[Congressional Record (Bound Edition), Volume 146 (2000), Part 18]
[Senate]
[Pages 27124-27129]
[From the U.S. Government Publishing Office, www.gpo.gov]



                      OMNIBUS APPROPRIATIONS BILL

  Mr. KENNEDY. Mr. President, I expect to support the omnibus 
legislation that will implement the final appropriations agreement for 
this Congress because it makes the kinds of investments in education, 
health, and work opportunities that are needed by all American 
families. In the long run, only through these basic investments can we 
preserve our capacity to keep our nation strong. I commend my 
colleagues for their diligence in crafting legislation that respects 
the highest priorities of the American people. Senator Harkin and 
Senator Specter have shown the power of bipartisan cooperation 
throughout their work on this legislation. We have all benefitted from 
the example and leadership of Senator Stevens and Senator Byrd as well.
  While this legislation is not perfect and certainly is no substitute 
for the unfinished work of the 106th Congress, it is good for the 
American people, and it shows what is possible when we resolve to work 
together. In this sense, it offers considerable hope for the 107th 
Congress.


                               EDUCATION

  In the critical area of education and the nation's schools, this 
appropriations agreement is a resounding victory for parents and 
communities across the country. Congress has lived up to its commitment 
to increase education funding. We are taking a giant step forward to 
ensure that children across the country receive the support they need 
to succeed in school and to make college more affordable for every 
qualified student. I'm proud to highlight a few of the key education 
accomplishments.
  For the first time, communities across the country will qualify for 
over $1.2 billion in federal aid to address their most urgent school 
building repair needs, such as fixing roofs, plumbing and electrical 
systems, and meeting fire and safety codes.
  Schools across the country will receive $1.623 billion, a 25 percent 
increase over last year, to continue hiring and training new teachers 
to reduce class sizes in the early grades. This year's funding increase 
will place 8,000 more teachers in classrooms, placing the goal of 
100,000 new teachers well within reach.
  Teacher quality will improve as well this year. Schools will receive 
$485 million, a 45 percent increase over last year, to help teachers 
improve their skills through professional development activities, 
reducing the number of uncertified and out-of-field teachers.
  Title I of the Elementary and Secondary Education Act, which helps 
disadvantaged students master the basics and achieve to high standards, 
is increased by $506 million, for a total of $8.4 billion.
  We know that children are most likely to engage in risky behavior in 
the hours just after school. Congress has responded by increasing 
support for after-school programs by 87 percent this year, to $851 
million. This increase will help more children stay out of trouble 
after school and get extra help with their schoolwork.
  The bill also provides an additional $91 million, for a total of $225 
million, to support state and local efforts to turn around low-
performing schools.
  Vocational and technical education programs received $1.240 billion, 
a $48 million increase, to improve programs that give students skills 
they need in order to meet the demands of the new high tech workforce.
  College students will also receive much needed support under this 
bill. The GEAR UP programs will receive $295 million, an increase of 
$95 million, and TRIO programs will receive $730 million, a $85 million 
increase, to help more low-income and minority middle and high school 
students prepare for college and succeed in college.
  Of all high school students in Boston, 80 percent of them now are 
tied into colleges. We have 12 different colleges that are tied into 
the high schools, where they are not just taking the individuals who 
show promise, which the TRIO Program does and does with extraordinary 
success, but to try to take the whole class together and move the whole 
class up. It is a relatively new concept and one which has worked very 
successfully in the several pilot areas where it has been tried. We are 
finding extraordinary response, positive response from colleges that 
engage in this undertaking, and extraordinary response from the 
schools. I think it will be one of the more important programs to 
enhance academic achievement for high school students.
  This legislation will also enable more undergraduate and graduate 
students to pay for college through part-time work assistance because 
the Federal Work Study program received a $77 million increase.
  This bill also strengthens Pell Grants, enabling many more students 
to take advantage of them. The maximum grant is increasing by $450--
from $3,300 to $3,750. Because there are so many young people who, even 
though they are eligible for the maximum Pell Grant, just couldn't make 
it with the lower maximum, this is perhaps the most important 
educational enhancement we have. It recognizes that many children are 
advantaged in their academic achievement and accomplishment but 
disadvantaged in the amount of resources they have.


