[Congressional Record (Bound Edition), Volume 145 (1999), Part 21]
[Senate]
[Pages 30966-30976]
[From the U.S. Government Publishing Office, www.gpo.gov]



TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT OF 1999--CONFERENCE 
                           REPORT--Continued


                         Privilege of the Floor

  Mr. MOYNIHAN. Mr. President, I ask unanimous consent that Kyle 
Kinner, a presidential management intern with the Finance Committee 
minority staff, be granted the privilege of the floor during the 
consideration of this conference report.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MOYNIHAN. I have the great pleasure to yield 5 minutes to my 
friend from Illinois, Senator Durbin.
  The PRESIDING OFFICER. The Senator from Illinois is recognized for 5 
minutes.
  Mr. DURBIN. I salute Senator Roth, Senator Moynihan, Senator Kennedy, 
Senator Jeffords, Senator Harkin, and others who worked so hard on this 
Work Incentives Improvement Act.
  A close friend of my family had a son who was mentally ill. This 
young man wanted more than anything to go to work. He knew if he did 
so, he would lose the protection of health insurance. So he was held 
back from that opportunity. I don't believe he was better for that. I 
don't believe America was better for that.
  This bill addresses that challenge and says that as the disabled go 
to work, they will still be able to use Medicaid and Medicare to 
protect themselves with health insurance even as they earn some income. 
That is only just. It opens up an opportunity that currently is not 
there. I am happy to be a supporter of this legislation. I look forward 
to voting for it when it comes to the floor.
  There is some reservation in my mind about the bill that is before 
us, not because of the provision I just mentioned, nor because of the 
extension of certain tax credits and benefits, but, rather, because of 
the language in this bill relating to organ donation.
  This is the challenge we face in America. If you are an American 
grievously ill, in need of an organ transplant, your chances of 
survival depend more than anything on your address and how much money 
you have. You could be the most seriously ill person in some State in 
this Union and be overlooked and bypassed in favor of another patient 
in another State who is not as seriously ill and might be able to wait. 
That needs to change. That is certainly not a fair or American way.
  The rules we are trying to promulgate to make that change have been 
the source of great controversy on Capitol Hill. It is sad when it 
comes to a point where Members of the House and Senate are deeply 
involved in a debate over the availability of organs for donation to 
those who need a transplant to live.
  In my State of Illinois, over the last 3 years, 97 people have died 
waiting for organ transplants at the University of Chicago. I see my 
colleague from the State of Pennsylvania, Senator Santorum, where 187 
people died waiting at the University of Pittsburgh. My colleagues, 
Senator Moynihan and Senator Schumer, know that 99 people died waiting 
at Mount Sinai in New York. In the last week alone, two people have

[[Page 30967]]

died at one of the Chicago transplant centers because an organ did not 
become available.
  If you are an American who needs a liver transplant to survive and 
you live in the following States, you have much less chance of 
receiving the transplant: Arizona, California, Colorado, Connecticut, 
Illinois, Massachusetts, Maryland, Michigan, New York, or Pennsylvania.
  This is not a fair system. It is a system which cries out for justice 
and one that cries out for the politicians to step aside. Let the 
medical community find the best and most efficient way organs can move 
to the people who need them to live, instead of getting caught up in 
some special interest tangle here or political dogfight. It is sad that 
we are now in a situation on this bill where we have not resolved this 
contentious issue. I sincerely hope all parties will come together, and 
soon, to make certain that changes are made to make the system fairer. 
We know, by the people we represent, that this is literally a life-or-
death argument.
  Kathryn Krivy lives in Chicago. She runs the wellness clinic at the 
Northwestern Memorial Hospital. She is desperately in need of a new 
liver. She has developed primary biliary cirrhosis, a very rare 
autoimmune disease that is incurable. She has been on the transplant 
list in Chicago for over 2 years, but currently, because of the delay, 
she has decided to sign up at the Mayo Clinic in Minnesota because it 
is much more likely she can receive a transplant in a shorter period of 
time. She has the knowledge and the resources to make that decision, 
but many of the poorer people in America waiting for an organ 
transplant do not have that luxury.
  We should not reach the point in America where something as basic as 
the gift of life, an organ donation, depends on your home address. That 
is exactly what has occurred. An estimated 66,000 potential organ 
recipients are waiting their turn. Only 20,000 will see an organ 
transplant this year. Nearly, 5,000 Americans will die each year, at 
least 13 every day, while awaiting organ transplants. Of those, it is 
estimated that 300 to 1,000 Americans, maybe up to 3 a day, might be 
spared if this system were fairer and were revised. Unfortunately, that 
is not the case.
  Though this is an excellent bill which I support, I believe it is a 
sad commentary that we have reached this state of affairs. I hope in 
the next session of Congress we can bring justice to organ donation.
  I yield the floor.
  Mr. ASHCROFT. Mr. President, today the United States Senate completes 
its business for calendar year 1999 by passing two important bills: 
H.R. 3194--the final spending bill, and H.R. 1180--the Work Incentives 
Act, which provides new opportunities for disabled individuals to enter 
the work force and includes $18 billion dollars in tax cuts. I am 
pleased to announce my support for both these bills.
  The Chairman of the Senate Budget Committee has eloquently explained 
how this budget agreement keeps faith with the Republican pledge that 
no Social Security trust fund monies be used to pay for other 
government programs.
  Last year, for the first since 1960--during the Eisenhower 
Administration--we balanced the budget without counting the Social 
Security surplus. Mr. President, for the first time in 39 years the 
government did not divert money from the Social Security Trust Fund to 
pay for other programs.
  As a result of the spending plan pursued by this Republican Congress, 
which called for protection of Social Security, increased spending on 
education and defense, and reduction of the national debt, we have 
begun to put our fiscal House in order.
  When I was elected to this body in 1994, the incoming 104th Congress 
inherited a projected four-year budget deficit of $906 billion. Now, 
through the hard work and discipline of this Congress, the tables have 
turned. That actual four-year period produced a net budget surplus of 
$63 billion--a turnaround of $969 billion, just a shade under a 
trillion dollars. With the passage of the final FY 2000 appropriations 
bill, we will continue on that path, reducing our national debt by $140 
billion dollars in the current fiscal year.
  Unlike last year's omnibus appropriations package that increased 
spending by almost $14 billion, this Congress successfully obtained 
offsets for all of the President's new spending, including an across-
the-board cut that will help eliminate government waste and excess. In 
addition, despite President Clinton's best efforts, the offsets do not 
include a tax increase.
  At the beginning of this year, I said that the Congress' primary 
responsibility was to protect the Social Security surplus. With the 
passage of this budget, we have accomplished that goal. In addition, 
not only have we avoided a tax hike, but we have also given the 
American people an $18 billion tax cut through the provisions contained 
in H.R. 1180--the Work Incentives Act.
  I am pleased that the final bill includes over $2 billion in 
additional education spending over last year and gives local school 
districts more flexibility in how they spend that federal assistance. 
The appropriations bill also contains an increase of $1.7 billion for 
veterans spending above President Clinton's request, as well as an 
increase in funding for national defense that includes a boost in pay 
and benefits for our soldiers, sailors, and airmen.
  But this bill does not just fund these important priorities, it also 
provides real cuts in government waste and abuse. The legislation 
includes a 0.38% across the board reduction that is essential to 
maintaining our fiscal discipline and protecting Social Security.
  Included in this package are provisions to address some unintended 
consequences of the Balanced Budget Act of 1997 to protect Medicare 
recipients and providers. This bill includes $16 billion over 5 years 
to ensure that senior citizens can continue to receive quality health 
care.
  These Medicare changes will help Medicare patients in hospitals--
particularly rural, teaching, and cancer hospitals--skilled nursing 
facility residents, home health care recipients, and seniors who wish 
to receive their health care through the innovative Medicare+Choice 
program rather than through the conventional fee-for-service mechanism. 
I have traveled around Missouri and heard from countless doctors, 
patients, nurses, and other health care providers about the necessity 
of these changes. These provisions are good for the seniors in Missouri 
and across the Nation.
  The package also provides for State Department Reauthorization, 
including language I authored that requires the State Department to 
publish a report documenting American victims of terrorist attacks in 
Israel, Gaza, and the West Bank.
  In addition, the almost 400,000 Missouri households that are 
satellite television viewers will be pleased that this bill includes 
language that will allow them to continue receiving local programming. 
The Satellite Home Viewer Act will give real price competition and 
choice in video programming to all Missourians.
  Finally, Mr. President, I am pleased that unlike last year, when we 
lumped all the bills together, allowing $14 billion in extra spending 
into one package, this year we finished our work on each of the bills, 
and negotiated each bill on its individual merits. While this bill is 
an omnibus package for procedural reasons, it was not negotiated as an 
omnibus package. Every provision was negotiated according to regular 
order, and as a result, we were able to succeed in our goal of 
protecting Social Security.
  Mr. WELLSTONE. Mr. President, I rise to support this conference 
report and I say, Mr. President, that I am very happy to have been an 
original cosponsor of the Work Incentives Improvement Act of 1999.
  People all across Minnesota who have contacted my office know the 
importance of the Work Incentives Improvement Act and how it will 
further expand the possibilities opened up by the Americans with 
Disabilities Act which was enacted in 1990. Thanks to the ADA, many 
people with disabilities in Minnesota and around the country are 
working, but others still cannot accept

