Record so I need not read it all.

----------------------------------------------------------------------------------------------------------------
FY03 Transfers FY 2003 FY 2004 FY 2004
Activity Enacted .65% ATB to DHS Comparable Request Senate
----------------------------------------------------------------------------------------------------------------
CDC

State and Local Preparedness $940,000 $6,110 ........... $933,890 $940,000 $940,000
Upgrading CDC Capacity...... 143,700 934 -584 142,182 143,700 143,700
Pharmaceutical Stockpile.... 300,000 1,950 -298,050 0
Smallpox Vaccine............ 100,000 650 -99,350 0
Anthrax Vaccine Research.... 18,040 117 ........... 17,923 18,040 18,040
Planning for Preparedness 10,700 70 ........... 10,630 10,416 10,416
Resp.......................
Deterrence.................. 4,000 26 ........... 3,974 4,000 4,000
Public Health Preparedness 5,000 33 ........... 4,968 0 0
Centers....................
Health Alert Network........ ........... 0 ........... 0 0 0
CDC Security PHSSEF......... 20,000 130 ........... 19,870 0 0
CDC Security (B&F non-add).. ........... 0 ........... 0 0 0
Independent Studies......... 2,000 13 ........... 1,987 0 0
-----------------------------------------------------------------------------------
Subtotal, CDC......... 1,543,440 10,032 -397,984 1,135,424 1,116,156 1,116,156
===================================================================================
HRSA

Hospital Preparedness....... 518,000 3,367 ........... 514,633 518,052 518,052
Education Incentives for 28,000 182 ........... 27,818 60,012 60,012
Medical School Curriculum..
EMS for Children............ ........... 0 ........... 0 18,943 0
Poison Control.............. ........... 0 ........... 0 21,166 0
-----------------------------------------------------------------------------------
Subtotal, HRSA........ 546,000 3,549 ........... 542,451 618,173 578,064
===================================================================================
OFFICE OF THE SECRETARY

Transfers to DHS............ 88,420 575 -87,845 0 0 0
Medical Research Corps...... 10,000 65 ........... 9,935 10,000 10,000
Preparedness Planning....... 6,800 44 ........... 6,756 6,800 6,800
Operations.................. 12,720 83 ........... 12,637 12,720 12,720
Advanced Research........... 5,000 33 ........... 4,968 5,000 5,000
Command and Control......... ........... 0 ........... 0 0 0
National Security Early 9,500 62 ........... 9,438 9,500 9,500
Warning....................
Secretary's Emergency 3,000 20 ........... 2,981 3,000 3,000
Response Team..............
Media/Public Information.... 4,800 31 ........... 4,769 4,800 4,800
Commissioned Corps 2,000 13 ........... 1,987 0 0
Revitalization.............
CyberSecurity............... 10,000 65 ........... 9,935 10,000 10,000
-----------------------------------------------------------------------------------
Subtotal, OS.......... 152,240 990 -87,845 63,405 61,820 61,820
CDC--Supplemental........... ........... .............. ........... 142,000 0 0
SAMHSA...................... ........... 0 ........... 0 0 0
AHRQ........................ 5,000 33 ........... 4,968 0 0
Pandemic Flu................ ........... 0 ........... 0 100,000 100,000
===================================================================================
Subtotal, 2,246,,680 14,603 -485,829 1,888,247 1,896,149 1,856,040
Bioterrorism--PHSSEF.
----------------------------------------------------------------------------------------------------------------

Mr. SPECTER. Madam President, then the Department of Homeland
Security bill was passed by this body with some $29 million, which
covers a great deal more funding.
I appreciate the initiative taken by the Senator from New York and
her diligence in coming up with this

