[Congressional Record (Bound Edition), Volume 147 (2001), Part 15]
[Senate]
[Pages 20887-20907]
[From the U.S. Government Publishing Office, www.gpo.gov]



  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
          RELATED AGENCIES APPROPRIATIONS ACT, 2002--Continued

  Mr. REID. Madam President, I ask unanimous consent that the list I 
will send to the desk, once this consent has been granted, be the only 
first-degree amendments to H.R. 3061, the Labor-HHS appropriations 
bill, and that these amendments be subject to relevant second-degree 
amendments.
  Mr. BROWNBACK. Madam President, I object.
  The PRESIDING OFFICER. The objection is heard.
  The Senator from New Mexico.


                           Amendment No. 2020

(Purpose: To provide for equal coverage of mental health benefits with 
respect to health insurance coverage unless comparable limitations are 
               imposed on medical and surgical benefits)

  Mr. DOMENICI. On behalf of myself, Senator Wellstone, and Senator 
Kennedy, I send an amendment to the desk.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The assistant legislative clerk read as follows:

       The Senator from New Mexico (Mr. Domenici), for himself, 
     Mr. Wellstone, and Mr. Kennedy, proposes an amendment 
     numbered 2020.

  Mr. DOMENICI. Madam President, I ask unanimous consent that reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  The PRESIDING OFFICER. The Senator from New Mexico is recognized.
  Mr. DOMENICI. Mr. President, I rise today to offer the Mental Health 
Equitable Treatment Act of 2001 as amendment to the fiscal year 2002 
Labor-HHS bill. I am joined by my friend and partner in this endeavor, 
Senator Wellstone.
  We are well aware of many of the arguments that will be made against 
our amendment. For instance, while the nation is rightly focused on 
recovering from the trauma and damage inflicted on September 11, it 
would be wrong to overlook this important issue because it is simply 
the right course of action to undertake. We are well past the time to 
act on extending and building on the federal mental health parity law 
that expired on September 30.
  Others will argue that our amendment costs too much. However, CBO has 
scored our bill as costing less than one percent 0.9 percent and again 
passing this bill is long overdue and the right thing do for the 
millions of Americans suffering from a mental illness. The number of 
Americans suffering from a mental illness or the number of family 
members affected by a mental illness has not magically decreased over 
the past couple of months.
  We are ready for a vigorous debate on a host of issues, but I would 
like to begin by saying: Our bill has 64 bipartisan cosponsors; the 
HELP Committee reported out the bill on August 1 by a vote of 21-0; 144 
organizations support the bill; and CBO has scored the bill as raising 
insurance premiums by 0.9 percent.
  The human brain is the organ of the mind and like the other organs of 
our body, it is subject to illness. And just as we must treat illnesses 
to our other organs, we must also treat illnesses of the brain.
  Building upon that, I would ask the following question: what if 
thirty years ago our nation had decided to exclude heart disease from 
health insurance coverage? Think about some of the wonderful things we 
would not be doing today like angioplasty, bypasses, and valve 
replacements and the millions of people helped because insurance covers 
these procedures.
  I would submit these medical advances have occurred because insurance 
dollars have followed the patient through the health care system. The 
presence of insurance dollars has provided an enticing incentive to 
treat those individuals suffering from heart disease.
  But sadly, those suffering from a mental illness do not enjoy those 
same benefits of treatment and medical advances because all too often 
insurance discriminates against illnesses of the brain. More often than 
not, opponents of mental health parity argue the costs are too great. 
However, I would submit the cost of parity is negligible, especially, 
when contrasted with the cost impact upon society. The devastating 
consequences inflicted upon not only those suffering from a mental 
illness, but their families, their friends, and their loved ones.
  Furthermore, the following are several additional costs that result 
from mental illness: 16 percent of all individuals incarcerated in 
State and local jails suffer from a mental illness; suicide is 
currently a national public health crisis, with approximately 30,000 
Americans committing suicide every year; of the 850,000 homeless 
individuals in the United States, about one-third or 300,000 of those 
individuals suffer form a serious mental illness; and finally what 
about the people that are crying out for help and society only hears 
their cries after they have committed a violent act against themselves 
or others.
  Just look, at the tragic incidents in Houston with the mother killing 
her five children, the Baptist church in Dallas/Forth Worth, and the 
United States Capitol to see the common link: a severe mental illness. 
Unfortunately, there is no place that a community can take these 
individuals for help. The police can do very little and likewise for 
hospitals.
  Some of you may have seen last year's 4 part series of articles in 
the New York times reviewing the cases of 100 rampage killers.
  Most notably the review found that 48 killers had some kind of formal 
diagnosis for a mental illness, often schizophrenia: 25 of the killers 
had received a diagnose of mental illness before committing their 
crimes; 14 of 24 individuals prescribed psychiatric drugs had stopped 
taking their medication prior to committing their crimes.
  In particular I would point to a couple of passages from the series:

       They give lots of warning and even tell people explicitly 
     what they plan to do.
       . . . a closer look shows that these cases may have more to 
     do with society's lack of knowledge of mental health issues . 
     . . In case after case, family members, teachers and mental 
     health professionals missed or dismissed signs of 
     deterioration.

  Now let us look at the number of individuals suffering from some of 
the dreaded mental illnesses.
  Major depressive disorder: 9.9 million American adults age 18 and 
older suffer from this disorder in a given year;
  Bipolar disorder: 2.3 million American adults age 18 and older suffer 
rrom this disorder in a given year;
  Schizophrenia: 2.2 million American adults age 18 and order suffer 
from this disorder in a given year; and
  Obsessive--compulsive disorder: 3.3 million American adults age 18-54 
suffer from this disorder in a given year.
  However, medical science is in an era where we can accurately 
diagnose mental illnesses and treat those afflicted so they can be 
productive.
  I would ask then, why with facts like these would we not cover these 
individuals and treat their illnesses like any other disease? We should 
not.
  Working together, we took a historic first step with the passage of 
the Mental Health Parity Act of 1996, but that law is also not working 
as intended. While there may be adherence to the letter of the law, 
there are violations of the spirit of the law.
  For instance, ways are being found around the law by placing limits 
on the number of covered hospital days and outpatient visits. 
Consequently, Senator Wellstone and I have again joint forces and 
introduced the Mental Health Equitable Treatment Act of 2001.
  The bill seeks a very simple goal: provide the same mental health 
benefits already enjoyed by Federal employees.

[[Page 20888]]

