[Congressional Record Volume 153, Number 45 (Thursday, March 15, 2007)]
[Senate]
[Pages S3201-S3224]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. DURBIN (for himself, Mr. Coburn, Mr. Leahy, Mr. Cornyn,
and Mr. Feingold):
S. 888. A bill to amend section 1091 of title 18, United States Code,
to allow the prosecution of genocide in appropriate circumstances; to
the Committee on the Judiciary.
Mr. DURBIN. Mr. President, 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. 888
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 ``Genocide Accountability Act
of 2007''.
SEC. 2. GENOCIDE.
Section 1091 of title 18, United States Code, is amended by
striking subsection (d) and inserting the following:
``(d) Required Circumstance for Offenses.--The circumstance
referred to in subsections (a) and (c) is that--
``(1) the offense is committed in whole or in part within
the United States;
``(2) the alleged offender is a national of the United
States (as that term is defined in section 101 of the
Immigration and Nationality Act (8 U.S.C. 1101));
``(3) the alleged offender is an alien lawfully admitted
for permanent residence in the United States (as that term is
defined in section 101 of the Immigration and Nationality Act
(8 U.S.C. 1101));
``(4) the alleged offender is a stateless person whose
habitual residence is in the United States; or
``(5) after the conduct required for the offense occurs,
the alleged offender is brought into, or found in, the United
States, even if that conduct occurred outside the United
States.''.
Mr. COBURN. Mr. President, I rise today as the lead Republican
sponsor of the Genocide Accountability Act of 2007. I thank my
colleague, Senator Durbin, for introducing this important piece of
legislation.
Senator Durbin serves as the chairman and I serve as the ranking
member of the new Subcommittee on Human Rights and the Law in the
Senate Judiciary Committee. We held our first hearing, entitled
``Genocide and the Rule of Law,'' on February 5, 2007. There could not
be a more appropriate way to begin examining the law as it relates to
human rights than to determine what we can and must do to prevent and
stop genocide. The United States is a signatory of the Convention on
the Prevention and Punishment of the Crime of Genocide. This convention
provides that the contracting parties must ``undertake to prevent and
to punish'' the crime of genocide. We have also passed a law
implementing the Genocide Convention.
However, our hearing demonstrated that there are changes that need to
be made in law and foreign policy to respond to the ongoing genocide in
Sudan and to any genocide that may occur elsewhere in the future.
Fortunately, two of these changes can be accomplished right now.
The first change can be accomplished through a bill Senators Durbin
and Cornyn introduced last week, of which I am a cosponsor. That bill,
the Sudan Divestment Authorization Act of 2007, will allow State and
local governments to prohibit the investment of State assets in the
Government of Sudan or companies with certain business relationships
with Sudan, while the Government of Sudan is subject to sanctions under
U.S. law. The second change can be accomplished through the bill we are
introducing today, the Genocide Accountability Act of 2007. This act
will ensure that our justice system has the authority to prosecute
someone who has committed genocide if that person is found or brought
into the United States.
Under current law, the United States can deny admission to and
exclude aliens from the United States on human rights grounds. The
Attorney General can also consider avenues for the prosecution of
aliens who have committed certain crimes, including genocide. However,
the Attorney General can only prosecute a perpetrator of genocide if he
committed his crimes within the United States or is a U.S. national.
[[Page S3202]]
What does this mean? It means that if a person who plans or
participates in the genocide occurring right now in Darfur travels to
the United States on vacation, business, or even to live here for an
extended period of time--as a refugee or student, for instance--a court
in the United States cannot touch him. The best our justice system can
do is deport him once his crime is discovered.
Without question, it may be more appropriate in some cases to
extradite someone who commits genocide to his home country or turn him
over to an international tribunal. However, there are also times when a
person's home country may not be willing to prosecute him and there is
no viable alternative for prosecution. In these cases, extraditing a
criminal would be no different than setting him free. This bill will
not force our justice system to prosecute those who commit genocide
just because they are found on our soil--it simply gives us the option.
Nonetheless, in America we are blessed with great resources and the
most effective and just legal system in the world. With these blessings
comes great responsibility. It is contrary to our system of justice to
allow perpetrators of genocide to go free without fear of prosecution.
It simply makes no sense to withhold from our justice system the
authority to prosecute someone who is found in the United States and
who committed a crime as atrocious as genocide just because he is not
American and did not commit the crime here. We have passed tough laws
that ensure that we can prosecute anyone found in the United States who
has committed terrorist acts or supports terrorism. We do not want to
become a safe haven for terrorists, so I ask: Do we want to be a safe
haven for those who have committed genocide? The answer should be
clear.
Fundamentally, we must decide if genocide is a bad enough crime, no
matter where it happens, that it warrants the same treatment as
terrorism-related crimes. I deeply believe that it is, and that is why
I am proud to cosponsor this bill today.
______
By Mr. INOUYE (for himself, Mr. Stevens, Mr. Roberts, and Mr.
Hagel):
S. 890. A bill to provide for certain administrative and support
services for the Dwight D. Eisenhower Memorial Commission, and for
other purposes; to the Committee on Energy and Natural Resources.
Mr. INOUYE. Mr. President, the Eisenhower Memorial Commission was
created by the U.S. Congress in 1999 as a bipartisan commission for the
purpose of considering and formulating plans for the location, design
and construction of a permanent memorial to President Dwight D.
Eisenhower to perpetuate his memory and his contributions to the United
States. Since being fully appointed in 2001, the Commission considered
twenty-six different sites in the District of Columbia. In 2005, it
selected a site between the Department of Education and the National
Air and Space Museum, two institutions resulting from and greatly
influenced by President Eisenhower's leadership.
In 2006, Congress approved the memorial's location within Area I, in
compliance with the Commemorative Works Act. The Commission secured
full approval for the selected site following extensive review by the
National Park Service, the National Capital Memorial Advisory
Commission, the National Capital Planning Commission, and the
Commission of Fine Arts. Since its inception, the Commission has also
taken great care to study and analyze President Eisenhower's legacy. It
produced a report by leading scholars and experts on President
Eisenhower that provides a definitive statement on the transcending
elements of President Eisenhower's enduring legacy. He ranks as one of
the preeminent figures in the global history of the 20th century.
The Eisenhower Memorial Commission now needs to move into the design
phase. As design begins, the Commission's organization, specifically
with regard to contracting and staffing, needs to be updated and
revised to enable efficient management and responsible stewardship. The
proposed legislation which I introduce today provides for the necessary
reorganization. I am joined by Senators Stevens, Roberts, and Hagel as
original cosponsors of the bill.
The legislation enables the Commission to retain the services of
full, part-time, and volunteer staff as government employees, without
the restrictions of the competitive service requirements. It also
provides the authority for the Commission's Executive Architect to
manage technical and administrative aspects of design and construction.
It provides for staff to be released on the completion of the memorial
and enables the Commission to work in collaboration with federal
agencies.
President Eisenhower spent his entire life in public service. His
extraordinary contributions include serving as Supreme Commander of the
Allied Expeditionary Forces in World War II and as 34th President of
the United States, but President Eisenhower also served as the first
commander of NATO and as President of Columbia University. Dramatic
changes occurred in America during his lifetime, many of which he
participated in and influenced through his extraordinary leadership as
President.
Although President Eisenhower grew up before automobiles existed, he
created the Interstate Highway System and took America into space. He
created the National Aeronautics and Space Administration, the
Department of Health, Education, and Welfare, and the Federal Aviation
Administration. He added the State of Hawaii and the State of Alaska to
the United States and ended the Korean War. President Eisenhower
desegregated the District of Columbia and sent Federal troops into
Little Rock, Arkansas, to enforce school integration. He defused
international crises and inaugurated the national security policies
that guided the nation for the next three decades, leading to the
peaceful end of the Cold War.
A career soldier, President Eisenhower championed peace, freedom,
justice and security, and, as President, he stressed the
interdependence of those goals. He spent a lifetime fulfilling his duty
to his country, always remembering to ask: What is best for America?
President Eisenhower once said, ``I know that the American people
share my belief that if a danger exists in the world, it is a danger
shared by all; and equally, that if hope exists in the mind of one
nation, that hope should be shared by all.'' President Eisenhower's
legacy provides hope to all of us--like him, through education and
public service, we, as a nation and individually, can rise to meet any
challenge. Accordingly, I urge my colleagues to support this
legislation.
I ask unanimous consent that the text of my 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. 890
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. DWIGHT D. EISENHOWER MEMORIAL COMMISSION.
Section 8162 of the Department of Defense Appropriations
Act, 2000 (Public Law 106-79; 113 Stat. 1274) is amended--
(1) by striking subsection (j), and inserting the
following:
``(j) Powers of the Commission.--
``(1) In general.--
``(A) Powers.--The Commission may--
``(i) make such expenditures for services and materials for
the purpose of carrying out this section as the Commission
considers advisable from funds appropriated or received as
gifts for that purpose;
``(ii) solicit and accept contributions to be used in
carrying out this section or to be used in connection with
the construction or other expenses of the memorial;
``(iii) hold hearings and enter into contracts;
``(iv) enter into contracts for specialized or professional
services as necessary to carry out this section; and
``(v) take such actions as are necessary to carry out this
section.
``(B) Specialized or professional services.--Services under
subparagraph (A)(iv) may be--
``(i) obtained without regard to the provisions of title 5,
United States Code, including section 3109 of that title; and
``(ii) may be paid without regard to the provisions of
title 5, United States Code, including chapter 51 and
subchapter III of chapter 53 of that title;
``(2) Gifts of property.--The Commission may accept gifts
of real or personal property to be used in carrying out this
section, including to be used in connection with the
construction or other expenses of the memorial.
[[Page S3203]]
``(3) Federal cooperation.--To ensure the overall success
of the efforts of the Commission, the Commission may call
upon any Federal department or agency to assist in and give
support to the Commission. The head of each Federal
department or agency shall furnish such information or
assistance requested by the Commission, as appropriate,
unless prohibited by law.
``(4) Powers of members and agents.--
``(A) In general.--If authorized by the Commission, any
member or agent of the Commission may take any action that
the Commission is authorized to take under this section.
``(B) Architect.--The Commission may appoint an architect
as an agent of the Commission to--
``(i) represent the Commission on various governmental
source selection and planning boards on the selection of the
firms that will design and construct the memorial; and
``(ii) perform other duties as designated by the
Chairperson of the Commission.
``(C) Treatment.--An authorized member or agent of the
Commission (including an individual appointed under
subparagraph (B)) providing services to the Commission shall
be considered an employee of the Federal Government in the
performance of those services for the purposes of chapter 171
of title 28, United States Code, relating to tort claims.
``(5) Travel.--Each member of the Commission shall be
allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of
business in the performance of services for the
Commission.'';
(2) by redesignating subsection (o) as subsection (q); and
(3) by adding at the end the following:
``(o) Staff and Support Services.--
``(1) Executive director.--There shall be an Executive
Director appointed by the Commission to be paid at a rate not
to exceed the maximum rate of basic pay for level IV of the
Executive Schedule.
``(2) Staff.--
``(A) In general.--The staff of the Commission may be
appointed and terminated without regard to the provisions of
title 5, United States Code, governing appointments in the
competitive service, and may be paid without regard to the
provisions of chapter 51 and subchapter III of chapter 53 of
that title, relating to classification and General Schedule
pay rates, except that an individual appointed under this
paragraph may not receive pay in excess of the maximum rate
of basic pay for GS-15 of the General Schedule.
``(B) Senior staff.--Notwithstanding subparagraph (A), not
more than 3 staff employees of the Commission (in addition to
the Executive Director) may be paid at a rate not to exceed
the maximum rate of basic pay for level IV of the Executive
Schedule
``(3) Staff of federal agencies.--Upon request by the
Chairperson of the Commission, the Vice-Chairperson, or the
Executive Director, the head of any Federal department or
agency may detail, on a nonreimbursable basis, any of the
personnel of the department or agency to the Commission to
assist the Commission to carry out its duties under this
section.
``(4) Federal support.--The Commission shall obtain
administrative and support services from the General Services
Administration on a reimbursable basis. The Commission may
use all contracts, schedules, and acquisition vehicles
allowed to external clients through the General Services
Administration.
``(5) Cooperative agreements.--The Commission may enter
into cooperative agreements with Federal agencies, State,
local, tribal and international governments, and private
interests and organizations which will further the goals and
purposes of this section.
``(6) Temporary, intermittent, and part-time services.--
``(A) In general.--The Commission may obtain temporary,
intermittent, and part-time services under section 3109 of
title 5, United States Code, at rates not to exceed the
maximum annual rate of basic pay payable under section 5376
of that title.
``(B) Non-applicability to certain services.--This
paragraph shall not apply to services under subsection
(j)(1)(A)(iv).
``(7) Volunteer services.--
``(A) In general.--Notwithstanding section 1342 of title
31, United States Code, the Commission may accept and utilize
the services of volunteers serving without compensation.
``(B) Reimbursement.--The Commission may reimburse such
volunteers for local travel and office supplies, and for
other travel expenses, including per diem in lieu of
subsistence, as authorized by section 5703 of title 5, United
States Code.
``(C) Treatment.--A person providing volunteer services to
the Commission shall be considered an employee of the Federal
government in the performance of those services for the
purposes of--
``(i) chapter 81 of title 5, United States Code, relating
to compensation for work-related injuries;
``(ii) chapter 171 of title 28, United States Code,
relating to tort claims; and
``(iii) chapter 11 of title 18, United States Code,
relating to conflicts of interest.
``(p) Authorization of Appropriations.--There are
authorized to be appropriated such sums as necessary to carry
out this section.''.
______
By Mr. INHOFE (for himself and Mr. Coburn):
S. 891. A bill to protect children and their parents from being
coerced into administering a controlled substance in order to attend
school, and for other purposes; to the Committee on Health, Education,
Labor, and Pensions.
Mr. INHOFE. Mr. President, I rise today, along with my colleague, Tom
Coburn, to proudly reintroduce the Child Medication Safety Act, a bill
to protect children and their parents from being coerced into
administering a controlled substance or psychotropic drug in order to
attend a school.
Parents today face many challenges when raising their children, one
of which is ensuring that their children receive the best education
possible. My views on education come from a somewhat unique perspective
in that my wife, Kay, was a teacher at Edison High School in Tulsa for
many years and now both of our daughters are teachers. I can assure you
that I am one of the strongest supporters of quality education.
However, it has come to my attention that schools have been acting as
physicians or psychologists by strongly suggesting that children with
behavioral problems be put immediately on some form of psychotropic
drugs. Schools and teachers are not equipped to make this diagnosis and
should not make it mandatory for the student to continue attending the
school. This is clearly beyond their area of expertise. Therefore, I am
introducing this legislation to ensure that parents are not required by
school personnel to medicate their children.
The Child Medication Safety Act requires, as a condition of receiving
funds from the Department of Education, that States develop and
implement polices and procedures prohibiting school personnel from
requiring a child to obtain a prescription as a condition of attending
the school. It should be noted that this bill does not prevent teachers
or other school personnel from sharing with parents or guardians
classroom-based observations regarding a student's academic performance
or regarding the need for evaluation for special education.
Additionally, this bill calls for a study by the Comptroller General of
the United States reviewing: (1) the variation among States in the
definition of psychotropic medication as used in public education, (2)
the prescription rates of medication used in public schools to treat
children with attention deficit disorder and other such disorders, 3)
which medications listed under the Controlled Substances Act are being
prescribed to such children, and 4) which medications not listed under
the Controlled Substances Act are being used to treat these children
and their properties and effects. This GAO report is due no later than
one year after the enactment of this Act.
I believe this is an extremely important bill that protects the
rights of our children against improper intrusion regarding health
issues by those not qualified. If a parent or guardian believes their
child is in need of medication, then they have the right to make that
decision and consult with a licensed medical practitioner who is
qualified to prescribe an appropriate drug. Please join us in support
of this legislation that protects the freedoms of our children.
______
By Mr. INHOFE:
S. 892. A bill to amend the Internal Revenue Code of 1986 to provide
for the indexing of certain assets for purposes of determining gain or
loss; to the Committee on Finance.
Mr. INHOFE. Mr. President, I rise today to introduce the Capital
Gains Inflation Relief Act of 2007. The taxation of inflation is one of
the most unjust practices of the tax code. This simple improvement will
not only enhance the basic fairness and efficiency of the tax code, but
will also immediately increase the net return on capital investment.
Under current law, a taxable capital gain occurs whenever a capital
asset is sold at a price higher than the original purchase price.
However, the timing of capital gains taxation sets it apart from other
types of income. While wages are generally taxed on a yearly basis, the
taxation on capital assets occurs at the time the capital asset holder
chooses to sell his asset and realize
[[Page S3204]]
his gains. The gains on capital assets accrue over the course of the
asset's life, which is usually many years. This is generally favorable
to the capital asset holder, because he can defer taxation on his gains
to a future year. This tax deferral is often cited as the primary
reason for holding assets long term.
However, the value of tax deferral is often times overstated because
current tax policy taxes the capital asset holder not only on real
gains, but also on gains due to inflation. This creates a situation
that is patently unfair to the American taxpayer. For example, an
American who purchased a share of stock for $10 in 1950 and sold it for
twice that amount today would be subject to capital gains taxes on the
nominal gain of $10, though the transaction was a clear loss when one
accounts for inflation. Why should an American taxpayer, who invested
in a capital asset in his youth, be forced to pay capital gains taxes,
on what can only be viewed as a loss, in his later years? In spite of
all our efforts to curb inflation, it will remain a fact of life. This
does not mean we should tax hard-working Americans with long-term goals
on gains that are due to inflation, gains that they will never actually
realize.
Without an inflation index, the tax code incentivizes short-term
speculation and discourages long-term capital investment. The current
turmoil in the subprime lending market is an example that demonstrates
the perils of emphasizing short-term speculation over long-term capital
investment. Though inflation has remained relatively modest recently,
there is no guarantee of future stability. Inflation indexing would
instantly increase the net return on capital investment and
consequently encourage more of it. Inflation indexing would also
restore core principles of sound tax policy such as ``horizontal
equity,'' wherein two taxpayers in identical situations are treated
identically by the tax system. Indexing capital gains would improve the
basic fairness of the tax code with only a minor increase in
administrative costs and a single step of simple multiplication for
taxpayer compliance.
The need for indexing is clear. It would help average Americans and
improve tax policy by enhancing both the basic fairness and the pro-
growth incentive of the tax code. The merits of the capital gains tax
are themselves debatable, but if we are to tax capital gains let us
make sure they are taxed fairly. Please join with me in supporting this
legislation to free the American taxpayer from the unfairness of the
current tax policy.
______
By Mrs. CLINTON:
S. 895. A bill to amend titles XIX and XXI of the Social Security Act
to ensure that every child in the United States has access to
affordable, quality health insurance coverage, and for other purposes;
to the Committee on Finance.
Mrs. CLINTON. Mr. President, I was proud to help create the State
Children's Health Insurance Program during the Clinton Administration.
It has provided health insurance for 6 million children, including more
than 425,000 in New York. SCHIP was the biggest expansion in providing
health insurance coverage in more than 30 years--a big first step to
providing quality health care coverage for all children.
And now it is time to take the next step. Today, I am introducing new
legislation with my colleague from the House of Representatives,
Chairman Dingell: a plan to make quality affordable health care
available to every child in America.
The Children's Health First Act will make quality, affordable health
care available to all children, and will pave the way to cover the more
than nine million children in our country without health coverage.
Our bill cuts red tape to allow States to provide affordable
healthcare options for all families to cover their children. It gives
States the financial incentives and resources to expand--existing State
coverage and find and enroll the 6 million children who are currently
eligible for health coverage but are not enrolled. And it provides
incentives to expand employer sponsored coverage for children.
As individuals and as a Nation, an ounce of prevention is truly worth
a pound of cure. Health care accessible and affordable for all children
will keep kids healthy, save lives, control costs, and end heartache
and worry for so many parents. This plan is practical and fiscally
responsible--it will honor our values and prevent kids from needing
more costly healthcare in the future.
Our bill will provide incentives for States to expand SCHIP to more
children and provide health coverage for children up to 400 percent of
poverty, about $70,000 for a family of three.
Parents whose incomes are above their State's SCHIP eligibility
levels and employers who want to provide coverage to dependents will
also have the option to buy-in to the SCHIP program. This will ensure
that all families have access to affordable coverage and aren't forced
into the private insurance market where affordable options for their
children are often out of reach.
And while expanding coverage is critical, enrolling children who are
already eligible must also be part of our efforts to ensure every child
has health insurance.
Currently, there are 6 million uninsured children who are eligible
for public programs but not enrolled. In order to receive expanded
Federal funding under our bill, States must undertake strategies
designed to enhance outreach and enrollment of currently eligible
children.
In addition, the Children's Health First Act would prevent funding
shortfalls like those that 14 States are currently facing. Unlike the
original SCHIP bill our legislation would determine funding based on
State spending and indexed to medical inflation and child population
growth so that states will get the funds they need.