[[Page 30968]]

jobs because they would lose their health care coverage. This Act will 
allow them to fulfill their dreams for employment and to be productive 
citizens.
  This legislation has enjoyed overwhelming bipartisan support--with 79 
Senate cosponsors. It would make it easier for those receiving 
disability benefits through Social Security programs to go to work 
without losing their Medicare or Medicaid health benefits. The 
legislation also encourages the disabled to seek paid employment by 
gradually reducing their cash benefits as income increases, rather than 
cutting them off completely.
  Let's look at the current situation for disabled individuals who seek 
employment and require health insurance coverage. For some of these 
people, employer-based coverage is unavailable because they are self-
employed or because their disabilities prevent them from working full-
time. For others, coverage is unaffordable because of co-pays and co-
insurance for repeated, ongoing treatments. For those offered 
affordable employer insurance, these plans generally cover only primary 
and acute care, not the specialized medications, equipment, supplies 
and other long term care needs that individuals with disabilities 
unfortunately require.
  Last year, in the Spring of 1998, the Minnesota Consortium for 
Citizens with Disabilities surveyed 1200 Minnesotans who have 
disabilities and found the vast majority were ready to go to work if 
their current health care benefits remained intact.
  Here are two examples from Minnesota:
  Let me tell my colleagues about Steve. Steve is a middle-aged adult 
with advanced Limb Girdle Muscular Dystrophy. He is married, has two 
grown children, and owns his own home in rural Minnesota. As the 
manifestations of his condition progressively worsen, Steve has 
struggled to remain self-sufficient as long as possible using all of 
his personal resources. Steve's desire to remain an independent 
contributing member of society is evident in his efforts to develop the 
skills that enable him to work from home in a computer-based business. 
Steve is on SSDI making him eligible for Medical Assistance that pays 
for his health care needs. He is growing weaker and cannot afford to 
lose his medical assistance eligibility. Steve has a fledgling 
publishing business; ghost-writing and copy-writing. He crafts sales 
ads and creates direct mail advertising packages. Steve uses the 
Internet to market his services. He uses his website as a forum for 
other authors to advertise their books. He sells space as one would a 
classified ad. Steve is becoming involved with e-bay auctioning 
focusing onbooks--first editions and autographed copies. Steve says the 
Work Incentives Improvement Act is his only opportunity to become 
financially independent. ``If a person in my position is at risk for 
all of the medical expenses that one could incur, that is a big 
incentive not to try to get ahead. I still have my pride, my ego, the 
desire to rise above.''
  Another Minnesotan whose story I would like to tell is Jean. Jean is 
in her mid-forties and has had Charcot-Marie-Tooth Disease since early 
childhood. Her muscles have wasted away from her elbows to her finger 
tips and from her thighs to her toes. She has trunk weakness and uses a 
power wheelchair for mobility. Jean works in an office as a clerk-
typist using a pencil held between her two hands to strike the computer 
keys and a trackball to navigate her computer. Jean's career is limited 
by not being able to accept raises, declining wage rewards for the 
continuing education and skills she has gained, because if she accepted 
these well deserved raisers, she would exceed Supplemental Security 
Income's (SSI) earnings threshold of just $500/month and lose her 
eligibility for medical assistance. ``It just seems unfair that people 
with disabilities don't have the same opportunities to advance in their 
careers. Why can't we earn enough money to live in a house? To purchase 
a van with a lift? To travel?''
  These are but two of the thousands of disabled Americans who, with 
guaranteed continued health care coverage--coverage they already have--
would be able to lead more productive lives, productive for themselves, 
for their families and for their communities. In my state there are not 
enough workers to meet the needs of Minnesota employers. and I know it 
is also the case in many communities around the country. According to 
the Disability Institute, in 7 years Minnesota will need 1 million new 
workers. The Work Incentives Improvement Act will help match the needs 
of Minnesota's disabled community with Minnesota employers. That is 
what I call a real win-win situation.
  When President Bush signed the Americans with Disability Act in 1990, 
he noted that when you add together all the state, federal, local and 
private funds, it costs almost $200 billion annually to support people 
with disabilities--to keep them dependent. The ADA was the first giant 
step forward to allow Americans with disabilities to be independent. 
The Work Incentives Improvement Act of 1999 which we have before us 
today is another giant step along the same path, and today I am happy 
to say that we will be taking that step.
  Mr. FRIST. Mr. President, yesterday, the House and Senate Conference 
Committee reached agreement on the Ticket to Work and Work Incentives 
Improvement Act of 1999, which addresses a fundamental inequity for 
individuals with disabilities.
  As a heart and lung transplant surgeon, I witnessed unfair 
discrimination against patients with disabilities. After a successful 
transplant, several of my patients were faced with a serious dilemma. 
They had to choose between keeping their health insurance coverage or 
returning to work. Under current law, if these patients choose to 
return to work and earn more than $500 per month, they lose their 
disability payments and health care coverage provided through Medicare 
and Medicaid as part of their Social Security Disability Insurance 
(SSDI). This is health care coverage that they simply cannot get in the 
private sector, as it is extremely difficult for individuals with 
severe disabilities to obtain coverage due to their medical history.
  Let me illustrate the profound impact this dilemma has had on our 
disabled Americans. Today, the unemployment rate among working-age 
adults with disabilities is nearly 75 percent. Only 7% of disabled 
Americans--318,728 of the 4.2 million non-blind individuals with 
disabilities--were working in 1997, according the General Accounting 
Office. Many persons with disabilities who currently receive federal 
disability benefits, such as SSDI and Supplemental Security Income 
(SSI), want to work; however, less than one-half of one percent of 
these beneficiaries successfully forego disability benefits and become 
self-sufficient. If disabled individuals try to work and increase their 
income, they lose their disability cash benefits and their health care 
coverage. The loss of these benefits is simply too powerful of a 
disincentive to return to work.
  In addition, more than 7.5 million disabled Americans receive cash 
benefits from SSI and SSDI. Disability benefit spending for SSI and 
SSDI totals $73 billion a year, making these disability programs the 
fourth largest entitlement expenditure in the federal government. If 
only one percent--or 75,000--of the 7.5 million disabled adults were to 
become employed, federal savings in disability benefits would total 
$3.5 billion over the lifetime of the beneficiaries. Removing barriers 
to work is not only a major benefit to disabled Americans in their 
pursuit of self-sufficiency, but it also contributes to preserving the 
Social Security Trust Fund.
  This legislation is critical to the health and well-being of our 
disabled Americans. It will create new opportunities for individuals 
with disabilities to return to work while allowing them to maintain 
their health insurance coverage and disability benefits. In particular, 
this bill expands new options to states under the Medicaid program for 
workers with disabilities; continues Medicare coverage for working 
individuals with disabilities; and establishes a ticket to work and 
self-sufficiency program.