  The bill is modeled after the mental health benefits provided through 
the Federal Employees Health Benefits Program and expands the Mental 
Health Parity Act of 1996 by prohibiting a groups health plan from 
imposing treatment limitations or financial requirements on the 
coverage of mental health benefits unless comparable limitations are 
imposed on medical and surgical benefits.
  At 2:25 this afternoon, an amendment arrived at the desk. I read off 
the names of the cosponsors, but I did not name the bill. So let me do 
that. This bill is called a mental health parity amendment. Another way 
of talking about it is that it is the mental health parity bill put 
into an amendment form. So we will not have to wait any longer to have 
a national debate as to whether insurance companies in the future--not 
this year but one full year from now is the way we have drafted the 
bill--will or will not be able to insure people against their illnesses 
and/or diseases and provide less coverage for the mentally ill as 
defined in this bill than they do for other well-recognized diseases 
such as cancer, diabetes, whatever they may be.
  That means the thousands upon thousands of American families who have 
young people in their teens with schizophrenia--well diagnosed, they 
are told by the medical people what they have, they are subject to 
treatment, to medication and, yes, a very long life of difficulty if, 
in fact, they do not have medication and treatment facilities in these 
great United States, the last group of Americans who have no health 
insurance because they are defined out of the coverage by the 
conventional approach to what is a disease and an illness and what is 
not. They are left out.
  So if one goes to New York or Chicago or, yes, Albuquerque, and finds 
street people and watches them and looks at them and says, oh, my, what 
are they doing, they will find that fully between 33 percent and 40 
percent are sick. That is why they are there. They are sick and they 
probably have no insurance coverage, even though they are as sick as 
someone's next door neighbor who had a heart attack and is being taken 
care of in the best heart facility at the local hospital, and the 
insurance company pays the bill.
  We have had a history in America of not covering the mentally ill 
under conventional, typical insurance coverage. Quite to the contrary, 
we have sat by and watched insurance companies--obviously they are 
doing the best they can and this is part of their business. They are 
remaining solvent and being able to insure people at the most 
reasonable prices. The insurance companies come along and say: Since we 
are not obligated to do so, we will not cover the mentally ill; or if 
we do, they will be covered with a much smaller total coverage number, 
and everything about the coverage will be less than what we cover for 
people with the ordinary diseases that we so often talk about, 
including the great strides being made in heart disease treatment, 
heart disease research, heart disease care, or any of the other 
diseases we are so free to talk about. Somebody is being taken care of. 
The insurance company is paying the bill. New buildings rise up to 
cover them because they are insured.
  That is a great resource, coming directly from the back of the 
insured to the marketplace, the marketplace of paying for the best 
doctors, of paying for facilities. If somebody can pay for them, you 
are apt to build them.
  What about the mentally ill? The mentally ill have no facilities to 
speak of--just a few--because nobody will pay for them. There are no 
specialty clinics to speak of. There is very little private sector 
involvement in building health facilities where the mentally ill can be 
taken to make sure they take their medicine and are cared for. In the 
ordinary language of the marketplace, there is no money in it. There is 
no money in it because the people are not insured.
  Five plus years ago, my friend Senator Wellstone and I passed the 
first parity bill. It was partial parity. It caused the discrimination 
against the mentally ill under insurance policies to go away partially. 
It just expired. This bill, that is now in amendment form, passed out 
of the committee 21 to 0. A couple of Republican Senators want to offer 
amendments, and I am pleased they can offer them now, this afternoon. 
We tried our best to get the bill called up as a freestanding bill, 
hoping we would be given a day, 2, or 3 days. We could never get it 
done because there were some Senators--and it is their privilege and 
prerogative--who thought that we don't need to mandate coverage, even a 
year and a half from now, as we do here, and we do not need to cover 
the mentally ill that doctors define as having a brain disease and 
should have coverage. Some think their cause of not covering it is 
better served if we never get this bill up.
  I understand what a great imposition this is on the appropriations 
process and on the two wonderful Senators managing this bill, but I 
don't see any other way to do it. There are millions of Americans who 
have worked through their organizations. There are 140 organizations in 
America supporting this legislation. Some have a special interest. Some 
will receive better payment for taking care of the mentally ill. Some, 
such as the National Alliance of the Mentally Ill, understand the 
plight of people with schizophrenia, the plight of people with bipolar 
diseases, the manic-depressive. They understand what parents are going 
through in America.
  These diseases do not always strike the elderly or the young. As a 
matter of fact, one of the most dread of these diseases has a 
propensity for showing itself when our young people are teenagers, 
between the ages of 17 and 18, up to 25 or 30. At this age the disease 
causes a great disability and poses a major problem for care of a son 
or daughter. Across this land thousands of people have already gone 
broke, cashing out every asset they own, trying to take care of their 
child, while America looks on the insurance system and says: We cannot 
tell anybody what kind of insurance they should cover. We cannot tell 
any insurance company what they ought to cover. We take for granted 
that they will cover heart conditions, heart research, they will cover 
any of the other diseases we more or less call ``physical'' diseases. 
On the periphery sits the mentally ill with little or no coverage.
  My good friend, Senator Wellstone, and I have been joined by 65 
Senators. I sent this to the desk at 2:25. This is a very historic 
time. This amendment will pass, if not today, tomorrow. And today we 
will finally have made the Senate vote. I am convinced they will vote 
yes, let's get this started; get rid of this discrimination that has 
festered long enough in terms of the health coverage system of the 
United States. Before the day is out, I believe the number of Senators 
will go up, not down.
  For those frightened for small business, the committee, headed by 
Senator Kennedy, the committee we entrusted with our bill, which has 
the jurisdiction, has the authority to decide to send us a bill or not, 
decided, in order to have great unity and the first time through to get 
Democrats and Republicans on board, they would make an exception for 
small business. Everyone should know, all businesses with 50 employees 
or fewer are exempt; we are not mandating this coverage at this point. 
Small businesses that might be worried about this, or Senators who 
might be worried in their behalf, can read this bill. They will find 
that exemption.
  There is much more to say. Taking this up at the end of the year does 
not do this bill justice. It is a major undertaking by the legislative 
branch of the U.S. Government, led by the Senate. Nonetheless, we are 
going to proceed. To those who procedurally are determined not to let 
us have a straight vote, you will find a few changes in this bill from 
the language that came out of the committee. We wanted to make sure 
this bill was as protected as we could make it from procedural motions 
on the floor. It is not effective until the year 2003. That cures a lot 
of procedural problems some might have had. It is not subject to a 
point of order, a 60-vote point of order, because of that change and 2 
or 3 other changes we made in order to see to it we got a straight up-
or-down vote.
  For the mentally ill, the schizophrenic whose family is desperately