Every child deserves a healthy start in life. This goes to the heart
of our values, our responsibility to one another, the promise of our
country. Far too many children in our Nation--more than 9 million--do
not have health care. And, for the first time in nearly a decade,
between 2004 and 2005, the number of uninsured children in New York
increased by 61,000--part of a trend nationally.
It's simply wrong that there are working parents who worry about
their children playing sports because they can't afford a doctor if
their child gets hurt. I've met parents who when their children get
sick fret and worry about their children's illness--but have the added
anxiety of wondering how they are going to pay for the doctor visit.
That just shouldn't happen.
No child in America, the greatest, richest Nation on Earth home to so
much promise, should lack for the care he or she needs to grow up to be
a healthy, happy adult.
We can tackle this challenge--and provide access to quality,
affordable health care for all children in America. It's the right
thing to do, and it's the smart thing to do.
I am proud to introduce this legislation. It will help us honor our
values, protect our children. We can meet this challenge and that's
what I'll be working with Chairman Dingell and my Senate colleagues to
achieve this year.
______
By Ms. MURKOWSKI (for herself, Mr. Schumer, Mr. Stevens, and Mr.
Sanders):
S. 896. A bill to amend the Public Health Service Act and the Social
Security Act to increase the number of primary care physicians and
medical residents serving health professional shortage areas, and for
other purposes; to the Committee on Health, Education, Labor, and
Pensions.
Ms. MURKOWSKI. Mr. President, I rise again this evening to speak
about a growing crisis in rural America. This crisis is found in rural
New England, throughout Appalachia, spans the Great Plains, crosses the
Western deserts, and reaches the mountains of the great Northwest. It
impacts the seniors, children, the women, and the men of rural America.
What I am speaking about today is a lack of access to quality health
care.
In rural America, patients have long gone without care. Despite the
fact that one-fifth of the U.S. population lives in rural America, only
9 percent of the Nation's physicians are practicing in these areas.
Over 50 million of these rural Americans live in areas that have a
shortage of physicians to meet their basic needs.
Now, physician recruitment to rural America is a big problem. Part of
this problem comes about through high student debt, which often forces
many students away from a rural practice and
[[Page S3205]]
into urban specialty medicine where they can probably command higher
salaries.
I recently held a Senate HELP Committee field hearing in Alaska. This
was during the February recess. I held this field committee hearing on
the physician shortage crisis in rural America. At that hearing, I had
a young woman come up and speak. She is a medical student who is
currently part of the WAMI Program, the Western States medical program.
This young woman, Melissa Howell, is 26 years old. She stated the
student debt she has accumulated is a huge concern that hangs over the
decisions she makes as she decides where she is going to practice.
Simply put, she said that the $100,000 student debt she faces is ``kind
of scary.'' I have to admit, that is kind of scary.
A dozen States already report severe physician shortages. These
shortages exist in the areas of cardiology, radiology, neurology, to
name a few. But the greatest shortages persistently have been in
primary care. In fact, the shortage of primary care physicians in rural
areas of the United States represents one of the most intractable
health policy problems of the past century.
It will only worsen. In 20 years, 20 percent of the U.S. population
will be 65 or older, and this is a percentage larger than at any other
time in our Nation's history. Just as this aging population places the
highest demand on our health care system, we have some experts who
predict a national shortage of close to 200,000 physicians. If that
becomes a reality, 84 million patients could be potentially left
without a doctor's care.
So the question has to be asked, where are the doctors going? We are
losing some of our doctors through attrition. One-third of physicians
are 55 years old and older and are likely to retire as this baby boom
generation moves into its time of greatest medical need. Additionally,
for the last quarter of a century, medical schools have kept their
student enrollments virtually flat.
We are also losing a lot of our doctors, quite simply, through
frustration. Low Medicare and Medicaid reimbursement rates, coupled
with complex regulations and paperwork, leave physicians aggravated,
leave them disappointed with the practice of medicine.
In Alaska, we have lived with provider shortages since statehood. I
grew up in a part of the State down in the southeastern area where you
did not have doctors who were available to deliver babies except on
Tuesdays and Thursdays. You hoped you could give birth on a Tuesday or
a Thursday. Still, in many parts of our State, we do not have providers
who can deliver. If you are out in the Aleutian chain, you are told by
your physician's attendant to come to Anchorage, some 600 miles away,
to wait out the remaining month of your pregnancy because they do not
have the facilities, do not have the doctors available to take care of
you in the event of an emergency.
So we have lived with provider shortages for a long time. Because our
State is larger than Texas and California and Montana combined,
``rural'' brings on a new meaning and the physician shortage crisis is
even more amplified, as I have given in my two examples. But we have
had some recent events in the State that have created a situation far
worse than Alaska has known in the past. Currently, in the State, we
have the sixth lowest ratio of physicians to population in the United
States. That is when you take into account Anchorage, which is our
largest population center. In rural Alaska, it is the worst physician-
to-population situation in the Nation. Alaska needs nearly 400 more
doctors to provide the same level of care as elsewhere in the country.
One of our problems is we do not have a medical school, and we are
not likely to be getting a medical school in the near future. We also
have the lowest per capita number of medical school slots in the
country and the lowest number of residency slots. We have two small but
very successful programs; this is the University of Washington Medical
School Partnership and the Alaska Family Residency Program. These two
programs help train Alaskans as physicians and also help us bring
doctors to Alaska. But despite the success of these programs, each is
far too small to meet our population's needs.
Each week, without fail, I receive faxes, phone calls, letters, and
e-mails from Alaskan seniors who simply cannot find a doctor to treat
them. I wish to read a few excerpts from recent e-mails we have
received. The first one is from a gentleman in Anchorage. Keep in mind,
Anchorage is our largest population center; about half the population
of the State is here.
He writes:
My mother . . . has had difficulty in the extreme in
getting a doctor who will take her on as she is a medicare
patient . . . doctors are telling potential patients that
they are no longer taking medicaid. My mother has made in
excess of 100 calls to physicians in Anchorage.
Another constituent writes--and this is also from Anchorage:
During the past year, I've tried to find a doctor that
accepts Medicare. I used the Anchorage Yellow pages and
called over 100 doctors, only to be told that they won't
accept any more Medicare patients.
She then writes to say:
I'll tell you ahead of time, we'll be going to the hospital
emergency rooms, to receive, even the basic medical care,
i.e.: colds, flu, and other basic medical care, that could
have been treated through seeing a doctor, at their
established practice. This doesn't sound like good fiscal
management.
Another constituent--and this was actually in a letter to the editor
in the Anchorage Daily News--says:
My friends telephoned more than 80 doctors recently, and
not one was accepting new Medicare patients.
A third gentleman from Kenai, AK, writes:
My mom has Medicare and she had to wait 5 months to be seen
by a Neurologist because she had been put on a waiting list
to be seen due to the fact she was a Medicare patient.
Another woman from Anchorage says:
I just got through trying to find a physician for an
elderly Medicare-dependent friend. At this time I have found
no one who will take her. Most physicians take no Medicare
patients or have a quota which is full. The Providence health
care provider list has no one who takes Medicare.
The last e-mail was from Anchorage stating:
Almost no family practice office in Anchorage is accepting
new Medicare patients.
This is just a sample of what we get from constituents around the
State of Alaska saying: I don't have anyone who can see my mother. I
can't get in to see anyone myself.
I mentioned in my comments this is a crisis that is growing. In
Alaska, we don't often think of it as being a State where we have a
large senior population. We think of some of the Southern States as
being the ones that attract our seniors. But the fact is Alaska has the
second fastest-growing senior population in the Nation, second only to
Nevada.
So again we ask the question: Why aren't Alaska's doctors able to
provide care to our seniors? Why are they saying: No, we are not
accepting any new Medicare patients? Well, a lot of it has to do with
the reimbursement rates. Recent Federal reductions in Alaska Medicare
reimbursement rates have been so severe that primary care physicians
report that Medicare pays them only 37 cents--it is actually between 37
cents to 40 cents--for every dollar that it costs to treat a patient.
So the doctor is spending a dollar in the care provided but is getting
reimbursed about 40 cents to every dollar. We had one physician testify
at the field hearing, and he said that in order for him to basically
break even with his medical practice, he would have to see one Medicare
patient every 7 minutes in order for him not to lose money. For those
of us who go into our doctor's office, if we only had 7 minutes in
there with our medical provider, I don't think we would feel we were
getting the care and the attention our medical issues deserve.
Losing money by seeing Medicare patients has meant that many of our
physicians have stopped accepting Medicare patients entirely. They are
making a decision not to accept any new Medicare patients. Or if you
have been a patient of a particular physician and you turn 65, you may
have had a good relationship with that physician, but if he tells you:
I am sorry, I am not accepting any new Medicare patients, that date of
your birthday comes and all of a sudden you don't have the care that
you had relied on for some period of time.
During this committee field hearing, we had testimony that revealed
that
[[Page S3206]]
only one neighborhood health clinic in the entire city of Anchorage--
and again, this is a city that has half the State's population--only
one neighborhood health clinic is still accepting new Medicare
patients.
So if you are lucky enough to find a physician, it often takes weeks
or months for an appointment. So when you are faced with this kind of a
delay, you have one of two options. You either go to the emergency room
if the conditions are severe enough or you go without care entirely,
putting it off until perhaps it becomes even more complicated down the
road.
We had testify at the field hearing one gentleman who is from the
city of Bethel. Bethel is in the western part of the State. He said he
was willing to fly the 500-some-odd miles from Bethel to Anchorage if
only he could find a primary care doctor who would accept him. He kind
of joked because he said he counted himself lucky because he had a
heart condition, and he was at least able to get in to see a specialist
once in awhile.
The chairman of the Alaska Commission on Aging, Mr. Frank Appel,
called the lack of access to health care for seniors ``the most
critical problem facing Alaska's seniors.''
I know Alaska is not alone. The crisis is not just Alaska. It is
nationwide. We as a body, as a Congress, should find this situation
intolerable.
I haven't been in the Senate for as long as many of my other
colleagues, but I have been here long enough to know that we fight a
lot about health care. We debate the solvency issues, the funding
issues, the insurance, the benefit coverage, universal coverage, health
savings accounts, the prescription drug benefit. We debate and argue
about a lot of these issues as they relate to health care, and each and
every one of these issues is certainly worthy of great debate. But I
would submit that not one of those very worthy debates matters in the
least to one of the seniors I have mentioned in these letters who can't
find a primary care doctor after making 100 phone calls.
So instead of this body debating how health care is delivered, it is
time we focus on the fact that it is not delivered in much of America.
We have a crisis that, simply put, cannot wait. We have to do two
things. We have to help current physicians stay in the practice of
medicine, and we must vastly increase our health care work force.
Earlier this year, Senator Stevens and I introduced the Rural
Physician Relief Act, and this is a bill that provides tax incentives
for physicians to practice in our most rural and frontier locations in
the country. Today, along with my colleagues, Senator Schumer, Senator
Stevens, and Senator Sanders, we are introducing legislation entitled
the ``Physician Shortage Elimination Act.'' This legislation will
double the funding for the National Health Service Corps, a program
that is dedicated to meeting the needs of the underserved. Despite its
success over the years, it has been vastly underfunded. We understand
that 85 percent of the applicants to this worthy program have to be
turned away each year because we don't fund it.
This legislation will also allow rural and underserved physician
residency programs to expand by removing barriers that prevent programs
from developing rural training programs.
We will also double certain title VII funding to create programs that
target disadvantaged youth in rural and underserved areas and nurture
them to create a pipeline to careers in health care. We need to get
more people interested in the field.
Finally, we must bolster the cornerstone of rural health care, which
is the community health center, through additional grants and by
allowing them to expand their residency programs.
I would suggest that the prognosis for the quality of health care in
America is poor. Fifteen million Americans in underserved areas across
the Nation already do without care. Soon, with even greater physician
shortages, it could mean that potentially another 84 million patients
will be left without a physician's care.
The time for Congress to act is now. In fact, it is past time. I look
forward to working with my colleagues on this issue that again is not
just Alaska-specific. I think the facts on the ground up North perhaps
make the arguments more accentuated, but I think it points to a
situation in this Nation that we must deal with now before the crisis
is felt throughout the country.
I appreciate the attention of the Chair.
______
By Ms. MIKULSKI (for herself, Mr. Grassley, Mr. Bond, Mrs.
Clinton, and Ms. Collins):
S. 897. A bill to amend the Internal Revenue Code of 1986 to provide
more help to Alzheimer's disease caregivers; to the Committee on
Finance.
Mr. GRASSLEY. Mr. President, I am pleased to join in cosponsoring the
Alzheimer's Family Assistance Act of 2007 introduced by my colleague,
Senator Mikulski.
As much as we all would like to think that we will remain healthy and
strong throughout our lifetimes, many of us will need long-term care.
The cost of that care, whether provided in a nursing home, assisted
living facility, or in one's own home with the assistance of health
aides, can quickly add up. That is why we should do everything we can
to make people aware of long-term care insurance and to ensure that
policies are affordable.
We need to encourage people to include long-term care insurance in
their planning, especially when people are younger and premiums would
be lower. The Deficit Reduction Act of 2005, DRA, made good progress in
that regard by expanding State long-term care partnership programs. In
addition, the DRA established an information clearinghouse to help
individuals learn about long-term care insurance options in their
states.
We also need to encourage older individuals to purchase long-term
care insurance. By establishing a deduction for long-term care
insurance premiums, this legislation will help accomplish that goal. In
order to qualify for the deduction, the policy must include several
important consumer protections recommended by the National Association
of Insurance Commissioners, NAIC. The DRA incorporated the same
protections plus some additional NAIC consumer protections into the
State long-term care partnership policies. As this bill moves forward,
I look forward to working with Senator Mikulski to ensure consistency
in the application of these consumer protections to long-term care
policies. Specifically, I hope we can expand the consumer protections
in this bill so they are in line with those included in the DRA.
Finally, this legislation recognizes that individuals and their
caregivers may need assistance in paying for medical supplies, nursing
care, and other long-term care expenses. The tax credit called for in
the bill, which increases from $1,000 to $3,000 in 2011 and beyond,
will help defray these costs.
Mr. President, I have long supported the policies included in this
legislation and commend my colleague for her work on this important
issue.
______
By Mr. DODD (for himself, Ms. Mikulski, Mrs. Murray, Mr. Sanders,
Mr. Durbin, Mr. Lieberman, Ms. Cantwell, Mr. Akaka, and Mr.
Levin):
S. 899. A bill to amend section 401(b)(2) of the Higher Education Act
of 1965 regarding the Federal Pell Grant maximum amount; to the
Committee on Health, Education, Labor, and Pensions.
Mr. DODD. Mr. President, I rise today, joined by my colleagues
Senators Mikulski, Murray, Sanders, Durbin, Lieberman, Cantwell, Akaka,
and Levin, to introduce legislation to amend the Higher Education Act
to improve access to college for low- and moderate-income students by
raising the authorized maximum Pell grant to $11,600 within 5 years.
This bill has the strong support of the American Association of
Universities, American Jesuit Colleges and Universities, the American
Association of Community Colleges, the National Association of
Independent Colleges and Universities, the American Council on
Education, and The Higher Education Consortium for Special Education.
Pell grants were first established in the early 1970s by our former
colleague, Senator Claiborne Pell. Pell grants are the largest source
of Federal grant aid for college students and make it possible for
millions of low- and moderate-income students to attend college. The
benefits of Pell grant aid cannot be overstated. Pell grants are
beneficial
[[Page S3207]]
to individual students as well as our society as a whole. Often, our
Nation's great innovators and creative minds sharpen their skills on
college campuses. By increasing the Pell grant, we make a college
education more affordable, and thus, make it more likely that qualified
and hard working low- and moderate-income students will attend. It
would be a significant loss to this great Nation if a generation of
individuals were not able to earn a college degree simply because they
could not afford to pay for it.
In 1975, the maximum appropriated Pell grant covered 80 percent of
the average student's tuition, fees, room, and board at 4-year public
universities. In 2005-2006, the average Pell grant covered 33 percent
of the total charges at 4-year public universities. That's not just a
drop in aid, it's a free-fall. For low- and moderate-income families,
the cost of college has also increased as a percentage of income. In
1999 it took 43 percent of a low-income family's income to pay for a
college education. In 1972, it only took 27 percent. The cornerstone of
American democracy is providing all citizens with access and
opportunities so that through hard work they can achieve the ``American
dream.'' We must keep that dream alive by providing students the
financial opportunity to attend college.
In order to meet the cost of attending college, many low- and
moderate-income students are forced to take out an exorbitant amount in
student loans. Upon graduation these students are often faced with an
unmanageable debt load. Surveys tell us that students with a
significant amount of debt are postponing marriage and having children.
Others are choosing their jobs based on where they think they can
afford to work. Clearly, we do not want student loan debt to solely
drive our young people's goals and aspirations.
Over the past several years, the administration has not raised the
maximum Pell grant. On top of leaving millions of children behind by
underfunding K-12 education, they are also leaving students behind who
have done well in school and want the chance to go on to college. If we
are serious about leaving no student behind--if we are serious about
having a society where equal opportunity for all is more than just
rhetoric--then we must increase the Pell grant.
It has been said that investing in a student's future is investing in
our Nation's future. We can start investing in our Nation's future by
supporting this bill to increase the maximum appropriated Pell grant to
$11,600. This bill won't bring the Pell grant's purchasing power back
to where it was in 1975, but it is a critical first step. I hope that
my colleagues will join me in taking this important step toward
ensuring all that have the ability to excel in college are given that
opportunity.
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. 899
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. FEDERAL PELL GRANT MAXIMUM AMOUNT.
Section 401(b)(2) of the Higher Education Act of 1965 (20
U.S.C. 1070a(b)(2)) is amended--
(1) by redesignating subparagraph (B) as subparagraph (C);
(2) by striking subparagraph (A) and inserting the
following:
``(A) Except as provided in subparagraph (B), the amount of
the Federal Pell Grant for a student eligible under this part
shall be--
``(i) $7,600 for academic year 2007-2008;
``(ii) $8,600 for academic year 2008-2009;
``(iii) $9,600 for academic year 2009-2010;
``(iv) $10,600 for academic year 2010-2011; and
``(v) $11,600 for academic year 2011-2012,
less an amount equal to the amount determined to be the
expected family contribution with respect to that student for
that year.''; and
(3) by inserting after subparagraph (A) (as amended by
paragraph (2)) the following:
``(B) If the Secretary determines that the increase from
one academic year to the next in the amount of the maximum
Federal Pell Grant authorized under subparagraph (A) does not
increase students' purchasing power (relative to the cost of
attendance at an institution of higher education) by not less
than 5 percentage points, then the amount of the maximum
Federal Pell Grant authorized under subparagraph (A) for the
academic year for which the determination is made shall be
increased by an amount sufficient to achieve such a 5
percentage point increase.''.
______
By Mr. HATCH (for himself and Mr. Bennett):
S. 900. A bill to authorize the Boy Scouts of America to exchange
certain land in the State of Utah acquired under the Recreation and
Public Purposes Act; to the Committee on Energy and Natural Resources.
Mr. .HATCH. Mr. President, I rise today to introduce the Boy Scouts
of America Land Transfer Act of 2007. This important legislation will
allow the exchange of two small parcels of land between the Utah Parks
Council of the Boy Scouts of America and Brian Head Ski Resort.
In 1983, the Bureau of Land Management granted the Boy Scouts of
America roughly 1,300 acres in Parowan, Utah. The land patent was
granted with the stipulation that it be used exclusively for purposes
of a Boy Scout camp. The Scout camp, known as Camp Thunder Ridge, is
situated in the mountains adjacent to Brian Head Ski Resort and near
Cedar Breaks National Monument.
When the land was given to the Scout Camp, a local rancher owned a
parcel of land adjacent to the camp and another parcel in the middle of
the camp. Upon his retirement, the rancher turned over his parcels,
totaling 120 acres, to Brian Head Ski Resort. Thus, the ski resort now
owns land in the middle of a Boy Scout Camp.
The Boy Scouts and the Resort agree that the land previously owned by
the rancher would best be used as part of Camp Thunder Ridge, while
certain parcels of the Scout Camp would be of more use to the Ski
Resort.
The Boy Scouts of America Land Transfer Act would allow the Boy
Scouts to exchange 120 acres of their land on the south end of the camp
with Brian Head for 120 acres on the eastern side of the camp,
including the 40 acres located in the middle of the camp. Because of
the stipulations of the original BLM patent given to the Scout Camp,
legislation is required to authorize this exchange.
While Camp Thunder Ridge is located in a steep, rough, mountainous
area, much of the land the Boy Scouts seek is flat, making it
particularly important for the camp. Obtaining the land would make it
possible for the Scouts to make the camp shooting area and archery
range safer and would allow them to improve and expand their camping
facilities. It would also allow for the installation of much-needed
septic tanks.
I am a strong supporter of the Boy Scouts of America. Scout camps,
such as Camp Thunder Ridge, give young men the opportunity to learn
vital skills, fulfill merit badge requirements, and otherwise improve
themselves. This small land exchange will allow Camp Thunder Ridge to
do a better job in helping these young men learn and grow.
