[Congressional Record Volume 152, Number 114 (Thursday, September 14, 2006)]
[Senate]
[Pages S9631-S9639]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. FRIST (for himself, Mr. McCain, and Mrs. Hutchison):
  S. 3892. A bill to reduce the number of deaths along the border 
between the United States and Mexico by improving the placement of 
rescue beacons, and for other purposes; to the Committee on the 
Judiciary.
  Mr. FRIST. Mr. President, one cold May morning earlier this year, a 
Border Patrol agent found the body of a 3-year-old boy in a blue 
windbreaker, his arms crossed. He had died trying to cross our southern 
border, the youngest victim our borders have claimed this year.
  The boy's mother's name is Edith Rodriguez. She is 25 years old. She 
attempted to cross the border illegally, in hopes that she might escape 
the desperate poverty of her home state of Veracruz, Mexico. Edith 
hired a human smuggler--a coyote.
  The coyote gave his charges an illegal drug, ephedrine, to help them 
keep awake and moving. But Edith and her son still could not keep up 
with the group. So the coyote, in a cruel and heartless act, abandoned 
them in the desert. Alone. With no food and little water, with a 
dangerous drug coursing through his system, exposed to the elements--
Edith Rodriguez's little boy died.
  Edith Rodriguez violated the laws of the United States when she 
crossed the border illegally. She was wrong to violate our border. But 
all should agree that her son did not deserve to die.
  Here are the facts: Every 18\1/2\ hours, someone dies trying to cross 
the border between the United States and Mexico. About a year ago, I 
asked the Government Accountability Office to study the deaths that 
take place along America's borders.
  Today, my office released that study. The results are sobering, 
shocking, and, I strongly believe, a cause for action. Since 1995, 
deaths along our borders have doubled. Despite the heroic rescue 
efforts of the men and women of Customs and Border Protection, things 
have gotten worse. In 1995, 266 people

[[Page S9632]]

died trying to cross our borders. Last year, 427 perished.
  The increases, it appears, stem largely from an increase in deaths 
from exposure to the elements in the Sonoran Desert in Arizona. Illegal 
entries, however, have not increased. Quite frankly, it is getting more 
dangerous to cross our border.
  Until recently, CBP did not even keep a systematic count of those who 
died crossing our borders. We still do not have a unified national 
strategy for reducing the deaths. We still do not know how well our 
safety efforts work--if they are saving lives or not. We need to do 
more.
  The founding document of our Nation, the Declaration of Independence, 
lists ``life'' first on the list of Government's responsibilities. The 
overwhelming majority of the people who cross our border do so in 
search of a better life. They take enormous risks and make enormous 
investments in hopes of helping their families.
  Illegal immigration needs to stop. We must defend our borders. We 
must construct physical barriers, add detention beds, hire personnel, 
and equip them with better technology. But we have a higher moral 
obligation to protect the life of every person--every man, woman, and 
child--who sets foot on American soil. We must do everything in our 
power to preserve life.
  That is why I propose the Border Death Reduction Act. I urge my 
colleagues to support it.
  The law will implement the GAO's recommendations. It will require CBP 
to create a strategy for reducing border deaths. It will mandate a full 
count of deaths along the border. It will impose tough, new penalties 
on coyotes who abandon their charges, and it will expand the network of 
rescue beacons that people in trouble can use to call for help.
  These beacons, I believe, are an absolutely vital link in our border 
security system. Let me explain. Rescue beacons are devices at 
prominent locations that individuals can activate when they need help. 
They are tall polls with lights at the top and radio transmitters 
inside. People in trouble can activate a beacon to let CBP know that 
they need help. We know that beacons work: CBP has already saved dozens 
of people based entirely on beacon alerts.
  But individuals who activate beacons do not get a free pass. They 
will, of course, receive necessary medical treatment. But rescued 
individuals will still be detained and deported like anyone else who 
violates our borders.
  Deploying more beacons in the desert will save lives in the desert 
and simultaneously improve the security of our frontiers.
  We cannot delay. We should not rest. We must protect the lives of all 
those who set foot upon our soil. I urge my colleagues to support the 
Border Death Reduction Act.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 3892

       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 ``Border Death Reduction Act 
     of 2006''.

     SEC. 2. DEFINITION OF A RESCUE BEACON.

       In this Act, the term ``rescue beacon'' means a clearly 
     visible device with an internal power source that is placed 
     in an area likely to experience extreme weather, that 
     contains instructions for its use, and by means of lights, 
     radio signals, and other means, allows individuals to alert 
     the United States Customs and Border Protection of their 
     presence.

     SEC. 3. COLLECTION OF STATISTICS.

       (a) In General.--Not later than 180 days after the date of 
     the enactment of this Act, the Commissioner of Customs shall 
     begin collecting data relevant to deaths occurring at the 
     border between the United States and Mexico, divided by 
     sector, and including--
       (1) the causes of the deaths;
       (2) the total number of deaths;
       (3) the location of deaths; and
       (4) demographic characteristics, including the sex and 
     approximate age of those deceased.
       (b) Development of Protocols.--The Commissioner of Customs 
     shall develop consistent, formal, written protocols for the 
     collection of data described in subsection (a).

     SEC. 4. ANNUAL REPORT ON BORDER DEATHS.

       Not later than 1 year after the date of the enactment of 
     this Act, and annually thereafter, the Commissioner of 
     Customs shall submit to the Secretary of Homeland Security a 
     report that contains--
       (1) an analysis of trends with respect to the statistics 
     collected under section (3)(a)(1) during the preceding year;
       (2) an evaluation, using multivariate statistical 
     approaches, of the Border Safety Initiative, including any 
     rescue beacons deployed, and any successor program designed 
     to reduce deaths along the border described in section 3(a); 
     and
       (3) recommendations of particular actions to reduce the 
     deaths described in section 3(a).

     SEC. 5. REPORT ON BEACON PLACEMENT.

       (a) Report Required.--Not later than 6 months after the 
     date of the enactment of this Act, the Commissioner of 
     Customs shall submit to the Secretary of Homeland Security a 
     report on enhancing the deployment of rescue beacons.
       (b) Focus of Report.--Such report shall contain particular 
     emphasis on enhancing the deployment of rescue beacons in the 
     Tucson Sector.
       (c) Contents of Report.--The report required by subsection 
     (a) shall include--
       (1) an assessment of the efficacy of the deployment of 
     rescue beacons in light of the statistics gathered under 
     section 3, including analysis of the locations of deaths 
     recorded and areas frequented by illegal migrants; and
       (2) recommendations on where additional rescue beacons 
     should be placed to reduce the number of deaths in the area 
     described by section 3 and section 5(b).
       (d) Authorization of Appropriations.--There are authorized 
     to be appropriated $500,000 to carry out the provisions of 
     this section.

     SEC. 6. DEPLOYMENT OF ENHANCED BEACON NETWORK.

       (a) Deployment of Rescue Beacons.--Not later than 1 year 
     after the date of the enactment of this Act, the Commissioner 
     of Customs shall deploy additional rescue beacons in all 
     areas recommended in the report required by section 5.
       (b) Guidelines for Placement of Rescue Beacons.--Not later 
     than 1 year after the date of the enactment of this Act, the 
     Commissioner of Customs shall issue to all sector chiefs 
     formal, written guidelines for the ongoing placement and 
     removal of rescue beacons and the appropriate response to the 
     activation of such beacons.
       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated $1,500,000 to carry out the provisions of 
     this section.