[[Page 20889]]

trying to take care of them, or someone suffering the great delusions 
that are typical, the mammoth delusions that are common for a 
schizophrenic or for the bipolar suffering--for some unknown reason, 
they can be in a very low mood and then as high as they can get, and in 
between the highs and lows is a great inability to live a normal life--
this is the best we can do for those families in America, for those 
millions suffering. We have to offer it today. We have to get the 
Senate to say yes or no on whether coverage by insurance policies is 
part of the normal, everyday coverage for health care, whether or not 
it will include that portion of Americans.
  Obviously, these dread diseases are not typical only to America. In 
any particular area where a group of humans live, there is a certain 
percentage who will turn up with schizophrenia. There is a certain 
group that will turn up with the enormous ups and downs of the bipolar 
disease I described.
  There is also clinical depression, which probably has more victims 
than any other in terms of numbers. What does depression bring, along 
with the other two diseases I mentioned? A total loss of hope; 
suicides, which are growing in numbers, especially among teenagers. 
More times than not when that event occurs, the trail of symptoms 
indicates if they had been treated for depression, it probably would 
not have happened.
  In any event, I am prepared to go on much longer and in much more 
detail.
  For those who want us to delay consideration of this measure, I urge 
you to come down. See if I am correct. I don't think you have a 
parliamentary way of avoiding having the Senate vote. I don't think 
there is a way that you can make it subject to a point of order where 
we will need 60 votes. I don't believe there is a point of order with 
reference to the budgetary impact because we are able to understand in 
advance those kinds of procedural approaches. The bill is no longer 
subject to those kinds of procedural attacks.
  We feel good about it. We would like to spend some time talking about 
the reality of this bill and what it will and won't do.
  I close by saying the last argument that will come from those who 
oppose it is: Can we afford it? I assume they will also say: We are now 
in a recession. So we really can't afford it.
  I just told you it is not effective until 2003. We give everyone time 
to get out of the recession. Besides that, in terms of budgetary 
problems, the best estimate we have, and we will put it in the Record 
shortly, is the Congressional Budget Office saying when fully 
implemented, this may increase the cost of health insurance by nine-
tenths of 1 percent. That is what the Congressional Budget Office says.
  I have given you the small business exemption. I have given you the 
experts' cost. I have given you when it will come into effect. Later on 
we will discuss who is covered by it. That is still something to be 
discussed. Some will want to know whether we made it too broad, whether 
we covered too many people, and whether we covered them in language 
that is so vague so that the disease is not adequately defined. We 
think we have done all of those things.
  We are pleased to engage later in the day with anybody who would like 
to talk about that.
  I yield the floor. I thank Senator Wellstone for his help. We will be 
here this afternoon defending this measure as long as we are needed.
  I yield the floor.
  Mr. WELLSTONE. Madam President, I believe the Senator from 
Pennsylvania wants to speak. I will defer to him. I ask unanimous 
consent that I follow the Senator from Pennsylvania.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SPECTER. Madam President, I compliment my distinguished colleague 
from New Mexico for his diligent work over a very long period of time 
on this very important issue. When he talks about the measure, it is 
Senator Domenici, for himself, Senator Wellstone, and Senator Specter. 
I am second on the cosponsor list on his substantive amendment. When he 
asked me before submitting it whether I would be a cosponsor, I said 
that I wanted to wait and see the discussion.
  The concern that I have is the moving of this appropriations bill. My 
colleague from New Mexico understands that full well. He is on the 
Appropriations Committee and is the chairman of the subcommittee. I 
think it is a bill which ought to be enacted. I believe there ought to 
be mental health parity. The reasons which he has given are very 
persuasive.
  The concern I have is it is legislation on an appropriations bill, 
and the concern as to whether there are tax implications to include 
deductibles, coinsurance, copayments, and catastrophic maximums which 
would provide a basis for a so-called blue slip by the House of 
Representatives. We can handle that in due course. I am going to await 
the arguments.
  I would like to find some way to accommodate this amendment. I am 
just not sure at this point that it is possible. But I wanted to 
express those views at this time. I know the Senator from Minnesota is 
waiting to comment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota is recognized.
  Mr. WELLSTONE. Madam President, I thank my colleague from 
Pennsylvania. I know in discussions with the Senator from Pennsylvania 
and Senator Harkin from Iowa that we can go over all of the points. We 
have made a special effort to deal with it.
  First of all, I thank my colleague, Senator Domenici from New Mexico. 
It has been my honor to have worked with him now for over half a decade 
on this question.
  I believe the Senate will pass this amendment. When we pass this 
amendment, I think it will be viewed favorably by historians. I am not 
trying to be melodramatic.
  There are 67 Senators, Republican and Democrat alike, who support 
this piece of legislation. It passed out of the HELP Committee by a 21-
to-0 vote. There are 150 organizations that support it. There are two 
reasons.
  First of all, this legislation is major civil rights legislation. We 
are coming to November 2001. When this amendment and bill pass, I 
believe we can keep it in conference. We will have passed a major piece 
of civil rights legislation which will say that we will no longer 
permit discrimination against those people who struggle with mental 
illness in our country.
  This legislation says, when it comes to those who are struggling with 
this illness, there will no longer be discrimination. It is modeled 
after the Federal Employees Benefits Plan.
  It basically says there will be the same requirements when it comes 
to deductibles, copays, and days in the hospital and outpatient visits.
  I thank the Senator from Massachusetts as chairman of the HELP 
Committee for helping us get this through the Health Committee on a 21-
to-0 vote. He and his staff have been there throughout all of the 
negotiations and work on this bill.
  I thank Senator Domenici. Next to Senator Domenici, I thank Senator 
Kennedy.
  I think there is going to be an overwhelmingly positive vote because 
it is just wrong for someone who is struggling with this kind of 
illness to be told they are going to have to pay a higher copay, and 
they are going to have to pay a higher deductible. No health insurance 
plan will let them stay a few days in the hospital. No. They can only 
have a certain number of outpatient visits.
  We will not do that with someone who suffers from a heart condition, 
nor to someone who is suffering from diabetes, nor to someone who broke 
their ankle. We don't say to them they are going to be in the hospital 
only 1 day and that is it, or 2 days and that is it. Nor would we 
charge them high copays and deductibles to the point where they can't 
afford it.
  We have to end the discrimination. It is 2001. The time has come for 
this idea.
  The Surgeon General in his report said close to 20 percent of 
American people struggle with this illness and 18 million people 
struggle with depression.
  I have had the honor of working with Al and Mary Kluesner from 
Minnesota.