For its part, Brian Head Ski Resort is seeking to expand their
operations and have received preliminary approval from local officials.
The local Planning Commission, however, has required them to build an
emergency exit for their property. The only place to build such a road
is through land owned by the Boy Scouts. The exchange will allow Brian
Head to construct the access road and comply with county fire safety
regulations.
The Boy Scouts have been working for more than 20 years to secure the
lands in question, and Brian Head needs to build on lands currently
owned by the Scouts. Therefore, it would be in the best interest of
both parties to authorize this land exchange. In fact, the exchange is
desperately needed by both parties, and I urge my colleagues to support
this important legislation.
______
By Mr. KENNEDY (for himself, Mr. Hatch, Mr. Dodd, Mr. Roberts,
Mr. Harkin, Mr. Bond, Ms. Mikulski, Ms. Snowe, Mr. Bingaman,
Mr. Domenici, Mr. Reed, Ms. Murkowski, Mrs. Clinton, Mr.
Bennett, Mr. Obama, Mr. Grassley, Mr. Brown, and Mr. Burr):
S. 901. A bill to amend the Public Health Service Act to provide
additional authorizations of appropriations for the health centers
program under section 330 of such Act, tot he Committee on Health,
Education, Labor, and Pensions.
Mr. KENNEDY. Mr. President, it's an honor to join Senator Hatch and
my
[[Page S3208]]
HELP Committee colleagues today in introducing this bill to reauthorize
the community health centers program. The Health Centers Renewal Act
extends the program through 2012, it authorizes the funds needed to
stabilize existing centers and enable them to increase their capacity
and funds for new centers in underserved areas that have no existing
center.
The community health centers program has been a success story by any
measure over the past 40 years. It began as a two-site demonstration
project for ``neighborhood health centers'' in 1965, with funds for
Columbia Point in Massachusetts and Mound Bayou in Mississippi. The
health center model was the brainchild of two young physicians and
civil rights activists, Dr. H. Jack Geiger and Dr. Count Gibson. Their
model was intended to address both health care and the roots of
poverty, by giving communities a voice in their health care through a
patient-majority community board, by creating jobs and investments in
local communities, and by focusing on primary care and reducing health
disparities among income groups.
Today, more than 1,000 health centers provide good health care to 16
million patients each year. They provide safety nets in their
communities for the most vulnerable Americans, and bring care to 1 of
every 4 Americans living in poverty. Nearly 70 percent of health center
patients have incomes below the poverty line, and two-thirds are
members of racial and ethnic minorities. Health centers give those who
are so often disenfranchised in our society a voice in their own health
care and in the care available in their community. Health centers are
also an incentive for economic growth, providing 50,000 jobs across the
country for residents in their communities.
As the number of uninsured and underinsured persons grows each year,
the need for health center services increases. More than 40 percent of
health center patients have no health insurance and their number is
increasing. Another 36 percent of patients have coverage through
Medicaid or CHIP, and cuts in these programs affect health centers as
well. As the number of patients who rely on health centers continues to
grow, we must provide the funds needed to open new centers in areas
that are underserved and to provide additional funds to enable existing
centers to meet the growing demand for care.
The funding authorized in this bill will provide stability and
expanded services in existing centers, and enable new centers to open
in areas that have no centers today. The legislation will keep health
centers on track to serve 20 million patients by 2010 and more than 23
million patients by 2012. It also provides the funds needed to expand
existing health centers to reach more uninsured and underinsured
patients, open new centers in underserved areas with no current
centers, expand coverage of mental health, dental, and pharmacy
services to all centers, invest in information technology, and take
other steps to improve health outcomes. Our goal in the bill is to make
sure that health centers can provide high-quality care to their
patients for years to come, and I look forward to its enactment into
law.
I ask unanimous request 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. 901
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 ``Health Centers Renewal Act
of 2007''.
SEC. 2. FINDINGS.
Congress finds as follows:
(1) Community, migrant, public housing, and homeless health
centers are vital to thousands of communities across the
United States.
(2) There are more than 1,000 such health centers serving
more than 16,000,000 people at more than 5,000 health
delivery sites, located in all 50 States of the United
States, the District of Columbia, and Puerto Rico, Guam, the
Virgin Islands, and other territories of the United States.
(3) Health centers provide cost-effective, quality health
care to poor and medically underserved people in the States,
the District of Columbia, and the territories, including the
working poor, the uninsured, and many high-risk and
vulnerable populations, and have done so for over 40 years.
(4) Health centers provide care to 1 of every 8 uninsured
Americans, 1 of every 4 Americans in poverty, and 1 of every
9 rural Americans.
(5) Health centers provide primary and preventive care
services to more than 700,000 homeless persons and more than
725,000 farm workers in the United States.
(6) Health centers are community-oriented and patient-
focused and tailor their services to fit the special needs
and priorities of local communities, working together with
schools, businesses, churches, community organizations,
foundations, and State and local governments.
(7) Health centers are built through community initiative.
(8) Health centers encourage citizen participation and
provide jobs for 50,000 community residents.
(9) Congress established the program as a unique public-
private partnership, and has continued to provide direct
funding to community organizations for the development and
operation of health centers systems that address pressing
local health needs and meet national performance standards.
(10) Federal grants assist participating communities in
finding partners and recruiting doctors and other health
professionals.
(11) Federal grants constitute, on average, 24 percent of
the annual budget of such health centers, with the remainder
provided by State and local governments, Medicare, Medicaid,
private contributions, private insurance, and patient fees.
(12) Health centers make health care responsive and cost-
effective through aggressive outreach, patient education,
translation, and other enabling support services.
(13) Health centers help reduce health disparities, meet
escalating health care needs, and provide a vital safety net
in the health care delivery system of the United States.
(14) Health centers increase the use of preventive health
services, including immunizations, pap smears, mammograms,
and HBa1c tests for diabetes screenings.
(15) Expert studies have demonstrated the impact that these
community-owned and patient-controlled primary care delivery
systems have achieved both in the reduction of traditional
access barriers and the elimination of health disparities
among their patients.
SEC. 3. ADDITIONAL AUTHORIZATIONS OF APPROPRIATIONS FOR
HEALTH CENTERS PROGRAM OF PUBLIC HEALTH SERVICE
ACT.
Section 330(r) of the Public Health Service Act (42 U.S.C.
254b(r)) is amended by amending paragraph (1) to read as
follows:
``(1) In general.--For the purpose of carrying out this
section, in addition to the amounts authorized to be
appropriated under subsection (d), there are authorized to be
appropriated--
``(A) $2,188,745,000 for fiscal year 2008;
``(B) $2,451,394,400 for fiscal year 2009;
``(C) $2,757,818,700 for fiscal year 2010;
``(D) $3,116,335,131 for fiscal year 2011; and
``(E) $3,537,040,374 for fiscal year 2012.''.
Mr. HATCH. Mr. President, today I am introducing the Health Centers
Renewal Act with my colleagues, Senators Kennedy, Roberts, Dodd, Bond,
Harkin, Snowe, Mikulski, Domenici, Bingaman, Murkowski, Reed, Bennett,
Clinton, Grassley, Obama, Burr and Brown.
The Health Centers program, created over 40 years ago, has an
outstanding record of providing quality health care services to many
Americans who do not have adequate health insurance. This ranges from
children to parents and grandparents, in virtually every comer of the
United States. In fact, Health Centers are a necessary component of our
nation's health care safety net--they supply health services to over 15
million people in our country.
Health Centers include community health centers, which are local,
not-for-profit 50l(c)(3) corporations that give community-oriented
health care and are governed by Boards of Directors that are made up of
at least 51 percent health centers patients, to ensure that the
patients and their communities are well represented.
From my work in Utah, I know how important Health Centers are. They
have made a tremendous difference for Utah's citizens with insufficient
health coverage--Utah community health centers serve close to 85,000
patients. Whenever I come home to Utah, I always hear wonderful things
about the work of Community Health Centers.
Since 2001, Congress has consistently increased funding for Community
Health Centers to meet President Bush's goal of having 1,200 new or
expanded centers. The new dollars have provided services to four
million new patients and have added facilities in over 750 communities
across the country. By reauthorizing this program, Health Centers will
give low-cost health care to many more deserving individuals.
S. 901 I will reauthorize the Health Centers program for 5 more
years; it includes funding levels of: $2,188,745,000
[[Page S3209]]
in fiscal year 2008; $2,451,394,400 in fiscal year 2009; $2,757,818,700
in fiscal year 2010; $3,116,335,131 in fiscal year 2011; and
$3,537,040,374 in fiscal year 2012. These numbers are based on the
National Association of Community Health Centers; NACHC, growth plan--
NACHC's goal is for Community Health Centers to serve 20 million
patients a year by 2010 and 30 million patients a year by 2015.
I believe that Community Health Centers are worth every dime that our
government invests in them.
Utah Health Centers have made a tremendous difference in the lives of
many Utahns--66 percent of patients come from Utah's urban areas and 27
percent are from the rural parts of the state. Ninety-six percent of
Utah Health Center patients' incomes are below 200 percent of the
Federal Poverty Level. Utah Health Centers have literally changed these
patients' lives, serving as a link to the health care safety net system
for the medically underserved and uninsured. In rural areas, Health
Centers are often the only health care provider.
Community Health Centers have made a huge impact on people's lives. I
am pleased and proud to support them by introducing this legislation
today.
I urge my colleagues to cosponsor this important bill, which not only
provides people with essential health care services, but also ensures
that the Health Centers will continue to have the funding necessary to
provide these services.
______
By Mr. HARKIN (for himself, Mr. Leahy, Mr. Kerry, Mr. Lautenberg,
Mr. Rockefeller, Ms. Landrieu, and Ms. Cantwell):
S. 902. A bill to provide support and assistance for families of
members of the National Guard and Reserve who are undergoing
deployment, and for other purposes; to the Committee on Armed Services.
Mr. HARKIN. Mr President, Americans are divided over the Iraq war,
but we are 100 percent united in our determination to support the
troops in the field and their families back home.
But just as we have seen shortcomings in the treatment of wounded
warriors at Walter Reed, it is clear to me that we are falling short in
supporting the families of Guard and Reserve personnel who serve in
Iraq and Afghanistan. These families are especially vulnerable because
of their isolation, their distance from military bases, and their lack
of access to the services that active-duty military families can draw
upon.
This is a new era for our National Guard and for the Reserves. They
are shouldering a huge share of the combat burden in Iraq and
Afghanistan, plus a stepped-up role in homeland security. More than
four times as many Guard members have been killed in Iraq as during the
entire Vietnam war.
With many Guard and Reserve members on their third or even fourth
deployment, and with some deployments being stretched out to 16 months,
the stresses on their families are acute. Their children are at greater
risk for depression, behavioral disorders, or academic problems. And
long family separations often result in financial difficulties and
troubled marriages.
To address this quiet crisis, today I am introducing legislation
titled the Coming Together for Guard and Reserve Families Act. This
bill does several things.
First, it expands and strengthens the existing family assistance
program. We need to ensure that there is adequate professional staff to
work with Guard and Reserve families and meet their special needs at
every point of the deployment cycle--as they prepare for deployment,
during the long absence, and during reunification and readjustment.
I am especially concerned that there are few resources for the
families of Guard and Reserve members who are wounded or experience
mental illness. My bill expands the VA's Disabled Transition Assistance
program to ensure that family members have access to family counseling
and mental health services during this critical time.
Children of deployed service members often react to parental
separation with acting-out behaviors, anxiety, or depression. My bill
calls for outreach to professionals who serve children--including
school administrators and teachers--to alert them to the special needs
of kids in military families, especially those with a parent deployed
in a war zone.
Forty-one percent of Guard members and Reservists report symptoms of
mental illness--including post-traumatic stress disorder--within 6
months of returning home from deployment. Currently, mental health
information is distributed to service members when they return from
deployment--and often that's it. But symptoms of PTSD may not appear
for months after return. My bill will ensure that families receive
mental health information 6 months post-deployment.
Finally, my bill creates a family-to-family mentoring program to
enable military spouses to serve as peer counselors to other spouses
and family members. It can be extremely valuable for a military spouse
to consult with someone who has gone through a similar experience.
The role of our Guard and Reserve members in defending our national
security abroad has significantly increased. In turn, we have an
expanded obligation to care for their spouses and children, who are
facing tremendous stresses, often alone and with no one to turn to.
The aim of my bill is to address the unmet needs of Guard and Reserve
families before this becomes the kind of full-fledged crisis we
witnessed at Walter Reed. I urge my colleagues to support this urgent
and important legislation.
______
By Mr. DURBIN (for himself, Mr. Bennett, Mrs. Clinton, Mr. Kerry,
and Mr. Harkin):
S. 903. A bill to award a Congressional Gold Medal to Dr. Muhammad
Yunus, in recognition of his contributions to the fight against global
poverty; to the Committee on Banking, Housing, and Urban Affairs.
Mr. DURBIN. Mr. President, I rise today to honor Dr. Muhammad Yunus
for his contributions to the fight against global poverty.
Today, joined by my colleague Senator Bennett of Utah as well as
Senators Clinton, Kerry and Harkin, I introduced the Muhammad Yunus
Congressional Gold Medal Act.
This bipartisan bill would award Dr. Yunus a Congressional Gold Medal
in recognition of his efforts to fight poverty and promote economic and
social opportunity.
Along with the Grameen Bank, which he founded, Dr. Yunus was awarded
the Nobel Peace Prize in 2006 for developing the concept of
microcredit. Through the Grameen system, Dr. Yunus created an
economically sound model of extending very small loans, at competitive
interest rates, to the very poor. Through this system, he has been
transforming lives, one loan at a time.
He began in 1976 with a loan of just $27, out of his own pocket, to
42 village craftspeople in Bangladesh. Over the past 30 years, his
model has been emulated around the world.
I met Dr. Yunus on my first trip to Bangladesh, and there I saw
firsthand the economic miracle that microcredit can help create.
Nearly half the world's population lives on less than $2 a day. We
can not hope to achieve lasting global peace and stability until we
find a means by which the world's poorest can begin to lift themselves
out of poverty.
The microcredit movement that Dr. Yunus pioneered has made enormous
strides towards that goal. Over 125 million households have already
been transformed by microcredit loans, and more are joining them every
day.
Dr. Yunus' work has had a particularly strong impact on improving the
economic prospects of women. Women disproportionately shoulder the
burden of poverty. They also make up over 95 percent of microcredit
borrowers.
I have long believed that if you want to predict the economic
prospects of a country, ask how it treats its women. If a country sends
its daughters to school, if its wives and mothers have economic and
political rights and opportunities, then it is likely to prosper. But
if it treats its women as second-class citizens, its chances for
development diminish dramatically. Microcredit opens doors for women
and in so doing it creates new opportunities for their sons and
daughters alike.
Muhammad Yunus's work has also affected the lives of millions of
Americans. Although Dr. Yunus launched his movement in 1976 in
Bangladesh--a long time ago and a long way away--it
[[Page S3210]]
has come home to us here in America and is still relevant today.
There are now an estimated 21 million microentrepreneurs in the U.S.,
accounting for approximately 16 percent of private employment in the
country. Over $318 million worth of microloans have been made to
American entrepreneurs in the past 15 years.
Culminating with his Nobel Peace Prize, Dr. Yunus has been recognized
around the world as a leading figure in the effort to fight poverty and
promote economic and social opportunity.
It is time that we properly recognize him here in Congress with our
most distinguished honor.
Dr. Yunus would join a long and illustrious line of Congressional
Gold Medal recipients that stretches back to 1776, when the award was
created. Although most of the recipients have been American, many have
not: Prime Minister Tony Blair, Pope John Paul II, and His Holiness,
the Fourteenth Dalai Lama, are just a few. We hope that Dr. Yunus will
join them.
I want to thank Senator Bennett and my other colleagues for joining
me today in honoring Dr. Yunus. Dr. Muhammad Yunus is a great man who
deserves our admiration and our thanks.
Mr. President, 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. 903
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. FINDINGS.
Congress finds that--
(1) Dr. Muhammad Yunus is recognized in the United States
and throughout the world as a leading figure in the fight
against poverty and the effort to promote economic and social
change;
(2) Muhammad Yunus is the recognized developer of the
concept of microcredit, and Grameen Bank, which he founded,
has created a model of lending that has been emulated across
the globe;
(3) Muhammad Yunus launched this global movement to create
economic and social development from below, beginning in
1976, with a loan of $27 from his own pocket to 42 crafts
persons in a small village in Bangladesh;
(4) Muhammad Yunus has demonstrated the life-changing
potential of extending very small loans (at competitive
interest rates) to the very poor and the economic feasibility
of microcredit and other microfinance and microenterprise
practices and services;
(5) Dr. Yunus's work has had a particularly strong impact
on improving the economic prospects of women, and on their
families, as over 95 percent of microcredit borrowers are
women;
(6) Dr. Yunus has pioneered a movement with the potential
to assist a significant number of the more than 1,000,000,000
people, mostly women and children, who live on less than $1 a
day, and the nearly 3,000,000,000 people who live on less
than $2 a day, and which has already reached 125,000,000
households, by one estimate;
(7) there are now an estimated 21,000,000
microentrepreneurs in the United States (accounting for
approximately 16 percent of private (nonfarm) employment in
the United States), and the Small Business Administration has
made over $318,000,000 in microloans to entrepreneurs since
1992;
(8) Dr. Yunus, along with the Grameen Bank, was awarded the
Nobel Peace Prize in 2006 for his efforts to promote economic
and social opportunity and out of recognition that lasting
peace cannot be achieved unless large population groups find
the means, such as microcredit, to break out of poverty; and
(9) the microcredit ideas developed and put into practice
by Muhammad Yunus, along with other bold initiatives, can
make a historical breakthrough in the fight against poverty.
SEC. 2. CONGRESSIONAL GOLD MEDAL.
(a) Presentation Authorized.--The Speaker of the House of
Representatives and the President pro tempore of the Senate
shall make appropriate arrangements for the presentation, on
behalf of Congress, of a gold medal of appropriate design, to
Dr. Muhammad Yunus, in recognition of his many enduring
contributions to the fight against global poverty.
(b) Design and Striking.--For purposes of the presentation
referred to in subsection (a), the Secretary of the Treasury
(referred to in this Act as the ``Secretary'') shall strike a
gold medal with suitable emblems, devices, and inscriptions,
to be determined by the Secretary.
SEC. 3. DUPLICATE MEDALS.
The Secretary may strike and sell duplicates in bronze of
the gold medal struck pursuant to section 3, under such
regulations as the Secretary may prescribe, at a price
sufficient to cover the cost thereof, including labor,
materials, dies, use of machinery, and overhead expenses, and
the cost of the gold medal.
SEC. 4. STATUS OF MEDALS.
(a) National Medals.--The medals struck pursuant to this
Act are national medals for purposes of chapter 51 of title
31, United States Code.
(b) Numismatic Items.--For purposes of sections 5134 and
5136 of title 31, United States Code, all medals struck under
this Act shall be considered to be numismatic items.
SEC. 5. AUTHORITY TO USE FUND AMOUNTS; PROCEEDS OF SALE.
(a) Authority to Use Fund Amounts.--There are authorized to
be charged against the United States Mint Public Enterprise
Fund, such amounts as may be necessary to pay for the costs
of the medals struck pursuant to this Act.
(b) Proceeds of Sale.--Amounts received from the sale of
duplicate bronze medals authorized under section 4 shall be
deposited into the United States Mint Public Enterprise Fund.
Mr. KERRY. Mr. President, I rise today to recognize Dr. Muhammad
Yunus. For those who don't already know, Dr. Yunus is a modest man of
great ideas, now revered around the world, as the father of microcredit
and the founder of the Grameen Bank. His concept of microcredit has
helped thousands of people work their way out of poverty. For his work
to beat global poverty, I am very proud to join my colleagues, Senators
Durbin and Bennett, in introducing a bill to honor Dr. Yunus with a
Congressional Gold Medal.
When I look at the success of Dr. Yunus's idea and the
microenterprise programs it has inspired over the past 30 years, one
thing that amazes me the most is that it all began with a loan of 27
U.S. dollars. The beauty of microcredit is that such a small amount of
money can have such tremendous and lasting effects to foster
entrepreneurship among those who would not qualify for typical bank
loans. By offering loans at competitive interest rates, or no interest,
Dr. Yunus's Grameen Bank has been able to give individuals suffering
from poverty the power to determine their own futures.
Last year, Dr. Yunus and his Grameen Bank were honored with a Nobel
Peace Prize for his economic imagination. Dr. Yunus's innovation and
entrepreneurship are certainly commendable and worthy of such an honor,
as well as the distinction of a Congressional Gold Medal. In accepting
his Nobel Peace Prize, Dr. Yunus challenged the world to think of an
entrepreneur as not only being motivated by profit, but also by ``doing
good to people and the world.''
