[Congressional Record (Bound Edition), Volume 145 (1999), Part 17]
[Senate]
[Pages 24489-24517]
[From the U.S. Government Publishing Office, www.gpo.gov]



   DEPARTMENT OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION AND 
          RELATED AGENCIES APPROPRIATIONS ACT, 2000--Continued

  Mr. SPECTER. Mr. President, I ask unanimous consent that we turn to 
the Senator from----
  Mr. REID. Mr. President, will the Senator yield?
  Mr. SPECTER. Florida for 15 minutes.
  Mr. REID. Mr. President, will the Senator yield for a brief 
statement?
  Mr. SPECTER. Pardon me. I withdraw that because the Senators from New 
Mexico were here sequenced ahead of Senator Graham.
  Mr. REID. Mr. President, I appreciate the statements of the chairman 
of the Judiciary Committee and the statement of the Senator from 
Pennsylvania on the judicial controversy. I hope we can end all of that 
this afternoon and get this bill completed because now we have people 
on our side wanting to come and talk about this matter dealing with 
Judge White. I hope we can move and get this bill finished before we 
have further speeches on this judicial controversy.
  Mr. SPECTER. Mr. President, I ask unanimous consent that the 
remainder of the time on this bill be directed to the amendment of the 
Senators from New Mexico, then 15 minutes to Senator Graham of Florida, 
then 10 minutes to be equally divided between the managers of the bill, 
and then go to final passage.
  Mr. REID. Reserving the right to object, if the ranking member of the 
Judiciary Committee wants to come over and speak on the judicial 
controversy, I want him to have 15 minutes, the same amount of time the 
chairman of the Judiciary Committee had.
  Mr. SPECTER. I incorporate that in the unanimous consent request.
  Mr. KENNEDY. If I could have 2 minutes.
  Mr. SPECTER. Two minutes for Senator Kennedy.
  Mr. INHOFE. Mr. President, reserving the right to object, for what 
purpose would the Senator be yielding to the Senator from Florida? Are 
we back on the judicial nominations?
  Mr. SPECTER. He is speaking on the bill.
  Mr. INHOFE. Is this on the nomination?
  Mr. SPECTER. Unless Senator Leahy comes and claims the time which 
Senator Reid has asked for.
  Mr. INHOFE. No objection.
  The PRESIDING OFFICER. Is there objection?
  Mr. HARKIN. Reserving the right to object.
  Mr. SPECTER. We added 5 more minutes for Senator Harkin: the 
managers, 15 minutes; Senator Harkin, 10; myself, 5.
  Mr. REID. And Senator Kennedy for 2 minutes.
  Mr. DOMENICI. I ask if Senator Kennedy is on the bill or something 
else?
  Mr. KENNEDY. All I want to do, indirectly on the bill, is just to 
announce that the House of Representatives passed the Patients' Bill of 
Rights 275-149.
  This is a hard-won victory for millions of patients and families 
throughout America, and a well-deserved defeat for HMOs and the 
Republican extremists in the House who put managed care profits ahead 
of patients' health.
  The Senate flunked this test in July, but the House has given us a 
new chance to do the right thing. The House-Senate conference should 
adopt the Norwood-Dingell provisions, without the costly and 
ineffective tax breaks added by House Republicans.
  Mr. DOMENICI. The Senator did it. Does he still need the 2 minutes?
  Mr. KENNEDY. No. I don't need the 2 minutes. I thank the Senator very 
much.
  Mr. SPECTER. Mr. President, exclude Senator Kennedy from the 
unanimous consent request.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SPECTER. Mr. President, I ask that we turn to the Senators from 
New Mexico.
  Mr. DOMENICI. Senator Bingaman has the floor.
  The PRESIDING OFFICER. The Senator from New Mexico.


                           Amendment No. 2272

  (Purpose: To require the Secretary of Health and Human Services to 
     conduct a study on the geographic adjustment factors used in 
 determining the amount of payment for physicians' services under the 
                           medicare program)

  Mr. BINGAMAN. Mr. President, I send an amendment to the desk.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from New Mexico (Mr. Bingaman), for himself, 
     and Mr. Domenici, proposes an amendment numbered 2272.

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

       At the end of title II, add the following:

     SEC. 216. STUDY AND REPORT ON THE GEOGRAPHIC ADJUSTMENT 
                   FACTORS UNDER THE MEDICARE PROGRAM.

       (a) Study.--The Secretary of Health and Human Services 
     shall conduct a study on--
       (1) the reasons why, and the appropriateness of the fact 
     that, the geographic adjustment factor (determined under 
     paragraph (2) of section 1848(e) (42 U.S.C. 1395w-4(e)) used 
     in determining the amount of payment for physicians' services 
     under the medicare program is less for physicians' services 
     provided in New Mexico than for physicians' services provided 
     in Arizona, Colorado, and Texas; and
       (2) the effect that the level of the geographic cost-of-
     practice adjustment factor (determined under paragraph (3) of 
     such section) has on the recruitment and retention of 
     physicians in small rural states, including New Mexico, Iowa, 
     Louisiana, and Arkansas.
       (b) Report.--Not later than 3 months after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall submit a report to Congress on the study 
     conducted under subsection (a), together with any 
     recommendations for legislation that the Secretary determines 
     to be appropriate as a result of such study.

  Mr. BINGAMAN. Mr. President, this is an amendment that Senator 
Domenici and I are offering to direct the Secretary of Health and Human 
Services to conduct a study of and the appropriateness of the 
geographic adjustment factor that is used in Medicare reimbursement 
calculations as it applies particularly to our State of New Mexico.
  We have a very serious problem in our State today; many of our 
physicians are leaving the State. The reimbursement that is available 
under Medicare, and accordingly under many of the health care plans in 
our State, is less for physicians performing procedures and practicing 
medicine in our State than it is in all of our surrounding States. We 
believe this is traceable to this adjustment factor, this geographic 
adjustment factor.
  This is a system that was put into place in 1992. It now operates, as 
I understand it, such that we have 89 geographic fee schedule payment 
areas in the country. We are not clear on the

[[Page 24490]]

precise way in which our State has been so severely disadvantaged, but 
we believe it is a serious problem that needs attention.
  Our amendment directs that the Secretary conclude this study within 
90 days, or 3 months, report back, and make recommendations on how to 
solve the problem. We believe it is a very good amendment. We recommend 
that Senators support the amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, first, I am pleased to say I am a 
cosponsor of this amendment. I have helped Senator Bingaman with it.
  This is a good amendment. We aren't asking for any money. We are not 
asking that any law be changed. We are merely saying that something is 
not right for our State.
  The reimbursement--or some aspect of how we are paying doctors under 
Medicare--is causing us to have much lower fees than the surrounding 
States, and as a result two things are happening: One, doctors are 
leaving. In a State such as ours, we can ill afford that. Second, we 
are being told it is harder and harder to get doctors to come to our 
State. That was not the case years ago. They loved New Mexico. They 
came for lots of reasons. But certainly we cannot be an underprivileged 
State in terms of what we pay our doctors--be a poor State in 
addition--and expect our citizens to get good health care.
  We want to know what the real facts are: Why is this the case? Is it 
the result of the way the geographic evaluation is applied to our State 
because maybe rural communities aren't getting the right kind of 
emphasis in that formula?
  Whatever it is, we want to know. When we know, fellow Senators, we 
can assure Members, if we find out it is not right and it is not fair, 
we will be on the floor to talk about some real changes. Until we have 
that, we ask Members for help in obtaining a study.
  I yield the floor.
  Mr. SPECTER. The managers have taken a look at this amendment and are 
prepared to accept it. It is a good amendment.
  There is one concern, and that is a jurisdictional concern with 
respect to the Finance Committee. We have attempted to contact the 
chairman of the Finance Committee to see if there was any substantial 
reason we should not accept it. If it went to a vote, it would clearly 
be adopted. It merely asks for a report for a very good purpose. 
Therefore, the amendment is accepted.
  The PRESIDING OFFICER. The question is on agreeing to the amendment.
  The amendment (No. 2272) was agreed to.
  Mr. DOMENICI. I move to reconsider the vote.
  Mr. SPECTER. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. GRAHAM. Mr. President, I am here today, as I was in July, to 
point out to my colleagues another stealth effort to kill competition 
within the Medicare program. Title I, section 214, buried in the middle 
of this long appropriations bill on page 49, carries the following 
statement:

       None of the funds provided in this Act or in any other Act 
     making appropriations for fiscal year 2000 may be used to 
     administer or implement in Arizona or in Kansas City, 
     Missouri or in the Kansas City, Kansas area the Medicare 
     Competitive Pricing Demonstration Project operated by the 
     Secretary of Health and Human Services under authority 
     granted in the Balanced Budget Act of 1997.

  If that statement sounds familiar, it is. Almost the same language 
was buried in the HMO Patients' Bill of Rights bill as it passed the 
Senate back in July. It passed then undebated and undiscussed as to its 
implications--just as we are about to do here tonight. July's action 
was outrageous. This action is even more so.
  There is a certain irony here. We have just heard that the House of 
Representatives passed, by an overwhelming vote, a version of the HMO 
Patients' Bill of Rights which is very similar to the bipartisan bill 
offered but not considered in the Senate. Our bipartisan bill was 
strongly opposed by the HMO industry. Their basic argument is: let's 
keep government out of our business, let us operate based on a 
competitive model that will allow the consumer, the beneficiary of the 
HMO contract, to negotiate without government standards, without 
government sanctions for failure to deliver on those standards with the 
HMO industry. They wanted to have laissez-faire free enterprise; Adam 
Smith roams the land.
  However, today we are about to pass a provision that says when the 
HMOs are dealing with their pocketbook and the question of how they 
will get reimbursed, how much money they are going to get paid from 
Medicare, they don't want to have a free market of competition; they 
don't want to have a means by which the taxpayers can be assured what 
they are paying for the HMO product is what the market says they should 
be paying.
  There is a certain amount of irony there which I think underscores 
the motivations of a significant portion of this industry. There also 
is a procedural ploy here. If this provision I just quoted were to be 
offered as an amendment to this bill, it would be ruled out of order 
under rule XVI in part because it purports not only to control action 
in this act but in any other act that Congress might consider making in 
an appropriations bill. But this is not an amendment; this is in the 
bill itself as it has come out of the Appropriations Committee, and 
therefore rule XVI does not apply.
  Normally under the procedures the Congress has followed 
traditionally, we would be dealing with a House bill because the House 
traditionally has led in the appropriations process; therefore, we 
would be amending a House bill. Thus, we could have excised this 
provision. However, because we are violating tradition and taking up a 
Senate bill first, we do not have the opportunity to remove it by a 
point of order.
  I will state for the record that henceforth, when it is proposed we 
take up a Senate appropriations bill before a House bill, I am going to 
stand here and object. This is exactly the kind of procedural abuse we 
can expect in the future as is happening right now.
  If that isn't bad enough, this is just plain bad policy. It stifles 
innovation by eliminating the competitive demonstration which hopefully 
would have led to a competitive process of compensating HMOs. It forces 
Medicare to pay more than necessary for some services in certain areas 
of the country while it denies managed care to other areas of the 
country.
  This HMO pricing is not without its own history. The Balanced Budget 
Act of 1997 included the competitive pricing demonstration program for 
Medicare. That provision was fought in the committee and fought in the 
Senate in 1997 by the HMO industry and certain Members of this body, 
but it prevailed. One by one, the HMO industry has been able to kill or 
has attempted to kill demonstrations which have been scheduled in many 
communities across the country. Today it is Arizona and Kansas City.
  The equation is pretty simple. It does not take rocket science to 
understand what is happening. Who benefits by continuing a system of 
paying Medicare HMOs that are not subject to competition? The HMOs 
benefit. Who loses when the same system is open to competition? The 
HMOs, because they no longer have the gravy train that exists today. 
Who gains by competition? Beneficiaries gain, particularly in rural 
areas which don't have managed care today. It would be the marketplace 
that would be establishing what the appropriate reimbursement level 
should be for an HMO in a currently unserved or underserved rural 
area--not a formula which underpays what the real cost of providing 
managed care would be in such an area. And the taxpayers lose because 
they do not get the benefit of the marketplace as a discipline of what 
the HMO's compensation should be.
  It is curious that out of one side of their mouth, they are screaming 
the current system of reimbursement is putting them out of business and 
causing them to have to leave hundreds of

[[Page 24491]]

thousands of former HMO beneficiaries high and dry and also to curtail 
benefits such as prescription drugs, but at the same time, they are 
saying out of the left side of their mouth they are doing everything 
they can to prevent the insertion of competitive bidding as a means of 
establishing what their HMO contracts are really worth and what they 
should be paid.
  They cannot have it both ways.
  It takes a certain degree of political courage to make this reform 
happen. Let me give an example. In my own State of Florida, we were 
part of this demonstration project. We were selected to have a 
demonstration for Part B services for what are referred to as durable 
medical equipment. Lakeland, FL, was selected as the place to 
demonstrate the potential savings for medical equipment such as oxygen 
supplies and equipment, hospital beds and accessories, surgical 
dressings, enteral nutrition, and urological supplies.
  The savings that have been achieved in this project are impressive.
  They are 18-percent savings for oxygen supplies. I know the Senator 
from Iowa has stood on this floor and at times has even wrapped himself 
in medical bandages to demonstrate how much more Medicare was paying 
than, for instance, the Veterans' Administration for the same items. 
This competitive bidding process is attempting to bring the forces of 
the market into Medicare, and an 18-percent savings by competitively 
bidding oxygen supplies and equipment over the old formula we used to 
use. There were 30-percent savings for hospital beds and accessories, 
13-percent savings for surgical dressings, 31 percent for enteral 
nutrition products, and 20 percent for urological supplies. It has been 
estimated if that Lakeland, FL, project were to be applied on a 
nationwide basis, the savings over 10 years would be in excess of $1 
billion. We are not talking about small change.
  Beneficiaries have saved money from this demonstration, and access 
and quality have been preserved and protected.
  I find it troubling we are again today, as we were in July, debating, 
at the end of a major piece of legislation, a silently, surreptitiously 
included item which has the effect of sheltering HMOs from the 
marketplace. We might find some HMOs cannot compete and others will 
thrive, but that is what the marketplace should determine. That is what 
competition is all about.
  I urge my colleagues to examine this provision, to examine the 
implications of this provision in this kind of legislation and the 
restraints it imposes upon us, as Members of the Senate, to excise it 
as inappropriate legislative language on an appropriations bill.
  I hope our conferees, as they meet with the House, will resist the 
inclusion of this in the final legislation we might be asked to vote 
upon when this measure comes back from conference. This disserves the 
beneficiaries of the Medicare program. It disserves the taxpayers of 
America. It disserves the standards of public policy development by the 
Senate. I hope we will not have a further repetition of this stealth 
attack on the Medicare program.
  Mr. ASHCROFT. Mr. President, I took great interest in the statement 
that Senator from Florida (Mr. Graham) made expressing his displeasure 
that this legislation contains a provision--Section 214--halting 
implementation of the Medicare Prepaid Competitive Pricing 
Demonstration Project both in Arizona and in the Kansas City 
metropolitan area.
  The Senator from Florida claimed that the inclusion of this provision 
was accomplished by HMOs. I would like to take this opportunity to 
point out to him that it was Medicare beneficiaries and doctors who 
alerted me to their grave concerns that the project would create huge 
patient disruption in the Kansas City area.
  In fact, after the Senator from Florida made similar remarks during 
debate on the Patient's Bill of Rights legislation regarding a similar 
provision in that bill, the Metropolitan Medical Society of Greater 
Kansas City wrote him a letter conveying their concerns with the 
implementation of the demonstration project in Kansas City, and 
expressing support for congressional efforts to stop the demonstration 
in their area. I ask unanimous consent that a copy of this letter be 
inserted in the record at the conclusion of my remarks.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. ASHCROFT. After hearing from a number of doctors and patients in 
my State over the past few months, I concluded that Kansas City is an 
inappropriate location for this project and that it will jeopardize the 
health care benefits that seniors currently enjoy in the area. I 
believe that halting this project is necessary to protect the health 
care of senior citizens and to assure that Medicare beneficiaries 
continue to have access to excellent health care at prices they can 
afford. HCFA's project is a clear and present danger to the health and 
well-being of my constituents.
  The Balanced Budget Act of 1997 created the Medicare Prepaid 
Competitive Pricing Demonstration Project to use competitive bidding 
among Medicare HMOs. Through the appointment of a Competitive Pricing 
Advisory Committee, HCFA was to select demonstration sites around the 
nation. Kansas City was one of the selected cities.
  As I understand it, the intent of the project was to bring greater 
competition to the Medicare managed care market, to address concerns 
that Medicare HMO reimbursement rates in some areas are too high, to 
expand benefits for Medicare HMO enrollees, and to restrain the cost of 
Medicare to the taxpayers. When considering these factors, it is clear 
that the Kansas City metropolitan area is not an appropriate choice for 
this demonstration.
  First, managed care competition in the Kansas City market is already 
vigorous, with six managed care companies currently offering Medicare 
HMOs in the area. Participation in Medicare HMOs is also high: As of 
July 1 of this year, nearly 23% of Medicare recipients in the Kansas 
City metropolitan area were in Medicare+Choice plans--approximately 
50,000 of 230,000 total beneficiaries. Nationally, only 17% of Medicare 
recipients are enrolled in such plans.
  Second, Medicare managed care payments in the Kansas City area are 
below the national average. According to a recent analysis by the 
Congressional Research Service of the Library of Congress, 1999 payment 
rates per Medicare+Choice enrollee in Kansas City are $511, while the 
national rate is $541. Documents provided to me by HCFA also 
demonstrate that 75 other cities had a higher adjusted average per 
capita cost (AAPCC) rate for 1997 than Kansas City. I wonder why Kansas 
City was chosen for this experiment, when so many other cities have 
higher payment rates.
  Third, I am concerned that this demonstration project will not 
provide expanded benefits to Medicare HMO enrollees, but will instead 
cause severe disruption of Medicare services. It is important to note 
that customer dissatisfaction is low in current Medicare managed care 
plans in the Kansas City area. Only one in twelve seniors disenrolls 
from Medicare HMOs each year.
  Currently, 33,000, or 66% of the seniors in Medicare managed care 
plans in the Kansas City area do not pay any premium. Under the bidding 
process set up by CPAC for the demonstration, a plan that bids above 
the enrollment-weighted median--which becomes the reimbursement rate 
for all plans--will be forced to charge seniors a premium to make up 
the difference between the plan's bid and the reimbursement rate paid 
by the government. In essence, the penalty for a high bid will be 
imposed upon seniors. Under this scenario, it is virtually assured that 
some seniors who pay no premium today will be required to start paying 
one.
  Moreover, seniors who cannot afford to pay a premium would be forced 
to abandon their regular doctor when it becomes necessary to change 
plans. Both individual doctors as well as the Metropolitan Medical 
Society of Greater Kansas City have warned that the demonstration could 
cause extreme disruption of beneficiaries away from current doctor-
patient relationships.

[[Page 24492]]

  I have also heard concerns that both health plans and physicians may 
withdraw from the Medicare program if reimbursements under the 
demonstration project prove financially untenable. As a result, 
Medicare beneficiaries may be left with fewer choices in care. This 
would be intolerable. I question why we should implement a project that 
will create more risk and uncertainty for my State's seniors, who are 
already satisfied with what they have.
  Finally, I question how the demonstration project would be able to 
provide us with useful information on how to improve the Medicare 
program if fee-for-service plans--which are generally the most 
expensive Medicare option--are not included in the project. In its 
January 6, 1999 Design Report, the Competitive Pricing Advisory 
Committee expressed the judgment that the exclusion of fee-for-service 
might ``limit HCFA's ability (a) to measure the impact of competitive 
pricing and (b) to generalize demonstration results to the entire 
Medicare program.''
  After studying this issue, I concluded that implementation of the 
Medicare Managed Care Demonstration Project in the Kansas City 
metropolitan area should be halted immediately. HCFA must not be 
allowed to risk the ability of my State's seniors to continue to 
receive high quality health care at affordable costs. I have been 
working closely with my Senate colleagues from Missouri and Kansas to 
protect our Kansas City area seniors from the dangers and uncertainty 
of a planned federal experiment with their health care arrangements.
  So, I want to make clear to my colleague from Florida that patients 
and doctors speaking on behalf of their patients were the ones who 
approached me and asked for my assistance in stopping the Medicare 
managed care demonstration project in the Kansas City area. I heard 
from a number of individual doctors, as well as medical societies in 
the State, expressing grave concerns about the project. The President 
of the Metropolitan Medical Society of Greater Kansas City even made 
the prediction that the unintended risk of the demonstration ``could 
dictate 100% disruption of beneficiaries away from their current 
relationships'' with their doctors. Clearly, this is unacceptable.
  Inclusion, Mr. President, I would like to quote from some of the 
letters I received from the seniors themselves, voicing their 
opposition to the Medicare managed care demonstration project coming to 
their area.
  Elizabeth Weekley Sutton, of Independence, Missouri, wrote to me:

       Dear Senator Ashcroft: We need help. My husband, my 
     friends, and I are very concerned and worried that our health 
     care will be very limited by the end of the Competitive 
     Pricing Demonstration that will be starting in January. Of 
     all the HMO's in the U.S., only the entire K.C. area and 
     Maricopa County in Arizona will be conducting this 
     competition for the next 5 years!

  And here are some excerpts from a letter sent by Edward Smith of 
Platte City, Missouri:

       I am totally opposed to the Health Care Financing 
     Administration competitive pricing demonstration project to 
     take place here in the Kansas City area. My health will not 
     permit me to be a guinea pig for a total of five years when 
     the rest of the country will have business as usual.

  He continues:

       Instead of the Health Care Financing Administration 
     determining what is best for the beneficiaries I would prefer 
     to do that myself.

  And finally, Mr. Smith says:

       If this plan is adopted my HMO could choose to leave the 
     market. Then what is gained? Certainly not my health.

  Mr. President, we need to listen to the voice of our seniors. We 
cannot afford to jeopardize their health with a risky experiment that 
could raise costs, limit choices, and cause doctor-patient disruption. 
For this reason, I have continued--and will continue--to work to halt 
this project in its present form in the Kansas City area.

                               Exhibit 1

                                      Metropolitan Medical Society


                                       of Greater Kansas City,

                                                    July 21, 1999.
     Hon. Bob Graham,
     U.S. Senate, Washington, DC.
       Dear Senator Graham: I was concerned to read in the July 
     16, 1999, Congressional Record your dissatisfaction about the 
     Senate's passage of the moratorium on the Medicare Prepaid 
     Competitive Pricing Demonstration Project in Kansas City and 
     Arizona. On behalf of the more than 2500 physicians of the 
     Metropolitan Medical Society of Greater Kansas City and its 
     affiliated organizations, I want to assure you that doctors 
     strongly support the moratorium that was passed in the Senate 
     Patient Bill of Rights legislation last week.
       The physicians of Kansas City have expressed serious 
     concerns about the demonstration project since April, and we 
     continue to be concerned. We believe the experiment will 
     bring unacceptable levels of disruption to our Medicare 
     patients and the local health care market. Additionally, I 
     worry that quality care, which is often more expensive, will 
     be less available to Medicare patients. In Kansas City, the 
     opposition to the project is widespread. Our senators acted 
     on behalf of our entire health care community, including 
     patients, doctors, hospitals, and health care plans.
       The medical community has participated in the discussions 
     about the demonstration with the Health Care Financing 
     Administration (HCFA) and the local Area Advisory Committee 
     for the demonstration project. Despite these discussions, 
     problems with the experiment remain. We support congressional 
     efforts to stop the demonstration project in the Kansas City 
     area.
       I remain concerned that under-funded HMOs place our most 
     vulnerable Medicare recipients at risk of getting less 
     attention to their health care needs. I expect to hear more 
     cases of catastrophes to Medicare recipients when the care 
     given is too little, too late. You may be aware that 
     Jacksonville, Florida is another potential site for the 
     demonstration.
       Thank you for your consideration of my concerns. I hope 
     I've helped to clarify the existence of broad based support 
     in Kansas City for the moratorium on the competitive pricing 
     demonstration.
           Sincerely,
                                              Richard Hellman, MD,
         President-Elect and Chair, National Government Relations 
           Committee.