[[Page 30969]]

  I would like to thank Senator Jeffords for his leadership on this 
critical issue. I would also like to thank Senators Lott, Roth, 
Moyinhan and Kennedy and their House colleagues for their dedication 
toward reaching consensus on this important legislation.
  Mr. KOHL. Mr. President, I rise today in support of the Work 
Incentives Conference Report. As my colleagues know, this conference 
report contains a number of items that have been joined together in 
order to accommodate the end of session schedule, and I would like to 
offer brief comments on several of those items.
  With regard to the tax portion of the conference report, I am in 
support of the compromise that was reached to extend the expired tax 
credits. Earlier this year, I supported an ambitious tax relief package 
which extended the credits and contained my child care tax credit and 
farmer income averaging relief provisions, as well as targeted tax 
measures to help Americans pay for education and health care and to 
expand the low-income housing tax credit. Hardworking American 
taxpayers created the budget surplus, and a significant portion of that 
surplus should be returned to them, allowing them to keep more of their 
own paychecks and helping them plan for their future. It is my hope 
that when we return in the spring, we will rise above partisan concerns 
and achieve bipartisan progress towards comprehensive tax relief, as 
well as the challenge of reforming both Medicare and Social Security 
And we must do so while continuing our vigilance in protecting the 
balanced budget gains of recent years.
  But for today we will content ourselves with the limited extenders 
package before us. The research and development tax credit promotes 
innovation and enhances the competitiveness of American business. The 
work opportunity and welfare-to-work tax credits continue the 
partnership between the public and private sector to move those in need 
of a helping hand off of public assistance and into the workforce. I am 
also pleased that this tax package preserves eligibility to important 
tax benefits, such as the child tax credit, by protecting against the 
encroachment of the alternative minimum tax. While I am concerned that 
the conferees did not offset fully the costs of these provisions and 
would have preferred a final version along the lines of the bipartisan, 
and fully offset, Senate bill, this package is modest and urgently 
needed. It deserves our endorsement.
  I am extremely pleased that we are finally taking the final step to 
enact the Work Incentives Improvement Act into law. I cosponsored this 
legislation because I believe strongly that it will have a tremendous 
impact on the lives of people with disabilities.
  Currently, over 9 million people receive disability benefits through 
the SSDI and SSI programs. Only \1/2\ of 1 percent of SSDI 
beneficiaries, and only 1 percent of SSI beneficiaries ever return to 
work. Yet we know that many--in fact, the vast majority--of people with 
disabilities want to work. In study after study, people with 
disabilities report that the single biggest obstacle to returning to 
work is the loss of health care benefits that often comes along with 
their decision to work. Many do not have access to employer-based 
health insurance and find policies in the individual insurance market 
prohibitively expensive. Therefore, disabled beneficiaries who want to 
work are faced with the choice of returning to work while risking their 
health benefits or forgoing work to maintain health coverage.
  This is simply unacceptable. People with disabilities deserve every 
opportunity to live healthy, productive lives, and we should encourage 
and support their efforts to work by ensuring that they continue to 
have access to the health care services they need. I am pleased that 
the Work Incentives Improvement Act accomplishes that goal. This bill 
will ensure that millions of people with disabilities have the 
opportunity to work if they are able--without the fear of losing the 
health insurance coverage they need in order to live healthier lives 
and to succeed in their work. I want to commend the bipartisan efforts 
of Chairman Roth, Senator Moynihan, Chairman Jeffords, and Senator 
Kennedy, in making this bill a reality.
  Again, I regret that end-of-year pressure has forced us to combine so 
many unrelated provisions into a single bill. However, I support the 
conference report for the reasons I have just stated, and I urge my 
colleagues to vote for its adoption.
  Mr. ALLARD. Mr. President, it is with great reluctance that I vote 
for the Work Incentives Act Conference Report.
  A particular provision, Section 408, has been added to this important 
piece of legislation at a date too late to make further changes. 
Section 408 was introduced in the House, included in the Conference 
Report, but never debated in the Senate. I am a cosponsor of the Senate 
version of this bill.
  In an effort to finish the first session of the 106th Congress we 
have had no time to sound our concerns and make due changes. Section 
408 extends the authority of state medicaid fraud units. Not only would 
this provision mandate more federal control over what has been 
historically governed by the states, it also calls for investigation 
and prosecution of resident abuse in non-Medicaid board and care 
facilities. This provision allows the federal government unprecedented 
control over the quality of care in private institutions. This is yet 
another example of government authority exceeding its' boundaries. I 
have always been a supporter of state's rights and less government 
control and I feel these regulations are best promulgated by the 
states. Certainly they should not be promulgated in the final days of 
the session.
  It is my opinion that we must reduce the amount of federal government 
regulation and not further impede the rights of care providers and 
state officials to monitor private industry. I make an effort to 
examine all pieces of legislation to ensure that the end results is 
objective and does not further burden individuals with undue 
regulation.
  Again it is with great reluctance that I vote for this act. The 
changes made in the Conference Report at this late date are onerous and 
threaten the sanctity of private health care providers.
  Mr. LIEBERMAN. Mr. President, I rise to express my support for the 
tax extenders package included in the Work Incentives Act conference 
report. In the context of our current budget situation of a small 
projected on-budget surplus for FY 2000, I believe this tax package 
strikes an important balance between fiscal responsibility and tax 
relief.
  Although I would have preferred a fully offset tax package, I am 
pleased that the bill is fully offset for FY2000 and partially offset 
for FY2001, the two years for which most of the tax provisions are 
extended by law. If two years from now when we reconsider most of these 
provisions a on-budget surplus does not exist, I will push for an 
extenders package that is fully offset to ensure that we do not go into 
deficit as a result of tax relief measures.
  The package includes several important provisions that I strongly 
support. The Research and Experimentation Tax Credit is important for 
our future international competitiveness. This tax credit provides an 
important incentive for our companies to research and innovate. I hope 
that in the near future we will update this credit to reflect current 
business conditions and to make it a permanent part of the tax code.
  The AMT modification, the Worker Opportunity Tax Credit, and the 
Welfare-to-Work Tax Credit are all important provisions to help low to 
moderate income earners create more opportunities and to improve their 
living standards. I am pleased that the Finance Committee decided to 
include renewal of the Generalized System of Preferences in this tax 
package. This is a critical program for promoting growth in developing 
economies and for increasing international trade integration.
  I strongly support the provision to extend and modify the tax credit 
for

[[Page 30970]]