The effectiveness of microcredit programs is evident by the success
stories they have inspired all around the world. As chairman of the
Small Business and Entrepreneurship Committee, I have seen first hand
the power of microcredit in this country, through the SBA's--Small
Business Administration's--microloan programs. In my home State of
Massachusetts, Thondup and Dolma Tsering, two Tibetan refugees in the
United States, were able to start their own restaurant in 2005, with
assistance from the Massachusetts Small Business Development Center and
financing from the Western Massachusetts Enterprise Fund. Through
financing and support, otherwise not available to them from the banking
community, they are now the successful owners of Lhasa Cafe in
Northampton. As small business owners, the Tserings are socially
responsible and support local farmers and their community.
From Dr. Yunus's first microloans to 42 entrepreneurs in Bangladesh
in 1976, the concept of microcredit has come a long way. Here in the
United States, where SBA has had a similar program since 1992, more
than $328 million in microloans have been made to deserving
entrepreneurs.
I have long been a supporter of funding microloan programs, which
offer current and potential small business owners the opportunity to
achieve financial independence, financial security, and dignity through
work. Sometimes they use it to work their way out of poverty, but
sometimes they use it to patch together income when they need more
money, lose a job, want to buy a house or car, or maybe pay for college
or send a child to college. These entrepreneurs create jobs, provide
services and products to our communities, and generate tax revenue to
benefit the economy. Funding microloan programs not only makes economic
sense; it makes social sense as well.
In spite of growing support for microloan programs, and in spite of
the
[[Page S3211]]
return on investment to our economy, microenterprise does not get the
support in this country that it does in other countries. In 2005, the
administration provided approximately $211 million for the development
of foreign microenterprise programs through the Agency for
International Development, USAID. In fiscal year 2006, we are told that
the administration provided more than $54 million for microloans in
Iraq:
The efforts of the U.S. government in its assistance to
Iraq have been broad based. . . For example, over $54 million
in micro-loans have been disbursed, resulting in 26,700 loans
in twelve cities, and the program is set to expand to even
more areas. Also, a Loan Guarantee Corporation is currently
being established to encourage private banks to make loans to
small businesses.--Ambassador Zalmay Khalilzad, U.S.
Ambassador to Iraq, May 9, 2006.
And for fiscal year 2007, we are told that the administration is
requesting supplemental funding for Iraq that includes at least $160
million for microloans.
We will help local leaders improve their capacity to govern
and deliver public services. Our economic efforts will be
more targeted on specific local needs with proven records of
success, like micro-credit programs. And we will engage with
leading private sector enterprises and other local
businesses, including the more promising state-owned firms,
to break the obstacles to growth.--Secretary of State
Condoleezza Rice, Foreign Relations Committee hearing on the
administration's plan for Iraq, January 11, 2007.
At the same time, the President has proposed for fiscal years 2005,
2006, 2007, and 2008 eliminating all funding for the SBA's microloan
programs.
Today I not only honor and recognize the genius of Dr. Yunus, but
also call attention to President Bush's lack of support for U.S.
microloans and call on the administration to reverse its policy. If we
can support microloans in Baghdad, we should support microloans in
Boston, and every other city that's home to a would-be entrepreneur.
I am honored to add my name in support of Dr. Muhammad Yunus, and I
am gratified to see the support he has received among my colleagues.
But I also implore my colleagues to pay tribute to American
entrepreneurs and to fund the SBA's microloan program. We must honor
Dr. Yunus's ingenuity with more than words; we must honor him with our
actions.
______
By Ms. SNOWE (for herself, Mr. Pryor, and Mr. Craig):
S. 904. A bill to provide additional relief for small business owners
ordered to active duty as members of reserve components of the Armed
Forces, and for other purposes; to the Committee on Small Business and
Entrepreneurship.
Ms. SNOWE. Mr. President, I rise today to introduce the Veterans
Small Business Opportunity Act of 2007. Senators Pryor, Craig, and I
are introducing this legislation to assist veterans and small
businesses that employ Guard and reservists. Our bill improves the
Small Business Administration's, SBA's, Military Reservist Economic
Injury Disaster Loan, MREIDL, program. Additionally, this bill
increases procurement opportunities, capital access, and other types of
business development assistance for veterans and service-disabled
veterans.
We all know today's small business men and women play a vital role in
the economic stability and prosperity of our Nation. Quite often, these
same entrepreneurs are the veterans who have protected our Nation in
years past, or who serve in the Armed Forces today. When our Nation's
patriotic men and women are called to duty, they often leave behind
thriving small businesses, and as a result, many of these businesses
experience production slowdowns and lost sales, or incur additional
expenses to compensate for an employee's absence.
In recent years, the Department of Defense has placed a greater
reliance on our country's Guard and Reserve Forces. In fact, since
September 2001, nearly 600,000 Guard and Reserve members have been
called up in support of current operations, comprising nearly one-third
of deployed service members in Iraq and Afghanistan. Furthermore, Guard
and Reserve members were charged with assisting recovery efforts in the
gulf coast region in the aftermath of Hurricanes Katrina and Rita.
In my 4 years as chair of the Senate Committee on Small Business and
Entrepreneurship, and now as ranking member, I have fought to support
our patriotic small businesses affected by the Guard and Reserve call-
ups. My home State of Maine has one of the highest Guard and Reserve
deployment levels in the country--over 50 percent have been deployed to
Iraq and Afghanistan. In response to this I commissioned a
Congressional Budget Office, CBO, study which found that 35 percent of
Guard and reservists work for small busineses or are self-employed. In
addition, the small businesses that employ them may be ``paying'' a
disproportionate and unfair share of the burden of increased Guard and
Reserve member call-ups. The burden is further magnified when it is the
small business owner or a key employee who is deployed.
Our legislation will raise the maximum MREIDL amount from $1,500,000
to $2,000,000. A maximum military reservist loan amount of $2,000,000
is the same level as many of the SBA's other loan programs, including:
7(a) loans, international trade loans, and 504 Certified Development
Corporation loans that serve a public policy goal.
Currently, some of the SBA's contracting and business development
programs have defined time limits for participation. If the firm's time
for participation expires prematurely, then competitive opportunities,
investments, and jobs become lost. Today, small business owners who get
called-up to active duty in the National Guard or Reserve are
effectively penalized because their active duty time is counted against
the time limitation participation in the SBA's programs. The Veterans
Small Business Opportunity Act amends the Small Business Act by
allowing small businesses owned by veterans and service-disabled
veterans to extend their SBA program participation time limitations by
the duration of their owners' active duty service after September 11,
2001.
Additionally, this bill will allow the SBA Administrator, either
directly or through banks, to offer loans up to $25,000 without
requiring collateral from a loan applicant. Currently, the SBA offers
military reservist loans up to $5,000 without collateral. This
provision would increase that level to eligible small businesses.
The bill will also require the Administrator to give military
reservist loan applications priority for processing and ensure that
Guard and Reserve members are adequately assisted with their loan
application by incorporating the support and expertise of SBA
entrepreneurial development partners, such as Small Business
Development Centers and Veterans Business Outreach Centers.
This legislation increases the authorization of appropriations for
the SBA's Office of Veteran Business Development to $2 million for
fiscal year 2008, $2.1 million for fiscal year 2009 and $2.2 million
for fiscal year 2010. Increased funding for SBA's Office of Veterans
Business Development help them better assist our Nation's veterans and
provide the business services they need.
This legislation will also strengthen the access of veterans and
service-disabled veterans to Federal contracts and subcontracts. Under
the Small Business Act and the President's Executive Order 13360,
Providing Opportunities for Service-Disabled Veteran Businesses To
Increase Their Federal Contracting and Subcontracting, Federal agencies
must award at least 3 percent of prime contracts and subcontracts to
small businesses owned by service-disabled veterans. The order states
that, to achieve these goals, Federal agencies ``shall more
effectively'' use the authorities in the Small Business Act to reserve
and award contracts to service-disabled veterans. During the Senate
Small Business and Entrepreneurship Committee hearing held in January,
it became very clear that Federal agencies have been short-changing
service-disabled veteran-owned small businesses to the tune of over
$7.5 billion a year in government contracts during fiscal year 2003
through fiscal year 2005. To remedy this unacceptable situation, our
legislation puts the force of a congressional statute behind the
requirements of the President's Executive order.
In addition, our legislation ensures that veterans and service-
disabled veterans do not face confusing and duplicative red tape before
they can be eligible to access the Federal procurement market.
Currently, the Department of
[[Page S3212]]
Veterans Affairs and the SBA both operate registration databases for
small businesses owned by veterans and service-disabled veterans. A
veteran must often register in both databases to be properly considered
for bidding. Surely, in this information age, we can have a better
process. Registration data can easily be made to migrate from one
database to the other. Our legislation requires that a single
registration point for both of these databases be established within a
year. Such one-stop registration must be reliable and compliant with
statutory provisions concerning veteran and service-disabled veteran
status certifications for small businesses.
To increase the capacity of service-disabled veteran-owned firms, my
legislation permits the SBA, in cooperation with the Department of
Veterans Affairs, to develop a business development assistance program,
including mentor-protege assistance, to be administered by the SBA. Our
legislation contains a strict fairness requirement that any such
program must be developed in such a way as to ensure success of other
small business contracting programs. Within a year, the SBA is required
to submit a report to Congress on its proposals for this program. In
2004, I succeeded in amending the Department of Defense Mentor-Protege
Program statute by expanding it to service-disabled veterans. Since
then, over $204 million in contracts and subcontracts have been awarded
to service-disabled veteran-owned small businesses as a result of the
$17 million in mentor-Protege assistance. This represents a stunning
$12 return for every $1 in assistance investment. I believe the success
of this initiative should be replicated. The SBA is already
administering a Mentor-Protege Program as part of the 8(a) business
development program for small disadvantaged businesses, and both the
SBA and the DOD programs would provide useful examples for helping our
disabled veterans succeed.
Finally, our legislation creates an interagency task force among
Federal agencies charged with improving procurement opportunities for
service-disabled veterans. The scope of this task force will, in
addition to procurement, include franchising, capital access, and other
types of business development assistance. In examining the
implementation of Executive Order 13360 and other veterans business
development initiatives, our committee found that the responsible
agencies were not talking to each other on a regular basis, and that no
overall ``game plan'' was in place to coordinate various Federal
efforts.
I would like to thank Senators Pryor and Craig for working with me on
this critical issue and I urge my colleagues to support this bill.
Mr. CRAIG. Mr. President, I rise to comment on a bill that is being
introduced by Senator Snowe today, the Veterans Small Business
Opportunity Act of 2007. I am proud to join with Senator Snowe and
Senator Pryor as an original cosponsor of this important bill.
This legislation will benefit patriot ``citizen-soldiers'' who are
called from their employment at America's small businesses to serve our
country in uniform. In States across the Nation, small businesses are
being affected by the mobilization of our Guard and Reserve personnel.
In my home State, the Idaho National Guard's 116th Brigade Combat Team
returned in 2005 from an 18-month deployment to Iraq. I visited members
of the 116th while they were in Iraq and discovered that a good number
had left jobs at small businesses across Idaho. I also held a hearing
in Idaho during the 109th Congress to examine the reemployment rights
of returning Guard and Reserve members.
At that hearing, it was emphasized that, although legal rights to
reemployment are critical, they do little for those who have no
employer, or no small business, to return to. To me, it was clear that
we should do more to help small businesses in coping with the financial
hardships of frequent and lengthy mobilizations of its employees or
owners during the war on terrorism. I believe we can provide some of
that needed assistance with this legislation, which includes key
provisions from The Patriot Loan Act of 2006, a bill that Senator Snowe
and I introduced last year.
This bill would enhance the U.S. Small Business Administration's
Military Reservist Economic Injury Disaster Loan, or MREIDL, Program.
That program provides loan assistance to small businesses to help them
meet ordinary and necessary operating expenses after essential
employees are called to active duty in their roles as citizen-soldiers.
This bill would raise the maximum military reservist loan amount from
$1.5 million to $2 million. It would also allow the Small Business
Administration, by direct loan or through banks, to offer unsecured
loans of up to $25,000, an increase from the current $5,000 limit. In
addition, this bill would ensure proactive outreach to Guard and
Reserve members about the MREIDL Program and other small business
programs by requiring SBA and the Department of Defense to develop a
joint Web site and printed materials with information about those
programs.
For the brave men and women who serve our Nation in the Guard and
Reserve, we must do what we can to ensure that their sacrifices do not
place them in financial harm's way when they return home. I urge my
colleagues to support these measures, and I thank Senator Snowe for her
leadership in introducing this bill.
______
By Mr. INHOFE:
S. 905. A bill to amend the Internal Revenue Code of 1986 to
eliminate the taxable income limit on percentage depletion for oil and
natural gas produced from marginal properties; to the Committee on
Finance.
Mr. INHOFE. Mr. President, the independent producers of oil and gas
are the backbone of our domestic supply of energy. They have played and
continue to play a critical role in meeting our domestic needs,
especially as the big oil companies' focus mainly offshore. In fact,
independents develop 90 percent of our Nation's wells. According to the
Department of Energy, independent producers supply 68 percent of
American oil production and 82 percent of overall American natural gas.
Therefore, I rise today to introduce legislation that eliminates the
taxable income limit on percentage depletion for oil and natural gas
produced from marginal wells; wells producing 15 barrels of day and
less than 90 thousand cubic feet of natural gas.
Under current law, the percentage depletion method is limited to only
independent producers and royalty owners. It is a form of cost recovery
for capital initially invested toward production of oil and gas wells.
Generally, the percentage depletion rate is 15 percent of the
taxpayer's gross income from an oil and gas producing property and is
limited to a daily average of 1,000 barrels of oil or 6,000 thousand
cubic feet of natural gas. However, under the net income limitation,
percentage depletion is limited to 100 percent of the net income from
an individual property. In the case of marginal wells, where total
deductions often do exceed this net-income, this limitation discourages
producers from investing in the continued production from marginal
wells.
As a result Congress has suspended the net-income limitation for 1998
through 2005; and again for 2006 and 2007, with the passage of the Tax
Relief and Health Care Act of 2006, H.R. 6111.
My bill would simply clarify the policy by doing away with the
taxable net income limitation altogether.
In my own State of Oklahoma, it is the small independents, basically
mom-and-pop operations, producing the majority of oil and natural gas,
with 85 percent of Oklahoma's oil coming from marginal wells.
Because marginal wells supply such a significant amount of our oil
and gas, it is vital we keep them in operation. According to the Energy
Department, between 1994 and 2003, we lost 110 million barrels of crude
oil due to plugged marginal wells. Thus, when we lose marginal wells,
we become more dependent upon foreign sources of energy, at a time when
virtually all agree that U.S. policies should encourage reliance upon
domestic sources. Furthermore, we lose domestic jobs to foreign
nations.
My bill would allow independents the necessary capital to continue to
produce from these existing marginal wells--which is critical to the
Nation's overall energy security. I ask unanimous consent that the text
of the bill be printed in the Record.
[[Page S3213]]
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 905
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. ELIMINATION OF TAXABLE INCOME LIMIT ON PERCENTAGE
DEPLETION FOR OIL AND NATURAL GAS PRODUCED FROM
MARGINAL PROPERTIES.
(a) In General.--Subparagraph (H) of section 613A(c)(6) of
the Internal Revenue Code of 1986 (relating to oil and
natural gas produced from marginal properties) is amended to
read as follows:
``(H) Nonapplication of taxable income limit with respect
to marginal production.--The second sentence of subsection
(a) of section 613 shall not apply to so much of the
allowance for depletion as is determined under subparagraph
(A).''.
(b) Effective Date.--The amendment made by this section
shall apply to taxable years beginning after December 31,
2006.
______
By Mr. OBAMA (for himself and Ms. Murkowski):
S. 906. A bill to prohibit the sale, distribution, transfer, and
export of elemental mercury, and for other purposes; to the Committee
on Environment and Public Works.
Mr. OBAMA. Mr. President, I am pleased to be joined today by my
esteemed colleague from Alaska, Ms. Murkowski, in introducing the
Mercury Market Minimization Act of 2007.
As most of us in this Chamber know, elemental mercury is a poisonous
neurotoxin that can cause serious disability or death if ingested.
Unfortunately, many people in the United States, and many millions more
worldwide, do indeed ingest mercury--unintentionally, however, as a
result of industrial emissions or practices, or poor waste management
and storage techniques. When mercury enters into the environment, it
often shows up in plants and animals, and that means a major source of
mercury ingestion for humans comes as a result of eating certain types
of fish. That, in turn, causes serious developmental problems in half a
million children in our country, and similar health problems in adults,
especially women at childbearing age.
Last year, an investigative report published in the Chicago Tribune
outlined the extent of mercury contamination in fish. After concluding
that the fish sampling efforts conducted by the Federal Government were
limited and outdated, the Tribune conducted its own sampling, and the
results showed surprisingly high levels of mercury concentrations in
freshwater and saltwater fish purchased by consumers in the Chicago
region--higher levels than had been documented by the Federal
Government. Mercury was found in both freshwater and saltwater
species--tuna, swordfish, orange roughy, and walleye, to name a few
examples. The Tribune also reported on how existing programs at the
Food and Drug Administration and the Environmental Protection Agency
have failed to adequately test and evaluate mercury levels in fish.
For those of us who like fish, it causes us to pause when we first
learn of the range of species with high mercury levels. For pregnant
women and other at-risk groups, however, this doesn't just cause pause,
it creates serious concerns about health consequences. Meanwhile,
experts tell us that fish is an excellent source of critical nutrients
and other compounds indispensable for good health. More of us should
eat more fish.
So the real long-term solution is not to eat less fish, or to
criticize those who commercially provide us with fish as food. It's not
about issuing advisories, or printing labels on tuna cans, or posting
placards at the supermarket, or creating inspection bureaucracies, or
collecting statistics. If we're serious about eliminating mercury from
fish, we need to reduce mercury in the environment.
Half of mercury settles where it is emitted, and the other half gets
transported around the globe where we lose track of it, and it winds up
in oceans, lakes, and rivers nowhere near mercury sources. From there,
up it goes, through the food chain. If mercury is both local, and
global, then the solution is not up to one state, or one nation, but up
to all states and nations. The bill we introduce today was crafted
based on that premise.
The Mercury Market Minimization Act, or M3 Act, establishes a ban on
U.S. exports of mercury by the year 2010. Such a ban, when coupled with
goal of the European Union to ban mercury exports by 2011, and the
insufficient capacity in the world's mercury mines to respond, will
result in a tightening of the global supply of commercially available
elemental mercury in sufficient quantities that developing nations that
still use mercury will be compelled to switch to the affordable
alternatives that are already widespread in industrialized nations.
The M3 Act also requires those Federal agencies that now hold mercury
in stockpiles to keep that mercury. Right now, the Department of
Energy, and the Department of Defense, possess tons of mercury left
over from various operations over the years. While it is the policy of
these agencies to keep this mercury--not to sell it, not to transfer
it, not to release it from their possession--it is not the law. The M3
act codifies these policies. In December of 2006, it was widely
understood that the Department of Energy was considering the sale of
its mercury stockpiles. After various inquiries into the matter, the
Department of Energy ultimately announced that it would not sell its
stockpiles. That underscores why a prohibition of stockpile sales must
be enacted into law by the M3 act if we are to be assured that mercury
remains safely stored, away from the environment, and not sold overseas
to places where tracking and emissions and waste disposal laws may be
inadequate.
Finally, the M3 Act calls for the creation of a committee to explore
and make recommendations on the issues associated with the development
of a permanent repository of mercury collected as a result of an export
prohibition. Mercury is not like spent nuclear fuel, or other
substances that may create community concerns, in that when mercury is
stored in stainless steel containers in refrigeration, it remains
benign. Every community must be provided the opportunity to evaluate
for themselves if and when mercury is stored nearby in secure and
stable storage. I do believe, however, that when mercury is safely and
permanently stored, it means less microscopic mercury on one's dinner
plate, less mercury in our kids' tuna fish sandwiches, and less mercury
in the air we breathe.
Last month, a United States delegation, led by the State Department,
participated in an international meeting in Kenya, sponsored by the
United Nations Environmental Programme, where world representative
discussed how to reduce mercury pollution. Two years ago, the U.S.
Government could have taken a bolder stance, and did not. This time,
with the decision of the E.U. to ban mercury exports, the United States
had an opportunity to partner with its allies to eliminate a major part
of worldwide elemental mercury contamination. Again, the State
Department did not.
It is not often that policy options, such as this, might be
considered ``low-hanging fruit''--in that a small act of international
leadership by the United States government could have far reaching
benefits for the health of our kids, as well as millions of low-income
hardworking artisanal gold miners whom we will never meet. But the
United States, so far, has not acted. This bill, the M3 bill, is
designed to change that course and the mark the beginning of the end of
a global market of an outdated and obsolete poison. I hope my
colleagues will support this bill, and I ask unanimous consent that a
copy of this legislation 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. 906
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 ``Mercury Market Minimization
Act of 2007''.
SEC. 2. FINDINGS.
