[Congressional Record (Bound Edition), Volume 146 (2000), Part 4]
[Senate]
[Pages 4668-4683]
[From the U.S. Government Publishing Office, www.gpo.gov]



          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. REID (for himself and Mr. Inouye):
  S. 2357. A bill to amend title 38, United States Code, to permit 
retired members of the Armed Forces who have a service-connected 
disability to receive military retired pay concurrently with veterans' 
disability compensation; to the Committee on Veterans' Affairs.


 armed forces concurrent retirement and disability payment act of 2000

  Mr. REID. Mr. President, I am pleased today to introduce legislation 
along with my esteemed colleague Senator Inouye that will correct an 
inequity for veterans who have retired from our Armed Forces with a 
service-connected disability.
  Our legislation will permit retired members of the Armed Forces who 
have a service connected disability to receive military retired pay 
concurrently with veterans' disability compensation.
  Mr. President, disabled military retirees are only entitled to 
receive disability compensation if they agree to wave a portion of 
their retired pay equal to the amount of compensation. This requirement 
discriminates unfairly against disabled career soldiers by requiring 
them to essentially pay their own disability compensation.
  Military retirement pay and disability compensation were earned and 
awarded for entirely different purposes. Current law ignores the 
distinction between these two entitlements. Members of our Armed Forces 
have dedicated 20 or more years to our country's defense earning their 
retirement for service. Whereas disability compensation is awarded to a 
veteran for injury incurred in the line of duty.
  It is inequitable and unfair for our veterans not to receive both of 
these payments concurrently. We have an opportunity to show our 
gratitude to these remarkable men and women who have sacrificed so much 
for this great country of ours. I hope the Senate will seriously 
consider passing this legislation, to end at last, this disservice to 
our retired military men and women.
  Mr. President, this legislation represents an honest attempt to 
correct an injustice that has existed for far too long. Allowing 
disabled veterans to receive military retired pay and veterans 
disability compensation concurrently will restore fairness to Federal 
retirement policy.
  This legislation is supported by veterans service organizations, 
including the Disabled American Veterans, the American Legion, and 
Paralyzed Veterans of America. This is simply the right thing to do. 
Our veterans have earned this and now it is our chance to honor their 
service to our nation.
  I ask unanimous consent that the text of the Armed Forces Concurrent 
Retirement Disability Payment Act of 2000 and attached documents be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 2357

       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 ``Armed Forces Concurrent 
     Retirement and Disability Payment Act of 2000''.

     SEC. 2. CONCURRENT PAYMENT OF RETIRED PAY AND COMPENSATION 
                   FOR RETIRED MEMBERS WITH SERVICE-CONNECTED 
                   DISABILITIES.

       (a) Concurrent Payment.--Section 5304(a) of title 38, 
     United States Code, is amended by adding at the end the 
     following new paragraph:
       ``(3) Notwithstanding the provisions of paragraph (1) and 
     section 5305 of this title, compensation under chapter 11 of 
     this title may be paid to a person entitled to receive 
     retired or retirement pay described in such section 5305 
     concurrently with such person's receipt of such retired or 
     retirement pay.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect on the date of the enactment of this Act, 
     and apply with respect to payments of compensation for months 
     beginning on or after that date.
       (c) Prohibition on Retroactive Benefits.--No benefits shall 
     be paid to any person by virtue of the amendment made by 
     subsection (a) for any period before the effective date of 
     this Act as specified in subsection (b).
                                  ____

                                                  Nevada Paralyzed


                                          Veterans of America,

                                     Las Vegas, NV, April 4, 2000.
     Senator Harry Reid,
     Hart Senate Office Building,
     Washington, DC.
       Dear Senator Reid: Nevada Paralyzed Veterans of America is 
     dedicated to all efforts that will support and enhance the 
     quality of life of our members. We consider ourselves an 
     important voice of reason and logic when issues of substance 
     arise regarding legislation and health care. In the tradition 
     of excellence that we acquired during our active military 
     training we continue to strive to maintain the same in 
     promoting quality of life post disability.
       As President of Nevada Paralyzed Veterans of America 
     (Nevada PVA), I would like to offer my support of your 
     legislation to permit the concurrent receipt of service-
     connected disability compensation and retirement pay, without 
     deductions. Nevada PVA has consistently supported legislation 
     that would attempt to remedy the unjust disparity in benefits 
     for the men and women who have served in our Armed Services.
       While Nevada PVA supports these measures, as we have in the 
     past, we must be assured that the other benefits currently 
     being received by veterans are in no way compromised or 
     reduced. VA has just recently begun getting the funding it 
     needs to avoid the devastating effects of past flat-lined 
     budgets. We hope that Congress will see the wisdom of 
     providing concurrent receipts.
       Thank you again for your continued support of our veterans 
     and for your legislation. We look forward to the passage of 
     your bill and the benefits it will bring to our deserving 
     service-connected disabled veterans.
           Sincerely,
                                        Lupo A. Quitoriano, Ph.D.,
     President.
                                  ____

                                       Disabled American Veterans,


                                         Department of Nevada,

                                     Las Vegas, NV, April 4, 2000.
     Senator Harry Reid.
       Dear Sir: It is our understanding that you are about to 
     introduce legislation that would establish ``Concurrent 
     Payments of Department of Veterans Affairs Disability 
     Compensation and Military Retirement''.
       The Department of Nevada DAV goes on record, with the 
     National DAV, in supporting such legislation.
       I submit, for your perusal, Resolution #30 from the DAV 
     Legislative Program, approved at convention in 1999.
       ``Whereas, ex-service members who are retired from the 
     military on length of service must waive a portion of their 
     retired pay in order to receive disability compensation from 
     the Department of Veterans Affairs (VA) and
       ``Whereas, it would be more equitable if the laws and 
     regulations were changed to provide that in such cases the 
     veteran would be entitled to receive both benefits 
     concurrently since eligibility was established and

[[Page 4669]]

     earned under two entirely different sets of enabling laws and 
     regulations: NOW
       ``Therefore be it resolved that the Disabled American 
     Veterans in National Convention assembled in Orlando, 
     Florida, August 21-25, 1999, supports legislation and changes 
     in applicable regulations which would provide that a veteran 
     who is retired for length of service and is later adjudicated 
     as having service-connected disabilities, may receive 
     concurrent benefits from the military department and from VA 
     without deduction from either.''
       Senator Reid, we thank you for introducing such 
     legislation. As usual, where Veterans are concerned, you are 
     right out front.
           Sincerely yours,
                                            William D. Brzezinski,
     Adjutant.
                                  ____

                                                  American Legion,


                                         Department of Nevada,

                                   Carson City, NV, April 4, 2000.
     Hon. Harry Reid,
     Washington, DC.
       Dear Senator Reid: It has come to my attention that you are 
     in the process of drafting a bill (Armed Forces Concurrent 
     Retirement and Disability Payment Act of 2000) that will 
     eliminate the present practice of deducting disability 
     compensation from the retired pay of military retired 
     veterans. I have always felt this practice was not fair to 
     our retired veterans. They are in fact funding their own 
     disability compensation.
       Commander Joe McDonnell and I, First Vice Commander of the 
     American Legion Department of Nevada, support this bill. If I 
     can be of assistance to you to get this bill passed feel free 
     to call on me.
           Sincerely,
                                                      Ron Gutzman,
                                             First Vice Commander.
                                 ______
                                 
      By Mr. INHOFE (for himself and Ms. Landrieu):
  S. 2358. A bill to amend the Public Health Service Act with respect 
to the operation by the National Institutes of Health of an 
experimental program to stimulate competitive research; to the 
Committee on Health, Education, Labor, and Pensions.


        NATIONAL INSTITUTES OF HEALTH EPSCoR PROGRAM ACT OF 2000

  Mr. INHOFE. Mr. President, I am pleased to introduce the National 
Institutes of Health EPSCoR Program Act of 2000 with my colleague, 
Senator Landrieu of Louisiana. This legislation we are introducing 
today, when passed, stands to make a major impact on the scope of 
biomedical research done in America today.
  Small and medium sized states, like ours, have been unfairly 
discriminated against in their competition for federal research 
dollars. In 1978, Congress created the EPSCoR program (Experimental 
Program to Stimulate Competitive Research), to make sure that all 
states would have the opportunity to compete for scientific research 
funds. Despite this intention, the EPSCoR program only served to 
exacerbate the exiting funding disparity. You may ask, how can this be 
so? The answer is really quite simple.
  The EPSCoR program does not extend to one of the biggest sources of 
scientific research--the National Institutes of Health (NIH). We are 
all aware, the NIH budget is growing rapidly; NIH's FY 2000 budget is 
$17.9 billion--up 8.43 percent in the past 5 years. Yet, despite this 
tremendous boom, 24 states receive 93 percent of NIH research grants, 
while the other 26 states split the remaining 7 percent.
  Although the NIH budget has resulted in great scientific gains, the 
research divide continues. One-half of the states have seen little 
benefit in the recent NIH increase. The time has come to correct this 
allocation program, but in a way that insures we have the best 
biomedical research in the world, and that those benefits are extended 
to the entire country. Research institutes provide a great opportunity 
to improve the health care delivery and quality in their home state, 
but only limited opportunity exists in half the states, because of the 
existing funding divide.
  The legislation we are introducing will provide $200 million to NIH-
EPSCoR states will enable states that currently receive historically 
low amounts of NIH grants to participate in two special funds.
  The first fund is to finance new infrastructure needs in these 
states. Because of their continued lack of equitable funding, many 
EPSCoR states have fallen behind in their infrastructure needs and are 
unable to compete against non-EPSCoR states. Our legislation will 
allocate $3.5 million each year to every NIH-EPSCoR state, to be used 
for projects the state EPSCoR committee targets as meeting the state 
biomedical research committees' goals. Because the state is responsible 
for choosing its infrastructure needs, we may finally be able to get 
away from the yearly requests for special projects in our states and 
allow federal funds to be spent in the most efficient manner possible.
  The second fund is dedicated toward research in the new NIH-EPSCoR. 
This research is for meritorious projects, co-funded by the NIH-EPSCoR 
fund and the NIH Institute or Center. These projects must meet existing 
NIH standards or merit and quality, but will not have to compete 
against proposals from the non-EPSCoR states, which already dominate 
the grant process.
  Finally, this process will be self sustaining. Because research is 
typically less expensive to perform in NIH-EPSCoR states, the savings 
in administrative costs are recaptured to fund additional research. In 
FY 1999 we estimate these savings would have added up to $49 million, 
which would have flowed back to NIH-EPSCoR states for additional 
research projects.
  In recent years, we have made great strides in biomedical research, 
however, that research has been limited to only a select few. I ask you 
to join us in resolving this discrepancy and restore equity to the NIH 
process and would invite my colleagues to join us in this effort.
                                 ______
                                 
      By Mr. SHELBY:
  S. 2360. A bill to amend the Gramm-Leach-Bliley Act to provide for a 
limitation on sharing of behavioral profiling information, and for 
other purposes; to the Committee on Banking, Housing and Urban Affairs.


             freedom from behavioral profiling act of 2000

  Mr. SHELBY. Mr. President, I rise today to introduce the ``Freedom 
from Behavioral Profiling Act of 2000.'' This legislation would 
disallow financial institutions from buying and selling an individual's 
most personal and detailed buying habits without proper notification 
and without his or her permission. Put another way, financial 
institutions would only be allowed to buy, sell or otherwise share an 
individual's behavioral profile if the institution has disclosed to the 
consumer that such information may be shared and the institution has 
received the consumer's affirmative consent to do so.
  Technology exists today that allows financial institutions to monitor 
and collect your personal buying and spending habits. According to the 
April 3 issue of Business Week magazine, Visa International is ``using 
neural networks to build up elaborate behavioral profiles. Over months, 
these systems . . . track a person's behavior online and off, then 
match it against models of similar personality and behavior types . . 
.''
  What this means is that financial institutions have the ability to 
follow you to the grocery store to track your purchases--whether you 
are abiding by your doctors recommended diet--and then to the drug 
store to see what kind of drugs you are purchasing. The institution can 
also track where you go throughout the day and into the evening, and 
exactly what time you were there.
  Business Week also reported that such ``far-flung threads'' as your 
``taste in paperbacks, political discussion groups'' and clothing are 
being ``sewn into online profiles where they are increasingly 
intertwined with your data on health, your education loans and your 
credit history.'' What does this information have to do with getting a 
mortgage? More importantly, are these institutions sharing these 
behavioral profiles? Given the track record of some of the blue chip 
firms like Chase Manhattan Bank and U.S. Bancorp, I believe the risk is 
too great to assume otherwise.
  Even more important, what happens when these behavioral profiles get 
into the wrong hands? That rarely happens you say. Guess again. A 
Russian teenager using the name ``Maxus'' stole 350,000 credit card 
numbers from CD Universe's Web site last December. He then told CD 
Universe that he would

[[Page 4670]]

post the numbers on the Internet unless they paid him $100,000. When 
they refused to pay him he posted the credit cards numbers and 
thousands of visitors downloaded more than 25,000 account numbers 
between December 25 and January 7.
  A similar case happened on March 24 of this year when two teens in a 
small Welsh village hacked into computers of several online merchants 
making off with more than 26,000 credit card numbers. The FBI says 
losses connected to the thefts could exceed $3 million.
  Mr. President, if teenagers from around the world are gaining access 
to account numbers, there is no question they can steal data banks of 
behavioral profiles. In fact, they are. A front page article in the New 
York Times dated April 3, 2000, reports that ``Law enforcement 
authorities are becoming increasingly worried about a sudden, sharp 
rise in the incidence of identity theft, the outright pilfering of 
people's personal information and, with that information in hand, 
thieves can acquire credit, make purchases and even secure residences 
in someone else's name.''
  Mr. President, an important point here is that potential criminals do 
not even have to steal the information. Due to the significant 
loopholes in the Gramm-Leach-Bliley Act passed last year, an 
individual's behavioral profile could legally be passed along without 
the affirmative consent of that individual. The unchecked growth of 
data banks and the business of profiling unquestionably facilitates 
identity theft.
  Some may suggest that there is no harm in behavioral profiling. I 
disagree. Despite the fact that consumers are ``shielded'' in 
fraudulent cases, subject to only $50 maximum liability, the burden is 
on credit card owners to prove the fraudulent charges are not their 
own. If the fraudulent charge is not found immediately, continued 
purchases or applications for more cards by the criminal can wreak 
havoc on an individual's credit rating. In fact, one witness recently 
testified before the Senate Subcommittee on Terrorism, Technology and 
Government Information that she spent over 400 hours trying to clear 
her name and restore her good credit.
  In ``card-not-present'' transactions, that is orders by mail, 
telephone or Internet where no signature is required, merchants are 
forced to cover the loss. Thus, identity theft and fraudulent purchases 
also take a toll on the small business man. Reports suggest that one 
out of every ten online purchases is fraudulent. My colleagues know 
that small businesses do not have the margins to eat the charge on one 
out of every 10 purchases.
  Mr. President, the American people are only now becoming aware of the 
behavioral profiling practices of the industry. The more they find out, 
the more they do not like it. That is why I am offering this 
legislation . . . to give the consumer the ability to control his or 
her most personal behavioral profile. Where they go, who they see, what 
they buy and when they do it--all of these are personal decisions that 
the majority of Americans do not want monitored and recorded under the 
watchful eye of corporate America.
  Mr. President, colleagues in the Senate, I hope you will join me in 
an effort to give the people what they want--the ability to control the 
indiscriminate sharing of their own personal, and private, consumption 
habits.
                                 ______
                                 
      By Mr. VOINOVICH (for himself, Mr. Breaux, Mr. Inhofe, and Ms. 
        Landrieu):
  S. 2362. A bill to amend the Clean Air Act to direct the 
Administrator of the Environmental Protection Agency to consider risk 
assessments and cost-benefit analyses as part of the process of 
establishing a new or revised air quality standard; to the Committee on 
Environment and Public Works.


