[Congressional Record Volume 155, Number 73 (Wednesday, May 13, 2009)]
[Senate]
[Pages S5437-S5443]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. BINGAMAN:
  S. 1028. A bill to amend the Public Health Service Act to improve the 
Nation's surveillance and reporting for diseases and conditions, and 
for other purposes; to the Committee on Health, Education, Labor, and 
Pensions.
  Mr. BINGAMAN. Mr. President, I am introducing legislation today 
entitled the Strengthening America's Public Health System Act of 2009.
  The ongoing swine flu pandemic makes clear the necessity for a robust 
public health system in the U.S. This legislation is designed to 
strengthen epidemiology and laboratory capacity in State and local 
health departments and, correspondingly, national surveillance and 
reporting of infectious diseases and other conditions of public health 
importance.
  Currently, many parts of the local-state-federal disease surveillance 
system are fragmented and paper-based, and have not fully benefited 
from new technologies that could improve the completeness and 
timeliness of reporting. A 2007 survey found that 20 states are 
manually reporting diagnostic findings, albeit with a web interface, 
and 16 are completely paper-based. Only 2 State public health 
laboratories have bidirectional data flow and can both send and receive 
laboratory messages, the gold standard for disease reporting. The 
potential for new pathogen discovery, rapid electronic exchange of 
public health information, national bacterial and viral databases for 
DNA ``fingerprinting'' of infectious disease organisms has not been 
fully realized. My legislation focuses on improving electronic disease 
surveillance and reporting so that all state and local health 
departments and public health laboratories can readily and seamlessly 
receive, monitor, and report infectious diseases and other urgent 
conditions of public health importance. The bill also authorizes a 
process for determining a list of nationally notifiable diseases and 
conditions and, creates a national committee to evaluate best practices 
in public health surveillance.
  The Strengthening America's Public Health System Act calls for the 
expansion of resources, renewed focus and mission, and new areas of 
special emphasis for several existing programs within the Centers for 
Disease Control and Prevention, CDC. These programs support public 
health capacity to identify and monitor the occurrence of infectious 
diseases and other conditions of public health importance; detect new 
and emerging infectious disease threats, including laboratory capacity 
to detect antimicrobial resistant infections; identify and respond to 
disease outbreaks; and hire and train necessary professional staff.
  The outbreak of swine flu that originated in Mexico highlights the 
need for cooperation between the U.S. and Mexico in the surveillance, 
reporting and control of infectious diseases that cross the border. 
Clear standards, however, have not yet been established for what 
information should be shared and how the sharing should take place. My 
legislation tasks the CDC to finalize and adopt the ``Guidelines for 
U.S.-Mexico Coordination on Epidemiological Events of Mutual Interest'' 
so that we have a clear mechanism in place for communication with 
public health officials in Mexico.
  This important legislation has been endorsed by the: American 
Association of Public Health Veterinarians, American Public Health 
Association, American Society for Microbiology, Association for 
Professionals in Infection Control & Epidemiology, Association of 
Public Health Laboratories, Association of Schools of Public Health, 
Association of State and Territorial Health Officials, Center for 
Infectious Disease Research and Policy, Council of State and 
Territorial Epidemiologists, Infectious Diseases Society of America, 
National Association of County and City Health Officials, National 
Alliance of State and Territorial AIDS Directors, National Association 
of State Public Health Veterinarians, National Public Health 
Information Coalition, Society for Healthcare Epidemiology of America, 
and Trust for America's Health.
  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. 1028

       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 ``Strengthening America's 
     Public Health System Act''.

     SEC. 2. PURPOSES.

       The purpose of the programs authorized under this Act is to 
     strengthen public health surveillance systems and disease 
     reporting by--
       (1) delineating existing grant mechanisms at the Centers 
     for Disease Control and Prevention designed to enhance 
     disease surveillance and reporting by improving and 
     modernizing capacity at the State and local level--
       (A) to identify and monitor the occurrence of infectious 
     diseases and other conditions of public health importance;
       (B) to detect new and emerging infectious disease threats; 
     and
       (C) to identify and respond to disease outbreaks;
       (2) expanding eligibility for grantees;
       (3) increasing funding to ensure all States and 
     jurisdictions have appropriate surveillance and reporting 
     capacity and can provide comprehensive electronic reporting, 
     including laboratory reporting;
       (4) delineating existing applied epidemiology, laboratory 
     science, and informatics fellowship programs designed to 
     reduce documented workforce shortages for these essential 
     public health professionals at the State and local level and 
     increasing funding for these programs;
       (5) expanding the Epidemic Intelligence Service;
       (6) delineating a refined process for establishing a list 
     of nationally notifiable diseases and conditions;
       (7) improving binational surveillance of diseases in the 
     United States and Mexico border region, including developing 
     improved standards and protocols for binational epidemiology, 
     surveillance, laboratory analyses, and control of infectious 
     diseases between the two nations; and
       (8) establishing a forum to permit review and 
     identification of best surveillance practices with a 
     particular focus on improving coordination of animal-human 
     disease surveillance.

     SEC. 3. STRENGTHENING PUBLIC HEALTH SURVEILLANCE SYSTEMS.

       Title XXVIII of the Public Health Service Act (42 U.S.C. 
     300hh et seq.) is amended by adding at the end the following:

     ``Subtitle C--Strengthening Public Health Surveillance Systems

     ``SEC. 2821. EPIDEMIOLOGY-LABORATORY CAPACITY GRANTS.