                             Early Learning

  As we strengthen our commitment to quality education at the 
elementary, secondary, and college levels, a strong body of research 
challenges us to broaden our commitment to education as well. Education 
is a continuum that begins at birth and continues long after 
graduation. On the birth-to-kindergarten side, we have much work to do. 
For the sake of each child, the nation, and our education system 
itself, all children must have access to the early learning 
opportunities that will enable them to enter school ready to learn.
  Today, 12 million children under age five have mothers who work 
outside the home. Yet many of these children are assigned to waiting 
lists instead of quality early learning programs because federal 
funding isn't adequate to meet existing needs, and more and more 
parents are accepting the responsibility of work under welfare reform. 
In Massachusetts, 14,000 children are wait-listed, as are 200,000 
children in California. Today's minimum wage for a full-time worker is 
$10,720 per year. This doesn't begin to cover the cost of quality early 
learning opportunities,

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which can be as high as ten thousand dollars a year.
  All of us remember a number of years ago when the Governors, 
Republicans and Democrats, met in Charlottesville and announced goals 
for the Nation in education. Their first goal is to have children ready 
to learn when they enter kindergarten and first grade, to build the 
skills they bring to school. The skills that little children need to 
develop as infants and toddlers self-confidence, self-awareness, some 
degree of self-esteem, inquisitiveness in academics, and, interestingly 
enough, a sense of humor.
  Eleven years ago, Senator McCain and I introduced the Military Child 
Care Act, which turned military child care into an early learning model 
for the nation. Today's legislation takes three important steps toward 
building on that success in civilian America.
  First, it increases federal child care subsidies by 69 percent, 
enabling states to remove 150,000 children from waiting lists next 
year. This increase was very much patterned upon the child care 
initiatives of our colleague, Senator Dodd, and I am deeply grateful 
for his leadership on this issue.
  Next, this legislation enables 70,000 of the nation's most at-risk 
children to participate in Head Start, which is highly regarded because 
it delivers the promise of early learning so effectively. The 
legislation also begins implementing the Early Learning Opportunities 
Act, which Senator Stevens, Senator Jeffords, and Senator Dodd and I 
supported over the past two years. This new law provides for parental 
education and support services, increased collaboration among early 
leaning providers, and incentives to improve the quality of early 
learning services. Its goal is to help the nation build an effective 
infrastructure of local councils to help each community evaluate how 
best to put the research on infant and toddler brain development into 
practice.
  The Head Start Program, the Early Head Start Program, and the new 
Early Learning Opportunities Act included in this appropriations bill 
will improve early learning in important ways. The Carnegie Commission 
and other experts who have studied the development of a child's brain 
in the early years, and made a series of recommendations. With this 
legislation we are beginning now to follow up on these recommendations 
by investing in children at early ages. That is extremely important.
  These steps show important momentum toward turning the research on 
children's brain development into sensible national policy, and we 
should build on this momentum in the next Congress. We can learn much 
more from the military's experience with early learning. We can build 
these lessons into the Child Care and Development Block Grant when it 
is reauthorized in the next Congress. We can pass additional 
legislation to turn the current patchwork of federal child care and 
early learning programs into a seamless structure directed at one 
goal--quality services to ensure that children enter school ready to 
learn. We also must continue expanding Head Start until it is available 
to all children who need it.
  The health funding in this bill is also a win for the American 
people.