Congress finds that--
(1) mercury and mercury compounds are highly toxic to
humans, ecosystems, and wildlife;
(2) as many as 10 percent of women in the United States of
childbearing age have mercury in the blood at a level that
could put a baby at risk;
(3) as many as 630,000 children born annually in the United
States are at risk of neurological problems related to
mercury;
(4) the most significant source of mercury exposure to
people in the United States is ingestion of mercury-
contaminated fish;
(5) the Environmental Protection Agency reports that, as of
2004--
[[Page S3214]]
(A) 44 States have fish advisories covering over 13,000,000
lake acres and over 750,000 river miles;
(B) in 21 States the freshwater advisories are statewide;
and
(C) in 12 States the coastal advisories are statewide;
(6) the long-term solution to mercury pollution is to
minimize global mercury use and releases to eventually
achieve reduced contamination levels in the environment,
rather than reducing fish consumption since uncontaminated
fish represents a critical and healthy source of nutrition
worldwide;
(7) mercury pollution is a transboundary pollutant,
depositing locally, regionally, and globally, and affecting
water bodies near industrial sources (including the Great
Lakes) and remote areas (including the Arctic Circle);
(8) the free trade of mercury and mercury compounds on the
world market, at relatively low prices and in ready supply,
encourages the continued use of mercury outside of the United
States, often involving highly dispersive activities such as
artisinal gold mining;
(9) the intentional use of mercury is declining in the
United States as a consequence of process changes to
manufactured products (including batteries, paints, switches,
and measuring devices), but those uses remain substantial in
the developing world where releases from the products are
extremely likely due to the limited pollution control and
waste management infrastructures in those countries;
(10) the member countries of the European Union
collectively are the largest source of mercury exports
globally;
(11) the European Union is in the process of enacting
legislation that will prohibit mercury exports by not later
than 2011;
(12) the United States is a net exporter of mercury and,
according to the United States Geologic Survey, exported 506
metric tons of mercury more than the United States imported
during the period of 2000 through 2004; and
(13) banning exports of mercury from the United States will
have a notable affect on the market availability of mercury
and switching to affordable mercury alternatives in the
developing world.
SEC. 3. PROHIBITION ON SALE, DISTRIBUTION, OR TRANSFER OF
MERCURY BY DEPARTMENT OF DEFENSE OR DEPARTMENT
OF ENERGY.
Section 6 of the Toxic Substances Control Act (15 U.S.C.
2605) is amended by adding at the end the following:
``(f) Mercury.--
``(1) Prohibition on sale, distribution, or transfer of
mercury by federal agencies.--Except as provided in paragraph
(2), effective beginning on the date of enactment of this
subsection, no Federal agency shall convey, sell, or
distribute to any other Federal agency, any State or local
government agency, or any private individual or entity any
elemental mercury under the control or jurisdiction of the
Federal agency.
``(2) Exception.--Paragraph (1) shall not apply to a
transfer between Federal agencies of elemental mercury for
the sole purpose of facilitating storage of mercury to carry
out this Act.''.
SEC. 4. PROHIBITION ON EXPORT OF MERCURY.
Section 12 of the Toxic Substances Control Act (15 U.S.C.
2611) is amended--
(1) in subsection (a) by striking ``subsection (b)'' and
inserting ``subsections (b) and (c)''; and
(2) by adding at the end the following:
``(c) Prohibition on Export of Mercury.--
``(1) Elemental mercury.--Effective January 1, 2010, the
export of elemental mercury from the United States is
prohibited.
``(2) Report to congress on mercury compounds.--
``(A) Report.--
``(i) In general.--Not later than 1 year after the date of
enactment of the Mercury Market Minimization Act of 2007, the
Administrator shall publish and submit to Congress a report
on mercuric chloride, mercurous chloride or calomel, mercuric
oxide, and other mercury compounds, if any, that may
currently be used in significant quantities in products or
processes.
``(ii) Inclusions.--The report shall include an analysis
of--
``(I) the sources and amounts of each mercury compound
produced annually in, or imported into, the United States;
``(II)(aa) the purposes for which each of the compounds are
used domestically;
``(bb) the quantity of the compounds currently consumed
annually for each purpose; and
``(cc) the estimated quantity of the compounds to be
consumed for each purpose during calendar year 2010 and
thereafter;
``(III) the sources and quantities of each mercury compound
exported from the United States during each of the preceding
3 calendar years;
``(IV) the potential for the compounds to be processed into
elemental mercury after export from the United States; and
``(V) other information that Congress should consider in
determining whether to extend the export prohibition to
include 1 or more of those mercury compounds.
``(B) Procedure.--
``(i) In general.--Except as provided in clause (ii), for
the purpose of preparing the report under this paragraph, the
Administrator may use the information gathering authorities
of this title, including sections 10 and 11.
``(ii) Exception.--Subsection (b)(2) of section 11 shall
not apply to activities under this subparagraph.
``(3) Excess mercury storage advisory committee.--
``(A) Establishment.--There is established an advisory
committee, to be known as the `Excess Mercury Storage
Advisory Committee' (referred to in this paragraph as the
`Committee').
``(B) Membership.--
``(i) In general.--The Committee shall be composed of 9
members, of whom--
``(I) 2 members shall be jointly appointed by the Speaker
of the House of Representatives and the Majority Leader of
the Senate--
``(aa) 1 of whom shall be designated to serve as
Chairperson of the Committee; and
``(bb) 1 of whom shall be designated to serve as Vice-
Chairperson of the Committee;
``(II) 1 member shall be the Administrator;
``(III) 1 member shall be the Secretary of Defense;
``(IV) 1 member shall be a representative of State
environmental agencies;
``(V) 1 member shall be a representative of State attorneys
general;
``(VI) 1 member shall be a representative of the chlorine
industry;
``(VII) 1 member shall be a representative of the mercury
waste treatment industry; and
``(VIII) 1 member shall be a representative of a nonprofit
environmental organization.
``(ii) Appointments.--Not later than 45 days after the date
of enactment of this subsection, the Administrator, in
consultation with the appropriate congressional committees,
shall appoint the members of the Committee described in
subclauses (IV) through (VIII) of clause (i).
``(C) Initial meeting.--Not later than 30 days after the
date on which all members of the Committee have been
appointed, the Committee shall hold the initial meeting of
the Committee.
``(D) Meetings.--The Committee shall meet at the call of
the Chairperson.
``(E) Quorum.--A majority of the members of the Committee
shall constitute a quorum.
``(F) Report.--Not later than 1 year after the date of
enactment of this subsection, the Committee shall submit to
Congress a report describing the findings and recommendations
of the Committee, if any, relating to--
``(i) the environmental, health, and safety requirements
necessary to prevent--
``(I) the release of elemental mercury into the
environment; and
``(II) worker exposure from the storage of elemental
mercury;
``(ii) the estimated annual cost of storing elemental
mercury on a per-pound or per-ton basis;
``(iii) for the 40-year period beginning on the date of
submission of the report, the optimal size, number, and other
characteristics of Federal facilities required to store
elemental mercury under current and anticipated jurisdictions
of each Federal agency;
``(iv) the estimated quantity of--
``(I) elemental mercury that will result from the
decommissioning of mercury cell chlor-alkali facilities in
the United States; and
``(II) any other supplies that may require storage to carry
out this Act;
``(v) for the 40-year period beginning on the date of
submission of the report, the estimated quantity of elemental
mercury generated from the recycling of unwanted products and
other wastes that will require storage to comply with the
export prohibitions under this Act;
``(vi) any legal, technical, economic, or other barrier
that may prevent the private sector from storing elemental
mercury produced by the private sector during the 40-year
period beginning on the date of submission of the report,
including a description of measures to address the barriers;
``(vii) the advantages and disadvantages of consolidating
the storage of mercury produced by public and private sources
under the management of the public or private sector;
``(viii) the optimal plan of the Committee for storing
excess mercury produced by public and private sources; and
``(ix) additional research, if any, required to determine a
long-term disposal option for the storage of excess mercury.
``(G) Compensation of members.--
``(i) In general.--
``(I) Non-federal employees.--A member of the Committee who
is not an officer or employee of the Federal Government shall
be compensated at a rate equal to the daily equivalent of the
annual rate of basic pay prescribed for level V of the
Executive Schedule under section 5316 of title 5, United
States Code, for each day (including travel time) during
which the member is engaged in the performance of the duties
of the Committee.
``(II) Federal employees.--A member of the Committee who is
an officer or employee of the Federal Government shall serve
without compensation in addition to the compensation received
for the services of the member as an officer or employee of
the Federal Government.
``(ii) Travel expenses.--A member of the Committee shall be
allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for an employee of an agency
under subchapter I of chapter 57 of title 5, United States
Code, while away from the home or regular place of business
of the member in the performance of the duties of the
Committee.
[[Page S3215]]
``(H) Staff and funding.--The Administrator shall provide
to the Committee such funding and additional personnel as are
necessary to enable the Committee to perform the duties of
the Committee.
``(I) Termination.--The Committee shall terminate 180 days
after the date on which the Committee submits the report of
the Committee under subparagraph (F).
``(4) Inapplicability of unreasonable risk requirement.--
Subsection (a) shall not apply to this subsection.''.
______
By Mrs. CLINTON:
S. 907. A bill to establish an Advisory Committee on Gestational
Diabetes, to provide grants to better understand and reduce gestational
diabetes, and for other purposes; to the Committee on Health,
Education, Labor, and Pensions.
Mrs. CLINTON. Mr. President, I am pleased to introduce the
Gestational Diabetes Act of 2007 with my colleague Senator Collins, to
bring attention to an important health issue facing women and children.
I don't need to tell anyone that we have an obesity epidemic in the
United States. Many of us realize that as parents, it is our
responsibility to pass on good nutritional habits to our children. But
many women may not realize that watching what you eat, exercising
regularly, and having control of your blood sugar levels are serious
health considerations during pregnancy. In fact, these factors are
serious enough that they can affect both the health of the mother and
the life of the child into adulthood.
More women than ever are entering their pregnancies overweight but
without an understanding of how their own weight and nutritional habits
can trigger gestational diabetes--a type of diabetes that only occurs
during pregnancy. Women who are overweight before pregnancy are not
only at greater risk of having gestational diabetes but are also more
likely to have a c-section and are at an increased risk for other
serious pregnancy complications.
In New York, gestational diabetes is on the rise. In New York City
alone, gestational diabetes has risen by nearly 50 percent in about 10
years. This means that gestational diabetes affects 1 in 25 women,
about 400 women per month. But across the Nation, between 4 and 8
percent of pregnant women in the United States are affected by
gestational diabetes. Infants of women who have gestational diabetes
are at increased risk for obesity and developing type 2 diabetes as
adolescents or adults.
As women, we need to pay attention to our health. We are always
worrying about the health of our children, our husbands, and our
parents, but we often forget to take care of ourselves.
Today, I am introducing the Gestational Diabetes Act, also known as
the GEDI Act. This legislation will increase our understanding of
gestational diabetes by determining the factors that contribute to this
condition and help mothers who had gestational diabetes reduce their
risk of developing type 2 diabetes post-pregnancy.
The GEDI Act will provide funding for projects to assist health care
providers, as well as for communities to find ways to reach out to
women so that they understand how their own good health during
pregnancy can decrease serious health risks for their children.
The GEDI Act would expand research to determine and develop
interventions to lower the incidence of gestational diabetes. We need
to alert women to the risk before this condition becomes an epidemic
and, as we have seen so many times before, education is critical.
We should be doing everything we can to address the impact of obesity
during pregnancy and to reduce the prevalence of gestational diabetes
in pregnant women. The GEDI Act is an important step in assuring that
women understand this critical issue and that we fully understand how
to equip pregnant women to make the best choices for their health.
The GEDI Act is supported by the American Diabetes Association,
American College of Obstetricians and Gynecologists, National Research
Center for Women & Families, International Community Health Services,
American Association of Diabetes Educators, and the American
Association of Colleges of Pharmacy.
______
By Mr. BINGAMAN (for himself, Mr. Akaka, Mr. Kerry, and Mrs.
Clinton):
S. 909. A bill to amend title XIX of the Social Security Act to
permit States, at their option, to require certain individuals to
present satisfactory documentary evidence of proof of citizenship or
nationality for purposes of eligibility for Medicaid, and for other
purposes; to the Committee on Finance.
Mr. BINGAMAN. Mr. President, the legislation I am introducing today
is designed to make several very important changes to current law to
ensure that U.S. citizens receive the Medicaid to which they are
entitled.
Since July 1, 2006, most U.S. citizens and nationals applying for or
renewing their Medicaid coverage face a new Federal requirement to
provide documentation of their citizenship status. Recent reports
indicate that tens-of-thousands of U.S. citizens, and in particular
children, inappropriately are being denied Medicaid benefits simply
because they don't have access to newly required documentation. The
articles below and report by the Center on Budget and Policy Priorities
highlight this very serious problem. Hospitals, physicians, and
pharmacies may not be willing to treat these individuals until they
have a source of payment, but they cannot qualify for Medicaid until
they produce a birth certificate and ID.
This new Federal requirement was added to Medicaid by the Deficit
Reduction Act of 2005, DRA, enacted February 8, 2006. The Tax Relief
and Health Care Act of 2006, TRHCA, signed into law December 20, 2006,
included some amendments to the DRA citizenship documentation
requirement, primarily to exempt certain groups. Prior to enactment of
the DRA, States were permitted to use their discretion in requiring
such citizenship documentation.
Under Section 6036 of the DRA, citizens applying for or renewing
their Medicaid coverage must provide ``satisfactory documentary
evidence of citizenship or nationality.'' The DRA specifies documents
that are acceptable for this purpose and authorizes the HHS Secretary
to designate additional acceptable documents. No Federal matching funds
are available for services provided to individuals who declare they are
citizens or nationals unless the State obtains satisfactory evidence of
their citizenship or determines that they are subject to a statutory
exemption.
It is important to note that citizenship documentation requirements
do not affect Medicaid rules relating to immigrants--they apply to
individuals claiming to be citizens. Most new legal immigrants are
excluded from Medicaid during their first 5 years in the U.S. and
undocumented immigrants remain eligible for Medicaid emergency services
only.
The legislation I am introducing would make several very important
changes to current law to ensure that U.S. citizens receive the
Medicaid to which they are entitled.
First, the legislation would restore citizenship verification to a
State option. Specifically, States would be permitted to determine when
and to what extent citizenship verification is required of U.S.
Citizens. States would also be permitted to utilize the standards most
appropriate to the their population as long as such standards were no
more stringent than those currently used by the Social Security
Administration and includes native American tribal documents when
appropriate.
Second, the legislation would ensure that individuals are afforded a
reasonable time period to provide citizenship documentation utilizing
the same reasonable time period standard that is available to legal
immigrants to provide satisfactory evidence of their immigration
status.
Third the legislation protects children who are U.S. citizens by
virtue of being born in the United States from being denied coverage
after birth because of citizenship verification requirements.
Fourth, the legislation also clarifies ambiguities in federal law to
ensure that these citizen children, regardless of the immigration
status of their parents, are treated like all other low-income children
born in the United States and are deemed eligible to receive Medicaid
services for one year.
Finally, the legislation also ensures that the thousands of citizen
children and adults, who were erroneously denied Medicaid coverage, may
receive
[[Page S3216]]
retroactive Medicaid eligibility for coverage they were inappropriately
denied because of citizenship verification requirements.
I urge my colleagues in the Senate to support this critical
legislation, which protects low-income U.S. citizens from being
inappropriately denied Medicaid coverage because of lack of
documentation.
I ask unanimous consent that the text of the bill and supporting
documentation 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. 909
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. STATE OPTION TO REQUIRE CERTAIN INDIVIDUALS TO
PRESENT SATISFACTORY DOCUMENTARY EVIDENCE OF
PROOF OF CITIZENSHIP OR NATIONALITY FOR
PURPOSES OF ELIGIBILITY FOR MEDICAID.
(a) In General.--Section 1902(a)(46) of the Social Security
Act (42 U.S.C. 1396a(a)(46)) is amended--
(1) by inserting ``(A)'' after ``(46)'';
(2) by adding ``and'' after the semicolon; and
(3) by adding at the end the following new subparagraph:
``(B) at the option of the State and subject to section
1903(x), require that, with respect to an individual (other
than an individual described in section 1903(x)(1)) who
declares to be a citizen or national of the United States for
purposes of establishing initial eligibility for medical
assistance under this title (or, at State option, for
purposes of renewing or redetermining such eligibility to the
extent that such satisfactory documentary evidence of
citizenship or nationality has not yet been presented), there
is presented satisfactory documentary evidence of citizenship
or nationality of the individual (using criteria determined
by the State, which shall be no more restrictive than the
criteria used by the Social Security Administration to
determine citizenship, and which shall accept as such
evidence a document issued by a federally-recognized Indian
tribe evidencing membership or enrollment in, or affiliation
with, such tribe (such as a tribal enrollment card or
certificate of degree of Indian blood, and, with respect to
those federally-recognized Indian tribes located within
States having an international border whose membership
includes individuals who are not citizens of the United
States, such other forms of documentation (including tribal
documentation, if appropriate) that the Secretary, after
consulting with such tribes, determines to be satisfactory
documentary evidence of citizenship or nationality for
purposes of satisfying the requirement of this
subparagraph));''.
(b) Limitation on Waiver Authority.--Notwithstanding any
provision of section 1115 of the Social Security Act (42
U.S.C. 1315), or any other provision of law, the Secretary of
Health and Human Services may not waive the requirements of
section 1902(a)(46)(B) of such Act (42 U.S.C.
1396a(a)(46)(B)) with respect to a State.
(c) Conforming Amendments.--Section 1903 of such Act (42
U.S.C. 1396b) is amended--
(1) in subsection (i)--
(A) in paragraph (20), by adding ``or'' after the
semicolon;
(B) in paragraph (21), by striking ``; or'' and inserting a
period; and
(C) by striking paragraph (22); and
(2) in subsection (x) (as amended by section 405(c)(1)(A)
of division B of the Tax Relief and Health Care Act of 2006
(Public Law 109-432))--
(A) by striking paragraphs (1) and (3);
(B) by redesignating paragraph (2) as paragraph (1);
(C) in paragraph (1), as so redesignated, by striking
``paragraph (1)'' and inserting ``section 1902(a)(46)(B)'';
and
(D) by adding at the end the following new paragraph:
``(2) In the case of an individual declaring to be a
citizen or national of the United States with respect to whom
a State requires the presentation of satisfactory documentary
evidence of citizenship or nationality under section
1902(a)(46)(B), the individual shall be provided at least the
reasonable opportunity to present satisfactory documentary
evidence of citizenship or nationality under this subsection
as is provided under clauses (i) and (ii) of section
1137(d)(4)(A) to an individual for the submittal to the State
of evidence indicating a satisfactory immigration status.''.
SEC. 2. CLARIFICATION OF RULES FOR CHILDREN BORN IN THE
UNITED STATES TO MOTHERS ELIGIBLE FOR MEDICAID.
Section 1903(x) of such Act (42 U.S.C. 1396b(x)), as
amended by section 1(c)(2), is amended--
(1) in paragraph (1)--
(A) in subparagraph (C), by striking ``or'' at the end;
(B) by redesignating subparagraph (D) as subparagraph (E);
and
(C) by inserting after subparagraph (C) the following new
subparagraph:
``(D) pursuant to the application of section 1902(e)(4)
(and, in the case of an individual who is eligible for
medical assistance on such basis, the individual shall be
deemed to have provided satisfactory documentary evidence of
citizenship or nationality and shall not be required to
provide further documentary evidence on any date that occurs
during or after the period in which the individual is
eligible for medical assistance on such basis); or''; and
(2) by adding at the end the following new paragraph:
``(3) Nothing in subparagraph (A) or (B) of section
1902(a)(46), the preceding paragraphs of this subsection, or
the Deficit Reduction Act of 2005, including section 6036 of
such Act, shall be construed as changing the requirement of
section 1902(e)(4) that a child born in the United States to
an alien mother for whom medical assistance for the delivery
of such child is available as treatment of an emergency
medical condition pursuant to subsection (v) shall be deemed
eligible for medical assistance during the first year of such
child's life.''.
SEC. 3. EFFECTIVE DATE.
(a) Retroactive Application.--The amendments made by this
Act shall take effect as if included in the enactment of the
Deficit Reduction Act of 2005 (Public Law 109-171; 120 Stat.
4).
(b) Restoration of Eligibility.--In the case of an
individual who, during the period that began on July 1, 2006,
and ends on the date of enactment of this Act, was determined
to be ineligible for medical assistance under a State
Medicaid program solely as a result of the application of
subsections (i)(22) and (x) of section 1903 of the Social
Security Act (as in effect during such period), but who would
have been determined eligible for such assistance if such
subsections, as amended by sections 1 and 2, had applied to
the individual, a State may deem the individual to be
eligible for such assistance as of the date that the
individual was determined to be ineligible for such medical
assistance on such basis.
____
[From the Associated Press, Nov. 29, 2006]
KS: Sebelius: New Medicaid Rules Could Cost State Millions
(By John Hanna)
The state could face millions of dollars in additional
costs because of federal rules requiring Medicaid recipients
to verify their citizenship, Gov. Kathleen Sebelius said
Wednesday.
Sebelius said she's worried the state will have to pick up
the full cost of caring for some poor, frail and elderly
Kansans who are living in nursing homes, instead of sharing
the cost with the federal government. Also, she said, she
will propose adding state employees to verify the citizenship
status of Medicaid recipients and applicants.