                           amendment no. 1845

     (Purpose: To express the sense of the Senate regarding school 
                            infrastructure)

  The PRESIDING OFFICER (Mr. Smith of Oregon). The Senator from Iowa.
  Mr. HARKIN. Mr. President, Senator Robb and I have an amendment at 
the desk. I call it up at this time, No. 1845.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Iowa [Mr. Harkin], for himself, and Mr. 
     Robb, proposes an amendment numbered 1845.

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

       At the end of title III, add the following:

     SEC. __. SENSE OF THE SENATE REGARDING SCHOOL INFRASTRUCTURE.

       (a) Findings.--The Senate makes the following findings:
       (1) The General Accounting Office has performed a 
     comprehensive survey of the Nation's public elementary and 
     secondary school facilities and has found severe levels of 
     disrepair in all areas of the United States.
       (2) The General Accounting Office has concluded that more 
     than 14,000,000 children attend schools in need of extensive 
     repair or replacement, 7,000,000 children attend schools with 
     life threatening safety code violations, and 12,000,000 
     children attend schools with leaky roofs.
       (3) The General Accounting Office has found the problem of 
     crumbling schools transcends demographic and geographic 
     boundaries. At 38 percent of urban schools, 30 percent of 
     rural schools, and 29 percent of suburban schools, at least 
     one building is in need of extensive repair or should be 
     completely replaced.
       (4) The condition of school facilities has a direct affect 
     on the safety of students and teachers and on the ability of 
     students to learn. Academic research has provided a direct 
     correlation between the condition of school facilities and 
     student achievement. At Georgetown University, researchers 
     have found the test scores of students assigned to schools in 
     poor condition can be expected to fall 10.9 percentage points 
     below the test scores of students in buildings in excellent 
     condition. Similar studies have demonstrated up to a 20 
     percent improvement in test scores when students were moved 
     from a poor facility to a new facility.
       (5) The General Accounting Office has found most schools 
     are not prepared to incorporate modern technology in the 
     classroom. Forty-six percent of schools lack adequate 
     electrical wiring to support the full-scale use of 
     technology. More than a third of schools lack the requisite 
     electrical power. Fifty-six percent of schools have 
     insufficient phone lines for modems.
       (6) The Department of Education has reported that 
     elementary and secondary school

[[Page 24493]]

     enrollment, already at a record high level, will continue to 
     grow over the next 10 years, and that in order to accommodate 
     this growth, the United States will need to build an 
     additional 6,000 schools.
       (7) The General Accounting Office has determined the cost 
     of bringing schools up to good, overall condition to be 
     $112,000,000,000, not including the cost of modernizing 
     schools to accommodate technology, or the cost of building 
     additional facilities needed to meet record enrollment 
     levels.
       (8) Schools run by the Bureau of Indian Affairs (BIA) for 
     Native American children are also in dire need of repair and 
     renovation. The General Accounting Office has reported that 
     the cost of total inventory repairs needed for BIA facilities 
     is $754,000,000. The December 1997 report by the Comptroller 
     General of the United States states that, ``Compared with 
     other schools nationally, BIA schools are generally in poorer 
     physical condition, have more unsatisfactory environmental 
     factors, more often lack key facilities requirements for 
     education reform, and are less able to support computer and 
     communications technology.''.
       (9) State and local financing mechanisms have proven 
     inadequate to meet the challenges facing today's aging school 
     facilities. Large numbers of local educational agencies have 
     difficulties securing financing for school facility 
     improvement.
       (10) The Federal Government has provided resources for 
     school construction in the past. For example, between 1933 
     and 1939, the Federal Government assisted in 70 percent of 
     all new school construction.
       (11) The Federal Government can support elementary and 
     secondary school facilities without interfering in issues of 
     local control, and should help communities leverage 
     additional funds for the improvement of elementary and 
     secondary school facilities.
       (b) Sense of the Senate.--It is the sense of the Senate 
     that Congress should provide at least $3,700,000,000 in 
     Federal resources to help communities leverage funds to 
     modernize public school facilities.

  Mr. HARKIN. Mr. President, Senator Robb and I are going to take a few 
minutes. I know the time is late. I know people want to get to a final 
vote on this. I want to talk about how good this bill is and to urge 
people to vote for it.
  This is a sense-of-the-Senate resolution. I will not go through the 
whole thing. It basically is a sense-of-the-Senate resolution saying 
Congress should appropriate at least $3.7 billion in Federal resources 
to help communities leverage funds to modernize public school 
facilities, otherwise known as public school construction.
  What we have in this country is schools that are on the average 40 to 
50 years old. We are getting great teachers, new methodologies, new 
math, new science, new reading programs, and the schools are crumbling 
down around us. They are getting older every day. Day after day, kids 
go to schools with leaky ceilings, inadequate heat, inadequate air 
conditioning for hot summer days and the fall when the school year is 
extended. They are finding a lot of these buildings still have asbestos 
in them, and it needs to be taken out. Yet we are shirking our 
responsibilities to refurbish, renovate, and rebuild the schools in 
this country. The General Accounting Office estimates 14 million 
American children attend classes in schools that are unsafe or 
inadequate. They estimate it will cost $112 billion to upgrade existing 
public schools to just ``good'' condition.
  In addition, the GAO reports 46 percent of schools lack adequate 
electrical wiring to support the full-scale use of technology. We want 
to get computers in the classrooms, we want to hook them to the 
Internet, and yet almost 50 percent of the schools in this country are 
inadequate in their internal wiring so kids cannot hook up with the 
Internet.
  The American Society of Civil Engineers reports public schools are in 
worse condition than any other sector of our national infrastructure. 
Think about that. According to the American Society of Civil 
Engineers--they are the ones who build our buildings, build our bridges 
and roads and highways and streets and sewers and water systems, and 
our schools--they say our schools are in the worst state of any part of 
the physical infrastructure of this country.
  Mr. HARKIN. Mr. President, if the nicest things our kids ever see or 
go to is shopping malls and sports arenas and movie theaters, and the 
most run-down places are their schools, what kind of signal are we 
sending them about the value we place on education and their future?
  This is a sense-of-the-Senate resolution which simply outlines the 
terrible situation we have in this country and calls on the Senate and 
the Congress to respond by providing at least $3.7 billion, a small 
fraction of what is needed but a step in the right direction--$3.7 
billion in Federal resources to modernize our Nation's schools.
  I yield the floor to my distinguished colleague and cosponsor, 
Senator Robb.
  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. ROBB. Mr. President, I thank my friend and colleague from Iowa. 
Senator Harkin and I have offered a sense of the Senate amendment 
relating to school construction, as Senator Harkin has just explained. 
The amendment is not unlike the amendment Senators Lautenberg, Harkin, 
and I offered to the Budget Resolution earlier this year. That 
amendment assumed that given the levels in the budget resolution, 
Congress would enact ``legislation to allow States and school districts 
to issue at least $24.8 billion worth of zero-interest bonds to rebuild 
and modernize our nation's schools, and to provide Federal income tax 
credits to the purchasers of those bonds in lieu of interest 
payments.'' The actual cost as it was scored was referred to by the 
Senator from Iowa. That amendment was accepted and put the entire 
Senate on record as supporting the concept of providing federal 
assistance in the area of school construction and renovation.
  Understanding that Rule 16 prevents us from doing anything of 
significance at this time with respect to school construction, Senator 
Harkin and I in just a moment will withdraw our amendment. But every 
day that passes, this Congress misses an opportunity to help our States 
and localities fix the leaky roofs, get rid of all the trailers, and 
install the wiring needed to bring technology to all of our children. 
These are real problems--problems that our nation's mayors, school 
boards, and families simply need some help in addressing.
  While school infrastructure improvement is typically a local 
responsibility, it is now a national need. Our schools, as the Senator 
from Iowa has indicated, are over 40 years old, on average; our school-
aged population is at record levels; and our States and localities 
can't keep up, despite their surpluses.
  Abstract talk about State surpluses provides little solace to our 
nation's teachers and students who are forced to deal with wholly 
inadequate conditions. In Alabama, the roof of an elementary school 
collapsed. Fortunately, it occurred just after the children had left 
for the day. In Chicago, teachers place cheesecloth over air vents to 
filter out lead-based paint flecks. In Maine, teachers have to turn out 
the lights when it rains because their electrical wiring is exposed 
under their leaky roofs.
  Mr. President, we are missing an opportunity to help our States and 
localities with a pressing need.
  I will continue to work for and press forward on this issue because I 
think it's an area where the Federal Government can be extremely 
constructive. When our children are asked about ``Bleak House,'' they 
should refer to a novel by Dickens and not the place where they go to 
school.
  In my own State of Virginia, there are over 3,000 trailers being used 
to educate students. And there are over $4 billion worth of unbudgeted, 
unmet needs for our schools. This is a problem that is not going to go 
away, and it's a problem that our nation's schools need our help to 
solve. And I regret that Rule 16 precludes us from considering 
legislation which would reaffirm the commitment that we made earlier 
this year.
  I thank the distinguished Senator from Iowa for his continued work on 
the subject of school construction, and I yield the floor.


                      Amendment No. 1845 Withdrawn

  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. HARKIN. Mr. President, I understand this amendment is not 
acceptable to the other side. It is late in the day. I know people have 
to get on with other things, and we want to get to a final vote on the 
bill. I believe strongly

[[Page 24494]]

in this. It is a sense-of-the-Senate amendment. Also, Senators Kennedy, 
Reid, Murray, and Johnson are added as cosponsors.
  In the spirit of moving this bill along and trying to wrap this up as 
quickly as possible, I ask unanimous consent to withdraw the amendment 
at this time, but it will be revisited.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. SPECTER. I thank my distinguished colleague. I am very 
sympathetic to the purpose of the sense-of-the-Senate amendment. He is 
correct; there would be objection, and I think it would not be adopted. 
I thank him for withdrawing the amendment.
  The PRESIDING OFFICER. The amendment is withdrawn.


        Amendments Nos. 2273 through 2289, 1852, 1869, and 1882

  Mr. SPECTER. Mr. President, I now submit the managers' package which 
has been cleared on both sides.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Pennsylvania [Mr. Specter] for himself, 
     and others proposes amendments, en bloc, numbered 2273 
     through 2287, 1852, 1869 and 1882.

  The amendments are as follows:


                           amendment no. 2273

       At the appropriate place in the bill add the following:

     SEC.   . CONFOUNDING BIOLOGICAL AND PHYSIOLOGICAL INFLUENCES 
                   ON POLYGRAPHY.

       (a) Findings.--The Senate finds that--
       (1) The use of polygraph tests as a screening tool for 
     federal employees and contractor personnel is increasing.
       (2) A 1983 study by the Office of Technology Assessment 
     found little scientific evidence to support the validity of 
     polygraph tests in such screening applications.
       (3) The 1983 study further found that little or no 
     scientific study had been undertaken on the effects of 
     prescription and non-prescription drugs on the validity of 
     polygraph tests, as well as differential responses to 
     polygraph tests according to biological and physiological 
     factors that may vary according to age, gender, or ethnic 
     backgrounds, or other factors relating to natural variability 
     in human populations.
       (4) A scientific evaluation of these important influences 
     on the potential validity of polygraph tests should be 
     studied by a neutral agency with biomedical and physiological 
     expertise in order to evaluate the further expansion of the 
     use of polygraph tests on federal employees and contractor 
     personnel.
       (b) Sense of the Senate.--It is the Sense of the Senate 
     that the Director of the National Institutes of Health should 
     enter into appropriate arrangements with the National Academy 
     of Sciences to conduct a comprehensive study and 
     investigation into the scientific validity of polygraphy as a 
     screening tool for federal and federal contractor personnel, 
     with particular reference to the validity of polygraph tests 
     being proposed for use in proposed rules published at 64 Fed. 
     Reg. 45062 (August 18, 1999).
                                  ____



                           AMENDMENT NO. 2274

    (Purpose: To provide funding for a dental sealant demonstration 
                                program)

       At the end of title II, add the following:


                  dental sealant demonstration program

       Sec. __. From amounts appropriated under this title for the 
     Health Resources and Services Administration, sufficient 
     funds are available to the Maternal Child Health Bureau for 
     the establishment of a multi-State preventive dentistry 
     demonstration program to improve the oral health of low-
     income children and increase the access of children to dental 
     sealants through community- and school-based activities.
                                  ____



                           AMENDMENT NO. 2275

   (Purpose: To limit the withholding of substance abuse funds from 
                            certain States)

       At the end of title II, add the following:


                  withholding of substance abuse funds

       Sec. __. (a) In General.--None of the funds appropriated by 
     this Act may be used to withhold substance abuse funding from 
     a State pursuant to section 1926 of the Public Health Service 
     Act (42 U.S.C. 300x-26) if such State certifies to the 
     Secretary of Health and Human Services that the State will 
     commit additional State funds, in accordance with subsection 
     (b), to ensure compliance with State laws prohibiting the 
     sale of tobacco products to individuals under 18 years of 
     age.
       (b) Amount of State Funds.--The amount of funds to be 
     committed by a State under subsection (a) shall be equal to 
     one percent of such State's substance abuse block grant 
     allocation for each percentage point by which the State 
     misses the retailer compliance rate goal established by the 
     Secretary of Health and Human Services under section 1926 of 
     such Act, except that the Secretary may agree to a smaller 
     commitment of additional funds by the State.
       (c) Supplement not Supplant.--Amounts expended by a State 
     pursuant to a certification under subsection (a) shall be 
     used to supplement and not supplant State funds used for 
     tobacco prevention programs and for compliance activities 
     described in such subsection in the fiscal year preceding the 
     fiscal year to which this section applies.
       (d) The Secretary shall exercise discretion in enforcing 
     the timing of the State expenditure required by the 
     certification described in subsection (a) as late as July 31, 
     2000.
                                  ____



                           AMENDMENT NO. 2276

(Purpose: To express the sense of the Senate that funding for prostate 
           cancer research should be increased substantially)

       At the appropriate place add the following:
       Sec. __. (a) Findings.--Congress makes the following 
     findings:
       (1) In 1999, prostate cancer is expected to kill more than 
     37,000 men in the United States and be diagnosed in over 
     180,000 new cases.
       (2) Prostate cancer is the most diagnosed nonskin cancer in 
     the United States.
       (3) African Americans have the highest incidence of 
     prostate cancer in the world.
       (4) Considering the devastating impact of the disease among 
     men and their families, prostate cancer research remains 
     underfunded.
       (5) More resources devoted to clinical and translational 
     research at the National Institutes of Health will be highly 
     determinative of whether rapid advances can be attained in 
     treatment and ultimately a cure for prostate cancer.
       (6) The Congressionally Directed Department of Defense 
     Prostate Cancer Research Program is making important strides 
     in innovative prostate cancer research, and this Program 
     presented to Congress in April of 1998 a full investment 
     strategy for prostate cancer research at the Department of 
     Defense.
       (7) The Senate expressed itself unanimously in 1998 that 
     the Federal commitment to biomedical research should be 
     doubled over the next 5 years.
       (b) Sense of the Senate.--It is the sense of the Senate 
     that--
       (1) finding treatment breakthroughs and a cure for prostate 
     cancer should be made a national health priority;
       (2) significant increases in prostate cancer research 
     funding, commensurate with the impact of the disease, should 
     be made available at the National Institutes of Health and to 
     the Department of Defense Prostate Cancer Research Program; 
     and
       (3) these agencies should prioritize prostate cancer 
     research that is directed toward innovative clinical and 
     translational research projects in order that treatment 
     breakthroughs can be more rapidly offered to patients.
                                  ____



                           amendment no. 2277

       On page 59, line 25, strike ``$1,404,631,000'' and insert 
     ``$1,406,631,000'' in lieu thereof.
       On page 60, before the period on line 10, insert the 
     following: ``: Provided further, That $2,000,000 shall be for 
     carrying out Part C of Title VIII of the Higher Education 
     Amendments of 1998.''
       On page 62, line 23, decrease the figure by $2,000,000.
                                  ____



                           amendment no. 2278

 (Purpose: To clarify provisions relating to the United States-Mexico 
                       Border Health Commission)

       At the appropriate place, insert the following:
       Sec.   . The United States-Mexico Border Health Commission 
     Act (22 U.S.C. 290n et seq.) is amended--
       (1) by striking section 2 and inserting the following:

     ``SEC. 2. APPOINTMENT OF MEMBERS OF BORDER HEALTH COMMISSION.

       ``Not later than 30 days after the date of enactment of 
     this section, the President shall appoint the United States 
     members of the United States-Mexico Border Health Commission, 
     and shall attempt to conclude an agreement with Mexico 
     providing for the establishment of such Commission.''; and
       (2) in section 3--
       (A) in paragraph (1), by striking the semicolon and 
     inserting ``; and'';
       (B) in paragraph (2)(B), by striking ``; and'' and 
     inserting a period; and
       (C) by striking paragraph (3).
                                  ____



                           amendment no. 2279

       On page 50, line 17, strike ``$459,000,000'' and insert in 
     lieu thereof ``$494,000,000''.
                                  ____



                           amendment no. 2280

       On page 66, line 24, strike out all after the colon up to 
     the period on line 18 of page 67.
                                  ____



                           amendment no. 2281

       On page 42, before the period on line 8, insert the 
     following: ``: Provided further, That sufficient funds shall 
     be available from the Office on Women's Health to support 
     biological, chemical and botanical studies to assist in the 
     development of the clinical evaluation of phytomedicines in 
     women's health''.

[[Page 24495]]

     
                                  ____
                           amendment no. 2282

    (Purpose: To provide for a report on promoting a legal domestic 
  workforce and improving the compensation and working conditions of 
                         agricultural workers)

       On page 19, line 6, insert before the period the following: 
     ``: Provided further, That funds made available under this 
     heading shall be used to report to Congress, pursuant to 
     section 9 of the Act entitled `An Act to create a Department 
     of Labor' approved March 4, 1913 (29 U.S.C. 560), with 
     options that will promote a legal domestic work force in the 
     agricultural sector, and provide for improved compensation, 
     longer and more consistent work periods, improved benefits, 
     improved living conditions and better housing quality, and 
     transportation assistance between agricultural jobs for 
     agricultural workers, and address other issues related to 
     agricultural labor that the Secretary of Labor determines to 
     be necessary''.
                                  ____



                           AMENDMENT NO. 2283

(Purpose: To express the sense of the Senate concerning women's access 
                to obstetric and gynecological services)

       Beginning on page 1 of the amendment, strike all after the 
     first word and insert the following:

     __. SENSE OF THE SENATE ON WOMEN'S ACCESS TO OBSTETRICAND 
                   GYNECOLOGICAL SERVICES.

       (a) Findings.--Congress makes the following findings:
       (1) In the 1st session of the 106th Congress, 23 bills have 
     been introduced to allow women direct access to their ob-gyn 
     provider for obstetric and gynecologic services covered by 
     their health plans.
       (2) Direct access to ob-gyn care is a protection that has 
     been established by Executive Order for enrollees in 
     medicare, medicaid, and Federal Employee Health Benefit 
     Programs.
       (3) American women overwhelmingly support passage of 
     federal legislation requiring health plans to allow women to 
     see their ob-gyn providers without first having to obtain a 
     referral. A 1998 survey by the Kaiser FamilyFoundation and 
     Harvard University found that 82 percent of Americans support 
     passage of a direct access law.
       (4) While 39 States have acted to promote residents' access 
     to ob- gyn providers, patients in other State- or in 
     Federally-governed health plans are not protected from access 
     restrictions or limitations.
       (5) In May of 1999 the Commonwealth Fund issued a survey on 
     women's health, determining that 1 of 4 women (23 percent) 
     need to first receive permission from their primary care 
     physician before they can go and see their ob-gyn provider 
     for covered obstetric or gynecologic care.
       (6) Sixty percent of all office visits to ob-gyn providers 
     are for preventive care.
       (b) Sense of the Senate.--It is the sense of the Senate 
     that Congress should enact legislation that requires health 
     plans to provide women with direct access to a participating 
     health provider who specializes in obstetrics and 
     gynecological services, and that such direct access should be 
     provided for all obstetric and gynecologic care covered by 
     their health plans, without first having to obtain a referral 
     from a primary care provider or the health plan.