              AIR QUALITY STANDARD IMPROVEMENT ACT OF 2000

 Mr. VOINOVICH. Mr. President, I rise today with my 
distinguished colleague from Louisiana, Senator Breaux, to introduce a 
bill that will provide a commonsense approach to promulgating 
regulations under the Clean Air Act. We are pleased that Senators 
Inhofe and Landrieu have joined us as original cosponsors. We introduce 
this bill today in a bipartisan manner to increase public health, 
safety and environmental protection.
  As a father and grandfather, I understand the importance of ensuring 
a clean environment for our future generations. Throughout my 33 years 
of public service, I have demonstrated a commitment to preserving our 
environment and the health and well-being of all Ohioans. I sponsored 
legislation to create the Ohio Environmental Protection Agency when I 
served in the state legislature, and I fought to end oil and gas 
drilling in the Lake Erie bed. As Governor, I increased funding for 
environmental protection by over 60 percent. While in the Ohio House of 
Representatives, I was responsible for creating the Environment and 
Natural Resources Committee and was honored to serve as the first vice 
chairman of that committee.
  In addition, the state of Ohio has made significant improvements in 
air quality in recent years. When I first entered office as Governor in 
1991, most of Ohio's urban areas were not attaining the 1-hour ozone 
standard. By the time I left, all but one city was in attainment. 
However, the Cincinnati community has worked together, through a 
variety of programs, to attain the 1-hour standard and is now awaiting 
final action by the EPA to redesignate it as in attainment.
  Overall, the ozone pollution level in Ohio has gone down by 25%, and 
in many urban areas, it has gone down by more than 50% in the past 20 
years. Ohio is doing its part to provide cleaner air. Nevertheless, 
over the years, I have become more and more concerned that just in 
order to comply with federal laws and regulations, our citizens, 
businesses and state and local governments must pay costs that can be 
inordinately burdensome or totally unnecessary.
  In the 104th Congress, I worked closely with a coalition of state and 
local government officials and members of the House and Senate to pass 
effective safe drinking water reforms. The results of our efforts 
culminated in the Safe Drinking Water Act Amendments, legislation which 
was enacted with broad bipartisan support in 1996. In addition, the 
bill had the support of environmental organizations, and I was pleased 
to attend the President's bill-signing ceremony when these reforms were 
signed into law. In fact, at that time the President praised the 
bipartisan work and said, ``Today we helped ensure that every family in 
America will have safe, clean drinking water to drink every time they 
turn on a faucet or stop at a public water fountain. From now on our 
water will be safer and our country will be healthier for it.''
  This cooperative effort is notable because it showed that a law could 
include commonsense reforms that make the government more accountable 
based on public awareness of risks, costs and benefits. I believe it 
set a key precedent for reform of other environmental regulations.
  I specifically mention the drinking water program because it is the 
model for the bill we are introducing today. This bill includes the 
very same risk assessment and cost-benefit analysis provisions that 
govern our drinking water. This bill clarifies EPA's obligation to 
identify risks, consider costs and benefits of a proposed rule and 
consider incremental costs and benefits of alternative air quality 
standards. However, EPA would retain flexibility in making final 
regulatory decisions.
  If we can agree these tools improve rulemakings for something as 
important as the water we drink, where a regulatory mistake could 
endanger millions of lives, they certainly must be good enough to 
protect the air that we breathe.
  When I was Governor of Ohio, I became more and more concerned that 
the EPA was not taking into consideration sound science, costs and 
benefits during the rulemaking process. I was particularly concerned 
about the standards for ozone and particulate matter. In fact, I was 
very concerned that the costs to this country to implement the new 
National Ambient Air Quality Standards (NAAQS) for ozone and 
particulate matter far outweighed the benefits to public health and the 
environment.

[[Page 4671]]

  In fact, according to EPA's own estimates, the costs for implementing 
the NAAQS standard for ozone exceeded the benefits. The President's own 
Council of Economic Advisors predicted that the benefits would be 
small, while the costs of reaching full attainment could total $60 
billion.
  Just last spring, a U.S. appeals court remanded EPA's ozone and 
PM2.5 standards, ruling that EPA did not justify its 
decision with sound scientific evidence. Ohio was a party to this 
lawsuit, which began when I was Governor. The court didn't say that EPA 
couldn't regulate at these levels, but that EPA didn't give sufficient 
justification for doing so.
  That has been my point all along. I have argued that the NAAQS 
standards were going to be costly and that we didn't even know if 
making those investments was going to make a difference. I believe this 
bill would help us avoid some of the legal and legislative wrangling 
that has occurred in the past few years with respect to how we achieve 
clean air.
  Federal agencies should not force businesses and consumers to throw 
billions of dollars at a problem without knowing if they're hitting the 
right target. Yet, the EPA is asking all of America to pay for these 
new regulations simply because the EPA said it is the right thing to do 
and that it has the authority to do so. However, they have failed to 
adequately determine the effects of changing the ozone and particulate 
matter standards.
  The challenge facing public officials today is determining how best 
to protect the health of our citizens and our environment with limited 
resources. We need to do a much better job of ensuring that 
regulations' costs bear a reasonable relationship with their benefits, 
and we need to do a better job of setting priorities and spending our 
resources wisely.
  I believe the bill we introduce today will help achieve these goals 
in air regulations. First, I believe this bill will increase the 
public's knowledge of how and why the EPA makes air regulations. In 
essence, this bill asks EPA to answer several simple, but vital 
questions:
  What science is needed to help us make good decisions?
  What is the nature of the risk being considered?
  What are the benefits of the proposed regulation?
  How much will it cost?
  And, are there better, less burdensome ways to achieve the same 
goals?
  It will also improve the quality of government decision-making by 
allowing the EPA to set priorities and focus on the worst risks first. 
Careful thought, reasonable assumptions, peer review and sound science 
will help target problems and find better solutions.
  Mr. President, Executive Order 12866 already requires agencies to 
conduct risk assessment and cost benefit analysis. What this bill will 
do is clarify that EPA must conduct risk assessment and cost benefit 
analysis. This bill does not mandate outcomes. In fact, it does nothing 
to circumscribe the EPA Administrator's ability to propose and 
implement regulations to protect public health. Quite simply, it 
imposes commonsense discipline and accountability in the rulemaking 
process by confirming that EPA has the flexibility to take risks and 
costs into consideration when setting standards that are going to 
affect public health or the environment.
  I want to make very clear that this bill does not mandate how EPA 
sets standards. The Administrator will have discretion to set 
appropriate standards to protect human health. EPA would be required to 
conduct an analysis of incremental costs and benefits of alternative 
standards, but would have the flexibility to choose between a standard 
where the benefits justify its cost or, when health considerations 
dictate, the maximum feasible standard.
  In addition, this bill does not keep information about air quality 
from the public. To the contrary, this bill is a public right-to-know 
bill that requires EPA to tell the public what information it 
considered before making a final decision.
  Nor does the bill ``gut'' the Clean Air Act, as some contend. In 
fact, it strengthens it by asking EPA to tell the public what the risks 
are that warrant regulation and what options are available to most 
efficiently and effectively reduce those risks. This bill will ensure 
that the Agency sets priorities and it makes sure that our limited 
resources are being spent to address the real risks to public health 
and the environment. While many air regulations set by EPA are well 
intended, we want to ensure that these regulations are going to achieve 
their purpose and not unnecessarily pass significant burdens onto our 
citizens and state and local governments.
  I strongly believe our challenge is to determine how best to meet our 
obligation of protecting the environment and health of our citizens 
with the limited financial resources we have available and with the 
scientific evidence to back up our actions. It should not be the 
government's policy to initiate or enact regulations simply because it 
sounds like a good idea. It should be because the evidence shows that 
it is the right thing to do.
  I have spoken to my colleague and chairman of the Environment and 
Public Works Committee's Clean Air Subcommittee, Senator Inhofe, and he 
has agreed to include this bill in a package of bills that will be 
introduced in the near future to advance discussions on Clean Air Act 
reauthorization.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2362

       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 ``Air Quality Standard 
     Improvement Act of 2000''.

     SEC. 2. PURPOSES.

       The purposes of this Act are--
       (1) to establish more effective environmental standards to 
     continue to safeguard public health and the environment;
       (2) to promote better resource allocation to ensure that 
     serious risks to air quality are addressed first;
       (3) to improve the ability of the Administrator of the 
     Environmental Protection Agency to use scientific and 
     economic analysis in developing air quality standards;
       (4) to yield increased public health and environmental 
     benefits and more effective protections while minimizing 
     costs;
       (5) to require that relevant qualitative and quantitative 
     information be considered in the process of evaluating the 
     costs and benefits of air quality standards;
       (6) to promote the right of the public to know about the 
     costs and benefits of air standards, the risks addressed, the 
     risks reduced, and the quality of scientific and economic 
     analysis used to support decisions; and
       (7) to require the Administrator of the Environmental 
     Protection Agency to conduct risk assessments and cost-
     benefit analyses as part of the process of establishing a new 
     or revised air quality standard.

     SEC. 3. RISK ASSESSMENT AND COST-BENEFIT ANALYSIS.

       The Clean Air Act (42 U.S.C. 7401 et seq.) is amended by 
     adding at the end the following:
         ``TITLE VII--RISK ASSESSMENT AND COST-BENEFIT ANALYSIS

     ``SEC. 701. DEFINITION OF AIR QUALITY STANDARD.

       ``In this title, the term `air quality standard' means--
       ``(1) a national ambient air quality standard established 
     under section 109 (including the setting of any emissions 
     budget for purposes of attaining or maintaining any national 
     ambient air quality standard);
       ``(2) an increment or ceiling for the prevention of 
     significant deterioration established under section 163;
       ``(3) regulations established under section 169A to address 
     the regional haze or other impairment of visibility by 
     manmade air pollution in a mandatory class I Federal area;
       ``(4) any finding or emission limitation determined under 
     section 126;
       ``(5) any emission standard or requirement that applies to 
     on-road and nonroad mobile sources (including aircraft engine 
     standards) established under title II;
       ``(6) any requirement that imposes a limitation on the 
     quality of fuel used in mobile sources;
       ``(7) any emission limitation or emission budget for sulfur 
     dioxide or nitrogen oxides established under title IV;
       ``(8) any preconstruction review requirement that regulates 
     new sources or major modifications of existing sources in 
     attainment or nonattainment areas;
       ``(9) the setting of any emissions budget or other 
     requirement for purposes of attaining or maintaining any 
     national ambient air quality standard under section 110;

[[Page 4672]]

       ``(10) any new source performance standard, existing source 
     performance standard, or design, equipment, work practice, or 
     operational standard established or revised under section 
     111;
       ``(11) any standard to protect public health and the 
     environment described in section 112(f);
       ``(12) any new regulation applicable to an electric utility 
     steam generating unit under section 112(n);
       ``(13) the designation of a pollutant under section 115 as 
     causing or contributing to air pollution that may reasonably 
     be anticipated to endanger public health or welfare in a 
     foreign country;
       ``(14) any air pollution control technique information, 
     transportation planning guidelines, information on procedures 
     and methods to reduce mobile source air pollution, or control 
     technique guidelines issued under sections 108 and 183;
       ``(15) any identification of attainment dates for national 
     ambient air quality standards under part D;
       ``(16) any identification of control measures for the 
     reduction of interstate ozone air pollution under section 
     184; and
       ``(17) any identification of reasonably available control 
     measures and best available control measures for particulate 
     matter under section 190.

     ``SEC. 702. RISK ASSESSMENT, MANAGEMENT, AND COMMUNICATION.

