[Congressional Record (Bound Edition), Volume 146 (2000), Part 11]
[Senate]
[Pages 15447-15463]
[From the U.S. Government Publishing Office, www.gpo.gov]



          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. WELLSTONE:
  S. 2888. A bill to guarantee for all Americans quality, affordable, 
and comprehensive health insurance coverage; to the Committee on 
Finance.


                 health security for all americans act

  Mr. WELLSTONE. Mr. President, today I want to talk about an issue 
that is of the utmost importance: Health Security.
  First I want to talk about the problem: Health insecurity. Then I 
want to talk about the solution: The Health Security for All Americans 
Act. And finally I want people around the country to hear what they can 
do to wake up Congress and make Health Security for All Americans a 
reality.
  This year has been a hard one for me. Two months ago, we buried one 
of my dear friends, Mike Epstein. Mike's sons came to be with him for 
the last few weeks of his struggle with cancer. Devoted sons, they 
spoke glowingly about their father at a memorial service for him in the 
Capitol. As any of you who has sat with a dying parent knows, emotions 
overflow, coping is difficult, and the grief is profound. The last 
thing a son or daughter, a parent or spouse, needs is to have the 
additional burden of wondering where will the next dollar for ever 
mounting health care bills come from; to worry about going into debt; 
to worry about going bankrupt because of a loved ones health care 
needs. Mike's sons did not have to worry about that because Mike had 
health care coverage as good as Congress gets.
  The wife of my health policy advisor, John Gilman, battled cancer for 
two and a half years before succumbing one month ago. She had required 
innumerable sessions of radiation therapy, plus chemotherapy and 
surgery. John had his hands full with work plus taking care of his 
wife, both physically and emotionally. It is draining, but can you 
imagine how much worse it would be if John and his wife, June, had no 
health insurance. John didn't have to worry about how to pay for the 
next medical bill because John and his wife had health care coverage as 
good as Congress gets.
  People do get ill. As hard as we try and as much as we pray, we can't 
always cure them. But we certainly can make sure they all have access 
to high quality, affordable care with dignity. There is no reason why 
all Americans can't have health insurance as good as everyone of us who 
serves in the United States Senate.
  The idea of procuring health security for all Americans is not a new 
one. Franklin Delano Roosevelt recognized the need for universal health 
care in the 1930s when we were in the depths of the depression; Harry 
Truman fought for it in the 1940s when the troops came home from World 
War II; John Kennedy envisioned it in the midst of the cold war; 
Richard Nixon had it high on his agenda before events overtook his 
Presidency.
  What these 20th century Presidents all understood is that there is a 
basic human drive for good health, and the good health of the American 
people is what drives this country and its economy. By 1992 it was far 
past due for us to recognize that all Americans should have a basic 
right to quality affordable

[[Page 15448]]

health care. We had the opportunity in 1993 and 1994 to confer that 
right on to all of our people--and we lost it, because of differences 
and failures to compromise, and obstructionists and nay sayers, and 
failing to keep our eye on the ball: Universal, quality, affordable 
health care for every American.
  I began introducing bills to provide universal health care in this 
country shortly after I arrived in the Senate in 1991. Back then people 
were aware of the problems of the uninsured--it wasn't being swept 
under the rug. Do you remember back in 1992, we were coming out of a 
recession, unemployment was at 7.5 percent, the national debt was 
increasing each year and 36 million Americans were uninsured, and 
everyone was talking about some form of health insurance for all.
  Eight years later, we're told the economy's humming along, 
unemployment is the lowest its been in 30 years, and there is a 
budgetary surplus. But despite the fact that there are 45 million 
Americans without health insurance--10 million more than there were 10 
years ago--nobody in Washington is talking seriously about doing 
anything about it. Incremental change may keep some people from losing 
their insurance, and may insure some people who would otherwise be 
uninsured, but incrementalism has not stopped the steady rise in the 
number of uninsured in America which will soar to 55 million people by 
2008.
  We need to change that. I don't think the fact that 140 million 
Americans own stocks today should make us forget that 45 million 
Americans don't have health insurance. And that millions more can't 
make ends meet because their health insurance is simply too expensive.
  Make no mistake about it: Not having health insurance has its 
consequences. And I know some of you know it personally too well. There 
are some myths out there about not having health insurance that need to 
be debunked:
  The first myth is that the uninsured can easily get the care they 
need. But the fact is: Uninsured Americans needlessly suffer because 
they don't have access to the care they need. For example, the 
uninsured are four times more likely to go without needed medical care 
and to delay seeking care; and are up to four times more likely to 
experience an avoidable hospitalization and emergency hospital care. 
The uninsured are more likely to be in fair or poor health and have a 
higher probability of in-hospital death than the privately insured.
  The second myth is that the lack of health insurance is usually a 
temporary condition and that most people get their coverage back 
quickly. But the fact is otherwise: Nearly 60 percent of people who are 
uninsured have been uninsured for at least two years. Or put another 
way: 6 out of 10 people who lose their health insurance this month will 
still be uninsured in July 2002!
  Employers used to do more to help assure their workers of coverage. 
In 1985, nearly two-thirds of businesses with 100 or more workers paid 
the full cost of health coverage. Last year only one-fourth of 
businesses did. In 1988, employers asked workers to pay on average 20 
percent of the cost through payroll deductions. By 1998, they had 
raised the average worker's share to 27 percent. Three-fourths of the 
working uninsured are not offered or eligible for any coverage through 
their workplace.
  The third myth is that most people don't have health insurance 
because they are not working. But the fact is: 75 percent of uninsured 
Americans hold down full-time jobs or are the dependents of someone who 
does, and nine out of ten come from working families. What's also a 
fact is that low wage workers frequently aren't offered insurance at 
all through their employment or if they are, it is at an unaffordable 
price.
  The fourth myth is that most people who don't have insurance could 
afford it but just choose not to buy it. But the fact is: The high cost 
of health insurance premiums is the main reason that half the uninsured 
don't have health insurance. Only 3 percent of people without insurance 
say the most important reason is because they don't think they need it.
  Going without health insurance means living in poorer health. Most 
uninsured adults have no regular source of health care. Most postpone 
getting care. Three in ten go without needed medical care. A quarter 
forego getting the medicine they need because they cannot afford to 
fill their medical prescriptions. Uninsured children are 30 percent 
more likely to fall behind on well-child care and 80 percent more 
likely to never have routine care at all.
  The uninsured are three to four times more likely to have problems 
getting the health care they feel the need. Uninsured children are at 
least 70 percent more likely not to get medical care for common 
conditions--like asthma--that if left untreated can lead to more 
serious health problems.
  Uninsured Americans are more likely to end up hospitalized for 
conditions--like uncontrolled diabetes--that they could have avoided 
with better health care. In the end, uninsured patients are more likely 
to die while hospitalized than privately insured patients with the same 
health problems.
  Partly because they are less likely to get regular mammograms, 
uninsured women are nearly 50 percent more likely to die of breast 
cancer. Our system takes its toll in senseless, random pain and 
suffering.
  Without insurance, the medical bills mount quickly. More than one in 
three uninsured adults have problems paying their medical bills. The 
uninsured are three times more likely to have problems with their 
medical bills than the insured. Eight out of ten uninsured people 
receive absolutely no reduced charge or free health services. The 
crushing weight of bankruptcy looms on the horizon. One out of four 
people filing for bankruptcy identified an illness or injury as a major 
reason for filing; 1 out of 3 had substantial medical bills; and almost 
50 percent had both.
  Even with insurance, low- and middle-income families frequently find 
themselves in a financial straight jacket. Families with annual incomes 
of $30,000 or less are spending an inordinate, unaffordable share of 
their income on health care expenses. And the average family with an 
income under $10,000 is paying well over 20 percent of its annual 
income on health care costs. These families can least afford to make 
that kind of payment.
  For families with annual incomes of $30,000 or more, the average 
amount of that income spent on premiums, deductibles and co-pays drops 
to below 5 percent on average. But these are just averages: many 
families at every income level spend more than 10 percent of their 
family income on health care, especially if someone in the family has a 
serious illness. That is not affordable. That is not fair.
  Since coming to the Senate, my number one priority has been achieving 
universal, affordable, comprehensive, quality care for all Americans. 
That is why I am proud to be introducing today the Health Security for 
All Americans Act.
  Let me digress and tell you how I arrived at this legislation.
  When I was first elected to the Senate and Bill Clinton was elected 
president two years later, I believed the political winds and tides 
were aligned for a decade of progressive change for America. I thought 
I had been elected at just the right time to be a part of this change. 
When President Clinton, in his State of the Union speech, announced he 
would veto any health care legislation that did not provide universal 
coverage, that every citizen must be covered, I jumped to my feet and 
cheered. This was why I came to Washington, to make this kind of 
change, and this was a fight I thought we could win.
  But I had some quick learning to do. When I spoke about my interest 
in a ``single-payer'' health care plan, similar to the Canadian system 
where doctors and hospitals remain in the private sector, but where 
there is just one insurer or payer, I was told by a senior colleague 
that my plan might be the best proposal. ``But it does not have a 
chance. The insurance industry hates it and it will go nowhere. It is 
just not realistic.''

[[Page 15449]]

  I was completely disillusioned. I could not accept then, and I do not 
accept now, the proposition that even before the American people have 
the opportunity to be informed or included, a good proposal is ``dead 
on arrival'' because the insurance industry opposes it. That isn't 
supposed to happen in a representative democracy!
  In spite of the advice, I did introduce the single payer plan with 
Jim McDermott, a congressman and physician from the state of 
Washington. I thought first you start with the most desirable, and 
later on in the process you'll find out what is politically feasible. I 
refused to admit defeat before we had even begun to fight. And I was 
hoping that our legislation would pull the debate in a more progressive 
direction.
  What happened was just the opposite. The trillion dollar health care 
industry, led by the insurance companies, went on the attack, not 
against our plan which ``wasn't realistic'' but against the President's 
plan which ``was''. ``Harry and Louise'' ads cried out against the 
horrors of ``government medicine.'' Intensive and expensive lobbying 
efforts expounded on the same theme.
  Media coverage, which should have been about the nuts and bolts of 
different proposals shifted now to focus on strategy rather than 
substance and head counts rather than hard information. So ordinary 
citizens no longer had a source of knowledge to form opinions and 
inform their elected leaders.
  But the problems were not limited to the insurance lobby and the 
media. The only way we could have beaten the health care industry would 
have been with dramatic and effective citizen politics. It never 
happened. Progressives didn't organize a constituency to fight for 
health care reform, and the Administration didn't have the political 
will to stand up to powerful interests and therefore never asked the 
American people to take on this fight. They tried to win with ``inside 
politics,'' cutting deals and making compromises with different 
economic interests.
  With each accommodation to private power, the President's plan became 
hopelessly complicated. As a constituent told me at the time, ``How can 
you be for something you don't understand?'' What started as a noble 
effort by the President to fill a crucial national need became instead 
an object of derision.
  Over the years, as I traveled around the country talking about the 
need for Universal Health Care and the Single Payer model, I found 
people turning off--not to the need for health insurance for all, but 
to the specific mechanism I favored. They wanted universal health care, 
but they didn't want a national single payer system or they didn't 
think one was possible here, so they stopped listening.
  The mood of the country has changed since the early 1990s. In 1990, 
there were 34 million uninsured. Ten years later, today, there are 45 
million, and the number is growing by 100,000 people per month. 
Numerous polls show that the large majority of Americans want universal 
affordable comprehensive health care coverage and that they are willing 
to pay higher taxes for everyone to be covered.
  The people and the States are ahead of the Federal politicians on 
this issue. The people want a big change; not an incremental change. In 
Massachusetts and Washington state, people are pushing for ballot 
referendums in the fall on universal coverage. Massachusetts and 
Maryland have already received commissioned cost studies of alternative 
universal coverage plans. California this past fall legislated a task 
force to investigate options for universal coverage.
  Governor Howard Dean (D) of VT (also a physician), whose state 
presently covers 93.5 percent of its citizens, says it well: ``It is my 
view that health insurance ought to be universal, the right of every 
citizen in Vermont.'' And there is bipartisan support in Vermont. 
``Health care is not a partisan issue in Vermont,'' state Sen. John 
Bloomer (R) said, adding that ``it's a bipartisan goal to expand health 
care access and affordability.''
  The Health Security for All Americans Act is a plan for a big change. 
It builds on the momentum going on in the states of this great Nation.
  So I decided that rather than trying to tell people how I thought the 
system should work, what I needed to do was first, to set out what I 
have found are the common goals of the American people: universal 
affordable comprehensive health coverage; and second to provide federal 
matching funds for each state to reach those goals in the way that best 
fits the needs of that state.
  So, let me tell you about the Health Security for All Americans Act.
  First, it is based on the premise that every American--not just 
everyone in this chamber, but every American--is entitled to have 
health care coverage as good as the Congress gets. Every Federal 
employee has that right. Why shouldn't every other American?
  Second, it is based on the premise that good health care must be 
affordable. Americans should not go broke trying to keep their bodies 
fixed. From my experience traveling around the country, Americans all 
across the income spectrum are willing to be responsible for an 
affordable fair share of the cost of coverage and care, and a growing 
number of polls show that a majority of Americans are willing to pay 
higher taxes so that all Americans will have health coverage. Under the 
Health Security for All Americans Act, a family's financial 
responsibilities for health care is based on a percentage of family 
income. At the lowest end of the income scale, families would be 
responsible for no more than one-half of 1 percent of family income, so 
they can have quality health care, and a roof over their head, and 3 
square meals a day. While at the higher end of the income scale, 
families would be responsible for no more than 5 percent or 7 percent 
of family income. For example, under the Health Security for All 
Americans Act, a family of four with an annual income of $25,000 would 
be responsible for no more than $11 a month in total health care costs, 
while a family of four with $50,000 in annual income would have the 
security of knowing that its total out-of-pocket health care spending 
(premiums and cost sharing) could not exceed 5 percent of family income 
or $2500 per year.
  Third, it's based on the premise that you have to have access to care 
when you or your family needs it. That is why the Health Security for 
All Americans Act includes the Norwood-Dingell Patient Bill of Rights 
that has been endorsed by over 300 health care organizations.
  Fourth, it's based on the premise that good health care delivery 
doesn't just happen. It depends on a well trained, well compensated 
health care workforce that doesn't have to constantly worry about where 
the next dollar is coming from. And I am referring to doctors and 
nurses and orderlies and home health workers, and nursing home 
workers--all health care workers. If we are going to deliver humane 
dignified health care to everyone in this country, we need to start by 
treating the health care workforce with dignity and respect and that 
starts with affordable health care for all workers. That is why the 
Health Security for All Americans Act includes health care quality, 
patient safety, and workforce standards.
  My experience has taught me that Americans agree with these premises. 
They want high quality, affordable health care as good as Congress 
gets, but they are not sure the best way to get there. That is why the 
Health Security for All Americans Act is a federal state partnership 
that says here is what Americans want; you--the states--design the plan 
you want to get your state there; and we the federal government will 
provide the majority of the funds you need to reach that goal in the 
manner you chose.
  States that submit plans early and achieve universal coverage are 
rewarded with increased federal dollars for their efforts. But all 
states must have plans in force within four years and coverage for all 
their residents within five years. States could reach these goals in a 
variety of ways: with an employer mandate, with a combination of public 
and private initiatives,

[[Page 15450]]

with single payer, or some other method. I think this is a good 
approach because it allows the states flexibility, but it clearly sets 
out a fair and just goal: Universal coverage; comprehensive benefits as 
good as Congress gets; quality care guaranteed with patient 
protections; real income protections; and honoring of health care 
workers. I am proud today to be introducing the Health Security for All 
Americans Act and I am proud that this legislation has the backing and 
support of the Service Employees International Union, America's largest 
health care union.
  To my colleagues I say, together we can put universal health care 
back on the front burner where it belongs.
  We all know that in 1994, the effort to bring health care coverage to 
all Americans failed. All of us have heard the reasons why. But what we 
haven't answered is why did we give up when we knew this was the right 
thing to do? Why have we become so timid? Why have we only been willing 
to take half steps?
  We must not shrink from the task at hand! America's doctors and 
nurses know how to cure disease better than anywhere else in the world. 
Well, now it is time to treat America's worst malady--45 million 
uninsured Americans, and millions more underinsured Americans who are 
spending far too much of their monthly pay check on health care costs.
  Martin Luther King, Jr. rightly said, ``Of all the forms of 
inequality, injustice in health care is the most shocking and 
inhumane.'' All the doctors and all the nurses and all the other health 
care providers in America cannot solve this problem nor right this 
injustice, but we in the Congress can.
  This is a problem that isn't going away on its own, but there is a 
solution. So to my colleagues, I say, ``Join me in sponsoring the 
Health Security for All Americans Act.'' And to members of the American 
public who are listening, I ask you to join thousands of your fellow 
citizens who have already written to Members of Congress, and call and 
write your Senators and Representatives and ask them to join in 
bringing quality, affordable health care coverage to all Americans.
  Mr. President, I ask unanimous consent that the bill and additional 
material be printed in the Record.
  There being no objection, the materials were ordered to be printed in 
the Record, as follows:

                                S. 2888

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Health 
     Security for All Americans Act''.
       (b) Table of Contents.--The table of contents of the Act is 
     as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.