[[Page S11105]]

amendment in an area which, beyond any question, is of overwhelming
importance, critical importance. I, frankly, do not know how to
evaluate her request for $93 million additional in the context of all
of the programs which are in existence.
I think it is fair to state, and I think the Senator from New York
has an abundance of experience in the executive branch, that the
executive branch has better planning capabilities in integrating these
items in the overall program. Not that the $93 million might not be
well placed, well positioned and critical. It might be, I just cannot
say. But I do know there has been extensive consideration by the
executive branch, and I also know that the $93 million is not within
the 302(b) allocation.
I come back to this again and again on items which I concede are
important, but we do not have the funds within the budget resolution
and within the allocation.
I know the Senator from New York will not be surprised that there
will be opposition to it. We will raise a point of order. But I do
think the amendment serves a very useful function in identifying what
the Senator from New York thinks are critical points that ought to be
funded.
I commit this to the Senator from New York--to have a hearing on the
subject and to include the precise items which she has raised so that
we will take them into account in our funding stream as we move into
the next fiscal year.
Mrs. CLINTON. Madam President, will the Senator from Pennsylvania
yield?
Mr. SPECTER. I do.
The PRESIDING OFFICER. The Senator from New York.
Mrs. CLINTON. Madam President, I wish to express my appreciation to
the chairman for that offer. Perhaps even before the bill is totally
wrapped up we could take a look at some of those categories of funding
because what I am concerned about, as the Senator rightly referenced,
is in all of the funding categories, these requests I have put in this
amendment are coming from constituent agencies, such as CDC, that at
least believe at this point in time that the money available for
bioterrorism has not been sufficiently targeted to this personnel
issue.
I appreciate not only the kind offer of a hearing, because I think
this is an issue that is going to go on for quite some time--it is not
going to be resolved one way or another even if this amendment were
successful--but also perhaps in the next several days if our staffs can
look to see if there is a better opportunity to better target some of
this funding to deal with this pipeline professional problem that is
not only at the Federal Government level, but State and local as well.
The PRESIDING OFFICER. The Senator from Pennsylvania.
Mr. SPECTER. Madam President, I would be delighted to follow the
suggestion made by the Senator from New York to take a look at them
regardless of the outcome of the vote. It may be that the executive
branch can learn from what the Senator from New York has found on her
inquiries and can redirect some of the existing funds, or it is
possible we could find some accommodation to this in the course of the
conference.
We will look very closely at the suggestions which the Senator from
New York has made and see if we can find a way to accommodate them.

Amendment Nos. 1561, 1560, and 1578

Mr. SPECTER. Madam President, I wish to turn for a few moments to the
amendments offered by the Senator from Ohio. I did not take time to
respond before the Senator from New York offered her amendment. She was
very patient in waiting while the Senator from Ohio went through quite
a long list of his amendments.
He has offered three amendments which are well directed and I think
meritorious when he talks about the historical impact of the
underground railroad. That is a matter of importance in education and
it comes right into Pennsylvania where currently the development
project in Lancaster has found remnants of the underground railroad.
The House of Representatives has put in $2.235 million.
When the Senator from Ohio talks about poison control centers for $5
million, again he is on a good point. And when he talks about graduate
medical education, he is not bringing it up to last year's level, he is
adding money. This is an item which this Senator spent a lot of time
on, as did Senator Harkin. There was no funding for this in 1999, and
in the year 2000, to start, it was slightly under $40 million, and then
when I chaired the subcommittee, with the concurrence of Senator
Harkin, we made an enormous increase to $234 million for fiscal year
2001.
We then added $50 million in 2002 to $284 million, and it was at $290
million in 2003. The administration made a request for slightly under
$200 million, and in a tough way we found $90 million more.
When you take them out of administration, there are going to be a lot
of people unemployed, and I do not know that we can direct that
unemployment solely to Ohio--I wish the Senator from Ohio were here--if
it would be possible to target that unemployment to the Senator's
State. But if you take out $22 million from administration--that is a
nice fat target to say take it out from administration. But there are
very substantial impacts when that money is taken out.
I am going to confer with the Secretary of the Department of
Education to see exactly what will happen, how many people will be
affected, specifying perhaps how many people from Ohio will be
affected.
When the Senator from Ohio wants to add $60 million to the mother-to-
child transmission, I think that is a very important item, but the fact
is we now have a grand total in the Labor-HHS bill directed toward AIDS
in excess of $14 billion. When the statement is made we are just going
to bring it back up to the President's request, in fiscal year 2003,
this was a $40 million item. The President asked for $150 million for
this year, and we found $90 million to accommodate.
Bear in mind that we do this in a context where the administration
has come in on many items far under what they were last year. For
example, graduate medical education, to which the Senator from Ohio
wants to add $15 million, we added $90 million over what the President
requested. So perhaps the Senator from Ohio would like us to go back to
the President's request on graduate medical education, and we would
have ample money to put in $60 million more to bring it up to the
President's request on the mother-to-child transmission.
I say that only by way of demonstrating that it is just not so easy
to come up to the President's request on a given item when many times
the President's request was far under what we are at the present time.
The idea of level funding is very important in the appropriations
process so you do not make drastic changes. People can live with what
they got last year without accounting for inflation, but if you want to
drop, as the President's budget did on graduate medical education, from
$290 million to $199 million, that is going to be very tough to absorb.
We took that into account.
The Constitution places the appropriations process in the Congress.
That is something which is frequently overlooked.
The President obviously has an important role because he has to sign
the bill, or we have to pass them without his signature, if we can do
that.
This bill is very carefully crafted. Perhaps it is easy to see that I
have to oppose the amendments by the Senator from Ohio. Perhaps there
can be some accommodation to some of the smaller amounts but that, too,
is difficult. Although the Senator from Wisconsin said a million
dollars was not very much money, quoting Everett Dirksen, a million
here and million there--maybe Everett Dirksen said a billion here or a
billion there, but if for Dirksen it was a billion here and a billion
there, then make it Arlen Specter, a million here and a million there,
it all adds up.
I yield to my colleague from Iowa.
Mr. HARKIN. I thank my chairman, friend and able leader on this
appropriations bill. I think we all wish we had a little bit more
302(b) allocation but that is for another time and place.
Earlier today I spoke about offering an amendment that would
basically prohibit the administration from moving ahead on implementing
a proposed rule that would basically undermine and do away with the 40-
hour workweek that we have had in the Fair