       ``(a) Use of Science in Decisionmaking.--In carrying out 
     this Act, (including establishing a new or revised air 
     quality standard under this Act), the Administrator shall 
     base any scientific or technical conclusions on--
       ``(1) the best available, peer-reviewed science and 
     supporting studies conducted in accordance with sound and 
     objective scientific practices;
       ``(2) data collected by accepted methods or the best 
     available methods (if the reliability of the method and the 
     nature of the decision justifies use of the data);
       ``(3) data (including the underlying research data) that 
     have been made available to the public, subject to the 
     exemptions under section 552 of title 5, United States Code.
       ``(b) Public Information.--
       ``(1) In general.--In carrying out this section, the 
     Administrator shall ensure, to the maximum extent 
     practicable, that the presentation of information on public 
     health effects concerning any new or revised air quality 
     standard is comprehensive, informative, understandable, and 
     conveniently available for public comment prior to the 
     promulgation of any regulation under this Act.
       ``(2) Specifications.--The Administrator shall, in a 
     document made available to the public in support of a 
     regulation proposed or promulgated under this Act concerning 
     an air quality standard, specify, to the maximum extent 
     practicable--
       ``(A) each population addressed by any estimate of public 
     health effects;
       ``(B) the expected risk or central estimate of risk for the 
     specific populations or resources, where applicable, and each 
     appropriate upper-bound or lower-bound estimate of risk;
       ``(C) each significant uncertainty identified in the 
     process of the assessment of public health effects, and 
     studies that would assist in resolving the uncertainty; and
       ``(D) peer-reviewed studies known to the Administrator that 
     support, are directly relevant to, or fail to support any 
     estimate of public health effects, and the methodologies used 
     to reconcile inconsistencies in the scientific data.
       ``(3) Health risk reduction and cost analysis.--
       ``(A) In general.--As part of the process of proposing a 
     new or revised air quality standard, the Administrator shall 
     publish in the Federal Register and seek public comment on an 
     analysis of each of the following:
       ``(i) Quantifiable and nonquantifiable benefits for which 
     there are factual bases in the rulemaking record to conclude 
     that the benefits are likely to occur as the result of 
     actions taken to comply with the new or revised air quality 
     standard.
       ``(ii) Quantifiable and nonquantifiable health benefits for 
     which there are factual bases in the rulemaking record to 
     conclude that the benefits are likely to occur from 
     reductions in other related pollutants that may be attributed 
     to compliance with the new or revised air quality standard, 
     excluding benefits resulting from compliance with other 
     proposed or promulgated regulations.
       ``(iii) Quantifiable and nonquantifiable costs for which 
     there is a factual basis in the rulemaking record to conclude 
     that the costs are likely to occur as the result of actions 
     taken to comply with or attain the new or revised air quality 
     standard, which costs shall include monitoring, actions taken 
     to comply with or attain the new or revised air quality 
     standard, and other costs, and excluding costs resulting from 
     compliance with other proposed or promulgated regulations.
       ``(iv) The incremental costs and benefits associated with 
     each alternative new or revised air quality standard 
     considered.
       ``(v) The effects of the air pollutant or pollutants for 
     which a new or revised air quality standard is being 
     considered on the general population, including, to the 
     extent relevant and appropriate and where data are reasonably 
     available, the effects on groups within the general 
     population such as infants, children, pregnant women, the 
     elderly, individuals with a history of serious illness, or 
     other subpopulations that are identified as likely to be at 
     greater risk of adverse health effects due to exposure to an 
     air pollutant than the general population.
       ``(vi) Any risk that may occur as the result of compliance 
     with or attainment of the new or revised air quality 
     standard, including risks associated with other related 
     pollutants.
       ``(vii) Other relevant factors, including the quality and 
     extent of the information available concerning the new or 
     revised air quality standard, the uncertainties in the 
     analysis supporting clauses (i) through (vi), and factors 
     with respect to the degree, and quantitative and qualitative 
     descriptions of the nature, of any risk.
       ``(B) Approaches to measure and value benefits.--The 
     Administrator may identify valid approaches for the 
     measurement and valuation of benefits under this paragraph, 
     including approaches to identify consumer willingness to pay 
     for reductions in health risks from air pollutants.
       ``(C) Authorization of appropriations.--There is authorized 
     to be appropriated to the Administrator to conduct studies, 
     assessments, and analyses described in this section 
     $35,000,000 for each of fiscal years 2000 through 2003.

     ``SEC. 703. COST-BENEFIT ANALYSIS.

       ``(a) Definitions.--In this section:
       ``(1) Benefit.--The term `benefit' means the reasonably 
     identifiable significant favorable effects, quantifiable and 
     nonquantifiable, including social, health, safety, 
     environmental, and economic effects, that are expected to 
     result from implementation of, or compliance with, a new or 
     revised air quality standard.
       ``(2) Cost.--The term `cost' means the reasonably 
     identifiable significant adverse effects, quantifiable and 
     nonquantifiable, including social, health, safety, 
     environmental, and economic effects, that are expected to 
     result from implementation of, or compliance with, a new or 
     revised air quality standard.
       ``(3) Cost-benefit analysis.--The term `cost-benefit 
     analysis' means an evaluation of the costs and benefits of a 
     new or revised air quality standard, quantified to the extent 
     feasible and appropriate and otherwise qualitatively 
     described, that is prepared in accordance with the 
     requirements of this section at the level of detail 
     appropriate and practicable for reasoned decisionmaking on 
     the matter involved, taking into consideration uncertainties, 
     the significance and complexity of the decision, and the need 
     to adequately inform the public.
       ``(b) Analysis.--For each new or revised air quality 
     standard proposed, the Administrator--
       ``(1) shall conduct and publish, for public comment, a 
     cost-benefit analysis to determine whether the benefits of 
     the new or revised air quality standard justify, or do not 
     justify, the costs; and
       ``(2) may analyze the potential distributional effects of 
     the new or revised air quality standard.
       ``(c) Determination of Health Risk Reduction and Cost 
     Considerations.--
       ``(1) Determination of no justification for cost.--
       ``(A) In general.--Notwithstanding any other provision of 
     this Act, if the Administrator determines, based on an 
     analysis conducted under subsection (b), that the benefits of 
     a new or revised air quality standard proposed or promulgated 
     in accordance with this Act do not justify the costs, the 
     Administrator may, after notice and opportunity for public 
     comment, promulgate an alternative new or revised air quality 
     standard at a cost that is justified by the benefits.
       ``(B) Scope of consideration.--In making a determination 
     under subparagraph (A), the Administrator shall consider--
       ``(i) only public health benefits, with respect to a 
     determination concerning a primary national ambient air 
     quality standard; and
       ``(ii) public health and environmental benefits, with 
     respect to a determination concerning any air quality 
     standard other than a national ambient air quality standard.
       ``(2) Judicial review.--A determination by the 
     Administrator under paragraph (1)--
       ``(A) shall be reviewed by a court only as part of a review 
     of a final regulation that has been promulgated based on the 
     determination; and
       ``(B) shall be set aside by a court if the court finds that 
     the determination is arbitrary and capricious.
       ``(d) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as are necessary to 
     carry out this section.''.
                                 ______
                                 
      By Mr. CRAPO:
  S. 2363. A bill to subject the United States to imposition of fees 
and costs in proceedings relating to State water rights adjudications; 
to the Committee on Energy and Natural Resources.


              water adjudication fee fairness act of 2000

 Mr. CRAPO. Mr. President, I rise to introduce the Water 
Adjudication Fee

[[Page 4673]]

Fairness Act of 2000. This bill would require the federal government to 
pay the same filing fees and costs associated with state water rights' 
adjudications as is currently required of states and private parties.
  To establish relative rights to water--water that is the lifeblood of 
many states, particularly in the west--states must conduct lengthy, 
complicated, and expensive proceedings in water rights' adjudications. 
In 1952, Congress recognized the necessity and benefit of requiring 
federal claims to be adjudicated in these state proceedings by adopting 
the McCarran Amendment. The McCarran Amendment waives the sovereign 
immunity of the United States and requires the federal government to 
submit to state court jurisdiction and to file water rights' claims in 
state general adjudication proceedings.
  These federal claims are typically among the most complicated and 
largest of claims in state adjudications, and federal agencies are 
often the primary beneficiary of adjudication proceedings where states 
officially quantify and record their water rights. However, in 1992, 
the United States' Supreme Court held that, under existing law, the 
U.S. need not pay fees for processing federal claims.
  When the United States does not pay a proportionate share of the 
costs associated with adjudications, the burden of funding the 
proceedings unfairly shifts to other water users and often delays 
completion of the adjudications by diminishing the resources necessary 
to complete them. Delays in completing adjudications result in the 
inability to protect private and public property interests or determine 
how much unappropriated water may remain to satisfy important 
environmental and economic development priorities.
  Additionally, because they are not subject to fees and costs like 
other water users in the adjudication, federal agencies can file 
questionable claims without facing court costs, inflating the number of 
their claims for future negotiation purposes. This creates an unlevel 
playing field favoring the federal agencies and places a further 
financial and resources burden on the system.
  For example, in the Snake River Basin Adjudication, which is in Idaho 
and is probably the largest water adjudication proceeding in the 
country, the United States Forest Service filed more than 3,700 federal 
claims. The Idaho Department of Water Resources expended thousands of 
dollars giving notice to all other claimants. Additionally the State of 
Idaho and private claimants spent over $800,000 preparing objections to 
the Forest Service's claims. On the eve of the objective deadline, the 
U.S. withdrew all but 71 of the claims--the Department of Justices' 
explanation: litigation strategy.
  This example is not an isolated incident. At best, the taxpayers and 
states should not be forced to incur these costs simply because the 
agency does not take the time to seriously evaluate its claims. At 
worst, the taxpayers should not bear the brunt of the federal 
government's Machiavellian tactics.
  I recognize that the federal government has a legitimate right to 
some reserved water rights; however, the federal government should play 
by the same rules as the states and other private users. The Water 
Adjudication Fee Fairness Act is legislation that remedies this 
situation by subjecting the United States, when party to a general 
adjudication, to the same fees and costs as state and private users in 
water rights adjudications.
  This measure has the full support of the Western States Water Council 
and the Western Governor's Association. I ask my colleagues to join me 
in supporting water users, taxpayers, the states, and welcome their co-
sponsorship.
  I ask unanimous consent that a copy of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2363

       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 ``Water Adjudication Fee 
     Fairness Act of 2000''.

      SEC. 2. FINDINGS.

       The Congress finds the following:
       (1) Generally, water allocation in the western United 
     States is based upon the doctrine of prior appropriation, 
     under which water users' rights are quantified under State 
     law. Appropriative rights carry designated priority dates 
     that establish the relative right of priority to use water 
     from a source. Most States in the West have developed 
     judicial and administrative proceedings, often called general 
     adjudications, to quantify and document these relative 
     rights, including the rights to water claimed by the United 
     States Government under either State or Federal law.
       (2) State general adjudications are typically complicated, 
     expensive civil court and administrative actions that can 
     involve hundreds or even thousands of claimants. Such 
     adjudications give certainty to water rights, provide 
     direction for water administration, and reduce conflict over 
     water allocation and water usage. Those claiming and 
     establishing rights to water are the primary beneficiaries of 
     State general adjudication proceedings.
       (3) The Congress has recognized the benefits of the State 
     general adjudication system, and by enactment of section 208 
     of the Department of Justice Appropriation Act, 1953 (43 
     U.S.C. 666; popularly known as the ``McCarran Amendment''), 
     required the United States to submit to State court 
     jurisdiction and to file claims in State general adjudication 
     proceedings.
       (4) Water rights claims by Federal agencies under either 
     State or Federal law are often the largest or most complex 
     claims in State general adjudications. However, the United 
     States Supreme Court, in the case United States v. Idaho, 508 
     U.S. 1 (1992), determined that the McCarran Amendment does 
     not require the United States to pay some filing fees simply 
     because they were misconstrued or perceived to be the same as 
     costs taxed against all parties.
       (5) Since Federal agency water rights claims are among the 
     most difficult to adjudicate, and since the United States is 
     not required to pay some fees and costs paid by non-Federal 
     claimants, the burden of funding adjudication proceedings 
     unfairly shifts to private water users and State taxpayers.
       (6) The lack of Federal Government funding to support State 
     water rights adjudications in relation to the complexity of 
     the claims involved has produced significant delays in 
     completion of many State general adjudications. These delays 
     inhibit the ability of both the States and Federal agencies 
     to protect private and public property interests. Also, 
     failure to complete the final adjudication of claims to water 
     restricts the ability of resource managers to determine how 
     much unappropriated water is available to satisfy 
     environmental and economic development demands.

     SEC. 3. LIABILITY OF UNITED STATES FOR FEES AND COSTS IN 
                   WATER USE RIGHTS PROCEEDINGS.

       (a) In General.--In any State administrative or judicial 
     proceeding for the adjudication or administration of rights 
     to the use of water in which the United States is a party, 
     the United States shall be subject to the imposition of fees 
     and costs on its claims to water rights under either State or 
     Federal law to the same extent as a private party to the 
     proceeding.
       (b) Application.--Subsection (a) shall apply to proceedings 
     pending on or initiated after the date of enactment of this 
     Act, including with respect to fees and costs imposed in such 
     a proceeding before the date of the enactment of this Act.
       (c) Report to Congress.--The head of any Federal agency 
     that files or has pending any water rights claim shall 
     prepare and submit to the Congress, within 90 days after the 
     end of each fiscal year, a report that identifies--
       (1) each such claim filed by the agency that has not yet 
     been decreed;
       (2) all fees and costs imposed on the United States for 
     each claim identified under paragraph (1);
       (3) any portion of such fees and costs that has not been 
     paid; and
       (4) the source of funds used to pay such fees and costs.
       (d) Fees and Costs Defined.--In this section, the term 
     ``fees and costs'' means any administrative fee, 
     administrative cost, claim fee, judicial fee, or judicial 
     cost imposed by a State on a party claiming a right to the 
     use of water under either State or Federal law in a State 
     proceeding referred to in subsection (a).
                                 ______
                                 
      By Mr. SANTORUM (for himself and Mr. Gregg):
  S. 2364. A bill to amend the Social Security Act to require Social 
Security Administration publications to highlight critical information 
relating to the future financing shortfalls of the social security 
program; to the Committee on Finance.


                   SOCIAL SECURITY RIGHT TO KNOW ACT

  Mr. SANTORUM. Mr. President, today, I am pleased to join with my 
colleague, Senator Judd Gregg of New Hampshire, in introducing the 
Social Security Right to Know Act of 2000.