  Mrs. MURRAY. Mr. President, included in the Manager's amendment is an 
important provision relating to women's health and access to 
reproductive health care services. I am pleased to have worked with the 
managers of this bill to send a strong message on the importance of 
direct access for women to their OB/GYN.
  I was disappointed that we were unable to address the rule XVI 
concerns with the amendment I had originally filed. My original 
amendment would simply allow women and their OB/GYNs to make important 
health care decisions without barriers or obstacles erected by 
insurance company policies. My amendment would have required that 
health plans give women direct access to their OB/GYN for all 
gynecological and obstetrical care and would have prohibited insurance 
companies from standing between a woman and her OB/GYN.
  However, it has been determined that my amendment would violate rule 
XVI. As a result of the announcement by the chairman of the Senate 
Appropriations Committee that he will make a point of order against all 
amendments that may violate rule XVI, I have modified my amendment. The 
modification still allows Members of the Senate to be on record in 
support of women's health or in opposition to removing barriers that 
hinder access for women to critical reproductive health care services.
  I am offering a sense-of-the-Senate that puts this question to each 
Member. I realize that this amendment is not binding, but due to 
opposition to my original amendment, I have been forced to offer this 
sense-of-the-Senate.
  I am disappointed that we could not act to provide this important 
protection to women, but I do believe this amendment will send an 
important message that the U.S. Senate does support greater access for 
women to quality health care benefits.
  I have offered this amendment due to my frustration and 
disappointment with managed care reform. I have become frustrated by 
stalling tactics and empty promises. The managed care reform bill that 
passed the Senate has been referred to as an empty promise for women. I 
can assure my colleagues that women are much smarter than they may 
expect and will not be fooled by empty promises or arguments of 
procedural discipline. When a woman is denied direct access to the care 
provided by her OB/GYN, she will not be interested in a discussion on 
ERISA or rule XVI. She wants direct access to her OB/GYN. She needs 
direct access, and she should have direct access.
  My amendment also reiterates the importance of ensuring that the OB/
GYN remains the coordinating physician. Any test or additional referral 
would be treated as if made by the primary care physician. This 
amendment does not call for the designation of an OB/GYN as a primary 
care physician, it simply says that if the OB/GYN decides additional 
care is necessary, the patient is not forced to seek approval from a 
primary care physician, who may not be familiar with her overall health 
care status.
  Why is this amendment important? The number one reason most women 
enter the health care system is to seek gynecological or obstetric 
care. This is the primary point of entry for women into the health care 
system. For most women, including myself, we consider our OB/GYN our 
primary care physician--maybe not as an insurance company defines it--
but, in practice, that's the reality.
  Does a woman go to her OB/GYN for an ear infection? No. But, does a 
pregnant woman consult with her OB/GYN prior to taking any antibiotic 
for the treatment of an ear infection? Yes, most women do.
  I know the policy endorsed in this amendment has in the past enjoyed 
bipartisan support. The requirements are similiar to S. 836, 
legislation introduced by Senator Specter and cosponsored by several 
Senators both Republican and Democrat. This amendment is similar to 
language that was adopted during committee consideration in the House 
of the fiscal year 1999 Labor, HHS appropriations bill. A similar 
directive is contained in the bipartisan House Patients' Bill of Rights 
legislation. It has the strong support of the American College of 
Obstetricians and Gynecologists and I know I have heard from several 
OB/GYNs in my own state testifying to the importance of direct access 
to the full range of care provided, not just routine care.
  I would also like to point out to my colleagues, that 39 states have 
similar requirements and that as participants in the Federal Employees 
Health Benefit Plan, all of us--as Senators--have this same guarantee 
as well as our family members. If we can guarantee this protection for 
ourselves and our families, we should do the same for women 
participating in a manager care plan.
  I realize that this appropriations bill may not be the best vehicle 
for offering this amendment. However, I have waited for final action on 
a Patients' Bill of Rights for too long. I have watched as patient 
protection bills have been stalled or delayed. Last year we were told 
that we would finish action on a good Patients' Bill of Rights package 
prior to adjournment.
  Well, here we sit--almost 12 months later--with little hope of 
finishing a good, comprehensive managed care reform bill prior to our 
scheduled adjournment this year.
  I also want to remind my colleagues that we have in the past used 
appropriations bills to address deficiencies in current law or to 
address an urgent need for action. I believe that addressing an urgent 
need in women's health care qualifies as a priority that we must 
address. I realize that the authorizing committee has objected to the 
original amendment I filed. As a member of the authorizing committee as

[[Page 24496]]

well, I can understand this objection. But, again I have little choice 
but to proceed on this appropriations bill.
  We all know that it was only recently on the fiscal year 1999 
supplemental appropriations bill that we authorized a significant 
change in Medicaid recoupment provisions despite strong objections from 
the Finance Committee.
  In last year's omnibus appropriations bill, we authorized a 
requirement that insurance companies must cover breast reconstruction 
surgery following a mastectomy. I can assure my colleagues that this 
provision never went through the authorizing committee. I would also 
point out that there are several antichoice riders contained in this 
appropriations bill that represent a major authorization.
  As these examples show, when we have to address these types issues 
through appropriations bills--we can do it. We have done it in the 
past, and we should do it today to meet this need.
  I urge my colleagues to support this amendment. We all talk about the 
need to ensure access for women to health care. I applaud Chairman 
Specter's efforts in this appropriations bill regarding women's health 
care. Adopting this amendment gives us the opportunity to do something 
that does ensure greater access for women. This is what women want. 
This is the chance for Senators to show their commitment to this 
critical benefit.
  I would like to quote a statement made by our subcommittee chairman 
that I believe more eloquently explains why I am urging this amendment. 
``I believe it is clear that access to women's health care cuts across 
the intricacies of the complicated and often divisive managed care 
debate.'' I could not agree more.
  We know from the current state requirement and the Federal Employee 
Health Benefit Program requirement, this provision does not have a 
significant impact on costs of health care. We also know from 
experience that it has a positive impact on health care benefits. Since 
60 percent of office visits to OB/GYNs are for preventive care, we 
could make the argument that adoption of this policy would reduce the 
overall costs of health care.
  I urge my colleagues to support this amendment and ask that we do 
more than simply make empty promises to women. We need an honest and 
fair debate on this policy.
  I would ask my colleagues to seek further education or advice from 
women as to the importance of direct access and ask their female 
constituents about the relationship they have with their own OB/GYN. 
Let women speak for themselves. If you listen, you will hear why this 
policy is so important and why women trust their OB/GYN far more than 
their insurance company or their Member of Congress.
  Mr. ROBB. Mr. President, I want to discuss my support for an 
amendment Senator Murray and I offered which puts the entire Senate on 
record in favor of removing one of the greatest obstacles to quality 
care that women face in our insurance system today: inadequate access 
to obstetricians and gynecologists.
  I understand that our provision will be included in the manager's 
amendment to this bill, and I want to thank the chairman of the Senate 
Appropriations Subcommittee on Labor, HHS and Education, Senator 
Specter, for his work both in including our amendment in his bill, as 
well as his leadership on this issue. He has been one of the most 
outspoken members in this body in favor of helping women have better 
access to women's health services.
  We know today that for many women, their OB/GYN is the only physician 
they see regularly. While they have a special focus on women's 
reproductive health, obstetricians and gynecologists provide a full 
range of preventative health services to women, and many women consider 
their OB/GYN to be their primary care physician.
  Unfortunately, some insurers have failed to recognize the ways which 
women access health care services. Some managed care companies require 
a woman to first visit a primary care doctor before she is granted 
permission to see an obstetrician or gynecologist. Others will allow a 
woman to obtain treatment directly from her OB/GYN, but then prohibit 
her from obtaining any follow-up care that her OB/GYN recommends 
without first visiting a primary care physician who serves as a 
``gatekeeper''.
  This isn't just cumbersome for women, it's bad for their health. 
According to a survey by the Commonwealth Fund, women who regularly see 
an OB/GYN are more likely to have had a complete physical exam and 
other important preventative services like mammograms, cholesterol 
tests and Pap smears. At a time when we need to direct our health care 
dollars more toward prevention, allowing insurers to restrict access to 
the health professionals most likely to offer women preventative care 
only increases the possibility that greater complications--and greater 
expenditures--will arise down the road. We ought to grant women the 
right to access medical care from obstetricians and gynecologists 
without any interference from remote insurance company representatives.
  Earlier this year, Senator Murray and I offered an amendment which 
would do just that. Unfortunately, a number of my colleagues from the 
other side of the aisle objected to some of the specific wording in our 
bill, and the amendment was defeated.
  Since that vote, we have reworked our amendment to address these 
concerns. We had hoped to offer an amendment which was identical to 
language included in a patient protection bill crafted by a Republican 
Congressman, Charlie Norwood, and that was approved by the House 
earlier today by an overwhelming vote of 275-151.
  Yet despite this consensus on this issue by Republicans and Democrats 
on the House side, my colleagues from the other side of the aisle 
threatened to challenge our amendment under Senate Rule 16. Senator 
Murray and I are cognizant of the problem this created, and we've opted 
to offer a Sense of the Senate resolution in place of the amendment we 
had hoped to see approved.
  This Sense of the Senate, which has been accepted by both sides, puts 
the entire Senate on record in favor of legislation which requires 
health plans to provide women with direct access to obstetrical and 
gynecological services, without first having to obtain a referral from 
a primary care provider or their health plan. It is a strong step 
forward in our efforts to improve women's access to the type of health 
care they need.
  To my Republican colleagues who objected, I say: your party joined 
with Democrats to hammer out this compromise language on the House 
side. Now that the Senate is on record as well, let's get behind this 
same amendment at the earliest available opportunity in the Senate and 
pass a provision which will help all women in this country get better 
care.


                           amendment no. 2284

(Purpose: To extend filing deadline for compensation of worker exposed 
                  to mustard gas during World War II)

       At the appropriate place, insert the following:
       Sec.   . The applicable time limitations with respect to 
     the giving of notice of injury and the filing of a claim for 
     compensation for disability or death by an individual under 
     the Federal Employees' Compensation Act, as amended, for 
     injuries sustained as a result of the persons exposure to a 
     nitrogen or sulfur mustard agent in the performance of 
     official duities as an employee at the Department of the 
     Army's Edgewood Arsenal before March 20, 1944, shall not 
     begin to run until the date of enactment of this Act.
                                  ____



                           amendment no. 2285

(Purpose: To correct a definition error in the Workforce Investment Act 
                                of 1998)

       At the appropriate place in TITLE V--GENERAL PROVISIONS of 
     the bill insert the following new section:
       Sec. 5   . Section 169(d)(2)(B) of P.L. 105-220, the 
     Workforce Investment Act of 1998, is amended by striking ``or 
     Alaska Native villages or Native groups (as such terms are 
     defined in section 3 of the Alaska Native Claims Settlement 
     Act (43 U.S.C. 1602)).'', and inserting in lieu thereof,'' or 
     Alaska Natives.''
                                  ____



                           amendment no. 2286

  (Purpose: To increase funds for the Centers for Disease Control and 
        Prevention to provide grants regarding childhood asthma)

       At the end of title II, add the following:

[[Page 24497]]




                            childhood asthma

       Sec.   . In addition to amounts otherwise appropriated 
     under this title for the Centers for Disease Control and 
     Prevention, 8.7 in addition to the $1 million already 
     provided for asthma prevention programs which shall become 
     available on October 1, 2000 and shall remain available 
     through September 30, 2001, and be utilized to provide grants 
     to local communities for screening, treatment and education 
     relating to childhood asthma.

  Mr. DURBIN. Mr. President, I rise today to offer this amendment 
regarding childhood asthma. For the next 15 minutes imagine breathing 
through a tiny straw the size of a coffee stirrer, never getting enough 
air. Now imagine suffering through this process three to six times a 
day. This is asthma.
  Today, asthma is considered the worst chronic health problem plaguing 
this nation's children, affecting nearly 15 million Americans. That 
figure includes more than 700,000 Illinoisans, of whom 213,000 are 
children under the age of 18. Illinois has the nation's highest asthma-
related death rate for African-American males, and Chicago has one of 
the highest rates of childhood asthma in the country.
  During a recent visit to Children's Memorial Hospital in Chicago, I 
met a wonderful little boy whose life is a daily fight against asthma. 
He told me he can't always participate in gym class or even join his 
friends on the playground. Fortunately, Nicholas is receiving the 
medical attention necessary to manage his asthma. Yet for millions of 
children, this is not the case. Their asthma goes undiagnosed and 
untreated, making trips to the emergency room as common as trips to the 
grocery store.
  In an effort to help the millions of children who live every day with 
undiagnosed or untreated asthma, I am offering this amendment with my 
colleague Sen. Mike DeWine. It would provide $50 million in grants 
through the Center for Disease Control, for community-based 
organizations including hospitals, community health centers, school-
based programs, foster care programs, childhood nutrition programs to 
support asthma screening, treatment, education and prevention programs.
  Despite the best efforts of the health community, childhood asthma is 
becoming more common, more deadly and more expensive. In the past 20 
years, childhood asthma cases have increased by 160 percent and asthma-
related deaths have tripled despite improved treatments.
  Chicago has the dubious distinction of having the second highest rate 
of childhood asthma in the country. Only New York City has higher 
rates. According to a study published by the Annals of Allergy, Asthma 
& Immunology, of inner-city school children in Chicago, researchers 
found that the prevalence of diagnosed asthma was 10.8 per cent, or 
twice the 5.8 per cent the federal Centers for Disease Control and 
Prevention estimates in that age group nationally. The study also found 
that most of the children with diagnosed asthma were receiving medical 
care, but it may not be consistent with what asthma care guidelines 
recommend. Researchers questioned parents of kindergartners and found 
10.8 per cent of the children had been found to have asthma. The 
researchers estimated an additional 6 to 7 percent had undiagnosed 
asthma. By comparison, the nationwide asthma rate for children 5 to 14 
is 7.4 per cent. Moreover, many of the asthma cases were severe: 42 per 
cent had trouble sleeping once or twice a week because of wheezing, and 
87 per cent had emergency room visits during the previous year.
  Asthma disproportionately attacks many of society's most vulnerable 
those least able to fight back, children and minorities. A recent New 
York Times article described a study in the Brooklyn area where it was 
found that a staggering 38 per cent of homeless children suffer from 
asthma.
  Some of the factors known to contribute to asthma such as poor living 
circumstances, exposure to cockroach feces, stress, exposure to 
dampness and mold are all experienced by homeless children. They are 
also experienced by children living in poor housing or exposed to urban 
violence. There are other factors such as exposure to second hand smoke 
and smog that also exacerbate or trigger asthma attacks.
  For minorities, asthma is particularly deadly. The Asthma death rate 
for African-Americans is more than twice as high as it is for other 
segments of the population. Illinois has the highest asthma-related 
death rate in the country for African-American males. The death rate is 
3 times higher than the asthma-related death rate for whites in 
Illinois. Nationwide, the childhood asthma-related death rate in 1993, 
was 3 to 4 times higher for African Americans compared to Caucasian 
Americans. The hospitalization rate for asthma is almost three times as 
high among African-American children under the age of 5 compared to 
their white counterparts The increased disparity between death rates 
compared to prevalence rates has been partially explained by decreased 
access to health care services for minority children.
  Even though asthma rates are particularly high for children in 
poverty, they are also rising substantially for suburban children. 
Overall, the rates are increasing. Every one of us knows of a child 
whether our own, a relative's or a friend's who suffers from asthma.
  Asthma-related death rates have tripled in the last two decades. My 
state of Illinois has the highest asthma-related deaths in the country 
for African American men.
  The effects of asthma on society are widespread. Many of you may be 
surprised to learn that asthma is the single most common reason for 
school absenteeism. Parents miss work while caring for children with 
asthma. Beyond those days missed at school and parents missing work, 
there is the huge emotional stress suffered by asthmatic children. It 
is a very frightening event for a small child to be unable to breathe. 
A recent US News article quoted an 8-yr old Virginian farm girl, 
Madison Benner who described her experience with asthma. She said ``It 
feels like something was standing on my chest when I have an asthma 
attack.'' This little girl had drawn a picture of a floppy-eared, big 
footed elephant crushing a frowning girl into her bed.
  In many urban centers, over 60 per cent of childhood admissions to 
the emergency room are for asthma. There are 1.8 million emergency room 
visits each year for asthma. Yet the emergency room is hardly a place 
where a child and the child's parents can be educated in managing their 
asthma. In 1994, 466,000 Americans were hospitalized with asthma, up 
from 386,000 in 1979.
  Asthma is one of the most common and costly diseases in the US. In 
contrast to most other chronic diseases, the health burden of asthma is 
increasing rapidly. The financial burden of asthma was $6.2 billion in 
1990 and is estimated to increase to more than $15 billion in 2000.
  Most children who have asthma develop it in their first year, but it 
often goes undiagnosed or as the study I mentioned earlier, the 
children may not receive the best treatment. The National Institutes of 
Health is home to the National Asthma Education and Prevention board. 
This is a large group of experts from all across the fields involved in 
health care and asthma. They have developed guidelines on both treating 
asthma and educating children and their parents in prevention. It is 
very important that when we spend money on developing such guidelines 
that they actually get out to communities so that they can take 
advantage of this research.
  CDC has been working in collaboration with NIH to make sure that 
health professionals and others get the most up to date information. My 
amendment could further help this effort by providing grantees with 
this information.
  We do have treatments that work for most people. Early diagnosis, 
treatment and management are key to preventing serious illness and 
death. There are several wonderful models for success already available 
to some communities. Take for example the ``breathmobile'' program in 
Los Angeles that was started 2 years ago. This program provides a van 
that is equipped with medical personnel, asthma education materials, 
and asthma treatment supplies. It goes out to areas

[[Page 24498]]

that are known to have a high incidence of childhood asthma and screens 
children in those areas. This ``Breathmobile'' program has reduced 
trips to the emergency room by 17 per cent in the first year of 
operation. This program is being expanded to sites in Phoenix, Atlanta, 
and Baltimore. I hope that we can be as successful in Illinois and 
other parts of the country. Children in these Breathmobile programs are 
also enrolled in the Children's Health Program if they are income 
eligible. We have all heard of how slow enrollment in the children's 
health program has been and anything that we can do to speed enrollment 
up is vitally important.
  In West Virginia, a Medicaid ``disease management'' program which 
seeks to coordinate children with asthma's care so that they get the 
very best care has been found to be very cost effective. It has reduced 
trips to the emergency room by 30 per cent.
  In Illinois, the Mobile CARE Foundation is setting up a program in 
Chicago based on the Los Angeles initiative. In addition, the American 
Association of Chest Physicians has joined with other groups to form 
the Chicago Asthma Consortium to provide asthma screening and 
treatment. Efforts like these need our amendment. This Childhood Asthma 
Amendment would expand these programs to help ensure that no child goes 
undiagnosed and every asthmatic child gets the treatment he or she 
needs.
  I am offering this amendment here today with my colleague from Ohio, 
so that we can expand these programs to other areas of the country. It 
is a very simple amendment. It adds $10 million to the Centers for 
Disease Control's appropriations for local community grants to screen 
children for asthma and if they are found to have it, to provide them 
with treatment and education into how to manage their asthma.
  CDC has current authority to carry out such programs and as the Bill 
Report already notes on page 93 of the report: ``The Committee is 
pleased with the work that CDC has done to address the increasing 
prevalence of asthma. However the increase in asthma among children, 
particularly among inner-city minorities, remains alarming. The 
Committee urges CDC to expand its outreach aimed at increasing public 
awareness of asthma control and prevention strategies, particularly 
among at risk minority populations in under-served communities.'' I 
couldn't agree more. We do need to do more in this area.
  No child should die from asthma. We need to make sure that people 
understand the signs of asthma and that all asthmatic children have 
access to treatment and information on how to lessen their exposure to 
things that trigger asthma attacks.
  My amendment responses to the alarming increase in childhood asthma 
cases and asthma-related deaths. It would provide funds to community 
and state organizations that serve areas with the largest number of 
children who are at risk of developing asthma and areas with the 
highest asthma-related death rates. The grantees could use the funds to 
develop programs to best meet the needs of their residents. The funds 
could be targeted to those communities where there are the highest 
number of children with asthma or where there is the highest number of 
asthma-related deaths.
  This amendment is a small step toward addressing this the single 
greatest chronic health illness of children today. $10 million is a 
pretty small sum. I am glad that this amendment has been accepted.
  The Amendment is supported by the American Lung Association, the 
National Association for Children's Hospitals and Research 
Institutions, the Academy of Pediatrics, the Asthma and Allergy 
Foundation of America and others who support children's health.
  I thank my colleagues on behalf of the 5 million children who suffer 
from asthma today in America for accepting this amendment that can make 
some progress to combat this the most preventable childhood illness.
  Mr. DeWINE. Mr. President, today I rise to support the Durbin-DeWine 
pediatric asthma amendment. This amendment would appropriate $10 
million for the Centers for Disease Control and Prevention, CDC, to 
award grants to local communities for screening, treatment, and 
education relating to childhood asthma.
  On May 5th of this year, the Allergy and Asthma Network's Mothers of 
Asthmatics organized an asthma awareness day to educate everyone about 
asthma. As most of you probably know, asthma is a chronic lung disease 
caused by inflammation of the lower airways. During an asthma attack, 
these airways narrow--making it difficult and sometimes impossible to 
breathe. Fortunately, we have the ``tools'' to handle asthma attacks 
once they occur. The most common way, of course, is to use an asthma 
inhaler that millions of us use every day. We also know a lot about how 
to prevent asthma attacks in the first place--through drug therapy and 
by avoiding many well-known asthma triggers.
  With asthma prevalence rates--and asthma death rates--on the rise, 
especially in inner-city populations, it is important for us to raise 
national awareness, so we can educate families on how to detect, treat, 
and manage asthma symptoms. Of the more than 15 million Americans who 
suffer from asthma, over five million are children. The American Lung 
Association estimates that in my home state of Ohio, 212,895 children 
under the age of 18 suffer from asthma. That's about two percent of the 
entire population in Ohio. Asthma is the most common chronic illness 
affecting children and is the leading cause of missed school days due 
to chronic illness.
  Asthma is hitting the youngest the hardest. Nationwide, the most 
substantial prevalence rate increase for asthma occurred among children 
4 years-old and younger. Hospitalization rates due to asthma were also 
highest in this young age group, rising 74 percent between 1979 and 
1992. These increases in hospitalization rates are especially affecting 
the inner city populations, where asthma triggers, like air pollutants, 
are more concentrated.
  An August 29 Akron Beacon Journal article cites statistics from the 
CDC that show the ratio of children under age four with asthma 
increased from one in forty-five in 1980 to one in seventeen in 1994. 
Every year, more than 5,000 Americans die from this disease--these are 
PREVENTABLE deaths. A July 27 New York Times article described the 
results of a study performed by a team at the Center for Children's 
Health and the Environment at Mount Sinai School of Medicine. This 
study found that hospitalization rates were as much as 21 times higher 
in poor, minority areas than in the hardest-hit areas of wealthier 
communities. The article quotes Dr. Claudio, an assistant professor in 
the division of neuropathology at Mount Sinai, who said, ``The outcomes 
in the poor Latino and African-American areas, especially among 
children, are tragic.'' This Mount Sinai report cited previous studies 
that suggest that poor African-American and Latino children are 
suffering at higher rates because the poor often rely on care in 
emergency rooms, where doctors have little time to educate families on 
how to control the disease and where there is little follow-up care. 
Without receiving adequate care and medication, the asthma victims 
eventually suffer such severe attacks that they need immediate 
hospitalization.
  Those are some of the reasons why I joined my colleague, Senator 
Durbin, in introducing S.805, the ``Children's Asthma Relief Act.'' 
This bill will help ensure that children with asthma receive the care 
they need to live normal lives. It provides grants that will be used to 
develop and expand asthma services to children, equip mobile health 
care clinics that provide diagnosis and asthma-related health care 
services, educate families on asthma management, and identify and 
enroll uninsured children who are eligible for, but not receiving, 
health coverage under Medicaid or the State Children's Health Insurance 
Program. By requiring coordination with current children's health 
programs, this bill will help us identify children--in programs

[[Page 24499]]

such as supplemental nutrition programs, Maternal and Child Health 
Programs, child welfare and foster care and adoption assistance 
programs--who are asthmatic, but might otherwise remain undiagnosed and 
untreated.
  By increasing local asthma surveillance activities through 
legislation, such as S.805, and by better educating the public on the 
importance of asthma awareness and management through events like 
Asthma Awareness Day, we can help reverse the distressing increase in 
hospitalization rates and mortality rates due to asthma. As a person 
with asthma, and as the father of 3 children with asthma, I know first-
hand how important diagnosis, treatment, and management are to ensuring 
that this manageable disease will not prevent children and adults from 
carrying on normal lives. We can make a big difference.
  Asthma is a serious health concern that simply must be addressed.
  I commend my colleague, Senator Frist, for the outstanding children's 
health hearing that his Public Health Subcommittee held on September 
16. A very articulate 13-year old named Robert Jackson from South 
Euclid, OH, testified at that hearing. He described how important early 
diagnosis and treatment plans are for children who suffer from asthma. 
According to Robert, doctors at Rainbow Babies and Children's Hospital 
in Cleveland explained to him how he could avoid asthma ``triggers''--
like cigarette smoke and strong odors like bleach--to avoid having 
serious asthma attacks. By learning how to manage his asthma through an 
asthma treatment plan, Robert now plays sports, attends school 
regularly, and maintains a newspaper route.
  At a time when States, like Ohio, finally are passing laws that allow 
students to take their asthma inhalers to school, we need to provide 
the federal public health dollars to the CDC for childhood asthma 
screening, treatment, and education. The states gradually are realizing 
the severity of this disease and the need for children to access their 
inhalers to manage their asthma. It is now time for the Federal 
Government to help local communities stem the rising prevalence of the 
worst chronic health problem affecting children.
  I commend my colleagues for supporting this very important amendment 
as it will help the nearly 5 million children who have been diagnosed 
with asthma, as well as those children who suffer from asthma, but 
remain undiagnosed and--sadly--untreated.


                           AMENDMENT NO. 2287

 (Purpose: To rename the Centers for Disease Control and Prevention as 
    the Thomas R. Harkin Centers for Disease Control and Prevention)

       At the appropriate place, insert the following:
       Sec. (a) The Centers for Disease Control and Prevention 
     shall hereafter be known and designated as the ``Thomas R. 
     Harkin Centers for Disease Control and Prevention''.
       (b) Effective upon the date of enactment of this Act, any 
     reference in a law, document, record, or other paper of the 
     United States to the ``Centers for Disease Control and 
     Prevention'' shall be deemed to be a reference to the 
     ``Thomas R. Harkin Centers for Disease Control and 
     Prevention''.
       (c) Nothing in this section shall be construed as 
     prohibiting the Director of the Thomas R. Harkin Centers for 
     Disease Control and Prevention from utilizing for official 
     purposes the term ``CDC'' as an acronym for such Centers.
                                  ____



                           AMENDMENT NO. 2288

  (Purpose: To designate the National Library of Medicine building in 
    Bethesda, Maryland, as the ``Arlen Specter National Library of 
                              Medicine'')

       At the appropriate place, insert the following:

     SEC. __. DESIGNATION OF ARLEN SPECTER NATIONAL LIBRARY OF 
                   MEDICINE.