       ``(a) In General.--Subject to the availability of 
     appropriations, the Secretary, acting through the Director of 
     the Centers for Disease Control and Prevention, shall 
     establish an Epidemiology and Laboratory Capacity Grant 
     Program to award grants to eligible entities to assist public 
     health agencies in improving surveillance for, and response 
     to, infectious diseases and other conditions of public health 
     importance by--

[[Page S5438]]

       ``(1) strengthening epidemiologic capacity;
       ``(2) enhancing laboratory practice;
       ``(3) improving information systems; and
       ``(4) developing and implementing prevention and control 
     strategies.
       ``(b) Eligible Entities.--In this section, the term 
     `eligible entity' means an entity that--
       ``(1) is--
       ``(A) a State health department;
       ``(B) a local health department that meets such criteria as 
     the Director of the Centers for Diseases Control and 
     Prevention determines for purposes of this section;
       ``(C) a tribal jurisdiction that meets such criteria as the 
     Director of the Centers for Disease Control and Prevention 
     determines for purposes of this section; or
       ``(D) a partnership established for purposes of this 
     section between one or more eligible entities described in 
     subparagraph (A), (B), or (C) and an academic center; and
       ``(2) submits to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require.
       ``(c) Use of Funds.--
       ``(1) In general.--An eligible entity shall use amounts 
     received under a grant under this section for core functions 
     described in this subsection including--
       ``(A) building public health capacity to identify and 
     monitor the occurrence of infectious diseases and other 
     conditions of public health importance;
       ``(B) detecting new and emerging infectious disease 
     threats, including laboratory capacity to detect 
     antimicrobial resistant infections;
       ``(C) identifying and responding to disease outbreaks;
       ``(D) hiring necessary staff;
       ``(E) conducting needed staff training and educational 
     development; and
       ``(F) other activities that improve surveillance as 
     determined by the Director of the Centers for Disease Control 
     and Prevention.
       ``(2) Development and maintenance of information 
     exchange.--
       ``(A) National standards.--Not later than 180 days after 
     the date of the enactment of this subtitle, the Secretary, 
     acting through the Director of the Centers for Disease 
     Control and Prevention, and in consultation with the National 
     Coordinator for Health Information Technology, shall issue 
     guidelines for public health entities that--
       ``(i) are designed to ensure that all State and local 
     health departments and public health laboratories have access 
     to information systems to receive, monitor, and report 
     infectious diseases and other urgent conditions of public 
     health importance; and
       ``(ii) are consistent with standards and recommendations 
     for health information technology by the National Coordinator 
     for Health Information Technology, and by the American Health 
     Information Community (AHIC) and its successors.
       ``(B) Secure information systems.--An eligible entity shall 
     use amounts received through a grant under this section to 
     ensure that the entity has access to a web-based, secure 
     information system that complies with the guidelines 
     developed under subparagraph (A). Such a system shall be 
     designed--
       ``(i) to receive automated case reports of State and 
     national reportable conditions from clinical systems and 
     health care offices that use electronic health records and 
     from clinical and public health laboratories, and to submit 
     reports of nationally reportable conditions to the Director 
     of the Centers for Disease Control and Prevention;
       ``(ii) to receive and analyze, within 24 hours, de-
     identified electronic clinical data for situational awareness 
     and to forward such reports immediately to the Centers for 
     Disease Control and Prevention at the time of receipt;
       ``(iii) to manage, link, and process different types of 
     data, including information on newly reported cases, exposed 
     contacts, laboratory results, number of people vaccinated or 
     given prophylactic medications, adverse events monitoring and 
     follow-up, in an integrated outbreak management system;
       ``(iv) to geocode analyze, display, report, and map, using 
     Geographic Information System technology, accumulated data 
     and to share data with other local health departments, State 
     health departments, and the Centers for Disease Control and 
     Prevention;
       ``(v) to receive, manage, and disseminate alerts, 
     protocols, and other information, including Health Alert 
     Network and Epi-X information, as appropriate, for public 
     health workers, health care providers, and public health 
     partners in emergency response within each health 
     department's jurisdiction and to automate the exchange and 
     cascading of such information with external partners using 
     national standards;
       ``(vi) to have information technology security and critical 
     infrastructure protection as appropriate to protect public 
     health information;
       ``(vii) to have the technical infrastructure needed to 
     ensure availability, backup, and disaster recovery of data, 
     application services, and communications systems during 
     natural disasters such as floods, tornados, hurricanes, and 
     power outages; and
       ``(viii) to provide for other capabilities as the Secretary 
     determines appropriate.
       ``(C) Laboratory systems.--An eligible entity shall use 
     amounts received under a grant under this section to ensure 
     that State or local public health laboratories are utilizing 
     web-based, secure systems that are in compliance with the 
     guidelines developed by the Secretary under subparagraph (A) 
     and that--
       ``(i) are fully integrated laboratory information systems;
       ``(ii) provide for the reporting of electronic test results 
     to the appropriate local and State health departments using 
     currently existing national format and coding standards;
       ``(iii) have information technology security and critical 
     infrastructure protection to protect public health 
     information (as determined by the Secretary);
       ``(iv) have the technical infrastructure needed to ensure 
     availability, backup, and disaster recovery of data, 
     application services, and communications systems during 
     natural disasters including floods, tornadoes, hurricanes, 
     and power outages; and
       ``(v) address other capabilities as the Secretary 
     determines appropriate.
       ``(D) Other uses.--In addition to the activities described 
     in subparagraphs (B) and (C), an eligible entity (including 
     the entity's public health laboratory) may use amounts 
     received under a grant under this section for systems 
     development and maintenance, hiring necessary staff, and 
     staff technical training. Grantees under this section may 
     elect to develop their own systems or use federally developed 
     systems in carrying out activities under this paragraph.
       ``(d) Priority.--In allocating funds under subsection 
     (f)(2) for activities under subsection (c)(2)(B) (relating to 
     secure information systems), the Secretary shall give 
     priority to eligible entities that demonstrate need.
       ``(e) Reports.--Not later than September 30, 2011, and each 
     September 30 thereafter, the Secretary shall submit to 
     Congress an annual report on the activities carried out under 
     this section by recipients of assistance under this section.
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $190,000,000 for each of fiscal years 2010 through 2013, of 
     which--
       ``(1) not less than $95,000,000 shall be made available 
     each such fiscal year for activities under subsection (c)(1);
       ``(2) not less than $60,000,000 shall be made available 
     each such fiscal year for activities under subsection 
     (c)(2)(B); and
       ``(3) not less than $32,000,000 shall be made available 
     each such fiscal year for activities under subsection 
     (c)(2)(C).