                       GRADUATE MEDICAL EDUCATION

  I will now address the excellent work that has been done under the 
balanced budget act, or BBA, programs, in particular the funding level 
for pediatric graduate medical education. This is not an area that has 
a history of proper federal attention. Last year, it received $40 
million and virtually no funding prior to that time.
  The Medicare Program has provided the funding for the training of 
much of the American medical personnel who, without question, are the 
best trained medical personnel in the country. It was funded through 
the Medicare system. The area of pediatrics never made it, so these 
children's hospitals, which train the majority of pediatricians, had to 
provide the additional training services and educational services 
without the support available to every other physician training 
program.
  That has been significantly corrected with this legislation. There 
are over 50 major children's hospitals across this country that will 
benefit from this program. We can be sure that as a result of today's 
work, the part of the medical profession that is focused upon caring 
for children will be significantly advanced, and I commend the 
appropriators for this.
  I am particularly pleased with the funding level for pediatric 
graduate medical education. The legislation allocates $235 million to 
support medical education costs incurred by freestanding children's 
hospitals. This figure is nearly a 500 percent increase over last 
year's appropriation of $40 million, and puts us much closer to fully 
funding the program.
  This program was created last year to address the historical 
inequities in federal support for graduate medical education activities 
occurring at independent children's hospitals. Until last year, the 
federal government has paid for hospital costs related to physician 
training from Medicare. However, because children's hospitals generally 
treat very few Medicare patients, they were historically and 
dramatically underpaid for teaching activities. Prior to enactment of 
this program, children's hospitals were given just \1/200\th of the 
federal support for teaching activities that other teaching hospitals 
received.
  Children's hospitals, which represent less than one percent of all 
hospitals in the country, train approximately 30 percent of the 
nation's pediatricians and the majority of many pediatric specialists. 
It is long past time for the federal government to support these 
activities. Next year, it is my hope that we will achieve permanent, 
full funding for this essential program.
  Children's hospitals around the country will benefit from the 
increased funds in this legislation. It will enable these important 
institutions to continue to be regional and national referral centers 
for children around the country. It will support new and continuing 
research activities that benefit children and adults alike. And, most 
importantly, it will help assure a steady supply of pediatricians and 
pediatric specialists to treat the nation's children now and in the 
future.
  With approximately 200 full-time employees in training at any one 
time, Boston Children's Hospital has the largest teaching program among 
independent children's hospitals. It has a top-notch faculty, and 
provides excellent teaching, research and patient care. These funds 
will assure its continued contribution to health of children in 
Massachusetts, the nation, and the world.


                     NATIONAL INSTITUTES OF HEALTH

  This bill also includes an increase of 13 percent for the National 
Institutes of Health, raising the NIH budget to more than $20 billion. 
These new resources will enable NIH to increase its support for the 
medical research that is urgently needed to develop new cures for the 
diseases that afflict millions of Americans.
  Massachusetts is a leader in medical science. It receives more than 
one out of every ten dollars that NIH spends on research grants--more 
than any other state except California--and Boston receives more NIH 
grant money than any other city in the nation.
  Last year alone, doctors and scientists in Massachusetts were awarded 
more than $1.5 billion in research grants from NIH. The new 
appropriations bill will increase this already impressive total by more 
than $180 million, so that Massachusetts will receive an estimated $1.7 
billion in NIH research grants in the coming year.
  NIH supports essential research across the state. In Boston, research 
supported by NIH very recently discovered an important relationship 
between the immune system and the brain that may lead to better 
treatments for diseases like multiple sclerosis. In Worcester, NIH 
funds are helping to build a new center for cancer research that will 
become a leader in this important field. In Cambridge, NIH will help 
support a major new center to study the nervous system, so that we can 
better understand brain diseases like Alzheimer's, schizophrenia and 
depression. NIH grants are essential for funding the basic research 
that is often considered too risky to be funded by

[[Page 27126]]

private companies, and ensure that the results of this work are 
available to all researchers.
  The investment that NIH makes in medical research is the foundation 
on which the nation's thriving biotechnology industry is built. More 
than 250 biotech companies in Massachusetts provide good jobs for 
thousands of professionals across the state, and contribute millions of 
dollars every year to the state's economy. New partnerships between 
universities and biotechnology companies form almost every day, 
embarking research ideas from the academic world to be developed 
rapidly into new medical breakthroughs that will improve the health of 
patients across the nation.
  By helping develop new cures for deadly diseases and by fostering the 
important new industry of biotechnology, the renewed commitment to the 
NIH that we make here today is an investment that will pay dividends 
now and for many years to come.