       (a) In General.--The National Library of Medicine building 
     (building 38) at 8600 Rockville Pike, in Bethesda, Maryland, 
     shall be known and designated as the ``Arlen Specter National 
     Library of Medicine''.
       (b) References.--Any reference in a law, map, regulation, 
     document, paper, or other record of the United States to the 
     building referred to in subsection (a) shall be deemed to be 
     a reference to the Arlen Specter National Library of 
     Medicine.
                                  ____



                           amendment no. 2289

 (Purpose: To increase funding for senior nutrition programs and rural 
      community facilities, offset with administrative reductions)

       On page 39, line 8, strike ``$6,682,635,000'' and insert 
     ``$6,684,635,000''.
       On page 40, line 20, strike ``$928,055,000'' and insert 
     ``$942,355,000''.
       On page 41, line 14, reduce the figure by $10,300,000.
       On page 62, line 23, strike ``$378,184,000'' and insert 
     ``$372,184,000''.
                                  ____



                           amendment no. 1852

  (Purpose: To express the sense of the Senate concerning needlestick 
                           injury prevention)

       At the appropriate place, insert the following:


       sense of the senate on prevention of needlestick injuries

       Sec. __. (a) Findings.--The Senate finds that--
       (1) the Centers for Disease Control and Prevention reports 
     that American health care workers report more than 800,000 
     needlestick and sharps injuries each year;
       (2) the occurrence of needlestick injuries is believed to 
     be widely under-reported;
       (3) needlestick and sharps injuries result in at least 
     1,000 new cases of health care workers with HIV, hepatitis C 
     or hepatitis B every year; and
       (4) more than 80 percent of needlestick injuries can be 
     prevented through the use of safer devices.
       (b) Sense of the Senate.--It is the sense of the Senate 
     that the Senate should pass legislation that would eliminate 
     or minimize the significant risk of needlestick injury to 
     health care workers.

  Mr. ENZI. Mr. President, I rise in opposition to Senator Reid's 
amendment No. 1852 as offered to S. 1650. As chairman of the Senate 
Subcommittee on Employment, Safety and Training, I have had the 
opportunity to follow this issue first-hand. Make no mistake, ensuring 
the safety of our Nation's health care workers is a priority--as it is 
for all of our Nation's workforce. How we can best capitalize on 
occupational safety, however, is the basis for my opposition to this 
amendment. I do not feel that this amendment is appropriate on a 
spending bill. Nor is our agreeing to future legislation--sight unseen. 
Moreover, the Occupational Safety and Health Administration is already 
examining this matter and has not commented to my request as to why 
legislation is now warranted.
  ``Sharp'' injuries by exposed needles have a long history. Not only 
has Senator Reid been interested in occupational injuries caused by 
unprotected syringes, but Senator Boxer has also shared her concerns as 
well. As chairman of the subcommittee with jurisdiction, I am a bit 
disappointed that my colleagues have yet to approach me on this issue. 
I am always eager to discuss occupational safety with members of this 
body. Instead, I first learned of this issue when the San Francisco 
Chronicle ran a series of articles in April, 1998. One article depicted 
a nurse practitioner who tried to catch three blood-collection tubes as 
they rolled toward a counter's edge. At the same time, she held a 
syringe in her right hand that had just drawn blood from a patient 
infected with HIV. The exposed needle pierced the side of her left 
index finger. Working with HIV infected patients is dangerous business, 
but the risk compounds when medical devices designed to improve health 
care end up doing just the opposite.
  At the request of the Service Employees International Union (SEIU) 
and other interested groups representing health care workers, federal 
OSHA announced last year that it was issuing a formal request for 
information pertaining to injuries caused by unprotected syringes. 
Senators Jeffords, Frist and I wrote to Secretary Herman. We sought 
answers concerning potential enforcement action by OSHA with regard to 
medical devices that could conflict with FDA's traditional and 
statutory jurisdiction. The FDA is statutorily charged with the 
nationwide regulation of medical devices. All syringes are defined as 
Class II medical devices in Section 513(a)(1) of the Federal Food, Drug 
and Cosmetic Act. According to Sections 510(k), 519(e) and 705(a), the 
FDA has the statutory jurisdiction to review, approve and recall 
medical devices as well as to disseminate information regarding the 
potential health dangers caused by any medical device.
  FDA's jurisdiction over medical devices pertains to the patient. 
Since OSHA's jurisdiction covers workers,

[[Page 24500]]

the agency is already moving forward to modify its Bloodborne Pathogens 
Standard to include regulation of medical ``sharp'' devices. In terms 
of worker safety, we are talking about nurses, doctors and other health 
care professionals and workers that regularly use or handle these 
medical devices. The regulatory lines between the two agencies are 
difficult to define in this setting. Moreover, the question of reusing 
medical devices designed for one-time use only is also a matter that 
requires careful consideration. Generally speaking, safer devices cost 
more money--raising the potential for re-use by providers. The FDA has 
not yet indicated that it will begin to examine this issue, but it is 
certainly a matter of importance that includes the very medical devices 
we're debating in this amendment.
  A medical device that has been determined by the FDA to meet the 
``reasonable assurance of safety and efficacy'' standard of the Federal 
Food, Drug and Cosmetic Act can be lawfully marketed. Nonetheless, it 
is conceivable, given its authority over the domain of worker safety 
and health that OSHA might prevent the use of that medical device in 
the workplace, thereby creating an environment of confusion for the 
regulated public. This confusion could result in diminished worker 
safety and health and jeopardize patient safety as well. At the very 
least, this duplication of effort promises to waste the scarce 
resources of both the FDA and OSHA.
  I recognize Section 4(b) of the Occupational Safety and Health Act of 
1970 and the problems inherent in conflicting regulations which are 
promulgated by different federal agencies and affect occupational 
safety and health. Although OSHA arguably might have sufficient 
jurisdiction to proceed in the indirect regulation of the 
aforementioned medical devices, I feel that it would be the best course 
for OSHA and the FDA to delineate boundaries of jurisdiction and 
coordinate efforts pertaining to the regulation and use of these 
medical devices. This is of particular importance because the FDA has 
the specific scientific expertise in the evaluation of medial devices--
not OSHA and not the National Institute for Occupational Safety and 
Health (NIOSH). Despite Secretary Herman's assurances that agency 
cooperation is ongoing, I am not convinced that these boundaries have 
been properly addressed at this time. This amendment does nothing to 
address the lack of communication between these agencies.
  There are currently two manufacturers that are actively marketing 
protected syringes. If OSHA is instructed to regulate this matter by 
statutory instruction, I am concerned that a shortage of supply could 
occur. Not only does this raise questions of anti-trust, it also places 
providers in the difficult position of being held liable for using 
medical devices that are short in supply. The market and what it can 
currently sustain would not be a matter of consideration if this 
amendment passes. Moreover, providers (hospitals) could be put in a 
position to determine what devices are safe and effective if their 
participation is not adequately included in this process.
  As OSHA moves forward on its own accord in a fashion that could lead 
to its regulation of medical devices, Senator Jeffords and I continue 
to wait for a formal explanation from the agency as to how legislation 
would impact their current efforts to flush out many of the concerns I 
have raised. We are still waiting for that response. Moreover, Chairman 
Jeffords has voiced his interest in examining this issue within the 
authorizing committee. In doing so, we would be better positioned to 
address this emotional and complex issue rather than haphazardly 
legislating on an appropriations bill.
  I am committed to finding ways to enhance worker safety. If I thought 
legislating through the appropriations process was such a wonderful 
option, I have a few bills that I wouldn't mind spending a little time 
debating on the floor of the Senate. In terms of improving occupational 
safety, I respect the role of our committee to examine these complex 
issues. Last Congress, I had the opportunity to amend the Occupational 
Safety and Health Act of 1970 three separate times. That was the first 
time the Act had been amended in 28 years. All of the bills were 
carefully considered prior to passage and not one of them were tagged 
to an appropriations bill. I ask that this issue be handled by its 
authorizing committee and not be attached to the underlying bill. I am 
committed to doing just that.


                           amendment no. 1869

(Purpose: To increase funding for the leveraging educational assistance 
                          partnership program)

       At the end of title III, add the following:


         leveraging educational assistance partnership program

       Sec.   . (a) In General.--Notwithstanding any other 
     provision of this title, amounts appropriated in this title 
     to carry out the leveraging educational assistance 
     partnership program under section 407 of the Higher Education 
     Act of 1965 (20 U.S.C. 1070 et seq.) shall be increased by 
     $50,000,000, and these additional funds shall become 
     available on October 1, 2000.

  Mr. REED. Mr. President, I am pleased that Chairman Specter and 
Ranking Member Harkin as part of the managers amendment have included 
an additional $50 million for the Leveraging Educational Assistance 
Partnership (LEAP) program.
  I had offered an amendment to provide this level of funding along 
with Senators Collins, Gordon Smith, Snowe, Jeffords, Kennedy, Murray, 
Levin, Conrad, Hutchinson, DeWine, Chafee, Bingaman, Kerry, Feingold, 
and Lautenberg.
  Since 1972, the Federal-State partnership now embodied by LEAP, with 
modest federal support, has helped states leverage grant aid to needy 
undergraduate and graduate students.
  When this program was funded at greater than $25 million, nearly 
700,000 students across the nation, including almost 12,000 students 
from my home state of Rhode Island, benefitted from LEAP grants. At $25 
million, the amount included in the Committee's original bill, we 
estimate that many of these students lose their grants.
  Without this important federal incentive, many states would not have 
established or maintained their need-based financial aid programs, and 
many students would not have attended or completed college.
  Indeed, as my colleagues, students, parents, and those involved in 
higher education know, the purchasing power of our main need-based aid 
program--the Pell Grant, created by and named for my predecessor, 
Senator Claiborne Pell--has fallen drastically in comparison to 
inflation and skyrocketing education costs.
  Students have searched for other sources of need-based higher 
education grants and have come to rely on LEAP.
  Two years ago, this program was on the brink of elimination. But it 
was this body which recognized the importance of LEAP and 
overwhelmingly voted--84 to 4--for an amendment I offered with my 
colleague from Maine, Senator Collins, to save it from elimination.
  Then, just last year, the Senate reaffirmed its support for LEAP by 
approving the Higher Education Act Amendments of 1998, which updated 
and added several key reforms to this program to leverage additional 
state dollars for grant aid.
  Prior to the reforms, federal funding for LEAP was matched by the 
states only on a dollar for dollar basis. Now, every dollar 
appropriated over the $30 million level leverages two new state 
dollars.
  States in turn gain new flexibility to use these funds to provide a 
broader array of higher education assistance to needy students, such as 
increasing grant amounts or carrying out community service work-study 
activities; early intervention, mentorship, and career education 
programs; secondary to postsecondary education transition programs; 
scholarship programs for students wishing to enter the teaching 
profession; and financial aid programs for students wishing to enter 
careers in information technology or other fields of study determined 
by the state to be critical to the state's workforce needs.
  The $25 million included in the Committee's bill falls far short of 
the funding level necessary to increase student

[[Page 24501]]

aid and trigger the reforms included in the Higher Education Act 
Amendments of 1998.
  In fact, LEAP, if funded at $75 million, as called for in our 
amendment, would leverage at least $120 million in new state funding--
thereby securing almost $200 million in grant aid for our nation's 
neediest students.
  Let me emphasize, LEAP is the only federal aid program that contains 
this leveraging component. It is the only program for needy college 
students that is a state-federal partnership.
  The bill does provide increased funding for many of the other student 
aid programs, but without providing additional funding for LEAP, the 
Senate will miss an opportunity to expand access to college and make 
higher education more affordable for some of our neediest students.
  LEAP is a vital part of our student aid package, which includes Pell 
Grants, Work Study, and SEOG, that make it possible for deserving 
students to achieve their higher education goals. All of the student 
aid programs must be well-funded if they are truly going to help 
students.
  Moreover, since there are no federal administrative costs connected 
with LEAP, all grant funds go directly to students, making it one of 
the most efficient federal financial aid programs.
  All higher education and student groups support $75 million in 
funding for LEAP, including the American Council on Education (ACE), 
the National Association of Independent Colleges and Universities 
(NAICU), the National Association of State Student Grant and Aid 
Programs (NASSGAP), the United States Student Association (USSA), and 
the U.S. Public Interest Research Group (USPIRG).
  By providing $75 million for LEAP, the Senate has an opportunity to 
help states leverage even more dollars to help students go to college. 
As college costs continue to grow, and as the grant-loan imbalance 
continues to widen--just 25 years ago, 80% of student aid came in the 
form of grants and 20% in the form of loans; now the opposite is true--
funding for LEAP is more important than ever.
  I thank Chairman Specter and ranking member Harkin for their 
willingness to accept this amendment. I look forward to working with 
them during the Conference to retain this level of funding, which is 
critical to providing greater access to higher education for our 
Nation's neediest students.
  Mr. JEFFORDS. Mr. President, I express my appreciation to Senators 
Specter and Harkin for including in the manager's package an amendment 
cosponsored by my colleague from Rhode Island, Senator Reed, myself and 
others increasing funding for the LEAP program.
  LEAP is an extraordinarily program that provides grant aid to needy 
undergraduate and graduate students. This federal program can be 
credited in large part with encouraging States to create, maintain and 
grow their own need-based financial aid programs. It is a program that 
relies on a partnership for its strength by matching the federal 
investment in grant aid with State dollars. The end result is a good 
one: increasing the pool of funds available to assist low income 
students who are struggling to pay for college.
  As part of the 1998 Higher Education Amendments, we made significant 
changes to the LEAP program with the goal of making additional grant 
aid and a greater array of services available to post-secondary 
students. We challenged States to increase the match that they 
contribute by offering $2 for every one federal dollar that we make 
available for this program. With the additional funds, States will have 
greater flexibility to provide more services to meet the diverse needs 
of low income students who are working to make the dream of a higher 
education degree a reality.
  I am proud to stand with the National Association of State Student 
Grant Aid, NASSGAP; the National Association of Independent Colleges 
and Universities, NAICU, the American Council on Education, ACE, the 
American Association of State Colleges and Universities, AASCU; the 
United States Public Interest Research Group, USPIRG; and the United 
States Student Association, USSA in support of this amendment that I 
believe will provide significant assistance to the students of this 
nation.


                           amendment no. 1882

 (Purpose: To express the sense of the Senate regarding comprehensive 
                           education reform)

       At the appropriate place, insert:

     SEC.   , SENSE OF THE SENATE REGARDING COMPREHENSIVE PUBLIC 
                   EDUCATION REFORM.

       (a) Findings.--The Senate finds the following:
       (1) Recent scientific evidence demonstrates that enhancing 
     children's physical, social, emotional, and intellectual 
     development before the age of six results in tremendous 
     benefits throughout life.
       (2) Successful schools are led by well-trained, highly 
     qualified principals, but many principals do not get the 
     training that the principals need in management skills to 
     ensure their school provides an excellent education for every 
     child.
       (3) Good teachers are a crucial catalyst to quality 
     education, but one in four new teachers do not meet state 
     certification requirements; each year more than 50,000 under-
     prepared teachers enter the classroom; and 12 percent of new 
     teachers have had no teacher training at all.
       (4) Public school choice is a driving force behind reform 
     and is vital to increasing accountability and improving low-
     performing schools.
       (b) Sense of the Senate.--It is the sense of the Senate 
     that the federal government should support state and local 
     educational agencies engaged in comprehensive reform of their 
     public education system and that any education reform should 
     include at least the following principals:
       (A) that every child should begin school ready to learn by 
     providing the resources to expand existing programs, such as 
     Even Start and Head Start;
       (B) that training and development for principals and 
     teachers should be a priority;
       (C) that public school choice should be encouraged to 
     increase options for students; and
       (D) that support should be given to communities to develop 
     additional counseling opportunities for at-risk students.
       (E) school boards, administrators, principals, parents, 
     teachers, and students must be accountable for the success of 
     the public education system and corrective action in 
     underachieving schools must be taken.

  Mr. KERRY. Mr. President, I thank my distinguished colleagues, Mr. 
Specter from the State of Pennsylvania and Mr. Harkin from the State of 
Iowa, for accepting in the manager's amendment of S. 1650 the sense of 
the Senate that my friend from Oregon, Mr. Smith and I offered on 
comprehensive education reform. Our amendment expresses the sense of 
the Senate that the federal government should support state and local 
efforts to reform and improve our nation's public schools, and further, 
that every child should begin school ready to learn; that training and 
development for principals and teachers should be a priority; that 
public school choice should be encouraged to increase options for 
students; that support should be given to communities to develop 
additional counseling opportunities for at-risk students; and that 
school boards, administrators, principals, parents, teachers, and 
students must be accountable for the success of the public education 
system.
  I appreciate that my distinguished colleagues have acknowledged the 
importance of a bipartisan, comprehensive approach to reforming the 
public education system that emphasizes the principles enumerated 
above. If education reform is to succeed in America's public schools, 
we must demand nothing less than a comprehensive reform effort. We 
cannot address only one challenge in education and ignore the rest. We 
must make available the tools for real comprehensive reform so that 
every aspect of public education functions better and every element of 
our system is stronger. We must empower low-performing schools to adopt 
all the best practices of our nation's best schools--public, private, 
charter or parochial. We must give every school the chance to quickly 
and easily put in place the best of what works in any other school--and 
with decentralized control, site-based management, parental engagement, 
and real accountability. Numerous high-performance school designs have 
been created such as the Modern Red Schoolhouse program and the Success 
for All program. The results of extensive evaluations of these programs 
have shown that these designs are successful in raising student 
achievement.

[[Page 24502]]

  We must also restore accountability in public education--demanding 
that each school embracing comprehensive reform set tangible, 
measurable results to gauge their success in raising student 
achievement. We must reward schools which meet high standards and 
demand that those which fall short of their goals take immediate 
corrective action--but the setting of high standards must undergird 
comprehensive reform.
  In order to do this, we must break out of the ideological bind we 
have put ourselves in. We cannot only talk about education--it's more 
than an issue for an election--we must do something about it. We have 
the opportunity to implement comprehensive education reform at a time 
when the American people are telling us that--for their families, for 
their futures--in every poll of public opinion, in every survey of 
national priorities, one issue matters most, and it's education. That 
is good news for all of us who care about education, who care about our 
kids. But the bad news is, the American people are not so sure that we 
know how to meet their needs anymore. They are not even sure we know 
how to listen. Every morning, more and more parents--rich, middle 
class, and even the poor--are driving their sons and daughters to 
parochial and private schools where they believe there will be more 
discipline, more standards, and more opportunity. Families are 
enrolling their children in Charter schools, paying for private schools 
when they can afford them, or even resorting to home schooling--the 
largest growth area in American education.
  Earlier in this debate, I supported two amendments offered by the 
distinguished Senator and my senior colleague from the State of 
Massachusetts, Mr. Kennedy. I am deeply disappointed that neither of 
these worthy amendments were adopted by the Senate. Mr. Kennedy's 
amendments would have exempted education from the across the board cuts 
in discretionary spending that Republicans have proposed and provided 
increased funding for teacher quality. We know the American people are 
willing to spend more on public education. Yet the Senate voted to 
allow cuts. And we know that the American people want qualified 
teachers in their children's schools. Yet the Senate did not 
appropriate the fully authorized level of the Teacher Quality 
Enhancement Grants program.
  I am also distressed that an amendment offered by my distinguished 
colleagues, Mr. Bingaman and Mr. Reed, and myself was not adopted by 
this body. Our amendment would have, for the first time, provided real 
accountability to poor children and ensure they attend successful 
schools. The American people have said time and again that education is 
their top policy concern. And we have heard time and again that the 
American people want their public schools held accountable. Yet we 
rejected this important amendment, that would have appropriated no new 
funding and would have ensured low-performing schools would be turned 
around, was rejected.
  Given our inability to pass these important amendments, I am 
particularly pleased that Mr. Smith and I could come together and offer 
this bipartisan amendment. The sense of the Senate we offered is the 
essence of our bill, S. 824, the ``Comprehensive School Improvement and 
Accountability Act.'' Our bill emphasizes the principles embodied in 
this sense of the Senate, such as early childhood development programs, 
challenge grants for professional development of principals, second 
chance schools for violent and disruptive students, and increased 
funding for the Title I program. We contend that these and other tenets 
are fundamental to the comprehensive reform of public schools.
  The PRESIDING OFFICER. Without objection, the amendments are agreed 
to.
  The amendments (Nos. 2273 through 2289, 1852, 1869, and 1882) were 
agreed to.


                      indian-chicano health center

  Mr. KERREY. I thank the Chairman and Ranking Member of the 
Subcommittee for their continued support for community health centers 
and other programs within the consolidated health centers account. I 
firmly believe that these centers represent the best investment the 
Federal government can make in health care for under-served populations 
and under-served areas. These centers provide an invaluable service to 
our communities and our citizens--they provide comprehensive primary 
and preventive services to a broad spectrum of persons without health 
insurance and members of under-served populations. I note that the bill 
before us increases funding for these centers by nearly $100 million, 
and exceeds the President's request by $79 million.
  It is my hope that the Department of Health and Human Services will 
use at least part of this new funding to establish new community health 
centers to address the needs of under-served populations. I am 
particularly interested in guaranteeing that a proposal from the 
Indian-Chicano Health Center of Omaha, Nebraska, be fully and fairly 
considered during any review of new health center applications. This 
organization has made an extraordinary effort to serve a unique 
community of low-income, uninsured Nebraskans who otherwise would go 
without health care.
  Mr. SPECTER. The Labor/HHS/Education Subcommittee made a particular 
effort within the constraints of this bill to increase funding for the 
consolidated health centers account. The Subcommittee strongly supports 
the provision of comprehensive health services to persons without 
health insurance through these important providers. I am pleased that 
we were able to increase funding for these critical services, and I 
encourage HHS to consider the proposal from the Indian-Chicano Health 
Center.
  Mr. HARKIN. I have long supported the work of the Iowa-Nebraska 
Primary Care Association and specific community health centers in the 
Midwest. These providers serve as models for effectively and 
efficiently providing access and quality care to under-served 
populations. I will also support full and fair consideration of the 
Indian-Chicano Health Center proposal.