     SEC. 7. PROHIBITION ON ABANDONMENT OF ALIENS IN A BORDER 
                   ZONE.

       (a) In General.--Any person who commits an act described in 
     section 274(a)(1)(A) of the Immigration and Nationality Act 
     (8 U.S.C. 1324(a)(1)(A)) and abandons an alien with respect 
     to that act in a place not within sight of a paved road or 
     rescue beacon, shall be considered to have placed in jeopardy 
     the life of a person as described in section 
     274(a)(1)(B)(iii) of such Act (8 U.S.C. 1324(a)(1)(B)(iii)).
       (b) Construction.--Nothing in this section shall be 
     construed to prohibit any person from being held in violation 
     of section 274(a)(1)(B)(iii) of such Act (8 U.S.C. 1324 
     (B)(iii)).
                                 ______
                                 
      By Ms. STABENOW (for herself and Mr. Levin):
  S. 3896. A bill to provide for the return of the Fresnel Lens to the 
lantern room atop Presque Isle Light Station Lighthouse, Michigan, and 
for other purposes; to the Committee on Commerce, Science, and 
Transportation.
  Ms. STABENOW. Mr. President, I rise today to offer the Lester Nichols 
Presque Isle Light Station Act with my colleague, Senator Levin. 
Congressman Stupak is introducing the companion legislation in the 
House of Representatives today. Our bill will restore the historic 
Fresnel lens to the Presque Isle lighthouse in Presque Isle Township, 
MI.
  Michigan has the most lighthouses of any State in the Nation with a 
total of over 120. At one time we had over 100 manned lighthouses, more 
than any other State. This is not surprising considering that Michigan 
has 3,288 miles of shoreline along the Great Lakes. We are proud of our 
lighthouses and we are proud of the history and the maritime heritage 
that they represent. Our lighthouses are part of our identity as a 
State. In addition to performing as navigation aids, they remain a 
symbol of the importance that the Great Lakes played and continue to 
play in Michigan's history.
  Most importantly, they are an important part of the economies of our 
coastal towns. Our lakeshore towns host visitors from across the 
country who travel to view the magnificence of our coastal areas and 
the lighthouses that illuminate them. These small communities are more 
dependent than ever on tourism dollars, and we must help them by 
coordinating our efforts to protect Michigan's lighthouses and promote 
Great Lakes' maritime culture.
  In 2002 the U.S. Coast Guard, the Michigan State Historic 
Preservation

[[Page S9633]]

Officer, and the township signed a memorandum of agreement stating that 
upon removal from the tower, the Fresnel lens would be restored by the 
township in a museum type setting with assistance from the Coast Guard. 
In 2005, the township completed their restoration work on the lens. 
Unfortunately, we soon learned that the Coast Guard has another policy 
that prevents a Fresnel lens from being replaced once it is removed 
from the tower.
  The result is that this lighthouse has been historically compromised. 
Replacing the lens in its original home for the enjoyment of all who 
visit our historic lighthouse will not only ensure the integrity of the 
lighthouse, but it will enhance the function the lighthouse provides as 
an active navigational aid.
  Very simply, our bill requires the Coast Guard to replace the 
restored Fresnel lens in the Presque Isle Lighthouse.
  Our bill is named after Les Nichols, who through years of hard work 
and perseverance has led the successful effort in the restoration of 
the historic 3rd Order Fresnel Lens. The Fresnel lens is an integral 
part of the historic value of the New Presque Isle Lighthouse and will 
continue to attract tourists to this region of the State. Under 
Lester's leadership, this historic artifact will now be able to be 
viewed by future generations. I also want to acknowledge the work of 
Peter Pettalia, the Presque Isle Township Supervisor.
  I hope that all of my colleagues will support this legislation and 
that we can move it quickly in the remaining time we have in the 
Senate.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 3896

       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 ``Lester Nichols Presque Isle 
     Light Station Act of 2006''.

     SEC. 2. RETURN OF FRESNEL LENS TO PRESQUE ISLE LIGHT STATION 
                   LIGHTHOUSE, MICHIGAN.

       (a) In General.--Subject to subsection (b), the Commandant 
     of the Coast Guard shall modify the 2004 Agreement for 
     Outgoing Loans (AOL) with Presque Isle Township, Michigan, in 
     order to provide for the return of the Historic Fresnel Lens 
     to the lantern room atop the Presque Isle Light Station 
     Lighthouse, Michigan.
       (b) Conditions.--
       (1) Compliance with applicable law.--Any modification under 
     subsection (a) of the Agreement for Outgoing Loans described 
     in that subsection shall comply with applicable provisions of 
     section 5506 of the Omnibus Consolidated Appropriations Act, 
     1997 (Public Law 104-208; 110 Stat. 3009-518), relating to 
     the conveyance of the Presque Isle Light Station.
       (2) Retention of ownership of lens.--Notwithstanding the 
     return of the Historic Fresnel Lens pursuant to subsection 
     (a), the United States shall retain ownership of the lens.
       (3) Continuing operation of aid to navigation.--
     Notwithstanding the return of the Historic Fresnel Lens 
     pursuant to subsection (a), the active aid to navigation, 
     together with associated electronic and lighthouse equipment, 
     at Presque Isle Light Station Lighthouse shall continue to be 
     operated and maintained by the United States within the 
     Historic Third Order Fresnel Lens at the Presque Isle Light 
     Station Lighthouse.
                                 ______
                                 