                       Balanced Budget Reform Act

  This legislation provides ``financial CPR'' for hospitals, home 
health agencies, nursing homes, and other important Medicare providers 
around the country. It also takes important steps to improve access to 
health care through CHIP and Medicaid, though more is needed.
  Nearly one million senior citizens and persons with disabilities 
depend on Medicare to provide high-quality care in Massachusetts. The 
health care industry is a critical component of the state economy. 
Today, we are saying that help is on the way.
  The Medicare, Medicaid and CHIP Beneficiary Improvement and 
Protection Act is the most significant relief package since passage of 
the Balanced Budget Act in 1997. Medicare spending will total $30 
billion over five years, and spending for Medicaid and the Children's 
Health Insurance Program will total $6 billion. In fact, the net cost 
of the entire package is likely to be closer to $15 billion over five 
years, because of the offsetting effect of savings achieved by a 
forthcoming regulation limiting the ability of states to obtain union 
funded Medicaid payments.
  The savings from the Medicaid regulation should be used to expand 
coverage to low-income populations. I strongly support the provider 
relief in this package, but I am disappointed that the Republican 
leadership opposed bipartisan efforts to enable states to extend health 
benefits to low-income pregnant women and children who are legal 
immigrants, but who would otherwise be eligible for CHIP and Medicaid. 
In addition, the Republican leadership refused to include the 
bipartisan Grassley-Kennedy Family Opportunity Act, which would have 
enabled children with disabilities to obtain or maintain health 
coverage through Medicaid.
  Massachusetts providers have estimated that they will receive 
approximately $450 million--close to half a billion dollars--over the 
next five years as a result of this legislation. While it is the most 
significant step Congress has taken to date to restore the unintended 
cuts made by the Balanced Budget Act of 1997, this Congress failed to 
finish the job, and we will be back at it again in the 107th Congress.
  The record budget surpluses now and projected for the years ahead are 
largely due to the savings achieved by cutting Medicare payments in the 
Balanced Budget Act of 1997. Those cuts were expected to total $116 
billion over five years, and nearly $400 billion over ten years--more 
than double the amount ever enacted in any previous legislation.
  In reality, these cuts are now estimated to total $200 billion over 
five years and more than $600 billion over 10 years. These excessive 
cuts, combined with low payments from private payors and Medicaid 
programs, have placed many outstanding health care institutions at 
risk, and threaten quality of care for millions of elderly, disabled 
and low-income Americans.
  In Massachusetts, two out of every three hospitals are losing money 
on patient care. Community hospitals across the state are struggling to 
survive. Key providers are questioning whether to participate in HMOs, 
and HMOs are deciding to cut benefits and trim service areas.
  Twenty-five percent of home health agencies in the state no longer 
serve Medicare patients, and 20 agencies have closed their doors since 
the BBA was enacted. The remainder see fewer patients, and see them 
less often.
  Forty-three nursing homes have closed in Massachusetts since 1998. 
One in four are in bankruptcy. One in seven nursing positions are 
unfilled, because Massachusetts nursing homes are unable to compete for 
staff.
  Congress has been slowly restoring these Medicare cuts year-by-year. 
In 1998, we included $1.65 billion in the FY99 Omnibus Appropriations 
bill for Medicare home health agencies as a stop-gap measure. The 
Balanced Budget Refinement Act of 1999 restored $16 billion over five 
years. And the legislation we are voting on today takes an even more 
significant step toward fixing the problems created by the BBA. But it 
does not finish the job. In fact, it contains new cuts for hospitals 
and nursing homes. Clearly, we will need to revisit this issue in the 
107th Congress. There is no need to turn funding for entitlement 
programs into an annual appropriations process, but that is precisely 
what this annual exercise has unfortunately become.
  In addition to the much-needed provider relief contained in this 
legislation, it also includes two other important improvements in 
Medicare benefits. First, it requires Medicare coverage of drugs that 
are not usually self-administered by a patient. This change restores 
and preserves coverage for certain drugs that are vital for senior 
citizens and persons with debilitating chronic illnesses. This 
provision will ensure that in determining whether a drug is usually 
self-administered, HCFA should only consider whether a majority of 
Medicare patients with the disease or condition actually administer the 
drug to themselves, reversing a contrary 1997 policy. This improvement 
will help assure that millions of elderly and disabled Americans have 
continued access to life-saving and life-improving drugs.
  Second, the bill improves coverage for immunosuppressive drugs for 
Medicare patients who have had an organ transplant. These drugs are 
needed to prevent rejection of the transplanted organ. Assuring 
permanent coverage will improve the quality of life for transplant 
patients, and assure a wiser use of scarce resources and scarce organs 
by helping patients to remain healthy after transplantation.


                           CHIP AND MEDICAID

  This legislation also includes several provisions that are important 
to working families whose children are eligible for CHIP or Medicaid.
  First, the legislation includes a redistribution mechanism to assure 
use of the funds allocated to insure low-income children through CHIP 
and Medicaid. The formula is fair, and it allows all states to benefit 
from unspent FY98 dollars in a manner that will assure continued 
enrollment of eligible children. Those states that have been slow to 
spend their initial CHIP allocation will now have additional time to 
spend their FY98 funds by reaching out and enrolling more children in 
these programs. Those states that spent all of their FY98 dollars 
because they were able to get their programs up and running early will 
obtain additional funds to continue their momentum. The result is a 
win-win for America's children.
  The legislation also enables states to immediately enroll uninsured 
children who are potentially eligible for CHIP or Medicaid in the 
proper program, while awaiting confirmation of actual eligibility. This 
step is important for improving enrollment rates. Unfortunately, the 
bill limits its applicability to children found only through outreach 
in primary and secondary schools. There is bipartisan support for a 
broader proposal that would have extended presumptive eligibility to a 
variety of other programs where uninsured eligible children or their 
parents are likely to be identified, including child care resource 
centers, child support agencies, housing agencies, and homeless 
shelters. We will pursue this and other CHIP and Medicaid outreach and 
enrollment improvements next year.