[[Page S11106]]

Labor Standards Act since 1938. Earlier this spring, the administration
proposed some rule changes. Not one hearing was held on it.
As we looked through these proposed rules this summer and dug into
them, it would drastically undermine the ability of working families,
working men and women in America, to get justly compensated for
overtime work in the future.
I was talking to one of my colleagues today about this, and he said
to me, I have not really had a big clamor in my State for these
changes. I got to thinking about it. I got to thinking I really have
not had anybody in the past year or 2 years ago, or earlier this year--
I have seen no real groundswell or anything about the fact that these
rules as they exist now need to be changed. I do not know where this
comes from. All of a sudden they are proposing this massive change in
the way people's work is defined in this country and whether they are
exempted from overtime pay or not.
So I have an amendment that I drafted that basically is just very
simple. It says:

None of the funds provided under this Act shall be used to
promulgate or implement any regulation that exempts from the
requirements of section 7 of the Fair Labor Standards Act of
1938 (29 U.S.C. 207) any employee who is not otherwise
exempted pursuant to regulations under section 13 of such
act (29 U.S.C. 213) that were in effect as of September 3,
2003.

So this is an amendment that I will be laying down sometime tomorrow.
I mention again that this proposed rule change could affect up to 8
million workers, but the first wave of people that will be affected by
this rule change will be women who are working in salaried positions
that today would be paid overtime if they worked more than 40 hours a
week. These would be women who work as bookkeepers, accountants,
secretaries, nurses, nurse's aides, a whole host of different
occupations. I say women because the way that theworkforce is
structured, where the salary level is, they will fall in that lower
spectrum of salary level where it will be above the minimum but it will
be in the range where they will now be exempted from overtime work.
That will be the first wave. That is just the first people who would be
affected by it.
After that, there would be many other people affected by it--police
officers, firefighters, first responders, and others.
There is no carve-out in the proposed rules and regulations for
police, firefighters, and emergency personnel. They are thrown in with
everybody else. So somehow I keep hearing this kind of a rumor or
statement that keeps floating around that, oh, police officers will not
be affected.
Well, would someone show me in the proposed rules where it says that
police officers will not be affected? It is nowhere in there. So I do
not know what they are talking about. They are thrown in with everybody
else.
Again, I do not want to take too much more time. I will lay down the
amendment tomorrow morning at the appropriate time. For the life of me,
though, I cannot understand why the administration is proposing this
drastic change when there has been no big groundswell for the change.
I have heard some people in this room say we have to change it
because it has not been changed since 1938. That is nonsense. We have
changed the Fair Labor Standards Act several times since 1938. In fact,
a number of times this has been changed without taking away overtime
for people in our country. So to say it has not been changed since 1938
is simply erroneous. A number of times we have addressed ourselves to
new types of work, new definitions, new people in the workforce, by
changing some of the definitions. In every case in which these
definitions were changed they were changed to make it easier, to
include more people in the overtime provisions, not to exclude people.
For example, the Department of Labor revised the overtime regulations
in 1940, 1949, 1954, 1958, 1959, 1961, 1963, 1967, 1970, 1973, 1975,
and 1981. In not one of those instances was the framework narrowed to
exclude more people from overtime protections. These changes were made
basically to enlarge, enhance, and to better define who was covered,
and that is why it never really invoked much debate or consternation
because we recognized that we wanted to protect people for overtime
pay.
The minimum salary threshold has been raised seven times since 1938.