[[Page 4674]]

  This legislation is aimed at providing the American people with 
accurate and up-to-date information about the current and future 
financial operations of the Social Security program, so that they may 
be in a better position to understand the choices involved in putting 
our most vital social program on sound financial footing for the long 
term.
  I would like to commend the Senator from New Hampshire for his 
instrumental role in promoting a similar proposal in the form of an 
amendment to the Social Security earnings test repeal legislation that 
this body recently considered and passed. Unfortunately, we did not 
take advantage of Senator Gregg's tireless efforts to reach across 
party lines to incorporate improved reporting to the public about the 
Social Security program as part of the earnings test repeal. This 
legislation is a complement to Senator Gregg's prior efforts, and I am 
pleased to be offering this legislation here today with his support.
  As Congress continues to consider options to preserve and strengthen 
our Social Security system, it is increasingly important that Americans 
have access to certain salient information with respect to Social 
Security's current and future financial picture.
  Why is this so important? As all of my colleagues will recall, in his 
State of the Union Address to Congress on January 27, 1998, President 
Clinton declared that it was time for the nation to begin a dialogue on 
the ``necessary measures to strengthen the Social Security system for 
the twenty-first century.'' He went on to say that the American people 
should be invited to join in this discussion, facing these issues 
squarely, and forming a true consensus on how we should proceed. In his 
address, the president announced a series of public policy forums to be 
held around the country, and also called for a White House Conference 
on Social Security to be held in December, 1998. The president 
indicated that early in 1999 he would convene the leaders of Congress 
to craft historic legislation that would re-create ``a Social Security 
system that is strong in the twenty-first century.''
  I know that there was bipartisan support here in the Senate and in 
the House of Representatives for President Clinton's calling to make 
long-term Social Security reform our most important domestic policy 
priority. And two years ago I was optimistic about the prospects for 
enacting such historical legislation, particularly about the 
opportunity to engage the nation in an honest national discussion about 
the need to reform Social Security, and exchange ideas as to how we 
might best achieve this. But, as we all know, we held a national 
dialogue on Social Security, and the American people did participate in 
the policy forums which came to pass, and yet here we are today with 
little progress toward a bipartisan consensus on sustainable Social 
Security reform.
  I believe that this is so partly because of the fact that there is a 
tremendous amount of misinformation and lack of understanding among the 
American public about Social Security's financing challenges, and this 
lack of understanding continues to harden popular resistance to long-
term Social Security solutions.
  Case in point: last week, we saw the release of the 2000 Annual 
Report of the Board of Trustees of the Federal Old-Age and Survivors 
Insurance and Disability Insurance Trust Funds, popularly referred to 
as the Social Security Trustees' Report. The Social Security 
Administration relayed that this Report revealed that the Social 
Security program's long-range financial picture has improved since last 
year. Specifically, the Board of Trustees announced that the Social 
Security Trust Fund assets will not be depleted until 2037--three years 
later than reported in last year's report.
  At first glance, this statistic might convey an air of reassurance to 
the public, such to the point in some minds that if we can just 
continue to grow our economy at its current rate, we will obviate the 
need for enacting fundamental reforms to Social Security. Or at least, 
such reporting of Social Security's finances might lead to the common 
conclusion that the program is perfectly fine for nearly 40 years.
  This reliance on the paradigm of trust fund accounting is one of the 
main reasons that we have not been able to achieve bipartisan consensus 
on long-term Social Security reform. There is scarce mention in the 
Trustees' Report that the Social Security Trust Fund balances ``are 
available to finance future benefit payments . . . only in a 
bookkeeping sense. They do not consist of real economic assets that can 
be drawn down in the future to fund benefits. Instead, they are claims 
on the Treasury that, when redeemed, will have to be financed by 
raising taxes, borrowing from the public, or reducing benefits, or 
other expenditures. The existence of a large trust fund balance, 
therefore, does not have any impact on the Government's ability to pay 
benefits.''
  Mr. President, if this description of the Trust Funds sounds 
familiar, it is because this is the exact wording contained in the 
Administration's budget up until its most recent submission for Fiscal 
Year 2001. What this means, in other words, is that the trust funds are 
merely claims on future government revenues, IOUs to be redeemed 
through higher taxation, lower spending on Social Security or other 
government obligations, or a return to deficit financing.
  I think that this is a rather important piece of information for the 
American people to understand in assessing Social Security's future. 
But it should not be buried in some multi-hundred page budget document 
or 223-page Social Security Trustees' Report. Maybe if we made this 
information more accessible and apparent, then we would have more 
concern for the fact that Social Security's financing problems begin as 
soon as 2015--when Social Security dedicated payroll tax receipts are 
no longer sufficient to pay benefits--and not in 2037. The Social 
Security Trustees last week revealed it will cost $11.3 trillion in new 
money between 2015 and 2037 to convert into cash benefits the IOUs held 
by the Social Security Trust Fund. But we have no actual resources 
necessary to meet these benefit promises between 2015 to 2037.
  Also not mentioned in the most recent Trustees' Report, Mr. 
President, is the fact that the system's unfunded obligations actually 
grew from the 1999 Report's release by about $1 trillion in constant 
2000 dollars, according to analysis by the House Budget Committee. This 
is because the change in valuation period adds a new, expensive, 
underfunded 75th year and drops a year when benefit costs are 
relatively cheaper. This is a paradox of pay-as-you-go financing that 
is not known or understood by most of the public, and is rarely if ever 
referenced in the media. To be sure, the unfunded obligations of the 
United States government are measured and accounted for in some obscure 
Department of Treasury publications, but this data should be at the 
front and center of the Social Security reform discussion, in plain 
view for every American to access.
  Another information gap which the Social Security Right to Know Act 
seeks to close relates to individual Social Security statements, 
formerly known as Personal and Earnings and Benefits Statements 
(PEBES). This document was conceived by our friend and venerable 
colleague, Senator Daniel Patrick Moynihan of New York. In 1989, 
Senator Moynihan persuaded Congress to adopt the requirement for the 
Social Security Administration to provide this document as a way ``to 
reassure Americans that Social Security will be there for them,'' and 
to help them adequately plan for retirement by indicating that Social 
Security doesn't fully replace wages or salaries.
  Though well intentioned, the current Social Security statement falls 
short of its desired goal by glaringly omitting certain information 
critical to understanding the system's serious future funding problems, 
and the related implications for individual and family retirement 
planning. To be fair, the statements do make reference to such bland 
phrases as ``changed in the past,'' ``must do so again'' and ``we are 
working to resolve.'' But the truth is that by 2037, the program will 
collect sufficient revenues to pay only $0.72 for

[[Page 4675]]

every dollar of promised benefits. Overall, Social Security's deficit 
that year will come to more than $1 trillion in today's dollars. Again, 
this is important information that should be made abundantly clear in 
order for the American public to assess Social Security's and their own 
financial futures.
  This is why this legislation is so important. For too long, the 
nature and scope of Social Security's financing problems have been 
shrouded by inconsistent and incomplete information, which has yielded 
public confusion and has polarized the Social Security reform debate.
  The Social Security Right to Know Act would improve the information 
contained in current Social Security Administration publications, and 
thereby enable Americans to better plan for their own retirement and to 
understand the benefits and costs that the current Social Security 
system will produce.
  This legislation will do several things to shed more light on what 
lies ahead for Social Security. First, it will expand the Personal and 
Earnings and Benefits Statements (PEBES), now called ``Social Security 
Statements,'' to include information about the projected date of the 
program's first financing deficits as estimated by the Social Security 
Trustees, and also the percentage of promised benefits that can be 
funded under current law.
  Second, it will require the Trustees' Report to include an estimate 
of Social Security's aggregate unfunded obligations--i.e., the 
difference between the program's promised benefit outlays and its cash 
income over the long-range 75-year evaluation period--and the change in 
such amount from the previous year's estimates.
  Third, it calls on the Trustees to submit to Congress a separate 
summary publication that highlights salient data pertaining to Social 
Security's financing, identifying the first year that Social Security 
is projected to run a cash deficit, as well as the size of projected 
deficits.
  Fourth, it will expand the PEBES or Social Security Statements and 
the annual Social Security Trustees' Report to include an explanation 
of the role of the Social Security Trust Funds as debt owed by the 
federal government, as opposed to an asset of the federal government.
  Fifth, it will broaden the public accessibility of the economic 
modeling employed by the Office of the Chief Actuary.
  Our bill would introduce no new information that is not already 
acknowledged somewhere in past publications of the Social Security 
Trustees or in previous Presidential budget submissions. However, it is 
our view that the importance of this information is so great that it 
should be displayed before every wage-earner and beneficiary of the 
Social Security system, and not buried in documentation that is now 
available only to policymakers.
  Americans deserve ``straight talk''--clear and accessible 
information--about Social Security's long-term financing challenges in 
order that they might better understand the consequences of a rapidly 
growing aging population, and the reality of the choices before us. 
This is just what the Social Security Right to Know Act is designed to 
provide. And with these objectives in mind, this legislation is long 
overdue.
  I presume that we are all in agreement that the federal government 
should be telling Americans the full truth about Social Security. It is 
my sincere hope that our colleagues will look at this legislation and 
join us in building on Senator Gregg's prior efforts and other 
bipartisan ideas to make sure that Americans have as much information 
as possible in our national discussion on how best to save and 
strengthen Social Security. The Social Security Right to Know Act is an 
effort to continue a process, based on the principle that ``knowledge 
is power,'' and I truly believe that the information that this 
legislation is seeking to provide Americans in a clear and concise 
manner is essential for our moving forward toward sustainable solutions 
to Social Security's funding problems. Though some of our colleagues 
may have ideas and input as to how best to provide the American public 
with a better understanding of Social Security's future--and I am open 
to working with my colleagues to improve this bill's specific 
provisions as we continue this process toward Social Security reform--
it is my firm belief that with the intent and principles contained in 
this legislation, we as a nation will be in a better position to cease 
assessing Social Security's future in terms of preconceived, fixed 
notions, and take heed of the demographic and economic realities which 
lie ahead.
  Mr. President, I again thank Senator Gregg for working with me in 
this effort, and ask unanimous consent that the text of the bill be 
printed in the Record.
  Mr. President, in closing, I would like to pay tribute to two of this 
Chamber's leaders on this issue: The Honorable Daniel Patrick Moynihan 
of New York and The Honorable Bob Kerrey of Nebraska. Both Senators 
Moynihan and Kerrey have been truly instrumental in advancing the cause 
of sustainable Social Security reform, and their presence and valued 
input on this issue will be sorely missed in the next session of 
Congress. I applaud both of them for their leadership in seeking to 
balance the interests and needs of younger and older Americans, and for 
their courage in working toward saving and strengthening Social 
Security in a manner that is fiscally responsible, actuarially sound 
and fair to all generations.
  Mr. GREGG. Mr. President, I am pleased to be an original cosponsor of 
this legislation, and I thank Senator Santorum for his leadership in 
drafting it.
  My colleagues in the Senate may recall that last week, I prepared an 
amendment to the earnings limit legislation that would have achieved 
many of the same objectives that are outlined by the Senator from 
Pennsylvania with respect to this bill. I believe that we have begun a 
process, an important dialogue involving many interested parties in 
both the executive and legislative branches, and that the result of 
this process will ultimately be improved information for the public and 
for Congress regarding the state of the Social Security program, and 
the benefits that it can finance.
  I am pleased by the number of important individuals who have 
expressed interest in this effort. I am especially gratified by the 
interest of Senator Roth and of Congressman Archer, the two members of 
Congress with principal jurisdiction over the Social Security program. 
They have each indicated that they are willing to explore these 
informational issues via various means, and to lend their considerable 
influence to the effort.
  I am further pleased that various individuals within the 
administration have sought to work with us on our concerns, and to lay 
a groundwork for improved reporting to the public regarding the Social 
Security program.
  In that context, I would stress that we are not at the end of this 
process, and that we do not have universal agreement on the best way to 
proceed. I do not believe that either Senator Santorum or I would say 
that the language in either this bill, or the one that I offered last 
week, is perfect, and cannot be improved upon. Senator Santorum's 
draft, like my original draft, would seek to include additional 
information in the annual Trustees' Reports. I do not know whether the 
Trustees' reports are necessarily the optimal place to report such 
information, and to the extent that individuals within the 
administration may have views as to how and where this information is 
best presented, I know that Senator Santorum and I would both be 
flexible as to how this is done. The important thing is that this 
information is routinely presented to Congress and to the public in a 
clear, understandable, helpful way, and the best time and format for 
this is certainly a matter where reasonable people can disagree.
  I do, however, want to review the elements of Senator Santorum's 
legislation, and to express why I believe that they are so important.
  First, it would add important new information to the Personal 
Earnings

[[Page 4676]]

and Benefit Statements that individuals are now receiving from the 
Social Security Administration. Those statements currently tell 
individuals how much they are promised in terms of benefits, and about 
their earnings history. Taken literally, however, they could provide a 
misleading picture as to what current law can actually finance. It is a 
misnomer to say that ``current law'' would provide a certain amount of 
benefits, when legally, the Social Security Administration does not 
have the authority to send out checks without financing. What ``current 
law'' would literally mandate, according to GAO, according to CRS, and 
according to everyone else who has studied this closely, is that 
benefits would be effectively cut sharply beginning in 2037 because 
benefit checks would have to wait until the available funds came in to 
finance them.
  Mr. President, it is unlikely that Congress would permit such a sharp 
and sudden set of benefit cuts to occur. Of course, neither we nor a 
future Congress would permit that. But it is also untrue to tell 
Americans that ``current law'' would provide them with all promised 
benefits. That is manifestly untrue by any definition. It is neither a 
true statement of current law, nor it is a true statement of how tax 
levels and benefit levels would look after necessary adjustments are 
made to the program to bring it into balance. Social Security 
beneficiaries certainly have a right to be told the truth about their 
benefits--the date through which they can currently be funded, the 
extent to which benefits could be provided under current estimates, as 
well as the additional revenues that must be collected through tax 
dollars, when the program first begins to experience cash flow 
deficits.
  Currently, there is a great misperception regarding Social Security 
financing that too many individuals are willing to tacitly encourage--
the idea that the existence of a positive Social Security Trust Fund 
balance enhances the ability of the federal government to pay Social 
Security benefits. It does not. The Social Security Trust Fund balance 
is actually a debt owed by the federal government, and it does not in 
any way finance benefits without requiring that the federal government 
turn to taxpayers to pay off that debt. Americans deserve to be told 
the truth about that, and Senator Santorum's language includes a 
statement that would explain the meaning of the Trust Fund, and the 
options before Congress when the program enters a phase of cash-flow 
deficits.
  Many of the paragraphs in the Santorum language, regarding increased 
clarity in the annual Trustees' report, are somewhat similar to 
language that I sought to pursue last week. Again, I would simply 
reiterate that reasonable people can disagree as to the proper venue 
for the reporting of this information. I personally am of the view that 
the annual Trustees' Reports should provide to Congress the relevant 
information that Congress, as the body that must budget for the Social 
Security program, needs to budget for it in the appropriate way. 
Congress has a right to insist, in my view, not on how these 
evaluations should be made, but that all relevant information be 
presented clearly to the Congress when they are made. However, the most 
important thing is that we reach an agreement among interested parties 
with common goals as to how best to do this.
  Currently, we receive 75-year actuarial estimates from the Trustees 
regarding the health of the Social Security Trust Fund. We only look at 
its impact on the overall federal budget over 10 years, through 
measurements by CBO and other bodies. We don't look out over the long 
term to judge the larger fiscal problems facing this long-term program 
and the unified federal budget. That is a problem. It tempts Congress 
and the Executive Branch to pursue ``solutions'' to Social Security's 
insolvency that improve the part of the picture that we see--the Trust 
Fund balance--heedless of the consequences for the part of the picture 
that we do not see--the impact on the unified federal budget. This is 
not an adequate method of approaching the problem of financing benefits 
over the long term. I believe that Congress should insist that 
portraits of the program's finances evaluate all scenarios on an 
absolutely level playing field, one that shows all costs borne by the 
system, and one that judges all possible solutions in terms of what 
they would actually cost and what they could actually pay. I commend 
Senator Santorum for his effort here, even as my mind is open on the 
best way to achieve this objective.
  Mr. President, I would simply close by saying that the Social 
Security program is too important to allow to operate in a fog of 
incomprehension and misunderstanding. There ought not to be resistance 
to efforts to bring additional ``sunshine'' upon the operations of the 
Social Security system as a whole. We currently operate, too often, in 
an atmosphere of selective information--one that measures only benefit 
promises, and current tax levels, without acknowledging the mismatch 
between the two, and what they mean for one another. A view that looks 
only at the Trust Fund balance, and not at the realities of the 
system's cost to future payers of both income and payroll taxes. This 
selective presentation of information encourages Congress to remain 
inactive, because it allows us to pretend that the consequences of 
current law are not actually worse than the choices that would be made 
in the course of reforming the program.
  We can do better than this, and we must, if we are to meet our 
responsibilities of stewardship for the Social Security program. I 
commend Senator Santorum for his effort.
                                 ______
                                 