[[Page 27127]]

  Finally, the legislation extends for one additional year the 
Transitional Medical Assistance program, which allows families who are 
leaving welfare for work to maintain Medicaid coverage during the 
transition. Most post-welfare jobs do not offer health insurance. We 
must do all we can to see that ``ending welfare as we knew it'' does 
not contribute to America's already shameful uninsured rate.


                   LOW INCOME HOME ENERGY ASSISTANCE

  I'm pleased that this year's final budget agreement includes $1.4 
billion to help families heat their homes this winter under the Low 
Income Home Energy Assistance Program. Massachusetts needs this 28 
percent increase in its block grant to help more families cope with 
higher heating costs this winter. Combined with LIHEAP emergency funds 
that the Clinton Administration has already made available in 
anticipation of this winter's needs, I am hopeful that the regular and 
emergency LIHEAP funding contained in this budget deal should enable 
low-income families to heat their homes throughout the winter that is 
already upon us. I regret that this year's budget agreement does not 
contain expected advance funding for the winter of 2002, so that 
families can plan ahead for heating assistance next year. I intend to 
do all I can to see that Congress corrects this omission as part of a 
supplemental spending bill early next year or as part of the broader 
national energy policy reevaluation likely to begin in the new 
Congress. For this winter, though, today's budget agreement remains a 
significant step forward for LIHEAP and the families who depend on it.