So to say that somehow we have never touched this since 1938 is
absolutely wrong. What is correct is that since 1938 we have not
circumscribed, we have not narrowed, the definitional framework to
exclude more people from overtime pay.
That is what these proposed regulations would do, and that is why the
Senate has to speak strongly, I hope next week sometime, in supporting
this amendment that would basically prohibit them from moving ahead
with this kind of a regulation.
I would point out that the House of Representatives narrowly defeated
this 213 to 210, with a number of Republicans supporting not allowing
the administration to proceed with these changes in rules. So, again, I
hope next week we can have a further debate. I intend either tomorrow
or Monday to again point out the people who are going to be affected,
what it means for their families and their income. What it basically
means is that we are going to have people working longer hours but they
are not going to be compensated for it.
As I said, many of them are women who are now paying for childcare.
Well, now they have to pay to keep their children in daycare maybe
longer but they do not get any extra pay for that.
So that is why this proposed change in rules and regulations is one
that we have to say no to. We have to make sure we continue to protect
and enhance the 40-hour workweek and make sure people who work over 40
hours, if they want to work over 40 hours or if they are compelled to
work over 40 hours, are justly compensated with it for time and a half
over 40 hours.
I yield the floor.
Mrs. FEINSTEIN. Madam President, I plan to offer an amendment to the
fiscal year 2004 Labor-HHS appropriations bill that seeks to offer
States an alternative Medicaid FMAP formula while allowing States to
remain in the current formula structure if they choose. This amendment
is vital to providing some relief to States who have been shortchanged
by hundreds of millions of dollars under the current FMAP formula for
the cost of providing Medicaid services. The amendment will not
penalize any State who wishes to remain under the current formula. It
simply allows States to opt into a new formula that better reflects
States' need. This new FMAP is only for Medicaid expenditures in excess
of fiscal year 2003 Medicaid expenditure levels.
For States who opt to go with the new formula, per capita income is
replaced with a ratio of the most recent 3-year averages of total
taxable resources, TTR, as determined by the U.S. Department of the
Treasury, and persons below the poverty level. The multiplier is also
lowered from 0.45, used in the current FMAP formula, to 0.40. For the
period 2004-2013, the new formula has a maximum increase of one
percentage point per fiscal year above the current FMAP formula for the
prior year. Once a State opts to go with the new formula, they will not
be able to switch back to the current FMAP formula. However, they will
be held harmless at the FMAP rate they would have gotten under the
current formula, prior to the Jobs and Growth Tax Relief Reconciliation
Act of 2003, for the current year. States opting for the new formula
will have Medicaid expenditures, up to the fiscal 2003 levels, matched
at the current FMAP formula and with expenditures above the fiscal 2003
levels matched at the new formula FMAP.
In a study released in July 2003, GAO found that the formula used to
calculate the portion of each State's Medicaid expenditures that the
Federal Government will pay--the FMAP--often widens the gap between
individual States and the national average. Under the current formula,
21 States move farther from the average State's funding ability after
the Federal match is added. In fact, 4 of the 21 States--California,
Florida, Hawaii, and New York--have below-average funding ability
before Federal matching is added and move farther below the average
after Federal matching aid is added.
Since Medicaid was enacted in 1965, the Federal match rate has been
determined by a State's per capital income. In its study, GAO found
that per capita

[[Page S11107]]

income is a poor proxy for determining both State resources and the
low-income population. The Feinstein amendment will give States the
option to choose a formula that is based on a combination of the
State's total taxable resources and population below the poverty level.
The PRESIDING OFFICER. The Senator from Alabama.

____________________