[Congressional Record Volume 150, Number 70 (Tuesday, May 18, 2004)]
[Senate]
[Pages S5609-S5612]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. NELSON of Nebraska (for himself and Mrs. Hutchinson):
  S. 2431. A bill to amend title XVIII of the Social Security Act to 
improve access to diabetes self-management training by designating 
certified diabetes educators recognized by the National Certification 
Board of Diabetes Educators as certified providers for purposes of 
outpatient diabetes education services under part B of the medicare 
program; to the Committee on Finance.
  Mr. NELSON of Nebraska. Mr. President, today I introduce an important 
piece of legislation that will correct an oversight from the Balanced 
Budget Act of 1997. In 1997, Congress created a new diabetes benefit 
under Medicare--diabetes self-management training--but did not create a 
new provider group to deliver it. Congress assumed that the existing 
diabetes education programs in hospitals would be able provide services 
to all who were in need.
  Certified Diabetes Educators, CDEs, were not given the ability to 
bill Medicare directly for diabetes self-management training when 
Congress passed the new benefit in 1997 because they did not feel there 
was a need to create a new provider since CDEs could work within a 
hospital setting and receive reimbursement through hospital billing. 
However, due to changing health care economics, hospital diabetes self-
management training programs have been closing at an alarming rate, 
forcing patients to seek other avenues for obtaining diabetes self-
management training, such as clinics and stand-alone programs.
  While small in scope, the Diabetes Self-Management Training Act of 
2004 will correct this oversight to ensure our Nation's seniors with 
diabetes have access to this important benefit.
  Diabetes education is very important in my State of Nebraska. 
According to the Nebraska Health and Human Services System, about five 
percent of Nebraska's adults have diagnosed diabetes--or about 60,000 
people. An additional 20,000 Nebraskans probably have diabetes but have 
not been diagnosed. While diabetes rates continue to grow at an 
alarming rate, lack of access to diabetes-self management training, 
which is critical to controlling diabetes and preventing secondary 
complications, has also become a chronic problem. Despite the fact that 
twenty percent of Medicare patients have diabetes, and about a quarter 
of all Medicare spending goes to treat diabetes and diabetes-related 
conditions, less than one-third of eligible patients are currently 
receiving the benefit.
  Because CDEs are not able to bill Medicare directly for diabetes 
self-management training, patients have limited options for obtaining 
the training they need to successfully manage their disease and prevent 
expensive and debilitating complications. The potential for 
complications is enormous. If patients with diabetes cannot gain access 
to diabetes self-management training, serious complications will arise, 
such as kidney disease, amputations, vision loss, and severe cardiac 
disease. In fact, half of all Medicare dialysis patients suffer from 
diabetes.
  By improving access to this important benefit, I believe we will take 
an important step toward helping patients control their diabetes, which 
will not only save the Medicare program the significant costs 
associated with the complications from uncontrolled diabetes, but more 
importantly it will dramatically improve the quality of life for the 
millions of Medicare beneficiaries with diabetes. That is why I am so 
proud to introduce this bi-partisan legislation, the Diabetes Self-
Management Training Act of 2004, along with my colleague Senator 
Hutchison.
  Throughout the Medicare debate last year, one of the top 
considerations for all Senators was the cost of the legislation and the 
long-term solvency of the Medicare program. In fact, we passed new 
programs in that legislation to begin studying new health care delivery 
models like Medicare that will improve the outcomes for beneficiaries 
with chronic diseases. While I strongly supported those new 
demonstration programs, we need not wait to begin helping our seniors.
  With diabetes already directly affecting so many seniors, and the 
baby boomers on the horizon, we cannot afford to deny seniors access to 
proven programs like diabetes self-management training any longer. I 
look forward to working to pass this legislation and help those with 
diabetes.
  Mrs. HUTCHISON. Mr. President, I rise today with Senator Nelson to 
introduce an important piece of legislation that will dramatically 
improve the quality of diabetes care under the Medicare program.
  Diabetes is a serious, debilitating chronic illness that afflicts 
more than 18 million Americans, including eight million Medicare 
beneficiaries. An additional eight million seniors suffer from a 
condition known as ``pre-diabetes'' that, when left untreated, will 
develop into diabetes. Diabetes' devastating complications--kidney 
failure, blindness, lower extremity amputation, heart disease and 
stroke--result in significant costs to the program. Although 
beneficiaries with diabetes comprise only 20 percent of the Medicare 
population, diabetes related complications account for more than 30 
percent of medicare expenditures.
  This is indeed troubling, and there is much that can be done to 
reduce the burden of diabetes and prevent these costly complications. 
Diabetes self-management training, DSMT, helps people with diabetes 
learn the skills they need to manage the daily regimen of diet, 
exercise, meal planning, medication and monitoring necessary to keep 
blood sugar under control. Certified Diabetes Educators, CDEs, are 
highly trained healthcare professionals--often nurses, pharmacists, or 
dieticians--who specialize in helping people with diabetes develop 
these skills. A CDE must be a licensed health care professional, 
possess a minimum of two years of professional practice experience in 
DSMT, have provided a minimum of 1,000 hours of DSMT to patients in the 
past five years, and have passed a rigorous national examination.
  The value of DSMT is well documented. The Diabetes Prevention Program 
study of 2002 demonstrated that participants, all of whom were at 
increased risk for developing type 2 diabetes, were able to reduce that 
risk by implementing the lifestyle changes taught as part of DSMT. 
Additional studies have found that patients with diabetes achieved 
significantly better outcomes when taking part in comprehensive 
diabetes management programs.
  Congress recognized the value of DSMT when it provided for this 
benefit under the Balanced Budget Act of 1997. At that time, CDEs were 
able to provide DSMT through hospital-based programs, billing under the 
hospital's provider number. Unfortunately, hospital-based DSMT programs 
are closing at a rate of two to five per month, leaving people with 
diabetes without access to this life-saving benefit. Our legislation 
would correct this problem by allowing CDEs to be recognized as 
providers under the Medicare program for the purposes of providing 
DSMT. This would provide CDEs with the flexibility they need to ensure 
that beneficiaries can access these critical services.
  As it is, the Centers for Medicaid and Medicare Services, CMS, 
estimates that only 30 percent of beneficiaries are utilizing the 
benefit. More must be done to increase access to life-saving DSMT 
programs. Our legislation will help to accomplish that goal.
  Diabetes already poses a serious burden for the Medicare program. As 
the 76 million baby-boomers age into the Medicare program, the cost of 
diabetes related complications could seriously undermine the financial 
stability of the Medicare program. We must act now to strengthen 
Medicare to ensure that beneficiaries with diabetes have the tools they 
need to prevent diabetes complications.