The governor told reporters she hopes Congress reviews the
issue and other attempts to prevent illegal immigrants from
obtaining social services or using driver's licenses as
identification.
``There was no input from the states on how realistic these
were or what the cost was,'' Sebelius said during a brief
news conference following an unrelated meeting.
Under Medicaid requirements that took effect July 1,
recipients must provide either a passport or two other
documents, such as a birth certificate and a driver's
license, to verify citizenship.
While the measure is targeted at illegal immigrants, some
advocates for the needy have worried that citizens will
either lose or be denied services because they have trouble
finding the necessary documents.
State officials say the number of Kansans covered by
Medicaid dropped almost 7 percent since July 1, down to
253,000 from 271,000. They believe much of the decline can be
attributed to the new requirements.
Typically, every $1 the state spends on Medicaid is matched
by about $1.50 from the federal government. If someone loses
their coverage, then the state faces paying the entire bill
for their services, Sebelius said.
``You're at 100 percent state dollars or push them out the
door,'' she said.
Also, Sebelius said, the state needs to ``ramp up'' its
staffing to handle the additional verification work. The
governor is working on the budget proposal she'll submit to
the 2007 Legislature, which convenes Jan. 8.
``We're certainly going to put some of them in place,'' she
said. ``We're trying to make a careful analysis of how many
we need.''
She said that if the state refuses to comply with the law,
it could face the loss of all federal health care dollars.
``We don't have a lot of latitude to say we're not going to
do this,'' she said. ``There are literally hundreds of
millions of dollars at stake.''
Meanwhile, Sebelius expressed concern about a federal law
on driver's licenses passed last year.
Starting in 2008, federal agencies won't treat a state's
licenses as valid ID unless a state requires license
applicants to document that they're living in the United
States legally. Lack of ID could prevent someone from
entering a federal building or boarding a plane.
Sebelius said the law will require local driver's licenses
offices to certify that someone has the proper documentation
and to store the information.
``Exactly how that's going to happen, we're not quite
sure,'' Sebelius said. ``We don't basically have any of the
equipment that's required to do that in any of the rural
areas.''
[[Page S3217]]
____
[From the Associated Press, Nov. 29, 2006]
KS: Thousands In Kansas Off Medicaid Following Citizenship Rules
Thousands of low-income Kansans have lost or been denied
state health care coverage because of new rules requiring
them to prove they are American citizens, state officials
say.
Since the federally mandated rules took effect July 1, the
number of Medicaid recipients in Kansas has decreased by
about 18,000, to 253,000. While officials can't determine
exactly how much of the 7 percent drop can be attributed to
the new rules, they believe much of it can.
``The impact to the consumer has been severe,'' said John
Anzivino, a vice president for MAXIMUS, a Reston, Va.,
company that helps administer the joint federal-state
Medicaid program in Kansas. ``From our perspective, this has
possibly been the most dramatic change and challenge to the
Medicaid program since its inception.''
The new rules were included in last year's federal deficit
reduction law and were designed to prevent illegal immigrants
from enrolling in the state programs providing health
coverage.
But consumer advocates said many vulnerable people who
legitimately were eligible for assistance would lose coverage
because they couldn't produce the necessary documentation.
``We expect that many of these that have lost coverage will
regain coverage once they have gathered and provided the
necessary documentation,'' Marcia Nielsen, executive director
of the Kansas Health Policy Authority, told the Lawrence
Journal-World. ``They will, however, experience a gap in
coverage that could prove to be significant for some.''
Medicaid applicants can prove their citizenship by
providing a passport. Or they can provide other documents
that verify both their citizenship, such as a birth
certificate, and their identities, such as a driver's
license.
Anzivino said most people seeking benefits don't have a
passport and are left scrambling to find birth certificates
and other documents.
The number of calls each month to a Kansas Medicaid
clearinghouse has more than doubled to 49,000 from 23,000,
official said.
Meanwhile, Rep. Dennis Moore, a Democrat whose district is
centered on the state's portion of the Kansas City area, said
federal officials were aware of states' problems with the new
rules and probably would work on it when the new Congress
takes office in January.
____
[From the Baltimore Sun, Jan. 22, 2007]
MD: Medicaid Called Harder for Poor; Health Advocates Fear Document
Rules Cause Many To Lose Coverage
(By Kelly Brewington)
Public health advocates fear that a new federal regulation
requiring Medicaid applicants to supply proof of identity and
citizenship has resulted in thousands of poor Marylanders
losing their health insurance.
The requirement, part of the federal Deficit Reduction Act
that went into effect in Maryland in September, was designed
to prevent illegal immigrants from fraudulently receiving
Medicaid, the nation's premier health insurance program for
the poor.
But advocates and health officers in some Maryland counties
insist the rule has burdened citizens who need health care
the most and is likely responsible for thousands of
Marylanders being kicked off the Medicaid rolls.
``It's a completely unnecessary law and Congress made a big
mistake in passing it,'' said Laurie Norris, an attorney with
the Public Justice Center. ``The people who are on Medicaid
in Maryland are supposed to be on Medicaid.``
The announcement of the regulations last June sparked an
uproar among advocates and state health officials, who were
given a July 1 deadline to enforce the mandate or risk losing
federal funding. The officials complained they were not given
enough time to train staff and inform Maryland's
approximately 650,000 affected Medicaid recipients that they
must furnish such identification as birth certificates,
driver's licenses and passports.
Nationwide, advocates feared huge enrollment declines,
saying many of Medicaid's neediest recipients don't possess
the necessary documents and would have to struggle to come up
with the money to obtain them. Maryland, for instance, does
not automatically issue birth certificates, which may be
ordered for $12.
Last summer, the federal government exempted from the
requirement elderly and disabled Medicaid recipients who
receive Supplemental Security Income from Social Security,
and last month it extended the exemption to foster children.
Still, states such as Virginia, Iowa, Wisconsin and New
Hampshire noted plunging Medicaid enrollment figures and
backlogs related to the regulation, according to a report
released earlier this month by the Kaiser Family Foundation's
Commission on Medicaid and the Uninsured. In Virginia, 12,000
children have been dropped from Medicaid rolls in the
requirement's first four months of implementation, the report
stated.
In Maryland, Medicaid enrollment numbers are down overall,
but state health officials say they are unsure whether the
drop is due to the new rule, a point that has frustrated
county health officers eager for evidence of the regulation's
impact that they could use to push for change.
From August through December 2006, the state Department of
Health and Mental Hygiene recorded about 6,000 fewer Medicaid
enrollees statewide compared with the same period in 2005.
Maryland officials say the enrollment computer system is not
configured to determine the exact cause of the decline.
``It is imperative that the state disclose data to
demonstrate the impact of this law,'' said Dr. Joshua
Sharfstein, Baltimore health commissioner. ``There are
warning signs that a major erosion in health coverage could
be happening as a result of this new law. This is really
concerning. . . .''
Charles Lehman, who oversees eligibility issues in the
state's Medicaid office, said the agency has concentrated its
limited resources on ``keeping people on Medicaid rather than
tracking the people going off.''
``It may not sound like we are doing everything we can, but
really, we are, with the resources we have,'' he said. ``It's
not just the clients, not just the caseworkers, everyone has
been impacted by this.''
Officials said while applicants are typically allowed a 30-
day grace period, caseworkers will not discontinue the
insurance if applicants are ``making a good-faith effort'' to
obtain the documents.
``I think we have done a good job applying the law
appropriately but not in a way that arbitrarily cuts people
off,'' said Lehman. ``We have made our best effort to keep
people on.''
The department has spent $1 million for a toll-free number
to help applicants, 866-676-5880.
The state health department has also partnered with other
state databases to verify the citizenship and identity of
beneficiaries, without requiring recipients to hand over
documents. In July, the agency searched birth certificate
records for about 600,000 Medicaid enrollees at the cost of
$12 per search, said Lehman.
But the effort has not gone as smoothly as hoped, said
Norris, with the Public Justice Center. For instance, the
databases are not automatically synched--staff must print out
the information and check it by hand.
``The state has been severely hampered in information
technology,'' she said.
Norris alerted state lawmakers to the problem at a briefing
in Annapolis last week. The problems come during a push by
advocates and some lawmakers and business groups to expand
Medicaid and help about 780,000 uninsured Marylanders.
Officials with local agencies have increased outreach and
said they have allowed people extra time to provide the
documents they need.
Nevertheless, in Anne Arundel County, for example, denial
rates for the state's Medicaid program for pregnant women and
children have jumped from an average of 18 percent from June
through December 2005 to 42 percent for the same period in
2006.
``It's really shocking,'' said Frances Phillips, the
county's health officer. ``This is so serious because the
people we are talking about are either children with no
insurance and no way to access health care, or pregnant
women.''
Many applicants eventually produce the documents and get
back on Medicaid, Phillips noted. But for vulnerable
populations, any discontinuation in coverage can be harmful,
she said.
A health department program in which nurses make home
visits to women with at-risk pregnancies has focused on
educating women on the documentation. ``We just feel that
this is so critical,'' said Phillips. `` . . . We touch base
with the women, find out what is going on with them and make
sure they get insurance.''
In Baltimore, outreach workers with Baltimore HealthCare
Access Inc., which assists some of the city's estimated
200,000 Medicaid enrollees, are making home visits and
contacting state agencies on applicants' behalf.
The agency received $5,000 from the Abell Foundation to
help applicants cover the cost of documents.
``We are plowing away that money pretty quickly,'' said
Kathleen Westcoat, the organization's president.
The funding helped Brenda Kent, 36, pay for her birth
certificate last month. She lost her wallet two months before
she was due to apply for Medicaid benefits for herself, her
twin sons and a daughter.
``I didn't know how I was supposed to get it,'' said Kent,
who does not work. ``If they didn't help me with the cost, it
would have taken me longer to do it.''
____
[From the Associated Press, Sept. 1, 2006]
NC: U.S. Citizenship Proof Required for Medicaid in N.C.
A requirement that Medicaid recipients in North Carolina
prove they hold U.S. citizenship probably won't uncover a
large amount of fraud, a state official says.
Starting Sept. 1, new Medicaid applicants and nearly every
current beneficiary must provide documentation of their
citizenship as part of a new federal law designed to prevent
illegal immigrants from receiving the health care coverage.
``I would be very surprised if we had a problem in our
state with any large number of people receiving benefits who
were not entitled to receive them,'' said Mark Benton, senior
deputy director for the state Division of Medical Assistance.
The law was to have taken effect nationwide July 1, but
North Carolina delayed its start while it prepared for the
changes.
[[Page S3218]]
Under the old rules, social services workers were supposed
to ask applicants about their citizenship status. They were
permitted to accept an applicant's word unless there was
reasonable doubt.
Now, the person seeking Medicaid will have to provide a
U.S. passport, or an original birth certificate with a
driver's license, or other combinations of eligible
documents.
Regardless of citizenship, people who need emergency care
will continue to receive it through Medicaid, although this
type of care is for a limited time period.
Officials say there is no way to know how many illegal
immigrants are on Medicaid. Some argue illegal immigrants
aren't enrolling in large numbers in a government program
like this for fear of being deported.
Illegal immigrants received emergency care of nearly $53
million in 2005, more than double the amount from 2000,
according to the division.
The changes nationwide will save Medicaid, the government-
run health care program for the poor and disabled, about $735
million by 2015, according to Congressional Budget Office
estimates.
____
Children Dropping Off Medicaid Rolls
(AP) For several years, there has been a steady increase in
the number of children enrolling in Virginia's health
insurance program for the poor. Beginning July 1, state
officials say, an unprecedented slide began.
Over the following five months, about 12,000 children
dropped off the state's Medicaid rolls.
``An entire year's growth has been wiped out,'' said
Cynthia Jones, chief deputy director for the state's
Department of Medical Assistance Services.
The drop-off, Jones points out, began about the time a new
federal law took effect. The law states that U.S. citizens
applying for Medicaid or renewing their participation must
present proof of their citizenship and identity. The law
emerged out of concern that illegal immigrants were obtaining
access to health insurance coverage sponsored by the
government.
But some officials say that's not who is losing coverage.
Besides Virginia, some other states are also reporting
declines in children enrolled in Medicaid or a decline in
applications. They include Iowa, Louisiana, New Hampshire and
Wisconsin. Health researchers say they don't know if the
states are representative of a nationwide pattern.
The states singled out as experiencing enrollment declines
were included in a report issued Tuesday by the Kaiser Family
Foundation, which conducts health research, and by the Center
on Budget and Policy Priorities, a liberal think tank.
The states experiencing declines are adamant that U.S.
citizens and certain legal immigrants are dropping off the
Medicaid rolls, not illegal immigrants.
``There is no evidence that the decline is due to
undocumented aliens leaving the program,'' said Anita Smith
of the Iowa Department of Human Services. ``Rather, we
believe that these new requirements are keeping otherwise
eligible citizens from receiving Medicaid because they cannot
provide the documents required to prove their citizenship or
identity.''
Medicaid is a health insurance program serving about 55
million people that is financed by the federal government and
the states. The declines cited would indicate that just a
fraction of the people enrolled in the program have dropped
out as a result of the documentation requirements, but they
do represent vulnerable populations, such as pregnant women
and children.
``We've delayed coverage for those children, and if those
children need medical care, there's going to be ramifications
for them,'' said Donna Cohen Ross, outreach director for the
Center on Budget and Policy Priorities.
But the agency that oversees Medicaid questioned claims
that would link enrollment declines to the new documentation
requirements.
``We believe we've given the states tools they need to both
implement the law and provide sufficient flexibility to
assist individuals in establishing their citizenship,'' said
Jeff Nelligan, spokesman for the Centers for Medicare and
Medicaid Services. ``We continue to monitor state
implementation and are not aware of any data that shows there
are significant barriers to enrollment.
``If states are experiencing difficulties, they should
bring them to our attention as we certainly want to
understand why they are not using the flexibilities we have
provided.''
After Congress passed the documentation requirements,
Medicaid officials released rules that established which
documents would suffice in meeting the law.
Primary evidence, namely a U.S. passport or a certificate
of U.S. citizenship, is considered the ideal. Secondary
evidence or lower-tier evidence must be accompanied by a
document showing identity. Such evidence includes birth
certificates, insurance records, and as a last resort,
written affidavits.
Original documents or copies certified by the issuing
agency are required by the regulation. Copies are not
acceptable. The federal government excluded millions of
seniors and disabled people from the new documentation
requirements. In December, Congress also approved an
exception for foster children.
____
New Medicaid Citizenship Documentation Requirement Is Taking a Toll:
States Report Enrollment Is Down and Administrative Costs Are Up
(By Donna Cohen Ross)
Introduction
A new federal law that states were required to implement
July 1 is creating a barrier to health-care coverage for U.S.
citizens--especially children--who are eligible for health
insurance through Medicaid. The new law, a provision of the
Deficit Reduction Act of 2005, requires U.S. citizens to
present proof of their citizenship and identity when they
apply for, or seek to renew, their Medicaid coverage. Prior
to enactment of the law, U.S. citizens applying for Medicaid
were permitted to attest to their citizenship, under penalty
of perjury.
In the six months following implementation of the new
requirement, states are beginning to report marked declines
in Medicaid enrollment, particularly among low-income
children. States also are reporting significant increases in
administrative costs as a consequence of the requirement.
This analysis presents the data available so far on this
matter. The available evidence strongly suggests that those
being adversely affected are primarily U.S. citizens
otherwise eligible for Medicaid who are encountering
difficulty in promptly securing documents such as birth
certificates and who are remaining uninsured for longer
periods of time as a result.
The new requirement also appears to be reversing part of
the progress that states made over the past decade in
streamlining access to Medicaid for individuals who qualify,
and especially for children. For example, to improve access
to Medicaid and reduce administrative costs, most states
implemented mail-in application procedures, and many states
reduced burdensome documentation requirements. The new
Medicaid citizenship documentation requirement now appears to
be pushing states in the opposite direction, by impeding
access to Medicaid. Families must furnish more documentation
and may be required to visit a Medicaid office in person to
apply or renew their coverage, bypassing simpler mail-in and
on-line enrollment opportunities, because they must present
original documents such as birth certificates that can take
time and money to obtain. This is likely to cause the most
difficulty for working-poor families that cannot afford to
take time off from work to visit the Medicaid office and for
low-income families residing in rural areas.
The new citizenship documentation requirement--which the
Bush Administration did not request and the Senate initially
did not adopt, but which the House of Representatives
insisted upon in conference--was presented by its proponents
as being necessary to stem a problem of undocumented
immigrants securing Medicaid by falsely declaring themselves
to be U.S. citizens. The new requirement was adopted despite
the lack of evidence that such a problem existed. In response
to a report in 2005 by the Inspector General of the
Department of Health and Human Services, Mark McClellan, then
the Administrator of the Centers for Medicare and Medicaid
Services at HHS, noted: ``The [Inspector General's] report
does not find particular problems regarding false allegations
of citizenship, nor are we aware of any.
Impact of the Citizen Documentation Requirement on Medicaid Applicants
and Beneficiaries: The Early Evidence
Medicaid enrollment figures for all states for the period
since the new requirement was implemented on July 1 are not
yet available. By contacting several individual states that
do have such data, however, we were able to secure enrollment
information from Wisconsin, Kansas, Iowa, Louisiana, Virginia
and New Hampshire. The data show the following:
All six states report a significant drop in enrollment
since implementation of the requirement began.
Medicaid officials in these states attribute the downward
trend primarily or entirely to the citizenship documentation
requirement.
Two types of problems are surfacing:
Medicaid is being denied or terminated because some
beneficiaries and applicants cannot produce the specified
documents despite, from all appearances, being U.S. citizens;
and
Medicaid eligibility determinations are being delayed,
resulting in large backlogs of applications, either because
it is taking time for applicants to obtain the required
documents or because eligibility workers are overloaded with
the new tasks and paperwork associated with administering the
new requirement.
Some states have designed mechanisms specifically to track
enrollment changes resulting from the new procedures.
Wisconsin, for example, has established computer codes to
distinguish when Medicaid eligibility is denied or
discontinued due to a lack of citizenship or identity
documents. In other states, a comparison of current and past
enrollment trends strongly suggests that the new requirement
is largely responsible for the enrollment decline. For
example, in many states aggressive ``back to school''
outreach activities conducted in August and September usually
result in increased child enrollment in September and
October. In 2006, however, states such as Virginia and
Louisiana reported that child enrollment declined despite
vigorous promotional campaigns, indicating that the new
requirement undermined the value of the outreach efforts.
[[Page S3219]]
The Medicaid enrollment declines identified in this memo do
not appear to be driven by broader economic trends or a
change in the employment of low-income families. If that were
the case, parallel enrollment decline trends would appear in
the Food Stamp Program, which is the means-tested program
whose enrollment levels are most responsive to such
developments. Instead, Food Stamp caseloads have been
increasing slightly in recent months. Moreover, each of the
states identified in this memo as having sustained a drop in
Medicaid enrollment saw its food stamp caseload rise during a
similar period.
Both Medicaid and the Food Stamp Program serve similar
populations of low-income families and are often administered
by the same agencies and caseworkers. A key difference is
that the citizenship documentation rules were applied to
Medicaid but there were no such changes in the Food Stamp
Program. It thus appears that the changes in Medicaid
enrollment are a result of changes in Medicaid policies--
particularly citizenship documentation--that do not affect
eligibility for food stamps.
The following states have documented declines in Medicaid
enrollment since the implementation of the Medicaid
citizenship documentation requirement:
Wisconsin: In five months--between August and December
2006--a total of 14,034 Medicaid-eligible individuals were
either denied Medicaid or lost coverage as a result of the
documentation requirement. The loss of Medicaid coverage
occurred despite Wisconsin's efforts to minimize the impact
of the requirement by obtaining birth records electronically
from the state's Vital Records agency. Obtaining proof of
identify, rather than proof of citizenship, was the major
problem for people in Wisconsin who were otherwise eligible
during this period: 69 percent of those who were denied
Medicaid or who lost Medicaid coverage due to the new
requirement did not have a required identity document, as
compared to 17 percent who did not provide the required
citizenship documents and 14 percent who were missing both a
citizenship and identity document. This indicates that most
of those who were denied were, in fact, U.S. citizens.
Kansas: The Kansas Health Policy Authority (KHPA) reports
that between 18,000 and 20,000 applicants and previous
beneficiaries, mostly children and parents, have been left
without health insurance since the citizenship documentation
requirement was implemented. About 16,000 of these
individuals are ``waiting to enroll'' or ``waiting to be re-
enrolled;'' the state says these eligibility determinations
are being delayed because of a large backlog of applications
related to the difficulties confronting individuals and
eligibility workers alike who are attempting to comply with
the new rule. Documents on the KHPA website state that the
``majority of families with pending applications will
qualify for coverage under the new requirements when we
are able to complete processing.'' In the meantime, these
children and parents are barred from getting the health
coverage for which they qualify and are, in most cases,
uninsured.