                         NEW MARKETS INITIATIVE

  The New Markets Initiative is another key bipartisan agreement 
included in this legislation. I am pleased that the Congress has joined 
President Clinton in his efforts to revitalize those communities that 
have been left behind at this time of record prosperity, and I commend 
Speaker Hastert for his leadership in reaching this agreement.
  This initiative increases the low-income housing tax credit, which is 
long overdue in light of its strong bipartisan support. With the 
growing regional and national economy, housing prices are rising faster 
in Massachusetts than in any other state. We must increase production 
in new affordable housing units to meet the overwhelming demand, and an 
increase in the credit is critical. The agreement also accelerates the 
private activity bond cap, which will also support increased 
development of affordable housing, as well as industrial development.
  The initiative also creates 40 Renewal Communities and 9 new 
Empowerment Zones--all of which provide tax incentives for development 
in those parts of the country that have struggled while others have 
prospered.
  Overall, this final budget agreement includes so many major 
achievements--from Class Size reduction to Pediatric Graduate Medical 
Education to dislocated worker assistance to New Markets development--
that the value of each part will only become apparent over time. Yet 
even as we celebrate the progress made by this legislation, we must 
also recognize that it is only a small part of the work that the public 
expects us to complete. I share the concern of many of my colleagues 
that the unfinished agenda of the 106th Congress is so long.
  We still lack a Patients' Bill of Rights, leaving HMO's free to 
sacrifice families' health needs in favor of their own economic 
interests.
  We still lack a prescription drug benefit for seniors, leaving our 
parents and grandparents vulnerable to drug-company extortion for drugs 
they need to stay alive.
  We still lack a plan to reduce medical errors, leaving thousands of 
hospital patients to die needlessly each year.
  We still lack a fair minimum wage, leaving people who work full time 
all year in difficult jobs to raise their children in poverty.
  We still lack common-sense gun laws, leaving school children 
vulnerable to ambush.
  We still lack strong laws against hate crimes, leaving the most 
vulnerable people in our society open to the most brutal acts 
imaginable.
  We still lack basic fairness in many of our immigration laws, leaving 
our proud heritage and noble ideals out in the cold with so many 
huddled masses.
  We still lack the most basic protection for women's work, leaving 
more women to raise their children in poverty because they consistently 
earn less than their male colleagues.
  We still lack a plan to protect people's privacy in the digital age, 
leaving our medical, consumer, and other personal information exposed 
to market demands.
  Also left unresolved are major Medicare and Social Security reforms 
that must be enacted now if we are to avoid a crisis for the seniors of 
2025 and beyond. I also believe that we should still address how to 
provide some tax relief for many families who bear a particular 
financial burden because they need to provide long term care for their 
loved ones.
  Every item on this list remains of vital importance to the nation. I 
must elaborate on a several of them.
  Unfortunately, the leadership of the 106th Congress turned its back 
on America's families who are raising children with disabilities. The 
Family Opportunity Act has sweeping bipartisan support in both 
chambers, including more than three-fourths of the Senate. There is no 
reason that this legislation should not have become law this year. 
Although Congress let American families down this year, I look forward 
to working with Senator Grassley again next year to ensure that no 
family in this nation has to turn down jobs, turn down raises, or give 
up custody of their disabled child to get the health care each child 
deserves.
  Few issues touch Americans more deeply than quality health care for 
themselves and their loved ones. This Congress failed to fulfill its 
responsibility to act on three great health issues. It did not pass a 
strong, effective patients' bill of rights to end the abuses of managed 
care and other insurance programs. It did not provide coverage of 
prescription drugs under Medicare. And it did not significantly expand 
insurance coverage for the uninsured. Now it is up to the new Congress 
that will assemble in January to do better. These three issues should 
be top priorities.
  Prompt passage of a patients' bill of rights is critical for every 
one of the 161 million Americans with private health insurance 
coverage. Every day that Congress fails to act more patients suffer.
  A survey by the School of Public Health at the University of 
California found that every day--each and every day--50,000 patients 
endure added pain and suffering because of their actions of their 
health plan. For 35,000 patients, needed care is delayed, or even 
denied all together. Thirty-five thousand patients have a specialty 
referral delayed or denied. Thirty-one thousand patients are forced to 
change doctors. Eighteen thousand patients are forced to change 
medications because of HMO abuses.
  A survey of physicians by the Kaiser Family Foundation and the 
Harvard School of Public Health found similar results. Every day, tens 
of thousands of patients suffer serious declines in the their health as 
the result of the action--or inaction--of their health plan.
  Whether the issue is diagnostic tests, specialty care, emergency room 
care, access to clinical trials, availability of needed drugs, 
protection of doctors who give patients their best possible advice, or 
women's ability to obtain gynecological services--too often, in all 
these cases, HMOs and managed care plans make the company's bottom line 
more important than the patient's vital signs. These abuses should have 
no place in American medicine. Every doctor knows it. Every patient 
knows it. And in their hearts, every member of Congress knows it.
  The House passed a Patient Bill of Rights--the Norwood-Dingell bill--
that effectively addressed these abuses. A solid bi-partisan majority 
of Congress supported the legislation. It is endorsed by 300 groups 
representing doctors, nurses, patients and advocates for women, 
children, and families. But in the Senate, it has been blocked by the

[[Page 27128]]