 TITLE I--HEALTH SECURITY FOR ALL AMERICANS--EXPANSION PHASE (PHASE I)

Sec. 101. Expansion phase (phase I) voluntary State universal health 
              insurance coverage plans.

            ``TITLE XXII--HEALTH SECURITY FOR ALL AMERICANS

               ``Part A--Expansion Phase (Phase I) Plans

``Sec. 2201. Purpose; voluntary State plans.
``Sec. 2202. Plan requirements.
``Sec. 2203. Coverage requirements for expansion phase (phase I) plans.
``Sec. 2204. Allotments.
``Sec. 2205. Administration.
``Sec. 2206. Definitions.''.

TITLE II--HEALTH SECURITY FOR ALL AMERICANS--UNIVERSAL PHASE (PHASE II)

Sec. 201. Universal phase (phase II) State universal health insurance 
              coverage plans.

               ``Part B--Universal Phase (Phase II) Plans

``Sec. 2211. Purpose; mandatory State plans.
``Sec. 2212. Plan requirements.
``Sec. 2213. Coverage requirements for universal phase (phase II) 
              plans.
``Sec. 2214. Requirements for employers regarding the provision of 
              benefits.
``Sec. 2215. Allotments.
``Sec. 2216. Administration; definitions.''.
Sec. 202. Consumer protections.

                     ``Part C--Consumer Protections

``Sec. 2221. Home care standards.
``Sec. 2222. Consumer protection in the event of termination or 
              suspension of services.
``Sec. 2223. Consumer protection through disclosure of information.''.
``Sec. 2224. Consumer protection through notice of changes in health 
              care delivery.''.

                     TITLE III--PATIENT PROTECTIONS

Sec. 301. Incorporation of certain protections.

 TITLE IV--HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS

Sec. 401. Health Care Quality, Patient Safety, and Workforce Standards 
              Institute.
Sec. 402. Health Care Quality, Patient Safety, and Workforce Standards 
              Advisory Committee.

                  TITLE V--IMPROVING MEDICARE BENEFITS

Sec. 501. Full mental health and substance abuse treatment benefits 
              parity.
Sec. 502. Study and report regarding addition of prescription drug 
              benefit.

                TITLE VI--LONG-TERM AND HOME HEALTH CARE

Sec. 601. Studies and demonstration projects to identify model 
              programs.

                        TITLE VII--MISCELLANEOUS

Sec. 701. Nonapplication of ERISA.
Sec. 702. Sense of Congress regarding offsets.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) The health of the American people is the foundation of 
     American strength, productivity, and wealth.
       (2) The guarantee of health care coverage and access to 
     quality medical care to all Americans is a fundamental right 
     and is essential to the general welfare.
       (3) 45,000,000 Americans, more than 11,000,000 of whom are 
     children, have no health insurance, and that number will grow 
     to more than 54,000,000 by 2007 even if the economy remains 
     strong.
       (4) Health insurance coverage is unstable; less than \1/2\ 
     of all adults have been in their current health plan for 3 
     years.
       (5) The average American will hold at least 7 jobs during 
     their life, risking lack of health coverage every time they 
     change or are between jobs.
       (6) In 1998, annual health care expenditures in the United 
     States totaled $1,150,000,000,000, or $4,094 per person. 
     National health expenditures are projected to total 
     $2,200,000,000,000 by 2008.
       (7) In 1998, health care expenditures represented 13.5 
     percent of the gross domestic product in the United States 
     and grew at the rate of 5.6 percent while the gross domestic 
     product grew only at the rate of 4.9 percent. By 2008, health 
     care expenditures are projected to reach 16.2 percent of 
     gross domestic product. Growth in health spending is 
     projected to average 1.8 percentage points above the growth 
     rate of the gross domestic product for the period beginning 
     with 1998 and ending with 2008.
       (8) Although the United States spends considerably more in 
     health care per person than any other nation, it ranks only 
     fifteenth among countries worldwide on an overall index 
     designed to measure a range of health goals according to the 
     World Health Organization.
       (9) One of 4 adults, about 40,000,000 people, say they have 
     gone without needed medical care because they couldn't afford 
     it.
       (10) Nearly 31,000,000 Americans face collection agencies 
     annually because they owe money for medical bills.
       (11) The average American worker is paying 3 times more for 
     family coverage than 10 years ago, and more than 4 times more 
     for employee-only coverage.
       (12) Because many individuals do not have health insurance 
     coverage, they may incur health care costs which they do not 
     fully reimburse, resulting in cost-shifting to others.
       (13) As a consequence of the piecemeal health care system 
     in the United States, administrative overhead costs 
     approximately $1,000 per person annually, while other Western 
     industrialized nations with universal health care systems 
     spend approximately $200 per person annually for 
     administrative overhead.
       (14) The United States should adopt national goals of 
     universal, affordable, comprehensive health insurance 
     coverage and should provide generous matching grants to the 
     States to achieve those goals within 5 years of the date of 
     enactment of this Act.

 TITLE I--HEALTH SECURITY FOR ALL AMERICANS--EXPANSION PHASE (PHASE I)

     SEC. 101. EXPANSION PHASE (PHASE I) VOLUNTARY STATE UNIVERSAL 
                   HEALTH INSURANCE COVERAGE PLANS.

       The Social Security Act (42 U.S.C. 301 et seq.) is amended 
     by adding at the end the following:

            ``TITLE XXII--HEALTH SECURITY FOR ALL AMERICANS

               ``PART A--EXPANSION PHASE (PHASE I) PLANS

     ``SEC. 2201. PURPOSE; VOLUNTARY STATE PLANS.

       ``(a) Purpose.--The purpose of this part is to provide 
     funds to participating States to

[[Page 15451]]

     enable those States to ensure universal health insurance 
     coverage by establishing State administered systems.
       ``(b) Expansion Phase (Phase I) Plan Required.--A State is 
     not eligible for a payment under section 2205(a) unless the 
     State has submitted to the Secretary a plan that--
       ``(1) sets forth how the State intends to use the funds 
     provided under this part to ensure universal, affordable, and 
     comprehensive health insurance coverage to eligible residents 
     of the State consistent with the provisions of this part; and
       ``(2) has been approved under section 2202(d).

     ``SEC. 2202. PLAN REQUIREMENTS.

       ``(a) In General.--Every expansion phase (phase I) plan 
     shall include provisions for the following:
       ``(1) Information on the level of health insurance 
     coverage.--
       ``(A) The level of health insurance coverage within the 
     State as determined under subsection (b).
       ``(B) The base coverage gap for the year involved as 
     determined under subsection (b)(4).
       ``(C) State efforts to provide or obtain health insurance 
     coverage for uncovered residents of the State, including the 
     steps the State is taking to identify and enroll all 
     uncovered residents of the State who are eligible to 
     participate in public or private health insurance programs.
       ``(2) Details of, and timelines for, expansion phase (phase 
     i) plan.--
       ``(A) Use of funds; coordination.--The activities that the 
     State intends to carry out using funds received under this 
     part, including how the State will coordinate efforts under 
     this part with existing State efforts to increase the health 
     insurance coverage of individuals.
       ``(B) Timelines.--Consistent with subsection (c), the 
     manner in which the State will reduce the base coverage gap 
     for the year involved, including a timetable with specified 
     targets for reducing the base coverage gap by--
       ``(i) 50 percent within 2 years after the date of approval 
     of the expansion phase (phase I) plan; and
       ``(ii) 100 percent within 4 years after such date.
       ``(3) Maintenance of effort.--The manner in which the State 
     will ensure that--
       ``(A) employers within the State will continue to provide 
     not less than the level of financial support toward the 
     health insurance premiums required for coverage of their 
     employees as such employers provided as of the date of 
     enactment of this title; and
       ``(B) the State will continue to provide not less than the 
     level of State expenditures incurred for State-funded health 
     programs as of such date.
       ``(4) State outreach programs; access.--The manner in 
     which, and a timetable for when, the State will--
       ``(A) institute outreach programs; and
       ``(B) ensure that all eligible residents of the State have 
     access to the health insurance coverage provided under this 
     part.
       ``(5) Assurance of coverage of essential services.--An 
     assurance that the State program established under this part 
     will comply with the requirements of section 1867 (commonly 
     referred to as the `Emergency Medical Treatment and Active 
     Labor Act').
       ``(6) Representation on boards and commissions.--The manner 
     in which the State will ensure that all Boards and 
     Commissions that the State establishes to administer the plan 
     will include, among others, representatives of providers, 
     consumers, employers, and health worker unions.
       ``(7) Disclosure of information to the public.--The manner 
     in which the State will ensure that, with respect to entities 
     and individuals that provide services for which reimbursement 
     is provided under this part--
       ``(A) financial arrangements between insurers and providers 
     and between providers and medical equipment suppliers are 
     disclosed to the public; and
       ``(B) ownership interests and health care worker 
     qualifications and credentials are disclosed to the public.
       ``(8) Consumer protections.--The manner in which the State 
     will ensure compliance with sections 2221, 2222, 2223, and 
     2224.
       ``(9) Public review.--The manner in which the State will 
     provide for the public review of institutional changes in 
     services provided, markets and regions covered, withdrawal or 
     movement of services, closures or downsizing, and other 
     actions that affect the provision of health insurance under 
     the plan.
       ``(10) Services in rural and underserved areas; cultural 
     competency.--The manner in which the State will ensure--
       ``(A) coverage in rural and underserved areas; and
       ``(B) that the needs of culturally diverse populations are 
     met.
       ``(11) Purchasing pools.--The manner in which the State 
     will encourage the formation of State purchasing pools that 
     provide choice of health plans, control costs, and reduce 
     adverse risk selection.
       ``(12) Limitation on administrative expenditures.--The 
     manner in which the State will ensure that all qualified 
     plans in the State expend at least 90 percent (or, during the 
     first 2 years of the plan, 85 percent) of total income 
     received from premiums on the provision of covered health 
     care benefits (excluding all costs for marketing, 
     advertising, health plan administration, profits, or capital 
     accumulation) to individuals.
       ``(13) Self-employed and multiemployed.--The manner in 
     which the State will address self-employed individuals and 
     multiwage earner families.
       ``(14) Medicaid wraparound coverage.--The manner in which 
     the State will ensure that individuals who are eligible for 
     medical assistance under title XIX and who receive benefits 
     under the expansion phase (phase I) plan shall receive any 
     items or services that are not available under the expansion 
     phase (phase I) plan but that are available under the State 
     medicaid program under title XIX through `wraparound 
     coverage' under such program.
       ``(15) Other matters.--Any other matter determined 
     appropriate by the Secretary.
       ``(b) Current Level of Coverage.--
       ``(1) In general.--The Secretary shall develop a survey 
     approach that provides timely and up-to-date data to 
     determine the percentage of the population of each State that 
     is currently covered by a health insurance plan or program 
     that provides coverage that meets the requirements of section 
     2203(a).
       ``(2) Biannual survey.--The Secretary shall provide for the 
     conduct of the survey developed under paragraph (1) not less 
     than biannually to make coverage determinations for purposes 
     of paragraph (1).
       ``(3) Use of alternative system.--The Secretary shall 
     permit a State to utilize an alternative population-based 
     monitoring system to make determinations with respect to 
     coverage in the State for purposes of paragraph (1) if the 
     Secretary determines that such system meets or exceeds the 
     methodological standards utilized in the survey developed 
     under paragraph (1).
       ``(4) Base coverage gap.--For purposes of subsection 
     (a)(1)(A), the base coverage gap for a State shall be equal 
     to 100 percent of the eligible individuals and families in 
     the State for the year involved, less the current level of 
     coverage for those individuals and families for such year as 
     determined under paragraph (1) or (3).
       ``(c) Reducing the Level of Uninsured Individuals.--
       ``(1) In general.--To be eligible to receive funds under 
     this part, a State shall agree to administer an expansion 
     phase (phase I) plan with a goal of providing health 
     insurance coverage for 100 percent of the eligible residents 
     of the State by not later than 4 years after the date of 
     approval of the State's expansion phase (phase I) plan.
       ``(2) Permissible activities.--A State may use amounts 
     provided under this part for any activities consistent with 
     this part that are appropriate to enroll individuals in 
     health plans and health programs to meet the targets 
     contained in the State plan under subsection (a)(2)(B), 
     including through the use of direct payments to health plans 
     or, in the case of a single State plan, directly to providers 
     of services.
       ``(d) Process for Submission, Approval, and Amendment of 
     Expansion Phase (Phase I) Plan.--The provisions of section 
     2106 apply to an expansion phase (phase I) plan under this 
     part in the same manner as they apply to a State plan under 
     title XXI, except that no expansion phase (phase I) plan may 
     be effective earlier than January 1, 2001, and all expansion 
     phase (phase I) plans must be submitted for approval by not 
     later than December 31, 2002.

     ``SEC. 2203. COVERAGE REQUIREMENTS FOR EXPANSION PHASE (PHASE 
                   I) PLANS.