      By Ms. COLLINS (for herself, Mr. Bond, Mr. Baucus, Mr. Jeffords, 
        Mr. Reed, Mr. Santorum, Mr. Abraham, Mrs. Murray, Mr. Cochran, 
        Mrs. Feinstein, Mr. Hollings, Ms. Mikulski, Mr. Bingaman, Mr. 
        Murkowski, Mrs. Hutchison, Mr. Schumer, Mr. Torricelli, Mr. 
        Edwards, Mr. Leahy, Mr. Enzi, Mr. Lugar, Mr. Cleland, Mr. 
        Hagel, Ms. Snowe, Mr. Bennett, Mr. Gorton, Mr. Hutchinson, Mr. 
        Helms, Mr. Allard, Mrs. Lincoln, Mr. L. Chafee, Mr. DeWine, Mr. 
        Ashcroft, Mr. Specter, Mr. Roberts, Mr. Brownback, and Mr. 
        Voinovich):
  S. 2365. A bill to amend title XVIII of the Social Security Act to 
eliminate the 15 percent reduction in payment rates under the 
prospective payment system for home health services; to the Committee 
on Finance.


                    HOME HEALTH PAYMENT FAIRNESS ACT

  Ms. COLLINS. Mr. President, I am pleased to join with 35 of my 
colleagues tonight to introduce the Home Health Payment Fairness Act to 
eliminate the automatic 15-percent reduction in Medicare payments to 
home health agencies that is currently scheduled to go into effect on 
October 1 of next year. The legislation we are introducing will provide 
a measure of financial relief for home health agencies across the 
country that are experiencing acute financial problems that are 
inhibiting their ability to deliver much needed care to some of the 
most vulnerable senior citizens in our country.
  America's home health agencies provide invaluable services that have 
enabled a growing number of our most frail and vulnerable Medicare 
beneficiaries to avoid hospitals and nursing homes and stay where they 
want to be--in the comfort and security of their own home.
  Unfortunately, due to cutbacks in the Medicare program, home health 
agencies in my State and others are having a very difficult time 
providing services, particularly to elderly people with complex health 
needs. One has only to look at the statistics from my home State of 
Maine to see the impact of these very onerous budget cuts, as well as 
burdensome regulations imposed by the Clinton administration.
  In Maine, in just over 2 years' time, there has been a 30-percent 
reduction in home health visits, which has resulted in more than 7,470 
senior citizens losing their home health services in my State. There 
has been a 26-percent reduction in the reimbursements that have been 
provided to home

[[Page 4677]]

health agencies in Maine. Mr. President, this situation cannot 
continue. The home health industry has already made an important 
contribution to reducing the rate of growth in Medicare spending. In 
fact, the spending cuts have been far beyond what Congress intended and 
what the CBO estimated.
  In 1996, home health was the fastest growing component of Medicare 
spending. The program grew at an average annual rate of more than 25 
percent from 1990 to 1997. As a consequence, the number of home health 
beneficiaries more than doubled and Medicare home health increased 
soared from $2.5 billion in 1989 to $17.8 billion in 1997.
  This rapid growth in home health spending understandably prompted 
Congress and the Administration, as part of the Balanced Budget Act of 
1997, to initiate changes that were intended to slow this growth in 
spending and make the program more cost-effective and efficient. These 
measures, however, have produced cuts in home health spending far 
beyond what Congress intended. Home health spending dropped to $9.7 
billion in FY 1999--just about half the 1997 amount. To cut payments by 
an additional 15 percent would put our already struggling home agencies 
at risk and would seriously jeopardize access to critical home health 
services for millions of our nation's seniors.
  It is now clear that the savings goals set for home health in the 
Balanced Budget Act of 1997 have not only been met, but far surpassed. 
According to the March 2000 Congressional Budget Office (CBO) baseline, 
Medicare home health payments fell by almost 35 percent in FY 1999, and 
this was on top of a 15 percent drop in FY 1998. In fact, the CBO cites 
this ``larger than anticipated reduction in the use of home health 
services'' as the primary reason that total Medicare spending dropped 
by one percent last year. The CBO now projects that the post-Balanced 
Budget Act reductions in home health will be about $69 billion between 
fiscal years 1998 and 2002. This is over four times the $16 billion 
that the CBO originally estimated for that time period and is a clear 
indication that the Medicare home health cutbacks have been far deeper 
and wide-reaching than Congress ever intended.
  Moreover, the financial problems that home health agencies have 
experienced have been exacerbated by a number of burdensome new 
regulatory requirements imposed by the Health Care Financing 
Administration, including the implementation of OASIS, the new outcome 
and assessment information data set; new requirements for surety bonds; 
IPS overpayment recoupment; and a new 15-minute increment reporting 
requirement.
  As a consequence of these payment cuts coupled with overly burdensome 
new regulatory requirements, cost-efficient home health agencies across 
the country have experienced acute financial difficulties and cash-flow 
problems, which have inhibited their ability to deliver much-needed 
care, particularly to the very Medicare beneficiaries who need it the 
most--individuals with diabetes, wound care patients, stroke patients, 
and other chronically ill individuals with complex care needs. Over 
2,500 agencies--about one quarter of all home health agencies 
nationwide--have either closed or stopped serving Medicare patients. 
Others have laid off staff or declined to accept new patients with more 
serious health problems. In addition, according to a study by the Lewin 
Group for the American Hospital Association, these cutbacks have 
resulted in a 30.5 percent reduction in hospital-based home health 
services.
  The effect of these home health cuts has been particularly 
devastating in my state. The number of Medicare home health patients in 
Maine dropped from 48,740 in June of 1998 to 41,269 in June of 1999, a 
decline of 15 percent. This means that 7,471 fewer Maine seniors are 
receiving home health services. Moreover, there was a 30 percent drop 
in the number of visits, and a 26 percent cut in Medicare payments to 
home health agencies in Maine.
  Keep in mind that Maine's home health agencies have historically been 
prudent in their use of resources and were low-cost to begin with. 
Ultimately, cuts of this magnitude degrade patient care. The real 
losers in this situation are our nation's seniors--particularly those 
sicker Medicare patients with complex, chronic care needs who are 
already experiencing difficulty in getting the home care services they 
need.
  The Balanced Budget Refinement Act did provide a small measure of 
financial and regulatory relief for home health agencies. It did, for 
example, delay the automatic 15 percent reduction in Medicare home 
health payments for one year. I do not think that this legislation went 
far enough, however: this automatic reduction should be eliminated 
entirely.
  An additional 15 percent cut in Medicare home health payments would 
ring the death knell for the low-cost, efficient agencies which are 
currently struggling to hang on and would further reduce our seniors' 
access to critical home care services. Moreover, we have already far 
surpassed the savings targets set by the Balanced Budget Act. Further 
cuts are unnecessary. I therefore urge all of my colleagues to join 
with myself and Senators Bond, Baucus, Jeffords, Reed, Santorum, 
Abraham, Murray, Cochran, Feinstein, Hollings, Mikulski, Bingaman, 
Murkowski, Hutchison, Schumer, Torricelli, Edwards, Leahy, Enzi, Lugar, 
Cleland, Hagel, Snowe, Bennett, Gorton, Hutchinson, Helms, Allard, 
Lincoln, DeWine, Chafee, Ashcroft, Specter, Roberts, Brownback, and 
Voinovich in cosponsoring the Home Health Payment Fairness Act to 
eliminate this additional 15 percent cut in Medicare home health 
payments.
  Mr. President, I hope my colleagues will join with me in providing 
much needed relief to America's home health agencies. Ultimately, if we 
don't act, the losers will be our senior citizens who depend so much on 
this important health care service.
  Thank you, Mr. President.
  The PRESIDING OFFICER. The Senator from Michigan is recognized.
  Mr. ABRAHAM. Mr. President, I rise to compliment the Senator from 
Maine for this proposal. I am happy to join as a cosponsor of the 
legislation, as I have on previous efforts on her part to address the 
home health care issues.
  I add my support to the legislation and compliment the Senator from 
Maine. I sincerely hope that as it moves forward with a variety of 
proposals before us, in the budget and elsewhere, to address Medicare 
issues we make sure we don't address those reform proposals without 
making sure our home health care programs are strong and of high 
quality.
  I yield the floor.
  Mr. BOND. Mr. President, I rise to join Senator Collins to offer a 
bill--the Medicare Home Health Payment Act--that will address the 
crisis in home health care.
  The crisis is that far too many seniors and individuals with 
disabilities can't get the home health care they need. They either go 
without needed care, or are forced into a medical facility such as a 
nursing home. This is a travesty, because home health can serve an 
extremely valuable role--it helps seniors get needed medical care while 
retaining the comfort and dignity of living in their own home.
  We have plenty of data that demonstrates the problem.
  Over 2,000 agencies driven out of business or out of the Medicare 
program. In Missouri alone, over 100 of the 300 agencies that were 
around in 1997 are gone.
  Independent studies that show that seniors and people with 
disabilities just can't get access to the home care they need--perhaps 
forcing them into nursing homes or other medical facilities.
  Reports that home health agencies feel forced to refuse to care for 
seniors because they fear the Medicare reimbursements won't cover their 
costs.
  Recent news from CBO that total Medicare home health spending has 
actually fallen by 45 percent in just two years--perhaps the largest 
reduction for a specific type of provider that we have ever seen in 
Medicare.
  Of course, last year I was also talking about the home health 
crisis--and Senator Collins and I had a bill to address the issue then 
as well.

[[Page 4678]]