insurance industry and the Republican leadership. The new Senate, the 
new Congress, and the new President have an obligation to pass this 
legislation into law.
  This is an issue which hopefully, given the strong voting and 
interests of our colleagues and their constituents, we will be able to 
resolve in a bipartisan way during the next Congress.
  The Congress' failure to provide prescription drug coverage to our 
nation's senior citizens is also unacceptable. Senior citizens need a 
strong drug benefit under Medicare. They earned it by a lifetime of 
hard work. They deserve it. And Congress and the new President owe it 
to them to act.
  Too many elderly Americans today must choose between food on the 
table and the medicine they need to stay healthy or to treat their 
illnesses. Too many senior citizens take half the pills their doctor 
prescribes, or don't even fill needed prescriptions --because they 
can't afford the high cost of prescription drugs.
  Too many seniors are paying twice as much as they should for the 
drugs they need, because they are forced to pay full price, while 
almost everyone with a private insurance policy benefits from 
negotiated discounts. Too many seniors are ending up hospitalized--at 
immense cost to Medicare--because they aren't receiving the drugs they 
need at all, or can't afford to take them correctly. Pharmaceutical 
products are increasingly the source of miracle cures for a host of 
dread diseases, but millions of senior citizens are being left out and 
left behind because Congress fails to act.
  The crisis that senior citizens face today will only worsen if we 
refuse to act, because insurance coverage continues to go down, and 
drug costs continue to go up.
  Twelve million senior citizens--one third of the total--have no 
prescription drug coverage at all. Surveys indicate that only half of 
all senior citizens have prescription drug coverage throughout the 
year. Coverage through employer retirement plans is plummeting. 
Medicare HMOs are drastically cutting back. Medigap plans are priced 
out of reach of most seniors. The sad fact is that the only senior 
citizens who have stable, reliable, affordable drug coverage are the 
very poor on Medicaid.
  Prescription drug costs themselves are out of control. Since 1996, 
costs have grown at double-digit rates every year. Last year, the 
increase was an unacceptable 16 percent, while the increase in the CPI 
was only 2.7 percent. No wonder access to affordable prescription drugs 
has become a crisis for so many elderly Americans
  In the face of this declining coverage and soaring cost, more and 
more senior citizens are being left out and left behind. The vast 
majority of the elderly are of moderate means. They cannot possibly 
afford to purchase the prescription drugs they need if serious illness 
strikes.
  Fifty-seven percent of seniors have incomes below $15,000 a year, and 
78 percent have incomes below $25,000. Only 7 percent have incomes 
above $50,000 a year. The older they are, the more likely they are to 
be in poor health--and the more likely they are to have very limited 
income to meet their health needs.
  Few if any issues facing the next Congress are more important than 
giving the nation's senior citizens the health security they have been 
promised. The promise of Medicare will not be fulfilled until Medicare 
protects senior citizens against the high cost of prescription drugs, 
in the same way that it protects them against the high cost of hospital 
and doctor care.
  Despite the gaps in Medicare and the abuses of many private insurance 
plans, those who have insurance coverage from these sources are still 
more fortunate than the 43 million of their fellow citizens who have no 
health insurance at all.
  It's a national disgrace that so many Americans find the quality of 
their health determined by the quantity of their wealth. In this age of 
the life sciences, the importance of good medical care in curing 
disease and improving and extending life is more significant than ever. 
Denying any family the health care they need is unacceptable.
  Every other industrialized society in the world except South Africa 
achieved that goal in the 20th century--and under Nelson Mandela and 
Thabo Mbeki, South Africa has taken giant steps toward universal health 
care today. But in our country, the law of the jungle still too often 
prevails. Forty-three million of our fellow citizens are left out and 
left behind when it comes to health insurance.
  The dishonor roll of suffering created by this national problem is a 
long one.
  Children fail to get a healthy start in life because their parents 
cannot afford the eyeglasses or hearing aids or doctor's visits they 
need.
  A young family loses its chance to participate in the American dream, 
when a breadwinner is crippled or dies because of lack of timely access 
to medical care.
  A teenager is condemned to go without a college education, because 
the family's income and energy are sucked away by the high financial 
and emotional cost of uninsured illness.
  An older couple sees its hope for a dignified retirement dashed, when 
the savings of a lifetime are washed away by a tidal wave of medical 
debt.
  Even in this time of unprecedented prosperity, more than 200,000 
Americans annually file for bankruptcy because of uninsured medical 
costs. And the human costs of being uninsured are often just as 
devastating.
  In any given year, one third of the uninsured go without needed 
medical care.
  Eight million uninsured Americans fail to take the medication that 
their doctor prescribes, because they cannot afford to fill the 
prescription.
  Four hundred thousand children suffer from asthma but never see a 
doctor. Five hundred thousand children with recurrent earaches never 
see a doctor. Another five hundred thousand children with severe sore 
throats never see a doctor.
  Thirty-two thousand Americans with heart disease go without life-
saving and life-enhancing bypass surgery or angioplasty--because they 
are uninsured.
  Twenty-seven thousand uninsured women are diagnosed with breast 
cancer each year. They are twice as likely as insured women not to 
receive medical treatment before their cancer has already spread to 
other parts of their bodies. As a result, they are 50 percent more 
likely to die of the disease.
  Overall, eighty-three thousand Americans die each year because they 
have no insurance. The lack of insurance is the seventh leading cause 
of death in America today. Our failure to provide health insurance for 
every citizen kills more people than kidney disease, liver disease, and 
AIDS combined.
  Passage of the CHIP program in 1997 opened the door of health 
insurance to a large majority of the 10 million uninsured children--but 
too many children eligible for CHIP and Medicaid have still not been 
enrolled. Legislation I sponsored with Congressman John Dingell would 
have substantially increased enrollment of eligible children in CHIP. 
It would have encouraged states to make more children eligible, and 
would have provided assistance to the low and moderate income uninsured 
parents of these uninsured children. This legislation received a vote 
of the majority of the members of the Senate, but it was defeated on a 
procedural motion.
  Today, our opportunity to end these millions of American tragedies is 
greater than ever before. Our prosperous economy gives us large new 
resources to invest in meeting this critical need. Recently, some 
Republicans in Congress have finally joined Democrats in urging our 
country to meet the challenge of providing health coverage to the 43 
million Americans who are left out and left behind. President-elect 
George Bush and Vice President Al Gore both campaigned on a pledge to 
expand health insurance coverage for the uninsured. I regret that this 
Congress did not take substantial steps to end this American tragedy, 
but it should be at the top of the agenda of the new Congress and the 
new Administration.
  The minimum wage ranks at the top of the list as well. Our leader, in 
a