      By Mr. GRASSLEY (for himself and Mr. Baucus):
  S. 3897. A bill to amend titles XI and XVIII of the Social Security 
Act to provide for the sharing of certain data collected by the Centers 
for Medicare & Medicaid Services with certain agencies, research 
centers and organizations, and congressional support agencies; from the 
Committee on Finance; to the Committee on Finance.
  Mr. GRASSLEY. Mr. President, I am pleased to join my colleague from 
Montana, Senator Baucus, in introducing the Medicare Data Access and 
Research Act. Senator Baucus and I have long enjoyed a good working 
relationship in our roles as chairman and ranking member of the Finance 
Committee. Our work on this bill once again demonstrates our commitment 
to working in a bipartisan manner.
  The Medicare Data Access and Research Act establishes a process 
through which Federal agencies and other researchers can access 
Medicare data for the purpose of health services research. This might 
seem like a pretty mundane issue to some people, but I can assure you 
that it is far from it. Medicare processes 500 million claims for 
benefits each year; millions of prescriptions have been filled under 
the new Medicare prescription drug benefit.
  Linking data on hospital and physician services provided to Medicare 
beneficiaries to prescription drug data will offer a tremendous 
resource for researchers in our Federal agencies, as well as those 
based at universities and other research centers. What of research can 
these data support? They can support studies and analyses related to 
postmarketing surveillance of prescription drugs and research on drug 
safety. More concretely, analyzing the Medicare claims data can help 
agencies, such as the Food and Drug Administration FDA, identify 
situations like the one involving Vioxx more quickly, and provide a new 
valuable tool to enable the FDA to take swifter action to protect the 
public's health and well-being.
  The Centers for Disease Control and Prevention, the Agency for 
Healthcare Research and Quality, and the National Institutes of Health 
all have missions that require the conduct of meticulous health 
services research. The Medicare database and access to it established 
under the bill we are introducing today will help these agencies 
fulfill their missions to study immunization rates; to develop and 
monitor the use of preventive screenings; conduct research on the 
clinical comparative effectiveness of prescription drugs; and to help 
prevent, diagnose, and treat disease.
  To ensure access to the data, the bill requires the Secretary of 
Health and Human Services to enter data release agreements on an annual 
basis with these agencies. In entering the data release agreements, the 
Secretary must take appropriate steps to protect the confidentiality of 
the information, while maintaining the ability of researchers at 
Federal agencies to conduct meaningful analyses.
  The bill also permits the Secretary to enter into data use agreements 
to permit researchers at universities and other organizations to have 
access to the data. As will be the case for the Federal agencies, these 
researchers may only use the data for purposes of advancing the 
public's health. They can conduct studies on the safety, effectiveness, 
and quality of health services.
  Some people might be concerned that these data will be given to just 
anyone. That is not the case. In applying for data access, researchers 
at universities and other organizations will have to meet strict 
criteria. They must have well-documented experience in analyzing the 
type and volume of data to be provided under the agreement. They must 
agree to publish and publicly disseminate their research methodology 
and results. They must obtain approval for their study from a review 
board. They must comply with all safeguards established by the 
Secretary to ensure the confidentiality of information. These 
safeguards cannot permit the disclosure of information to an extent 
greater than permitted by the Health Insurance Portability and 
Accountability Act of 1996 and the Privacy Act of 1974.
  The final section of the bill ensures that congressional support 
agencies, including the Congressional Budget Office, the Congressional 
Research Service, the Government Accountability Office, and the 
Medicare Payment Advisory Commission, also have access to data they 
need to carry out their functions and responsibilities. This body 
depends on the research and analyses conducted by those agencies to 
inform our deliberations and decisions on the Medicare Program.
  Last year, Senator Baucus and I introduced the Medicare Value-Based 
Purchasing Act to establish a pay for performance system under 
Medicare. That bill was aimed at promoting quality and ensuring value 
under the Medicare Program. The bill that we are introducing today 
complements that objective. How can we promote quality and ensure value 
in Medicare? By having a better understanding of what services are 
effective, by knowing how we can help beneficiaries avoid illness and 
disease, by having insight about potential over-use and under-use of 
health care services, and by identifying troubling trends and patterns. 
How can we learn about those topics? By supporting rigorous health 
services research.

[[Page S9634]]

  Mr. President, the Medicare Data Access and Research Act creates a 
sound framework for accomplishing that objective.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 3897

       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 ``Medicare Data Access and 
     Research Act''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) The new Medicare drug benefit under part D of title 
     XVIII of the Social Security Act is delivered through private 
     prescription drug plans. Private plans submit administrative 
     and beneficiary level data to the Centers for Medicare & 
     Medicaid Services as a condition of participation and payment 
     in the new Medicare drug program.
       (2) Data from the new Medicare drug benefit can be linked 
     with hospital, ambulatory care, and other data to create a 
     new comprehensive resource for the study of drug safety and 
     effectiveness of medical care in older adults and low-income, 
     disabled, and vulnerable populations. With appropriate 
     protections for privacy, this data should be available to the 
     Food and Drug Administration, the Centers for Disease Control 
     and Prevention, the Agency for Healthcare Research and 
     Quality, and the National Institutes of Health, and 
     university-based research centers and other research 
     organizations interested in furthering the public health 
     through research on the safety, effectiveness, and quality of 
     health care services provided under the Medicare program 
     under title XVIII of the Social Security Act.
       (3) Timely and ready access to certain data from the new 
     Medicare drug benefit will allow congressional support 
     agencies to inform and advise Congress on the cost, scope, 
     and impact of the new benefit and assess its quality.

     SEC. 3. DRUG AND HEALTH CARE DATA RELEASE.

       (a) In General.--Title XI of the Social Security Act (42 
     U.S.C. 1301 et seq.) is amended by inserting after section 
     1121 the following new sections:


               ``DRUG AND HEALTH CARE CLAIMS DATA RELEASE

       ``Sec. 1121A.  (a) In General.--Notwithstanding any 
     provision under part D of title XVIII that limits the use of 
     prescription drug data collected under such part, for the 
     purpose of improving the public's health, the Secretary, 
     acting through the Centers for Medicare & Medicaid Services, 
     shall--
       ``(1) enter into data release agreements on an annual basis 
     with the agencies described in subsection (b) to provide 
     access to relevant data submitted by prescription drug plans 
     and MA-PD plans under part D of title XVIII, excluding 
     negotiated price concessions under such part (such as 
     discounts, direct or indirect subsidies, rebates, and direct 
     or indirect remunerations), and linked to hospital, 
     physician, and other relevant medical claims, utilization, 
     and diagnostic data collected under titles XVIII and XIX, 
     including data from the uniform reporting systems established 
     under section 1121(a); and
       ``(2) permit agencies described in such subsection to link 
     data provided under this section with other relevant health 
     data, including survey data, vital statistics, and disease 
     registries, as needed by the agency in order to accomplish 
     its research objectives.
       ``(b) Agencies Described.--The agencies described in this 
     subsection are as follows:
       ``(1) The Food and Drug Administration.
       ``(2) The Centers for Disease Control and Prevention.
       ``(3) The Agency for Healthcare Research and Quality.
       ``(4) The National Institutes of Health.
       ``(c) Use of the Data Provided.--Data provided under a data 
     release agreement under subsection (a)(1) shall only be used 
     for the following purposes:
       ``(1) FDA.--In the case of the Food and Drug 
     Administration, to enhance post marketing surveillance by--
       ``(A) studying patterns of drug and vaccine utilization 
     over time after a drug has been placed on the market;
       ``(B) studying health risks associated with such 
     utilization, particularly with respect to improving the speed 
     of risk identification in order to mitigate or resolve such 
     risks;
       ``(C) studying drug utilization in order to promote 
     consumer education that would allow consumers and health care 
     providers to make informed product choices and informed drug 
     compliance choices; and
       ``(D) performing such other functions, consistent with the 
     purposes of this section and the Agency's mission, as are 
     determined appropriate by the Secretary.
       ``(2) CDC.--In the case of the Centers for Disease Control 
     and Prevention, to--
       ``(A) improve surveillance of clinical outbreaks and 
     emerging threats;
       ``(B) study immunization rates;
       ``(C) study outcomes of specific diseases;
       ``(D) develop and monitor the use of preventive screening 
     protocols using claims data;
       ``(E) study drug and medical utilization in order to 
     promote consumer education and treatment for specific public 
     health risks; and
       ``(F) perform such other functions, consistent with the 
     purposes of this section and the Agency's mission, as are 
     determined appropriate by the Secretary.
       ``(3) AHRQ.--In the case of the Agency for Healthcare 
     Research and Quality, to--
       ``(A) carry out the Agency's research obligations under 
     section 1013 of the Medicare Prescription Drug, Improvement, 
     and Modernization Act of 2003;
       ``(B) conduct research consistent with the Agency's mission 
     to improve the quality, safety, efficiency, and effectiveness 
     of health care; and
       ``(C) perform such other functions, consistent with the 
     purposes of this section and such mission, as are determined 
     appropriate by the Secretary.
       ``(4) NIH.--In the case of the National Institutes of 
     Health, to--
       ``(A) help prevent, detect, diagnose, and treat disease and 
     disabilities; and
       ``(B) perform such other functions, consistent with the 
     purposes of this section and the Agency's mission, as are 
     determined appropriate by the Secretary.
       ``(d) Timeframe for Data Release.--A data release agreement 
     entered into under this section shall provide for the release 
     of information as needed by the Agency for the uses described 
     in subsection (c).
       ``(e) Data Release Procedures.--
       ``(1) Determining appropriate level and elements of data 
     for release.--
       ``(A) In general.--The Secretary shall establish a process 
     to determine the appropriate level and elements of data to be 
     released to an Agency under this section in order to ensure 
     that the Agency, and researchers within the Agency, are able 
     to conduct meaningful analyses while maintaining the 
     confidentiality of the data provided under the data release 
     agreement.
       ``(B) Relationship to procedures for release to private 
     researchers.--The process established under subparagraph (A) 
     may be analogous to the process used by the Centers for 
     Medicare & Medicaid Services for the release of data to 
     private researchers.
       ``(2) Agency feedback on analyses conducted.--The Secretary 
     shall establish a process for Agencies that are provided data 
     under a data release agreement under this section to provide 
     the results of the analyses conducted using such data to the 
     Centers for Medicare & Medicaid Services for use in the 
     administration and assessment of programs administered by the 
     Centers for Medicare & Medicaid Services, including the 
     program under part D of title XVIII.
       ``(3) Review of data procedures.--The Secretary shall 
     establish a process to review and update the following:
       ``(A) The processes established under paragraphs (1)(A) and 
     (2).
       ``(B) Procedures for transmission and retention of data 
     released under this section.
       ``(f) Notification of Inaccuracies Discovered in Data 
     Provided.--The Secretary shall establish procedures to ensure 
     that an Agency that is provided data under this section 
     notifies the Secretary of any inaccuracies discovered in the 
     data by the Agency within a reasonable time of such 
     discovery.
       ``(g) Report.--The Secretary shall include (beginning with 
     2007), as part of the annual report submitted to Congress 
     under section 1875(b), an evaluation of the data release 
     agreements entered into under subsection (a)(1), including a 
     description of the reports and analyses conducted by agencies 
     using data provided under such an agreement.
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as are necessary to 
     carry out the purposes of this section.