            The Maryland Children's Health Insurance Program

  Mr. SARBANES. Mr. President, as the Senate continues its 
consideration of the Labor-HHS Appropriations bill today, I rise to 
discuss a problem the State of Maryland is struggling to overcome as it 
seeks to extend health care coverage to the 158,000 uninsured children 
in our State. This issue is particularly timely in light of the Census 
Bureau report issued earlier this week which shows that the ranks of 
the uninsured grew by approximately 1 million in 1998 to a total of 
44.3 million. The Census report also shows that the number of uninsured 
children has not decreased despite the establishment of a new Federal 
program designed to encourage States to expand health insurance 
coverage to more low-income children. Moreover, Maryland experienced 
one of the highest increases in uninsured people last year bringing the 
total number of uninsured to 837,000 or one-sixth of the population. A 
quarter of these uninsured Marylanders are children.
  To address the growing number of uninsured children throughout the 
United States, Congress enacted the Children's Health Insurance Program 
(CHIP) in 1997, and Maryland eagerly applied to participate in this new 
Federal-State partnership. However, over the past couple of years, 
Maryland has been penalized under this program for having previously 
extended partial Medicaid coverage under a five year demonstration 
program to a class of low-income children who would not otherwise have 
qualified for Medicaid. These children should now be eligible for CHIP 
funding, but the Department of Health and Human Services (HHS) is 
blocking Maryland from accessing its CHIP funds for the benefit of 
these kids.
  The law establishing the CHIP program prohibits the States from 
enrolling children into the State's CHIP program if those children were 
previously covered by the State's Medicaid program. HHS has made the 
decision to treat all children once eligible for the

[[Page 24503]]

Maryland demonstration program, called the Maryland Kids Count program, 
as though they were covered under Medicaid. As a result of this 
discretionary decision by HHS, the majority of Maryland's uninsured 
children are ineligible for CHIP funding. In addition, Maryland has 
been unable to access most of the CHIP funding allocated to it.
  The Maryland demonstration program should not be used to disqualify 
the State from accessing its CHIP funds because this demonstration 
cannot be equated with covering this group of children with full 
Medicaid coverage. The Maryland demonstration offered only partial 
Medicaid benefits (primary and preventive care). Hospitalization as 
well as dental and medical equipment were not covered. Thus, for each 
child in the demonstration program, Maryland spent less than half the 
amount it would have spent had Medicaid been extended to these 
children.
  In addition, this demonstration program was conducted under a time-
limited waiver which was scheduled to expire at about the same time the 
CHIP program was launched. In fact, HHS informed Maryland that it would 
not renew the waiver because Congress was establishing a more 
comprehensive children's insurance program and also because the 
Maryland demonstration had been rather unsuccessful. Only 5,000 
children were enrolled, largely because the benefits offered were so 
limited.
  HHS has used its discretionary authority in implementing the CHIP 
program to equate the Maryland demonstration program with full Medicaid 
coverage. Since they used discretionary authority to make this 
erroneous determination, HHS clearly has the authority to reverse this 
decision administratively. Would the Senator from Delaware, the 
Chairman of the Finance Committee, agree that the Department of Health 
and Human Services has authority to allow Maryland to access its CHIP 
funds to extend health insurance coverage to those low-income children 
previously eligible for the Maryland Kids Count demonstration program 
without additional legislative action?
  Mr. ROTH. I understand the Senator from Maryland's concerns. It is my 
view that the Secretary of Health and Human Services has authority, 
without additional legislative direction, to determine that children 
who had been covered under Maryland's expired, limited-benefit 
demonstration program were not receiving true Title XIX coverage, and 
could therefore be considered uninsured for the purposes of CHIP 
eligibility.
  Mr. SARBANES. I thank the Chairman for that clarification. Do you 
agree that HHS may use its section 1115 waiver authority to allow 
Maryland to use its CHIP funds to cover those children previously 
eligible for the Maryland Kids Count program?
  Mr. ROTH. I concur with the Senior Senator from Maryland that HHS 
could use its section 1115 waiver authority to address Maryland's 
concerns.
  Mr. SARBANES. Thank you, Mr. Chairman.


                daniel j. evans school of public affairs

  Mr. GORTON. Mr. President, the current political climate in our 
society is becoming increasingly disillusioned and thus less involved 
in public life and civil discourse. More than ever, we need public 
servants who combine vision, integrity, compassion, analytic rigor and 
practicality. As the first school of public affairs at a public 
university, the Graduate School of Public Affairs at the University of 
Washington has trained public servants and leaders in the Northwest for 
37 years. The school's mission is motivating a new generation towards 
excellence in public and non-profit service and restoring the 
confidence, involvement and investment in public service.
  Recently, the school was renamed for Daniel J. Evans, a longtime 
public servant for the people of Washington state who embodies the 
Graduate School of Public Affairs focus and values. As a governor, U.S. 
Senator and regent for the University of Washington, Dan Evans has 
stood for effective, responsible, balanced leadership. His public 
service legacy has touched so many citizens and has greatly impacted 
the state of Washington. Dan Evans' involvement in the Graduate School 
of Public Affairs will provide students the opportunity to learn from 
someone who represents effective, responsible and balanced leadership 
and who embodies the school's ideals.
  The Graduate School of Public Affairs at the University of Washington 
has played a vital role in public policy and management and is now 
positioned to become the region's primary source of expertise and 
outreach on public issues. I have strongly endorsed these efforts and 
believe it is worthy of our support and investment.
  Mr. SPECTER. There certainly is a need for additional leaders in 
public service. I appreciate the opportunity to learn about the work at 
the University of Washington and will take a close look at this 
worthwhile project during the conference with the House.
  Mr. GORTON. I appreciate your commitment to developing highly 
skilled, principled individuals dedicated to service and leadership.


                          medicare contractors

  Mr. CRAIG. I am concerned about the funding level for Medicare 
contractors. The Senate Committee mark reduced the FY 2000 funding 
level by $30 million below the President's Budget recommendation. I 
want to be sure that this funding reduction will not adversely impact 
fee-for-service claims processing activities or the ability of 
contractors to provide critical beneficiary and providers services.
  In the recent past, we have seen the effect that inadequate funding 
levels can have on services. In 1998 payments were slowed down, and 
beneficiaries and providers were forced to deal with more voice mail 
rather than human beings when they called their contractors with 
questions about claims.
  Looking only at numbers, I see funding $21 million less than FY 1999 
and $30 million less than the President's request. However, I 
understand this funding level reflects $30 million in savings from 
changes in the processing of dates. Therefore, am I correct in saying 
this would reflect efficiency and technological improvement, not a 
policy change in fee-for-service claims processing or beneficiaries and 
provider services? Furthermore, this $30 million in savings should not 
result in decreased funding to services for beneficiaries or providers, 
should it?
  Mr. DORGAN. I want to make it clear that funding to assure the timely 
and accurate processing of Medicare claims also is a high priority for 
me and the beneficiaries in my state.
  I also would like a reassurance that the mark will not affect access 
to health care services in rural America.
  Mr. SPECTER. The Senators have correctly described the Committee's 
intent. These savings would be realized as a result of a change in 
direction by HCFA for a managed care related project, and is not at all 
related to fee- for-service Medicare. I understand the Senators' 
concerns and want to assure them Medicare contractor services will not 
be harmed. These savings of $30 million for HCFA's managed care project 
will not result in any related funding cut to the Medicare contractor 
budget.
  I understand the issues both Senators are raising and the importance 
of adequately funding the Medicare contractor program. Let me assure my 
colleagues that the savings reflected in this bill will not hamper 
Medicare contractors' ability to fulfill their responsibilities as 
Medicare administrators.


                          parkinson's research

  Mr. COCHRAN. Mr. President, I want to thank the Chairman for his 
strong leadership and support for the medical research in our nation. I 
strongly support his efforts to double funding for the National 
Institutes of Health, and I am heartened by the increases in this bill. 
I also want to thank him for his leadership in increasing funding for 
Parkinson's research and holding the September 28, 1999, hearing on the 
promise of Parkinson's research and the need for increased funding. 
Michael J. Fox put it best when he said that ``this is a winnable war'' 
as long as the funding is there to match the scientific promise.
  Mr. SPECTER. Mr. President, that's right. Dr. Fischbach testified 
that he

[[Page 24504]]

sincerely believes that we are close to solving Parkinson's. The 
scientific research community believes that it is realistic to think 
that we will conquer Parkinson's in 5 to 10 years. Dr. William 
Langston, President of the Parkinson's Institute told the Subcommittee 
at the hearing that we have an historic opportunity with Parkinson's 
because the research is at a point where a focused, adequately funded 
effort will produce a cure. He also testified that once we understand 
and unravel Parkinson's, we will have answers to many other 
neurodegenerative diseases such as Alzheimer's and Lou Gehrig's 
disease.
  Mr. WELLSTONE. Mr. President, the Parkinson's hearing was great news 
for all those who suffer from this disease. The advocacy community was 
well-represented by actor Michael J. Fox, Joan Samuelson--President of 
the Parkinson's Action Network, and Jim Cordy--a Parkinson's advocate 
from Pennsylvania. Their personal stories underscore the need for 
Congress to ensure that there is increased funding for Parkinson's 
research. Parkinson's is the most curable neurological disorder and the 
one most likely to produce a breakthrough. Congress passed the Morris 
K. Udall Research Act, making clear that Parkinson's should receive the 
funding it needs to eradicate this truly dreadful disease. Now it is 
time to fulfill that promise.
  Mr. COCHRAN. Mr. President, I agree. At the hearing, we were asked to 
increase funding for Parkinson's research $75 million over current 
funding levels by increasing funding levels at two institutes, the 
National Institute of Neurological Disorders and Stroke (NINDS) and the 
National Institute of Environmental Health Sciences (NIEHS), at $50 
million and $25 million respectively. The research community thinks 
that this will provide enough funding to quicken seriously the pace of 
research on Parkinson's--a down payment, if you will--on a fully funded 
Parkinson's research agenda that scientific experts in the community 
conservatively estimate to be over $200 million. I believe NIH should 
be able to do this from the funds provided in our bill.
  Mr. SPECTER. Mr. President, as I said at the hearing, I think the 
scientific community can find a cure in even less time, as few as 2 to 
4 years, if they have the resources. With the overall $2 billion 
increase in NIH funding provided in this bill, those institutes will 
have sufficient funds to provide the increases to Parkinson's focused 
research.
  Mr. HARKIN. As Ranking Member of the Subcommittee I want to express 
my strong support for substantially increasing NIH support for 
Parkinson's research. We have a tremendous opportunity for real break 
through in the fight against this horrible disease and we cannot pass 
that up.


                      YOUTH LEADERSHIP INITIATIVE

  Mr. WARNER. Mr. President, I have a second degree amendment to 
Senator DeWine's amendment on higher education, amendment No. 1847.
  Senator Specter, Senator Harkin and my other distinguished colleagues 
on the Labor, Health and Human Services, Education Subcommittee 
certainly have your work cut out in crafting S. 1650, the Labor-HHS 
appropriations bill. The subcommittee was faced with a difficult task 
of appropriating limited funds to hundreds of programs.
  I commend the subcommittee for its hard work and for its dedication 
to education funding. This bill provides $37.6 billion for the 
Department of Education. This amount is more than $2 billion above 
fiscal year 1999 levels and $537 million above the Administration's 
request.
  Of this $37.6 billion, the committee bill provides over $139.5 
million for the fund for the improvement of education. This amount is 
$500,000 over fiscal year 1999 appropriations. These funds are provided 
to support significant programs and projects to improve the quality of 
education, help students meet high academic standards and contribute to 
the achievement of educational goals.
  During the appropriations process, Senator Specter, I submitted a 
letter requesting that the subcommittee provide $1.5 million in funds 
for an innovative educational program known as the Youth Leadership 
Initiative (``YLI'') at the University of Virginia. I am thankful for 
the subcommittee's consideration of my request and am grateful that the 
subcommittee recognized the importance of YLI by including report 
language on this invaluable educational program.
  The goal of YLI is to work with America's middle and high school 
students to prepare them for a lifetime of political participation. YLI 
seeks to transform the way students view their role in our democracy, 
develop their trust in and awareness of our system, and instill in our 
students the core values of good citizenship and democracy.
  To achieve its goal, YLI teaches students in the functional 
components of America's political process. Among other things, YLI 
students will learn how to run student-forged mock campaigns, organize 
political events, conduct election analysis, and hold mock elections.
  Senator Specter, these lessons need to be taught and are of paramount 
importance. In 1998, voter participation during the mid-term 
Congressional elections was the lowest since 1942. Almost every survey 
of public opinion shows growing disinterest in the American electoral 
process, and disinterest is strongest among our young people.
  Thomas Jefferson once warned Americans about the ramifications of 
such disinterest in our political system, stating, ``Lethargy is the 
forerunner of death to other public liberty.'' America's form of 
government is uniquely dependent upon the active participation of its 
citizens. Therefore, if voter participation continues to decrease, then 
our democracy will suffer.
  By combining academic excellence with hands-on civic activity, YLI 
will help turn our schools and communities into hotbeds for the 
rejuvenation of our democracy. Since its launch last spring, YLI has 
attracted national attention for its unique approach to teaching our 
young people about democracy. In a pilot program currently in progress 
in several Virginia communities, thousands of students in hundreds of 
classrooms are experiencing the wonders of this pioneering program. 
Students and teachers have participated in YLI training sessions and 
members of the inaugural class of youth leaders are already hard at 
work organizing public debates between actual legislative candidates 
which they will host in the coming weeks.
  On Tuesday, October 26, 1999, nearly 35,000 middle and high school 
students will be eligible to participate in the largest internet ballot 
ever conducted. On this day, YLI students will be voting on-line using 
a secure, encrypted state-of-the-art ``cyber-ballot'' that is 
specifically tailored to each student's voting precinct.
  These achievements are only the beginning. YLI is a national crusade. 
This year's pilot program in Virginia is laying the foundation for next 
year's expansion throughout Virginia. Plans are already underway to 
make this program available to every middle and high school in the 
United States soon after the 2000 elections.
  YLI already has the financial support of the Commonwealth of Virginia 
and many of America's leading corporations, foundations and 
individuals. YLI is a model public-private partnership that will make 
available to all Americans students a program which will increase 
participation in our democracy for future generations. Senator Specter, 
a small investment today will pay dividends for many generations to 
come.
  Again, I say to the Senator from Pennsylvania, I certainly understand 
the difficult task facing your subcommittee in crafting a bipartisan, 
fiscally responsible appropriations bill. I know you recognize the 
importance of YLI and that's why report language was included in the 
Committee's report. I ask my distinguished colleague, however, to 
ensure that YLI receives the requested funding in the eventual bill 
that emerges from conference.
  Mr. SPECTER. I thank my distinguished colleague for his kind remarks 
and for his strong statement in support of the Youth Leadership 
Initiative. The Youth Leadership Initiative is certainly an innovative 
program designed

[[Page 24505]]

to enhance public participation in our democracy. I share the goal of 
enhancing participation in our democracy, and I recognize that this is 
a priority for the senior senator from Virginia. As we conference with 
the House, I will keep in mind that this project helps us achieve our 
mutual goal of increasing voter participation in our democracy.
  Mr. WARNER. Thank you Senator Specter for your support of YLI.


                          star schools grants

  Mr. BENNETT. Mr. President, there has been some uncertainty in my 
state about the continuation of Star School grants. For my colleagues 
who are not familiar with Star Schools, it is a grant program that has 
helped distance learning move forward in many parts of the country. The 
beneficiaries in my state include many students in the San Juan school 
district, a small, rural, and remote school district in southeastern 
Utah. Many Star School grants have been awarded to the winners of a 
competition. Often these grants are multi-year grants. Some recipients 
are fearful about losing funding for the continuation of their grants 
if new projects are funded. Is it the intent of the chairman that 
continuing grants will receive a high priority in funding allocations?
  Mr. SPECTER. It was my intent to include enough funding in this bill 
to continue grants that have been awarded if at all possible. I believe 
the amount recommended by the Senate will provide the means to do so. 
While I do not know what the conference committee's final 
recommendation will be for Star Schools, it is my desire that there be 
enough dollars allocated to fund ongoing grants as planned.
  Mr. BENNETT. I thank the chairman for clarifying his intent, and for 
his efforts to provide adequate funding for these projects.


                            heartland manor

  Mr. LEVIN. Mr. President, Senator Abraham and I have come to the 
floor to seek assurance from Senator Roth and Senator Specter that they 
will include our amendment concerning Heartland Manor in any Medicare 
BBA fix bill that is taken up by the Finance Committee.
  Mr. SPECTER. I understand the Finance Committee will be working on a 
Medicare BBA repair bill and will review this amendment for possible 
inclusion in any such legislation and I believe he will give you such 
assurance directly.
  Mr. LEVIN. I appreciate the assurance that the Senator from 
Pennsylvania has given on this issue. I would like to ask the Chairman 
of the Finance Committee, Senator Roth, will he review our amendment 
for possible inclusion in any Medicare BBA legislation that he takes up 
this year?
  Mr. ROTH. Yes, we will review the amendment through the committee 
process to determine inclusion in any Medicare BBA package that the 
Finance Committee takes up this year. I recognize how important this 
amendment is to the Senators from Michigan.
  Mr. LEVIN. I thank Senators Roth and Specter for their help in this 
matter and I look forward to working with Senator Roth as we move 
forward with this amendment.
  Mr. ABRAHAM. I also thank Senators Roth and Specter for their help 
and appreciate their assurances.
  Mr. LEVIN. I would like to describe this amendment and why it is so 
necessary. Our amendment concerns Heartland Manor, a nursing home 
located in Flint, Michigan, that provides care to an underserved 
population. Heartland Manor is not out to make money--it is owned by 
the Hurley Foundation which is not for profit 501(c)(3) subsidiary of 
Hurley Medical Center. Hurley Medical Center is a not for profit public 
hospital with an excellent reputation. Hurley Medical Center is one of 
the few city owned hospitals left in the country, and it is the largest 
hospital in Flint, Michigan.
  On July 27, 1989, Chateau Gardens, a privately owned nursing home 
facility, was terminated from the Medicare program. On January 1, 1994, 
Hurley Foundation, a not for profit 501(c)(3) subsidiary of Hurley 
Medical Center, purchased Chateau Gardens at the request of the state. 
In 1994 Heartland Manor applied for certification into the Medicare 
program as a new or prospective provider. Heartland Manor had never 
before entered into a Medicare participation agreement and had never 
been issued a provider number. However, HCFA treated Heartland as a re-
entry provider and Heartland was subsequently denied participation into 
the Medicare program based in large part on violations which HCFA 
carried over from Chateau Gardens, the previous owner. If Heartland 
Manor had been treated as a new provider, it would have been approved 
and would presently be in the Medicare program.
  This amendment would allow the facility to come into the Medicare 
program as a prospective provider which is exactly how the facility 
should be treated.
  Heartland Manor has the backing of Citizens for Better Care, a 
nonprofit agency, funded by the United Way, which monitors nursing home 
care in Michigan. Moreover, the Mayor of Flint, Woodrow Stanley, the 
Congressman representing Flint, Representative Dale Kildee, and State 
Senator Bob Emerson all want to keep this nursing home open. These 
organizations and I wouldn't all be supportive of the facility if this 
nursing home were not meeting the needs of the Flint community.
  I have visited Heartland manor and I believe that it should not be 
closed. I would not make such a bold assertion if I could not honestly 
say that this is a nursing home that has made great strides in recent 
years and which is now providing an important service to the Flint 
community.
  Mr. President, I look forward to working with my colleagues to ensure 
that this amendment is part of any Medicare BBA package.


                            Dental SeaLants

  Mr. BINGAMAN. I rise today in strong support of the use of dental 
sealants for children for purposes of oral health promotion and disease 
prevention. They have been proven to be safe and effective in the 
prevention of dental caries in children, and when coupled with 
fluoridated water systems can virtually eliminate dental decay and 
reduce tooth loss. I believe that the most successful dental sealant 
programs for our children covered in the EPSDT programs in Medicaid 
could be those that are school linked and community based. Analyses 
show that an amount of $1,000,000 is a reasonable amount to begin a 
demonstration project such as this.
  Mr. HARKIN. I am pleased that the Labor HHS Appropriations bill 
contains language to provide for a multistate dental sealant 
demonstration project. I feel that the Maternal Child Health Bureau of 
the Health Resources and Services Administration will be the most 
appropriate entity to conduct a quality demonstration program. I concur 
with the Senator from New Mexico that this amount seems reasonable.
  Mr. SPECTER. I thank my colleague from New Mexico for raising this 
important public health matter. Prevention is a high priority for our 
subcommittee as we have invested significant amounts of resources in 
bolstering the agencies of the U.S. Public Health Service. The amount 
the Senator suggests is reasonable for a demonstration project and I 
concur that the Maternal Child Health Bureau of the Health Resources 
and Services Administration is an appropriate agency to conduct a 
quality demonstration program.
  Mr. BINGAMAN. I thank the Senators from Pennsylvania and Iowa and 
urge the department to conduct the demonstration project in an 
expeditious manner. Despite the fact that dental sealants have been 
available for over 25 years, their use remains low and children deserve 
this preventive service.


                     pediatric research initiative

  Mr. DeWINE. Mr. President, I rise to thank my colleague from 
Pennsylvania, Senator Specter, and his subcommittee, for the tremendous 
job they have done in putting together this $312 billion bill. It is 
not easy to work within tight budget caps and fund so many agencies and 
institutes at levels that will make all members--and constituents--
happy. I'd like to take this opportunity to especially thank Senator 
Specter for his hard work and dedication in providing start-up funding 
for the Ricky Ray Fund. Even

[[Page 24506]]

though we would have all liked to have seen full funding, I realize 
that Senator Specter and his subcommittee performed a monumental task 
in funding $50 million to make the Ricky Ray Fund a reality. I look 
forward to working with my colleagues next year to finish the job we 
are beginning in this appropriations bill and fund the remaining 
amounts for the Ricky Ray Fund that we authorized last year.
  As for the appropriations bill that is before us, I would like to ask 
my colleague from Pennsylvania, Senator Specter, to clarify the 
``Pediatric Research Initiative'' provision that is on page 138 of the 
Committee Report. It is my understanding that the Report should state 
that the ``Committee further encourages the Director of NIH to expand 
extramural research directly related to the illnesses and conditions 
affecting children.'' The Report currently states that the National 
Institute of Child Health and Human Development (NICHD) should expand 
extramural research, but it should state that the Committee encourages 
the Director of NIH to expand extramural pediatric research--is that 
correct?
  Mr. SPECTER. Yes, that is correct. The Office of the Director 
currently funds the Pediatric Research Initiative at NIH, and we are 
encouraging the Director to expand extramural pediatric research.
  Mr. DeWine. The Committee Report also currently states that the 
Committee also encourages the Institute to provide additional support 
for institutional and individual research training grants for medical 
schools' departments of pediatrics. It is my sense that the Report 
should state that the Committee encourages the NICHD to provide 
additional support for institutional and individual research training 
grants for medical schools' departments of pediatrics. Is that correct?
  Mr. SPECTER. Yes, my colleague is correct. The NICHD supports such 
pediatric research training grants, and the Committee is encouraging 
NICHD to expand its support for such pediatric research training 
grants. I will work to ensure that the Conference Report for this bill 
accurately reflects these clarifications, which my colleague from Ohio 
and I have just discussed.
  Mr. DeWINE. Again, I thank my friend from Pennsylvania for his 
clarifications and for his tremendous effort in increasing the funds 
for NIH to ensure that medical research, including pediatric research, 
remains a top priority for our country.