electricity produced by wind and biomass materials. In order to ensure 
energy security and address national environmental priorities such as 
clean air and mitigation of global climate change, it is essential that 
renewable energy options become more competitive. These tax provisions 
will ensure that renewable energy technologies will be able to compete 
more equitably with fossil sources such as coal and oil. However, while 
this package includes modest extensions and modifications, I am 
disappointed that the bill does not go further by extending the credit 
to include landfill methane and other cellulosic feedstocks.
  I would like to thank Chairman Roth and Senator Moynihan for their 
hard work in getting this package together. It is a fiscally 
responsible and an appropriate package under our current fiscal 
situation. I urge my colleagues to support this bill.
  Mr. JEFFORDS. Mr. President I am delighted to stand before you today, 
to speak about an extremely important piece of legislation. The bill we 
are sending to the President today, a bill I know he is eager to sign 
into law, will have a tremendous impact on people with disabilities. In 
fact, this legislation is the most important piece of legislation for 
the disability community since the Americans with disabilities Act.
  My reason for sponsoring this particular piece of legislation is 
quite simple. The Work Incentives Improvement Act of 1999 addresses a 
fundamental flaw in current law. Today, individuals with disabilities 
are forced to make a choice . . . an absurd choice. They must choose 
between working and receiving health care. Under current federal law, 
if people with disabilities work and earn over $700 per month, they 
will lose cash payments and health care coverage under Medicaid or 
Medicare. This is health care coverage that they need. This is health 
care coverage that they cannot get in the private sector. This is not 
right.
  Once enacted, the Work Incentives Improvement Act of 1999 will allow 
individuals with disabilities, in states that elect to participate, 
continuing access to health care when they return to work or remain 
working. In addition, those individuals who seek it, will have access 
to job training and job placement assistance from a wider range of 
providers than is available at this time. Currently, there are 9.5 
million individuals with disabilities across the country who receive 
cash payments and health care coverage from the federal government. 
Approximately 24,000 of these individuals live in my home state, 
Vermont. Once enacted, the Work Incentives Improvement Act will 
actually save the federal government money. For example, let's assume 
that 200 Social Security disability beneficiaries in each state return 
to work and forgo cash payments. That would be 10,000 individuals out 
of the 9.5 million individuals with disabilities across the country. 
The annual savings to the Federal Treasury in cash payments for just 
these 10,000 people would be $133,550,000! Imagine the savings to the 
Federal Treasury if this number were higher. Clearly, the Work 
Incentives Improvement Act of 1999 is fiscally responsible legislation.
  I began work on this bill 1996. Though it was a long and sometimes 
difficult task, many hands made light work. Senator Kennedy, Ranking 
member on the HELP Committee, joined me in March 1997. Senators Roth 
and Moynihan, Chairman and Ranking Member on the Finance Committee 
signed on as committed partners in December of 1998. Last January, 35 
of our colleagues, from both sides of the aisle, joined us in 
introducing S. 331, the Senate version of this legislation. One week 
later, in a Finance Committee hearing, we heard compelling testimony 
from our friend, former Senator Dole, a strong supporter of this 
legislation. A month later, we marked this legislation out of the 
Finance Committee with an overwhelming majority in favor of the bill. 
Finally, on June 15th, with a total of 80 cosponsors, we passed this 
legislation on the floor of the United States Senate, with a unanimous 
vote of 99-0.
  Four months later, over 35 of our colleagues in the House of 
Representatives, took to the floor of their chamber, and spoke 
eloquently for their version of this legislation. Later that day, the 
bill passed the floor of the House with a vote of 412-9. Since then, 
the Senate and House Conferees have been working diligently in effort 
to reach common ground. I am very pleased today, that the differences 
in policy in the two different bills have been resolved and consensus 
has been reached on a conference agreement. This agreement does not 
compromise the original intent of the legislation, retaining key 
provisions from S. 331.
  From my perspective, the Work Incentives Improvement Act of 1999 
represents a natural and important progression in federal policy for 
individuals with disabilities. That is, federal policy increasingly 
reflects the premise that individuals with disabilities are cherished 
by their families, valued and respected in their communities, and are 
an asset and resource to our national economy. Today, most federal 
policy promotes opportunities for these individuals, regardless of the 
severity of their disabilities, to contribute to their maximum 
potential--at home, in school, at work, and in the community.
  I have been committed to improving the lives of individuals with 
disabilities throughout my Congressional career. Providing a solid 
elementary and secondary education for children with disabilities, so 
that they will be equipped, along with their peers, to benefit from 
post-secondary and employment opportunities is crucial. When I came to 
Congress in 1975, Public Law 94-142, the Education for all Handicapped 
Children Act, now the Individuals with Disabilities Education Act 
(IDEA), was enacted into law. IDEA assures each child with a 
disability, a free and appropriate public education. I am proud to be 
one of the original drafters of this legislation which has reshaped 
what we offer to and expect of children with disabilities in our 
nation's schools.
  In addition, I have been committed to providing job training 
opportunities for individuals with disabilities. In 1978, I played a 
central role in ensuring access to programs and services offered by the 
federal government for individuals with disabilities through an 
amendment to the Rehabilitation Act. I believe that this amendment 
alone laid the foundation for significant legislation that followed, 
including the Technology-Related Assistance for Individuals with 
Disabilities Act of 1988, now the Assistive Technology Act of 1998, 
both of which I drafted. Most importantly, this legislation opened the 
doors for the most comprehensive piece of legislation of all, the 
Americans with Disabilities Act of 1990. This legislation prohibits 
discrimination on the basis of disability in employment, public 
services, public accommodations, transportation, and telephone service.
  These laws have forever changed the social landscape of America. They 
serve as models for other countries who recognize that their citizens 
with disabilities are an untapped resource. In our country, individuals 
with disabilities are seen everywhere, doing everything. Just this past 
weekend, thousands of physically disabled individuals participated in 
the New York City Marathon, as they have been doing for years. The 
expectations that these people set for themselves and the standards we 
apply to them have increasingly been raised, and now in many 
circumstances equal those set and applied to other individuals.
  Unfortunately, one major inequity remains. That is, the loss of 
health care coverage if an individual on the Social Security disability 
rolls chooses to work. Individuals with disabilities want to work. They 
have told me this. In fact, a Harris survey found that 72 percent of 
Americans with disabilities want to work, but only one-third of them do 
work. With today's enactment of the Work Incentives Improvement Act of 
1999, individuals with disabilities will no longer need to worry about 
losing their health care if they choose to work a forty-hour week, to 
put in overtime, or to pursue career advancement. Individuals with 
disabilities are sitting at home right now, waiting for this 
legislation to become law. Having a job will provide them with a sense 
of

[[Page 30971]]

self-worth. Having a job will allow them to contribute to our economy. 
Having a job will provide them with a living wage, which is not what 
one has through Social Security.
  In addition to continuing health care coverage and providing job 
training opportunities for individuals with disabilities, this 
legislation offers many other substantial long-term benefits. The Work 
Incentives Improvement Act of 1999 will give us access to data 
regarding the numbers, the health care needs, and the characteristics 
of individuals with disabilities who work. Furthermore, this 
legislation will provide the federal government as well as private 
employers and insurers, the facts upon which to craft appropriate 
future health care options for working individuals with disabilities. 
It will allow employers and insurers to factor in the effects of 
changing health care needs over time for this population. Hopefully, it 
will even improve the way in which employers operate return-to-work 
programs. Through increased tracking of data, we will learn the 
benefits of intervening with appropriate health care, when an 
individual initially acquires a disability. We will also learn the 
value of continuing health care to a working individual with a 
disability. If an individual, even with a severe disability, knows that 
he or she has access to uninterrupted, appropriate health care, the 
individual will be a healthier, happier and thus more productive 
worker.
   I would like to take the time now to briefly outline the major 
provisions which have remained as part of this legislation. The 
conference agreement retains the two state options of establishing 
Medicaid buy-ins for individuals on Social Security disability rolls, 
who choose to work and exceed income limits in current law, as well as 
for those who show medical improvement, but still have an underlying 
disability. For working individuals with disabilities, the conference 
agreement extends access, beyond what is allowed in current law, to 
Medicare. In addition, the legislation before us today retains several 
key provisions from S. 331, including, the authority to fund Medicaid 
demonstration projects to provide access to health care to working 
individuals with a potentially severe disability; the State 
Infrastructure Grant Program, to assist states in reaching and helping 
individuals with disabilities who work; work incentive planners and 
protection and advocacy provisions; and finally, most of the provisions 
in the Ticket to Work Program.
  In order to control the cost of this legislation, compromises were 
made. Although the purpose of the State Infrastructure Grant Program 
and the Medicaid Demonstration Grant Program remain the same, the terms 
and conditions of these grants were altered in conference. As a result, 
states are not required to offer a Medicaid buy-in option to 
individuals with disabilities on Social Security, who work and exceed 
income limits in current law, prior to receiving an Infrastructure or a 
Medicaid Demonstration Grant.
  Also in Conference, the extended period of eligibility for Medicare 
for working individuals with disabilities has been changed from 24 to 
78 months. During this extended period, the federal government is to 
cover the cost of the Part A premium of Medicare for a working 
individual with a disability, who is eligible for Medicare. S. 331 
would have extended such coverage for an individual's working life, if 
he or she became eligible during a 6-year time period.
  I would like to note two changes to the Ticket to Work program made 
during Conference. The new legislation shifts the appointment authority 
for the members of the Work Incentives Advisory Panel from the 
Commissioner of Social Security to the President and Congress. In 
addition, language regarding the reimbursements between employment 
networks and state vocational rehabilitation agencies was deleted in 
Conference. The new legislation gives the Commissioner of Social 
Security the authority to address these matters through regulation.
  Although several changes have been made from the original Work 
Incentives bill, I am still very pleased with what we are adopting 
today. This is legislation that makes sense, and it will contribute to 
the well-being of millions of Americans, including those with 
disabilities and their friends, their families, and their co-workers. 
Today's vote provides us the opportunity to bring responsible change to 
federal policy and to eliminate a misguided result of the current 
system--if you don't work, you get health care; if you do work, you 
don't get health care. The Work Incentives Improvement Act of 1999 
makes living the American dream a reality for millions of individuals 
with disabilities, who will no longer be forced to choose between the 
health care coverage they so strongly need and the economic 
independence they so dearly desire.
  In closing, I would like to thank the many people who contributed to 
reaching this day. I especially thank the conferees, Majority Leader 
Lott, Senators Roth and Moynihan, and in the House, Majority Leader 
Armey, and Congressmen Archer, Bliley, Rangel, and Dingell. I also 
thank their staff who worked so closely in effort to reach this day. 
From my staff, I thank Pat Morrissey, Lu Zeph, Leah Menzies, Chris 
Crowley, and Kim Monk. I want to recognize and extend my appreciation 
to the staff members of my three fellow sponsors of this bill; Connie 
Garner in Senator Kennedy's office, Jennifer Baxendell and Alexander 
Vachon with Senator Roth, and Kristen Testa, John Resnick, and Edwin 
Park from Senator Moynihan's staff. Finally, I wish to thank Ruth Ernst 
with the Senate Legislative Counsel for her drafting skill and 
substantive expertise, her willingness to meet time tables, and most of 
all, her patience. In addition to staff, we received countless hours of 
assistance and advice from the Work Incentives Task Force of the 
Consortium for Citizens with Disabilities. These individuals worked 
tirelessly to educate Members of Congress about the need for and the 
effects of this legislation.
  Finally, I would like to urge my colleagues in both chambers to set 
aside any concerns about peripheral matters and to focus on the central 
provisions of this legislation. Let's focus on what today's vote will 
mean to the 9.5 million individuals with disabilities across the 
nation. At last, these individuals will be able to work, to preserve 
their health, to support their families, to become independent, and 
most importantly, to contribute to their communities, the economy, and 
the nation. We are making a statement, a noble statement and we must do 
the right thing. Let's send this bill to the President.
  Mr. REED. Mr. President, I rise today in strong support of the Ticket 
to Work and Work Incentives Improvement Act.
  I want to pay tribute to my colleagues, Senators Kennedy and 
Jeffords, who began working on this legislation in the last Congress--
effectively building support for this bill from a handful of senators 
to 79 cosponsors.
  I also want to commend Senators Moynihan and Roth, who have dedicated 
their time and effort to this important cause. They have kept the 
debate on this bill focused on the substance, and have prevented it 
from degenerating into grandstanding or partisan bickering.
  But the lion's share of credit should go to the members of the 
disability community, who have been tireless advocates for work 
incentives legislation. Without their hard work, we would not be here 
today. This bill is the product of their grassroots activism--making a 
common sense idea into a national policy.
  As my colleagues know, the major provisions of the Ticket to Work and 
Work Incentives Improvement Act are infinitely sensible. They would 
remove the most significant barrier that individuals with disabilities 
face when they try to return to work--continued access to adequate 
health care.
  Currently, individuals with disabilities face the dilemma of choosing 
between the Medicare and Medicaid health benefits they need and the job 
they desire. Mr. President, this is not a choice at all, and it is 
regrettable.
  According to surveys, about three quarters of individuals with 
disabilities