[[Page S5610]]

                                 ______
                                 
      By Mr. BINGAMAN (for himself and Mr. Thomas):
  S. 2433. A bill to amend the Internal Revenue Code of 1986 to allow 
self-employed individuals to deduct health insurance costs in computing 
self-employment taxes; to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, today my colleague, Senator Thomas, and 
I are introducing the ``Equity for Our Nation's Self-Employed Act of 
2004.'' This legislation would reduce the cost of health insurance for 
the self-employed by allowing these workers to exclude the cost of 
their health insurance from their income for purposes of calculating 
their payroll taxes. Although the self-employed are now allowed an 
income tax deduction for the amount they pay for health insurance, they 
must still calculate their payroll taxes as if they were not allowed 
this income tax deduction. Essentially, the self-employed are paying 
payroll taxes on the amount they pay for health insurance. The 
legislation we are introducing today would stop this inequitable tax 
treatment and allow the self-employed to deduct the amount they pay for 
health insurance from their calculation of payroll taxes.
  This problem affects all self-employed who provide health insurance 
to their families. According to the Census Bureau, there are almost 
74,000 self-employed workers in New Mexico. While we have no idea how 
many of these people in New Mexico have health insurance, we do know 
that roughly 3.6 million working families in the United States paid 
self-employment tax on their health insurance premiums. Estimates 
indicate that roughly 60 percent of our Nation's uninsured are either 
self-employed or work for a small business. According to the Kaiser 
Family Foundation, self-employed workers spend more than $9,000 per 
year to provide health insurance for their family. Because they cannot 
deduct this as an ordinary business expense, those that spend this 
amount will pay a 15.3 percent payroll tax on their premiums resulting 
in almost $1,400 of taxes annually.
  This problem was identified by the National Taxpayer Advocate in 
several of her annual reports to Congress and is supported by a variety 
of groups including the National Association for the Self-employed, the 
National Small Business Association, the National Federation of 
Independent Businesses, the U.S. Chamber of Commerce, the U.S. Hispanic 
Chamber of Commerce, and the Small Business Legislative Council.
  I look forward to working with my colleagues to get this important 
legislation passed.
                                 ______
                                 