       ``(a) Required Scope of Health Insurance Coverage.--Health 
     insurance coverage provided under this part shall consist of 
     at least the benefits provided under the Federal Employees 
     Health Benefits Program standard Blue Cross/Blue Shield 
     preferred provider option service benefit plan, described in 
     and offered under section 8903(1) of part 5, United States 
     Code, including mental health and substance abuse treatment 
     benefits parity.
       ``(b) Limitations on Premiums and Cost-Sharing.--
       ``(1) Description; general conditions.--An expansion phase 
     (phase I) plan shall include a description, consistent with 
     this subsection, of the amount (if any) of premiums, cost-
     sharing, or other similar charges imposed. Any such charges 
     shall be imposed pursuant to a public schedule.
       ``(2) Limitations on premiums and cost-sharing.--
       ``(A) Individuals and families with income below 150 
     percent of poverty line.--In the case of an individual or 
     family whose income is at or below 150 percent of the poverty 
     line--
       ``(i) the State plan may not impose a premium; and
       ``(ii) the total annual aggregate amount of cost-sharing 
     imposed by a State with respect to all individuals in a 
     family may not exceed 0.5 percent of the family's income for 
     the year involved.
       ``(B) Individuals and families with income between 150 and 
     300 percent of poverty line.--In the case of an individual or 
     family whose income exceeds 150 percent but does not exceed 
     300 percent of the poverty line--
       ``(i) the State plan may not impose a premium that exceeds 
     an amount that is equal to--

       ``(I) 20 percent of the average cost of providing benefits 
     to an individual (or a family) under this part in the year 
     involved; or

[[Page 15452]]

       ``(II) 3 percent of the family's income for the year 
     involved; and

       ``(ii) the total annual aggregate amount of premiums and 
     cost-sharing (combined) imposed by a State with respect to 
     all individuals in a family may not exceed 5 percent of the 
     family's income for the year involved.
       ``(C) Individuals and families with income above 300 
     percent of poverty line.--In the case of an individual or 
     family whose income exceeds 300 percent of the poverty line--
       ``(i) the State plan may not impose a premium that exceeds 
     20 percent of the average cost of providing benefits to an 
     individual (or a family of the size involved) under this part 
     in the year involved; and
       ``(ii) the total annual aggregate amount of premiums and 
     cost-sharing (combined) imposed by a State with respect to 
     all individuals in a family may not exceed 7 percent of the 
     family's income for the year involved.
       ``(D) Self-employed individuals.--The State shall establish 
     rules for self-employed individuals based on individual and 
     family income.
       ``(3) Collection.--The State shall establish procedures for 
     collecting any premiums, cost-sharing, or other similar 
     charges imposed under this part. Such procedures shall 
     provide for annual reconciliations and adjustments.
       ``(c) Application of Certain Requirements.--
       ``(1) Restriction on application of preexisting condition 
     exclusions.--The expansion phase (phase I) plan shall not 
     permit the imposition of any preexisting condition exclusion 
     for covered benefits under the plan.
       ``(2) Choice of plans.--
       ``(A) In general.--Except as provided in subparagraph (B), 
     the expansion phase (phase I) plan shall offer eligible 
     individuals and families a choice of qualified plans from 
     which to receive benefits under this part. At least 1 plan 
     shall be a preferred provider option plan.
       ``(B) Waiver.--The Secretary--
       ``(i) may waive the requirement under subparagraph (A) if 
     determined appropriate; and
       ``(ii) shall waive such requirement in the case of a State 
     that establishes a single State plan.

     ``SEC. 2204. ALLOTMENTS.

       ``(a) State Allotments.--
       ``(1) In general.--With respect to a fiscal year, the 
     Secretary shall allot to each State with an expansion phase 
     (phase I) plan approved under this part the amount determined 
     under paragraph (2) for such State for such fiscal year.
       ``(2) Determination of cost of coverage.--The amount 
     determined under this paragraph is the amount equal to--
       ``(A) the product of--
       ``(i) the Federal participation rate for the State as 
     determined under subsection (b) or, if applicable, the 
     enhanced Federal participation rate for the State, as 
     determined under subsection (c);
       ``(ii) the estimated cost for the minimum benefits package 
     required to comply under section 2203, not to exceed the sum 
     of--

       ``(I) the total annual Government and employee 
     contributions required for individual or self and family 
     health benefits coverage under the Federal Employees Health 
     Benefits Program standard Blue Cross/Blue Shield preferred 
     provider option service benefit plan, described in and 
     offered under section 8903(1) of title 5, United States Code 
     (adjusted for age, as the Secretary determines appropriate); 
     and
       ``(II) the estimated average cost-sharing expense for an 
     individual or family; and

       ``(iii) the estimated number of residents to be enrolled in 
     the expansion phase (phase I) plan; less
       ``(B) the sum of--
       ``(i) the individual or family health insurance 
     contribution and cost-sharing payments to be made in 
     accordance with section 2203(b); and
       ``(ii) any applicable employer contribution to such 
     payments.
       ``(b) Federal Participation Rate.--For purposes of 
     subsection (a)(2)(A)(i), the Federal participation rate for a 
     State shall be equal to the enhanced FMAP determined for the 
     State under section 2105(b).
       ``(c) Enhanced Federal Participation Rate.--
       ``(1) In general.--For purposes of subsection (a)(2)(A)(i), 
     the enhanced Federal participation rate for a State shall be 
     equal to the Federal participation rate for such State under 
     subsection (b), as adjusted by the Secretary based on the 
     decrease in the base coverage gap in the State.
       ``(2) Amount of adjustment and application.--
       ``(A) Amount of adjustment.--The Federal participation rate 
     under subsection (b) with respect to a State shall be 
     increased by--
       ``(i) 1 percentage point if the base coverage gap of the 
     State has decreased by at least 50 percent within 2 years 
     after the date of approval of the expansion phase (phase I) 
     plan, as determined by the Secretary; and
       ``(ii) 3 percentage points if the base coverage gap of the 
     State has decreased by 100 percent within 4 years after the 
     date of approval of the expansion phase (phase I) plan, as 
     determined by the Secretary.
       ``(B) Application.--The increase described in--
       ``(i) subparagraph (A)(i) shall only apply to a State for 
     the period beginning with the month of the determination 
     under such subparagraph and ending with the month preceding 
     the month of the determination under subparagraph (A)(ii) (if 
     any), but in no event for more than 24 months; and
       ``(ii) subparagraph (A)(ii) shall apply to a State for any 
     year (or portion thereof) beginning with the month of the 
     determination under such subparagraph.
       ``(3) Full coverage.--For purposes of this part, a State 
     shall be deemed to have decreased its base coverage gap by 
     100 percent if the Secretary determines that--
       ``(A) 98 percent of all eligible residents of the State are 
     provided health insurance coverage under the expansion phase 
     (phase I) plan; and
       ``(B) the remaining 2 percent of such residents are served 
     by alternative health care delivery systems as demonstrated 
     by the State.
       ``(d) Grants to Indian Tribes, Native Hawaiian 
     Organizations, and Alaska Native Organizations.--
       ``(1) In general.--Out of funds appropriated under 
     subsection (e), the Secretary shall reserve an amount, not to 
     exceed 1 percent of the total allotments determined under 
     subsection (a) for a fiscal year, to make grants to Indian 
     tribes, Native Hawaiian organizations, and Alaska Native 
     organizations for development and implementation of universal 
     health insurance coverage plans for members of such tribes 
     and organizations.
       ``(2) Plan.--To be eligible to receive a grant under 
     paragraph (1), an Indian tribe, Native Hawaiian organization, 
     or Alaska Native organization shall submit a universal health 
     insurance coverage plan to the Secretary at such time, in 
     such manner, and containing such information, as the 
     Secretary may require.
       ``(3) Regulations.--The Secretary shall issue regulations 
     specifying the requirements of this part that apply to Indian 
     tribes, Native Hawaiian organizations, and Alaska Native 
     organizations receiving grants under paragraph (1).
       ``(e) Appropriation.--
       ``(1) In general.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to carry out 
     this title such sums as may be necessary for fiscal year 2001 
     and each fiscal year thereafter.
       ``(2) Budget authority.--Paragraph (1) constitutes budget 
     authority in advance of appropriations Acts and represents 
     the obligation of the Federal Government to provide States, 
     Indian tribes, Native Hawaiian organizations, and Alaska 
     Native organizations with the allotments determined under 
     this section and the grants for administrative and outreach 
     activities under section 2205.

     ``SEC. 2205. ADMINISTRATION.

       ``(a) Payments.--
       ``(1) In general.--
       ``(A) Quarterly.--Subject to subparagraph (B) and 
     subsection (b), the Secretary shall make quarterly payments 
     to each State with an expansion phase (phase I) plan approved 
     under this part, from its allotment under section 2204.
       ``(B) Funding for administration and outreach.--
       ``(i) Authority to make grants.--In addition to the 
     allotments determined under section 2204, the Secretary may 
     make grants to States, Indian tribes, Native Hawaiian 
     organizations, and Alaska Native organizations for 
     expenditures for administrative and outreach activities.
       ``(ii) Amounts.--

       ``(I) In general.--A grant awarded under this subparagraph 
     shall not exceed the applicable percentage (as determined 
     under subclause (II)) of the total amount allotted to the 
     State, Indian tribe, Native Hawaiian organization, or Alaska 
     Native organization under section 2204.
       ``(II) Applicable percentage.--For purposes of subclause 
     (I), the applicable percentage is--

       ``(aa) 14 percent during the first 2 years an expansion 
     phase (phase I) plan is in effect and complies with the 
     requirements of this title;
       ``(bb) 12 percent during the third, fourth, and fifth years 
     that such plan, or a universal phase (phase II) plan added by 
     an addendum to an expansion phase (phase I) plan, is in 
     effect and complies with the requirements of this title; and
       ``(cc) 10 percent during any year thereafter such plan (or 
     universal phase (phase II) plan added by an addendum to such 
     plan) is in effect and complies with the requirements of this 
     title.
       ``(2) Advance payment; retrospective adjustment.--The 
     Secretary may make payments under this part for each quarter 
     on the basis of advance estimates by the State and such other 
     investigation as the Secretary may find necessary, and may 
     reduce or increase the payments as necessary to adjust for 
     any overpayment or underpayment for prior quarters.
       ``(3) Flexibility in submittal of claims.--Nothing in this 
     subsection shall be construed as preventing a State from 
     claiming as expenditures in the quarter expenditures that 
     were incurred in a previous quarter.
       ``(b) Authority for Blended Rate for Health Security, 
     Medicaid, and SCHIP Funds.--The Secretary shall establish 
     procedures for blending the payments that a State

[[Page 15453]]

     is entitled to receive under this title, title XIX, and title 
     XXI into 1 payment rate if--
       ``(1) the State requests such a blended payment; and
       ``(2) the Secretary finds that the State meets maintenance 
     of effort requirements established by the Secretary.
       ``(c) Limitations on Federal Payments Based on Cost 
     Containment.--
       ``(1) Determination of baseline.--Each year (beginning with 
     2001), the Secretary shall establish a baseline projection 
     for the national rate of growth in private health insurance 
     premiums for such year.
       ``(2) Requirement.--Beginning with fiscal year 2002 and 
     each fiscal year thereafter, any payment made to a State 
     under section 2204 shall not exceed the amount paid to the 
     State under such section for the preceding fiscal year, 
     adjusted for changes in enrollment and a premium inflation 
     adjustment that is 0.5 percent below the baseline projection 
     determined under paragraph (1) for the year.
       ``(d) Other Limitations On Use of Funds.--
       ``(1) In general.--A State participating under part A, and, 
     effective January 1, 2005, all States under part B, shall 
     ensure that any payments received by the State under section 
     2205 or 2116(a) are not used by any individual or entity, 
     including providers or health plans that contract to provide 
     services herein, to finance directly or indirectly, or to 
     otherwise facilitate expenditures to influence health care 
     workers of such individual or entity with respect to issues 
     related to unionization.
       ``(2) Construction.--Nothing in this subsection shall be 
     construed to limit expenditures made for the purpose of good 
     faith collective bargaining or pursuant to the terms of a 
     bona fide collective bargaining agreement.
       ``(e) Waiver of Federal Requirements.--A State may request 
     (and the Secretary may grant) a waiver of any provision of 
     Federal law that the State determines is necessary in order 
     to carry out an approved expansion phase (phase I) plan under 
     this part.
       ``(f) Report.--Not later than January 1, 2002, and each 
     January 1 thereafter, the Secretary, in consultation with the 
     General Accounting Office and the Congressional Budget 
     Office, shall prepare and submit to the appropriate 
     committees of Congress a report on the number of States 
     receiving payments under this part for the year for which the 
     report is being prepared as well as the level of insurance 
     coverage attained by each such State.

     ``SEC. 2206. DEFINITIONS.

       ``In this title:
       ``(1) Cost-sharing.--The term `cost-sharing' has the 
     meaning given such term under the Federal Employees Health 
     Benefits Program standard Blue Cross/Blue Shield preferred 
     provider option service benefit plan described in and offered 
     under section 8903(1) of part 5, United States Code, and 
     includes deductibles, copayments, coinsurance, as such terms 
     are defined for purposes of such plan.
       ``(2) Eligible residents of a state.--
       ``(A) In general.--The term `eligible residents of a State' 
     means an individual or family who--
       ``(i) is (or consists of) a resident of the State involved;
       ``(ii) except as provided in subparagraph (B), has a family 
     income that does not exceed 300 percent of the poverty line;
       ``(iii) is (or consists of) a citizen of the United States, 
     a legal resident alien, or an individual otherwise residing 
     in the United States under the authority of Federal law; and
       ``(iv) in the case of an individual, is not eligible for 
     benefits under the medicare program under title XVIII or for 
     medical assistance under the medicaid program under title XIX 
     (other than under the application of section 
     1902(a)(10)(A)(ii)(XIV)).
       ``(B) Option to provide coverage for individuals and 
     families with higher income.--If approved by the Secretary, a 
     State may increase the percentage described in subparagraph 
     (A)(ii), or eliminate all income eligibility criteria in 
     order to provide coverage under this part to more individuals 
     and families.
       ``(3) Expansion phase (phase i) plan.--The term `expansion 
     phase (phase I) plan' means the State universal health 
     insurance coverage plan submitted under section 2201(b).
       ``(4) Health care services.--The term `health care 
     services' includes medical, surgical, mental health, and 
     substance abuse services, whether provided on an in-patient 
     or outpatient basis.
       ``(5) Health care worker.--The term `health care worker' 
     means an individual employed by an employer that provides--
       ``(A) health care services; or
       ``(B) necessary related services, including administrative, 
     food service, janitorial, or maintenance service to an entity 
     that provides such health care services.
       ``(6) Health plan.--The term `health plan' includes health 
     insurance coverage, as defined in section 2791(b)(1) of the 
     Public Health Service Act (42 U.S.C. 300gg-91(b)(1)) and 
     group health plans, as defined in section 2791(a) of such Act 
     (42 U.S.C. 300gg91(b)(1)).
       ``(7) Mental health and substance abuse treatment benefits 
     parity.--
       ``(A) In general.--The term `mental health and substance 
     abuse treatment benefits parity' means the same level of 
     parity for such benefits as is required under the Federal 
     Employees Health Benefits Program standard Blue Cross/Blue 
     Shield preferred provider option service benefit plan, 
     described in and offered under section 8903(1) of part 5, 
     United States Code, as of January 1, 2001.
       ``(B) Exception.--Notwithstanding subparagraph (A), there 
     shall be no limit on parity benefits for patients who do not 
     substantially follow their treatment plans unless such limits 
     also are imposed on all medical and surgical benefits.
       ``(8) Poverty line.--The term `poverty line' has the 
     meaning given such term in section 673(2) of the Community 
     Services Block Grant Act (42 U.S.C. 9902(2)), including any 
     revision required by such section.
       ``(9) Premium.--The term `premium' includes any enrollment 
     fees and other similar charges.
       ``(10) Qualified plan.--The term `qualified plan' means a 
     health plan that satisfies the coverage requirements 
     described under section 2203 and participates in an expansion 
     phase (phase I) plan.''.