[[Page 30972]]

who are receiving Supplemental Security Income (SSI) and Social 
Security Disability Insurance (SSDI) benefits want to work. Sadly, less 
than one percent are actually able to make a successful transition into 
the workforce. A major barrier seems to be the lack of sufficient 
health care coverage.
  By passing this legislation, we will extend eligibility for Medicare 
and Medicaid and provide a helping hand to individuals with 
disabilities who aspire to work.
  Mr. President, this legislation also takes a step to help workers who 
are stricken with progressive, degenerative diseases, such as Multiple 
Sclerosis, HIV/AIDS, and Parkinson's Disease, which can be slowed with 
proper treatment. With the health coverage buy-in offered under this 
bill, these workers can continue to hold a job instead of leaving the 
workforce in hopes of meeting the need requirements for Medicaid 
coverage.
  These citizens can continue to make substantial contributions to the 
workplace and to society while benefitting intellectually and 
emotionally.
  With the Americans with Disabilities Act, Congress adopted 
legislation to combat discrimination and remove physical barriers from 
the workplace. Now, we have the chance to lift yet another barrier to 
work, the loss of health care coverage.
  In my home state of Rhode Island, more than 40,000 individuals with 
disabilities could benefit from the work incentives bill. Across the 
country, more than 9.5 million people could be positively affected by 
this legislation.
  Our booming economy has created millions of new jobs, and has brought 
thousands of Americans into the workforce for the first time. By 
passing this legislation, we can take another step to help a 
significant group of Americans participate in our national economic 
prosperity.
  Mr. President, before I yield, I would like to briefly mention my 
concern about some offsets attached to this measure. As colleagues who 
have followed this bill know, it seemed as if there was a revolving 
door when it came to the consideration of offsets during the 
Conference. Provisions came and went and returned again.
  I was pleased that a controversial offset regarding the refund of FHA 
upfront mortgage insurance premiums was withdrawn. This offset was 
essentially a $1,200 tax on approximately 900,000 low- and middle-
income families and first-time home-buyers, and the conferees were 
right to omit it from this bill.
  Regrettably, the bill retains two other controversial offsets, which 
I oppose. The first is an assessment on attorneys representing clients 
with Social Security disability benefits claims. Although the 
Administration supports this offset, I believe that it will discourage 
qualified attorneys from taking on these complicated, labor-intensive 
claims cases--which already offer little remuneration to attorneys. 
Ultimately, this assessment will hurt those individuals trying to 
secure their rightful benefits, not the attorneys. I commend the 
conferees for taking steps to blunt the impact of this provision by 
capping the fee at 6.3% and requiring GAO to study the cost and 
efficiency of this and alternative assessment structures. Nonetheless, 
I still believe that this is an inappropriate offset.
  The other offset changes the index for student loan interest rates 
from the 91-day Treasury bill to the three-month rate for commercial 
paper. This provision saves a modest amount of money in the short-term. 
Unfortunately, those savings will not be transferred to students, and 
the offset will actually put taxpayers on the hook if the markets turn 
sour. Let me add that this provision flies in the face of an agreement 
reached in last year's Higher Education Act Amendments. Under that 
legislation, we were to study the impact of this type of conversion. We 
are still awaiting the findings of that study, and in the absence of an 
authoritative conclusion, I believe it is premature to entertain this 
change in policy. Mr. President, setting these important concerns 
aside, I believe that the Ticket to Work and Work Incentives 
Improvement Act is a major victory for all Americans, and we should all 
support it. I want to again commend the leading Senate sponsors, 
Senators Kennedy, Jeffords, Moynihan, and Roth for their tremendous 
work in bringing this legislation to this point, and I urge all of my 
colleagues to vote for it.
  The PRESIDING OFFICER. Who yields time?
  Mr. ROTH. Mr. President, I yield 8 minutes to the Senator from 
Pennsylvania.
  The PRESIDING OFFICER. The Senator from Pennsylvania is recognized 
for 8 minutes.
  Mr. SANTORUM. Mr. President, I want to pick up where the Senator from 
Illinois left off. I think he hit the nail on the head with respect to 
our concern with a provision in this bill which will create an 
additional moratorium for the organ allocation regulations to go into 
effect.
  There will be a 90-day moratorium. Senator Durbin, Senator Schumer, 
Senator Moynihan, Senator Specter, and I, and many others have some 
grave concerns about its impact on thousands of people who are on 
transplant lists across this country and their ability to get organs in 
what may be the last few days of their lives. That is, unfortunately, 
what is going to occur. We are going to delay a system being put into 
place which would put a priority on the health status of the person on 
the transplant list as opposed to the residency status of where that 
person happens to be in the hospital.
  It is a battle. It is an economic battle in many respects. And 
certainly, from some perspectives, I have transplant centers in my 
State that support these regulations; I have transplant centers in my 
State that oppose them. I look at it from the unbiased position of, 
what is in the best interest of the patient? For me, as Senator Durbin 
just said, when 3 of the 11 people who will die today because organs 
are not available, when 3 of them needlessly die because we are 
transplanting organs that would otherwise go to them into people who 
are healthier and would not die but for the transplant, then we have 
something seriously wrong in this country. We have something seriously 
wrong when geography trumps patient need. That is what the current 
organ allocation system has.
  Why has that occurred? This was a system that was put in place well 
over 10 years ago, when there were fewer transplant centers and when 
organs could not survive as long after being harvested. So geography 
did play an important role because the organ that was harvested had to 
be quickly transported to a hospital and implanted into the donee. That 
has changed. Now organs survive for around 4 hours, according to our 
transplant surgeon, Dr. Frist, who lectured us on this a little while 
ago. Now we have the ability to more broadly spread these organs out so 
we can reach sicker people. Yet the organ allocation system developed 
well over 10 years ago still focuses on geography. It may have been 
applicable at one time. It doesn't work anymore. People are dying as a 
result of it.
  We have 4,000 people on transplant lists; 1,000 will die. And it is 
incredible to me that those will die unnecessarily--4,000 will die and 
1,000 will die unnecessarily--because of our regulations.
  We have gone through a moratorium on these regs. I know this is a 
very controversial issue. It is a controversial issue because of 
economics. There is no controversy anymore as to what is in the best 
interest of patients. Last year, when Bob Livingston was able to get a 
year delay as chairman of the Appropriations Committee, we said, well, 
the medical evidence will sustain their position that geography is the 
best way to do this. So we asked for a study--the study of the 
Institute of Medicine--to determine the findings of a nonpartisan, 
nonbiased organization. Let me tell you what they came back with:

       On the basis of the analysis of this report, it seems 
     apparent that patients on liver transplant--

  That is what they specifically looked at--

     waiting lists will be better served by an allocation system 
     that facilitates broader sharing within broader populations.


[[Page 30973]]


  The Institute of Medicine says ``broader sharing,'' with geography 
being a lower priority factor in the decision.
  This question was also put forward: Will more people die if we 
continue this system?
  Again, the Institute of Medicine was very clear:

       Increased sharing of organs would result in increasing 
     transplantation rates for status 1 patients, the sickest 
     patients, decreasing pre-transplantation mortality for sicker 
     patients, which is status 2(b), and decreasing 
     transplantation rates for status 3 patients, without 
     increasing mortality.

  That is the key. Yes, status 3, the healthier patients, will get 
fewer organs, but they won't die as a result of that. Yes, status 1 and 
2(b) patients will get more transplantations and will live as a result 
of that, where they otherwise would die.
  So it is clear, again, from the medical evidence the Institute of 
Medicine has put forward that a broader geographic sharing is the way 
to go. That is what these regulations dictate--that the sicker patients 
should get these before they die, not healthy patients who would 
otherwise live or would live for a long period of time without 
transplants.
  The other issue you will hear brought up is that we need geography to 
be a big factor because it increases the availability of organs, that 
people want to donate organs in their community. The Institute of 
Medicine looked at this and found no convincing evidence to support the 
claim that broader sharing would adversely affect donation rates, or 
potential donors would decline to donate because an organ might be used 
outside the immediate geographic area.
  I have an organ donor card. I am someone who, upon my demise, wants 
to be able to give organs to someone else so they might live. I don't 
care whether it goes to somebody in Pittsburgh, or in Chicago, or in 
Alabama, as long as it goes to the person who needs it the most.
  That brings me to my final point, on which I think we can all agree. 
This debate is contentious, and the reason for that is, we don't have 
enough organs. So I just say that we can all agree that we need to do 
more to encourage organ donation. People are needlessly dying because 
people and families have trouble at that moment of death--I know how 
difficult that can be--making the decision to donate the organs of 
somebody who is brain dead to someone else who can live as a result of 
that donation. Hopefully, through this discussion, we can also work on 
how we can broaden the availability of organs so this contentious issue 
of regional transplant centers will be minimized in the future.
  Mr. President, with that, I yield back the remainder of my time.
  The PRESIDING OFFICER. Who yields time?
  Mr. MOYNIHAN. Mr. President, I have the great honor and pleasure to 
yield 5 minutes to the Senator from Iowa, who is so active in the 
Ticket to Work legislation.
  The PRESIDING OFFICER. The Senator from Iowa is recognized for 5 
minutes.
  Mr. HARKIN. Mr. President, I thank the ranking member on the 
committee. I rise in strong support of the Work Incentives Improvement 
Act. I really want to commend my two colleagues, Senator Jeffords of 
Vermont and Senator Kennedy from Massachusetts, for their excellent 
work in getting this very important piece of legislation through. I 
want to also thank the members of the Finance Committee--in particular, 
Senator Roth and Senator Moynihan--for their hard work on this 
legislation.
  For people with disabilities all over this country, this is truly an 
incredible day. Congress is continuing to fulfill the promise we made 
to people with disabilities 9 years ago when we passed the Americans 
With Disabilities Act in 1990. When we passed the ADA, they told 
Americans with disabilities that the door to equal opportunity was 
finally open. And the ADA has opened doors of opportunity--plenty of 
them. Americans with disabilities now expect to be treated as full 
citizens, with all the rights and responsibilities that entails.
  But our work is not finished. Far too many people with disabilities 
who want to work are unemployed. One of the main reasons they are 
unemployed is, under the current system, people have to choose between 
a job and health care. I could not put it any better than a constituent 
of mine, a young woman by the name of Phoebe Ball. Phoebe just 
graduated from the University of Iowa. She was shocked when they found 
that if she took an entry-level job paying $18,000 a year, she would 
suffer a huge loss--her health insurance.
  So Phoebe wrote an article for the newspaper. I will read part of it:

       I want off SSI desperately . . . I want to work. I want to 
     know that I have earned the money I have . . .
       My parents and my society made a promise to me. They 
     promised me that I can live with this disability, and I can . 
     . . What is limiting me right now is not this wheelchair, and 
     it's not this limb that's missing. It's a system that says if 
     I can work at all, then I'm undeserving of any assistance, 
     I'm undeserving of the basic medical care that I need to stay 
     alive.
       . . . What is needed is a government that understands its 
     responsibility to its citizens . . . then we'll see what we 
     are capable of, then we'll be working and proving the worth 
     of the Americans With Disabilities Act.

  I could not say it any better than Phoebe just did. The Work 
Incentives Improvement Act is a comprehensive bill that will be the 
answer to Phoebe Ball's dilemma. If only 1 percent--or 75,000--of the 
7.5 million people with disabilities, such as Phoebe, who are now on 
benefits were to become employed, Federal savings would total $3.5 
billion over the work life of these beneficiaries. That not only makes 
economic sense, it contributes to preserving the Social Security trust 
fund.
  The disability community across this country and Members from both 
sides of the aisle have wholeheartedly endorsed this bill. Rarely do we 
see such broad bipartisan support. But that is because on this 
particular issue it is easy to agree--people with disabilities should 
continue to move toward greater and greater independence.
  In that spirit, Senator Specter and I introduced the Medicaid 
Community Attendant Services and Supports Act earlier this week. Its 
shorthand name is MCASSA. This bill will build on what we are doing 
today with the Work Incentives Improvement Act. Ten years after the 
passage of the Americans With Disabilities Act, next year, we are still 
facing the situation where our current long-term care program favors 
putting people into institutions.
  A person has a right to the most expensive form of care--a nursing 
home bed--because nursing home care is an entitlement. But if that same 
person with a disability wants to live in the community, he or she is 
going to have to face a lack of available services because community 
services are optional under Medicaid. Nursing home is a mandatory 
entitlement, but if you want to live in the community, that is 
optional. Well, the purpose of our bill is to level the playing field 
and give people with disabilities a real choice.
  Our bill would allow any person entitled to medical assistance who 
would go to a nursing facility to use the money for community attendant 
services and support. In shorthand, what our bill says is: Let the 
Federal money follow the person and not the program. If that person 
wants to use that money for community-based services and attendant 
services, that person with a disability ought to be able to use the 
money that way. If they want to use the money for a nursing home, leave 
it up to the individual; we should not be dictating where they ought to 
live and how they ought to live. As is the work incentives bill, MCASSA 
is rooted in the promise of ADA--equality of opportunity, full 
participation, independent living, and economic self-sufficiency for 
all.
  I thank the Chair.
  I thank the President.
  I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  Mr. ROTH. Mr. President, I yield 4 minutes to the Senator from 
Alabama.
  The PRESIDING OFFICER. The Senator from Alabama is recognized for 4 
minutes.
  Mr. SESSIONS. Mr. President, I thank the Senator from Delaware, and

[[Page 30974]]