      By Mr. HATCH (for himself, Mrs. Boxer, Mrs. Hutchison, and Mr. 
        Bingaman):
  S. 2434. A bill to establish the Commission to Study the Potential 
Creation of a National Museum of the American Latino Community to 
develop a plan of action for the establishment and maintenance of a 
National Museum of the American Latino Community in Washington, D.C., 
and for other purposes; to the Committee on Energy and Natural 
Resources.
  Mr. HATCH. Mr. President, today I am introducing legislation to 
create a national commission to study the potential establishment of a 
National Museum of the American Latino Community in Washington, D.C.
  I am pleased to introduce this measure today, and I am joined by my 
colleagues Senators Barbara Boxer, Kay Bailey Hutchison, and Jeff 
Bingaman, all of whom have worked extensively with the Hispanic 
community on issues of importance.
  The Hispanic community is the fastest growing ethnic group in the 
United States, and in my home State of Utah, Hispanics now account for 
nearly 10 percent of the population. Utah is a wonderful mosaic, 
encompassing a diverse number of peoples and cultures, and in fact, the 
latest census shows that Utah's Hispanic population has nearly doubled 
since 1990. But this phenomenon is not just happening in Utah.
  It is clear we are seeing remarkable growth in our Nation's Hispanic 
population. And with this growth, we need to recognize and find ways to 
better highlight the accomplishments of Latinos over their rich history 
in America. We need to express the importance of diversity, pride, and 
the sharing of the cultures that contribute to the vibrancy and 
splendor of our Nation.
  Every day we are reminded of the fact that Latinos are among our 
Nation's largest minorities, and numbers do have meaning. It is my 
belief that Latinos in America exhibit a strong desire--a commitment to 
building a nation where people are judged by their actions and not by 
their accents. They believe in the work ethic, patriotism, the 
importance of families, the free enterprise system, and the value of 
faith; they believe in these things and they experience these tenets, 
as they live them day in and day out here in America.
  I believe strongly in preserving the sanctity of the heritage of 
cultures, and we should treasure these gifts. I believe that all 
Americans are enriched by learning to view the history of our Nation 
through the prisms of other cultures and languages.
  When American and foreign tourists visit Washington, They expect to 
gain a better understanding of our collective history and culture. They 
see exhibits that educate visitors about our Nation's miraculous 
technological achievements, our military sacrifices and 
accomplishments, and the documents establishing the most sacred tenets 
of our democratic traditions. Yet, as demonstrated by the efforts to 
establish the National Museum of the American Indian and the National 
Museum of African American History and Culture, the lessons taught by 
our institutions are incomplete.
  Children who visit museums in Washington should have the opportunity 
to learn the full history of who we are and who we are becoming as 
Americans. Nearly 40 million U.S. residents share a cultural heritage 
that is only beginning to be understood as wholly American, yet few of 
the exhibits in the Smithsonian's and other museums in Washington 
commemorate American Latino cultural contributions.
  This legislation would take the next step toward ensuring that the 
lessons taught by our premier institutions for the arts and humanities 
include a better representation of American Latino cultural 
contributions. I hope that we will soon be able to say that the 
Nation's Capital truly exhibits America's rich cultural diversity.
  I would like to note that Representative Xavier Becerra has 
introduced a companion bill in the House of Representatives, and I am 
honored to introduce this companion legislation in the Senate. I hope 
this measure will be approved by the Senate in short order.
                                 ______
                                 
      By Mr. LEAHY (for himself and Mr. Grassley):
  S. 2435. A bill to permit Inspectors General to authorize staff to 
provide assistance to the National Center for Missing and Exploited 
Children, and for other purposes; to the Committee on the Judiciary.
  Mr. LEAHY. Mr. President, I rise today to introduce ``The Missing 
Child Cold Case Review Act of 2004,'' which will allow an Inspector 
General to authorize his or her staff to provide assistance on and 
conduct reviews of the inactive case files, or ``cold cases,'' 
involving children stored at the National Center for Missing & 
Exploited Children (NCMEC) and to develop recommendations for further 
investigations.
  I am pleased that Senator Grassley joins me as the lead cosponsor of 
this bipartisan legislation. I thank him for his leadership in this 
area.
  Speed is everything in homicide investigations. As a former 
prosecutor in Vermont, I know firsthand that speed is of the essence 
when trying to solve a homicide. This focus on speed, however, has led 
the law enforcement community to generally believe that any case not 
solved within the first 72 hours or lacking significant leads and 
witness participation has little likelihood of being solved, regardless 
of the expertise and resources deployed. With time, such unsolved cases 
become ``cold,'' and these are among the most difficult and frustrating 
cases detectives face because they are, in effect, cases that other 
investigators, for whatever reason, failed to solve.
  Our Nation's law enforcement agencies, regardless of size, are not 
immune to rising crime rates, staff shortages and budget restrictions. 
Such obstacles have strained the investigative and administrative 
resources of all agencies.