TITLE II--HEALTH SECURITY FOR ALL AMERICANS--UNIVERSAL PHASE (PHASE II)

     SEC. 201. UNIVERSAL PHASE (PHASE II) STATE UNIVERSAL HEALTH 
                   INSURANCE COVERAGE PLANS.

       Title XXII of the Social Security Act, as added by section 
     101, is amended by adding at the end the following:

               ``PART B--UNIVERSAL PHASE (PHASE II) PLANS

     ``SEC. 2211. PURPOSE; MANDATORY STATE PLANS.

       ``(a) Purpose.--The purposes of this part are to--
       ``(1) require States to establish and implement State-
     administered systems to ensure universal health insurance 
     coverage; and
       ``(2) provide funds to States for the establishment and 
     implementation of such systems.
       ``(b) Universal Phase (Phase II) Plan Required.--
       ``(1) In general.--Except as provided in paragraph (2), not 
     later than January 1, 2004, a State shall submit to the 
     Secretary a plan that sets forth how the State intends to use 
     the funds provided under this part to ensure universal, 
     affordable, and comprehensive health insurance coverage to 
     eligible residents of the State consistent with the 
     provisions of this part.
       ``(2) States with phase i plans.--
       ``(A) In general.--Not later than January 1, 2004, a State 
     with a phase I State plan shall submit an addendum to such 
     plan that provides assurances to the Secretary that such plan 
     conforms to the requirements of this part.
       ``(B) Conversion to universal phase (phase ii) plan.--If an 
     addendum to an expansion phase (phase I) plan is approved by 
     the Secretary--
       ``(i) the plan shall be automatically converted to a 
     universal phase (phase II) plan; and
       ``(ii) section 2214 and any provision of part A that is 
     inconsistent with this part shall not apply to the plan.
       ``(3) Failure to submit plan or addendum.--If a State fails 
     to submit a plan as required in paragraph (1) (or an addendum 
     as required in paragraph (2)), or fails to have such plan or 
     addendum approved by the Secretary, such State shall be in 
     violation of this part; and any residents of such a State may 
     bring a cause of action against the State in Federal district 
     court to require the State to comply with the provisions of 
     this part.

     ``SEC. 2212. PLAN REQUIREMENTS.

       ``(a) In General.--A universal phase (phase II) plan shall 
     include a description, consistent with the requirements of 
     this part, of the following:
       ``(1) Details of the universal phase (phase ii) plan.--The 
     activities that the State intends to carry out using funds 
     received under this part to ensure that all eligible 
     residents of the State have access to the coverage provided 
     under this part, including how the State will coordinate 
     efforts under the program under this part with existing State 
     efforts to increase to 100 percent the health insurance 
     coverage of eligible residents of the State by January 1, 
     2006.
       ``(2) Requirements for employers.--The manner in which the 
     State will ensure that employers within the State will comply 
     with the requirements of section 2214.
       ``(3) Part a provisions.--The following provisions apply to 
     a universal phase (phase II) plan under this part in the same 
     manner as such provisions apply to an expansion phase (phase 
     I) plan under part A:
       ``(A) State outreach programs; access.--Section 2202(a)(4).
       ``(B) Assurance of coverage of essential services.--Section 
     2202(a)(5).
       ``(C) Representation on boards and commissions.--Section 
     2202(a)(6).
       ``(D) Disclosure of information to the public.--Section 
     2202(a)(7).
       ``(E) Consumer protections and workforce standards.--
     Section 2202(a)(8).
       ``(F) Public review.--Section 2202(a)(9).
       ``(G) Services in rural and underserved areas; cultural 
     competency.--Section 2202(a)(10).

[[Page 15454]]

       ``(H) Purchasing pools.--Section 2202(a)(11).
       ``(I) Limitation on administrative expenditures.--Section 
     2202(a)(12).
       ``(J) Self-employed and multiemployed.--Section 
     2202(a)(13).
       ``(K) Medicaid wraparound coverage.--Section 2202(a)(14).
       ``(4) Other matters.--Any other matter determined 
     appropriate by the Secretary.
       ``(b) Permissible Activities.--A State may use amounts 
     provided under this part for any activities consistent with 
     this part that are appropriate to enroll individuals in 
     health plans to ensure that all eligible residents of the 
     State are provided coverage under this part, including 
     through the use of direct payments to health plans or 
     providers of services.
       ``(c) Cost Containment; Competitive Bidding.--
     Notwithstanding subsection (b), State purchasing pools shall 
     solicit bids from health plans at least annually.
       ``(d) Process for Submission, Approval, and Amendment of 
     Universal Phase (Phase II) Plan.--Section 2106 applies to a 
     universal phase (phase II) plan under this part in the same 
     manner as such section applies to a State plan under title 
     XXI, except that no universal phase (phase II) plan may be 
     effective earlier than January 1, 2005, and all such plans 
     must be submitted for approval by not later than January 1, 
     2004.

     ``SEC. 2213. COVERAGE REQUIREMENTS FOR UNIVERSAL PHASE (PHASE 
                   II) PLANS.

       ``(a) Required Scope of Health Insurance Coverage.--Section 
     2203(a) applies to a universal phase (phase II) plan under 
     this part.
       ``(b) Universal Coverage.--All States shall ensure that by 
     January 1, 2006, 100 percent of eligible residents of the 
     State have health insurance coverage that meets the 
     requirements of section 2203(a).
       ``(c) Limitations on Premiums and Cost-Sharing.--Section 
     2203(b) applies to a universal phase (phase II) plan under 
     this part.
       ``(d) Application of Certain Requirements.--Section 2203(c) 
     applies to a universal phase (phase II) plan under this part.

     ``SEC. 2214. REQUIREMENTS FOR EMPLOYERS REGARDING THE 
                   PROVISION OF BENEFITS.

       ``(a) Requirements.--Subject to subsection (c)(2)(B), an 
     employer in a State shall comply with the following 
     requirements:
       ``(1) Employers with less than 500 employees.--
       ``(A) In general.--An employer with less than 500 employees 
     shall enroll each employee in a State-designated purchasing 
     pool.
       ``(B) Contributions.--
       ``(i) In general.--Notwithstanding subparagraph (A) and 
     subject to clause (ii), the employer shall make a 
     contribution on behalf of each employee for health insurance 
     coverage that is equal to at least 80 percent of the total 
     premiums for such coverage for employees and their families 
     if the employee elects dependent coverage.
       ``(ii) Limitation.--An employer shall not be liable under 
     subparagraph (B) for more than 10 percent of each employee's 
     annual wages.
       ``(2) Employers with at least 500 employees.--
       ``(A) In general.--An employer with at least 500 employees, 
     a majority of whose wages fall below an amount equal to 300 
     percent of the poverty line applicable to a family of the 
     size involved, shall comply with the requirements applicable 
     to an employer under paragraph (1).
       ``(B) Other employers.--
       ``(i) In general.--An employer with at least 500 employees 
     that is not described in subparagraph (A) shall, at the 
     option of the employer, either--

       ``(I) comply with the requirements applicable to an 
     employer under paragraph (1); or
       ``(II) provide health insurance coverage to all employees 
     and their families (if the employee elects dependent 
     coverage) that meets the requirements of section 2213 and the 
     employer contribution required under paragraph (1)(B).

       ``(ii) Additional employer contribution.--An employer that 
     elects to comply with clause (i)(I) shall contribute an 
     additional 1 percent of payroll into the State-designated 
     purchasing pool in which it participates.
       ``(3) Rule of construction.--Nothing in this title shall be 
     construed as prohibiting a labor organization from 
     collectively bargaining for an employer contribution that is 
     greater than the contribution that is required under 
     paragraph (1)(B) or, as applicable, for health insurance 
     benefits that are greater than the coverage required under 
     paragraph section 2203(a).
       ``(4) Part-time employees.--An employer shall be 
     responsible for meeting the requirements under this 
     subsection for all employees of the employer.
       ``(5) Multiemployer families.--In the case of a family with 
     more than 1 employer, the employers of individuals within the 
     family shall apportion their contributions in accordance with 
     rules established by the State.
       ``(b) Nonapplicability.--This section shall not apply--
       ``(1) to any State that establishes a single payor system; 
     or
       ``(2) to any State that established a universal phase 
     (phase II) plan through an approved addendum to an expansion 
     phase (phase I) plan.
       ``(c) Private Cause of Action.--
       ``(1) Liability.--An employer that fails to comply with the 
     requirements of subsection (a) or otherwise takes adverse 
     action against an employee for the purpose of interfering 
     with the attainment of any right to which the employee may be 
     entitled to under this title, shall be liable to the employee 
     affected.
       ``(2) Amount.--The amount of the liability described in 
     paragraph (1) shall be an amount equal to--
       ``(A) the contributions that otherwise would have been made 
     by the employer on behalf of the employee under this section;
       ``(B) an additional amount as liquidated damages; and
       ``(C) consequential damages for reasonably foreseeable 
     injuries resulting from such action.
       ``(3) Jurisdiction; equitable relief.--
       ``(A) Jurisdiction.--An action under this subsection may be 
     maintained against any employer in any Federal or State court 
     of competent jurisdiction by any 1 or more employees.
       ``(B) Equitable relief.--In addition to the damages 
     described in paragraph (2), a court may enjoin any act or 
     practice that violates this title.
       ``(4) Attorney's fees.--If a plaintiff or plaintiffs 
     prevail in an action brought under this subsection, the court 
     shall, in addition to any judgment awarded to the plaintiff 
     or plaintiffs, award the reasonable attorney's fees and costs 
     associated with the bringing of the action.

     ``SEC. 2215. ALLOTMENTS.

       ``(a) State Allotments.--Subsections (a) and (b) of section 
     2204 apply to a universal phase (phase II) plan under this 
     part in the same manner as such subsections apply to an 
     expansion phase (phase I) plan under part A.
       ``(b) Special Rule for Expansion Phase (Phase I) Plans.--A 
     State that operated an expansion phase (phase I) plan and 
     converted such plan to a universal phase (phase II) plan 
     pursuant to section 2211(b)(2)(B) shall continue to be 
     eligible for the enhanced Federal participation rate 
     determined under section 2204(c).
       ``(c) Grants to Indian Tribes, Native Hawaiian 
     Organizations, and Alaska Native Organizations.--Section 
     2204(d) applies to a universal phase (phase II) plan under 
     this part.
       ``(d) Appropriation.--
       ``(1) In general.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to carry out 
     this title such sums as may be necessary for fiscal year 2005 
     and each fiscal year thereafter.
       ``(2) Budget authority.--Paragraph (1) constitutes budget 
     authority in advance of appropriations Acts and represents 
     the obligation of the Federal Government to provide States, 
     Indian tribes, Native Hawaiian organizations, and Alaska 
     Native organizations with the allotments determined under 
     this section and the grants for administrative and outreach 
     activities under section 2205(a)(1)(B) (as applied to this 
     part under section 2216(a)).

     ``SEC. 2216. ADMINISTRATION; DEFINITIONS.

       ``(a) Administration.--The provisions of section 2205 
     (other than subsection (c) of such section) apply to a 
     universal phase (phase II) plan under this part in the same 
     manner as such provisions apply to an expansion phase (phase 
     I) plan under part A.
       ``(b) Definitions.--
       ``(1) Application of section 2206.--The definitions set 
     forth in section 2206 apply to a universal phase (phase II) 
     plan under this part in the same manner as such provisions 
     apply to an expansion phase (phase I) plan under part A 
     except that for purposes of this part, the definition of 
     `eligible residents of a State' set forth in section 2206(2) 
     shall be applied without regard to subparagraphs (A)(ii) and 
     (B).
       ``(2) Universal phase (phase ii ) plan.--In this title, the 
     term `universal phase (phase II) plan' means the State 
     universal health insurance coverage plan submitted under 
     section 2211(b).''.

     SEC. 202. CONSUMER PROTECTIONS.

       Title XXII of the Social Security Act, as amended by 
     section 201, is amended by adding at the end the following:

                     ``PART C--CONSUMER PROTECTIONS

     ``SEC. 2221. HOME CARE STANDARDS.

       ``In order to ensure that home care services are provided 
     in a consumer-directed manner, a State participating under 
     part A, and, effective January 1, 2005, all States under part 
     B, shall satisfy the Secretary that any health plan that 
     provides home care services under this title creates, or 
     contracts with, a viable entity other than the consumer or 
     individual provider to provide effective billing, payments 
     for services, tax withholding, unemployment insurance, and 
     workers compensation coverage, and to serve as the statutory 
     employer of the home care provider. Recipients of such 
     services shall retain the right to independently select, 
     hire, terminate, and direct the work of the home care 
     provider.

     ``SEC. 2222. CONSUMER PROTECTION IN THE EVENT OF TERMINATION 
                   OR SUSPENSION OF SERVICES.

       ``A State participating under part A, and, effective 
     January 1, 2005, all States under

[[Page 15455]]

     part B, shall satisfy the Secretary that any health plan 
     providing services under this title shall ensure that 
     enrollees will receive continued health services in the event 
     that the plan's health care services are terminated or 
     suspended, including as the result of the plan filing for 
     bankruptcy relief under title 11, United States Code, or the 
     failure of the plan to provide payments to providers, 
     lockouts, work stoppages, or other labor management problems.

     ``SEC. 2223. CONSUMER PROTECTION THROUGH DISCLOSURE OF 
                   INFORMATION.

       ``(a) In General.--A State participating under part A, and, 
     effective January 1, 2005, all States under part B, shall 
     satisfy the Secretary that any health care provider that 
     provides services to individuals under this title shall 
     provide to the State information regarding the identity, 
     employment location, and qualifications of health care 
     workers providing services under--
       ``(1) the licensure of the provider; or
       ``(2) a contract between the provider and a health plan or 
     the State.
       ``(b) Availability to Public.--A health care provider shall 
     make the information described in subsection (a) available to 
     the public.''.

     ``SEC. 2224. CONSUMER PROTECTION THROUGH NOTICE OF CHANGES IN 
                   HEALTH CARE DELIVERY.

       ``A State participating under part A, and, effective 
     January 1, 2005, all States under part B, shall describe how 
     the State will provide, at a minimum, the following 
     protections:
       ``(1) Adequate advance notice to the public, the affected 
     health care workers, and labor organizations representing 
     such workers, of a pending--
       ``(A) facility or operating unit closure;
       ``(B) sale, merger, or consolidation of a facility or 
     operating unit;
       ``(C) transfer of work from 1 facility or entity to another 
     facility or entity; or
       ``(D) reduction of services.
       ``(2) A right of first refusal for similar vacant positions 
     with--
       ``(A) the resulting entity, in the case of a health care 
     worker whose position was eliminated following a merger of 
     the worker's original employer with a new entity; or
       ``(B) the contractor, in the case of a health care worker 
     whose position was eliminated following the contracting out 
     of the work the worker formerly performed.''.

                     TITLE III--PATIENT PROTECTIONS

     SEC. 301. INCORPORATION OF CERTAIN PROTECTIONS.

       (a) Incorporation.--The provisions of the following bills 
     are hereby enacted into law:
       (1) H.R. 2723 of the 106th Congress (other than section 
     135(b)), as introduced on August 5, 1999.
       (2) H.R. 137 of the 106th Congress, as introduced on 
     January 6, 1999.
       (b) Publication.--In publishing this Act in slip form and 
     in the United States Statutes at Large pursuant to section 
     112, of title 1, United States Code, the Archivist of the 
     United States shall include after the date of approval at the 
     end appendixes setting forth the texts of the bills referred 
     to in subsection (a) of this section.