     ``SEC. 2822. FELLOWSHIP TRAINING IN APPLIED PUBLIC HEALTH 
                   EPIDEMIOLOGY, PUBLIC HEALTH LABORATORY SCIENCE, 
                   PUBLIC HEALTH INFORMATICS, AND EXPANSION OF THE 
                   EPIDEMIC INTELLIGENCE SERVICE.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     may carry out activities to address documented workforce 
     shortages in State and local health departments in the 
     critical areas of applied public health epidemiology and 
     public health laboratory science and informatics and may 
     expand the Epidemic Intelligence Service.
       ``(b) Specific Uses.--In carrying out subsection (a), the 
     Secretary, acting through the Director of the Centers for 
     Disease Control and Prevention, shall provide for the 
     expansion of existing fellowship programs operated through 
     the Centers for Disease Control and Prevention in a manner 
     that is designed to alleviate shortages of the type described 
     in subsection (a).
       ``(c) Other Programs.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     may provide for the expansion of other applied epidemiology 
     training programs that meet objectives similar to the 
     objectives of the programs described in subsection (b).
       ``(d) Work Obligation.--Participation in fellowship 
     training programs under this section shall be deemed to be 
     service for purposes of satisfying work obligations 
     stipulated in contracts under section 338I(j).
       ``(e) General Support.--Amounts may be used from grants 
     awarded under this section to expand the Public Health 
     Informatics Fellowship Program at the Centers for Disease 
     Control and Prevention to better support all public health 
     systems at all levels of government.
       ``(f) Authorizations of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $39,500,000 for each of fiscal years 2010 through 2013, of 
     which--
       ``(1) $5,000,000 shall be made available in each such 
     fiscal year for epidemiology fellowship training program 
     activities under subsections (b) and (c);
       ``(2) $5,000,000 shall be made available in each such 
     fiscal year for laboratory fellowship training programs under 
     subsection (b);
       ``(3) $5,000,000 shall be made available in each such 
     fiscal year for the Public Health Informatics Fellowship 
     Program under subsection (e); and
       ``(4) $24,500,000 shall be made available for expanding the 
     Epidemic Intelligence Service under subsection (a).

     ``SEC. 2823. NATIONALLY NOTIFIABLE DISEASES AND CONDITIONS.

       ``(a) In General.--At the request of the Council of State 
     and Territorial Epidemiologists, the Director of the Centers 
     for Disease Control and Prevention shall assist the Council 
     in developing or improving a process for States to conduct 
     surveillance and submit reports to the Director on nationally 
     notifiable diseases and conditions.
       ``(b) List of Nationally Notifiable Diseases and 
     Conditions.--The process under subsection (a) shall include a 
     list of nationally notifiable diseases and conditions as 
     follows:

[[Page S5439]]

       ``(1) The Council of State and Territorial Epidemiologists 
     and the Director of the Centers for Disease Control and 
     Prevention will jointly develop--
       ``(A) not later than 1 year after the date of the enactment 
     of the Strengthening America's Public Health System Act, a 
     list of nationally notifiable diseases and conditions; and
       ``(B) a process for reviewing the list on an annual basis 
     and, as appropriate, modifying the list, taking into account 
     newly recognized diseases and conditions of public health 
     importance and advances in diagnostic technology.
       ``(2) A disease or condition will be included on the list 
     only if a majority of the States represented on the Council 
     approve such inclusion.
       ``(3) The list will include standard definitions for 
     confirmed, probable, and suspect cases for each nationally 
     notifiable disease or condition.
       ``(4) The list will distinguish between--
       ``(A) diseases and conditions of urgent public health 
     importance for which immediate action may be needed; and
       ``(B) diseases and conditions for which reporting is less 
     urgent and mainly for the purpose of monitoring trends and 
     evaluating public health intervention programs.
       ``(c) Notifications to CDC.--The process under subsection 
     (a) shall provide for reporting to the Director of the 
     Centers for Disease Control and Prevention as follows:
       ``(1) For diseases and conditions described in subsection 
     (b)(4)(A), reporting will occur--
       ``(A) by telephone or by using a system described in 
     section 2821(c)(2)(B); and
       ``(B) within 24 hours of the State making a determination 
     that a disease or condition meets the criteria for national 
     reporting for that disease or condition.
       ``(2) For diseases and conditions described in subsection 
     (b)(4)(B), reporting will occur--
       ``(A) by using a system described in section 2821(c)(2)(B); 
     and
       ``(B) only if funding is sufficient for the State to 
     conduct individual case surveillance and to have the 
     necessary systems to support electronic reporting.
       ``(d) Definitions.--In this section, the term `nationally 
     notifiable', with respect to a disease or condition, means 
     included on the list developed pursuant to subsection (b).

     ``SEC. 2824. IMPROVING BINATIONAL SURVEILLANCE AND 
                   NOTIFICATION.

       ``(a) Findings.--The Congress finds as follows:
       ``(1) Nearly 1,000,000 people cross the international 
     border between the United States and Mexico on a daily basis, 
     and this transmobility of population presents actual cases 
     and the potential risk of transmission of infectious diseases 
     and disease agents between these countries.
       ``(2) Numerous infectious disease cases in the United 
     States are binational in origin, thus requiring improved 
     epidemiology, surveillance, follow-up investigations, and 
     disease case management along the United States and Mexico 
     border.
       ``(b) Guidelines for Binational Cooperation.--Not later 
     than 1 year after the date of the enactment of this subtitle, 
     the Director of the Centers for Disease Control and 
     Prevention shall--
       ``(1) develop an expedited review and approval process and 
     adopt the resultant version of the `Guidelines for U.S.-
     Mexico Coordination on Epidemiological Events of Mutual 
     Interest', which have been developed with input from United 
     States and Mexican State health agencies, including the 
     Mexican Federal Health Secretariat, the United States 
     Department of Health and Human Services, and the Centers for 
     Disease Control and Prevention; and
       ``(2) use these guidelines as the basis for developing 
     improved standards and protocols for binational epidemiology, 
     surveillance, laboratory analyses, and control of infectious 
     diseases between the United States and Mexico.
       ``(c) Definition.--In this section, the term `binational' 
     refers to both sides of the United States-Mexico border, 
     whether collectively, such as an activity or program being 
     carried out concurrently by or in both countries, a 
     phenomenon (for example, a disease outbreak or health 
     emergency) affecting a population or geographic area in both 
     countries, or a disease case that originated on one side of 
     the border and was transmitted to the other.