  But I'm here to share bad news with my colleagues--Medicare home 
health is still in crisis.
  While we did address home health in the Balanced Budget Refinement 
Act late last year--which helped--it didn't solve everything.
  That's because all we did last year to the biggest threat that's out 
there for home health care providers--the 15-percent across-the-board 
cuts that are in addition to all of the other cuts made thus far--was 
postpone things.
  What we did not do--except for one minor provision--is increase home 
health reimbursement rates. Keep in mind that we did provide relief in 
the form of increased payments for most other Medicare providers, like 
hospitals and nursing facilities.
  So what we did is simply postpone further cuts in an already-
devastated industry. That cannot be the end of the story.
  So what should we do? Senator Collins and I--in the bill we are 
introducing today with 34 of our colleagues--propose to eliminate 
permanently the planned 15-percent home health cuts forever.
  I think this initial show of support from my colleagues is 
tremendous--and I look forward to working with my colleagues to make 
sure this bill becomes law. The millions of Americans on Medicare--for 
whom the home health benefit is so important--deserve no less.
  Mr. BAUCUS. Mr. President, I rise today to introduce the Home Health 
Payment Fairness Act. This bill will prevent a 15 percent cut to home 
health care agencies and allow them to continue their critical mission 
of caring for the chronically ill and the elderly.
  During the first 15 years of the Medicare program, home health 
spending accounted for one to two percent of all Part A expenditures. 
In 1997, home health expenditures reached 14 percent of Part A 
payments. Congress needed to respond to this growth. And we did so in 
the Balanced Budget Act of 1997.
  Congress decided to pay home health agencies under a Prospective 
Payment System. In the meantime, we established an interim payment 
system, or IPS, that would move agencies away from the old system.
  Since then, home care agencies have undergone deep budget cuts. 
Recent CBO projections show that reductions in home health care will be 
about $69 billion between 1998 and 2002--over four times the original 
estimate for the same time period. Clearly, home health care agencies 
have had their budgets cut much more severely than Congress ever 
intended.
  Congress has recognized the severity of the cuts and has twice 
postponed implementing the planned across-the-board 15 percent cut. 
Currently, the 15 percent cut is scheduled to take effect October 1, 
2001.
  So what does the legislation I am introducing do? Simply put, this 
bill takes the necessary step of not postponing the cut, but 
eliminating it altogether. The planned cut must be eliminated because 
we have achieved--in fact, far surpassed--the savings targets set by 
the Balanced Budget Act. Efficient home health agencies in Montana and 
across the country have experienced acute financial difficulties and 
cash flow problems, inhibiting their ability to deliver much needed 
care.
  Over 2,500 home health agencies nationwide have closed or stopped 
serving Medicare patients, and, according to a study done by the Lewin 
Group for the American Hospital Association, these cutbacks have 
resulted in a 30.5 percent reduction in hospital-based home health 
services. Moreover, the Health Care Financing Administration estimates 
that 500,000 fewer home health patient received services in 1998 than 
in 1997 (the last year for which figures are available), which points 
to the most central and critical issue. The real losers in this 
situation are our seniors. Cuts of this magnitude simply cannot be 
sustained without ultimately affecting patient care.
  While patient care across the nation will be impacted if the planned 
cuts are implemented, rural areas will be especially had hit. If the 
planned cuts are implemented, rural health care providers will be 
forced to find ways to further cut costs. Such cost-cutting measures 
could include closing branches or limiting services. This means that 
rural patients could face difficulties accessing quality health care. 
This is especially significant because a high percentage of seniors 
over the age of 65 live in rural areas; in Montana, that figure is 77 
percent. Thus, any reduction in home health care will directly impact 
our nation's seniors.
  Eliminating the 15 percent cut makes financial sense. If home health 
care budgets are cut further, costs will increase in other areas. If 
patients--especially in rural areas--are not receiving the care they 
need, they will turn to other resources, such as hospital emergency 
rooms, inpatient cares, and nursing homes. In the long run, this will 
be more expensive and less efficient. Above all, we must ensure that 
our nation's elderly and ill receive the care they need. We must not 
create a situation in which cash-strapped home health agencies have 
strong incentives to limit- or even deny-care to the sickest.
  This bill prevents such a scenario, while respecting Congress' 
original intention of reducing home health care spending, I think that 
most of us agree that our seniors and the ill deserve quality home 
health care. This is a common sense measure that will allow us to 
realize our original intention of reducing home health care spending, 
while at the same time protecting the right of our elderly and ill to 
quality care.
 Mr. JEFFORDS. Mr. President, I am here today to join in 
introducing the Home Health Payment Fairness Act of 2000. This 
important bill has been crafted to protect the Medicare home health 
services that our seniors depend upon. I want to recognize the 
leadership of Senators Collins, Bond, Baucus, Reed, and the many others 
who are original cosponsors of this effort to protect access to home 
health services.
  My own state of Vermont is a model for providing high-quality, 
comprehensive care with a low price tag. For most of the 1990's, the 
average Medicare expenditure for home health care in Vermont has been 
the lowest in the nation. Vermont's home care system was designed to 
efficiently meet the needs of frail and elderly citizens in our largely 
rural state, but it, like home care across the country, has been put 
under tremendous pressure.
  Since the enactment of the Balanced Budget Act of 1997 (BBA) and 
imposition of the interim payment system (IPS), the Medicare home 
health benefit has been seriously eroded. The BBA failed to recognize 
how the new home health reimbursement would affect small, rural home 
health care providers. The IPS has caused such significant cash flow 
problems, that many agencies are struggling to make meet their payroll 
needs. Now, because of the BBA, agencies are facing the prospect of 15 
percent cut in Medicare funding in October of 2001. With providers 
already struggling to survive, any further cuts could spell disaster 
for low-cost, efficient providers, non-profit agencies, and patients.
  That is why we are introducing the Home Health Payment Fairness Act 
to eliminate the 15 percent reduction. The original budget target for 
home health expenditures from the BBA has already been far exceeded. 
The Congressional Budget Office now estimates that the total home 
health cuts from BBA will total $69 billion in five years. That's more 
than four times what was originally estimated when BBA was passed.
  The Balanced Budget Refinement Act of 1999 contained a provision 
requiring the Secretary of Health and Human Services to report to 
Congress in 2001 on whether the 15 percent reduction is still 
considered necessary. I think the answer is becoming more and more 
clear. We don't need it, and the Home Health Payment Fairness Act is 
designed to stop it.
  Adequate home health care services cannot survive any further 
reductions. Seniors depend on the home health benefit offered by the 
Medicare program, and we must make sure it will be there for them. Once 
again, I want to thank all the cosponsors for giving this legislation 
such broad, bipartisan support. Our seniors are depending on that kind 
of support more than ever before.

[[Page 4679]]


  Mr. REED. Mr. President, I rise today to join Senator Collins, 
Senator Bond, Senator Jeffords and 32 others in introducing the Home 
Health Payment Fairness Act. The intent of this important legislation 
is quite simple--to eliminate the 15 percent reduction in home health 
payments that is scheduled to go into effect in October 2001. Last 
year, Senator Jeffords and I introduced a more broad home health bill, 
called the Preserve Access to Care in the Home, or PATCH Act, which 
among other things, would have eliminated this potentially devastating 
payment reduction. Although we were not able to get this provision 
included in the 1999 Balanced Budget Refinement Act (BBRA), we were 
successful in getting a delay in the implementation of this reduction. 
However, we must see to it that the 15 percent cut is eliminated--and I 
hope we can achieve that goal this year.
  Over the past thirty years, there has been a tremendous shift in the 
location where health care is actually provided. Increasingly, older 
and sicker patients are able to receive care in the comfort of their 
own home, instead of a hospital or nursing home. This incredible change 
can be attributed to four primary causes: greater reliance on 
alternative care settings because of the growing cost of inpatient 
care; technological improvements that have enhanced the capacity to 
provide sophisticated medical treatments in the home setting; the 
growing aging population; and the increasing popularity of home- and 
community-based care as an alternative to the institutional care of a 
nursing home. Indeed, home health care is an integral part of the 
spectrum of long term care.
  As a result, by the mid-1990's the average annual growth rate for 
Medicare home health spending was 5.3%. The 1997 Balanced Budget Act 
(BBA) sought to restrain the unbounded growth in outlays for this 
benefit. Originally, the Congressional Budget Office (CBO) anticipated 
that savings through changes in the benefit would total $16.1 billion 
over five years. In reality, we have saved a total of $19.7 billion in 
just two years, and are expected to reduce outlays by $69 billion over 
the five year period--four times what was originally projected. Not 
surprisingly, since the BBA's enactment, there has been a remarkable 48 
percent decline in Medicare home health expenditures.
  These dramatic reductions have all too often been borne on the backs 
of small, nonprofit home health agencies and the elderly and disabled 
beneficiaries they serve. Home health care agencies in my home state of 
Rhode Island have been especially hard hit by these changes. We have 
seen a significant decline in the number of beneficiaries served and 
access to care for more medically complex patients threatened by these 
cuts. These reductions have clearly had negative impact on patients who 
heavily rely on home health services. In one instance, a woman from 
Pawtucket, Rhode Island had to wait 112 days after being discharged 
from the hospital before getting home health services. In the 
wealthiest nation in the world, this kind of situation is simply 
unacceptable.
  Mr. President, nationally, between 1997 and 1998, the number of 
Medicare beneficiaries receiving home health services has fallen 14 
percent, while the total number of home health visits has fallen by 40 
percent. We have seen a similar trend in Rhode Island, where over 3,000 
fewer beneficiaries are receiving home health care--representing a 
decline of 16 percent--and the total number of visits has fallen 38 
percent. These individuals are either being forced to turn to more 
expensive alternatives, such as institutional-based nursing homes and 
skilled nursing facilities for their care, or these individuals are 
simply going without care, which places an immeasurable burden on the 
family and friends of vulnerable beneficiaries.
  I truly do not believe this is the path we want to remain on when it 
comes to home health care. In light of the impending ``senior boom'' 
that will be hitting our entitlement programs in a few short years, we 
should be doing what we can to preserve and strengthen the Medicare 
home health benefit. We can begin to do this by eliminating the 15 
percent reduction in home health payments. By taking this step, we will 
alleviate an enormous burden that has been looming over financially 
strapped home health agencies and the frail and vulnerable Medicare 
beneficiaries who rely on these critical services.
  I urge my colleagues to join us in enacting legislation that will 
repeal this unnecessary and inappropriate reduction. I look forward to 
working with Senator Collins, Senator Jeffords and my other colleagues 
on this critical issue.
                                 ______
                                 
      By Mr. FRIST (for himself, Mr. Jeffords, Mr. Gregg, Mr. Enzi, Mr. 
        Hutchinson, Ms. Collins, Mr. Brownback, Mr. Hagel, and Mr. 
        Sessions):
  S. 2366. A bill to amend the Public Health Service Act to revise and 
extend provisions relating to the Organ Procurement Transplantation 
Network; to the Committee on Health, Education, Labor, and Pensions.


  the organ procurement and transplantation network amendments act of 
                                  2000

 Mr. FRIST. Mr. President, I ask unanimous consent that the 
text of the bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2366

       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 ``Organ Procurement and 
     Transplantation Network Amendments Act of 2000''.

     SEC. 2. ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK.

       (a) In General.--Section 372 of the Public Health Service 
     Act (42 U.S.C. 274) is amended to read as follows:

     ``SEC. 372. ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK.

       ``(a) Establishment of Network.--
       ``(1) In general.--An Organ Procurement and Transplantation 
     Network (in this section referred to as the `Network' or the 
     `OPTN') is established as a private network and shall operate 
     under this section.
       ``(2) Requirements.--The Network shall--
       ``(A) in accordance with criteria developed under 
     subsection (c)(1)(B), include as members of the Network 
     qualified organ procurement organizations (as described in 
     section 371(b)), transplant centers, and other entities that 
     have a demonstrated interest in the fields of organ donation 
     or transplantation (such members shall be referred to in this 
     section as `Network participants'); and
       ``(B) have a policy board (referred to in this section as 
     the `OPTN Board') that meets the requirements of subsection 
     (b).
       ``(b) OPTN Policy Board.--
       ``(1) Composition.--The OPTN Board shall be composed of not 
     more than 36 voting members to be elected under paragraph (2) 
     and 5 nonvoting, ex officio members appointed under paragraph 
     (3).
       ``(2) Elected members.--
       ``(A) In general.--The voting members of the OPTN Board 
     shall be elected by the members of the Network described in 
     subsection (a)(2)(A), from among the nominees submitted under 
     subparagraph (B), through a fair and open process.
       ``(B) Nominating committee.--The nominating committee 
     established under paragraph (5) shall, prior to each election 
     of OPTN Board members under this paragraph, develop a list of 
     nominees for such election. Such list shall reflect the 
     diversity of Network members described in subsection 
     (a)(2)(A), including factors such as program type and size 
     and geographic location. Recommendations may be submitted to 
     the nominating committee by the Secretary, the members of the 
     Network described in subsection (a)(2)(A), or the general 
     public.
       ``(C) Qualifications.--The OPTN Board shall be composed 
     of--
       ``(i) transplant surgeons and transplant physicians;
       ``(ii) representatives of qualified organ procurement 
     organizations, transplant centers, voluntary health 
     associations, or the general public, including patients 
     awaiting a transplant or transplant recipients or individuals 
     who have donated an organ, or the family members of such 
     patients, recipients or donors; and
       ``(iii) individuals distinguished in the fields of ethics, 
     basic, clinical and health services research, biostatistics, 
     health care policy, or health care economics or financing.
       ``(D) Representation requirement.--The OPTN Board shall be 
     structured to ensure that--
       ``(i) at least 50 but not more than 55 percent of the 
     members elected under this paragraph are transplant surgeons 
     and transplant physicians; and
       ``(ii) at least 20 but not more than 25 percent of the 
     members elected under this paragraph are transplant 
     candidates, transplant recipients, organ donors and family 
     members of such individuals.

[[Page 4680]]

     Nothing in this subparagraph shall be construed to preclude 
     an individual voting member of the OPTN Board from being a 
     representative described in each of clauses (i) and (iii) or 
     (ii) and (iii) of subparagraph (C) so long as the limitation 
     described in clause (i) of this subparagraph is complied 
     with.
       ``(3) Appointed members.--
       ``(A) In general.--The Secretary shall appoint as ex 
     officio, nonvoting members of the OPTN Board, 1 
     representative from each of the following:
       ``(i) The Health Resources and Services Administration.
       ``(ii) The National Institutes of Health.
       ``(iii) The Health Care Financing Administration.
       ``(iv) The Agency for Healthcare Research and Quality.
       ``(B) Network administrator.--The Network Administrator 
     shall appoint an ex officio nonvoting member of the OPTN 
     Board.
       ``(4) Terms of elected members.--
       ``(A) In general.--Except as provided for in this 
     paragraph, members of the OPTN Board elected under paragraph 
     (2) shall serve for a term of 3 years and may be re-elected.
       ``(B) New members.--To ensure the staggered rotation of \1/
     3\ of the elected members of the OPTN Board each year, the 
     initial members of the OPTN Board elected under paragraph (2) 
     shall serve for terms of 1, 2, or 3 years respectively as 
     designated by the nominating committee.
       ``(C) Transition.--Consistent with subsection (c)(3), the 
     voting members of the OPTN Board who are serving on the date 
     of enactment of the Organ Procurement and Transplantation 
     Network Amendments Act of 2000 may continue to serve until 
     the expiration of their terms. Upon such termination, the 
     nominating committee, in submitting nominations to fill such 
     vacancies, shall ensure the staggered rotation of \1/3\ of 
     the members elected under paragraph (2) every 3 years.
       ``(D) Contract status.--A change in the status of a 
     contract under subsection (f), or a change in the contractor, 
     shall not affect the terms of the members of the OPTN Board.
       ``(5) Chairperson and committees.--The OPTN Board shall 
     have a chairperson, an executive committee, a nominating 
     committee, a membership committee, and such other committees 
     as the OPTN Board determines to be appropriate.
       ``(c) General Functions of the OPTN Board.--
       ``(1) Establishment of network policies and criteria.--The 
     OPTN Board shall--
       ``(A) after consultation with Network participants and the 
     Network Administrator, establish and carry out the policies 
     and functions described in this section for the Network;
       ``(B) establish membership criteria for participating in 
     the Network;
       ``(C) establish medical criteria for allocating organs and 
     for listing and de-listing patients on the national lists 
     maintained under paragraph (2); and
       ``(D) establish performance criteria for transplant 
     programs.
       ``(2) National system.--The OPTN Board shall maintain a 
     national system to match organs and individuals who need 
     organ transplants. The national system shall--
       ``(A) have 1 or more lists of individuals who are in need 
     of organ transplants; and
       ``(B) be operated in accordance with Network policies and 
     criteria established under paragraph (1).
       ``(3) No fiduciary responsibility.--The OPTN Board shall 
     have no voting member who has any fiduciary responsibility to 
     the entity that holds the contract provided for under this 
     section.
       ``(4) OPTN board requirements.--The OPTN Board shall 
     cooperate with the Network Administrator to ensure compliance 
     with the requirements of this section including the contract 
     entered into under subsection (f).
       ``(d) Organ Transplant Policy.--The OPTN Board shall 
     establish organ transplant policies, including organ 
     allocation policies for potential organ recipients and 
     policies that affect patient outcomes. Such policies shall--
       ``(1) be based on sound medical principles;
       ``(2) be based on valid scientific data;
       ``(3) be equitable;
       ``(4) seek to achieve the best use of donated organs;
       ``(5) be designed to avoid wasting organs, to avoid futile 
     transplants and reduce the risk of retransplantation, to 
     promote patient access to transplantation, and to promote the 
     efficient management of organ placement;
       ``(6) be specific for each organ type or combination of 
     organ types;
       ``(7) be based on standardized medical criteria for listing 
     and de-listing candidates from organ transplant waiting 
     lists;
       ``(8) determine priority rankings (within categories as 
     appropriate) for candidates who are medically suitable for 
     transplantation, such rankings shall be based on standardized 
     medical criteria and ordered according to medical urgency and 
     medical appropriateness;
       ``(9) seek distribution of organs as appropriate based on 
     paragraphs (1) through (8);
       ``(10) develop and apply appropriate performance 
     indicators, including patient-focused indicators, to assess 
     transplant program performance and reduce inter-transplant 
     program variance to improve program performance; and
       ``(11) seek to reduce disparities in transplantation 
     resulting from socioeconomic status, race, ethnicity, or 
     being medically underserved.
       ``(e) Enforcement of Organ Transplant Policy.--
       ``(1) In general.--
       ``(A) Proposed policy.--This paragraph shall apply to any 
     proposed transplant policy that is developed by the OPTN 
     Board that the Board or the Secretary determines should be 
     enforced under this section or under section 1138 of the 
     Social Security Act.
       ``(B) Submission of policy.--Not later than 60 days prior 
     to the implementation of a proposed policy described in 
     subparagraph (A), the OPTN Board shall submit such proposed 
     policy to the Secretary.
       ``(C) Publication.--Upon receipt of a proposed policy under 
     subparagraph (B), the Secretary shall publish the policy in 
     the Federal Register for a 60-day public comment period.
       ``(D) Action by secretary.--Not later than 90 days after 
     receipt of a proposed policy under subparagraph (B), the 
     Secretary shall consider public comments received under 
     subparagraph (C) and shall--
       ``(i) notify the OPTN Board that the policy is consistent 
     with this section and therefore enforceable; or
       ``(ii) notify the OPTN Board that the policy is 
     inconsistent with this section and direct the Board to 
     reconsider and revise the policy consistent with the 
     recommendations of the Secretary.
       ``(E) Reconsideration.--
       ``(i) In general.--Not later than 30 days after receiving a 
     notice from the Secretary under subparagraph (D)(ii), the 
     OPTN Board shall reaffirm the proposed policy or revise and 
     submit such revised policy to the Secretary.
       ``(ii) Action by secretary.--Not later than 30 days after 
     receiving a revised policy under clause (i), the Secretary 
     shall--