 TITLE IV--HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS

     SEC. 401. HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE 
                   STANDARDS INSTITUTE.

       (a) Establishment.--
       (1) Institute.--There is established within the Agency for 
     Healthcare Research and Quality, an institute to be known as 
     the Health Care Quality, Patient Safety, and Workforce 
     Standards Institute (in this section referred to as the 
     ``Institute'').
       (2) Director.--The Secretary of Health and Human Services 
     shall appoint a director of the Institute. The director shall 
     administer the Institute and carry out the duties of the 
     director under this section subject to the authority, 
     direction, and control of the Secretary.
       (b) Mission.--The mission of the Institute is to--
       (1) demonstrate how patient safety issues and workplace 
     conditions are linked to quality patient care and the 
     reduction of the incidence of medical errors; and
       (2) reduce the incidence of medical errors and improve 
     patient safety and quality of care.
       (c) Duties.--In carrying out the mission of the Institute, 
     the director of the Institute shall--
       (1) work closely with the director of the Agency for 
     Healthcare Research and Quality to ensure that issues related 
     to workplace conditions are reflected in the activities 
     conducted by such agency in order to reduce the incidence of 
     medical errors and improve patient safety and quality of 
     care, including--
       (A) the establishment of national goals;
       (B) the development and implementation of a research 
     agenda;
       (C) the development and promotion of best practices;
       (D) the development of performance and staffing standards 
     in consultation with the Health Care Financing Administration 
     and other Federal agencies, as appropriate; and
       (E) the development and dissemination of information, 
     educational and training materials, and other criteria as it 
     relates to the delivery of quality care;
       (2) provide recommendations to the Secretary of Health and 
     Human Services and other Federal agencies with responsibility 
     for health care quality and the development of standards that 
     impact on the delivery of quality patient care on standards 
     related to workplace conditions and patient safety;
       (3) support the activities of the Health Care Financing 
     Administration related to the development of new or revised 
     conditions of participation under the medicare and medicaid 
     programs and subsequent rulemaking on issues related to 
     workplace conditions, medical errors, and patient safety and 
     quality of care; and
       (4) conduct other activities determined appropriate by the 
     director of the Institute.
       (d) Workplace Conditions.--For purposes of this section, 
     the term ``workplace conditions'' shall include issues 
     related to--
       (1) health care worker staffing;
       (2) hours of work;
       (3) confidentiality and whistleblower protections;
       (4) employee participation in decisionmaking roles that 
     contribute to improved quality of care and the reduction of 
     the incidence of medical errors;
       (5) workforce training; and
       (6) the impact of health care delivery restructuring on 
     communities and health care workers.
       (e) Definition of Health Care Worker.--
       (1) In general.--In this section, the term ``health care 
     worker'' means an individual employed by an employer that 
     provides--
       (A) health care services; or
       (B) necessary related services, including administrative, 
     food service, janitorial, or maintenance service to an entity 
     that provides such health care services.
       (2) Health care services.--In paragraph (1), the term 
     ``health care services'' includes medical, surgical, mental 
     health, and substance abuse services, whether provided on an 
     in-patient or outpatient basis.
       (f) Authorization of Appropriations.--There are authorized 
     to be appropriated to the Institute such sums as may be 
     necessary to carry out the purposes of this section.

     SEC. 402. HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE 
                   STANDARDS ADVISORY COMMITTEE.

       (a) Establishment of Committee.--There is established a 
     Health Care Quality, Patient Safety, and Workforce Standards 
     Committee (in this section referred to as the ``Committee'').
       (b) Functions of Committee.--
       (1) Advice to institute.--The Committee shall provide 
     advice to the Director of the Health Care Quality, Patient 
     Safety, and Workforce Standards Institute established under 
     section 401 on issues related to the duties of the Director.
       (2) Initial report.--Not later than December 31, 2001, the 
     Committee shall submit an initial report to the Secretary 
     that contains--
       (A) recommendations regarding minimal workforce standards 
     that are critical for improved health care quality and 
     patient safety; and
       (B) recommendations regarding additional ways to reduce the 
     incidence of medical errors and to improve patient safety and 
     quality of care.
       (3) Final report.--Not later than December 31, 2002, the 
     Committee shall submit a final report to the Secretary of 
     Health and Human Services regarding the recommendations 
     contained in the initial report required under paragraph (2), 
     including any modifications of such recommendations.
       (c) Structure and Membership of the Committee.--
       (1) Structure.--The Committee shall be composed of the 
     Director of the Health Care Quality, Patient Safety, and 
     Workforce Standards Institute established under section 401 
     and 15 additional members who shall be appointed by the 
     Secretary of Health and Human Services.
       (2) Membership.--
       (A) In general.--The members of the Committee shall be 
     chosen on the basis of their integrity, impartiality, and 
     good judgment, and shall be individuals who are, by reason of 
     their education, experience, and attainments, exceptionally 
     qualified to perform the duties of members of the Committee.
       (B) Specific members.--In making appointments under 
     paragraph (1), the Secretary of Health and Human Services 
     shall ensure that the following groups are represented:
       (i) Health care providers and health care workers, 
     including labor unions representing health care workers.
       (ii) Consumer organizations.
       (iii) Health care institutions.
       (iv) Health education organizations.
       (d) Chairman.--The Director of the Health Care Quality, 
     Patient Safety, and Workforce Standards Institute established 
     under section 401 shall chair the Committee.

                  TITLE V--IMPROVING MEDICARE BENEFITS

     SEC. 501. FULL MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT 
                   BENEFITS PARITY.

       Notwithstanding any provision of title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.), beginning January 1, 
     2001, each individual who is entitled to benefits under

[[Page 15456]]

     part A or enrolled under part B of the medicare program, 
     including an individual enrolled in a Medicare+Choice plan 
     offered by a Medicare+Choice organization under part C of 
     such program, shall be provided full mental health and 
     substance abuse treatment parity under the medicare program 
     established under such title of such Act consistent with 
     title XXII of the Social Security Act (as added by this Act).

     SEC. 502. STUDY AND REPORT REGARDING ADDITION OF PRESCRIPTION 
                   DRUG BENEFIT.

       Not later than January 1, 2003, the Director of the 
     Institute of Medicine shall study and report to Congress and 
     the President legislative recommendations for adding a 
     comprehensive, accessible, and affordable prescription drug 
     benefit to the medicare program established under title XVIII 
     of the Social Security Act (42 U.S.C. 1395 et seq.).

                TITLE VI--LONG-TERM AND HOME HEALTH CARE

     SEC. 601. STUDIES AND DEMONSTRATION PROJECTS TO IDENTIFY 
                   MODEL PROGRAMS.

       The Secretary of Health of Human Services shall--
       (1) conduct studies and demonstration projects, through 
     grant, contract, or interagency agreement, that are designed 
     to identify model programs for the provision of long-term and 
     home health care services;
       (2) report regularly to Congress on the results of such 
     studies and demonstration projects; and
       (3) include in such report any recommendations for 
     legislation to expand or continue such studies and projects.

                        TITLE VII--MISCELLANEOUS

     SEC. 701. NONAPPLICATION OF ERISA.

       The provisions of section 514 of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1144) shall not apply 
     with respect to health benefits provided under a group health 
     plan (as defined in section 733(a) of that Act (29 U.S.C. 
     1191b(a))) qualified to offer such benefits under an 
     expansion phase (phase I) plan under title XXII of the Social 
     Security Act (as added by this Act) or under a universal 
     phase (phase II) plan under such title.

     SEC. 702. SENSE OF CONGRESS REGARDING OFFSETS.

       It is the sense of Congress that any sums necessary for the 
     implementation of this Act, and the amendments made by this 
     Act, should be offset by--
       (1) general revenues available as a result of an on-budget 
     surplus for a fiscal year;
       (2) direct savings in health care expenditures resulting 
     from the implementation of this Act; and
       (3) reductions in unnecessary Federal tax benefits 
     available only to individuals and large corporations that are 
     in the maximum tax brackets.
                                  ____


          GROWTH IN THE NUMBER OF UNINSURED AMERICANS: 1988-98
                   [Millions of nonelderly uninsured]
------------------------------------------------------------------------
                            Year
------------------------------------------------------------------------
1988.......................................................         33.6
1989.......................................................         34.3
1990.......................................................         35.6
1991.......................................................         36.3
1992.......................................................         38.3
1993.......................................................         39.3
1994.......................................................         39.4
1995.......................................................         40.3
1996.......................................................         41.4
1997.......................................................         43.1
1998.......................................................         43.9
1999.......................................................     \1\ 45.0
2000.......................................................     \2\ 55.0
------------------------------------------------------------------------
\1\ Approximate.
\2\ Projected.
 
Source: Employee Benefits Institute, 2000.
Data: Current Population Surveys (March) 1989-1999 Health Insurance
  Association of America (HIAA).


      MOST IMPORTANT REASONS FOR NOT HAVING HEALTH INSURANCE, 2000
------------------------------------------------------------------------
                                                                Percent
------------------------------------------------------------------------
It is too expensive..........................................         47
Your job doesn't offer coverage..............................         15
You are between jobs or unemployed...........................         15
You can't get coverage or were refused.......................          5
You don't think you need it..................................          3
Other........................................................         15
------------------------------------------------------------------------
Source: The NewsHour with Jim Lehrer/Kaiser Family Foundation National
  Survey on the Uninsured, 2000.

                               ______
                                 ___
      By Mr. DURBIN:
  S. 2889. A bill to amend the Federal Cigarette Labeling and 
Advertising Act and the Comprehensive Smokeless Tobacco Health 
Education Act of 1986 to require warning labels for tobacco products; 
to the Committee on Commerce, Science, and Transportation.


         the stronger tobacco warning labels to save lives act

 Mr. DURBIN. Mr. President, today I am introducing the Stronger 
Tobacco Warning Label to Save Lives Act. This legislation would replace 
the current cigarette warning label on tobacco products with larger, 
more direct messages that will have an impact on current smokers and 
potential smokers who are usually children. The Stronger Tobacco 
Warning Label to Save Lives Act will require a new series of warning 
labels modeled after new, more effective warning labels in Canada.
  On January 19, 2000, Canadian Health Minister Allan Rock unveiled new 
and larger health warning labels for tobacco products which include 
color graphics and images that illustrate the damage that cigarettes do 
to the health of smokers and those around them. These warning labels 
will cover 50% of the front and back panels of tobacco products--one 
side in English and the other in French--and provide more information 
on the harmful ingredients in tobacco products. These new warning 
labels apply to all tobacco products. They will take effect on January 
1, 2001.
  After the U.S. Surgeon General publicly announced the dangers of 
tobacco use in 1965, the U.S. became the first country to impose 
mandatory health warning labels on all cigarette packs. In 1984, the 
U.S. replaced that label with a system of four rotating warning labels. 
Since then, the U.S. cigarette warning labels have become stale and 
ineffective. Many smokers have memorized all of the current warning 
labels. Others never notice the warnings because they are placed 
inconspicuously the side of the pack.
  Other countries have since taken the lead and required stronger 
health warning labels. These labels have been effective in reducing 
smoking rates. For example, in South Africa, tobacco consumption 
decreased by 15% between 1994 and 1997 due to a combination of radio 
advertising campaigns, increased excise taxes on cigarettes, and new 
health warning labels. Fifty-eight percent of smokers said that the 
cigarette warning labels made them want to quit, cut down on smoking, 
or at least change to a lighter cigarette. Among non-smokers, 38% said 
that the warnings made them glad they had never started smoking.
  The tobacco industry's massive expenditures on tobacco product 
promotion and public relations have ensured that, over time, Americans 
have seen more positive than negative imagery surrounding tobacco. The 
Stronger Tobacco Warning Label to Save Lives Act will ensure that every 
time someone lights up, the first thing that comes to mind is the 
health consequences--not the alluring lifestyle images associated with 
tobacco industry marketing. Too many young people smoke because they 
are led to believe it's cool and glamorous, when the truth is that 
tobacco kills.
  Because tobacco products are highly addictive for many users, and 
because most users start using tobacco at a very young age, the 
standard of warning for tobacco must be much higher than for other 
products. The warning labels should at least be as prominent in selling 
the health message as the industry's design is effective in promoting 
the product. This is not about banning or regulating a legal product, 
this is about providing the consumer with the appropriate information 
so they can make an informed decision.
  Mr. President, I urge my colleagues to join me in cosponsoring this 
important legislation to ensure that every time someone lights up, the 
first thing that comes to mind are the health consequences--not the 
alluring lifestyle images associated with tobacco industry marketing. I 
ask unanimous consent that a copy of the legislation be printed in the 
Congressional Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2889

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Stronger Tobacco Warning 
     Labels to Save Lives Act''.

     SEC. 2. AMENDMENT TO FEDERAL CIGARETTE AND LABELING 
                   ADVERTISING ACT.

       (a) Amendment.--The Federal Cigarette Labeling and 
     Advertising Act (15 U.S.C. 1331 et seq.) is amended by 
     striking section 4 and inserting the following:

     ``SEC. 4. LABELING.

       ``(a) Label.--
       ``(1) In general.--It shall be unlawful for any person to 
     manufacture, package, or import for sale or distribution 
     within the

[[Page 15457]]