     ``SEC. 2825. EVALUATION OF BEST PRACTICES IN PUBLIC HEALTH 
                   SURVEILLANCE.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     shall establish a committee--
       ``(1) to evaluate best practices in public health 
     surveillance, including human and animal disease surveillance 
     and environmental health monitoring of harmful exposures 
     through air, water, soil, or other means; and
       ``(2) to assess systems needed for improving coordination 
     among public health surveillance and monitoring systems.
       ``(b) Composition.--The committee established under 
     subsection (a) shall be composed of--
       ``(1) an epidemiologist employed and designated by the 
     Director of the Centers for Disease Control and Prevention;
       ``(2) an informatics specialist designated by the Director 
     of the Centers for Disease Control and Prevention;
       ``(3) an epidemiologist designated by the Director of the 
     Centers for Disease Control and Prevention to represent the 
     National Center for Environmental Health and the Agency for 
     Toxic Substances and Disease Registry;
       ``(4) a representative of an academic center or 
     professional, scientific association designated by the 
     American Society for Microbiology;
       ``(5) a food scientist designated by the Commissioner of 
     Food and Drugs;
       ``(6) an individual designated by the Secretary of 
     Agriculture from the Division of Veterinary Services;
       ``(7) a wildlife disease specialist designated by the 
     Secretary of Agriculture;
       ``(8) an epidemiologist employed by a State and designated 
     by the Council of State and Territorial Epidemiologists;
       ``(9) a public health laboratorian employed by a State and 
     designated by the Association of Public Health Laboratories;
       ``(10) a public health veterinarian employed by a State and 
     designated by the National Association of State Public Health 
     Veterinarians;
       ``(11) a laboratorian designated by the American 
     Association of Veterinary Laboratory Diagnosticians;
       ``(12) a State health official designated by the 
     Association of State and Territorial Health Officials;
       ``(13) a local health official designated by the National 
     Association of County and City Health Officials;
       ``(14) an environmental health scientist employed and 
     designated by the Administrator of the Environmental 
     Protection Agency; and
       ``(15) a representative with expertise in the Department of 
     Veterans Affairs' disease monitoring systems.
       ``(c) Functions.--The committee established under 
     subsection (a) shall--
       ``(1) review innovative approaches adopted by State and 
     local agencies to improve disease detection;
       ``(2) evaluate best practices in public health 
     surveillance;
       ``(3) develop model data sharing agreements among local, 
     State, and Federal health agencies;
       ``(4) assess systems needed for coordinated animal and 
     human disease surveillance and develop recommendations for 
     the improvement of such surveillance; and
       ``(5) disseminate findings and recommendations to relevant 
     local, State and Federal agencies.
       ``(d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $750,000 for 
     each of fiscal years 2010 through 2011.''.
                                 ______
                                 
      By Mr. ROCKEFELLER (for himself, Ms. Snowe, and Mr. Kerry):
  S. 1029. A bill to create a new incentive fund that will encourage 
States to adopt the 21st Century Skills Framework; to the Committee on 
Finance.
  Mr. ROCKEFELLER. Mr. President, today, along with my colleague 
Senator Snowe of Maine and Senator Kerry of Massachusetts, I am 
introducing legislation to provide incentives for States to adopt the 
21st Century Skills Framework. I take this step because the knowledge 
base and skills set that most students learn in school should expand to 
provide students with the skills like critical thinking and problem 
solving, needed to succeed in modern workplaces and communities. 
Increasingly, these settings are no longer defined by conventional 
boundaries such as time, distance, language, and culture. Moreover, 
rigorous higher education coursework, career challenges, and a globally 
competitive workforce--all demand that America's schools align their 
classroom environments with real world environments by infusing 21st 
century skills into their learning and teaching.
  What are those skills? The framework describes essential attributes 
of learning that America's children need in order to succeed as 
citizens and workers in the 21st century. These include mastery in the 
core subjects of English, reading, mathematics, science, foreign 
languages, civics, Government, economics, art, history, and geography. 
This bill does not ignore core curriculum, but it seeks to add skills 
and new awareness to this basic knowledge. Today's students need 
preparation to put their education in context including a sense of 
global awareness; financial, economic, business and entrepreneurial 
literacy; civic literacy; and health and wellness awareness that 
complements the traditional core subjects. Given the fast pace of our 
workplace and culture, our students need the ability to engage in life-
long learning that ensures adaptability in the face of rapidly changing 
work environments brought on by new scientific, technological, and 
social developments. Plus, students need to be able to use information 
and communications technology both to learn core