I thank him particularly for his interest on this issue and so many 
other issues that have been before this Senate, including all of the 
major tax cuts in our country in the last number of years. He has been 
a key player in that.
  The issue before us today involves many different aspects. I believe 
very strongly that the organ transplant issue is critical for our 
Nation. We have made such magnificent progress in enhancing the 
availability of organs, helping people who receive those organs, and 
increasing the success rate of organ transplants. It has been a 
continual series of advancements--whether it is medication to avoid 
rejection, or the skill of a surgeon, and so forth. The key to that has 
been the magnificent services rendered by organ transplant centers all 
over the country.
  The plan that has been directed and proposed by Secretary Shalala of 
HHS, which gives her, in fact, the total ability to void and dictate 
the regulations, that plan has been opposed and is not supported by the 
overwhelming number of organ transplant centers in this country. They 
do not believe it will save lives. They do not believe it will help the 
system to have Washington decide who gets organ transplants.
  We have a system that is working and getting better on a daily basis, 
which is something of which we can be extraordinarily proud.
  In Alabama, the University of Alabama at Birmingham is No. 1 in the 
world in kidney transplants. They are exceptionally skilled at that 
procedure, and is one of the great organ transplant centers in the 
world. Others are similar around the country. They are very uneasy 
about and object to this consolidation of power in the Secretary's 
office--a person who is not elected by the people, and yet is about to 
impose regulations on the dispersement of organs in America.
  This is a matter that ought to be and by law and right should be done 
in the U.S. Congress. The House passed a bill quite different from the 
Secretary's proposal. The committee met in the appropriations, and 
several Senators who had a view on this came up with a bill giving a 
42-day window to change any rule she might pass. We will hardly be in 
session. We will not be in session in 42 days. Ninety days is the 
minimum time we can have so that this Congress can fulfill its 
responsibility to the health and safety of this country by having 
hearings and passing legitimate legislation on organ transplantation.
  I would point out that the chairman of that subcommittee of the 
committee of which I am a member, Senator Frist, Dr. Frist, is one of 
the great organ transplant surgeons in America. He did the first organ-
lung transplant in the history of the State of Tennessee. He will chair 
that committee. He is going to be fair on this issue.
  But there is a congressional responsibility, and the minimum time we 
can accept is the 90 days that has been proposed.
  I thank the Chair.
  I hope and I am confident that will be part of this legislation.
  Mr. MOYNIHAN. Mr. President, I am happy to yield 3 minutes to my 
colleague and friend from New York.
  The PRESIDING OFFICER. The Senator from New York is recognized for 3 
minutes.
  Mr. SCHUMER. Mr. President, I thank the Senator for yielding time.
  I rise, along with my colleagues from Pennsylvania and Illinois, very 
much against my colleague from Alabama on this important issue.
  When somebody donates a liver or lungs or a kidney or a heart, they 
do not donate it in a particular area. They don't donate it and say: I 
want the person who lives in the State of Alabama or the State of New 
Jersey to have it. They donate it to do the most good.
  Finally, we have come up with a solution with provisions that are 
fair--that say it doesn't matter where you live but rather what your 
need is in terms of getting an organ.
  All of a sudden, to my disappointment, in the dark of night a ruling 
of that position was put into the legislation.
  I think this is wrong. When somebody needs a liver in New York, and 
they need it, and their life depends on the liver, that liver should 
not go to someone in another State who has at least 3 years to live on 
their existing organs.
  It is so wrong to create geographic divisions. We have learned that. 
The Secretary of HHS has promulgated regulations which, if I had my 
way, would be promulgated immediately.
  My friend and colleague, who I know is very sincere in this, the 
Senator from Alabama, and others, put in a provision to delay this for 
90 days.
  I thank the Senator from Pennsylvania, Senator Lott, and the 
Secretary of HHS for trying to compromise this issue so it can be fair 
to all.
  We must and we will continue to fight, those of us who believe that 
organ donations should go to those who need it the most, and not those 
who live in a certain geographical area be given those organs.
  The system has been supported by the National Academy of Sciences 
Institute of Medicine. It was developed by medical people and 
scientists. That is the way it ought to be.
  We ought not hold organs hostage to political, geographic, and other 
divisive considerations.
  Again, when somebody donates an organ, a beautiful and selfless act, 
it ought not be marred by politics. It ought to go to the person of 
greatest need, no matter where that person lives.
  Mr. President, I yield the remainder of my time.
  Mr. MOYNIHAN. Mr. President, I am happy to yield 3 minutes to my 
friend, Senator Wellstone.
  The PRESIDING OFFICER. The Senator from Minnesota is recognized for 3 
minutes.
  Mr. WELLSTONE. Mr. President, I want to actually start out on a 
positive note by raising one question.
  This Work Incentives Improvement Act is a very important piece of 
legislation for all the reasons my colleagues have explained. I will go 
through that in a moment.
  I don't understand why there is in this piece of legislation a $1.7 
billion subsidy for higher education lenders. I don't understand what 
that is doing in this piece of legislation. We are talking about 
whether or not people with disabilities are going to be able to work 
and maintain their health care coverage. That is what is so important 
about this legislation. It is incredibly important to the disabilities 
community in my State and across the country.
  I thank Senators Kennedy, Jeffords, Roth, and Moynihan. But I have to 
raise this question just for the record.
  What are we doing putting a $1.7 billion subsidy in here for higher 
education lenders? Students could use this money by way of expanding 
the Pell grant. Students could use the money by way of low interest 
loans. Students could use the money to make higher education more 
affordable. But why is this provision being linked to another piece of 
legislation?
  I must say again that when we get back to how we conduct our 
business, I hope next time we will not put these kinds of provisions 
together. This is not the way to legislate.
  I think it is a great piece of legislation. I am going to support it. 
But I certainly don't think we should have this $1.7 billion subsidy 
for the lenders as a part of this bill.
  I yield the floor.
  The PRESIDING OFFICER. The majority leader.
  Mr. LOTT. Mr. President, I ask unanimous consent that the voting 
schedule occur no later than 5 p.m. this evening, and that it be 
reversed so that the first vote will now occur on the adoption of the 
Work Incentives conference report, to be followed by the cloture vote, 
and finally adoption of the appropriations conference report.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MOYNIHAN. Mr. President, in the spirit of the hour, the 
Democratic side yields the remainder of its time to the distinguished 
and ebulliently happy majority leader.
  Mr. LOTT. Thank you, Mr. President. It is always a great pleasure to 
work with the Senator from New York. It is

[[Page 30975]]