     United States any cigarettes the package of which fails to 
     bear, in accordance with the requirements of this section, a 
     warning label.
       ``(2) Regulations.--Not later than 1 year after the date of 
     enactment of this section, the Secretary shall promulgate 
     regulations describing the warning label required by 
     paragraph (1).
       ``(3) Content of label.--The regulations promulgated under 
     paragraph (2) shall ensure that the text of each warning 
     label addresses one of the following:
       ``(A) Diseases or fatal health conditions caused by 
     cigarette smoking.
       ``(B) Any physical addiction that results from cigarette 
     smoking.
       ``(C) The influence that cigarette smoking by adults has on 
     young children and teenagers and the consequences of such 
     use.
       ``(D) The health hazards of secondhand smoke from 
     cigarettes.
       ``(4) Graphics.--
       ``(A) In general.--The regulations promulgated under 
     paragraph (2) shall ensure that each warning label contains a 
     color graphic or picture that illustrates or emphasizes to 
     the greatest practicable extent the message of the text of 
     the corresponding warning label.
       ``(B) Contents.--The graphics described in subparagraph (A) 
     shall enhance the message of the text of the warning label 
     and may include a color picture of one of the following:
       ``(i) A diseased lung, heart, or mouth.
       ``(ii) An individual suffering from addiction.
       ``(iii) Children watching an adult smoke a cigarette.
       ``(iv) An individual adversely affected by secondhand smoke 
     from a cigarette, including pregnant women or infants.
       ``(b) Advertising.--It shall be unlawful for any 
     manufacturer or importer of cigarettes to advertise or cause 
     to be advertised within the United States any cigarette 
     unless the advertising bears, in accordance with the 
     requirements of this section, one of the warning label 
     statements required by subsection (a).
       ``(c) Requirements for Labeling.--
       ``(1) Location.--Each label statement required by 
     subsection (a) shall be located on the upper portion of the 
     front panel of the cigarette package (or carton) and occupy 
     not less than 50 percent of such front panel.
       ``(2) Type and color.--Each label statement required by 
     subsection (a) shall be printed in at least 17 point type 
     with adjustments as determined appropriate by the Secretary. 
     All the letters in the label shall appear in conspicuous and 
     legible type, in contrast by typography, layout, or color 
     with all other printed material on the package, and be 
     printed in a black-on-white or white-on-black format as 
     determined appropriate by the Secretary.
       ``(d) Requirements for Advertising.--
       ``(1) Location.--Each label statement required by 
     subsection (b) shall occupy not less than 50 percent of the 
     area of the advertisement involved.
       ``(2) Type and color.--
       ``(A) Type.--Each label statement required by subsection 
     (b) shall be printed in a point type that is not less than 
     the following types:
       ``(i) With respect to whole page advertisements on 
     broadsheet newspaper--45 point type.
       ``(ii) With respect to half page advertisements on 
     broadsheet newspaper--39 point type.
       ``(iii) With respect to whole page advertisements on 
     tabloid newspaper--39 point type.
       ``(iv) With respect to half page advertisements on tabloid 
     newspaper--27 point type.
       ``(v) With respect to DPS magazine advertisements--31.5 
     point type.
       ``(vi) With respect to whole page magazine advertisements--
     31.5 point type.
       ``(vii) With respect to 28cm x 3 column advertisements--
     22.5 point type.
       ``(viii) With respect to 20cm x 2 column advertisements--15 
     point type.
     The Secretary may revise the required type sizes as the 
     Secretary determines appropriate within the 50 percent 
     requirement.
       ``(B) Color.--All the letters in the label under this 
     paragraph shall appear in conspicuous and legible type, in 
     contrast by typography, layout, or color with all other 
     printed material and be printed in an alternating black-on-
     white and white-on-black format as determined appropriate by 
     the Secretary.
       ``(e) Rotation of Label Statements.--
       ``(1) In general.--Except as provided in paragraph (2), the 
     label statements specified in subsections (a) and (b) shall 
     be rotated by each manufacturer or importer of cigarettes 
     quarterly in alternating sequence on packages of each brand 
     of cigarettes manufactured by the manufacturer or importer 
     and in the advertisements for each such brand of cigarettes 
     in accordance with a plan submitted by the manufacturer or 
     importer and approved by the Federal Trade Commission. The 
     Federal Trade Commission shall approve a plan submitted by a 
     manufacturer or importer of cigarettes which will provide the 
     rotation required by this subsection and which assures that 
     all of the labels required by subsections (a) and (b) will be 
     displayed by the manufacturer or importer at the same time.
       ``(2) Application of other rotation requirements.--
       ``(A) In general.--A manufacturer or importer of cigarettes 
     may apply to the Federal Trade Commission to have the label 
     rotation described in subparagraph (C) apply with respect to 
     a brand style of cigarettes manufactured or imported by such 
     manufacturer or importer if--
       ``(i) the number of cigarettes of such brand style sold in 
     the fiscal year by the manufacturer or importer preceding the 
     submission of the application is less than \1/4\ of 1 percent 
     of all the cigarettes sold in the United States in such year; 
     and
       ``(ii) more than \1/2\ of the cigarettes manufactured or 
     imported by such manufacturer or importer for sale in the 
     United States are packaged into brand styles which meet the 
     requirements of clause (i).
     If an application is approved by the Commission, the label 
     rotation described in subparagraph (C) shall apply with 
     respect to the applicant during the 1-year period beginning 
     on the date of the application approval.
       ``(B) Plan.--An applicant under subparagraph (A) shall 
     include in its application a plan under which the label 
     statements specified in subsection (a) will be rotated by the 
     applicant manufacturer or importer in accordance with the 
     label rotation described in subparagraph (C).
       ``(C) Other rotation requirements.--Under the label 
     rotation which the manufacturer or importer with an approved 
     application may put into effect, each of the labels specified 
     in subsection (a) shall appear on the packages of each brand 
     style of cigarettes with respect to which the application was 
     approved an equal number of times within the 12-month period 
     beginning on the date of the approval by the Commission of 
     the application.
       ``(f) Application of Requirement.--Subsection (a) does not 
     apply to a distributor or a retailer of cigarettes who does 
     not manufacture, package, or import cigarettes for sale or 
     distribution within the United States.
       ``(g) Cigars; Pipe Tobacco.--
       ``(1) In general.--The Secretary shall promulgate such 
     regulations as may be necessary to establish warning labels 
     for cigars and pipe tobacco. Such regulations shall require 
     content-specific messages regarding health hazards posed by 
     cigars and pipe tobacco, include graphic illustrations of 
     such content messages, as is required under subsection (a), 
     and be formatted in a clear and unambiguous manner, as is 
     required under subsection (a).
       ``(2) Definitions.--In this subsection:
       ``(A) Cigar.--The term `cigar' means any roll of tobacco 
     wrapped in leaf tobacco or in any substance containing 
     tobacco (other than any roll of tobacco that is a cigarette 
     or cigarillo).
       ``(B) Pipe tobacco.--The term `pipe tobacco' means any 
     loose tobacco that, because of the appearance, type, 
     packaging or labeling of such tobacco, is likely to be 
     offered to, or purchased by, consumers as a tobacco to be 
     smoked in a pipe.''
       (b) Effective Date.--The amendment made by this section 
     shall take effect 1 year after the date of enactment of this 
     section.

     SEC. 3. AMENDMENT TO THE COMPREHENSIVE SMOKELESS TOBACCO 
                   HEALTH EDUCATION ACT OF 1986.

       (a) Amendment.--The Comprehensive Smokeless Tobacco Health 
     Education Act of 1986 (15 U.S.C. 4401 et seq.) is amended by 
     striking section 3 and inserting the following:

     ``SEC. 3. SMOKELESS TOBACCO WARNING.

       ``(a) General Rule.--
       ``(1) Label on package.--It shall be unlawful for any 
     person to manufacture, package, or import for sale or 
     distribution within the United States any smokeless tobacco 
     product unless the product package bears, in accordance with 
     the requirements of this section, a warning label.
       ``(2) Label in advertisements.--It shall be unlawful for 
     any manufacturer, packager, or importer of smokeless tobacco 
     products to advertise or cause to be advertised within the 
     United States any smokeless tobacco product unless the 
     advertising bears, in accordance with the requirements of 
     this Act, one of the labels required by paragraph (1).
       ``(b) Regulations.--Not later than 1 year after the date of 
     enactment of this section, the Secretary shall promulgate 
     regulations describing the warning labels required under 
     subsection (a).
       ``(c) Content of label.--The regulations promulgated under 
     subsection (b) shall ensure that the text of each warning 
     label addresses one of the following:
       ``(1) Diseases resulting from use of smokeless tobacco 
     products.
       ``(2) Any physical addiction that results from using 
     smokeless tobacco products.
       ``(3) The influence that use of smokeless tobacco products 
     by adults has on young children and teenagers and the 
     consequences of such use.
       ``(d) Number of labels.--The regulations promulgated under 
     subsection (b) shall ensure that not less than 2 warning 
     labels are created for each subject matter described in 
     paragraphs (1), (2), and (3) of subsection (c). Such 
     regulations shall also require that each package of smokeless 
     tobacco bear 1 warning label that shall be rotated in 
     accordance with subsection (g).

[[Page 15458]]

       ``(e) Graphics.--
       ``(1) In general.--The regulations promulgated under 
     subsection (b) shall ensure that each warning label required 
     by subsection (a) contains a color graphic or picture that 
     illustrates or emphasizes to the greatest practicable extent 
     the message of the text of the corresponding warning label.
       ``(2) Contents.--The graphics described in paragraph (1) 
     shall enhance the message of the text of the warning label 
     and may include a color picture of one of the following:
       ``(A) A diseased mouth or other physical effect of using 
     smokeless tobacco products.
       ``(B) An individual using a smokeless tobacco product.
       ``(C) Children watching an adult use a smokeless tobacco 
     product.
       ``(f) Format.--
       ``(1) Location.--Each label statement required by 
     subsection (a)(1) shall be located on the principal display 
     panel of the product and occupy not less than 50 percent of 
     such panel.
       ``(2) Type and color.--Each label statement required by 
     subsection (a)(1) shall be printed in 17 point type with 
     adjustments as determined appropriate by the Secretary to 
     reflect the length of the required statement. All the letters 
     in the label shall appear in conspicuous and legible type in 
     contrast by typography, layout, or color with all other 
     printed material on the package and be printed in an 
     alternating black on white and white on black format as 
     determined appropriate by the Secretary.
       ``(g) Advertising and Rotation.--The provisions of sections 
     (d) and (e)(1) of the Federal Cigarette Labeling and 
     Advertising Act (as amended by the Stronger Tobacco Warning 
     Labels to Save Lives Act) shall apply to advertisements for 
     smokeless tobacco products required under subsection (a)(2) 
     and the rotation of the label statements required under 
     subsection (a)(1) on such products.
       ``(h) Application of Requirement.--Subsection (a) does not 
     apply to a distributor or a retailer of smokeless tobacco 
     products who does not manufacture, package, or import such 
     products for sale or distribution within the United States.
       ``(i) Television and Radio Advertising.--It shall be 
     unlawful to advertise smokeless tobacco or cigars on any 
     medium of electronic communications subject to the 
     jurisdiction of the Federal Communications Commission.''.
       (b) Effective Date.--The amendment made by this section 
     shall take effect 1 year after the date of enactment of this 
     section.
                                 ______
                                 
      By Ms. SNOWE (for herself and Mr. L. Chafee):
  S. 2890. A bill to provide States with funds to support State, 
regional, and local school construction; to the Committee on Health, 
Education, Labor, and Pensions.


  building, renovating, improving, and constructing kids' schools act

  Ms. SNOWE. Mr. President, I rise today with my friend and colleague, 
Senator Chafee, to introduce a revised version of the ``Building, 
Renovating, Improving, and Constructing Kids' Schools (BRICKS) Act''--
legislation that would address our nation's burgeoning need for K-12 
school construction, renovation, and repair.
  The legislation--which is endorsed by the National Education 
Association (NEA) and National PTA, and the National Association of 
State Boards of Education (NASBE)--would accomplish this in a fiscally-
responsible manner while seeking to find the middle ground between 
those who support a very direct, active federal role in school 
construction, and those who are concerned about an expanded federal 
role in what has been--and remains--a state and local responsibility.
  Mr. President, the condition of many of our nation's existing public 
schools is abysmal even as the need for additional schools and 
classroom space grows. Specifically, according to reports issued by the 
General Accounting Office (GAO) in 1995 and 1996, fully one-third of 
all public schools needing extensive repair or replacement.
  As further evidence of this problem, an issue brief prepared by the 
National Center for Education Statistics (NCES) in 1999 stated that the 
average public school in America is 42 years old, with school buildings 
beginning rapid deterioration after 40 years. In addition, the NCES 
brief found that 29 percent of all public schools are in the ``oldest 
condition,'' which means that they were built prior to 1970 and have 
either never been renovated or were renovated prior to 1980.
  Not only are our nation's schools in need of repair and renovation, 
but there is a growing demand for additional schools and classrooms due 
to an ongoing surge in student enrollment. Specifically, according to 
the NCES, at least 2,400 new public schools will need to be built by 
the year 2003 to accommodate our nation's burgeoning school rolls, 
which will grow from a record 52.7 million children today to 54.3 
million by 2008.
  Needless to say, the cost of addressing our nation's need for school 
renovations and construction is enormous. In fact, according to the 
General Accounting Office (GAO), it will cost $112 billion just to 
bring our nation's schools into good overall condition, and a recent 
report by the NEA identified $332 billion in unmet school modernization 
needs. Nowhere is this cost better understood than in my home state of 
Maine, where a 1996 study by the Maine Department of Education and the 
State Board of Education determined that the cost of addressing the 
state's school building and construction needs stood at $637 million.
  Mr. President, we simply cannot allow our nation's schools to fall 
into utter disrepair and obsolescence with children sitting in 
classrooms that have leaky ceiling or rotting walls. We cannot ignore 
the need for new schools as the record number of children enrolled in 
K-12 schools continues to grow.
  Accordingly, because the cost of repairing and building these 
facilities may prove to be more than many state and local governments 
can bear in a short period of time, I believe the federal government 
can and should assist Maine and other state and local governments in 
addressing this growing national crisis.
  Admittedly, not all members support strong federal intervention in 
what has been historically a state and local responsibility. In fact, 
many argue with merit that the best form of federal assistance for 
school construction or other local educational needs would be for the 
federal government to fulfill its commitment to fund 40 percent of the 
cost of special education. This long-standing commitment was made when 
the Individuals with Disabilities Education (IDEA) Act was signed into 
law more than 20 years ago, but the federal government has fallen 
woefully short in upholding its end of the bargain, only recently 
increasing its share above 10 percent.
  Needless to say, I strongly agree with those who argue that the 
federal government's failure to fulfill this mandate represents nothing 
less than a raid on the pocketbook of every state and local government. 
Accordingly, I am pleased that recent efforts in the Congress have 
increased federal funding for IDEA by nearly $2.5 billion over the past 
four years, and I support ongoing efforts to achieve the 40 percent 
federal commitment in the near future.
  Yet, even as we work to fulfill this long-standing commitment and 
thereby free-up local resources to address local needs, I believe the 
federal government can do more to assist state and local governments in 
addressing their school construction needs without infringing on local 
control.
  Mr. President, the legislation we are offering today--the ``BRICKS 
Act''--will do just. Specifically, it addresses our nation's school 
construction needs in a responsible fiscal manner while bridging the 
gap between those who advocate a more activist federal role in school 
construction and those who do not.
  First, our legislation will provide $20 billion in federal loans to 
support school construction, renovation, and repair at the local level. 
By designating that at least one-half of these loan monies must be used 
to pay the interest owed to bondholders on new school construction 
bonds that are issued through the year 2003, the federal government 
will leverage the issuing of new bonds by states and localities that 
would not otherwise be made. In addition, by providing that up to one-
half of the monies may be used for state-wide school construction 
initiatives, the bill provides needed flexibility to ensure that unique 
state and local approaches to school construction will also be 
supported, such as revolving loan funds.
  Of importance, these loan monies--which will be distributed on an 
annual basis using the Title I distribution formula--will become 
available to each