[[Page S5440]]

academic subjects and to gain 21st century content knowledge and 
abilities.
  The 21st Century Skills Framework also identifies the critical role 
teachers must play in bringing life skills into their classrooms--
skills that include leadership, ethics, accountability, adaptability, 
personal productivity, personal responsibility, self-direction, and 
social responsibility. West Virginia is working to include this model 
in their classrooms, and I have watched how this model enhances the 
engagement of students.
  In today's global, knowledge-based economy these 21st Century skills 
form the lifeblood of a productive workforce particularly in 
scientific, engineering, and other advanced technological sectors. If 
the U.S. is to exercise continued economic leadership internationally 
we must enable strong partnerships to form among educators, 
administrators, policy makers, and the business community so that they 
may work collectively to better prepare our students for the realities 
of the 21st century.
  This initiative began in 2002 with funding from the U.S. Department 
of Education to support innovative education reforms. The partnership 
was a collaboration of educators and businesses, particularly high-tech 
business that did surveys and meetings to discuss the real skills that 
students need to learn to succeed. It clearly builds on the core 
subjects, but it adds the skills and awareness that are essential to 
the workplace.
  The purpose of the 21st Century Skills Incentive Fund Act is to offer 
competitive grants from in the Department of Education for States 
willing to invest in education reform. To qualify, States need to have 
a plan for implementations of the 21st Century Skills Framework. It 
also calls an assessment of progress towards the four student learning 
priorities and evaluation.
  Ten States have also already taken steps to implement the 21st 
Century Skills initiative, including Arizona, Iowa, Kansas, Maine, 
Massachusetts, New Jersey, North Carolina, South Dakota, West Virginia, 
and Wisconsin. Such States that are willing and eager to engage in such 
reforms deserve the chance to compete for incentives.
  In my own State of West Virginia and in the other committed States, 
education leaders report enthusiasm for reforms.
  Although the economic downturn has current challenges for new 
investment in education, waiting for a better time to engage in reform 
would be unwise. Today's sixth grade class, will be entering the work 
force in 2015, after high school or 2019 after college, they need to be 
prepared. The 21st Century Skills Incentive Act makes attention to this 
imperative a national priority.
                                 ______
                                 
      By Mrs. LINCOLN (for herself and Ms. Collins):
  S. 1030. A bill to amend the Internal Revenue Code of 1986 to 
eliminate the reduction in the credit rate for certain facilities 
producing electricity from renewable resources; to the Committee on 
Finance.
  Mrs. LINCOLN. Mr. President, I have come to my colleagues today, 
having come down to the floor last week, when I came to the Senate 
floor to announce a new plan to give working families and businesses 
the tools they need to succeed during this current economic crisis we 
are in. I come today also to add to my Arkansas plan a package of tax 
cuts and Tax Code simplification measures designed to move Arkansas and 
our State's hard-working families forward. Together, these tax measures 
will allow working families and small businesses to get ahead and 
emerge from the economic crisis stronger and more competitive.
  We have a lot of small businesses, hard-working families down in 
Arkansas; entrepreneurs who unfortunately feel as though during this 
crisis they are not getting much out of Washington. We want to change 
that attitude. We want to make sure they are getting our support and 
that we as the Government are creating an atmosphere and an environment 
where they can be successful.
  We are also going to encourage innovation and entrepreneurship to 
create new jobs and lessen our dependence on foreign oil and reduce the 
burden on working families and small businesses by simplifying our Tax 
Code. It is way too complicated these days. We have created too much of 
a complicated code that people can't use it for its intended purposes, 
and that is, obviously, to encourage good, healthy businesses to thrive 
and to be competitive.
  Last week, I introduced a number of legislative measures that will 
allow working families and small businesses to emerge from the economic 
crisis stronger and more competitive than before. This week, my 
Arkansas plan focuses on encouraging innovation and entrepreneurship to 
create new jobs here at home and lessen our dependence on foreign oil. 
All of us want to be able to be more independent. We want to make sure 
we are creating jobs here, but we also want to know that, globally, we 
are more independent as a country and that we are not seeing that 
dependence on imported oil coming from other places.
  Yesterday, I introduced the USA Jobs Act of 2009, which offers a new 
research and development bonus incentive to companies that both 
research and manufacture their products in the United States. Before, 
in the stimulus package, we extended the research and development tax 
credit to encourage more research and development of new ideas and new 
products, new methodologies so we could create jobs from those. We also 
need to make sure we are not sending those new ideas and that new 
research somewhere else on the globe to be able to be produced or 
manufactured. We want to incentivize that it stays right here at home.
  Our Nation faces record unemployment, with more than 540,000 
Americans put out of work last month alone and 90,000 job losses in 
Arkansas. It is more important now than ever before that we encourage 
the creation and preservation of American jobs. My bill provides a new 
job tax credit for manufacturers that do a substantial portion of their 
research and manufacturing right here at home in the United States. 
This new tax credit will encourage greater domestic production, which 
would, in turn, lead to the creation of more American jobs.
  Today, I am focused on a series of alternative energy and 
conservation proposals as well. My first bill provides an even playing 
field for all renewable energy production. The Federal Tax Code 
currently offers an income tax credit for the production of electricity 
produced from renewable energy resources, but not all resources are 
treated the same. Under current law, some energy resources receive a 
higher level credit than others, and as a result, certain new renewable 
energy technologies have a more difficult time finding the necessary 
investment capital they need to start that process of investing in new 
technology and getting it to the marketplace in a reasonable way so it 
is cost-effective.
  These are critical ideas that exist out there. We need to make sure 
everybody is at the table. When we look at renewable energy, we see 
that there are a multitude of great ideas out there, but getting those 
ideas to the table and then out into the marketplace is a critical part 
of that journey. If we don't make sure everyone has that same benefit 
with their ideas and technologies and being able to get out there, if 
it is not a fair playing field, then we are going to lose multiple 
opportunities.
  I hope we will look forward and not backward in terms of how we are 
incentivizing this renewable energy. So much of what we see in terms of 
complications or challenges small businesses face in finding investment 
capital is particularly problematic with the pursuit of renewable 
energy opportunities in my home State of Arkansas, where biomass is a 
predominant renewable resource but only gets half the tax credit that 
many other resources receive.
  That is ridiculous. We have a tremendous resource right here and 
available to us--not just in Arkansas but in many States in our 
country. It can play a tremendous role in lifting our dependence on 
foreign oil and finding renewable sources of energy.
  My proposal would level the playing field for all energy resources by 
increasing the value of the credit to a full credit level for those 
resources that currently receive only a partial credit. It certainly 
makes sense not only in the sense that there are certain resources that 
exist today that are moving forward in their technology, but there are 
also resources down the road. It is amazing to me to see what