       Treatment of Child and Adolescent Violence Related Trauma

  Mr. KENNEDY. As you know, it is well documented that domestic, 
school, and community violence survived or witnessed by children and 
adolescents causes psychological trauma with very real and serious 
consequences. These consequences can be physical (changes in the brain, 
delayed development), psychological (anxiety, depression, learning 
difficulty), or interpersonal (aggressive and violent behavior, 
affected individuals passing on the problems to their children). 
Fortunately, there is a growing body of knowledge that attests to the 
effectiveness of treating this psychological trauma. While the course 
of treatment may vary depending on the type of trauma, the length of 
exposure, and the age of the child, it undoubtedly requires staff with 
the specialized training needed to identify the signs and symptoms of 
trauma, and to provide the appropriate therapeutic interventions. In 
the wake of the violent tragedies in schools, community centers, 
churches, and increasingly in communities and homes across this 
country, the desperate need to develop this specialized expertise and 
to make it more widely available could not be clearer.
  Mr. STEVENS. I could not agree more with my friend from Massachusetts 
and I have been pleased to work with him on this vitally important 
issue. Research has shown that children exposed to negative brain 
stimulation in the form of physical abuse or community violence causes 
the brain to be miswired making it difficult for the child to learn, 
develop healthy family relationships, reduce peer pressure, and to 
control violent impulses. Early intervention and treatment is much more 
successful than adult rehabilitation. This certainly points to a need 
for more early intervention and treatment programs for children and 
adolescents who suffer from violence related trauma. It also highlights 
the need for more professional training in the best practices for 
treating this psychological trauma.
  Mr. KENNEDY. I appreciate the remarks from my friend from Alaska and 
thank him for his interest in children and in child development. I 
would also like to thank my friend from Pennsylvania, the Chairman of 
the Labor-HHS-Education Sub-Committee, for his longstanding commitment 
to children. I understand that bill before us includes $10 million for 
the creation of national centers of excellence on youth violence. I 
also understand that a key aspect of these centers is going to be the 
development of effective treatments for violence related psychological 
trauma in children, youth, and families, and the provision of training 
and technical assistance needed to make these best practices more 
widely available. Is that the Sub-Committee Chairman's understanding.
  Mr. SPECTER. Yes it is. My friend from Massachusetts has identified a 
critically important need and this activity is intended to be an 
integral function of these centers of excellence.
  Mr. STEVENS. I have worked closely on this with both the Sub-
Committee Chairman and Senator from Massachusetts, and this is 
certainly my understanding as well.
  Mr. KENNEDY. I thank both the Full Committee Chairman and the Sub-
Committee Chairman for that clarification, and I hope that as we move 
forward with this process, should additional funding become available, 
that it could be targeted to this effort. I thank my colleagues and I 
yield the floor.


                    gender-based digestive diseases

  Mr. REID. I rise today to address an issue of great concern to me. I 
was recently made aware of the findings contained in a recent report 
from the Office of Research on Women's Health (ORWH) regarding gender-
based differences in digestive diseases. The report identifies 
irritable bowel syndrome, functional bowel disorder and colorectal 
cancer treatment and detection as serious health problems that 
disproportionately affect women.
  Mr. SPECTER. I am aware of this report and also am very concerned 
about gender based differences in digestive diseases.
  Mr. REID. The ORWH report recommends that Federal research efforts 
focus on the need to: (1) develop a better understanding of the 
mechanisms of gastrointestinal motility and altered sensitivity to 
sensory dysfunction that will help explain why irritable bowel syndrome 
so disproportionately affects women more than men; (2) examine the 
relationship between hereditary colon cancer and gynecologic malignancy 
in women; and (3) determine the relationship between functional bowel 
diseases and pelvic floor dysfunction. As a result of these findings 
and recommendations, I hope that the Office on Women's Health will work 
with NIDDK to address these digestive diseases that so 
disproportionately affect women.
  Mr. HARKIN. I strongly believe that NIH should respond to the 
recommendations in this ORWH report and examine this problem as soon as 
possible.


                              cdc funding

  Mr. CLELAND. Mr. President, I would like to engage the distinguished 
Ranking Member of the Labor/HHS/Education Subcommittee on funding for 
the Centers for Disease Control (CDC) and Prevention's building and 
facilities project. The CDC's physical plant facilities are in dire 
need of expansion and renovation. The lack of adequate laboratory and 
research facilities is crippling one of the nation's critical 
resources. Some of the infectious disease laboratories which conduct 
research on deadly organisms are 60-year old temporary wooden 
structures. This raises serious concerns regarding safety for employees 
and the public. The existing CDC's buildings and facilities threatens 
the United States' position as the world's last line of defense for 
protecting the health of the public.

[[Page 24507]]


  Mr. SPECTER. Mr. President. I concur with Senator Cleland's concerns 
and share in his support of the CDC and its vital role in research and 
public safety. The Senate Labor/HHS/Education Appropriations 
Subcommittee had one of its most challenging years developing the FY 
2000 budget. The Subcommittee recommended a total of $60 million for 
CDC, $40 million in regular line item building and facilities 
construction and an additional $20 million in emergency funding. This 
represents a significant portion of the funding needed by the CDC.
  Mr. CLELAND. I commend the Chairman and Ranking Member and the Labor/
HHS/Education Appropriations Subcommittee for the FY 2000 
appropriations bill. Under the circumstances, The Subcommittee has done 
a more than adequate job than others in addressing CDC's needs. The 
Administration's FY 2000 budget request was $39.8 million for all of 
CDC's buildings and facilities activities, including the repair and 
improvement of existing structures. The House Labor/HHS/Education 
Subcommittee mark was for $40 million for buildings and facilities. The 
Ranking Member is correct in stating that the Senate Subcommittee 
exceeded the Administration and marks by $20 million. I want to state 
for the record that, given the need, the initial funding request was 
set far too low. The CDC needs $141 million or an additional $81 
million to modernize the substandard existing buildings and 
laboratories. I would request that Senate conferees examine all 
possible sources to obtain additional funding for CDC, and at the very 
least, hold firm behind the Senate's funding level in conference.
  Mr. HARKIN. I thank you Senator Cleland for clarifying the funding 
needs for the CDC building infrastructure. We will continue to seek 
ways to provide funding to adequately bring the CDC physical plant to 
not only meet standard safety levels, but to exceed those levels. We 
have an obligation to maintain this world renowned institution and to 
facilitate its ability to attract highly skilled scientists, provide a 
safe environment for the research of highly pathogenic organisms and to 
fulfill its intended objectives.
  Mr. CLELAND. I thank the Senator. One last point: does the Chairman 
and Ranking Member believe that it would be appropriate for the 
Administration to submit a more adequate proposal for CDC buildings and 
facilities in its FY 2001 budget?
  Mr. SPECTER. The Senator is correct. I would hope that the FY 2001 
Administration budget will appropriately address CDC's need for 
facilities expansion and renovation.
  Mr. HARKIN. I too agree that the FY 2001 budget will address this 
issue.


                          vocational education

  Mr. DORGAN. I am concerned about the funding level in the Senate bill 
for vocational education. While the Senate bill generally increases our 
investment in education, unfortunately funding for vocational education 
basic state grants would remain at the President's request of 
$1,030,650,000.
  Funding for vocational education basic state grants has been 
virtually frozen over the last several years by both the Congress and 
the President. Consequently funding for vocational, career, and 
technical programs has not kept pace either with inflation or with 
funding for other education programs. In fact, if vocational education 
funding had simply kept pace with inflation over the last eight years, 
it would be $220 million greater than is being proposed for FY2000. I 
would suggest an additional $100 million in funding for basic state 
grants, which represents about a 10 percent increase, but 
realistically, I believe $50 million would represent a reasonable step 
in the correct direction.
  Mr. DeWINE. I share the concerns of the Senator from North Dakota 
about the proposed funding level for vocational education. As the 
Chairman of the Senate Subcommittee that had the responsibility for 
reauthorizing the Perkins Act, I can assure my colleagues that the 
reauthorization of this law, which Congress enacted last year with 
strong bipartisan support updated the Perkins programs. The authorized 
funding level for the Perkins Act was increased by $10 million from 
$1.14 billion to $1.15 billion. Now that this work is done, now is the 
appropriate time to increase funding for vocational education.
  Mr. DORGAN. I appreciate the Senator from Ohio's leadership on this 
issue and the Senator from Alaska's comments in support of vocational 
education funding at the Appropriations Committee mark-up. I wonder if 
the Senator from Alaska would give his assurance that he will work to 
secure additional funding for vocational education as the Labor-HHS-
Education appropriations bill moves forward?
  Mr. STEVENS. I share the concerns that the Senators are raising and 
join in their support of vocational education. I want to assure them 
that I am committed to work with the senior Senator from Pennsylvania 
to try to find additional funds for vocational education during 
Conference. I also want to encourage the Administration to request an 
increase in funds for vocational education in its FY2001 budget 
submission.
  Mr. HARKIN. I want to add my support to the comments that have been 
made here. I, too, feel strongly that additional funding for vocational 
education is urgently warranted, and I will do what I can as the 
ranking member on the Labor-HHS-Education Appropriations Subcommittee 
to direct more resources to basic state grants in this area. Will the 
Chairman of the Subcommittee also join me in this effort?
  Mr. SPECTER. I recognize that funding for vocational education has 
not kept up with inflation or with funding for other education 
programs. I will work with Chairman Stevens, Senator Dorgan, Senator 
DeWine, and Senator Harkin to try to obtain additional funding for 
vocational education.


 The University of Medicine and Dentistry of New Jersey's Child Health 
                               Institute

  Mr. TORRICELLI. Mr. President, I rise to ask the distinguished 
managers of the bill if they would consider a request I have concerning 
the conference. Knowing the great difficulty they faced in reporting a 
bill that would not exceed this year's stringent budget restrictions, I 
understand why they were not able to provide funding for the University 
of Medicine and Dentistry of New Jersey's (UMDNJ) Child Health 
Institute. However, I hope that funding for the Children's Health 
Institute can be found in conference.
  The increased attention to childhood disease clusters in various 
communities throughout New Jersey and other states require molecular 
studies for an explanation and solution. In that regard, UMDNJ of the 
Robert Wood Johnson Medical School developed the Child Health Institute 
of New Jersey as a comprehensive biomedical research center focused on 
the development, growth and maturation of children.
  The mission of the Institute is to improve child health and quality 
of life by fostering scientific research that will produce new 
discoveries about the causes of many childhood diseases and new 
treatments for these diseases. Researchers will direct their efforts 
toward the prevention and cure of environmental, genetic and cellular 
diseases of infants and children. The Institute will work closely with 
both the Cancer Institute of New Jersey and the Environmental and 
Occupational Health Science Institute--two NIH-designated centers of 
excellence. Organizations which also played a part in developing the 
Child Health Institute.
  The Institute is seeking funds to develop three components: a program 
in Molecular Genetics and Development; (2) a program in Development and 
Behavior; and (3) a program in Environment and Development. These 
programs will study human development and its disorders, noting the 
changing environmental conditions which alter gene function during 
development, maturation and aging. Institute scientists will also study 
human growth and development and the emergence of cognition, motion, 
consciousness and individuality.
  The hospitals in central New Jersey birth nearly 20,000 babies each 
year. The founding of the Child Health Institute has created an 
extraordinary health care resource for those hospitals and the patients 
they serve. The new Children's Hospital at Robert Wood

[[Page 24508]]

Johnson University Hospital is scheduled to open in 2000 and the Child 
Health Institute in 2001. Together these institutions will provide 
state of the art clinical and scientific research and treatment complex 
to serve children and their families, not only in New Jersey, but 
throughout the nation with cutting edge care and the latest scientific 
developments.
  Mr. LAUTENBERG. Indeed, New Jersey is poised to become a regional and 
national resource for research into the genetic and environmental 
influences on child development and childhood disease. Working in close 
partnership with the pharmaceutical and biotechnology industries, the 
Child Health Institute of New Jersey will become a force for healthy 
children nationwide. I thank my fellow Senator from the State of New 
Jersey and join him in giving my highest recommendation for this 
project.
  Mr. TORRICELLI. I thank the Senator from New Jersey for his efforts 
on this project. I believe that the work of the Institute is an 
appropriate focus for the committee because the research focus will be 
of enormous value for the nation as a whole. Indeed, the Child Health 
Institute will be one of the world's only research centers to examine 
not only the biological and chemical effects on childhood, but also the 
effects of behavioral and societal influences as well.
  The Child Health Institute's request is for $10 million in one time 
funding from the federal government for the construction of the 
Institute building. Total building costs are estimated at $27 million. 
The Institute has already raised more than $13 million from private 
sources including $5.5 million from the Robert Wood Johnson Foundation 
and $5.5 million from Johnson and Johnson. Also, the Robert Wood 
Johnson University Hospital has made a $2 million in-kind contribution 
of the land on which the Institute will be built. At maturity, the 
Child Health is expected to attract $7 to $9 million in new research 
funding annually, as well as provide $52 million in revenue for the 
local economy.
  Mr. President, funding for the Child Health Institute in this bill 
would be entirely appropriate under Health Resources and Services 
Administration (HRSA) account. Indeed, it would be money well spent.
  Senator Lautenberg and I simply ask that when the bill goes to 
conference the managers remember this request for funding the UMDNJ 
Child Health Institute.
  Mr. SPECTER. We have received numerous requests for funding of health 
facilities. In the past, we have faced difficult choices in making a 
determination of funding priorities and this year promises to be no 
exception. We are aware of the request by the Child Health Institute 
and commend its efforts toward enhancing its research and service 
capacity. In conference, we will keep in mind its request as well as 
those with similar meritorious characteristics and goals.
  Mr. HARKIN. I, too, am aware of the Child Health Institute request 
for assistance and share Senator Specter's views on this matter.
  Mr. TORRICELLI. I thank both my distinguished colleagues for their 
assistance with this matter.
  Mr. LAUTENBERG. I also would like to thank my colleagues for their 
help.


                       MEDICARE INTEGRITY PROGRAM

  Mr. HARKIN. I am very concerned about the proposed $70 million 
funding cut to the Medicare Integrity Program (MIP) approved by the 
House Appropriations Committee. The Senate has recommended that MIP be 
funded at $630 million, the amount authorized in the Health Insurance 
Portability and Accountability Act of 1996 (HIPAA).
  In 1998, Medicare contractors saved the Medicare Trust Fund nearly $9 
billion in inappropriate payments--about $17 for every dollar invested. 
Any funding cut to MIP is tantamount to the government throwing money 
out the window. In fact, I believe, because of the tremendous need to 
reduce an estimated $13 billion in Medicare waste, we should increase 
MIP funding. Therefore, I will work hard to ensure that the Senate 
funding level for this important program is not compromised.
  Mr. ROTH. I've long been committed to the effective and efficient 
management of the Medicare program, specifically the detection of fraud 
and abuse. I supported the creation of the MIP program, established 
under HIPAA, to provide a stable and increasing funding source for 
fraud and abuse detection efforts. Prior to MIP, Medicare contractor 
funding for anti-fraud and abuse activities was often reduced because 
of other spending priorities in the annual appropriations process. MIP 
was created to prevent that from happening again. The House 
Appropriations Committee recommendation is in clear disregard of 
congressional intent.
  Mr. SPECTER. I understand the importance of the MIP program to the 
integrity of the Medicare Trust Fund, and I will work to ensure that 
MIP is funded at the Senate recommended level of $630 million.


 Prevention and Treatment of Fetal Alcohol Syndrome and Fetal Alcohol 
                                Effects

  Mr. DASCHLE. Mr. President, I have worked closely with my colleagues 
Senator Stevens, Senator Specter and Senator Harkin to make treatment 
and prevention of fetal alcohol syndrome (FAS) and fetal alcohol effect 
(FAE) more of a federal priority and to place language in the report 
accompanying the Fiscal Year 2000 Labor, Health and Human Services and 
Education Appropriations bill to underscore this commitment. I 
appreciate their efforts to support programs that will prevent and 
address this important public health problem and their commitment to 
continuing those efforts as they serve on the conference committee.
  There is a dramatic need for an additional infusion of resources to 
address alcohol-related birth defects, which are the leading known 
cause of mental retardation. These funds are needed for the development 
of public awareness and education programs, health and human service 
provider training, standardized diagnostic criteria and other 
strategies called for in the competitive grant program authorized under 
the Fetal Alcohol Syndrome and Fetal Alcohol Effect Prevention and 
Services Act. These resources will complement the excellent work that 
has been started by grass-roots organizations like the National 
Organization for Fetal Alcohol Syndrome and the Family Resource 
Institute.
  I look forward to working with Senator Stevens, Senator Specter and 
Senator Harkin to promote treatment and prevention of FAS and FAE. It 
should be a priority for the Fiscal Year 2000 conference committee to 
fund these much-needed programs, and I am hopeful that the conferees 
will be able to find additional resources for this purpose. I believe 
it is critical that we provide line item funding for the competitive 
program that this Congress authorized last year. I look forward to 
working with the Administration and my colleagues in the Senate toward 
that end as they begin to draft the Fiscal Year 2001 Labor, Health and 
Human Services, and Education Appropriations bill.
  Mr. STEVENS. Mr. President, I share the sentiments expressed by my 
colleague from South Dakota. I have witnessed first hand the 
devastating effects of FAS and FAE in Alaska, which has the highest 
rate of FAS/FAE in the nation. Our Alaska Native people are especially 
at risk for these entirely preventable conditions. It has been 
estimated that the lifetime cost of treating and providing necessary 
services for a single victim of FAS/FAE is in excess of $1 million. I 
am pleased that the bill before us contains language encouraging the 
Department of Health and Human Services to provide necessary resources 
to fund comprehensive FAS/FAE prevention, education and treatment 
programs for Alaska and for a four-state region including South Dakota 
and will work with the conference committee to ensure that funds are 
available for these programs. I also support language in the report 
mandating development of a nationwide, comprehensive FAS/FAE research, 
prevention and treatment plan. I know that federal support can make a 
difference. In Alaska, federal assistance has allowed two residential 
treatment programs for pregnant women and their children--the Dena A 
Coy program in Anchorage and the Lifegivers

[[Page 24509]]

program in Fairbanks--to make a positive difference in the lives of 
numerous Alaska Native women and their children. I look forward to 
working with my colleague to find real solutions to the problems of 
alcohol-related birth defects.
  Mr. SPECTER. Mr. President, I have worked closely with my colleagues 
to find creative ways to address FAS and FAE at the federal level while 
drafting the Fiscal Year 2000 Labor, Health and Human Services and 
Education Appropriations bill. I agree that it is critical to continue 
that effort during the conference with members from the House of 
Representatives in order to further improve the federal commitment to 
individuals with FAS and FAE and their families.
  Mr. HARKIN. Mr. President, I would like to add my voice in support of 
the comments expressed by my colleagues from South Dakota, Alaska and 
Pennsylvania. FAS and FAE are 100 percent preventable. Our country 
should be doing everything it can to put an end to alcohol-related 
birth defects and help individuals and families trying to copy with the 
disease.


                          idea funding at nih

  Mr. NICKLES. I would like to address a question to my friend from 
Pennsylvania regarding the Institutional Development Awards (IDeA) 
Program funding within the National Institutes of Health (NIH) budget. 
I am joined by my colleagues Senators Lott, Daschle, and Reid in 
support of the House level of funding for IDeA in the Labor, Health and 
Human Services, and Education, and related agencies Appropriations 
bill. It is my understanding that the Senate level is $20,000,000 while 
the House level is $40,000,000.
  Mr. LOTT. It is my understanding that movement to the House level is 
not an increase in the NIH budget, is that correct? As I understand it, 
this would reallocate money within the NIH budget and that this would 
not be additional funding. This would set aside a portion of NIH 
research money for those states, Mississippi included, to more fully 
exploit the opportunities to develop a competitive biomedical research 
base.
  Mr. NICKLES. The distinguished Majority Leader is correct. The point 
of this inquiry is to ask the chairman if he would reserve some 
resources for those IDeA states that receive the least among of 
research money.
  Mr. DASCHLE. I agree with my colleagues that this program is of 
tremendous benefit to rural states and to our nation's ability to 
produce top quality research. In recent years, five states have 
received 48 percent of the NIH research money. We need to broaden this 
distribution. In my state of South Dakota, universities have benefitted 
from this program in the past, but we need to continue this investment 
so that they may compete for research monies on an equal footing. 
Increasing IDeA funding would help to meet this goal.
  Mr. REID. I would also like to point out that according to the NIH's 
own figures, an average IDeA state, such as Nevada, receives $67 per 
person in research money while the other states receive, on average, 
$258 per person. This program helps to disburse this vital research 
money to those states who traditionally do not fair well but can 
perform this research for much lower overhead and indirect costs.
  Mr. NICKLES. I would also add that Oklahoma only receives, an 
average, $45 per person of research money.
  Mr. SPECTER. Mr. President, I would agree with Senators Lott, 
Daschle, and Reid on the value of the IDeA program. As Senator Nickles 
mentioned before, we did increase this allocation from fiscal year 1999 
in order to broaden the geographic distribution of NIH funding of 
biomedical research by enhancing the competitiveness of biomedical and 
behavioral research institutions which historically have had low rates 
of success in obtaining funding. With their concern in mind, I would 
therefore like to assure my fellow Senators that when we conference, we 
will take a very close look at the House funding level of $40,000,000 
for IDeA.
  Mr. NICKLES. I would like to thank the Chairman for his assistance.
  Mr. KENNEDY. Mr. President, in the interest of moving this 
appropriations bill forward, I will withdraw my amendment to increase 
the funding for the successful GEAR-UP program. However, I urge the 
conferees to fund this program at $240 million--- $60 million over the 
Senate bill--so that now needy students can get the support they need 
to attend college.
  More than 130,000 students will be denied services if GEAR UP is 
funded at $180 million rather than at the President's request of $240 
million. $154 million is needed just to fully fund continuation grants 
for this year's grantees. We must uphold our commitment to these 
students, and extend the opportunity that this program offers to every 
needy student.
  This year, 678 applications for both state and local partnerships 
were received and we were only able to fund 185--only 1 out of 4 
applications. We have to do more to help children early so that college 
is accessible for every child.
  Many low-income families do not know how to plan for college, often 
because they have not done it before. We should do more to ensure that 
schools and communities can provide the academic support, early college 
awareness activities, and information on financial aid and scholarships 
so that students and their families can plan for a better future. We 
must encourage our young people to have high expectations, to stay in 
school, and to take the necessary courses so that they can succeed in 
college. We cannot abandon the five-year commitment that we made to 
these families last year.
  I commend my colleagues on the appropriations committee for making 
hard choices between important programs. But, I urge you to give GEAR 
UP your highest consideration in conference.
  Ms. MIKULSKI. Mr. President, I rise to speak on the Fiscal Year 2000 
Appropriations bill funding the Departments of Labor, Health and Human 
Services and Education. I would like to thank Senator Specter and 
Senator Harkin for the tremendous job they and their staffs have done 
on an extremely large, complex, and vitally important appropriations 
bill. This bill is important because it meets the day-to-day needs of 
Americans as well as the long-range needs of our country.
  However, I am concerned that the Senate has had to resort to gimmicks 
and tricks such as ``forward funding'' and ``emergency spending.'' When 
Congress resorts to these tricks, it means we're not doing our job 
right. The GM worker in Baltimore can't ``forward fund'' or declare his 
next trip to the grocery store ``emergency spending.'' If a mother 
can't pay for her children's health care using such devices, then 
Congress should not be able to resort to them to pay for our children's 
education, health care for the underserved, or job training.
  I am pleased with a number of funding levels in this bill. I know 
that Senators Specter and Harkin had a difficult task in funding so 
many programs that meet compelling human needs. As the Senator for and 
from the National Institutes of Health, I am very glad to see the $2 
billion increase in NIH funding, which keeps us on pace to double NIH's 
budget over five years. I am particularly pleased with the $680.3 
million for the National Institute on Aging (NIA). This is an increase 
of more than $80 million over last year. As we double NIH's budget, I 
believe that it is especially important to double NIA's budget. Our 
population is aging; by 2030 there will be about 70 million Americans 
age 65 and older, more than twice their number in 1997. This is clearly 
an investment in the future health of our nation.
  Many of the day-to-day needs of our nation's seniors are met by the 
Older Americans Act (OAA). It is heartening to see the $35 million 
increase in funding for home delivered meals because it is greatly 
needed. We are seeing an increased demand for home delivered meals 
which assist more older persons in remaining in their homes and 
communities. The Committee has also provided a $1 million increase for 
the ombudsman program and an $8 million increase to $26 million for 
state and local innovations/projects of national significance (Title 
IV).