       ``(I) notify the OPTN Board that the revised policy is 
     consistent with this section and therefore enforceable; or
       ``(II) notify the OPTN Board that the revised policy is 
     inconsistent with this section and submit the revised policy, 
     with the comments and proposed revisions of the Secretary, to 
     the Scientific Advisory Committee on Organ Transplantation 
     (referred to in this subsection as the `Committee') 
     established under paragraph (2).

       ``(iii) Action by committee.--Not later than 30 days after 
     the submission of a revised policy to the Committee under 
     clause (ii), the Committee may, by a majority vote, 
     disapprove the comments or revision of the Secretary. If the 
     Committee disapproves such comments or revisions, the revised 
     policy shall not take effect until a majority of the 
     Committee approves the policy or the revisions to such 
     policy.
       ``(2) Scientific advisory committee on organ 
     transplantation.--
       ``(A) Establishment.--The Secretary shall establish an 
     advisory committee to be known as the Scientific Advisory 
     Committee on Organ Transplantation. Consistent with the 
     requirements of sections 5 and 10 of the Federal Advisory 
     Committee Act--
       ``(i) the deliberations of the Committee shall not be 
     inappropriately influenced by the Secretary or by any special 
     interest and shall only be the result of the independent 
     judgment of the Committee; and
       ``(ii) the meetings of the Committee shall be open to the 
     public, advance notice of meetings shall be published in the 
     Federal Register, and records or minutes of meetings shall be 
     made available to the public.
       ``(B) Duties.--The Committee shall make recommendations 
     with respect to policy matters related to reviews conducted 
     under paragraph (1)(E)(ii)(II).
       ``(C) Membership.--The Committee shall be composed of 15 
     members, of which--
       ``(i) five members shall be appointed by the Secretary from 
     nominations submitted by the OPTN Board under subparagraph 
     (D);
       ``(ii) five members shall be appointed by the Secretary 
     from nominations submitted by the Institute of Medicine under 
     subparagraph (D); and
       ``(iii) five members shall be appointed by the Secretary.
       ``(D) Nominations.--The OPTN Board and the Institute of 
     Medicine shall each nominate, in an independent manner, 5 
     qualified individuals to serve on the Committee.
       ``(E) Qualifications.--In appointing individuals to serve 
     on the Committee under subparagraph (C), the Secretary shall 
     ensure that--
       ``(i) nine members are transplant physicians or transplant 
     surgeons of whom--

       ``(I) 3 shall be selected from the nominations submitted by 
     the OPTN Board; and
       ``(II) 3 shall be selected from the nominations submitted 
     by the Institute of Medicine; and

       ``(ii) the remaining members are individuals who are--

       ``(I) distinguished in the fields of ethics, basic, 
     clinical or health services research, biostatistics, or 
     health care policy, economics or financing; or
       ``(II) transplant candidates, transplant recipients, organ 
     donors or family members of such individuals.

[[Page 4681]]

       ``(F) Experts.--The Committee shall seek advice from 
     appropriate experts, as needed, to evaluate the proposed 
     policy and revisions under review.
       ``(G) Chairperson.--The members of the Committee shall 
     elect a member to serve as the chairperson of the Committee.
       ``(H) Terms.--Members of the Committee shall serve for a 
     term of 5 years. Vacancies shall be filled in the same manner 
     as the original appointment was made.
       ``(f) Network Administration and Operation.--The Secretary 
     shall contract with a nonprofit private entity (referred to 
     in this section as the `Network Administrator') for the 
     administration and operation of the Network. The Network 
     Administrator shall administer and operate the OPTN Board in 
     accordance with subsection (b). The Network Administrator 
     shall, pursuant to the policies and criteria established by 
     the OPTN Board--
       ``(1) maintain and operate a national system as established 
     by the OPTN Board to match organs and individuals who need 
     organ transplants;
       ``(2) operate in accordance with medical criteria 
     established by the OPTN Board, and administer the national 
     system established under subsection (c)(2);
       ``(3) maintain 1 or more lists of individuals who need 
     organ transplants as provided for under subsection (c)(2)(A);
       ``(4) maintain a 24-hour communication service to 
     facilitate matching organs with individuals included on the 
     list or lists;
       ``(5) assist organ procurement organizations in obtaining 
     and distributing organs in accordance with the policies 
     established by the OPTN Board;
       ``(6) adopt and use standards of quality for the 
     acquisition and transportation of donated organs, including 
     standards regarding the transmission of infectious diseases;
       ``(7) prepare and distribute, on a regionalized basis (and, 
     to the extent practicable, among regions or on a national 
     basis), samples of blood sera from individuals who are 
     included on the list in order to facilitate matching the 
     compatibility of such individuals with organ donors;
       ``(8) coordinate, as appropriate, the transportation of 
     organs from organ procurement organizations to transplant 
     centers;
       ``(9) provide information to physicians, health care 
     professionals, and the general public regarding organ 
     donation;
       ``(10) carry out studies and demonstration projects for the 
     purpose of improving procedures for organ procurement and 
     allocation; and
       ``(11) work actively with organ procurement organizations, 
     transplant centers, health care providers, and the public to 
     increase the supply of donated organs.
       ``(g) Data Collection, Analysis and Distribution.--
       ``(1) In general.--The Network Administrator shall analyze, 
     maintain, verify, make available and publish timely data to 
     the extent necessary to--
       ``(A) enable the OPTN Board to fulfill its responsibilities 
     under this section;
       ``(B) assess the compliance of members of the Network with 
     performance and other criteria developed pursuant to 
     subsection (c)(1);
       ``(C) evaluate the quality of care provided to transplant 
     candidates and patients generally and in an individual 
     program;
       ``(D) provide data needed by the Scientific Registry 
     maintained pursuant to section 373;
       ``(E) provide transplant candidates and patients, 
     physicians and others with information needed to evaluate or 
     select a transplant program;
       ``(F) provide a member of the Network with data about the 
     member, including results of analysis or other processing of 
     data originally supplied by the member;
       ``(G) enable the OPTN Board, the Network Administrator and 
     the Secretary to fulfill respective enforcement and oversight 
     responsibilities under subsections (j) and (k); and
       ``(H) comply with the requirements under subsection (l).
       ``(2) Types of data.--Data provided under paragraph (1) 
     shall include--
       ``(A) data on transplant candidates, transplant recipients, 
     organ donors, donated organs, and transplant programs; and
       ``(B) as appropriate, data, graft- and patient-survival 
     rates (actual and adjusted to reflect program-specific 
     population disease severity), program specific data, and 
     aggregate data.
       ``(h) Contract.--The contract under subsection (f) shall--
       ``(1) be awarded through a process of competitive bidding 
     as determined by the Secretary; and
       ``(2) be awarded for a period of no longer than 5 years.
       ``(i) Network Membership and Patient Registration Fee.--
       ``(1) In general.--The Network Administrator may assess a 
     fee, to be collected by the Network Administrator, for 
     membership in the Network (to be known as the `Network 
     membership fee'), and for the listing of each potential 
     transplant recipient on the national organ matching system 
     maintained by the Network Administrator (to be known as the 
     `patient registration fee'), in an amount determined under 
     paragraph (2).
       ``(2) Amount.--The amounts of the fees to be assessed under 
     paragraph (1) shall be calculated so as to be--
       ``(A) reasonable and customary; and
       ``(B) sufficient to cover the Network's reasonable costs of 
     operation in accordance with this section.
       ``(3) Annual recalculation.--
       ``(A) In general.--The fees calculated under paragraph (2) 
     shall be annually recalculated, based on--
       ``(i) changes in the level or cost of contract tasks and 
     other activities related to organ procurement and 
     transplantation; and
       ``(ii) changes in expected revenues from contract funds, 
     Network membership fees and patient registration fees 
     available to the Network Administrator.
       ``(B) Procedure.--
       ``(i) Proposal.--The Network Administrator shall submit to 
     the Secretary a written proposal for, and justification of, a 
     recalculated fee under subparagraph (A).
       ``(ii) Determination.--The proposal of the Network 
     Administrator for a recalculated fee under clause (i) shall 
     take effect unless the Secretary, within 60 days of receiving 
     the proposal, provides the Network Administrator with a 
     written determination, with justification, that the proposed 
     fee level does not meet the requirement of subparagraph (A).
       ``(4) Use of fees.--
       ``(A) In general.--All fees collected by the Network 
     Administrator under this subsection shall be available to the 
     Network, without fiscal year limitation, for use in carrying 
     out the functions described in subsection (f).
       ``(B) Restriction.--Fees collected under this subsection 
     may not be used for any activity for which contract funds may 
     not be used under this section.
       ``(5) Rule of construction.--Nothing in this subsection 
     shall be construed as prohibiting the Network Administrator 
     from collecting or accepting other fees, donations or gifts 
     or for using such other fees, donations or gifts to carry out 
     activities other than those authorized under the contract 
     under this section.
       ``(j) Oversight of Network Participants.--
       ``(1) Monitoring.--
       ``(A) In general.--The OPTN Board and the Network 
     Administrator shall, on an ongoing and periodic basis, or as 
     requested by the Secretary, monitor the operations of Network 
     participants to determine whether the participants are 
     maintaining compliance with the criteria and policies 
     established by the OPTN Board.
       ``(B) Procedures.--
       ``(i) Notice.--In monitoring a Network participant under 
     subparagraph (A), the OPTN Board or the Administrator--

       ``(I) shall inform the participant and the Secretary upon 
     initiating a compliance review of a Network participant; and
       ``(II) shall inform the participant and the Secretary of 
     any findings indicating noncompliance by the participant with 
     such criteria and policies.

       ``(ii) Appeals.--The Network Administrator shall establish 
     procedures for appealing noncompliance determinations. Such 
     procedures shall ensure due process and shall allow for 
     corrective action.
       ``(2) Peer review proceedings.--
       ``(A) In general.--The OPTN Board shall establish a peer 
     review system and conditions for the application of peer 
     review requirements to ensure that members of the Network 
     comply with policies and criteria established by the OPTN 
     Board under this section. Such peer review system may include 
     prospective reviews and shall be administered by the Network 
     Administrator and overseen by the OPTN Board.
       ``(B) Policies, review and evaluation.--As part of the peer 
     review system established under subparagraph (A), the OPTN 
     Board shall establish such policies, and the Network 
     Administrator shall conduct such ongoing and periodic reviews 
     and evaluations of members of the Network, as necessary to 
     ensure compliance with the policies and criteria established 
     by the OPTN Board under this section.
       ``(C) Emerging issues.--As part of such peer review system 
     established under subparagraph (A), the OPTN Board shall 
     establish policies to work with and direct the Network 
     Administrator to respond to emerging issues and problems.
       ``(k) Enforcement.--
       ``(1) Recommendations.--The OPTN Board or the Network 
     Administrator shall provide advice, and make recommendations 
     for appropriate action, to the Secretary concerning the 
     results of any reviews or evaluations that, in the opinion of 
     the OPTN Board or the Network Administrator, indicate--
       ``(A) noncompliance by Network participants with--
       ``(i) the policies or criteria established by the OPTN 
     Board; or
       ``(ii) the operating procedures of the Network 
     Administrator; or
       ``(B) a risk to the health of organ transplant patients or 
     to public safety.
       ``(2) Enforcement by network.--
       ``(A) In general.--If the OPTN Board determines that one of 
     the members of the network has violated a requirement 
     established by this section or by the Network, the OPTN Board 
     may impose on the member 1 or more of the sanctions described 
     in subparagraph (B), or may recommend that the Secretary take 
     enforcement action under paragraph (3).