[[Page S5441]]

scientists are doing, even with things like algae, to be able to 
produce oil, and looking at how we can use our agricultural 
byproducts--a host of things, any of that woody biomass that we can 
begin to put to good use in making energy and be less dependent on 
imported oil.
  Also, I am introducing legislation today that provides long-term 
certainty for producers and consumers of biofuels. Currently, the U.S. 
Tax Code includes credits to encourage the production of biodiesel and 
renewable diesel, which are proven alternative fuels that will help us 
lessen our dependence on foreign oil. Every barrel of biofuel that we 
produce is a barrel of imported oil we would not have to import. These 
incentives have been extended on a short-term basis in recent years and 
are scheduled to expire at the end of this year.
  When we see all of these great ideas and we see people who are 
willing to invest their capital and their time and energy and resources 
into moving these industries to the marketplace, and in a reasonable, 
cost-effective way they can then integrate it into the marketplace, it 
takes resources. But it takes predictability in our Tax Code as well, 
knowing they are going to be able to depend on a certain tax treatment 
over a certain period of time that allows them to access that capital 
in the capital market.
  If these credits were allowed to expire, these new technologies in 
renewable fuels would be priced significantly higher than petroleum 
diesel and, as a result, would not be competitive in the fuels 
marketplace. Biofuel producers and consumers in our State need the 
certainty that these economic incentives provide and help to sustain 
this new market.
  We cannot move forward in changing our mindset and our marketplace 
from an old energy economy to a new one if we don't embrace the idea 
that we have to produce some predictability for these new emerging 
industries and fuels in a way they can--particularly in these difficult 
economic times--access the capital they need to move forward with the 
ideas and development and the production of all of these great new 
ideas that exist out there.
  My proposal would provide a 10-year extension of the credits through 
2018 to provide a stable environment for the creation of a strong 
domestic biofuels industry.
  I want to highlight a bill I introduced a few weeks ago with Senators 
Roberts, Snowe, Cantwell, and Collins that would allow electricity from 
biomass produced onsite to qualify for the section 45 renewable 
electricity production tax credit.
  According to the American Forest and Paper Association, in 2005, the 
industry produced 28.5 million megawatt hours of biomass-based 
electricity, which avoided the use of more than 200 million barrels of 
oil. There it is, plain and simple--what we can be doing with an 
industry that has available to them--the biomass--from byproducts and 
from other woody products that are there, which may be discarded or 
unusable--to be able to produce electricity from a renewable source.
  The use of biomass electricity, whether produced onsite or purchased 
from a utility, has the same positive impact of reducing fossil fuel 
consumption and should be encouraged. That is exactly what we want to 
do. We want to encourage these types of activities and what we can do 
in terms of creating new and innovative ideas with renewable energy.
  Later this week I plan to introduce a bill to also encourage 
workforce training and development. Together, I think these bills will 
create jobs at home. They will help strengthen our economy and reduce 
our dependence on foreign oil. These are all priorities I think each 
one of the Members of this body seek to achieve. I, for one, decided to 
put together a plan that I think is particularly good for my State, 
with a series of different types of bills that I am introducing--last 
week, this week, and next week--in a way that I think can be productive 
for my State. I think most Senators will find that these are tools that 
will be just as effective for their States as well. I encourage them to 
take a look at what we are doing.
  Next week, I will complete the rollout of our Arkansas plan by 
introducing reform measures to simplify the Tax Code and reduce the 
burden on Americans, and particularly Arkansas's working families and 
businesses by working to build a tax structure that is fair and 
equitable for all Americans.
  Again, I encourage my colleagues to take a look at these commonsense 
measures to see how they will benefit their own constituents. I work 
hard in the Senate to be pragmatic and look for solutions that are good 
for everybody and, more important, that are focused on the issues that 
are important to us as a country, like getting our economy back on 
track, making sure Americans can keep jobs, and for those who have lost 
jobs, we can put back to work, with the new ideas that we know 
Americans are so very capable of.
  We must make our Nation's working families and our small businesses a 
top priority. The Arkansas plan does just that. I will continue to 
fight to bring our families the relief they need and our business 
owners the tools they require to invest and grow and be competitive in 
the global marketplace that we have been begging so longingly for over 
the years. We need to make sure Government is going to create that 
environment where they can do just that--invest, grow, and be 
competitive.
                                 ______
                                 
      By Mrs. BOXER:
  S. 1031. A bill to amend the Public Health Service Act to establish 
direct care registered nurse-to-patient staffing ratio requirements in 
hospitals, and for other purposes; to the Committee on Health, 
Education, Labor, and Pensions.
  Mrs. BOXER. Mr. President, as we mark the end of National Nurses 
Week, I want to express my heartfelt appreciation to the dedicated 
professionals who serve on the front lines of our health care system. 
Nurses are heroes--not just to their patients, but to the families and 
loved ones who rely on their compassion and care.
  While we celebrate nurses this week, we must also acknowledge that 
too many nurses are overworked because of staffing levels that are 
simply inadequate.
  Nurses treat patients not just in hospitals or emergency rooms but in 
homes, schools, community health centers and more. Nurses take on a lot 
of different duties and roles, but they all have at least one thing in 
common--they are all on the front lines of providing care to patients.
  For decades nurses have been telling us that there are not enough of 
them, especially in hospitals. Study after study has been done--we know 
there is a nationwide nursing shortage.
  By 2020, it is estimated that the demand for full time nurses will 
exceed supply by 1 million nurses.
  This is unacceptable. We must address a problem that affects the 
quality of care that patients receive and drives too many nurses away 
from the hospital bedside.
  That is why I am introducing the National Nursing Reform and Patient 
Advocacy Act, which will not only help address the nationwide shortage 
of skilled nurses, it will improve the quality of health care for all 
Americans.
  The National Nursing Reform and Patient Advocacy Act champions 
nursing rights, nursing ratios, and nursing reform.
  Specifically, this bill protects the rights of nurses to speak out 
for their patients and to speak out for themselves, without the fear of 
discrimination or retaliation, because if there is a problem in a 
hospital nurses should be able to talk about it.
  This bill sets minimum nurse to patient ratios, because you cannot 
give patients high quality care without giving nurses the time to 
provide it. It offers transparency in the process of establishing 
staffing plans in hospitals and puts forward the tools to report 
inadequate staffing or care.
  This bill reforms the role of hospitals not just in retaining nurses 
but also in training nurses. It creates a Registered Nurse Workforce 
Initiative that invests in the education of nurses and nursing faculty, 
because we will need many more nurses to meet the needs of our Nation--
especially after we expand access to health care.
  President Obama has made improving patient safety and quality care 
one of the cornerstones of the health care reform effort. You can't 
have high quality health care without a high quality nurse workforce to 
provide it.
  Ten years ago, nurses in California fought and won a major battle for 
their