[[Page 15459]]

state at the request of a Governor. While the federal loans can only be 
used to support bond issues that will supplement, and not supplant, the 
amount of school construction that would have occurred in the absence 
of the loans, there will be no requirement that states engage in a 
lengthy application process that does not even assure them of their 
rightful share of the $20 billion pot.
  Second, our bill ensures that these loans are made by the federal 
government in a fiscally responsible manner that does not cut into the 
Social Security surplus or claim a portion of non-Social Security 
surpluses that may prove ephemeral in the future.
  Specifically, our bill would make these loans to states from the 
Exchange Stabilization Fund (ESF)--a fund that was created through the 
Gold Reserve Act of 1934 and has grown to hold more than $40 billion in 
assets. The principal activity of the fund--which is controlled solely 
by the Secretary of the Treasury--is foreign exchange intervention that 
is intended to limit fluctuations in exchange rates. However, the fund 
has also been used to provide stabilization loans to foreign countries, 
including a $20 billion line of credit to Mexico in 1995 to support the 
peso.
  In light of the controversial manner in which the ESF has been used, 
some have argued that additional constraints should be placed on the 
fund. Still others--including former Federal Reserve Board Governor 
Lawrence B. Lindsey--have stated that, for various reasons, the fund 
should be liquidated.
  Regardless of how one feels about exercising greater constraint over 
he ESF or liquidating it, I believe that if this $40 billion fund can 
be used to bailout foreign currencies, it certainly can be used to help 
America's schools.
  Accordingly, I believe it is appropriate that the $20 billion in 
loans provided by my legislation will be made from the ESF--an amount 
identical to the line of credit that was extended to Mexico by the 
Secretary of the Treasury in 1995. Of importance, these loans will be 
made from the ESF on a progressive, annual basis--not in a sudden or 
immediate manner. Furthermore, these monies will be repaid to the fund 
to ensure that the ESF is compensated for the loans it makes.
  Although the ESF will recoup all of the monies it lends, it should 
also be noted that my proposal ensures that states and local 
governments will not be forced to pay excessive interest, or that they 
will be forced to repay over an unreasonable period of time. In fact, 
if the federal government fails to substantially increase its share of 
IDEA funding, states will incur no interest at all!
  Specifically, to encourage the federal government to meet its funding 
commitment for IDEA--and to compensate states for the fact that every 
dollar in foregone IDEA funding is a dollar less that they have for 
school construction or other local needs--our bill would impose no 
interest on BRICKS loans during the first five years provided the 40 
percent funding commitment is not met.
  Thereafter, the interest rate is pegged to the federal share of IDEA: 
zero in any year that the federal government fails to fund at least 20 
percent of the cost of IDEA; 2.5 percent--the long-term projected 
inflation rate--in years that the federal share falls between 20 and 30 
percent; 3.5 percent in years the federal share is 30 to 40 percent; 
and 4.5 percent in years the full 40 percent share is achieved.
  Combined, these provisions will minimize the cost of these loans to 
the states, and maximize the utilization of these loans for school 
construction, renovation, and repair.
  Mr. President, by providing low-interest loans to states and local 
governments to support school construction, I believe that our bill 
represents a fiscally-responsible, centrist solution to a national 
problem.
  For those who support a direct, active federal role in school 
construction, our bill provides substantial federal assistance by 
dedicating $20 billion to leverage a significant amount of new school 
construction bonds. For those who are concerned about the federal 
government becoming overly-engaged in an historically state and local 
responsibility--and thereby stepping on local control--my bill directs 
that the monies provided to states will be repaid, and that no onerous 
applications or demands are placed on states to receive their share of 
these monies.
  Mr. President, I urge that my colleagues support the ``BRICKS Act''--
legislation that is intended to bridge the gap between competing 
philosophies on the federal role in school construction. Ultimately, if 
we work together, we can make a tangible difference in the condition of 
America's schools without turning it into a partisan or ideological 
battle that is better suited to sound bites than actual solutions.
  Thank you, Mr. President. I ask unanimous consent that the letters of 
support from the NEA, PTA, NASBE, and Jim Rier, the Chairman of the 
Maine State Board of Education, be inserted in the Record following my 
statement.
  There being no objection, the materials were ordered to be printed in 
the Record, as follows:

                               National Education Association,

                                    Washington, DC, July 13, 2000.
     Senator Olympia Snowe,
     U.S. Senate,
     Washington, DC.
       Dear Senator Snowe: On behalf of the National Education 
     Association's (NEA) 2.5 million members, we would like to 
     thank you for your leadership in introducing a revised 
     version of the Building, Renovating, Improving, and 
     Constructing Kids' Schools (BRICKS) Act.
       As you know, our nation's schools are in desperate need of 
     repair and renovation. Too many students attend classes in 
     overcrowded buildings with leaky roofs, faulty wiring, and 
     outdated plumbing. A recently-released NEA study documents 
     more than $300 billion in unmet infrastructure and technology 
     needs, nearly three times the level estimated in previous 
     research by the General Accounting Office.
       NEA believes the revised BRICKS Act offers a meaningful 
     avenue for assisting schools. The bill would make available 
     $20 billion in guaranteed funding over 15 years to provide 
     low-interest--and in many cases zero interest--school 
     modernization loans to states and schools. According to a 
     preliminary Department of Education analysis, the BRICKS Act 
     would provide schools with a benefit of $465 for each $1,000 
     in bonds.
       We are pleased that the BRICKS Act would allow up to 50 
     percent of federal funds to be used for payment of actual 
     construction costs or the principal portion of loans, as well 
     as the interest costs. We also appreciate the provision 
     allowing those states with laws that prohibit borrowing to 
     pay the interest costs on school bonds to use 100 percent of 
     their BRICKS loans for state revolving loan funds or other 
     state administered school modernization programs.
       NEA believes it is essential to enact meaningful school 
     modernization assistance this year. We thank you for your 
     leadership in this area and look forward to continuing to 
     work with you toward passage of bipartisan school 
     modernization legislation.
           Sincerely,
                                           Mary Elizabeth Teasley,
     Director of Government Relations.
                                  ____



                                                 National PTA,

                                        Chicago, IL, July 7, 2000.
     Hon. Lincoln D. Chafee,
     Hon. Olympia J. Snowe,
     United States Senate, Washington, DC.
       Dear Senators Chafee and Snowe: On behalf of the 6.5 
     million parents, teachers, students, and other child 
     advocates who are members of the National PTA, I am writing 
     to support the Building, Renovating, Improving, and 
     Constructing Kids' Schools (BRICKS) Act, which you plan to 
     introduce next week.
       We thank you for your leadership in proposing this 
     initiative, which acknowledges the federal government's 
     responsibility to help schools repair and renovate their 
     facilities. As you are aware, the U.S. General Accounting 
     Office has estimated that the cost of fixing the structural 
     problems in schools across the nation will cost more than 
     $112 billion. If new schools are built to accommodate 
     overcrowding, and if schools' technology, wiring, and 
     infrastructure needs are added in, this estimate would exceed 
     $200 billion dollars.
       This is a problem schools cannot address without a 
     partnership with the federal government, and National PTA 
     supports a variety of approaches to address this growing 
     crisis. In addition to endorsing the BRICKS bill, National 
     PTA is supporting the Public School Repair and Renovation 
     Act, which would provide tax credits to pay the interest on 
     school modernization bonds and create a grant and loan 
     program for emergency repairs in high-need districts; and 
     also the America's Better Classrooms Act, which would provide 
     $22 billion over two years in zero interest school 
     construction and modernization bonds.

[[Page 15460]]

       Under BRICKS, nearly $20 billion would be available over 15 
     years to provide low interest, and in many cases zero 
     interest, loans to States for interest payments on their 
     school modernization bonds. We are pleased that the proposal 
     will allow increased flexibility in using the federal funds 
     for interest payments, as well as for other state-
     administered programs that assist state entities or local 
     governments pay for the construction or repair of schools.
       National PTA is committed to helping enact a federal school 
     modernization proposal this Congress. We believe the BRICKS 
     Act should be promoted as one of the ways the federal 
     government can assist schools, and we thank you for your 
     leadership in this area. We look forward to continuing to 
     work with you toward formulation and passage of bipartisan 
     school modernization legislation.
           Sincerely,
                                                      Vicki Rafel,
     Vice President for Legislation.
                                  ____

                                           National Association of


                                    State Boards of Education,

                                    Alexandria, VA, July 18, 2000.
     Hon. Olympia Snowe,
     U.S. Senate,
     Washington, DC.
       Dear Senator Snowe: The National Association of State 
     Boards of Education (NASBE) is a private nonprofit 
     association representing state and territorial boards of 
     education. Our principal objectives are to strengthen state 
     leadership in education policy-making, promote excellence in 
     the education of all students, advocate equality of access to 
     educational opportunity, and assure responsible governance of 
     public education.
       We are writing to applaud your efforts to provide federal 
     assistance to states for school construction. The 
     deterioration of America's school infrastructure has reached 
     crisis proportions. At least one-third of all U.S. schools 
     are in need of extensive repairs or replacement and 60% have 
     at least one major building deficiency such as cracked 
     foundations, leaky roofs, or crumbling walls. We cannot 
     expect our children to learn much less excel in such decrepit 
     and unsafe environments.
       The more than $112 billion needed to renovate and/or repair 
     existing school facilities has simply overwhelmed state and 
     local resources. This national problem demands federal 
     attention and we are encouraged that your office is 
     attempting to address this need by proposing a $20 billion 
     federal loan program.
       Your legislation, the Building, Renovating, Improving, and 
     Construction Kids' Schools Act (BRICKS), will leverage new 
     school construction expenditures at the state and local 
     levels and provides flexibility to integrate this assistance 
     with the variety of solutions states have already undertaken, 
     such as revolving funds, to enhance the financing of school 
     construction.
       We appreciate your efforts and attention to address this 
     critical situation. NASBE is encouraged by your actions and 
     we look forward to working with your office to foster a 
     partnership between federal, state and local entities to 
     improve the learning conditions of American children.
           Sincerely,
                                        Brenda Lilienthal Welburn,
     Executive Director.
                                  ____



                                     State Board of Education,

                                      Augusta, ME, April 29, 2000.
     Senator Olympia J. Snowe,
     United States Senate,
     Washington, DC.
       Dear Senator Snowe: The age and condition of our nation's 
     public schools are an expanding crisis and should be of great 
     concern to all. Decades of neglect, unfunded maintenance 
     programs, constrained state and municipal budgets, shifting 
     populations, technology requirements, and programmatic 
     changes have combined to weaken the infrastructure of public 
     education. As you are well aware, a 1995 GAO report estimated 
     that just repairing existing school facilities would cost 
     $112 billion. In addition, building new facilities to met the 
     demands of program and increased enrollments could cost 
     another $73 billion. We have allowed the condition of our 
     schools to deteriorate to a point that there are now critical 
     implications for the health and safety of our students and 
     staff who occupy those buildings. A number of states have 
     launched major efforts to address their school facilities 
     needs. The task is huge and beyond the ability of most local 
     and even state resources.
       Unfortunately, Maine mirrors the nation. A Facilities 
     Inventory Study, conducted in 1996 by the Department of 
     Education and the University of Maine's Center for Research 
     and Evaluation, identified approximately $650 million in 
     needed facility improvements. Of particular concern was the 
     need for over $60 million in serious health and safety 
     related improvements as well as an additional $150 million in 
     other renovation and upgrades required.
       In response to Maine's survey of over 700 buildings, 
     Governor King appointed a Commission to develop a plan to 
     address the needs identified. Their report was delivered to 
     the Maine Legislature in February 1998, and the 
     recommendations were enacted in April 1998. Maine has 
     responded to address the identified needs with significant 
     state and local resources. However, even as we develop policy 
     and resources to aggressively address those needs, our 
     concern grows.
       Progressing from the condition survey to a detailed 
     engineering and environmental analysis of the conditions 
     causes even greater alarm. Roofs that were reported as 
     leaking in the survey are found to have serious structural 
     integrity problems with greater safety risks for occupants as 
     well as more complex and costly solutions. Indoor air quality 
     problems in the survey grow from increased air exchange 
     solutions to more complex ones due to mold and microbial 
     growth in the interior walls. Again, this poses increased 
     health risk for students and staff. As we learn more about 
     the problems, our concerns grow and the necessary resources 
     increase. The critical health and safety needs from the 1996 
     survey ($60 million) have grown to over $86 million in our 
     latest project estimates. Many more projects are yet to be 
     identified.
       Applications for Major Capital Construction projects were 
     received in August of 1999 from over 100 buildings throughout 
     Maine. Even with a major new commitment of over $200 million 
     from this Session of the Maine Legislature we will only be 
     able to address approximately 20 of those projects over the 
     next two years. More will be applying in the next two-year 
     cycle that begins in July 2001.
       Although school construction and modernization is and 
     should remain primarily a state and local responsibility, 
     states and school districts cannot meet the current urgent 
     needs alone. Federal assistance in the form of reduced or low 
     interest loans as you have included in S1992, the BRICKS ACT, 
     responds to the urgent need and could provide a critical 
     component to a comprehensive but flexible approach to address 
     Maine's, as well as the nation's, school facilities needs. As 
     currently proposed, your legislation would allow the 
     flexibility to address the renovation and upgrade of existing 
     facilities as well as provide relief for overcrowding and 
     insufficient program space where major capital construction 
     is required. It creates an effective local/state/federal 
     partnership, while leaving decisions about which schools to 
     build or repair up to states and local school units. In 
     Maine, that would allow us to strengthen our Revolving 
     Renovation Fund (created to aid local units in the upgrade 
     and renovation of existing buildings), and it would enhance 
     our bonding capacity for long term debt commitment to major 
     capital construction projects.
       Structurally unfit, environmentally deficient, or 
     overcrowded classrooms impair student achievement, diminish 
     student discipline, and compromise student safety. Although 
     not cited often, the learning environment does affect the 
     quality of education and our ability to help students achieve 
     high standards.
       The National Association of State Boards of Education has 
     identified school construction as one of its priority issues. 
     I serve as Vice-Chair of their Governmental Affairs Committee 
     and would be happy to enlist their help in focusing the 
     nation's attention on the poor condition of our schools and 
     the need for comprehensive federal assistance. If you have 
     questions or need information from NASBE please contact David 
     Griffith, Director of Governmental Affairs at 703-684-4000. 
     As Chairman of the Maine State Board of Education and the 
     governor's School Facilities Commission I am available and 
     would be pleased to participate in any way you think 
     appropriate to outline Maine's innovative and comprehensive 
     school facilities program, and to elaborate on how federal 
     assistance could best complement state and local efforts to 
     address our school construction needs.
       It was an honor to meet you in March during NASBE's 
     Legislative Conference. I look forward to working with you in 
     support of a federal partnership with state and local school 
     units to provide a safe, healthy, and effective learning 
     environment for all.
           Sincerely,
                                               James E. Rier, Jr.,
                                                            Chair.