    ``RESEARCH CENTER AND ORGANIZATION DRUG AND HEALTH CARE DATA USE

       ``Sec. 1121B.  (a) In General.--Notwithstanding any 
     provision under part D of title XVIII that limits the use of 
     prescription drug data collected under such part, for the 
     purpose of improving the public's health, the Secretary 
     shall--
       ``(1) enter into data use agreements with the research 
     centers and organizations described in subsection (b) to 
     provide access to relevant data submitted by prescription 
     drug plans and MA-PD plans under part D of title XVIII, 
     excluding negotiated price concessions under such part (such 
     as discounts, direct or indirect subsidies, rebates, and 
     direct or indirect remunerations), and linked to hospital, 
     physician, and other relevant medical claims, utilization, 
     and diagnostic data collected under titles XVIII and XIX, 
     including data from the uniform reporting systems established 
     under section 1121(a);
       ``(2) permit research centers and organizations described 
     in such subsection to link data provided under this section 
     with other relevant health data, including survey data, vital 
     statistics, and disease registries, as needed by the research 
     center or organization in order to accomplish its research 
     objectives; and
       ``(3) prepare the linked sets of data described in 
     paragraph (1) for release not later than July 1, 2007.
       ``(b) Research Centers and Organizations Described.--The 
     research centers and organizations described in this 
     subsection are as follows:
       ``(1) A University-based research center.
       ``(2) Any other research center or organization--
       ``(A) whose primary mission is to conduct public health 
     research; and
       ``(B) which the Secretary determines can appropriately 
     conduct analyses consistent with the purposes of this 
     section.

[[Page S9635]]

       ``(c) Use of Data and Penalties.--
       ``(1) Use of data.--
       ``(A) In general.--Data provided to a research center or 
     organization under a data use agreement under this section 
     shall be used solely for purposes of research on the safety, 
     effectiveness, and quality of, disparities in, and related 
     aspects of health care use by individuals entitled to, or 
     enrolled for, benefits under part A of title XVIII, or 
     enrolled for benefits under part B of such title, conducted 
     for the purpose of developing and providing generalizable 
     knowledge to inform the public health through scientific 
     publication and other forms of public dissemination.
       ``(B) Approval by review board for the protection of human 
     subjects.--Such use shall be approved by a review board for 
     the protection of human subjects.
       ``(C) Review process.--The Secretary shall establish a 
     review process to ensure that--
       ``(i) data use agreements under this section include a 
     detailed description of how the data is to be used under the 
     agreement; and
       ``(ii) such use is consistent with the purposes described 
     in subparagraph (A).
       ``(2) Penalties.--
       ``(A) In general.--A research center or organization who 
     knowingly or intentionally uses data provided under a data 
     use agreement under this section for any purpose other than 
     the purposes described in paragraph (1)(A) shall be subject, 
     in addition to any other penalties that may be prescribed by 
     law, to--
       ``(i) a civil money penalty of not less than $25,000 for 
     each infraction; and
       ``(ii) disqualification from receipt of any data under this 
     section for not less than 2 years.
       ``(B) Procedure.--The provisions of section 1128A (other 
     than subsections (a) and (b) and the second sentence of 
     subsection (f)) shall apply to a civil money penalty under 
     this paragraph in the same manner as such provisions apply to 
     a penalty or proceeding under section 1128A(a).
       ``(d) Release of Data.--
       ``(1) In general.--A data use agreement entered into under 
     subsection (a)(1) shall provide for the release of 
     information according to a schedule approved by the Secretary 
     under the criteria developed in accordance with paragraph 
     (2).
       ``(2) Criteria for approving research applications.--
       ``(A) Development.--The Secretary, in consultation with 
     health services researchers and academicians, shall develop 
     criteria for the approval of a data use agreement under this 
     section.
       ``(B) Criteria.--The criteria developed under subparagraph 
     (A) shall include the following requirements:
       ``(i) The research center or organization has well-
     documented scientific expertise, a record of scholarship on 
     the topic of the proposed study, and a likelihood of 
     successful publication, as demonstrated by a prior record of 
     relevant publication by key staff and other evidence of 
     appropriate scientific qualifications of the proposed 
     research team.
       ``(ii) The research center or organization demonstrates a 
     credible capability to conduct and complete the proposed 
     study, including experience with scientific investigations 
     using similar types of data.
       ``(iii) The research center or organization demonstrates 
     the public health importance of the proposed study, and the 
     potential of such study to provide public knowledge needed to 
     improve the safety, use, and outcomes of treatments, the 
     administration of the program under title XVIII, and the care 
     provided to individuals entitled to, or enrolled for, 
     benefits under part A of title XVIII, or enrolled for 
     benefits under part B of such title.
       ``(iv) The research center or organization develops a data 
     management plan that describes in detail the measures that 
     will be implemented to safeguard the data and protect the 
     privacy of individuals entitled to, or enrolled for, benefits 
     under part A of title XVIII, or enrolled for benefits under 
     part B of such title, including any proposed data linkages.
       ``(v) The research center or organization enters into an 
     agreement under which the research center or organization 
     agrees to--

       ``(I) place detailed results of the proposed study in the 
     public domain through publication in a reasonable timeframe, 
     not to exceed 1 year after completion of such study, 
     including a thorough description of the methodology used to 
     conduct the study;
       ``(II) make available to the public, without charge, any 
     product or tool developed using the data provided under this 
     section; and
       ``(III) not sell such data to other entities or create 
     commercial data products (such as data extracts or analytical 
     files) using such data.