[[Page S5611]]

More crime often means that fewer cases are vigorously pursued, fewer 
opportunities arise for follow-up and individual caseloads increase for 
already overworked detectives.
  All the obstacles that hamper homicide investigations in their early 
phases contribute to cold cases. The National Center for Missing and 
Exploited Children--our Nation's top resource center for child 
protection--presently retains a backlog of cold cases involving 
children that law enforcement departments nationwide have stopped 
investigating primarily due to all these obstacles. NCMEC serves as a 
clearinghouse for all cold cases in which a child has not been found 
and/or the suspect has not been identified.
  The bill that Senator Grassley and I introduce today would allow an 
Inspector General to provide staff support to NCMEC for the purpose of 
conducting reviews of inactive case files to develop recommendations 
for further investigation and similar activities. The Inspector General 
community has one of the most diverse and talented criminal 
investigative cadres in the Federal government. A vast majority of 
these special agents have come from traditional law enforcement 
agencies, and are highly-trained and extremely capable of dealing with 
complex, criminal cases.
  Under current law, an Inspector General's duties are limited to 
activities related to the programs and operations of an agency. Our 
bill would allow an Inspector General to permit criminal investigators 
under his or her supervision to review cold case files, so long as 
doing so would not interfere with normal duties. An Inspector General 
would not conduct actual investigations, and any Inspector General 
would only commit staff when the office's mission-related workloads 
permitted. At no time would these activities be allowed to conflict 
with or delay the stated missions of an Inspector General.

  From time to time a criminal investigator employed by an Inspector 
General may be between investigations or otherwise available for brief 
periods of time. This act would also allow those resources to be 
provided to the National Center for Missing & Exploited Children. 
Commitment of resources would be at a minimum and would not materially 
affect the budget of any office.
  We have before us the type of bipartisan legislation that should be 
moved easily through the Senate and House. It is supported by the 
Department of Justice Office of the Inspector General. I applaud the 
ongoing work of the National Center for Missing & Exploited Children 
and hope both the Senate and the House will promptly pass this bill to 
provide NCMEC with the resources it requires to solve cold cases 
involving missing children.
  I ask unanimous consent that the text of the Missing Child Cold Case 
Review Act of 2004 be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2435

       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 ``Missing Child Cold Case 
     Review Act of 2004''.

     SEC. 2. AUTHORITY OF INSPECTORS GENERAL.

       Title XXXVII of the Crime Control Act of 1990 (42 U.S.C. 
     5779 et seq.) is amended by inserting after section 3701 the 
     following:

     ``SEC. 3701A. AUTHORITY OF INSPECTORS GENERAL.

       ``(a) In General.--An Inspector General appointed under 
     section 3 or 8G of the Inspector General Act of 1978 (5 
     U.S.C. App.) may authorize staff to assist the National 
     Center for Missing and Exploited Children--
       ``(1) by conducting reviews of inactive case files to 
     develop recommendations for further investigations; and
       ``(2) by engaging in similar activities.
       ``(b) Limitations.--
       ``(1) Priority.--An Inspector General may not permit staff 
     to engage in activities described in subsection (a) if such 
     activities will interfere with the duties of the Inspector 
     General under the Inspector General Act of 1978 (5 U.S.C. 
     App.).
       ``(2) Funding.--No additional funds are authorized to be 
     appropriated to carry out this section.''.
                                 ______
                                 