[[Page 24510]]

  I am disappointed that other programs under the Older Americans Act 
did not see needed increases in funding. OAA programs have been level 
funded and losing ground for too long. I am also deeply concerned that 
there is no provision to fund the National Family Caregiver Support 
Program. This program would offer valuable services to assist our 
nation's caregivers by providing respite care, counseling, information, 
and assistance among other services. This program has strong bipartisan 
support. I would urge that we look at ways to provide the necessary 
resources for this program in Fiscal Year 2000 so that it can be funded 
once it is authorized. As the Ranking Member of the Subcommittee on 
Aging, I will continue to work with my colleagues on the HELP Committee 
to reauthorize the OAA during Fiscal Year 2000.
  In addition, I was distressed by the drastic cut of almost $860 
million to the Social Services Block Grant. However, I'm pleased that 
the Senate has restored these funds. The Social Services Block Grant 
provides help to those who practice self help. In Maryland, this 
program funds adoption, case management, day care, foster care, home 
based services, information and referral, prevention and protective 
services to more than 200,000 people.
  I must also mention the importance of funding for the Centers for 
Disease Control and Prevention (CDC). I am very aware of the funding 
constraints the we have been operating under and believe that the $30 
million increase for CDC is a step in the right direction. However, it 
is below the President's budget request and does not go far enough. 
While I am appreciative of the efforts to increase funding to modernize 
CDC's facilities and improve public health infrastructure, CDC has been 
revenue starved for too long. Improving public health in our country 
requires investments in NIH, CDC, and FDA. I am thrilled with our 
support of NIH, but I believe that if we do not provide sufficient 
resources to CDC and FDA we are only doing part of the job. I would 
urge that we consider this as we move to conference on this bill and 
when we look at funding for these agencies next year.
  I am also pleased at the funding levels of many of our national 
education programs and this bill is certainly better than the one that 
passed the House. I am very concerned that the funding level for the 
bill overall has been reduced to pay for other programs. The spending 
caps put us in a tough position. And it is education that always 
suffers the most.
  Like I said, even though the Senate funding levels are much better 
than the House, there are at least two major problems with the Senate 
bill. There is no funding in this bill for school construction and 
there is no funding in this bill for lowering class size and hiring 
100,000 new teachers. Last year, we passed a bipartisan bill, and we 
all agreed to lower class size. We agreed that this is one of the most 
important things we can do for our kids and our classrooms. Yet this 
bill contains no money for class size.
  There is also no funding for school construction. What happened to 
our commitment to make sure our kids are not attending classes in 
crumbling schools? I see there is $1.2 billion in the bill for 
something called ``Teacher Assistance Initiative.'' As far as I know, 
no one knows what this means exactly. Like Senator Murray said on the 
floor of the Senate last week, it clearly isn't class size reduction.
  I have serious reservations about this bill. It does not live up to 
the commitment we made here in the Senate to reduce class size and hire 
100,000 teachers. It does nothing to fix our broken down schools. And 
the House bill is even worse.
  The House bill cuts $2.8 billion out of the President's education 
agenda to improve public schools. It denies 42,000 additional children 
the opportunity to participate in Head Start. It repeals last year's 
bipartisan agreement to fund 100,000 new teachers to create smaller 
classes. It combines Class Size Reduction, Eisenhower Teacher Training 
and Goals 2000 into a block grant funded at $200 million less than the 
authorized level and $396 million less than the President's request for 
comparable programs.
  Given our recent tragedies in our schools, it is a shame that the 
House bill denies after school services to an additional 850,000 
``latch key'' children in 3,300 communities during the critical 2-6 
p.m. hours when children are most likely to get into trouble. The bill 
also freezes federal funding to help schools to create safer learning 
environments and denies funding for an additional 400 drug and school 
violence coordinators serving 2,000 middle schools.
  We need to work hard in conference. We are going to have to fight to 
keep our stand behind our kids. We cannot allow the House to gut these 
important programs. We cannot let the Senate ignore class size and 
school construction. I look forward to working with my colleagues to 
make sure we increase the Federal investment in education.
  Mrs. MURRAY. Mr. President, this evening we will vote on what is 
arguably the most important of our 13 appropriations bills, the Labor, 
Health and Human Services and Education Appropriations Act. When it 
comes to funding for education, the Congress has fundamentally ignored 
the messages of the American people. In this bill, education spending 
remains in the neighborhood of 1.6 percent of overall federal spending, 
a very poor neighborhood indeed. The American people cannot understand 
why, if education is their first priority, it is the last bill passed 
and the lowest funding priority of their Congress. They cannot fathom 
why, in a year when school districts across the country are hiring 
highly-qualified teachers to reduce class size, the Congress is walking 
away from its commitment.
  The House, regrettably, has done far worse by education than any of 
us could have imagined. The drastic cuts to education that would take 
effect under the House bill would send America back into the 19th 
century, not forward into the 21st. The House bill would cause 142,000 
fewer children to be served in Head Start, would keep 50,000 students 
out of after-school programs, and would deprive 2.1 million children in 
high-poverty communities of extra help in mastering the basics of 
reading and math.
  The Senate has done better by our schools, but only through smoke-
and-mirrors budgeteering that should give our school communities no 
long-term confidence. Advance funding is not without effect on the 
local school budget, which demands consistency and predictability.
  The numbers in the Senate bill are a better level from which to 
negotiate in the conference committee, but even these funding levels 
ignore the grim reality that our schools face a fundamentally tougher 
job than they did even five years ago, with skyrocketing enrollment, of 
students who are more expensive to educate, and who have less support 
at home and in the community.
  Despite all this, at least the Senate provides current funding for 
most educational services, makes some effort toward meeting the higher 
needs in others, and does a good job of providing new investments in a 
few areas. Funding for the Individuals with Disabilities in Education 
Act is increased by more than $900 million, a good start toward meeting 
our national commitment to fund forty percent of a local school 
district's costs of educating a disabled child.
  The $200 per student increase for Pell grants is a good investment, 
but only about half of what is needed this year. I'm particularly proud 
that we were able to increase funding for adult and family literacy, by 
increasing the adult basic education program by more than $100 million. 
This means that thousands more adults and their families will be able 
to take the first steps toward increased viability in our changing 
economy.
  The failures in this bill are many, however. As an example, let's 
look at funding for vocational and technical education. Current funding 
or freezes in funding are not sufficient in a world where the economy 
changes as rapidly as ours is changing. Young people need the skills 
not only to survive but to

[[Page 24511]]

thrive. All young people need access to applied skills as well as 
theoretical ones, in order for them to succeed in the workplace, the 
classroom, and in life. And yet, we do not make the significant 
investments needed.
  The largest failure of all, of course, is the backward step the 
majority is taking on class size reduction. Reducing class size by 
helping school districts hire 100,000 high-quality teachers nationwide 
is an investment in our schools that is paying dividends right now. The 
first 30,000 teachers are in the classroom, and what a classroom it is. 
To walk from a class with 25 or 28 first graders into one of the 
smaller classes I've been visiting this fall is a stark contrast. 
Improved achievement, increased time on task, more individual 
attention, and a lack of discipline problems are obvious in the smaller 
class. The teacher in the larger class looks as if he is running to 
catch up, and the student must keep her hand in the air for too long a 
time. This is a very real, tangible investment we have made in our 
schools. The Senate and the House, on a completely partisan basis, are 
reneging on the most common-sense investment in school improvement made 
in recent history. The reason that the Republicans are so afraid of 
these 30,000 teachers is that this program is actually working.
  Pili Wolfe, Principal at Lyon Elementary School in Tacoma, 
Washington, where federal class size funds are being used to 
dramatically reduce class size in first grade, and to provide high-
quality professional development for teachers through a program called 
Great Start, says: ``Children in our first-grade Great Start classrooms 
have shown more growth within the first month of school than any 
previous first-grade class.''
  Andrea Holzapfel, a first-grade teacher at Lyon, says: ``Smaller 
numbers allow me to spend significantly more time in individual and 
small-group instruction. Having fewer children allows more 
participation by the kids in discussion and classroom activities.''
  The program works. The one-page, on-line application form means no 
paperwork, no bureaucracy. Two-hundred and sixty-one of Washington 
state's two-hundred and ninety-six school districts have already put 
class size reduction and teacher professional development into effect 
in their schools. The accountability is to the local community, through 
a school report card describing how many teachers were hired and in 
which grades. Improved student achievement will be the ultimate measure 
of the success of this year's investment.
  But the investment cannot stop here.
  The President has said that this bill is headed for a veto, because 
of the lack of continued investment in class size reduction, and other 
key education efforts.
  One such effort is GEAR UP, which enables low-income schools and 
their neighboring colleges to form partnerships to get mentors to help 
students study hard, stay in school, and go on to college. Funding for 
this program is only $180 million, not the $240 necessary to get this 
important investment to the communities where it is needed most.
  Increased funding for after-school programs was given short shrift, 
despite what the research shows about the link between young people 
having no positive pursuits in the afternoon and evening, and the 
related increase in crime.
  Education technology has been cut by the House, and the Senate 
numbers are not sufficient to meet the growing need in an area where 
the federal government is the primary funding source in most schools 
and communities, far beyond the investments made by states and 
localities.
  When it comes to education, this Congress has not stepped up to the 
very challenge we are asking the educators, students, families and 
communities across America to meet. When the expectations on Congress 
increased, the level of commitment and vision decreased.
  I am voting for this bill to move the process along. If class size 
funding and other key investments are not restored, the conference 
report will be vetoed. If it is vetoed, I and many of my colleagues 
will vote to sustain that veto. This bill in its current form is only a 
vehicle through which we may negotiate higher numbers in conference.
  The American people have a stake in this battle. We need to hear 
their voices now.
  This has been a difficult vote for me. While the bill does provide a 
significant investment in public health and safety, it does so on the 
backs of our children and retreating from our commitment to improve 
class size. This bill cannot survive in its current form.
  I do want to point out what I believe are positive aspects of this 
bill. I applaud the efforts of Chairman Specter and Senator Harkin in 
preparing an appropriations bill that meets important public health 
priorities. I know how difficult this appropriations process has been 
and know their job was not easy. As a member of the Labor, Health & 
Human Services & Education Subcommittee, I am pleased that our product 
does maintain our commitment and investment in public health.
  The additional $2 billion investment for NIH alone will bring us that 
much closer to finding a cure for diseases like cancer, Parkinson's, 
cardiovascular, Alzheimer's, MS and AIDS. Every dollar invested in NIH 
reaps greater savings in health care dollars as well as greater savings 
in human lives. This additional investment will ensure that we remain 
on a course to double NIH funding. I know how important this funding is 
and am proud to represent outstanding research institutions like the 
University of Washington and the Fred Hutchinson Cancer Research Center 
who receive significant research funding from NIH.
  I am also pleased that we have provided funding for trauma care 
planning and development for the states. This is an essential program 
that assists the states in efforts to effectively develop trauma care 
strategies. We have neglected trauma care and we have lost ground in 
life saving delivery of critical care. I was pleased that the 
Subcommittee recognized the importance of trauma care planning.
  As many of my colleagues know, I have been pushing for federal 
funding to establish a national poison control plan. My allegiance to 
``Mr. Yuk'' is well known within this chamber, as well as within the 
HELP Committee. It was only two years ago that I offered an amendment 
during FDA reform to protect voluntary poison control labeling like Mr. 
Yuk from possible elimination. I have used my position on the 
Appropriations Committee to push for funding for poison control centers 
and for a national 1-800 hotline. I am pleased that this legislation 
includes $3 million for poison control efforts. This line-item within 
HRSA is a major victory for children and their parents. We have taken a 
huge step forward in developing a national poison control plan that 
builds on successful efforts in all of the states, like those made in 
Washington state.
  As one of the most vocal women's health care advocates in the Senate, 
I am pleased that the Committee report to accompany this Appropriations 
bill addresses several women's health issues and enhances programs to 
eliminate gender bias or discrimination. I want to thank the Chairman 
for his support of funding for the CDC Breast and Cervical Cancer 
Screening Program for low income women. This continued commitment will 
save lives and improve survival rates for women who often have little 
or no access to cancer screening. We know that early dedication offers 
the greatest hope of survival.
  I am pleased that we have been able to provide additional funding to 
expand the WISE WOMEN program to screen for cardiovascular disease as 
well as breast and cervical cancer. Cardiovascular disease is the 
number one killer of American women. Twice as many women die from 
cardiovascular disease than breast and cervical cancers combined. I was 
disappointed that we could not find additional monies to expand this 
program in all 50 states, and will continue to work to secure 
additional funding for FY2000.
  There are many reasons why I consider the Labor, HHS Appropriations

[[Page 24512]]

bill one of the most important appropriations bills and the one piece 
of legislation that truly effects all Americans and offers hope to the 
most vulnerable. But, perhaps one of the most critical programs funded 
in this appropriations bill is funding for battered women's shelters. 
This funding does save lives. This funding is the life line for 
battered and abused women and children. I am proud to have worked with 
the Chairman of the Subcommittee to increase our investment in battered 
women's shelters. I am working for the day when we need no more 
battered women's shelters. Unfortunately, we have a long way to go. 
But, by increasing the funds available by $13.5 million for FY2000, we 
have offered communities more resources to assist victims of domestic 
violence find a vital, life-saving safe shelter.
  I am hopeful that these important public health investments will 
survive what will likely be a difficult conference with the House.
  Mrs. FEINSTEIN. Mr. President, I am pleased today to support the FY 
2000 Labor-HHS-Education Appropriations bill, H. R. 1650, because it 
addresses important priorities of the American people.
  Among other increases, this bill increases funding for the National 
Institutes of Health (NIH) by $2 billion, including a $384 million 
increase for the National Cancer Institute. This will continue us on 
the path of doubling the funding of NIH over five years. The President 
requested only a 2.1 percent increase over FY 1999, which does not keep 
pace with medical research inflation, projected to be 3.5 percent next 
year.
  The National Institutes of Health--often called the ``crown jewel'' 
of the federal government--offers hope to millions of Americans who 
suffer from diseases like diabetes, arthritis, Alzheimers, Tourette's 
Syndrome, Parkinson's and on and on. Sadly, NIH can now only fund 31 
percent of applications. Under the Presidents's FY 2000 proposal, it 
could have fallen to 28 percent, a 10 percent drop. This is the wrong 
direction, especially at a time when research is opening many new 
scientific doors.
  Federal support for curing diseases and finding new treatments is not 
a partisan issue. Federal spending on health research is only 1 percent 
of the federal budget. Sixty eight percent of Americans support 
doubling medical research over five years; 61 percent of Americans 
support spending part of the surplus on medical research. Fifty five 
percent of Californians said they would pay more in taxes for more 
medical research, in a Research America poll.
  NIH is especially important to my state where some of the nation's 
leading research is conducted. The University of California received 
$1.7 billion in NIH funds in 1998. The federal government supports over 
55 percent of UC's research.
  I am pleased that the bill includes $ 3.28 billion for the National 
Cancer Institute. This is an increase of $384 million or 13 percent 
over last year. With this, NCI will be able to fund at least 10 percent 
more grants. If we had gone along with the President proposed 2 percent 
increase for cancer research, NCI would have been able to fund 10 
percent fewer grants. That is the wrong direction, at a time when 
cancer incidence and deaths are about to explode.
  Today, one in every four deaths is due to cancer. Cancer costs over 
$100 billion a year. Because of the aging of the population, the 
incidence of cancer will explode by 2010, with a 29 percent increase in 
incidence and a 25 percent increase in deaths, at a cost of over $200 
billion per year. The cancer burden will hit America the hardest in the 
next 10 to 25 years as the country's demographics change. (These are 
the findings of the September 1999 Cancer March Research Task Force.) 
Cancer deaths can be reduced from 25 to 40 percent over the next 20 
year period, saving 150,000 to 225,000 lives each year if we do the 
right thing.
  I want to thank the chairman of the subcommittee for including in the 
committee report language indicating that we need to increase cancer 
research funding consistent with the recommendations of the Research 
Task Force of the Cancer March. The Cancer March called for increasing 
the National Cancer Institute budget by 20 percent each year for four 
years, to get to $10 billion by 2005. This bill with its 12 to 13% 
increase in funds is a step on the way.
  The National Cancer Dialogue, a national group representing leaders 
of the entire cancer community and over 120 cancer organizations, 
recommended that NCI be funded at $5 billion in FY 2000 and CDC cancer 
activities at $516 million.
  What can be accomplished with $5 billion for research?
  More drugs: NCI could bring 40 new cancer drugs from the laboratory 
to clinical trials. In NIH's entire history, only 70 drugs have been 
approved for treating cancer.
  Cancer Genetics: Continuing to identify genes involved in cancer. 
Improving our understanding of the interaction between genes and 
environmental exposures.
  Imaging: Finding new ways to detect cancers earlier when they are 
small, not invasive and more easily treated.
  Clinical Trials: Increase participation from 2 percent currently. 
Medicare beneficiaries account for more than 50 percent of all cancer 
diagnoses and 60 percent of all cancer death.
  Prevention: 70 percent of all cancers are preventable says the 
American Cancer Society. By expanding the CDC's efforts to provide 
cancer screening, cancer registries and other measures to help people 
prevent cancer screening, cancer registries and other measures to help 
people prevent cancer. For example, tobacco-related deaths are the 
single most preventable cause of death and disability and account for 
30 percent of all US cancer death.
  I am also pleased to see an increase of $200 million over last year 
and $100 million over the President's request for Ryan White AIDS, as 
well as a 12 percent increase for AIDS research at NIH.
  California has the second highest incidence of HIV/AIDS in the US. 
While the AIDS death rate has declined it is still too high. Over 
40,000 new infections develop each year. In California, 100,000 people 
are living with HIV/AIDS. Half of all HIV-infected people do not 
receive regular medical care according to the Rand study, December 
1998.
  We face serious challenges. We must find a cure. We must find new 
treatments. HIV lingers in cells so long that the ``virus cannot be 
eradicated at all with current treatments * * * it remains tucked away 
longer than though,'' according to the New England Journal of Medicine, 
May 1999.
  This funding bill also includes important funding for education at 
all levels. There is hardly a more important function of government 
than providing a solid education for our youngsters.
  The bill raises education by $2 billion over last year. This is 
important in light of the decline in the federal share of total 
education funding from 14 percent in 1980 to six percent in 1998, 
according to the Office of Management and Budget.
  No doubt we need to do more. Our nation's schools face unprecedented 
challenges. My state is fraught with problems: California has 6 million 
students, more students than 36 states have in total population and one 
of the highest projected enrollments in the country, California will 
need 210,000 new teachers by 2008. We have about 30,000 teachers on 
emergency credentials. We have the most diverse student body in the 
county. In some schools, over 50 languages are spoken. While this 
diversity is one of my state's great strengths, in the classroom, it 
places huge responsibilities on teachers.
  Buildings: We need to build 6 new classrooms per day, $809 million 
per year. Some elementary schools have over 5,000 students. Our schools 
are too big.
  In higher education, California is preparing for ``Tidal Wave II,'' 
the demographic bulge created by children of the baby boomers which 
will inundate our colleges and universities between 2000 and 2010.
  And so our needs are huge. Our challenges are great.
  I am disappointed that the Senate did not adopt the Murray amendment

[[Page 24513]]

that would have ensured that $1.4 billion be used to hire teachers and 
reduce class size. By adding $200 million and raising the allocation 
from $1.2 billion to $1.4 billion and specifying that it be used to 
hire teachers and reduce class sizes, California could have hired 1,100 
new teachers, on top of the 3,322 that will provide funding for last 
year. I hope the conference will see the importance of this.
  One area of this bill that I have given my attention to is ESEA Title 
I, the program that provides over $8 billion for educating poor 
children. Unfortunately, despite my efforts in the Appropriations 
Committee, I was unable to delete what is known as the ``hold 
harmless'' provisions. Also, the committee would not accept my 
amendment to clarify and insure that any new or additional funds, over 
last year, go to states that are hurt by the hold harmless provision.
  The Title I hold harmless provisions (there are two in the bill, for 
basic grants and for concentration grants) hold states and districts 
``harmless.'' They say in essence that no state or district will 
receive less than it did the previous year despite changes in the 
number of poor children. In the bill, these apply to the Title I basic 
grants and the concentration grants. These provisions freeze funding in 
place despite the number of poor children, despite their eligibility.
  I tried to delete these provisions in the committee, but because, 
frankly, there are more low-growth states than high-growth states like 
mine, in the Senate, did not have the votes to completely eliminate 
them.
  Here is why the hold harmless provisions are wrong: One, they violate 
the purpose of the program since 1965, to target funds on poor 
children, two, they contravene the census update requirement. The 
authorizing law requires the Department to update child poverty data 
every year so that each state will receive funds according to the 
number of poor children. The hold harmless renders that requirement 
virtually meaningless.
  Secretary Riley wrote, April 29, 1999: ``I do share your concern that 
the 100 percent hold-harmless provision undermines the apparent 
statutory intent that allocations for Title I and other programs be 
based on the most recent census data.''
  Three, a poor child is a poor child. Congress recognized that poor 
children need extra help, wherever that child may be. A poor child in 
California is as worthy as a poor child in Mississippi and should not 
be deprived of funding.
  A July 1999 study found that students in poor school districts (West 
Fresno, Mendota, Farmersville) ranked at or near the bottom of 
California's achievement tests. ``Most of the lowest-scoring school 
districts * * * are in rural areas with high unemployment and poverty 
and have many children from migrant farm worker families who speak 
little English and have little education.'' (Fresno Bee, 7/25/99)
  Four, hold harmless provisions disproportionately hurt states with 
high growth rates in poor children, states like California, Arizona, 
New Mexico, Texas, Hawaii, South Carolina, Maryland, Nevada, Virginia, 
Georgia, Florida, New York, North Carolina, Oklahoma.
  Here are some examples of losses of Title I Funds under FY 1999 hold 
harmless: California $36 million; Florida $32 million; New Mexico $4.5 
million; New York $48 million; North Carolina $8 million; Texas $32 
million.
  Last year, under the bill's Title I hold harmless, California lost 
$32 million. California has 14 percent of all Title I children and gets 
11 percent of Title I funds. (US Dept of Education). California has a 
22 percent poverty rate for children; The US rate is 18.7 percent. (9 
states exceed California's). California's number of poor students grew 
53 percent from 1990 to 1995; nationally, it grew 22 percent. In total 
federal dollars, California pays 12.5 percent of federal taxes but gets 
back only 11.2 percent.
  California receives $656 in Title I funds per poor child. The 
national average is $745. Some states receive as much as $1,289, 
according to the US Department of Education. California has almost 40 
percent of the nation's immigrants. The poverty rate for immigrants 
grew by 123 percent from 1979 to 1997. (Center for Immigration Studies, 
9/2/99). Income inequality is growing in California faster than the 
rest of the country (Public Policy Institute of California, 2/9/99)
  Five, the hold harmlesses freeze in the status quo, even for those 
not eligible. The hold harmless provision gives funds to states and 
districts that may not even be eligible for funds, merely because they 
got funds in the past. What good are eligibility rules if we ignore 
them, override them willy-nilly. We either have eligibility rules or we 
don't.
  If Congress believes the formula is not properly structured or 
targeted, Congress should change it in the authorizing statute. 
Congress will have that opportunity next year when ESEA is 
reauthorized.
  I am grateful that the committee agreed, at my request, to modify the 
bill so that the Title I hold harmless will not apply in FY 2000 to the 
eight federal programs have funding formulas based in whole or in part 
on the Title I formula. Those programs are: Safe and Drug-free Schools; 
Even Start Family Literacy; Comprehensive School Reform; Eisenhower 
Professional Development (Teacher training); Technology Literacy; Class 
Size Reduction; Goals 2000, Title III; and McKinney Homeless Education.
  This amendment was needed because, in FY 1998 and 1999, the 
Department of Education applied the 100 percent hold harmless to 8 
other education programs, thus compounding the harm of the Title I hold 
harmless provision and the cuts that result from it.
  I believe in the current bill, Congress is giving the Department 
clear guidance that the Title I hold harmless provision should not be 
applied to other programs.
  Because last year the Department applied the hold harmless to other 
programs, my state lost funds under the following programs: Teacher 
Training $40,000; School Reform $700,000; Technology Literacy $5.4 
million; Goals 2000 $3 million; EvenStart/Literacy $1 million.
  I thank the committee for remedying this inequity.
  I am disappointed that the Committee did not provide funding for the 
President's English Language and Civics Education Initiative, under the 
Adult Education program. This is an effort to help states and local 
communities provide instruction to adults who want to learn English as 
a Second Language (ESL) programs, as well as instruction in civics and 
life skills. If adequately funded, this initiative would help ensure 
that those who seek to become American citizens learn not only the 
words of the citizenship oath, but also the broader language of our 
civic life. Simply put, this initiative would help our nation's 
newcomers become full participants in American life.
  In 1990, there were about 25.5 million U.S. adults age 18 and older 
who spoke a language other than English at home. Many of these non-
English speakers were new immigrants. Some immigrants have lived here 
for many years. Still, other non-English speakers were born in the 
United States but grew up without mastering the English language. Many 
of these adults reported that they have difficulty speaking English, 
but were highly motivated to learn the language, especially to obtain 
jobs and gain access to educational opportunities.
  As the number of non-English speaking residents has increased, so has 
the demand for placement in English-as-a Second-Language (ESL) classes. 
In the last five years, enrollment for ESL classes has jumped from 1.2 
million in 1994 to nearly 2 million in 1998. In the state of 
California, more than 1.2 million adult students enrolled in these 
classes in 1998, accounting for 38.2 percent of the adult education 
students in the state.
  The increased demand for ESL classes have resulted in long waiting 
lists for ESL classes in many parts of the country. For example, Los 
Angeles has a waiting list of 50,000 people for ESL classes. Chicago's 
ESL programs are filled to capacity as soon as they open

[[Page 24514]]

their doors. And, New York State has resorted to a lottery system to 
select individuals who wish to learn English.
  I have visited several immigrant communities throughout California 
and have been impressed by the high work force participation rates, the 
strong sense of family, and a tireless commitment to their community. 
However, during these visits and in letters from my constituents, I 
have been often told about the lack of opportunities to participate in 
adult English education courses. This is particularly troublesome, 
given the large number of people in my state seeking to become American 
citizens, and to otherwise more fully participate in our civic life.
  More support for programs like English Language and Civics Education 
Initiative would help states and communities throughout California and 
the rest of the nation that are struggling to keep up with this demand. 
Providing $70 million requested by the Administration would not merely 
be an expenditure, but an investment in our nation's future.
  While this bill cannot address all the health and education needs of 
our nation or even those that are a federal responsibility, allocations 
are good--$2 billion more for education and $3 billion more for health 
(for the discretionary programs). It does not do all I wish it would 
do. For example, it does not adequately fund afterschool programs, 
health professions training, or educational technology as much as I 
would like, but it does address many important needs and I will vote 
for it.
  I urge my colleagues to give it their strong support.
  Mr. SPECTER. Mr. President, we are under very heavy time constraints 
because some of our Members are about to depart. On two personal notes, 
I had said earlier that I had recused myself from consideration of the 
funding for the National Constitution Center because my wife is the 
director of development there. I want to repeat that and include, 
again, a copy of a letter to Senator Cochran who took over on that 
issue as the next senior ranking Republican.
  I ask unanimous consent to print the letter in the Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                             United States Senate,


                                  Committee on Appropriations,

                               Washington, DC, September 17, 1999.
     Hon. Thad Cochran,
     U.S. Senate, Washington DC.
       Dear Thad: As a precautionary matter, I think it is 
     advisable for me to recuse myself on the issue of the 
     appropriation for the National Constitution Center since my 
     wife, Joan Specter, is director of fundraising.
       I would very much appreciate it if you would substitute for 
     me on that issue since you are the senior Republican on the 
     Subcommittee for Labor, Health and Human Services and 
     Education.
           Sincerely,
                                                    Arlen Spector.