       ``(vi) The research center or organization and the proposed 
     research team provide assurances that such team is 
     independent from the sources of funding or any other party 
     and has the right to independently and freely publish the 
     scientific findings of the study.
       ``(vii) Such other requirements, consistent with the 
     purposes of this section, as the Secretary determines 
     appropriate.
       ``(3) Timely review and action on requests.--The Secretary 
     shall provide for timely review of, and action on, requests 
     for a data use agreement under this section, taking into 
     consideration the reasonable needs of the research center or 
     organization.
       ``(4) Public disclosure.--The Secretary shall make 
     available to the public the criteria used to grant or deny 
     data use agreements under the criteria developed under 
     paragraph (2)(A).
       ``(e) Feedback by Research Center or Organization.--
       ``(1) Notification of inaccuracies discovered in data 
     provided.--The Secretary shall establish procedures to ensure 
     that a research center or organization that is provided data 
     under this section notifies the Secretary of any inaccuracies 
     discovered in the data by the center or organization within a 
     reasonable time of such discovery.
       ``(2) Feedback on data collection.--The Secretary shall 
     permit researchers to provide feedback on the collection of 
     data with respect to the programs administered by the Centers 
     for Medicare & Medicaid Services and make recommendations 
     with respect to the collection of additional data elements 
     with respect to such programs.
       ``(f) Confidentiality.--
       ``(1) Determining appropriate level of data to be 
     provided.--The Secretary shall establish a process to 
     determine the appropriate level of data to be provided to a 
     research center or organization under this section in order 
     to ensure that the center or organization, and researchers 
     within the center or organization, are able to conduct 
     meaningful analyses while maintaining the confidentiality of 
     the data provided under the data use agreement.
       ``(2) Safeguards to protect confidentiality of data 
     provided.--
       ``(A) In general.--The Secretary shall establish safeguards 
     to protect the confidentiality of data after it is provided 
     to a research center or organization under this section. Such 
     safeguards shall not provide for greater disclosure by the 
     research center or organization than is permitted under any 
     of the following:
       ``(i) The Federal regulations (concerning the privacy of 
     individually identifiable health information) promulgated 
     under section 264(c) of the Health Insurance Portability and 
     Accountability Act of 1996.
       ``(ii) Sections 552 or 552a of title 5, United States Code, 
     with regard to the privacy of individually identifiable 
     beneficiary health information.
       ``(B) Confidentiality of physicians and medical 
     practices.--The safeguards established under subparagraph (A) 
     shall ensure that the data provided to a research center or 
     organization under this section that identifies individual 
     physicians or medical practices is not released by the 
     research center or organization, or otherwise made public.
       ``(g) Report.--The Secretary shall include (beginning with 
     2007), as part of the annual report submitted to Congress 
     under section 1875(b), an evaluation of the agreements 
     entered into under subsection (a).
       ``(h) Reasonable Fee.--The Secretary may charge a research 
     center or organization a reasonable fee based on the cost of 
     preparing and providing data to such center or organization 
     under this section.''.
       (b) Criteria Development and Publication.--The Secretary 
     shall develop and publish the criteria required under section 
     1121B(d)(2)(A) of the Social Security Act, as added by 
     subsection (a), not later than 180 days after the date of 
     enactment of this Act.

     SEC. 4. ACCESS TO DATA ON PRESCRIPTION DRUG PLANS AND 
                   MEDICARE ADVANTAGE PLANS.

       (a) In General.--Section 1875 of the Social Security Act 
     (42 U.S.C. 1395ll) is amended--
       (1) in the heading, by inserting ``to congress; providing 
     information to congressional support agencies'' after ``and 
     recommendations''; and
       (2) by adding at the end the following new subsection:
       ``(c) Providing Information to Congressional Support 
     Agencies.--
       ``(1) In general.--Notwithstanding any provision under part 
     D that limits the use of prescription drug data collected 
     under such part, upon the request of a congressional support 
     agency, the Secretary shall provide such agency with 
     information submitted to, or compiled by, the Secretary under 
     part D (subject to the restriction on disclosure under 
     paragraph (2)), including--
       ``(A) only with respect to congressional support agencies 
     that make official baseline spending projections, conduct 
     oversight studies mandated by Congress, or make official 
     recommendations on the program under this title to Congress--
       ``(i) aggregate negotiated prices for drugs covered under 
     prescription drug plans and MA-PD plans; and
       ``(ii) bid information (described in section 1860D-
     11(b)(2)(C)) submitted by such plans; and
       ``(B) access to drug event data submitted by such plans 
     under section 1860D-15(d)(2)(A), except, with respect to data 
     that reveals prices negotiated with drug manufacturers, such 
     data shall only be available to congressional support 
     agencies that make official baseline spending projections, 
     conduct oversight studies mandated by Congress, or make 
     official recommendations on the program under this title to 
     Congress.
       ``(2) Restriction on data disclosure.--
       ``(A) In general.--Data provided to a congressional support 
     agency under this subsection shall not be disclosed, 
     reported, or released in identifiable form.
       ``(B) Identifiable form.--For purposes of subparagraph (A), 
     the term `identifiable form' means any representation of 
     information that permits identification of a specific 
     prescription drug plan, MA-PD plan, pharmacy benefit manager, 
     drug manufacturer, drug wholesaler, or individual enrolled in 
     a prescription drug plan or an MA-PD plan under part D.

[[Page S9636]]

       ``(3) Timing.--The Secretary shall release data under this 
     subsection in a timeframe that enables congressional support 
     agencies to complete congressional requests.
       ``(4) Use of the data provided.--Data provided to a 
     congressional support agency under this subsection shall only 
     be used by such agency for carrying out the functions and 
     activities of the agency mandated by Congress.
       ``(5) Confidentiality.--The Secretary shall establish 
     safeguards to protect the confidentiality of data released 
     under this subsection. Such safeguards shall not provide for 
     greater disclosure than is permitted under any of the 
     following:
       ``(A) The Federal regulations (concerning the privacy of 
     individually identifiable health information) promulgated 
     under section 264(c) of the Health Insurance Portability and 
     Accountability Act of 1996.
       ``(B) Sections 552 or 552a of title 5, United States Code, 
     with regard to the privacy of individually identifiable 
     beneficiary health information.
       ``(6) Definitions.--In this subsection:
       ``(A) Congressional support agency.--The term 
     `Congressional support agency' means--
       ``(i) the Medicare Payment Advisory Commission;
       ``(ii) the Congressional Research Service;
       ``(iii) the Congressional Budget Office; and
       ``(iv) the Government Accountability Office.
       ``(B) MA-pd plan.--The term `MA-PD plan' has the meaning 
     given such term in section 1860D-1(a)(3)(C).
       ``(C) Prescription drug plan.--The term `prescription drug 
     plan' has the meaning given such term in section 1860D-
     41(a)(14).''.
       (b) Conforming Amendment.--Section 1805(b)(2) of the Social 
     Security Act (42 U.S.C. 1395b-6(b)(2)) is amended by adding 
     at the end the following new subparagraph:
       ``(D) Part d.--Specifically, the Commission shall review 
     payment policies with respect to the Voluntary Prescription 
     Drug Benefit Program under part D, including--
       ``(i) the factors affecting expenditures;
       ``(ii) payment methodologies; and
       ``(iii) their relationship to access and quality of care 
     for Medicare beneficiaries.''.