[[Page S5442]]

patients and for themselves--and the results were minimum nurse to 
patient ratios in California hospitals.
  I am proud to bring this fight to Washington, DC and to pursue 
federal legislation that would extend these rights, ratios and reforms 
to nurses in hospitals across the country.
  Reports on California ratios have only begun to show what all of the 
nurses in this room already know--that setting a minimum standard for 
safe staffing can be the difference between life and death of patients.
  A 2002 study found that for every patient added to a nurse's workload 
there is a seven percent increase in the chance of death following 
common surgeries.
  In California, the hospitals that have seen the greatest effect in 
reduced mortality were the ones that started with the worst staffing 
ratios.
  We also know that hospitals are losing good nurses because of these 
staffing shortages. A poll of nurses nationwide found that almost half 
of the nurses who plan to quit their job say that inadequate staffing 
is the reason they are leaving. The cost of replacing these valuable 
workers has been estimated at $25,000 to $60,000 per nurse.
  Too many nurses get burned out by being overloaded with too many 
patients. Too many nurses have given up on serving in hospitals because 
the hospitals have given up on providing a better environment for both 
nurses and patients.
  We need to remind hospitals that by investing more in their nursing 
staff, they will save money by avoiding costly medical mistakes and 
providing better care for their patients--and most importantly, they 
will save lives.
  I strongly believe that health care reform cannot succeed unless we 
invest in our health care workforce. At 2.9 million strong, nurses are 
the largest health care workforce in our country, and this investment 
is long overdue.
  My new legislation builds on the success of California's historic law 
for registered nurse staffing ratios. Under the California ratios law, 
lives are being saved, nurses' ability to be effective advocates for 
their patients is stronger and more registered nurses are entering the 
workforce and staying at the bedside longer--which is easing the 
State's nursing shortage.
  Nurses are not just the face of the movement to improve health care 
in our country, they are the face of health care in our country. This 
bill is for them and the patients they so faithfully serve.
                                 ______
                                 
      By Mr. LEVIN (for himself and Mr. McCain) (by request):
  S. 1033. A bill to authorize appropriations for fiscal year 2010 for 
military activities of the Department of Defense, to prescribe military 
personnel strengths for fiscal year 2010, and for other purposes; to 
the Committee on Armed Services.
  Mr. LEVIN. Mr. President, Senator McCain and I are today introducing, 
by request, the administration's proposed National Defense 
Authorization Act for fiscal year 2010. As is the case with any bill 
that is introduced by request, we introduce this bill for the purpose 
of placing the administration's proposals before Congress and the 
public without expressing our own views on the substance of these 
proposals. As chairman and ranking member of the Armed Services 
Committee, we look forward to giving the administration's requested 
legislation our most careful review and thoughtful consideration.
                                 ______
                                 
      By Mr. REID (for himself, Mrs. Feinstein, and Mrs. Boxer):
  S. 1035. A bill to enhance the ability of drinking water utilities in 
the United States to develop and implement climate change adaptation 
programs and policies, and for other purposes; to the Committee on 
Environment and Public Works.
  Mr. REID. 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. 1035

       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 ``Drinking Water Adaptation, 
     Technology, Education, and Research (WATER) Act''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) the consensus among climate scientists is overwhelming 
     that climate change is occurring more rapidly than can be 
     attributed to natural causes, and that significant impacts to 
     the water supply are already occurring;
       (2) among the first and most critical of those impacts will 
     be change to patterns of precipitation around the world, 
     which will affect water availability for the most basic 
     drinking water and domestic water needs of populations in 
     many areas of the United States;
       (3) drinking water utilities throughout the United States, 
     as well as those in Europe, Australia, and Asia, are 
     concerned that extended changes in precipitation will lead to 
     extended droughts;
       (4) supplying water is highly energy-intensive and will 
     become more so as climate change forces more utilities to 
     turn to alternative supplies;
       (5) energy production consumes a significant percentage of 
     the fresh water resources of the United States;
       (6) since 2003, the drinking water industry of the United 
     States has sponsored, through a nonprofit water research 
     foundation, various studies to assess the impacts of climate 
     change on drinking water supplies;
       (7) those studies demonstrate the need for a comprehensive 
     program of research into the full range of impacts on 
     drinking water utilities, including impacts on water 
     supplies, facilities, and customers;
       (8) that nonprofit water research foundation is also 
     coordinating internationally with other drinking water 
     utilities on shared research projects and has hosted 
     international workshops with counterpart European and Asian 
     water research organizations to develop a unified research 
     agenda for applied research on adaptive strategies to address 
     climate change impacts;
       (9) research data in existence as of the date of enactment 
     of this Act--
       (A) summarize the best available scientific evidence on 
     climate change;
       (B) identify the implications of climate change for the 
     water cycle and the availability and quality of water 
     resources; and
       (C) provide general guidance on planning and adaptation 
     strategies for water utilities; and
       (10) given uncertainties about specific climate changes in 
     particular areas, drinking water utilities need to prepare 
     for a wider range of likely possibilities in managing and 
     delivery of water.