Iowa: Iowa has identified an unprecedented decline in
Medicaid enrollment that state officials attribute to the
Medicaid citizenship documentation requirement. Prior to July
1, 2006, overall Medicaid enrollment had steadily increased
for the past several years. While sporadic declines occurred
in rural counties, no county in the state's larger population
centers experienced a decline in the months leading up to the
implementation of the new requirement. However, between July
and September 2006, Medicaid enrollment sustained the largest
decrease in the past five years; this also was the first time
in five years that the state has experienced an enrollment
decline for three consecutive months.
Although other factors may contribute to the recent
decrease in enrollment, state officials point out the state
is now experiencing a more severe effect on enrollment than
it has following any of the Medicaid changes that have
occurred over the past several years. The state's conclusion
that the citizenship documentation requirement is driving the
decline is supported by the fact that enrollment has dropped
among the populations subject to the requirement (children
and families) but has remained steady among groups not
affected by the requirement (individuals receiving Medicare
and SSI).
Louisiana: In two months--September and October of 2006--
Louisiana experienced a net loss of more than 7,500 children
in its Medicaid program despite a vigorous back-to-school
outreach effort and a significant increase in applications
during the month of September.
According to state officials, the enrollment decline is not
driven by population loss from Hurricane Katrina and
contrasts dramatically with enrollment spikes that usually
occur in September and have reached up to 13,000 in the past.
The reason for the drop-off is two-fold, according to the
state: for some people, Medicaid is being denied or
terminated because they have not presented the required
citizenship or identity documents. In addition, the
additional workload generated by the new requirement is
diverting the time and effort eligibility workers normally
would spend on activities to ensure that Medicaid
beneficiaries do not lose coverage at renewal.
Virginia: Since July, enrollment of children in the state's
Medicaid program has declined steadily each month. By the end
of November, the total net decline stood at close to 12,000
children. During the same period, enrollment of children in
the state's separate SCHIP program, not subject to the new
requirement, increased. Virginia also reported a substantial
backlog in application processing at its central processing
site, with 2,600 cases pending approval for Medicaid in
September, when normally no more than 50 such cases are
pending at the end of a month.
After the plunge in children's Medicaid enrollment over
several months, a small increase occurred in December 2006
(although Medicaid enrollment for children then began
dropping again in January). State officials say the December
``up-tick'' suggests that some families are finally ``getting
over the hurdles'' imposed by the new law and children (who
were eligible at the time they applied but lacked the
required documentation) are getting health coverage after a
significant delay during which they were without coverage.
New Hampshire: Data from the New Hampshire Healthy Kids
Program, a private organization that processes mail-in
applications for the state's Medicaid and SCHIP programs,
indicate that the percentage of applications submitted with
all necessary documents in September of this year dropped by
almost half compared to the percentage of complete
applications submitted in September 2005. If applicants do
not supply missing documentation within 28 days, New
Hampshire closes the application. The percentage of
applications closed due to missing documents has also
increased significantly: from around 10 percent of
applications before the new requirement to 20 percent in
August 2006. In addition, New Hampshire Healthy Kids reports
that between June 2006 and September 2006, enrollment
of children in Medicaid dropped by 1,275.
Impact on State Administrative Costs
Data on state Medicaid administrative costs for the months
since July 1 are not available from CMS or any other national
source. Several states, however, have examined the impact of
the new Medicaid citizenship documentation requirement on
their administrative expenditures. Their findings are as
follows:
Illinois: Illinois is projecting $16 million to $19 million
in increased staffing costs in the first year of
implementation of the requirement.
Arizona: The Arizona legislature has allocated $10 million
to implement the citizenship documentation requirement. This
included the costs associated with staffing, training and
payments for obtaining birth records.
Colorado: The FY07-08 budget request for the Colorado
Department of Health Care Policy and Financing includes a
request for an additional $2.8 million for county
administration costs. This request is based on an assumption
by the Centers for Medicare and Medicaid Services (CMS) that
it will take an additional 5 minutes per application for a
caseworker to process citizenship and identity documents. The
Department stated in a Joint Budget Committee Hearing that
this amount ``may not be sufficient for Colorado counties and
special record storage needs.
Washington: Washington State is projecting additional costs
associated with hiring 19 additional FTEs in FY07 due to the
new requirement, and retaining seven of them in FY08 and
FY09. The state estimates that the costs will be $2.7 million
on FY07 and $450,000 in each of the succeeding two years.
Wisconsin: Wisconsin is expecting increased costs of $1.8
million to cover the increased workload associated with
administering the requirement in FY07 and $600,000 to
$700,000 per year for the two years after that.
Minnesota: Minnesota is estimating that it will spend $1.3
million in FY07 for new staff, birth record fees and other
administrative expenses.
Conclusion
Based on these findings and reports, and strong anecdotal
evidence, it seems increasingly clear that the new Medicaid
citizenship documentation requirement is having a negative
impact on Medicaid enrollment, especially among children.
Insufficient information is available to determine the
precise extent to which individuals whose Medicaid
eligibility has been delayed, denied or terminated are U.S.
citizens, eligible legal immigrants, or ineligible
immigrants. However, the fact that significant numbers of
individuals are being approved for Medicaid after delays of
many months, during which they were uninsured, demonstrates
that the requirement is adversely affecting substantial
numbers of U.S. citizens, especially children who are
citizens. Moreover, a large body of research conducted over a
number of years has conclusively shown that increasing
documentation and other administrative burdens generally
results in eligible individuals failing to obtain coverage as
a result of the enrollment and renewal processes having
become more complicated to understand and more difficult to
navigate. Regarding the Medicaid enrollment declines, Anita
Smith, Chief of the Bureau of Medical Supports for the Iowa
Department of Human Services, has stated: ``There is no
evidence that the [enrollment] decline is due to undocumented
aliens leaving the program. Rather, we believe that these new
requirements are keeping otherwise eligible citizens from
receiving Medicaid because they cannot provide the documents
required to prove their citizenship or identity.''
[[Page S3220]]
A number of governors across the nation are announcing
their intentions to push new initiatives to cover the
uninsured, particularly children. These proposals are being
designed to build upon existing public coverage programs, of
which Medicaid is the largest, and invariably these proposals
call for the enrollment of individuals who are currently
eligible for existing programs but remain uninsured. Success
will depend, in large measure, on policies and procedures
that facilitate rather than frustrate such efforts so that
eligible individuals can obtain the benefits for which they
qualify. The Medicaid citizenship documentation requirement,
which appears to be an extremely blunt instrument, stands to
undercut such efforts by placing a daunting administrative
obstacle in the way of many low-income U.S. citizens who
otherwise have shown that they qualify or by discouraging
potentially eligible citizens from applying because the
process appears too complex or intimidating. The requirement
also appears to be deflecting state human and financial
resources away from activities designed to reach eligible
children and families and to enroll them in the most
efficient and effective manner.
______
By Mr. KENNEDY (for himself, Mr. Dodd, Mr. Harkin, Ms. Mikulski,
Mrs. Murray, Mrs. Clinton, Mr. Obama, Mr. Sanders, Mr. Brown,
Mr. Durbin, Mr. Inouye, Mr. Biden, Mr. Levin, Mr. Kerry, Mr.
Rockefeller, Mr. Lieberman, Mr. Akaka, Mrs. Boxer, Mr.
Feingold, Mr. Schumer, Mr. Lautenberg, Mr. Menendez, and Mr.
Casey):
S. 910. A bill to provide for paid sick leave to ensure that
Americans can address their own health needs and the health needs of
their families; to the Committee on Health, Education, Labor, and
Pensions.
Mr. KENNEDY. Mr. President day in and day out across America,
millions of men and women go to work in jobs that are the backbone of
our economy. They make our country great and prosperous. They work hard
to provide for their families and care for them.
Often, however, they have to miss days of work because of illness.
Every parent knows what it's like to care for a sick child, and every
child knows the importance of a parent taking care of them when they
are ill. Yet, every day, countless Americans find their paychecks or
even their jobs at risk when illness strikes.
As Members of Congress, we don't lose our pay or risk our jobs if we
stay home because of illness. But millions of our fellow citizens are
not so fortunate.
Mr. President, 57 million Americans--nearly half of all private-
sector workers in the United States--do not have paid sick days.
Seventy percent don't have paid sick days they can use to care for
family members. They can't take a day off to recover from the flu. They
can't leave work to care for a child who is running a fever.
Among workers in the lowest income quarter, the numbers are even
worse--percent do not have the right to take time off for illness
without losing their payor even their jobs.
This lack of protection is especially difficult for working women
with children. Women have moved into the workforce in record numbers,
but they continue to have primary responsibility for their children's
health. Nearly 80 percent of mothers say they are solely responsible
for their children's medical care. Yet they can't take a day off to
care for a sick child.
If we truly care about families, we have to change those facts.
Americans want to be responsible employees and responsible parents. We
need workplace laws that allow workers the time needed to care for
themselves or family members when they are sick without losing payor
risking their jobs.
That is why today I am introducing the Healthy Families Act, to give
American workers up to seven paid days of sick leave a year. Now
Congresswoman Rosa DeLauro is introducing the legislation in the House
of Representatives.
Earlier this week, she and I met with hundreds of workers and parents
from around the country, representing tens of thousands of parents
asking Congress to take action.
I am talking about hard-working people such as Bertha Brown, who
spoke to hundreds of us in front of the Capitol. Bertha is a home
healthcare aide. She has spent her life caring for America's sick and
elderly, yet she herself has no paid sick days to care for herself or
her children. She told us how she had to leave her sick daughter at
home when she went to work.
Paid sick days aren't just a family issue--they are also a public
health issue. When sick people go to work, they are likely to infect
their coworkers and the public. Every day, we hear reports of stomach
illnesses breaking out in restaurants or on cruise ships. We learn of
flu outbreaks leading to hospitalization of the elderly. Such illnesses
are contagious, but their spread can be minimized if sick people stay
at home.
However, a high proportion of workers who have constant contact with
the public have no paid sick days--85 percent of food service workers
and 55 percent of workers in the retail industry are denied that
benefit; 30 percent of health care workers can't take paid time off
when they are ill.
That is why nurses and doctors support paid sick days. When our
Health Committee held a hearing on this issue last month, we heard from
pediatricians at Boston Children's Hospital and a public health expert
in San Francisco about the significant health benefits and reduction of
medical costs that result from paid sick days. We all know that
preventive care helps reduce medical costs. Giving people the
opportunity to obtain medical treatment for illnesses or chronic
medical conditions before their conditions worsen is common sense.
Paid sick days also are important to help children stay healthy and
in school so that they can learn. When sick children go to school, they
don't learn well, and they are likely to infect their fellow students.
We also heard this week from Carolyn Duff, a nurse in an elementary
school in South Carolina. She treated a fifth grader she suspected had
strep throat. His parents did not have paid sick days and could not
take him to the doctor. After 4 days, his condition worsened. He
developed scarlet fever and a rash covered his entire body--all because
his parents, for fear of losing their jobs, weren't able to take time
off to care for him. As Carolyn Duff said, the child not only suffered
without the care of his parents, he also lost 10 precious days of his
studies at school.
Paid sick days will result in significant savings to our economy and
our health care system. That is why employers support paid sick days
too. Dancing Deer Bakery--a small business Boston--sent me a letter
making this important point:
A national paid sick days law creates a level playing field
for all businesses. . . . We hope that a bill will move
through both Chambers and be on the President's desk. Paid
sick days should be a non-partisan issue. A healthy nation is
a productive nation.
Paid sick days are good for families, good for our public health, and
good for our economy. Our people have waited long enough for this need
to be met. It is time to pass the Healthy Families 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. 910
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 ``Healthy Families Act''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Working Americans need time to meet their own health
care needs and to care for family members, including their
children, spouse, parents, and parents-in-law, and other
children and adults for whom they are caretakers.
(2) Health care needs include preventive health care,
diagnostic procedures, medical treatment, and recovery in
response to short- and long-term illnesses and injuries.
(3) Providing employees time off to meet health care needs
ensures that they will be healthier in the long run.
Preventive care helps avoid illnesses and injuries and
routine medical care helps detect illnesses early and shorten
their duration.
(4) When parents are available to care for their children
who become sick, children recover faster, more serious
illnesses are prevented, and children's overall mental and
physical health improve. Parents who cannot afford to miss
work and must send children with a contagious illness to
child care or school contribute to the high rate of
infections in child care centers and schools.
(5) Providing paid sick leave improves public health by
reducing infectious disease. Policies that make it easier for
sick adults and children to be isolated at home reduce the
spread of infectious disease.
[[Page S3221]]
(6) Routine medical care reduces medical costs by detecting
and treating illness and injury early, decreasing the need
for emergency care. These savings benefit public and private
payers of health insurance, including private businesses.
(7) The provision of individual and family sick leave by
large and small businesses, both here in the United States
and elsewhere, demonstrates that policy solutions are both
feasible and affordable in a competitive economy. Measures
that ensure that employees are in good health and do not need
to worry about unmet family health problems help businesses
by promoting productivity and reducing employee turnover.
(8) The American Productivity Audit found that
presenteeism--the practice of employees coming to work
despite illness--costs $180,000,000,000 annually in lost
productivity. Studies in the Journal of Occupational and
Environmental Medicine, the Employee Benefit News, and the
Harvard Business Review show that presenteeism is a larger
productivity drain than either absenteeism or short-term
disability.
(9) The absence of paid sick leave has forced Americans to
make untenable choices between needed income and jobs on the
one hand and caring for their own and their family's health
on the other.
(10) Nearly half of Americans lack paid leave for self-care
or to care for a family member. For families in the lowest
quartile of earners, 79 percent lack paid sick leave. For
families in the next 2 quartiles, 46 and 38 percent,
respectively, lack paid sick leave. Even for families in the
highest income quartile, 28 percent lack paid sick leave. In
addition, millions of workers cannot use paid sick leave to
care for ill family members.
(11) Due to the roles of men and women in society, the
primary responsibility for family caretaking often falls on
women, and such responsibility affects the working lives of
women more than it affects the working lives of men.
(12) An increasing number of men are also taking on
caretaking obligations, and men who request leave time for
caretaking purposes are often denied accommodation or
penalized because of stereotypes that caretaking is only
``women's work''.
(13) Employers' reliance on persistent stereotypes about
the ``proper'' roles of both men and women in the workplace
and in the home continues a cycle of discrimination and
fosters stereotypical views about women's commitment to work
and their value as employees.
(14) Employment standards that apply to only one gender
have serious potential for encouraging employers to
discriminate against employees and applicants for employment
who are of that gender.
(15) It is in the national interest to ensure that all
Americans can care for their own health and the health of
their families while prospering at work.
SEC. 3. PURPOSES.
The purposes of this Act are--
(1) to ensure that all working Americans can address their
own health needs and the health needs of their families by
requiring employers to provide a minimum level of paid sick
leave including leave for family care;
(2) to diminish public and private health care costs by
enabling workers to seek early and routine medical care for
themselves and their family members;
(3) to accomplish the purposes described in paragraphs (1)
and (2) in a manner that is feasible for employers; and
(4) consistent with the provision of the 14th amendment to
the Constitution relating to equal protection of the laws,
and pursuant to Congress' power to enforce that provision
under section 5 of that amendment--
(A) to accomplish the purposes described in paragraphs (1)
and (2) in a manner that minimizes the potential for
employment discrimination on the basis of sex by ensuring
generally that leave is available for eligible medical
reasons on a gender-neutral basis; and
(B) to promote the goal of equal employment opportunity for
women and men.
SEC. 4. DEFINITIONS.
In this Act:
(1) Child.--The term ``child'' means a biological, foster,
or adopted child, a stepchild, a legal ward, or a child of a
person standing in loco parentis, who is--
(A) under 18 years of age; or
(B) 18 years of age or older and incapable of self-care
because of a mental or physical disability.
(2) Employee.--The term ``employee'' means an individual--
(A) who is--
(i)(I) an employee, as defined in section 3(e) of the Fair
Labor Standards Act of 1938 (29 U.S.C. 203(e)), who is not
covered under clause (v), including such an employee of the
Library of Congress, except that a reference in such section
to an employer shall be considered to be a reference to an
employer described in clauses (i)(I) and (ii) of paragraph
(3)(A); or
(II) an employee of the Government Accountability Office;
(ii) a State employee described in section 304(a) of the
Government Employee Rights Act of 1991 (42 U.S.C. 2000e-
16c(a));
(iii) a covered employee, as defined in section 101 of the
Congressional Accountability Act of 1995 (2 U.S.C. 1301),
other than an applicant for employment;
(iv) a covered employee, as defined in section 411(c) of
title 3, United States Code; or
(v) a Federal officer or employee covered under subchapter
V of chapter 63 of title 5, United States Code; and
(B) who works an average of at least 20 hours per week or,
in the alternative, at least 1,000 hours per year.
(3) Employer.--
(A) In general.--The term ``employer'' means a person who
is--
(i)(I) a covered employer, as defined in subparagraph (B),
who is not covered under subclause (V);
(II) an entity employing a State employee described in
section 304(a) of the Government Employee Rights Act of 1991;
(III) an employing office, as defined in section 101 of the
Congressional Accountability Act of 1995;
(IV) an employing office, as defined in section 411(c) of
title 3, United States Code; or
(V) an employing agency covered under subchapter V of
chapter 63 of title 5, United States Code; and
(ii) is engaged in commerce (including government), in the
production of goods for commerce, or in an enterprise engaged
in commerce (including government) or in the production of
goods for commerce.
(B) Covered employer.--
(i) In general.--In subparagraph (A)(i)(I), the term
``covered employer''--
(I) means any person engaged in commerce or in any industry
or activity affecting commerce who employs 15 or more
employees for each working day during each of 20 or more
calendar workweeks in the current or preceding calendar year;
(II) includes--
(aa) any person who acts, directly or indirectly, in the
interest of an employer to any of the employees of such
employer; and
(bb) any successor in interest of an employer;
(III) includes any ``public agency'', as defined in section
3(x) of the Fair Labor Standards Act of 1938 (29 U.S.C.
203(x)); and
(IV) includes the Government Accountability Office and the
Library of Congress.
(ii) Public agency.--For purposes of clause (i)(III), a
public agency shall be considered to be a person engaged in
commerce or in an industry or activity affecting commerce.
(iii) Definitions.--For purposes of this subparagraph:
(I) Commerce.--The terms ``commerce'' and ``industry or
activity affecting commerce'' mean any activity, business, or
industry in commerce or in which a labor dispute would hinder
or obstruct commerce or the free flow of commerce, and
include ``commerce'' and any ``industry affecting commerce'',
as defined in paragraphs (1) and (3) of section 501 of the
Labor Management Relations Act, 1947 (29 U.S.C. 142 (1) and
(3)).
(II) Employee.--The term ``employee'' has the same meaning
given such term in section 3(e) of the Fair Labor Standards
Act of 1938 (29 U.S.C. 203(e)).
(III) Person.--The term ``person'' has the same meaning
given such term in section 3(a) of the Fair Labor Standards
Act of 1938 (29 U.S.C. 203(a)).
(C) Predecessors.--Any reference in this paragraph to an
employer shall include a reference to any predecessor of such
employer.
(4) Employment benefits.--The term ``employment benefits''
means all benefits provided or made available to employees by
an employer, including group life insurance, health
insurance, disability insurance, sick leave, annual leave,
educational benefits, and pensions, regardless of whether
such benefits are provided by a practice or written policy of
an employer or through an ``employee benefit plan'', as
defined in section 3(3) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1002(3)).
(5) Health care provider.--The term ``health care
provider'' means a provider who--
(A)(i) is a doctor of medicine or osteopathy who is
authorized to practice medicine or surgery (as appropriate)
by the State in which the doctor practices; or
(ii) is any other person determined by the Secretary to be
capable of providing health care services; and
(B) is not employed by an employer for whom the provider
issues certification under this Act.
(6) Parent.--The term ``parent'' means a biological,
foster, or adoptive parent of an employee, a stepparent of an
employee, or a legal guardian or other person who stood in
loco parentis to an employee when the employee was a child.
(7) Pro rata.--The term ``pro rata'', with respect to
benefits offered to part-time employees, means the proportion
of each of the benefits offered to full-time employees that
are offered to part-time employees that, for each benefit, is
equal to the ratio of part-time hours worked to full-time
hours worked.
(8) Secretary.--The term ``Secretary'' means the Secretary
of Labor.
(9) Sick leave.--The term ``sick leave'' means an increment
of compensated leave provided by an employer to an employee
as a benefit of employment for use by the employee during an
absence from employment for any of the reasons described in
paragraphs (1) through (3) of section 5(d).
(10) Spouse.--The term ``spouse'', with respect to an
employee, has the meaning given such term by the marriage
laws of the State in which the employee resides.
SEC. 5. PROVISION OF PAID SICK LEAVE.
(a) In General.--An employer shall provide for each
employee employed by the employer not less than--
[[Page S3222]]
(1) 7 days of sick leave with pay and employment benefits
annually for employees working 30 or more hours per week; or
(2) a pro rata number of days or hours of sick leave with
pay and employment benefits annually for employees working
less than--
(A) 30 hours per week on a year-round basis; or
(B) 1,500 hours throughout the year involved.