  Mr. BAUCUS. Mr. President, today, I am pleased to join Chairman 
Grassley in introducing the Medicare Data Access and Research Act. This 
bill will take an important step to advance the safety, efficacy, and 
quality of health care services delivered to people under the Medicare 
Program and it will help improve the care delivered to all Americans.
  This bill requires the Secretary of Health and Human Services, HHS, 
to make Medicare data accessible to Federal health agencies and the 
health services research community for the purpose of conducting 
studies that will serve the public health. As the largest single payer 
of health care services in the United States--covering over 40 million 
lives, 70 million hospital days, and processing nearly a billion 
physician claims per year--Medicare collects and maintains a wealth of 
information on the health services delivered to a significant portion 
of the population. This information has been a national resource for 
research and analysis of health care. And with the addition of the 
Medicare prescription drug benefit, it will be the most comprehensive 
resource our Nation has to study the effects of diseases and the 
treatments we have for them.
  The Centers for Medicare and Medicaid Service, CMS, currently 
releases certain Medicare data to the public and more comprehensive 
data to the research community. This bill would build on current 
activities by requiring CMS to link hospital claims, physician claims, 
and other relevant information to data collected under the new Medicare 
drug benefit.
  In addition, the Secretary will provide yearly access to the linked 
Medicare dataset to all Federal health agencies within the department, 
such as the Food and Drug Administration, the Centers for Disease 
Control, the National Institutes of Health, and the Agency for 
Healthcare Quality and Research. These agencies will enter into data 
use agreements with CMS to ensure that the type and level of Medicare 
data shared is appropriate, that the agencies conduct research in 
accordance with their missions and the purpose of furthering the public 
health, and that the privacy of the data is protected. The goal is to 
give Federal health agencies another tool to evaluate the safety, 
efficacy, and quality of care delivered to Medicare beneficiaries--a 
large segment of the health system.
  This bill also provides public health researchers access to the 
linked Medicare dataset. Expanding access to Medicare data will open up 
a new era in our health system. It will enable scientists to more 
quickly identify both short- and long-term safety concerns with drug 
regimens and health treatments. It will enable more treatments to be 
compared. And it will promote more development of guidelines, so 
providers and patients know more about what works best.
  Some may argue that access to linked Medicare data should not be 
limited to researchers and should be available for commercial purposes. 
But the full Medicare database should be used exclusively for the 
public good and not for private or commercial gain. This is the crux of 
this bill. Hence, the bill limits the use of data to the purpose of 
providing ``generalizable knowledge to inform the public health through 
scientific publication and other forms of public dissemination.'' 
Strict penalties will be imposed on any unauthorized use of the data 
including civil money penalties and disqualification from receiving 
Medicare data for at least 2 years.
  CMS will publish criteria used to approve research applications to 
ensure that those selected are qualified and experienced to conduct 
analyses and maintain the confidentiality of Medicare information. 
Researchers will also make public their detailed results and methods 
within 1 year from completing their studies. They will make available 
to the public at no charge any tool developed through this program. 
They must agree not to sell data or create commercial data products 
using such data and abide by safeguards protecting the confidentiality 
of the data established by the Secretary.
  The final section of the bill ensures that congressional support 
agencies, including the Congressional Budget Office, the Congressional 
Research Service, the Government Accountability Office, and the 
Medicare Payment Advisory Commission, also have access to the full 
range of data they need to carry out their functions and 
responsibilities. Congress depends on the research and analyses 
conducted by these agencies to inform our deliberations and decisions 
on the Medicare Program.
  Last year, I worked with Senator Grassley to introduce the Medicare 
Value-Based Purchasing Act, which establishes a pay for performance 
system under Medicare. An important element of that system is the 
collection and reporting of quality measures to CMS and to the public. 
The bill we are introducing today complements those activities. We can 
improve health care by allowing Medicare to become a value-based 
purchaser of services and by reporting quality measures through the 
Medicare Program. And we can improve health care for all by allowing 
rigorous health services research to be conducted using the resource of 
Medicare data.
  Mr. President, the Medicare Data Access and Research Act will allow 
us to expand our knowledge of health care and improve the quality of 
care for all Americans.
                                 ______
                                 
      By Mr. GREGG (for himself, Mr. Frist, Mr. Burr, Mr. Cornyn, and 
        Mr. Bennett):
  S. 3900. A bill to amend title XVIII of the Social Security Act to 
improve the quality and efficiency of health care, to provide the 
public with information on provider and supplier performance, and to 
enhance the education and awareness of consumers for evaluating health 
care services through the development and release of reports based on 
Medicare enrollment, claims, survey, and assessment data; to the 
Committee on Finance.
  Mr. GREGG. Mr. President, I rise today to introduce the Medicare 
Quality Enhancement Act of 2006 to improve quality and reduce the cost 
of health care.
  The Medicare Quality Enhancement Act addresses three important 
problems in our Nation's health care delivery system: rising costs, 
broad variations in the quality of care, and a lack of information on 
health care quality and cost.
  Among the most pressing issues that need to be addressed in the area 
of health care is the issue of rapidly rising health care costs. The 
United States spends more on health care as a percentage of GDP than 
any other industrialized country. According to the Centers for Medicare 
and Medicaid Services (CMS), total health expenditures are estimated to 
be $2.16 trillion

[[Page S9637]]