[[Page 4682]]

       ``(B) Types of sanctions.--The sanctions described in this 
     subparagraph may include--
       ``(i) the loss of any or all privileges of membership in 
     good standing in the Network;
       ``(ii) the imposition upon the member of additional or more 
     frequent reviews or evaluations under subsection (j)(1)(A), 
     and assessments of the reasonable costs of such additional or 
     more frequent reviews or evaluations; and
       ``(iii) such other sanctions as the Secretary may permit 
     the OPTN Board to impose.
       ``(3) Enforcement by the secretary.--
       ``(A) In general.--If the Secretary, after consultation 
     with the OPTN Board or Network Administrator, determines that 
     a member of the Network has violated a requirement 
     established by this section or a requirement of a policy that 
     is enforceable under subsection (f), the Secretary may impose 
     on the member 1 or more of the sanctions described in 
     subparagraph (B).
       ``(B) Types of sanctions.--The sanctions described in this 
     subparagraph shall include--
       ``(i) requiring the member to follow a directed plan of 
     correction;
       ``(ii) imposing upon the member a monetary assessment (to 
     be paid to the General Fund of the Treasury) in an amount not 
     to exceed $10,000 for each violation or for each day of 
     violation;
       ``(iii) requiring the member to pay to the Network 
     Administrator the costs of onsite monitoring of the member;
       ``(iv) the loss of any or all privileges of membership in 
     the Network; and
       ``(v) in cases where the violation creates a risk to 
     patient health or to public health, such other action as the 
     Secretary determines to be necessary.
       ``(C) Procedures.--The Secretary shall develop and 
     implement procedures for the imposition of sanctions under 
     clauses (i) through (v) of subparagraph (B). Such procedures 
     shall include--
       ``(i) the provision of reasonable notice to the Network 
     member and the OPTN Board that the Secretary is considering 
     imposing a sanction;
       ``(ii) affording the member a reasonable opportunity to be 
     heard in response to the notice;
       ``(iii) the provision of notice to the member that the 
     Secretary has decided to impose a sanction; and
       ``(iv) the opportunity for the Network member to appeal 
     such sanction.
       ``(l) Annual Report.--
       ``(1) In general.--Not later than September 30 of each 
     year, the Network Administrator shall prepare and submit to 
     the Secretary an annual report on the performance and 
     policies of the Network. The report shall include additional 
     items as specified in the contract under this section or 
     requested in a timely manner by the Secretary.
       ``(2) Requirement of optn board approval.--The OPTN Board 
     shall review and approve the report required under paragraph 
     (1) prior to the submission of such report to the Secretary.
       ``(3) Submission to congress.--
       ``(A) In general.--Not later than December 31 of each year, 
     the Secretary shall transmit the report submitted under 
     paragraph (1) and the comments of the Secretary concerning 
     such report, to the appropriate committees of Congress.
       ``(B) Clarifying information.--The Secretary may, upon the 
     receipt of the report under paragraph (1), but prior to 
     transmission of the report to Congress under subparagraph 
     (A), request that the Network Administrator submit clarifying 
     information or an addenda as needed to fulfill the 
     requirements of this subsection.
       ``(m) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2001 through 
     2005.''.

     SEC. 3. SCIENTIFIC REGISTRY

       Section 373 of the Public Health Service Act (42 U.S.C. 
     274a) is amended to read as follows:

     ``SEC. 373. SCIENTIFIC REGISTRY.

       ``The Secretary shall by contract, develop and maintain a 
     scientific registry of the recipients of organ transplants. 
     The registry shall include information, with respect to organ 
     transplant patients and transplant procedures, as the 
     Secretary determines to be necessary to an ongoing evaluation 
     of the scientific and clinical status of organ 
     transplantation.''.

     SEC. 4. ORGAN DONATION.

       Part H of title III of the Public Health Service Act (42 
     U.S.C. 273 et seq.) is amended--
       (1) by redesignating section 378 (42 U.S.C. 274g) as 
     section 379; and
       (2) by inserting after section 377 (42 U.S.C. 274f) the 
     following:

     ``SEC. 378. ORGAN DONATION AND RESEARCH.

       ``(a) Inter-Agency Task Force on Organ Donation and 
     Research.--
       ``(1) In general.--The Secretary shall establish an inter-
     agency task force on organ donation and research (referred to 
     in this section as the `task force') to improve the 
     coordination and evaluation of--
       ``(A) federally supported or conducted organ donation 
     efforts and policies; and
       ``(B) federally supported or conducted basic, clinical and 
     health services research (including research on preservation 
     techniques and organ rejection and compatibility).
       ``(2) Composition.--The task force shall be composed of--
       ``(A) the Surgeon General, who shall serve as the 
     chairperson;
       ``(B) representatives to be appointed by the Secretary from 
     relevant agencies within the Department of Health and Human 
     Services (including the Health Resources and Services 
     Administration, Health Care Financing Administration, 
     National Institutes of Health, and Agency for Healthcare 
     Research and Quality);
       ``(C) a representative from the Department of 
     Transportation;
       ``(D) a representative from the Department of Defense;
       ``(E) a representative from the Department of Veterans 
     Affairs;
       ``(F) a representative from the Office of Personnel 
     Management; and
       ``(G) representatives of other Federal agencies or 
     departments as determined to be appropriate by the Secretary.
       ``(3) Annual report.--In addition to activities carried out 
     under paragraph (1), the task force shall support the 
     development of the annual report under subsection (d)(2).
       ``(4) Termination.--The task force may be terminated at the 
     discretion of the Secretary following the completion of at 
     least 2 annual reports under subsection (d). Upon such 
     termination, the Secretary shall provide for the on-going 
     coordination of federally supported or conducted organ 
     donation and research activities.
       ``(b) Education.--
       ``(1) Public education and awareness.--The Secretary shall, 
     directly or through grants or contracts, carry out a 
     comprehensive and effective national public education program 
     to increase organ donation, including living donation.
       ``(2) Development of curricula and other education 
     activities.--
       ``(A) In general.--The Secretary shall support the 
     development and dissemination of model curricula to train 
     health care professionals and other appropriate professionals 
     (including religious leaders in the community and law 
     enforcement officials) in issues surrounding organ donation, 
     including methods to approach patients and their families, 
     cultural sensitivities, and other relevant issues.
       ``(B) Health care professionals.--For purposes of 
     subparagraph (A), the term `health care professionals' 
     includes--
       ``(i) medical students, residents and fellows, attending 
     physicians (through continuing medical education courses and 
     other methods), nurses, social workers, and other allied 
     health professionals; and
       ``(ii) hospital- or other health care-facility based 
     chaplains; and
       ``(iii) emergency medical personnel.
       ``(c) Grants.--The Secretary shall award peer-reviewed 
     grants to public and non-profit private entities, including 
     States, to carry out studies and demonstration projects to 
     increase organ donation rates, including living donation. The 
     Secretary shall ensure that activities carried out by 
     grantees under this subsection are evaluated for 
     effectiveness and that such findings are disseminated.
       ``(d) Reports.--
       ``(1) IOM report on best practices.--
       ``(A) In general.--The Secretary shall enter into a 
     contract with the Institute of Medicine to conduct an 
     evaluation of the organ donation practices of organ 
     procurement organizations, States, other countries, and other 
     appropriate organizations that have achieved a higher than 
     average organ donation rate.
       ``(B) Barriers.--In conducting the evaluation under 
     subparagraph (A), the Institute of Medicine shall examine 
     existing barriers to organ donation.
       ``(C) Report.--Not later than 18 months after the date of 
     enactment of this section, the Institute of Medicine shall 
     submit to the Secretary a report concerning the evaluation 
     conducted under this paragraph. Such report shall include 
     recommendations for administrative actions and, if necessary, 
     legislation in order to replicate the best practices 
     identified in the evaluation and to otherwise increase organ 
     donation and procurement rates.
       ``(2) Annual report on donation.--
       ``(A) In general.--Not later than 1 year after the date on 
     which the report is submitted under paragraph (1)(C), and 
     annually thereafter, the Secretary shall prepare and submit 
     to Congress a report concerning federally supported or 
     conducted organ donation and procurement activities, 
     including donation and procurement activities evaluated or 
     conducted under subsection (a) to increase organ donation.
       ``(B) Requirements.--To the extent practicable, each annual 
     report under subparagraph (A) shall--
       ``(i) evaluate the effectiveness of activities, identify 
     best practices, and make recommendations regarding broader 
     adoption of best practices with respect to organ donation and 
     procurement;
       ``(ii) assess organ donation and procurement activities 
     that are recently completed, current or planned.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to

[[Page 4683]]

     carry out this section, $15,000,000 for fiscal year 2001, and 
     such sums as may be necessary for each of fiscal years 2002 
     through 2005.''.
                                 ______
                                 
      By Mr. ABRAHAM (for himself, Mr. Kennedy, Mr. Leahy, Mr. DeWine, 
        Mr. Jeffords, Mr. Akaka, Mr. Graham, and Mr. Inouye):
  S. 2367. A bill to amend the Immigration and Nationality Act to make 
improvements to, and permanently authorize, the visa waiver pilot 
program under the Act; to the Committee on the Judiciary.


               TRAVEL, TOURISM, AND JOBS PRESERVATION ACT

  Mr. ABRAHAM. Mr. President, I rise today to introduce the Travel, 
Tourism, and Jobs Preservation Act. This bill makes the Visa Waiver 
Pilot Program permanent and strengthens the documentation and reporting 
requirements established under the pilot program.
  This legislation is important not only because it facilitates travel 
and tourism in the United States, thereby creating many American jobs, 
but also because it benefits American tourists who wish to travel 
abroad, since visa requirements are generally waived on a reciprocal 
basis.
  The Visa Waiver Pilot Program authorizes the Attorney General to 
waive visa requirements for foreign nationals traveling from certain 
designated countries as temporary visitors for business or pleasure. 
Aliens from the participating countries complete an admission form 
prior to arrival and are admitted to stay for up to 90 days.
  The criteria for being designated as a Visa Waiver country are as 
follows: First, the country must extend reciprocal visa-free travel for 
U.S. citizens. Second, they must have a nonimmigrant refusal rate for 
B-1/B-2 visitor visas at U.S. consulates that is low, averaging less 
than 2 percent the previous two full fiscal years, with the refusal 
rate less than 2.5 percent in either year, or less than 3 percent the 
previous full fiscal year. Third, the countries must have or be in the 
process of developing a machine-readable passport program. Finally, the 
Attorney General must conclude that entry into the Visa Waiver Pilot 
Program will not compromise U.S. law enforcement interests.
  Countries are designated by the Attorney General in consultation with 
the Secretary of State. Nations currently designated as Visa Waiver 
participants are Andorra, Argentina, Australia, Austria, Belgium, 
Brunei, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, 
Japan, Liechtenstein, Luxembourg, Monaco, Netherlands, New Zealand, 
Norway, Portugal, San Marino, Singapore, Slovenia, Spain, Sweden, 
Switzerland, United Kingdom, and Uruguay. Greece has been proposed for 
participation in the program.
  The Visa Waiver Pilot Program was established by law in 1986 and 
became effective in 1988, with 8 countries participating for a period 
of three years. The program has been considered successful and as such 
has been expanded to include 29 participating countries. Since 1986, 
Visa Waiver has been reauthorized on 6 different occasions for periods 
of one, two, or three years at a time.
  The time has come to make the Visa Waiver Pilot Program permanent, 
and, in the process, to strengthen further current requirements. Its 
status is no longer truly experimental. No serious disagreement exists 
that the program should continue in place for the foreseeable future, 
and no significant problems have been raised with the fundamentals of 
how it has been operating for the past 14 years. To the contrary, 
failure to continue the program would cause enormous staffing problems 
at U.S. consulates, which would have to be suddenly increased 
substantially to resume issuance of visitor visas. It would also be 
extremely detrimental to American travelers, who would most certainly 
find that, given reciprocity, they now would be compelled to obtain 
visas to travel to Europe and elsewhere. Finally, there are costs to 
continuing to reauthorize the program on a short-term rather than a 
permanent basis, as it periodically creates considerable uncertainty in 
the United States and around the world about what documents travelers 
planning their foreign travel have to obtain.
  Accordingly, I am today introducing the Travel, Tourism, and Jobs 
Preservation Act. This legislation eliminates the need for frequent 
extensions of Visa Waiver by making the program permanent. I am pleased 
to see that the House bill on Visa Waiver also makes the program 
permanent. Second, the current requirement that countries be in the 
process of developing a program for issuing machine-readable passports 
will be replaced with a stricter requirement that all countries in the 
program as of May 1, 2000 certify by October 1, 2001 that they will 
have an operational machine-readable passport program by 2003 and that 
new countries have a machine-readable passport program in place before 
becoming eligible for designation as a Visa Waiver country. The bill 
also establishes a deadline of October 1, 2008 by which time all 
travelers must have machine-readable passports to come to the United 
States under Visa Waiver. The judgment of everyone involved in these 
issues is that the technology is now sufficient that it is time for 
everyone to move from the concept and planning to the prompt 
implementation of these requirements.
  Finally, under the Travel, Tourism, and Jobs Preservation Act, the 
Attorney General must submit a written report at least once every five 
years evaluating ``the effect of each program country's continued 
designation on the law enforcement and national security interests of 
the United States.'' This will ensure that the operation of the program 
is periodically reviewed. I should note that under current law the 
Attorney General, in consultation with the Secretary of State, may for 
any reason (including national security) refrain from waiving the visa 
requirement in respect to nationals of any country which may otherwise 
qualify for designation or may, at any time, rescind any waiver or 
designation previously granted'' under Visa Waiver.
  I think the additions in the bill strengthen the program while 
preserving the significant job creation benefits Americans gain from 
the Visa Waiver program. International travel generates $95 billion in 
expenditures and created one million U.S. jobs last year, according to 
the Travel Industry Association of America. An estimated half of all 
visitors to the United States enter the country under Visa Waiver.
  I would like to thank my cosponsors Senators Kennedy, Leahy, DeWine, 
Jeffords, Akaka, Graham, and Inouye for supporting this important 
legislation.

                          ____________________