  Mr. SPECTER. I have one other item on a personal note. Senator Inouye 
for some time has urged the naming of a building for me, which I had 
resisted. After my wife heard about it and the grandchildren, I have 
succumbed to the majority vote on the naming of the building the 
National Library of Medicine.
  In conclusion, I hope we will have a very strong vote in favor of 
this bill. This bill stretches about as far as it can and is about as 
low cost as it can be with the chance of getting the President's 
signature. This is only one step along the way toward conference, and 
we need a very strong vote in favor of this bill if we are to take care 
of the important funding, especially for not only worker safety but 
health and education.
  I yield to my colleague.
  Mr. REID. Will the Senator yield to this Senator?
  Mr. HARKIN. Are we in our 10 minutes of time on which we had a 
unanimous consent agreement?
  Mr. SPECTER. That time might have already been used. Why don't we 
proceed with Senator Harkin's closing statement until Senators, who 
have planes to catch, arrive.
  Mr. HARKIN. I yield such time as he may want to the majority whip.
  Mr. REID. Mr. President, I state for the record that the issue of 
class size reduction is of vital importance to everyone on this side of 
the aisle, as the case has been made very clear. There are going to be 
enough votes to pass this bill by virtue of the Democrats voting in 
favor of it, but we want to at this time alert the conferees that if 
they fail to adequately address this matter, it will be extremely 
difficult to support this Labor-HHS conference report.
  Further, the two managers of this bill have worked very hard. They 
have shown compassion, courage, and expertise in getting the bill to 
this point, and I congratulate and commend both of them for their 
diligent work.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. HARKIN. Mr. President, I thank Senator Reid for all of his 
support and his help and great work in moving this bill along. We 
appreciate it very much.
  We have had a good debate, a long debate, a good exchange of 
amendments on this bill. We have had amendments that have been approved 
and rejected on both sides of the aisle.
  I thank and commend my chairman, Senator Specter, for his leadership, 
his skill, and his persistence, his dogged persistence in managing this 
bill and getting it through. Senator Specter had tried time and time 
again during the long, hot, dog days of summer and coming into this 
fall, never giving up, always pushing us to get this bill up and get it 
through. Again, I commend him and thank him for his leadership and also 
thank Senator Specter and his staff for always working closely with us. 
I can honestly say that at no time were we ever surprised about 
anything. We have had a very good working relationship. We may not have 
always agreed on everything--that is the nature of things around here--
but we always had a good, open, fair, and thoughtful relationship. I 
appreciate that very much on the part of my chairman.
  This is always the toughest appropriations bill to get through. It 
was tough when I was chairman and Senator Specter was ranking member. 
Things have not changed a bit. This year was a greater challenge than 
ever. But I say to my colleagues on this side of the aisle, we have 
produced a very good bill--not just a good bill, a very good bill. It 
is not perfect. Maybe there are some things I would like to have seen 
different. Perhaps we can improve it a little bit in conference. But it 
is a very good bill.
  Let me just give a few of the highlights of what we were able to 
accomplish in this bill:
  First of all, an overall increase of $4 billion over last year; a 
$2.2 billion increase for education programs. That is $500 million more 
than the President asked for. So if anyone says we did not take care of 
education, they do not know what they are talking about, and I say that 
in all candor; $500 million more than what the President asked for.
  A $2 billion increase for the National Institutes of Health--$2 
billion last year, $2 billion this year, keeping our promised goal of 
doubling NIH funding in 5 years.
  We have had a very important increase for community health centers, a 
$100 million increase for community health centers. Community health 
centers in rural areas and in some of our poorer areas of this country 
are the health care system for a lot of poor people in our country, and 
they are doing a great job. This bill has a $100 million increase for 
community health centers.
  We maintain the funding for all the job training and worker 
protection provisions in the Department of Labor. We have over a $600 
million increase for Head Start. Maybe I would like to see a little bit 
more, but it is good progress. We are moving in the right direction 
towards getting all 4-year-olds covered in Head Start programs.
  The Dodd amendment almost doubles the child care development block 
grant to $2 billion for child care. That is very important.
  We double the funding for afterschool programs. Again, I know how 
strongly Senator Specter feels about this. He authored a bill, the 
youth antiviolence bill, of which I am a cosponsor, taking care of 
these kids after school. We doubled from $200 million to $400 million 
the afterschool programs.

[[Page 24515]]

  We raised the maximum Pell grant from $3,150 to $3,325, the highest 
it has ever been.
  Let me cut to the quick. I know many of my colleagues on this side of 
the aisle have signed a letter expressing their concern over the lack 
of authorization of reducing class size. We have the money in there for 
it, but we do not have the authorization.
  As I have said repeatedly, reducing class size is critical. I am 
personally disappointed that Senator Murray's amendment was not 
adopted. But I want to be very clear, though, that there is absolutely 
no inconsistency with signing that letter and voting for passage of 
this bill.
  We vote to send bills with problematic issues to conference all the 
time around here. Maybe there is one little thing we do not agree with, 
but overall we agree with the major thrust of the bill, and we send it 
to conference.
  Do not let the perfect be the enemy of the good. This is a good bill. 
We should send it to conference. If you are concerned about class size, 
the best and quickest way to have those concerns resolved is to vote 
the bill out and send it to conference. We will have a chance there to 
make improvements. If you still have problems after that, you can vote 
against the conference report.
  But this bill is too important to the health, the well-being, and the 
education of the American people to kill it on the Senate floor. 
Everyone who votes for this bill can be proud of their vote, proud of 
the investments that we have made in the human infrastructure of this 
country.
  Lastly, people have said there are a lot of gimmicks in this bill. 
There are no gimmicks in this bill. We advance funds because of the 
unique way that education is funded in this country. We do not pay it 
out until the next year anyway. So there are no gimmicks in this bill. 
This is straightforward. This is a sound bill. I strongly urge my 
colleagues to vote for this bill.
  Again, I thank Senator Specter, his staff: Bettilou Taylor, Jim 
Sourwine, Mary Dietrich, Kevin Johnson, Mark Laisch, Jack Chow, and 
Aura Dunn for all of their hard work. I also thank my minority staff: 
Ellen Murray and Jane Daye; also my personal staff: Bev Schroeder on 
education; Chani Wiggins on labor; Sabrina Corlette on health; Katie 
Corrigan on disabilities; Rosemary Gutierrez on child labor; and, of 
course, my outstanding leader, legislative director, Peter Reinecke, 
for all of his hard work.
  So again I urge my colleagues on this side of the aisle to give this 
bill their ``yes'' vote and send it to conference resoundingly because 
it is a good bill, and it is good for America.
  I ask unanimous consent that several letters in support of passage of 
this bill be printed in the Record.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

         National Association of Child Care Resource and Referral 
           Agencies,
                                  Washington, DC, October 7, 1999.
     Hon. Tom Harkin,
     U.S. Senate,
     Washington, DC.
       Dear Senator Harkin: On behalf of the Board of Directors 
     and the more than 700 members of the National Association of 
     Child Care Resource and Referral Agencies (NACCRRA), this 
     letter urges the U.S. Senate to pass the FY2000 budget bill. 
     NACCRRA appreciates the inclusion of a set-aside for child 
     care resource and referral and school-age child care in the 
     Child Care and Development Block Grant (CCDBG), even though 
     we sought an increase in the CCDBG to provide more and 
     improved services to children and families throughout the 
     country.
       NACCRRA especially thanks the Senate for including language 
     for the Child Care Aware service in the budget bill. Child 
     Care Aware is the only national hot-line for parents, 
     families and community persons interested and involved in 
     child care and early education to get connected to the CCR&R 
     in their community. We continue to request inclusion of a 
     funding amount for CCA: $500,000.
       Thank you once again.
           Sincerely,
     Yasmina Vinci,
       Executive Director.
     Edna Ranck,
       Director of Public Policy and Research.
                                  ____



                                         Student Aid Alliance,

                                  Washington, DC, October 7, 1999.
     Hon. Tom Harkin,
     Ranking Member, Labor, Health and Human Services 
         Subcommittee, Washington, DC.
       Dear Senator Harkin: We write on behalf of the Student Aid 
     Alliance--a coalition of 60 organizations representing 
     colleges and universities, students, and parents--to thank 
     you for your leadership in crafting a Labor-HHS-Education 
     appropriations bill for FY 2000 that recognizes the need for 
     increased investment in student aid programs.
       Despite the constraints of a woefully inadequate 302(b) 
     allocation and stringent budget caps, your bill will help 
     maintain access to postsecondary education for low-income 
     students. It clearly recognizes the need for sustained 
     federal investment in proven student aid programs. We 
     appreciate the central role you have played in bringing about 
     increases for student aid programs in FY 2000.
       At the outset of this year's appropriations process, the 
     Student Aid Alliance set important goals for student aid 
     funding. As you will recall, we have advocated for a $400 
     increase in the maximum Pell Grant, substantial increases in 
     campus-based aid (SEOG, Perkins Loans, and Work-Study), LEAP, 
     TRIO, and graduate education programs. Your bill takes a step 
     in the right direction toward achieving our funding goals.
       During the final weeks of the Congressional session, we 
     will continue to seek additional opportunities to help 
     achieve the funding recommendations of the Student Aid 
     Alliance. We hope that by working together we can build upon 
     your good work to make even more funding available for your 
     subcommittee's priorities.
       Again, thank you for your work on behalf of all college 
     students. We look forward to working with you as the 
     appropriations process continues.
           Sincerely,
     Stanley O. Ikenberry,
       Co-Chair.
     David L. Warren,
       Co-Chair.


                  Members of the Student Aid Alliance

       American Association for Higher Education
       American Association of Colleges for Teacher Education
       American Association of Colleges of Nursing
       American Association of Colleges of Pharmacy
       American Association of Collegiate Registrars and 
     Admissions Officers
       American Association of Community Colleges
       American Association of Dental Schools
       American Association of State Colleges and Universities
       American Association of University Professors
       American College Personnel Association
       American College Testing
       American Council on Education
       American Psychological Association
       American Society for Engineering Education
       American Student Association of Community Colleges
       APPA: The Association of Higher Education Facilities 
     Officers
       Association of Academic Health Centers
       Association of Advanced Rabbinical and Talmudic Schools
       Association of American Colleges and Universities
       Association of American Law Schools
       Association of American Medical Colleges
       Association of American Universities
       Association of Catholic Colleges and Universities
       Association of Community College Trustees
       Association of Governing Boards of Universities and 
     Colleges
       Association of Jesuit Colleges and Universities
       Career College Association
       Council for Christian Colleges and Universities
       Coalition of Higher Education Assistance Organizations
       College and University Personnel Association
       College Board
       College Fund/UNCF
       College Parents of America
       Council for Advancement and Support of Education
       Council for Higher Education Accreditation
       Council of Graduate Schools
       Council of Independent Colleges
       Educational Testing Service
       Hispanic Association of Colleges and Universities
       Lutheran Educational Conference of North America
       NAFSA: Association of International Educators
       National Association for Equal Opportunity in Higher 
     Education
       National Association for College Admission Counseling
       National Association of College and University Attorneys
       National Association of College and University Business 
     Officers
       National Association of Graduate-Professional Students
       National Association of Independent Colleges and 
     Universities
       National Association of State Universities and Land-Grant 
     Colleges

[[Page 24516]]

       National Association of Student Financial Aid 
     Administrators
       National Association of Student Personnel Administrators
       National Collegiate Athletic Association
       National Council of University Research Administrators
       NAWE: Advancing Women in Higher Education
       National Education Association
       The Council on Government Relations
       The Council for Opportunity in Education
       United States Public Interest Research Group
       United States Student Association
       University Continuing Education Association
       Women's College Coalition
                                  ____

                                            National Coalition for


                                              Cancer Research,

                                  Washington, DC, October 7, 1999.
     Hon. Tom Harkin,
     U.S. Senate,
     Washington, DC.
       Dear Senator Harkin: On behalf of the National Coalition 
     for Cancer Research, a coalition of 25 national organizations 
     of cancer researchers, patients, and research advocates 
     dedicated to eradicating cancer through a vigorous publicly 
     and privately-supported research effort; I want to thank you 
     and your colleagues on the Labor-HHS Appropriations Committee 
     for your strong support of the National Institutes of Health 
     (NIH) with regard to the FY 2000 appropriations.
       It is very important that the Senate make a strong 
     statement regarding the continued commitment to double the 
     budget of the NIH in order to sustain the momentum of this 
     historic initiative. It is vitally important that the Senate 
     pass this legislation in order to provide the necessary 
     leverage to maintain the Senate's position in conference 
     negotiations and to move this important legislation to the 
     next process. Thank you for your strong support and 
     consideration of this important issue.
           Sincerely,
                                                Carolyn R. Aldige,
     President.
                                  ____

                                         National Alliance for Eye


                                          and Vision Research,

                                  Washington, DC, October 7, 1999.
     Hon. Tom Harkin,
     U.S. Senate,
     Washington, DC.
       Dear Senator Harkin: Thank you for your continued strong 
     commitment to biomedical research demonstrated by the $2 
     billion increase provided for the NIH in the Fiscal Year 2000 
     spending bill moving through the Senate.
       On behalf of the National Alliance for Eye and Vision 
     Research (NAEVR), I urge you and your colleagues to hold firm 
     to your commitment through the conclusion of the budget 
     process in order to stay on track towards doubling the NIH 
     budget by 2003. Your efforts have given renewed hope to 
     millions of Americans afflicted with disease and disabling 
     conditions that improved treatments and cures may be close at 
     hand.
       It is critical that the Senate pass the Labor-HHS-Education 
     spending bill in order that the nation's commitment to 
     biomedical research is not weakened in the negotiations to 
     determine the final funding outcome for NIH.
       Once again, thank you for your strong support and for your 
     consideration of this important issue.
           Sincerely,
                                              Stephen J. Ryan, MD,
                                                        President.

  Mr. LOTT addressed the Chair.
  The PRESIDING OFFICER. The majority leader.
  Mr. LOTT. I will be brief because I know we need to go to final 
passage.
  I must say that, amazingly, in a moment we are going to be voting on 
final passage of the Labor-HHS appropriations bill. I think this is the 
first time in 3 years that we have done that. I know we did not have 
one last year. I cannot recall for sure about 1997. I know we did in 
1996. Regardless, this is the 13th and last of the appropriations 
bills. We are going to get to final passage. I hope it will pass.
  I have to extend my congratulations to the chairman of the 
subcommittee, the Senator from Pennsylvania, and the Senator from Iowa. 
A lot of people thought we could not get it done, but here we are. I 
want to say a special thanks to Paul Coverdell, who acted as one of my 
assistants on this matter, working with the whip on our side, and Harry 
Reid, who did a great job. In fact, I had asked Senator Coverdell if he 
would do this every week, and he has respectfully declined.
  Having said that, following this bill--the last appropriations bill--
there will be no further votes this evening, and no votes will occur on 
Friday of this week. In addition, the Senate will not be in session on 
Monday, in light of the Columbus Day holiday.
  On Friday, the Senate will begin consideration of the Comprehensive 
Test Ban Treaty at 9:30 a.m. Obviously, this is a very important 
treaty, a very important matter, so I urge my colleagues to participate 
in the debate tomorrow. I think we have somewhere between 10 and 20 
speakers who are going to speak on this tomorrow. I hope the Senators 
will watch it from their offices or review the debate that occurs on 
Friday.
  This evening, the Senate will shortly begin the Agriculture 
appropriations conference report. Additional debate on that issue will 
occur this evening. Several votes will occur on Tuesday, October 12, 
beginning at 5:30. There could be one vote or more. I think it is very 
possible there could be a couple votes at that time on Tuesday dealing 
with the Agriculture appropriations conference report and possibly with 
the Comprehensive Test Ban Treaty.
  So I thank all my colleagues for their cooperation. We have had a 
very successful week. We passed the FAA reauthorization, confirmed two 
judicial nominations, passed the foreign operations conference report. 
Now we are hopefully fixed to pass the Labor-HHS appropriations bill, 
and we will file cloture tonight, since it seems it is necessary, on 
the Agriculture appropriations conference report.
  The bottom line: No further votes tonight; the next vote, 5:30 on 
Tuesday.
  I yield the floor.
  Mr. SPECTER addressed the Chair.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. SPECTER. I have a good bit to say, but since colleagues want to 
get to the airport, I shall say it after the final vote takes place.
  I yield the floor.
  The PRESIDING OFFICER. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed for a third reading and was read 
the third time.
  Mr. COVERDELL. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  The PRESIDING OFFICER. The bill having been read the third time, the 
question is, Shall it pass? The yeas and nays have been ordered. The 
clerk will call the roll.
  The legislative clerk called the roll.
  Mr. REID. I announce that the Senator from New York (Mr. Schumer) is 
necessarily absent.
  I also announce that the Senator from Connecticut (Mr. Dodd) is 
absent because of family illness.
  The PRESIDING OFFICER (Mr. Sessions). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced--yeas 73, nays 25, as follows:

                      [Rollcall Vote No. 321 Leg.]

                                YEAS--73

     Abraham
     Akaka
     Baucus
     Bennett
     Biden
     Bingaman
     Bond
     Boxer
     Breaux
     Bryan
     Burns
     Byrd
     Campbell
     Chafee
     Cleland
     Cochran
     Collins
     Coverdell
     Daschle
     DeWine
     Domenici
     Dorgan
     Durbin
     Feinstein
     Frist
     Gorton
     Grassley
     Gregg
     Harkin
     Hatch
     Hollings
     Hutchinson
     Hutchison
     Inouye
     Jeffords
     Johnson
     Kennedy
     Kerrey
     Kerry
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lott
     Lugar
     Mack
     McConnell
     Mikulski
     Moynihan
     Murkowski
     Murray
     Reed
     Reid
     Robb
     Roberts
     Rockefeller
     Roth
     Santorum
     Sarbanes
     Shelby
     Smith (OR)
     Snowe
     Specter
     Stevens
     Thompson
     Thurmond
     Torricelli
     Warner
     Wellstone
     Wyden

                                NAYS--25

     Allard
     Ashcroft
     Bayh
     Brownback
     Bunning
     Conrad
     Craig
     Crapo
     Edwards
     Enzi
     Feingold
     Fitzgerald
     Graham
     Gramm
     Grams
     Hagel
     Helms
     Inhofe
     Kyl
     McCain
     Nickles
     Sessions
     Smith (NH)
     Thomas
     Voinovich

                             NOT VOTING--2

     Dodd
     Schumer
       
  The bill (S. 1650), as amended, was passed.
  The text of the bill will be printed in a future edition of the 
Record.
  Mr. SPECTER. Mr. President, I move to reconsider the vote.

[[Page 24517]]


  Mr. STEVENS. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. SPECTER. Mr. President, I thank my colleagues on both sides of 
the aisle.
  I ask unanimous consent when the Senate completes all action on S. 
1650, it not be engrossed and be held at the desk.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SPECTER. Mr. President, I thank my colleagues on both sides of 
the aisle for the very strong vote in support of this bill. I thank my 
distinguished colleague, Senator Harkin, ranking member, for his 
cooperation, for his leadership, and for his extraordinary diligence. 
We have had an extraordinary process in moving through this bill.
  It is very difficult to structure funding for the Department of 
Education, the Department of Health and Human Services, and the 
Department of Labor which can get concurrence on both sides of this 
aisle. The bill came in at $91.7 billion. There have been some 
additions. It is hard to have enough spending for some, and it is hard 
not to have too much spending for others. I think in its total we have 
a reasonably good bill to go to conference.
  The metaphor that I think is most apt is running through the 
raindrops in a hurricane. We are only partway through. We are now 
headed, hopefully, for conference. I urge our colleagues in the House 
of Representatives to complete action on the counterpart bill so we may 
go to conference.
  We have already started discussions with the executive branch. I had 
a brief conversation with the President about the bill. He said his 
priorities were not recognized to the extent he wanted. I remind 
Senators that the Constitution gives extensive authority to the 
Congress on the appropriations process. We have to have the President's 
signature, but we have the constitutional primacy upon establishing the 
appropriations process at least to work our priorities. I am hopeful we 
can come to an accommodation with the President.
  We have had extraordinarily diligent work done by the staff: Bettilou 
Taylor, to whom I refer as ``Senator Taylor,'' has done an 
extraordinary job in shepherding this bill through and taking thousands 
of letters of requests from Senators; Jim Sourwine has been at her side 
and at my side; I acknowledge the tremendous help of Dr. Jack Chow, as 
well as Mary Dietrich, Kevin Johnson, Mark Laisch, and Aura Dunn. On 
the minority staff, Ellen Murray has been tremendous, as has Jane Daye.
  There is a lot more that could be said, but there is a great deal of 
additional business for the Senate to transact. I thank my colleagues 
for passing this bill.

                          ____________________