in 2006 and are projected to rise to over $4 trillion in 2015.
  The pressures of rising health care costs are being felt by 
consumers, providers, employers, State and local governments, and the 
Federal budget alike--with no end in sight. Premiums for employer-based 
health insurance rose by 9.2 percent in 2005--the fifth consecutive 
year of increases over 9 percent. Health insurance expenses are the 
fastest growing expense to employers, consuming more and more of each 
company's bottom line.
  From a Federal budget perspective, over the next 10 years, Medicare 
will grow on average 8.5 percent to $885 billion and Medicaid will grow 
similarly at 8 percent to $413 billion. These programs along with 
Social Security will take up 56 percent of the total budget in 2016. 
Such rate of growth is unsustainable.
  Despite this enormous level of spending, there is wide variation in 
the quality of the care Americans receive. In addition to the existing 
crisis of ever increasing costs, we are now learning that there are 
vast variations in the ratio of spending to outcomes, meaning that more 
care is not necessarily better care. A recent report by the Dartmouth 
Atlas Project demonstrated this point and showed no correlation between 
high utilization of services and high quality of care. This information 
provides an opportunity to improve care and reduce costs. We simply 
cannot afford business as usual in health care, especially when we have 
no way of determining the value of what we are purchasing.
  The Agency on Healthcare Research and Quality (AHRQ) also reports 
wide variation in health care practice. AHRQ claims that millions of 
Americans fail to receive necessary care resulting in complications and 
increased costs. Others, they say, receive health care services that 
are completely unnecessary, which also increases costs.
  These problems are compounded by a third issue the lack of 
information available to consumers and purchasers on quality and cost. 
Currently, health care consumers do not have the tools necessary to 
make sound quality and cost decisions about their care. The few tools 
that are available to them are based on limited amounts of privately 
held data and their analysis is often not broad enough to provide the 
most accurate results.
  The Medicare Quality Enhancement Act gives consumers, employers, 
providers and others the tools they need to begin controlling 
unnecessary spending; improves quality of care in our nation's health 
care delivery system; and provides the public with reports to make 
informed health care decisions.
  The bill works by sharing taxpayer funded Medicare data with private 
sector Medicare Quality Reporting Organizations (MQROs), allowing them 
to develop reports to measure health care quality for the public. 
Consumer groups, employers, insurance companies, labor unions and 
others have repeatedly requested access to Medicare claims data to 
improve the quality of the health care provided to their members, 
employees, and beneficiaries and to help control the ever-rising costs 
of health care. The Medicare Quality Enhancement Act ensures that the 
data collected by Medicare and paid for by the taxpayer can be utilized 
by qualified organizations to measure quality and control costs while 
protecting beneficiary privacy.
  The measure also empowers consumer groups, providers, employers, 
insurance plans, labor unions and others by allowing them to request 
health care quality and efficiency reports from the newly-formed 
MQROs--information that will assist in better-informed purchasing 
decisions. Further, the bill provides for the public release of all 
reports, including detailed information on the methodology, standards 
and measures of quality used in developing the reports ensuring the 
information is available for the general public. In addition, MQROs 
that contract with the Department of Health and Human Services will be 
authorized to aggregate both private and public data, providing a 
significantly more robust assessment of both quality and efficiency.
  In the development of this bill, my first goal was to protect 
beneficiary privacy. Specifically, the bill limits the number of MQRO 
participants and explicitly holds them to the strict standards of both 
the Health Insurance Portability and Accountability Act (HIPAA) and the 
Privacy Act. It also requires MQROs to have operational standards and 
procedures in place to provide for the security of the database. 
Lastly, the bill requires a privacy review by the Department of Health 
and Human Services of each analytical report prior to release.
  The Medicare Quality Enhancement Act promotes the development of 
model quality standards through a newly established Quality Advisory 
Board within the Department of Health and Human Services and encourages 
the Administration to continue its extraordinary work with providers, 
consumers, insurers and others in the health care community toward 
sound quality measurement for all patients. Collaborative groups such 
as the Ambulatory Care Quality Alliance (AQA) and the Hospital Quality 
Alliance (HQA) are working hard to establish standards and the Medicare 
Quality Enhancement Act encourages their work to continue.
  Under the bill, researchers are granted additional access to Medicare 
data and are allowed to report in a provider- and supplier-identifiable 
format as long as they meet existing strict criteria for the use of 
Medicare data within CMS. Some of our best information on quality and 
efficiency has been borne of fine academic institutions and private 
study and they, too, should have the opportunities to use this data to 
improve our health care system.
  In closing, the Medicare Quality Enhancement Act is needed in order 
for America's health care system to improve. The public needs to 
understand the quality of the care they are purchasing and the time has 
come for the health care community to compete on quality, value, and 
cost payment should not simply be for the volume of care provided, but 
instead for the quality of the care provided.
  The Medicare Quality Enhancement Act takes important steps to provide 
health care consumers with the information they need to make educated 
decisions about health care; information they already have to make 
decisions on nearly every other product they purchase in the 
marketplace. It requires that information paid for by the taxpayer and 
held by Medicare is fully available to improve our health care system. 
The public will then finally have the tools necessary to make informed 
health care decisions for themselves and their families.
  This bill has the support of groups that represent consumers, 
providers, employers and insurers. I hope my colleagues will see the 
merit of this legislation and that it will be considered before we 
adjourn this year.
  Mr. FRIST. Mr. President, for decades, healthcare analysts and 
industry experts have wondered whether healthcare should consume 16 
percent of our Nation's economic output, as it currently does.
  By virtually any measure, we spend more on healthcare than any other 
country in the world.
  Consider the facts. According to the World Health Organization; we 
spend twice as much per person on healthcare as Britain and Japan; and 
we spend nearly 30 percent more than second-ranking Monaco.
  In the past 5 years alone, the cost of health insurance to companies 
has nearly doubled--from $4,200 to $8,100 per family.
  But experts also concur that rising healthcare costs does not mean 
the quality of healthcare is improving. Just this summer, the Institute 
of Medicine released the most extensive report ever on medication 
errors.
  The results? At least 1.5 million Americans are sickened, injured, or 
killed each year by errors in prescribing, dispensing, and taking 
medications.
  Errors are widespread--on average, a hospital patient is subjected to 
1 error each day he or she occupies a hospital bed--and they are 
costly, at an estimated expense of $3.5 billion per year.
  We have good reason to question the cost and quality of our 
healthcare services. That is why, in August, President Bush issued an 
executive order requiring all Federal agencies with a health insurance 
program to increase price transparency and provide options promoting 
quality and efficiency of care.

[[Page S9638]]

  The Executive Order builds on the Federal Govermment's efforts to 
release Medicare payment information for individual healthcare 
providers.
  While this is an important step toward transparency, more can be 
done. We need a way to analyze that data and make the results of the 
analysis consumer friendly, so that patients have real information they 
can use to make better informed healthcare decisions.
  The bill before us today--of which I am a proud cosponsor--picks up 
where current Federal efforts leave off. The Medicare Quality 
Enhancement Act establishes quality transparency in the Medicare 
Program.
  It doesn't require anything extra of providers. In fact, CMS is 
already collecting the data we need--because any provider that accepts 
Medicare patients must report quality data to CMS.
  Instead, the bill requires CMS to establish public-private 
partnerships with Medicare quality reporting organizations, or MQROs. 
CMS will provide MQROs with data CMS already collects--Medicare 
enrollment, claims, and survey and assessment data. The MQROs will then 
perform the analysis.
  Any entity or provider will be able to make report requests of MQROs, 
the results of which will be made public. The methodology an MQRO uses 
to analyze the data will also be made public. And providers can 
additionally instruct MQROs to use a certain methodology when making a 
report request.
  I know many providers are concerned about CMS's capacity and 
capability to analyze healthcare quality data.
  In part, that is why this bill requires CMS to contract with MQROs. 
The Secretary must determine that each MQRO has the research capability 
to conduct and complete reports as a condition for entering into the 
contract. MQROs must also demonstrate that they have the experience and 
expertise to analyze quality data.
  As an additional contract requirement, each MQRO must comply with 
Federal privacy regulations to ensure beneficiary confidentiality. 
Additionally, MQROs must disclose financial interests as a condition to 
contract.
  As a transplant surgeon, I understand the concerns and fears 
providers have. Many providers are worried that we aren't far enough 
along in terms of quality data collection to be able to analyze it.
  But we must push the envelope in this area. It is my hope that 
provider groups will take the lead and request reports using a 
methodology and standards of quality that represent the best care in 
each of their fields.
  Quality transparency is absolutely essential to improving healthcare. 
Without it, beneficiaries cannot make informed decisions about their 
healthcare.
  Consumers already enjoy transparency in other industries. When we buy 
a new car, we can open an Internet browser and in a matter of moments 
can make objective side-by-side comparisons of different models--and 
then we can take them for a test drive.
  When we need groceries, we pull out the Sunday supermarket ads to see 
what is on sale and where.
  And when we furnish our homes, we shop around--comparing style, 
price, color, quality, warranty, and service.
  But right now, we can't do that in healthcare. Whether it is a 
routine checkup or a heart transplant, we have no way of assessing how 
much bang we are getting for a buck.
  Only when we institute quality transparency do we empower 
beneficiaries to make informed decisions about their healthcare.
  This bill is a great step toward the goal of complete quality 
transparency. It is a formidable goal; that is why we are starting with 
something we know--Medicare.
  Senator Gregg has worked long hours to bring this bill to fruition, 
and I thank him for his efforts. I hope our colleagues will join us in 
supporting this important measure.
                                 ______
                                 