  Mr. L. CHAFEE. Mr. President, I am pleased to join my colleague from 
Maine, Senator Snowe, in introducing a revised version of BRICKS--the 
Building, Renovating, Improving, and Constructing Kids' Schools Act. 
This legislation represents a fresh approach to addressing the 
infrastructure problems in our nation's elementary and secondary 
schools.
  Many thanks to Senator Snowe for her commitment to this issue and for 
her leadership; to the National PTA and the NEA, both of whom have 
endorsed the proposal; and special thanks to the Rhode Island 
Department of Education and Commissioner Peter McWalters for offering 
suggestions which I believe helped to improve this proposal.
  As some of you may know, Senator Snowe first introduced the BRICKS

[[Page 15461]]

proposal at the end of the last session. In January, I joined as a 
cosponsor. We had hoped to offer this revised version as an amendment 
to S. 2 but were unable to do so. As a result, we are introducing the 
revised version of BRICKS today in a form we hope many of our 
colleagues will be enthusiastic about cosponsoring.
  The BRICKS Act would permit the federal government to provide low, or 
no, interest loans to states to address their serious school 
infrastructure problems. The National Center for Education Statistics 
reports that three quarters of our nation's public schools need to 
build, renovate, improve or modernize their facilities. In some cases 
the need arises from increased school-age population. In other cases, 
school facilities are simply old and in need of repair. Today's 
estimated cost of modernizing and improving school facilities 
throughout the United States is $127 billion. There is no argument 
about whether a serious problem exists. There are differences on how 
best to solve this terribly serious problem.
  BRICKS recognizes that our nation faces a grave problem. We worry 
about whether our children are learning enough to compete in the 
international marketplace, yet we send our children to school in 
overcrowded classrooms. We tell them to do their best without adequate 
air conditioning, heating and plumbing. We expect them to learn in 
buildings with leaky roofs and crumbling walls, or we house them in 
``temporary'' classrooms in trailers on school parking lots.
  In Rhode Island, our schools are old: twenty five percent were built 
before 1930; another thirty-six percent were built in the 1940s and 
1950s; twenty-three percent were built in the 1960s; and thirteen 
percent were built in the recent 1980s. Between 1986 and 1990, our 
small State spent about $400 million on school construction projects, 
averaging about 11 projects per year, and there is much more to be 
done. My State isn't asking the federal government to step in and take 
over its school facilities responsibilities or the responsibilities of 
local communities. Rather, help is being sought at the federal level to 
meet a critical and immediate need.
  The legislation which Senator Snowe and I are introducing today, 
addresses that need by providing twenty billion dollars in federal 
loans to the states. Each state receives funds, based on the Elementary 
and Secondary Education Act's Title I distribution formula, at the 
request of the Governor. States have until 2003 to request the loans. 
Fifty percent of the loans must be used to repay the interest on school 
construction bonds. The other fifty percent may be used to support 
existing state-administered school construction programs. Decisions 
about the use of these federal dollars are made by the Governor in 
consultation with the director of the state education agency. I am very 
pleased that the revised legislation encourages the loans to go to 
those school districts with the greatest need, but the final decisions 
are made by those closest to the problems.
  As a former mayor, the person at the local level signing the checks 
to pay for my community's education needs, I am very familiar with 
educational priorities at the local level. I am deeply committed to 
ensuring that the federal government meets its overdue goal of paying 
up to forty percent of the cost of educating children with special 
needs. Since coming to the Senate, I have made fully-funding IDEA--the 
Individuals with Disabilities Education Act--a top priority. This bill 
links the interest states and localities will be required to pay to the 
federal level of IDEA funding.
  Until 2006, there will be zero interest on BRICKS loans. After that, 
interest will be determined by the federal funding level for IDEA. If 
federal IDEA funding remains, as it is today, below twenty percent, the 
loans will remain at zero interest. If the federal spending on IDEA is 
between twenty and thirty percent, interest will be 2.5 percent. If 
federal spending on IDEA rises to between thirty and forty percent, 
interest rises to 3.5 percent. Finally, if the federal government meets 
its forty percent goal, interest peaks at 4.5 percent. Taking into 
account federal funding of IDEA seems completely appropriate to me. I 
hope this linkage of IDEA and spending on school facilities is another 
step which encourages Congress to meet the goal of fully funding IDEA.
  Our proposal does not ask the federal government to assume 
responsibility for building, improving and maintaining school 
facilities. States and local school districts already have accepted 
that responsibility by spending more than ever before on facilities. 
According to the most recent study by the General Accounting Office on 
school facilities, issued in March 2000, spending on school 
infrastructure increased by 39 percent from 1990 to 1997. But they 
cannot do it alone. The federal government can and should help by 
providing BRICKS loans.
  I hope that Senators who care about this issue will put aside 
partisan differences and look carefully at the plan Senator Snowe and I 
are proposing. We believe that BRICKS addresses an immediate problem in 
a responsible manner that does not usurp the authority or 
responsibility of states and school districts. I urge my colleagues to 
join as cosponsors of BRICKS.
                                 ______
                                 
      By Mr. REID:
  S. 2891. A bill to establish a national policy of basic consumer fair 
treatment for airline passengers; to the Committee on Commerce, 
Science, and Transportation.


                AIR TRAVELERS FAIR TREATMENT ACT OF 2000

  Mr. REID. Mr. President, I rise to introduce the Air Travelers' Fair 
Treatment Act of 2000.
  Air travel is an increasingly unpleasant and stressful experience. 
Anyone who flies much at all knows that airports are crowded, flights 
too often delayed or canceled without explanation, ticket prices are 
unpredictable and hard to figure out, passengers are more unruly and 
occasionally violent.
  Monday's edition of the Washington Post included a front-page story 
reporting that delays and cancellations are at an all-time high. 
According to Time Magazine, the number of air-rage incidents reported 
by flight crews from 66 in 1997, to 534 last year. It doesn't take a 
great leap of faith to see a relationship between the two.
  Last year, Congress passed my ``air rage'' bill that increased 
penalties on passengers who commit acts that threaten the health or 
safety of other passengers or jeopardize the safety of the flight. That 
was a good bill, that I think will help passengers and airlines alike 
to reduce the amount of stress associated with flying.
  But punishing unruly passengers is only half of the solution, because 
unruly passengers are not the only source of stress in air travel. Air 
rage is not only a cause, but a symptom, of stress.
  The airlines have cut corners in recent years in ways that make 
traveling by air more and more difficult and unpleasant for customers.
  A few weeks ago, the Inspector General of the Department of 
Transportation released a study on the performance of the airline 
industry. According to the study:
  Through the first four months of this year, the number of passenger 
complaints to the Department has increased a whopping 74 percent 
compared to last year.
  Complaints about delays, cancellations, and missed connections were 
up 115 percent since last year--in other words, they have more than 
doubled in only one year.
  And even these numbers may be low, because the Inspector General 
estimates that the airlines receive anywhere from 100 to 400 complaints 
for every one that is filed with the government.
  Last fall, the airlines announced that they would voluntarily 
implement their own reforms. They made a great show of implementing 
their ``12 Commandments for Customer Service'' last fall.
  But this study reveals that things have become worse, not better. The 
study cites numerous instances where the airlines have violated their 
own so-called ``Commandments.''
  For example, one of these so-called Commandments is to notify 
customers about delays and cancellations. The Transportation 
Department's report

[[Page 15462]]

indicated that airlines were, in fact, making an effort to communicate 
delays and cancellations--but that the information communicated was, to 
quote the Inspector General, ``frequently inaccurate, incomplete or 
unreliable.''
  Airlines are often poorly equipped to handle in-flight emergencies--
some carriers have virtually no first-air or medical equipment on their 
flights, and the amount of first-aid training that flight crews 
received varies widely from carrier to carrier.
  And airlines ticket prices are still confusing and arbitrary. Some 
carriers have enacted rules that prohibit customers from combining legs 
of different tickets to get the best prices.
  Now, there are some explanations for the decline in service and the 
increase in the number of complaints. Last year, the airlines carried a 
total of 635 million passengers, a record number, double the number of 
passengers 20 years ago. The average load factor--which refers to the 
percentage of passengers compared to available seats--is 71 percent, 
also a record.
  But crowded airports are no excuse for airlines to violate their own 
so-called Commandments for Customer Service.
  It's no excuse for providing misleading or inaccurate explanations of 
delays or cancellations to air travelers. People make plans around 
posted flight schedules, important personal or business plans. If a 
flight is canceled or delayed, they should be able to find out what's 
going on, so that they can make alternative plans if they need to.
  The bill I am introducing today will address some of these concerns.
  The bill has seven provisions.
  (1) Pricing Policies: Due to the complex way that airlines price 
their tickets, in some cases, a trip will be cheaper if a passenger 
purchases a ticket to a different destination and gets off during the 
layover, leaving the second leg of the ticket unused, rather than 
buying a ticket directly to his/her intended destination. Similarly, a 
passenger may save money by combining portions of different tickets. To 
prevent this and to force passengers to pay the higher prices, airlines 
have begun canceling the return ticket if the passenger does not use 
the entire ticket, and penalizing travel agents who allow customers to 
combine ticket portions this way. The bill would allow passengers to 
use all, part or none of a purchased ticket without penalty by the 
airline, enabling passengers and travel agents to freely mix-and-match 
tickets to get the best price.
  (2) Flight Delays: The bill requires air carriers to provide 
travelers with accurate and timely explanations of the reasons for a 
flight cancellation, delay or diversion from a ticketed itinerary, by 
classifying the failure to do so as an unfair business practice.
  (3) Right to Exit Aircraft: Where a plane has remained at the gate 
for more than 1 hour past its scheduled departure time and the captain 
has not been informed that the aircraft can be cleared for departure 
within 15 minutes, passengers would have the right to exit the plane 
into the terminal to make alternative travel plans, or simply to 
stretch their legs, get something to eat, etc. I believe this provision 
will help prevent ``air rage'' incidents when passengers are forced to 
sit in parked planes for long periods of time.
  (4) Right to In-flight Medical Care: Currently, each airline has its 
own policy regarding what kind of medical and first-aid equipment and 
training is provided on their flights, so that the available equipment 
varies widely, particularly with more expensive equipment like 
defibrillators. This bill would direct the Secretary of Transportation 
to issue uniform minimum regulations for all carriers regarding the 
type of medical equipment each flight must carry, and the kind of 
medical training each flight crew should receive.
  (5) Access to State Laws: The Federal Courts have split on whether 
the Airline Deregulation Act of 1978 pre-empts state consumer 
protection and personal injury laws as applied to airlines. The Ninth 
Circuit Court of Appeals has held that passengers may sue airlines in 
state court for violations of state tort and consumer laws; in 
contrast, the Fourth Circuit has held that airlines are immune from 
state laws. The Supreme Court has not acted on the issue. The bill 
would add a provision making clear that the 1978 Act does not pre-empt 
state tort and consumer protection laws.
  (6) Termination of Ticket Agents: Travel agencies provide a valuable 
service to customers looking for the best prices. Yet airlines have 
enormous leverage over what kind of information they can and cannot 
provide to customers, because they can withdraw their accounts without 
notice from any travel agency for any reason--even if the only reason 
is that the travel agency is giving the customer the best rates. The 
bill requires carriers to provide written 90-day advance statement of 
reasons before canceling a travel agency's account with the airline, 
and to give them 60 days to correct the identified deficiencies.
  (7) Independent Commission: Finally, the bill would establish an 
independent Commission to study the airlines' pricing practices and 
their effects on customer choice, on the number of routes available, 
and on the quality of service provided by the airlines.
  The stress associated with air travel has increased considerably, and 
much of that stress is caused by things that airlines do to save money 
and maximize profit that hurt customers. I believe that we must look at 
unfair and deceptive practices of the airlines that contribute to the 
stress of air travel, in a specific, targeted and reasonable manner. 
This bill will do that.
                                 ______
                                 
      By Mr. SCHUMER (for himself and Mr. Moynihan):
  S. 2892. A bill to designate the Federal building located at 158-15 
Liberty Avenue in Jamaica, Queens, New York, as the ``Floyd H. Flake 
Federal Building''; to the Committee on Environment and Public Works.


    DESIGNATING A FEDERAL BUILDING AS THE ``FLOYD H. FLAKE FEDERAL 
                               BUILDING''

                                 ______
                                 
      By Mr. SCHUMER (for himself and Mr. Moynihan):
  S. 2893. A bill to designate the facility of the United States Postal 
Service located at 757 Warren Road in Ithaca, New York, as the 
``Matthew F. McHugh Post Office''; to the Committee on Government 
Affairs.


DESIGNATING A UNITED STATES POSTAL FACILITY AS THE ``MATTHEW F. McHUGH 
                             POST OFFICE''

  Mr. SCHUMER. Mr. President, I had the honor and privilege of working 
with former Representative Floyd H. Flake during my tenure in the House 
and it gives me great pleasure to join Senator Moynihan and my House 
colleague Congressman Greg Meeks in introducing a bill to name a 
Federal building in Jamaica, Queens, New York, after the man who served 
that district with the utmost honor and dedication.
  Floyd was elected to the House of Representatives in 1986 to serve 
the 6th Congressional District of New York. He served his constituents 
admirably for 11 years until his retirement in 1997. He is most 
remembered for his service on the Banking and Financial Services 
Committee, a committee we served on together.
  In the House, Floyd distinguished himself as a leader in the fight 
for the revitalization of urban communities. He worked tirelessly to 
pass the Community Development Financial Institutions Act of 1993 and 
to ensure passage of the Community Reinvestment Act. These two acts, 
along with Floyd's countless other efforts to help urban communities, 
illustrates his commitment as a true public servant.
  Since his retirement, Floyd has continued his service to the public. 
He is currently the Pastor of the Allen A.M.E. Church in Queens and has 
led a movement to increase church-based non-profit activity in 
communities. He has dedicated his life to helping New York City 
residents work their way towards a better life through innovative 
employment programs, community improvement projects and renewal of 
spiritual faith.
  Floyd has distinguished himself as a true leader who was able to 
combine high morals with government. I can think of no one more 
deserving of this honor than Reverend Flake.

[[Page 15463]]


                                 ______
                                 
      By Mr. LUGAR (for himself, Mr. Roberts, Mr. Burns, and Mr. 
        Santorum):
  S. 2894. A bill to provide tax and regulatory relief for farmers and 
to improve the competitiveness of American agricultural commodities and 
products in global markets; to the Committee on Finance.


                THE RURAL AMERICA PROSPERITY ACT OF 2000

  Mr. LUGAR. Mr. President, I rise today to introduce the Rural America 
Prosperity Act of 2000. I am pleased that Senator Roberts, Senator 
Santorum, and Senator Burns have joined as cosponsors of this bill.
  A Republican controlled Congress in 1996 produced a sweeping reform 
of farm programs. Farmers were no longer told by the government what 
crops they had to plant. Farmers were no longer forced by the 
government to idle part of their land. That farm bill disentangled 
farmers from government controls and enabled them to make production 
decisions based on market signals.
  Freeing farmers from excessive, and often counterproductive, 
government controls is an important step, but we should do more to give 
farmers the tools they need to succeed. Specifically, we need to work 
to open foreign markets for our agricultural commodities and products, 
ease the tax and regulatory burden, and provide new risk management 
tools for farmers.
  There are three tax provisions in this legislation that I have long 
advocated as crucial to the financial health of farmers. First is the 
repeal of the estate tax. A repeal of this tax, which has prevented 
some farms from being passed from one generation to the next, is 
essential. We are proposing the same 10-year phase-out of the estate 
tax which Congress just passed, and the President has promised to veto. 
Excluding capital gains from the sale of farmland would put production 
agriculture on the same footing as homeowners who benefit from a 
capital gains exclusion for their home. The deduction of health care 
insurance costs is needed for farmers and others who are self-employed.
  Recently Congress provided over $8 billion to improve the federal 
crop insurance program. While crop insurance is an important risk 
management tool, today we offer two other risk management tools for 
farmers--income averaging and FARRM accounts. Two years ago Congress 
made income averaging a permanent risk management tool for farmers when 
calculating taxes. Unfortunately, the interaction between income 
averaging and the alternative minimum tax has prevented many farmers 
from receiving the benefit of income averaging. This bill fixes that 
problem. Under this bill, farmers will be able to contribute up to 20 
percent of annual farm income into a FAARM account and deduct this 
amount from their taxes. This is an excellent tool for managing 
financial volatility associated with farming.
  We also address regulatory reform in our bill. We are seeking a 
review of existing and proposed regulations to determine the cost of 
compliance for farmers, ranchers and foresters. We want to determine if 
there are more cost-effective ways for farmers, ranchers and foresters 
to achieve the objectives of these regulations.
  Finally, we must do more to help develop new markets abroad for our 
farm commodities and agricultural products. Opportunity lies in 
developing countries where growing wealth allows for increased demand 
for meat and processed commodities. Authorizing fast-track authority 
for the President to negotiate international trade agreements may be 
the single most important thing we can do to facilitate exports.
  We also need to address sanctions. Sanctions that prohibit the export 
of U.S. agricultural products into the sanctioned country are often 
morally indefensible because they deny necessities to people, not the 
offending government. Such sanctions also deny markets for U.S. 
agricultural products which are then captured by our competitors.
  This legislation represents what I believe is necessary to further 
the historic reforms initiated in the farm bill 4 years ago. I urge my 
colleagues to cosponsor this bill. I will continue to encourage my 
colleagues and the Administration to work to enact these proposals.

                          ____________________