      By Mr. INOUYE:
  S. 2436. A bill to reauthorize the Native American Programs Act of 
1974; to the Committee on Indian Affairs.
  Mr. INOUYE. Mr. President, I rise to introduce a bill to reauthorize 
the Native American Programs Act.
  This act is administered by the Administration for Native Americans 
within the Department of Health and Human Services. Funds appropriated 
for the Administration for Native Americans enable the provision of 
grants for social and economic development initiatives addressing the 
needs of Native communities, for Native language preservation, and to 
provide support for environmental initiatives.
                                 ______
                                 
      By Mr. ENSIGN:
  S. 2437. A bill to amend the Help America Vote Act of 2002 to require 
a voter-verified permanent record or hardcopy under title III of such 
Act, and for other purposes; to the Committee on Rules and 
Administration.
  Mr. ENSIGN. Mr. President, I rise today to speak about an issue that 
is fundamental to our democracy. That issue is the right for each 
American to know that their vote has been cast and accurately counted. 
Earlier today, I introduced legislation, the Voting Integrity and 
Verification Act, which would provide each American with those 
assurances.
  The United States Constitution is sacred to Americans and it is the 
envy of the free world. It preserves the rights and freedoms that 
Americans hold so dear. Our Constitution also guarantees the right of 
each American to vote. Central to the integrity of our democracy is the 
right for each American to participate in our democracy.
  Democracy works best when each eligible voter participates. As a 
Nation, we learned in 2000 that even a Presidential election can be 
determined by handfuls of votes. I learned this lesson in my own 1998 
U.S. Senate campaign against incumbent Senator Harry Reid. In one of 
the closest Federal elections that year, a mere 428 votes separated us 
after all votes had been counted statewide.
  After the election I requested a recount in Clark County, the only 
county at the time using electronic voting machines. The result of the 
recount was identical to the first count. That is because there was 
nothing to recount. After rerunning a computer program, the computer 
produced the same exact tally.
  I conceded to Senator Reid and was elected to Nevada's other Senate 
seat in 2000, but I was still troubled by the fact that Clark County 
voters had no assurance that their votes had been accurately counted. 
Innocent computer malfunctions or intentional tampering could have 
altered their votes without anyone ever knowing.
  That is why I led the fight for voter verification paper trails in 
the Help American Vote Act (HAVA) that President Bush signed into law 
in 2002. A voter-verified paper trail would allow a voter to review a 
physical printout of their ballot and correct any errors before leaving 
the voting booth. This printout would be preserved at the polling for 
use in any recounts.
  Unfortunately, the language that is contained in HAVA has not 
resolved this issue. Now, I am working to address this issue once and 
for all. By introducing the Voting Integrity and Verification Act, I 
want to ensure that HAVA is clear--voters must be assured that their 
votes will be accurate and will be counted properly. A paper trail 
provides just such an assurance.

  A paper trail is not just a hypothetical answer to electronic ballot 
mishaps that may not ever happen. On January 6, 2004, a special 
election was held in Broward County, FL, for House District Seat 91. 
The margin of victory was 12 votes, but the machine failed to record 
the votes of 134 ballots. The results of this election have to be 
called into question, because the House seat was the only item on the 
ballot. It is doubtful that 134 voters would go to the polling place, 
stand in line, enter the voting booth but leave without casting a vote. 
Yet that was the explanation offered to explain the failure of the 
electronic voting machines to record 134 votes. This triggered an 
automatic recount under Florida law but there were no paper records 
with which to conduct a recount. Election workers were left to rerun 
the computer program. Just as happened in my Senate race, rerunning a 
computer program to conduct a manual ``recount'' did not change the 
outcome.
  In Maryland on November 5, 2002, and in Fairfax County, VA, on 
November 4,

[[Page S5612]]

2003, voters who used electronic ``touch screen'' voting machines 
watched as the ``X'' they placed on the video screen next to one 
candidate's name appeared in a box for the other candidate. There were 
no verified paper ballots, so a recount was not possible. The voters 
who witnessed such an irregularity, and all voters who used those 
voting machines, have no assurances that the machine accurately 
recorded their vote. This calls into question any results determined by 
these machines and shows that there is no limit as to the number of 
votes that may have been miscounted.
  It's not written in the Constitution this way, but it seems to me 
quite obvious that the right of citizens of the United States to vote 
shall not be denied on account of a lack of a paper trail. We must 
uphold the sanctity of our vote by making sure there is an accurate way 
to confirm and recount votes. I call on Congress to act swiftly to 
preserve America's faith in our election process and enact the Voting 
Integrity and Verification Act.

                          ____________________