      By Mr. BAUCUS:
  S. 3902. A bill to provide for education competitiveness; to the 
Committee on Finance.
  Mr. BAUCUS. Mr. President, in August of 1802, from his desk in 
Monticello, President Thomas Jefferson glimpsed the future of the young 
American economy. He was shaken by what he saw.
  Jefferson had just finished reading a book published a year earlier 
in London. The slim volume was the travel account of Alexander 
MacKenzie, a young Scotsman working in Great Britain's Canadian 
colonies.
  In June of 1793, MacKenzie had crossed the Continental Divide at a 
place where it was just 3,000 feet high and easily portaged. Two weeks 
later, he reached the Pacific Ocean. Using a makeshift paint of 
vermilion and grease, Mackenzie inscribed his name on a rock to 
memorialize his discovery, and to claim it for Great Britain.
  The economic implications of MacKenzie's discovery were enormous. In 
his book, MacKenzie urged the British to build on his discovery and 
develop a passage to the Pacific. Such a passage would give Great 
Britain control over much of North America's lucrative fur trade and 
access to the world's markets. Worse, MacKenzie's discovery threatened 
to stunt America's economic growth in its infancy.
  MacKenzie's book lit a fire under Jefferson. That summer, he talked 
of little else. He enlisted the most qualified man he knew. And with 
him, Jefferson devised a plan for action. It was a plan to counter the 
economic threat from the north. It was a plan to safeguard America's 
economic future.
  That December, President Jefferson presented his plan to Congress. It 
was America's first economic competitiveness plan. It called for one 
officer, a dozen soldiers, and $2,500.
  Thomas Jefferson's economic competitiveness plan of 1802 has become 
better known as the Lewis and Clark Expedition. Today, we see that 
expedition as one of our Nation's great displays of ambition and 
courage. And today, we see that it laid the foundation of the United 
States as we know it.
  Today, America faces a new competitive challenge. Our challenge is 
not over control of the fur trade. It comes not from an imperial power 
or its colony. It is not a race for territory in unexplored lands. Our 
challenge is far more complex. And the need to act is even more urgent.
  America today faces a world more integrated, more interdependent, and 
more intensely competitive than ever in our history. In this world, it 
is our challenge to succeed. It is our challenge to leave our children 
and grandchildren an economy that is better than the one that we 
inherited.
  We seek an economy that is not laden with debt, but bursting with 
opportunity. We seek an economy that plants the seeds of innovation and 
education today, knowing that generations far in the future will 
harvest their bounty. We seek an economy whose workers are increasingly 
productive, and whose skills are continuously sharpened.
  Our challenge is to create an economy in which investment in our 
workers is our greatest asset, not our heaviest burden. Our challenge 
is to create an economy known for what it will be, rather than for what 
it was.
  To realize this competitive economy, we must--like Jefferson--rise to 
the challenge. We must--like Jefferson--look to unknown horizons and 
march out to meet them. We must call upon our greatest minds and set 
them to creating a plan. And we must dedicate the resources necessary 
to implement that plan.
  I have spent much of the past year planning a comprehensive 
competitiveness agenda. In February, I introduced the Trade 
Competitiveness Act, a bill to open markets and keep a level playing 
field for America's ranchers, farmers, and businesses.
  In March, I introduced the Energy Competitiveness Act, to fund 
cutting edge research in energy while making alternative energies more 
affordable.
  In April, I introduced the Savings Competitiveness Act, to create 
savings today, so that we may invest and innovate tomorrow.
  In May, I introduced the Research Competitiveness Act, to give start-
ups and universities better access to capital for research and 
development, and to improve and make permanent the R&D tax credit.
  Today, I am introducing the fifth in this series of bills: the 
Education Competitiveness Act of 2006. Just as education is the 
foundation of a competitive economy, this legislation is the foundation 
of my competitiveness agenda.

[[Page S9639]]

  Thomas Jefferson knew that it was not enough to send Lewis and Clark 
to the Pacific Ocean without the means to return. Lewis and Clark knew 
that the discoveries and contacts that they made had to be lasting to 
make a difference for our economy.
  The Education Competitiveness Act is also designed to have a lasting 
effect. This legislation embraces education in its earliest stages, 
following through to continuing education and worker training. Each 
provision is designed with maximum flexibility to meet our States' 
unique needs. It is a bill that recognizes excellence, welcomes 
innovation, and rewards ambition.
  The Education Competitiveness Act has seven important components.
  First, it recognizes that our Nation needs to continue to bring 
quality teachers into the classroom. The bill funds 100,000 
scholarships for future teachers of languages, early education, and 
science. It creates incentives for teachers to serve in rural and 
underserved areas. And it rapidly expands funding to advanced placement 
and international baccalaureate programs.
  Second, the bill recognizes that early education is widely considered 
to be one of the best education investments that money can buy. The 
bill creates a flexible program of matching grants to build a national 
system of universal, voluntary prekindergarten. The bill sets out 
benchmarks for quality and provides help for States to make sure that 
their teachers are the best that they can be.
  Third, the bill helps students to go the extra mile in their studies, 
by offering States the means to expand afterschool programs in 
everything from college test preparation to drug prevention. Summer 
programs get students out of the classroom for hands-on experience in 
science, technology, mathematics, and engineering.
  Fourth, the bill looks to the needs of tomorrow's workforce. That 
workforce will increasingly demand technical skills based in math, 
science, and engineering. The bill provides a free college education to 
any student wishing to study science, technology, math, or engineering. 
In return, the student must work 4 years in that field of study. The 
bill offers States matching grants to establish and expand specialty 
math, science, and technology schools. And the bill makes young 
promising scientists eligible for cash grants to continue their 
research.
  Fifth, the bill addresses the chronic neglect of our Nation's Indian 
education. The bill fully funds Indian colleges and makes a real 
commitment to the Johnson O'Malley program. The bill also increases the 
Pell grant to $6,000. Eighty percent of Montana's students rely on 
financial aid, including Pell grants.
  Sixth, the Education Competitiveness Act allows American workers to 
continue learning. The bill funds programs to link businesses and 
schools, to give workers the skills that they need. Where universities 
and community colleges are too far away, distance learning grants will 
help bridge that gap.
  Finally, the bill's tax provisions grant greater access to education. 
The bill starts by simplifying confusing tax credits and combining them 
into a single refundable higher education credit of up to $2,000 per 
student. The bill eases the burden of loan repayment by permitting 
graduates to deduct more of the interest paid on their student loans. 
And the bill increases the deductions for charitable contributions to 
schools as well as teachers' expenses in classrooms.
  Taken together, these seven components form a bill that is both 
comprehensive and responsible. It is a bill that would help to secure a 
more competitive American economy.
  I look forward to returning to the floor to describe each title in 
greater detail. I also look forward to discussing these proposals with 
my colleagues.
  The Education Competitiveness Act sets out a bold agenda, to be sure. 
Some of its rewards may only be reaped decades from now. Some of its 
benefits may only be realized by our grandchildren. But I firmly 
believe that this is an agenda that we must begin to implement today.
  Like the journey of Lewis and Clark 200 years ago, this is an agenda 
that portends discovery and rewards for America. It is an agenda that 
promises a passage to a new nation. I urge my colleagues to join me as 
we advance to this future, and join me in sponsoring the Education 
Competitiveness Act.

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