     SEC. 3. RESEARCH ON THE EFFECTS OF CLIMATE CHANGE ON DRINKING 
                   WATER UTILITIES.

       (a) In General.--The Administrator of the Environmental 
     Protection Agency, in cooperation with the Secretary of 
     Commerce, the Secretary of Energy, and the Secretary of the 
     Interior, shall establish and provide funding for a program 
     of directed and applied research, to be conducted through a 
     nonprofit drinking water research foundation and sponsored by 
     water utilities, to assist the utilities in adapting to the 
     effects of climate change.
       (b) Research Areas.--The research conducted in accordance 
     with subsection (a) shall include research into--
       (1) water quality impacts and solutions, including 
     research--
       (A) to address probable impacts on raw water quality 
     resulting from--
       (i) erosion and turbidity from extreme precipitation 
     events;
       (ii) watershed vegetation changes; and
       (iii) increasing ranges of pathogens, algae, and nuisance 
     organisms resulting from warmer temperatures; and
       (B) on mitigating increasing damage to watersheds and water 
     quality by evaluating extreme events, such as wildfires and 
     hurricanes, to learn and develop management approaches to 
     mitigate--
       (i) permanent watershed damage;
       (ii) quality and yield impacts on source waters; and
       (iii) increased costs of water treatment;
       (2) impacts on groundwater supplies from carbon 
     sequestration, including research to evaluate potential water 
     quality consequences of carbon sequestration in various 
     regional aquifers, soil conditions, and mineral deposits;
       (3) water quantity impacts and solutions, including 
     research--
       (A) to evaluate climate change impacts on water resources 
     throughout hydrological basins of the United States;
       (B) to improve the accuracy and resolution of climate 
     change models at a regional level;
       (C) to identify and explore options for increasing 
     conjunctive use of aboveground and underground storage of 
     water; and
       (D) to optimize operation of existing and new reservoirs in 
     diminished and erratic periods of precipitation and runoff;
       (4) infrastructure impacts and solutions for water 
     treatment and wastewater treatment facilities and underground 
     pipelines, including research--
       (A) to evaluate and mitigate the impacts of sea level rise 
     on--
       (i) near-shore facilities;
       (ii) soil drying and subsidence;
       (iii) reduced flows in water and wastewater pipelines; and
       (iv) extreme flows in wastewater systems; and
       (B) on ways of increasing the resilience of existing 
     infrastructure, planning cost-effective responses to adapt to 
     climate change, and developing new design standards for 
     future infrastructure that include the use of energy 
     conservation measures and renewable

[[Page S5443]]

     energy in new construction to the maximum extent practicable;
       (5) desalination, water reuse, and alternative supply 
     technologies, including research--
       (A) to improve and optimize existing membrane technologies, 
     and to identify and develop breakthrough technologies, to 
     enable the use of seawater, brackish groundwater, treated 
     wastewater, and other impaired sources;
       (B) into new sources of water through more cost-effective 
     water treatment practices in recycling and desalination; and
       (C) to improve technologies for use in--
       (i) managing and minimizing the volume of desalination and 
     reuse concentrate streams; and
       (ii) minimizing the environmental impacts of seawater 
     intake at desalination facilities;
       (6) energy efficiency and greenhouse gas minimization, 
     including research--
       (A) on optimizing the energy efficiency of water supply and 
     wastewater operations and improving water efficiency in 
     energy production and management; and
       (B) to identify and develop renewable, carbon-neutral 
     energy options for the water supply and wastewater industry;
       (7) regional and hydrological basin cooperative water 
     management solutions, including research into--
       (A) institutional mechanisms for greater regional 
     cooperation and use of water exchanges, banking, and 
     transfers; and
       (B) the economic benefits of sharing risks of shortage 
     across wider areas;
       (8) utility management, decision support systems, and water 
     management models, including research--
       (A) into improved decision support systems and modeling 
     tools for use by water utility managers to assist with 
     increased water supply uncertainty and adaptation strategies 
     posed by climate change;
       (B) to provide financial tools, including new rate 
     structures, to manage financial resources and investments, 
     because increased conservation practices may diminish revenue 
     and increase investments in infrastructure; and
       (C) to develop improved systems and models for use in 
     evaluating--
       (i) successful alternative methods for conservation and 
     demand management; and
       (ii) climate change impacts on groundwater resources;
       (9) reducing greenhouse gas emissions and improving energy 
     demand management, including research to improve energy 
     efficiency in water collection, production, transmission, 
     treatment, distribution, and disposal to provide more 
     sustainability and means to assist drinking water utilities 
     in reducing the production of greenhouse gas emissions in the 
     collection, production, transmission, treatment, 
     distribution, and disposal of drinking water;
       (10) water conservation and demand management, including 
     research--
       (A) to develop strategic approaches to water demand 
     management that offer the lowest-cost, noninfrastructural 
     options to serve growing populations or manage declining 
     supplies, primarily through--
       (i) efficiencies in water use and reallocation of the saved 
     water;
       (ii) demand management tools;
       (iii) economic incentives; and
       (iv) water-saving technologies; and
       (B) into efficiencies in water management through 
     integrated water resource management that incorporates--
       (i) supply-side and demand-side processes;
       (ii) continuous adaptive management; and
       (iii) the inclusion of stakeholders in decisionmaking 
     processes; and
       (11) communications, education, and public acceptance, 
     including research--
       (A) into improved strategies and approaches for 
     communicating with customers, decisionmakers, and other 
     stakeholders about the implications of climate change on 
     water supply and water management;
       (B) to develop effective communication approaches--
       (i) to gain public acceptance of alternative water supplies 
     and new policies and practices, including conservation and 
     demand management; and
       (ii) to gain public recognition and acceptance of increased 
     costs; and
       (C) to create and maintain a clearinghouse of climate 
     change information for water utilities, academic researchers, 
     stakeholders, government agencies, and research 
     organizations.
       (c) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $25,000,000 for 
     each of fiscal years 2010 through 2020.

                          ____________________