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meeting of our Democratic caucus, indicated this afternoon that one of 
his great disappointments in this session is failing to provide an 
increase in the minimum wage for the 13 million Americans who need and 
deserve an increase. The last time we increased it was 1997. We have 
had unparalleled economic prosperity before and since. We have had 
record low unemployment. We have had stability in inflation. It is 
inexcusable that we have not increased the minimum wage for these 
workers. I am strongly committed to working with our colleagues to 
address that situation in the new Congress.
  I join our Democratic leader in expressing my deep disappointment in 
the failure of this Congress to increase the minimum wage. A fair 
increase is long overdue. It is urgently needed to improve the lives of 
over ten million hard-working, low-wage earners in this country. It is 
shameful that Congress is holding the increase hostage to tax cuts for 
the wealthy. It is even more shameful that Congress recently acted to 
raise its own pay for the third time in four years--yet they have not 
found time in the past three years to give any pay increase at all to 
the lowest paid workers.
  The long period of inaction comes at a time when the country as a 
whole is enjoying unprecedented prosperity--the longest period of 
economic growth in the nation's history and the lowest unemployment 
rate in three decades. In these strong economic times, Congress should 
not be acting like Scrooge.
  Millions of low income workers have dedicated their lives to building 
this strong economy. Yet, in many cases they have been forced to labor 
for increasingly longer and longer hours, with less and less time to 
spend with their families, and without sharing fairly in the nation's 
prosperity. Poverty has almost doubled among full-time, year-round 
workers since the late 1970s--from about 1.5 million then to almost 3 
million in 1998--and an unacceptably low minimum wage is part of the 
problem.
  Minimum wage employees working 40 hours a week, 52 weeks a year, earn 
only $10,700 a year--$3,400 below the poverty line for a family of 
three. At that rate, minimum wage workers now fail to earn enough to 
afford adequate housing in any area of this country. Waitresses, 
teacher's aides, child care workers, elder care workers and all other 
employees deserve to be paid fairly for the work they do. No one who 
works for a living should have to live in poverty.
  By failing to increase the minimum wage, Congress has broken its 
promise to American workers. We are denying them just compensation for 
their many contributions to building a strong nation and a strong 
economy.
  We have broken our promise to women, since 60 percent of minimum wage 
earners are women.
  We have broken our promise to people of color, because 16 percent of 
those who would benefit from a minimum wage increase are African 
American and 20 percent of those who would be helped are Hispanic.
  We have broken our promise to children, because 33 percent of minimum 
wage earners are parents with children. In America today, 4.3 million 
children live in poverty, despite living in a family where someone 
works full-time, year-round.
  And we have broken our promise to the American family, because too 
many parents are required to spend more and more time away from their 
families to make ends meet. On average, Americans are working 416 more 
hours in 1999 then they were in 1979.
  Each year we fail to act on the minimum wage, families across the 
country fall farther behind. As the result of not implementing the 
dollar increase we first proposed three years ago, when the clock 
strikes midnight on the December 31st, minimum wage workers will have 
lost over $3000 because of the inaction by Congress. Today, the real 
value of the minimum wage is now $2.90 below what it was in 1968. To 
have the purchasing power it had in 1968, the minimum wage would have 
to be at least $8.05 an hour today, not $5.15.
  We will never give up or give in on this issue, because it is an 
issue of fundamental fairness. We will be back next year with a new 
bill to raise the minimum wage. I hope that the new Congress will act 
as quickly as possible to pass a fair increase that reflects the losses 
suffered as the result of our shameful inaction this year.
  President-Elect Bush has emphasized many of these priorities, and I 
look forward to working with him. The lesson of the legislation before 
us today is that when we fail to consider each other's ideas, only 
gridlock results--but when we work together for the nation's good, the 
result is the kind of progress that makes us all proud to serve the 
American people.
  The PRESIDING OFFICER (Mr. Abraham). The Senator from Nevada.

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