(b) Accrual.--
(1) Period of accrual.--Sick leave provided for under this
section shall accrue as determined appropriate by the
employer, but not on less than a quarterly basis.
(2) Accumulation.--Accrued sick leave provided for under
this section shall carry over from year to year, but this Act
shall not be construed to require an employer to permit an
employee to accumulate more than 7 days of the sick leave.
(3) Use.--The sick leave may be used as accrued. The
employer, at the discretion of the employer, may loan the
sick leave to the employee in advance of accrual by such
employee.
(c) Calculation.--
(1) Less than a full workday.--Unless the employer and
employee agree to designate otherwise, for periods of sick
leave that are less than a normal workday, that leave shall
be counted--
(A) on an hourly basis; or
(B) in the smallest increment that the employer's payroll
system uses to account for absences or use of leave.
(2) Variable schedule.--If the schedule of an employee
varies from week to week, a weekly average of the hours
worked over the 12-week period prior to the beginning of a
sick leave period shall be used to calculate the employee's
normal workweek for the purpose of determining the amount of
sick leave to which the employee is entitled.
(d) Uses.--Sick leave accrued under this section may be
used by an employee for any of the following:
(1) An absence resulting from a physical or mental illness,
injury, or medical condition of the employee.
(2) An absence resulting from obtaining professional
medical diagnosis or care, or preventive medical care, for
the employee subject to the requirement of subsection (e).
(3) An absence for the purpose of caring for a child, a
parent, a spouse, or any other individual related by blood or
affinity whose close association with the employee is the
equivalent of a family relationship, who--
(A) has any of the conditions or needs for diagnosis or
care described in paragraph (1) or (2); and
(B) in the case of someone who is not a child, is otherwise
in need of care.
(e) Scheduling.--An employee shall make a reasonable effort
to schedule leave under paragraphs (2) and (3) of subsection
(d) in a manner that does not unduly disrupt the operations
of the employer.
(f) Procedures.--
(1) In general.--Paid sick leave shall be provided upon the
oral or written request of an employee. Such request shall--
(A) include a reason for the absence involved and the
expected duration of the leave;
(B) in a case in which the need for leave is foreseeable at
least 7 days in advance of such leave, be provided at least 7
days in advance of such leave; and
(C) otherwise, be provided as soon as practicable after the
employee is aware of the need for such leave.
(2) Certification.--
(A) Provision.--
(i) In general.--Subject to subparagraph (C), an employer
may require that a request for leave be supported by a
certification issued by the health care professional of the
eligible employee or of an individual described in subsection
(d)(3), as appropriate, if the leave period covers more than
3 consecutive workdays.
(ii) Timeliness.--The employee shall provide a copy of such
certification to the employer in a timely manner, not later
than 30 days after the first day of the leave. The employer
shall not delay the commencement of the leave on the basis
that the employer has not yet received the certification.
(B) Sufficient certification.--
(i) In general.--A certification provided under
subparagraph (A) shall be sufficient if it states--
(I) the date on which the leave will be needed;
(II) the probable duration of the leave;
(III) the appropriate medical facts within the knowledge of
the health care provider regarding the condition involved,
subject to clause (ii); and
(IV)(aa) for purposes of leave under subsection (d)(1), a
statement that leave from work is medically necessary;
(bb) for purposes of leave under subsection (d)(2), the
dates on which testing for a medical diagnosis or care is
expected to be given and the duration of such testing or
care; and
(cc) for purposes of leave under subsection (d)(3), in the
case of leave to care for someone who is not a child, a
statement that care is needed for an individual described in
such subsection, and an estimate of the amount of time that
such care is needed for such individual.
(ii) Limitation.--In issuing a certification under
subparagraph (A), a health care provider shall make
reasonable efforts to limit the medical facts described in
clause (i)(III) that are disclosed in the certification to
the minimum necessary to establish a need for the employee to
utilize paid sick leave.
(C) Regulations.--Regulations prescribed under section 13
shall specify the manner in which an employee who does not
have health insurance shall provide a certification for
purposes of this paragraph.
(D) Confidentiality and nondisclosure.--
(i) Protected health information.--Nothing in this Act
shall be construed to require a health care provider to
disclose information in violation of section 1177 of the
Social Security Act (42 U.S.C. 1320d-6) or the regulations
promulgated pursuant to section 264(c) of the Health
Insurance Portability and Accountability Act (42 U.S.C.
1320d-2 note).
(ii) Health information records.--If an employer possesses
health information about an employee or an employee's child,
parent, spouse or other individual described in subsection
(d)(3), such information shall--
(I) be maintained on a separate form and in a separate file
from other personnel information;
(II) be treated as a confidential medical record; and
(III) not be disclosed except to the affected employee or
with the permission of the affected employee.
(g) Current Leave Policies.--
(1) Equivalency requirement.--An employer with a leave
policy providing paid leave options shall not be required to
modify such policy, if such policy includes provisions for
the provision, use, and administration of paid sick leave
that meet the requirements of subsections (a) through (f).
(2) No elimination, reduction, or redesignation of existing
leave.--An employer may not eliminate, reduce, or redesignate
any leave in existence on the date of enactment of this Act
in order to comply with the provisions of this Act.
SEC. 6. POSTING REQUIREMENT.
(a) In General.--Each employer shall post and keep posted a
notice, to be prepared or approved in accordance with
procedures specified in regulations prescribed under section
13, setting forth excerpts from, or summaries of, the
pertinent provisions of this Act including--
(1) information describing leave available to employees
under this Act;
(2) information pertaining to the filing of an action under
this Act;
(3) the details of the notice requirement for foreseeable
leave under section 5(f)(1)(B); and
(4) information that describes--
(A) the protections that an employee has in exercising
rights under this Act; and
(B) how the employee can contact the Secretary (or other
appropriate authority as described in section 8) if any of
the rights are violated.
(b) Location.--The notice described under subsection (a)
shall be posted--
(1) in conspicuous places on the premises of the employer,
where notices to employees (including applicants) are
customarily posted; or
(2) in employee handbooks.
(c) Violation; Penalty.--Any employer who willfully
violates the posting requirements of this section shall be
subject to a civil fine in an amount not to exceed $100 for
each separate offense.
SEC. 7. PROHIBITED ACTS.
(a) Interference With Rights.--
(1) Exercise of rights.--It shall be unlawful for any
employer to interfere with, restrain, or deny the exercise
of, or the attempt to exercise, any right provided under this
Act, including--
(A) discharging or discriminating against (including
retaliating against) any individual, including a job
applicant, for exercising, or attempting to exercise, any
right provided under this Act;
(B) using the taking of sick leave under this Act as a
negative factor in an employment action, such as hiring,
promotion, or a disciplinary action; or
(C) counting the sick leave under a no-fault attendance
policy.
(2) Discrimination.--It shall be unlawful for any employer
to discharge or in any other manner discriminate against
(including retaliating against) any individual, including a
job applicant, for opposing any practice made unlawful by
this Act.
(b) Interference With Proceedings or Inquiries.--It shall
be unlawful for any person to discharge or in any other
manner discriminate against (including retaliating against)
any individual, including a job applicant, because such
individual--
(1) has filed an action, or has instituted or caused to be
instituted any proceeding, under or related to this Act;
(2) has given, or is about to give, any information in
connection with any inquiry or proceeding relating to any
right provided under this Act; or
(3) has testified, or is about to testify, in any inquiry
or proceeding relating to any right provided under this Act.
(c) Construction.--Nothing in this section shall be
construed to state or imply that the scope of the activities
prohibited by section 105 of the Family and Medical Leave Act
of 1993 (29 U.S.C. 2615) is less than the scope of the
activities prohibited by this section.
SEC. 8. ENFORCEMENT AUTHORITY.
(a) In General.--
(1) Definition.--In this subsection:
(A) the term ``employee'' means an employee described in
clause (i) or (ii) of section 4(2)(A); and
(B) the term ``employer'' means an employer described in
subclause (I) or (II) of section 4(3)(A)(i).
[[Page S3223]]
(2) Investigative authority.--
(A) In general.--To ensure compliance with the provisions
of this Act, or any regulation or order issued under this
Act, the Secretary shall have, subject to subparagraph (C),
the investigative authority provided under section 11(a) of
the Fair Labor Standards Act of 1938 (29 U.S.C. 211(a)), with
respect to employers, employees, and other individuals
affected.
(B) Obligation to keep and preserve records.--An employer
shall make, keep, and preserve records pertaining to
compliance with this Act in accordance with section 11(c) of
the Fair Labor Standards Act of 1938 (29 U.S.C. 211(c)) and
in accordance with regulations prescribed by the Secretary.
(C) Required submissions generally limited to an annual
basis.--The Secretary shall not require, under the authority
of this paragraph, an employer to submit to the Secretary any
books or records more than once during any 12-month period,
unless the Secretary has reasonable cause to believe there
may exist a violation of this Act or any regulation or order
issued pursuant to this Act, or is investigating a charge
pursuant to paragraph (4).
(D) Subpoena authority.--For the purposes of any
investigation provided for in this paragraph, the Secretary
shall have the subpoena authority provided for under section
9 of the Fair Labor Standards Act of 1938 (29 U.S.C. 209).
(3) Civil action by employees or individuals.--
(A) Right of action.--An action to recover the damages or
equitable relief prescribed in subparagraph (B) may be
maintained against any employer in any Federal or State court
of competent jurisdiction by one or more employees or
individuals or their representative for and on behalf of--
(i) the employees or individuals; or
(ii) the employees or individuals and others similarly
situated.
(B) Liability.--Any employer who violates section 7
(including a violation relating to rights provided under
section 5) shall be liable to any employee or individual
affected--
(i) for damages equal to--
(I) the amount of--
(aa) any wages, salary, employment benefits, or other
compensation denied or lost by reason of the violation; or
(bb) in a case in which wages, salary, employment benefits,
or other compensation have not been denied or lost, any
actual monetary losses sustained as a direct result of the
violation up to a sum equal to 7 days of wages or salary for
the employee or individual;
(II) the interest on the amount described in subclause (I)
calculated at the prevailing rate; and
(III) an additional amount as liquidated damages; and
(ii) for such equitable relief as may be appropriate,
including employment, reinstatement, and promotion.
(C) Fees and costs.--The court in an action under this
paragraph shall, in addition to any judgment awarded to the
plaintiff, allow a reasonable attorney's fee, reasonable
expert witness fees, and other costs of the action to be paid
by the defendant.
(4) Action by the secretary.--
(A) Administrative action.--The Secretary shall receive,
investigate, and attempt to resolve complaints of violations
of section 7 (including a violation relating to rights
provided under section 5) in the same manner that the
Secretary receives, investigates, and attempts to resolve
complaints of violations of sections 6 and 7 of the Fair
Labor Standards Act of 1938 (29 U.S.C. 206 and 207).
(B) Civil action.--The Secretary may bring an action in any
court of competent jurisdiction to recover the damages
described in paragraph (3)(B)(i).
(C) Sums recovered.--Any sums recovered by the Secretary
pursuant to subparagraph (B) shall be held in a special
deposit account and shall be paid, on order of the Secretary,
directly to each employee or individual affected. Any such
sums not paid to an employee or individual affected because
of inability to do so within a period of 3 years shall be
deposited into the Treasury of the United States as
miscellaneous receipts.
(5) Limitation.--
(A) In general.--Except as provided in subparagraph (B), an
action may be brought under paragraph (3), (4), or (6) not
later than 2 years after the date of the last event
constituting the alleged violation for which the action is
brought.
(B) Willful violation.--In the case of an action brought
for a willful violation of section 7 (including a willful
violation relating to rights provided under section 5), such
action may be brought within 3 years of the date of the last
event constituting the alleged violation for which such
action is brought.
(C) Commencement.--In determining when an action is
commenced under paragraph (3), (4), or (6) for the purposes
of this paragraph, it shall be considered to be commenced on
the date when the complaint is filed.
(6) Action for injunction by secretary.--The district
courts of the United States shall have jurisdiction, for
cause shown, in an action brought by the Secretary--
(A) to restrain violations of section 7 (including a
violation relating to rights provided under section 5),
including the restraint of any withholding of payment of
wages, salary, employment benefits, or other compensation,
plus interest, found by the court to be due to employees or
individuals eligible under this Act; or
(B) to award such other equitable relief as may be
appropriate, including employment, reinstatement, and
promotion.
(7) Solicitor of labor.--The Solicitor of Labor may appear
for and represent the Secretary on any litigation brought
under paragraph (4) or (6).
(8) Government accountability office and library of
congress.--Notwithstanding any other provision of this
subsection, in the case of the Government Accountability
Office and the Library of Congress, the authority of the
Secretary of Labor under this subsection shall be exercised
respectively by the Comptroller General of the United States
and the Librarian of Congress.
(b) Employees Covered by Congressional Accountability Act
of 1995.--The powers, remedies, and procedures provided in
the Congressional Accountability Act of 1995 (2 U.S.C. 1301
et seq.) to the Board (as defined in section 101 of that Act
(2 U.S.C. 1301)), or any person, alleging a violation of
section 202(a)(1) of that Act (2 U.S.C. 1312(a)(1)) shall be
the powers, remedies, and procedures this Act provides to
that Board, or any person, alleging an unlawful employment
practice in violation of this Act against an employee
described in section 4(2)(A)(iii).
(c) Employees Covered by Chapter 5 of Title 3, United
States Code.--The powers, remedies, and procedures provided
in chapter 5 of title 3, United States Code, to the
President, the Merit Systems Protection Board, or any person,
alleging a violation of section 412(a)(1) of that title,
shall be the powers, remedies, and procedures this Act
provides to the President, that Board, or any person,
respectively, alleging an unlawful employment practice in
violation of this Act against an employee described in
section 4(2)(A)(iv).
(d) Employees Covered by Chapter 63 of Title 5, United
States Code.--The powers, remedies, and procedures provided
in title 5, United States Code, to an employing agency,
provided in chapter 12 of that title to the Merit Systems
Protection Board, or provided in that title to any person,
alleging a violation of chapter 63 of that title, shall be
the powers, remedies, and procedures this Act provides to
that agency, that Board, or any person, respectively,
alleging an unlawful employment practice in violation of this
Act against an employee described in section 4(2)(A)(v).
SEC. 9. COLLECTION OF DATA ON PAID SICK DAYS AND FURTHER
STUDY.
(a) Compilation of Information.--Effective 90 days after
the date of enactment of this Act, the Commissioner of Labor
Statistics shall annually compile information on the
following:
(1) The number of employees who used paid sick leave.
(2) The number of hours of the paid sick leave used.
(3) The demographic characteristics of employees who were
eligible for and who used the paid sick leave.
(b) GAO Study.--
(1) In general.--The Comptroller General of the United
States shall annually conduct a study to determine the
following:
(A)(i) The number of days employees used paid sick leave
and the reasons for the use.
(ii) The number of employees who used the paid sick leave
for leave periods covering more than 3 consecutive workdays.
(B) Whether employees used the paid sick leave to care for
illnesses or conditions caused by domestic violence against
the employees or their family members.
(C) The cost and benefits to employers of implementing the
paid sick leave policies.
(D) The cost to employees of providing certification issued
by a health care provider to obtain the paid sick leave.
(E) The benefits of the paid sick leave to employees and
their family members, including effects on employees' ability
to care for their family members or to provide for their own
health needs.
(F) Whether the paid sick leave affected employees' ability
to sustain an adequate income while meeting health needs of
the employees and their family members.
(G) Whether employers who administered paid sick leave
policies prior to the date of enactment of this Act were
affected by the provisions of this Act.
(H) Whether other types of leave were affected by this Act.
(I) Whether paid sick leave affected retention and turnover
and costs of presenteeism.
(J) Whether the paid sick leave increased the use of less
costly preventive medical care and lowered the use of
emergency room care.
(K) Whether the paid sick leave reduced the number of
children sent to school when the children were sick.
(2) Aggregating data.--The data collected under
subparagraphs (A), (B), and (E) of paragraph (1) shall be
aggregated by gender, race, disability, earnings level, age,
marital status, and family type, including parental status.
(3) Reports.--
(A) In general.--Not later than 18 months after the date of
enactment of this Act, the Comptroller General of the United
States shall prepare and submit a report to the appropriate
committees of Congress concerning the results of the study
conducted pursuant to paragraph (1) and the data aggregated
under paragraph (2).
(B) Followup report.--Not later that 5 years after the date
of enactment of this Act the Comptroller General of the
United States shall prepare and submit a followup report to
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the appropriate committees of Congress concerning the results
of the study conducted pursuant to paragraph (1) and the data
aggregated under paragraph (2).
SEC. 10. EFFECT ON OTHER LAWS.
(a) Federal and State Antidiscrimination Laws.--Nothing in
this Act shall be construed to modify or affect any Federal
or State law prohibiting discrimination on the basis of race,
religion, color, national origin, sex, age, or disability.
(b) State and Local Laws.--Nothing in this Act shall be
construed to supersede any provision of any State or local
law that provides greater paid sick leave or other leave
rights than the rights established under this Act.
SEC. 11. EFFECT ON EXISTING EMPLOYMENT BENEFITS.
(a) More Protective.--Nothing in this Act shall be
construed to diminish the obligation of an employer to comply
with any contract, collective bargaining agreement, or any
employment benefit program or plan that provides greater paid
sick leave rights to employees or individuals than the rights
established under this Act.
(b) Less Protective.--The rights established for employees
under this Act shall not be diminished by any contract,
collective bargaining agreement, or any employment benefit
program or plan.
SEC. 12. ENCOURAGEMENT OF MORE GENEROUS LEAVE POLICIES.
Nothing in this Act shall be construed to discourage
employers from adopting or retaining leave policies more
generous than policies that comply with the requirements of
this Act.
SEC. 13. REGULATIONS.
(a) In General.--
(1) Authority.--Except as provided in paragraph (2), not
later than 120 days after the date of enactment of this Act,
the Secretary shall prescribe such regulations as are
necessary to carry out this Act with respect to employees
described in clause (i) or (ii) of section 4(2)(A) and other
individuals affected by employers described in subclause (I)
or (II) of section 4(3)(A)(i).
(2) Government accountability office; library of
congress.--The Comptroller General of the United States and
the Librarian of Congress shall prescribe the regulations
with respect to employees of the Government Accountability
Office and the Library of Congress, respectively and other
individuals affected by the Comptroller General of the United
States and the Librarian of Congress, respectively.
(b) Employees Covered by Congressional Accountability Act
of 1995.--
(1) Authority.--Not later than 120 days after the date of
enactment of this Act, the Board of Directors of the Office
of Compliance shall prescribe (in accordance with section 304
of the Congressional Accountability Act of 1995 (2 U.S.C.
1384)) such regulations as are necessary to carry out this
Act with respect to employees described in section
4(2)(A)(iii) and other individuals affected by employers
described in section 4(3)(A)(i)(III).
(2) Agency regulations.--The regulations prescribed under
paragraph (1) shall be the same as substantive regulations
promulgated by the Secretary to carry out this Act except
insofar as the Board may determine, for good cause shown and
stated together with the regulations prescribed under
paragraph (1), that a modification of such regulations would
be more effective for the implementation of the rights and
protections involved under this section.
(c) Employees Covered by Chapter 5 of Title 3, United
States Code.--
(1) Authority.--Not later than 120 days after the date of
enactment of this Act, the President (or the designee of the
President) shall prescribe such regulations as are necessary
to carry out this Act with respect to employees described in
section 4(2)(A)(iv) and other individuals affected by
employers described in section 4(3)(A)(i)(IV).
(2) Agency regulations.--The regulations prescribed under
paragraph (1) shall be the same as substantive regulations
promulgated by the Secretary to carry out this Act except
insofar as the President (or designee) may determine, for
good cause shown and stated together with the regulations
prescribed under paragraph (1), that a modification of such
regulations would be more effective for the implementation of
the rights and protections involved under this section.
(d) Employees Covered by Chapter 63 of Title 5, United
States Code.--
(1) Authority.--Not later than 120 days after the date of
enactment of this Act, the Director of the Office of
Personnel Management shall prescribe such regulations as are
necessary to carry out this Act with respect to employees
described in section 4(2)(A)(v) and other individuals
affected by employers described in section 4(3)(A)(i)(V).
(2) Agency regulations.--The regulations prescribed under
paragraph (1) shall be the same as substantive regulations
promulgated by the Secretary to carry out this Act except
insofar as the Director may determine, for good cause shown
and stated together with the regulations prescribed under
paragraph (1), that a modification of such regulations would
be more effective for the implementation of the rights and
protections involved under this section.
SEC. 14. EFFECTIVE DATES.
(a) In General.--This Act shall take effect 1 year after
the date of issuance of regulations under section 13(a)(1).
(b) Collective Bargaining Agreements.--In the case of a
collective bargaining agreement in effect on the effective
date prescribed by subsection (a), this Act shall take effect
on the earlier of--
(1) the date of the termination of such agreement; or
(2) the date that occurs 18 months after the date of
issuance of regulations under section 13(a)(1).
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