even more fun to hear him speak. I am not sure what he said, but it 
sounded beautiful. I take it as a high compliment as I always do.
  For the sake of a colloquy to clarify a section in the work 
incentives bill, I yield to Senator Santorum. We will have a colloquy 
with Senator Santorum, Senator Schumer, and myself.
  Mr. SANTORUM. Mr. President, there is an issue over the language 
contained in section 413 of H.R. 1180 and the intent thereof that I ask 
the majority leader to clarify.
  Mr. LOTT. Mr. President, I thank the Senator from Pennsylvania, and 
the Senator from New York, Mr. Schumer, for working with me on this and 
for their devotion to this important public health issue.
  It is one which is important to our country and to the people that 
need the organ transplants. We have to try to find the best and the 
fairest way to deal with this issue. I am happy to clarify this issue 
contained in the legislative measure.
  Mr. SANTORUM. I wish to clarify the language in section 413 of H.R. 
1180 pertaining to the implementation of the Secretary of Health and 
Human Service's final rule on organ procurement and the transplantation 
printed in the Federal Register on October 20, 1999, specifically to 
ensure that this language allows, but does not require, the Secretary 
of HHS to revise this rule after the 90-day period beginning on the 
date of enactment of this act.
  Mr. LOTT. Mr. President, the language will delay the rule for 90 
days. That is what is required and that was my intent, from the date of 
enactment of H.R. 1180, in order to facilitate additional public 
review. It is not the intent of the legislation to cause any 
unreasonable delay in the formulation of necessary improvements in 
national organ transplant policies, but rather to permit constructive 
review of the information that will be available and for the Congress 
to review it.
  Furthermore, I make clear section 413 provides that the rule is not 
effective until the expiration of the 90-day rule beginning on the date 
of enactment of this act. During that 90-day period, the Secretary 
shall publish a notice eliciting public comments on the rule and shall 
conduct a full review of the comments. At the end of the period, 
section 413 allows, but does not require, the Secretary to make any 
revisions in the rule that she deems appropriate.
  Mr. SANTORUM. I thank the majority leader for the clarification.
  The PRESIDING OFFICER. The Senator from New York.
  Mr. SCHUMER. Mr. President, will the Senator from Pennsylvania yield 
for a brief statement?
  Mr. LOTT. I believe I have the time and I will yield.
  Mr. SCHUMER. Mr. Leader and Senator Santorum, I have spoken with the 
Secretary of HHS and she has assured me this clarification has the 
support of the administration and it is something she, and it, intend 
to stand by.
  Mr. LOTT. I thank the Senator.
  Does the Senator from Alabama wish to speak?
  Mr. SESSIONS. Mr. President, is it your expectation following the 90-
day period during which the Secretary reviews the public comments that 
as of today we have not had a formal comment period, as I understand 
it; that the Secretary should inform the Congress of her reasons behind 
any final decision she would make?
  Mr. LOTT. Yes, absolutely. I expect that and I believe she will do 
that.
  Mr. SESSIONS. I wish to say that I know a lot of hard work has gone 
into this very contentious issue. Some said this had happened in the 
dead of night. What happened in the dead of night--I serve on the 
health committee that should be dealing with this--this 42-day rule 
went in. Our committee never voted on that or had hearings on it.
  This at least gives our committee a narrow window of opportunity to 
try to deal with it. It won't be a full 90 days because we will be out 
half of that. It will be a narrow opportunity with Senator Bill Frist 
chairing it and maybe we can work out some things that make sense. 
Right now I am very troubled. The overwhelming majority of the 
transplant centers are not happy with these rules as they are being 
developed. I think the Congress must speak.
  I yield the floor.
  Mr. LOTT. Mr. President, if I have time remaining, I yield the floor. 
I believe we are prepared to begin our series of votes, unless the 
chairman or ranking member would desire to wrap up.
  The PRESIDING OFFICER. All time has expired.
  Mr. ROTH. Mr. President, I would also like to quickly thank several 
staff members who have been working long and hard to make this bill 
possible.
  Let me thank several members of Senator Moynihan's staff--as always, 
they are skilled professionals who have been our partners working on 
this bill every step of the way.
  In particular, let me thank Jon Resnick, Edwin Park, and David 
Podoff. And I would like to thank a former member of the Moynihan 
staff, Kristen Testa, who was there at the very beginning of this 
bill's legislative life and without whom there would not have been a 
Work Incentives Improvement Act.
  I would also like to thank Pat Morrissey, Leah Menzies, and Lu Zeph 
of Senator Jeffords' office, and Connie Garner on Senator Kennedy's 
staff. They have been tireless in their efforts on behalf of this 
legislation. Jennifer Baxendell and Alec Vachon from my staff worked 
tirelessly on this legislation and deserve special commendation.
  Since this bill's inception, our staffs have worked together closely 
and well. I would like to thank you all for your dedication and hard 
work throughout all the many ups and downs this bill has faced.
  Mr. President, I would also like to thank the dedicated professionals 
who worked so diligently to complete this year's tax legislation. First 
of all, I would like to thank my Finance team--Frank Polk, Joan 
Woodward, Mark Prater, Brig Pari, Tom Roesser, Bill Sweetnam, Jeff 
Kupfer, Ed McClellan, Ginny Flynn, Tara Bradshaw, Connie Foster and 
Myrtle Agent. I would also like to thank John Duncan and Bill Nixon 
from my personal staff for their commitment to seeing this process 
through to its successful completion.
   I would also like to thank the members of Senator Moynihan's Finance 
staff who have helped make this a bipartisan effort--David Podoff, Russ 
Sullivan, Stan Fendley, Anita Horn, and Mitchell Kent.
  It is also important to recognize the professionals of the Joint 
Committee on Taxation. In particular, I would like to thank Lindy 
Paull, Bernie Schmitt, Rick Grafmeyer, Carolyn Smith, Cecily Rock, Mary 
Schmitt, Greg Bailey, Tom Barthold, Ben Hartley, David Hering, Harold 
Hirsch, Laurie Matthews, Sam Olchyk, Oren Penn, Todd Simmens, Paul 
Schmidt, Mel Schwarz, and Barry Wold.
  I would also like to thank Jim Fransen and Mark Mathiesen of the 
Senate's Legislative Counsel office who have the thankless job of 
turning tax policy into statute.
  Finally, I would like to thank the Treasury's Office of Tax Policy. 
In particular, Linda Robertson, Jon Talisman and Joe Mikrut deserve 
special recognition for their help in this important legislation.
  On this occasion I would also like to thank the staff who worked so 
hard on the Medicare, Medicaid, and SCHIP reform provisions included in 
the Omnibus Appropriations Act. They have worked incredibly long hours, 
with real dedication, to develop the strong, consensus product before 
the Senate today. In particular, let me thank Kathy Means, Teresa 
Houser, Mike O'Grady, Jennifer Baxendell, and Alec Phillips on the 
Majority staff.
  I would also like to thank Senator Moynihan's staff for their 
cooperation and input. Let me thank Chuck Konigsberg, Liz Fowler, Edwin 
Park, Jon Resnick, Faye Drummond, Kyle Kinner, Dustin May, Julianne 
Fisher, Jewel Harper, and Doug Steiger.
  I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?

[[Page 30976]]

  There is a sufficient second.
  The yeas and nays were ordered.
  The PRESIDING OFFICER. The question is on agreeing to the conference 
report. The yeas and nays have been ordered.
  The clerk will call the roll.
  The legislative assistant called the roll.
  Mr. NICKLES. I announce that the Senator from Arizona (Mr. McCain), 
the Senator from Washington (Mr. Gorton), and the Senator from Oregon 
(Mr. Smith) are necessarily absent.
  I further announce that, if present and voting, the Senator from 
Oregon (Mr. Smith) would vote yea.
  Mr. REID. I announce that the Senator from Washington (Mrs. Murray), 
is absent attending a funeral.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 95, nays 1, as follows:

                      [Rollcall Vote No. 372 Leg.]

                                YEAS--95

     Abraham
     Akaka
     Allard
     Ashcroft
     Baucus
     Bayh
     Bennett
     Biden
     Bingaman
     Bond
     Boxer
     Breaux
     Brownback
     Bryan
     Bunning
     Burns
     Byrd
     Campbell
     Chafee, L.
     Cleland
     Cochran
     Collins
     Conrad
     Coverdell
     Craig
     Crapo
     Daschle
     DeWine
     Dodd
     Domenici
     Dorgan
     Durbin
     Edwards
     Enzi
     Feingold
     Feinstein
     Fitzgerald
     Frist
     Graham
     Gramm
     Grams
     Grassley
     Gregg
     Hagel
     Harkin
     Hatch
     Helms
     Hollings
     Hutchinson
     Hutchison
     Inhofe
     Inouye
     Jeffords
     Johnson
     Kennedy
     Kerrey
     Kerry
     Kohl
     Kyl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lott
     Lugar
     Mack
     McConnell
     Mikulski
     Moynihan
     Murkowski
     Nickles
     Reed
     Reid
     Robb
     Roberts
     Rockefeller
     Roth
     Santorum
     Sarbanes
     Schumer
     Sessions
     Shelby
     Smith (NH)
     Snowe
     Specter
     Stevens
     Thomas
     Thompson
     Thurmond
     Torricelli
     Warner
     Wellstone
     Wyden

                                NAYS--1

       
     Voinovich
       

                             NOT VOTING--4

     Gorton
     McCain
     Murray
     Smith (OR)
  The conference report was agreed to.
  Mr. GORTON. Mr. President, had I been present for the vote on the 
conference report on H.R. 1180, I would have voted ``no.'' I would have 
done so in spite of my high approval of most of the tax extenders and 
of many of the work initiative provisions. Nevertheless, the bill 
included an unwise and ill-considered new tax credit for the use of 
chicken waste for power production. That provision could never have 
survived standing alone. It is another unjustified complication in our 
tax code never considered by either House of Congress. It poisons the 
entire bill.
  Mr. MOYNIHAN. I move to reconsider the vote.
  Mr. LOTT. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. LOTT addressed the Chair.
  The PRESIDING OFFICER (Mr. Santorum). The majority leader.

                          ____________________