[[Page 20890]]

They started an organization. It is now a national organization. It is 
called SAVE. Two of their children committed suicide. They have two 
children who are doing spectacularly well.
  Up until very recently, a lot of families, parents, brothers, 
sisters, husbands, and wives blamed themselves when they lost a loved 
one who took their life. There has been this shame. People have blamed 
themselves. But now we know a lot more. Now we know how much of that is 
biochemical. Now we know it can be diagnosed. Now we know it is 
treatable. The success rate for treatment of those who are struggling 
with depression is 80 percent.
  Kay Jamison, a psychiatrist at Johns Hopkins who has tried to take 
her life twice, has written several powerful books. One book is called 
``An Unquiet Mind'' about her own experiences. Just a month ago she 
received the McArthur Award--the genius grant --for her work. She has 
written about the gap between what we know and what we do. It is 
lethal.
  The Kluesners became involved and people all across the country have 
become involved. They no longer will accept the stigma. They no longer 
will accept the discrimination. They have come out of the closet. They 
have come out of the closet to speak for their loved ones because they 
know it is a matter of life or death.
  If we would end the discrimination, we would get the care to people; 
we would save some lives.
  Suicide is the third leading cause of death among young people in our 
country. In Minnesota, it is the second leading cause of death.
  So much of this can be diagnosed. So much of this is preventable. 
That is why this amendment and this legislation is so important.
  It is not just a question of civil rights. It is not just a question 
of saying it is the end of discrimination. It is also a question of 
what we can now do as a nation. Because if our health care plans--
modeled after the plan that we participate in, the Federal Employees 
Health Benefits Plan--say there will be no difference in terms of the 
way we treat this illness versus any physical illness, then, I say to 
Senator Domenici, the care will follow the money. Once the health care 
plans provide the coverage, you will have an infrastructure of care out 
there for people that we do not have right now.
  There will be arguments and counterarguments, and I am ready for all 
of them.
  Let me just make a couple more points because I will be in this 
Chamber for a while with this amendment, and other Senators are in the 
Chamber right now.
  There was a young woman named Anna Westin. Her mom and dad, Kitty and 
Mark Westin, have brought parents together as well. They have brought 
parents together because their daughter--a beautiful young woman--
struggled with anorexia. Same issue: She tried to get coverage from the 
plan. It was the Blue Cross/Blue Shield plan in Minnesota. They could 
not get the coverage for the days in-hospital that she needed to be 
there. They lost their daughter.
  By the way, Blue Cross/Blue Shield has made a settlement with them 
and is going to do much better in terms of providing the coverage. I 
cannot make a one-to-one correlation and say because she did not get 
coverage, therefore, Anna took her life. But I can tell you this: I 
have met with parents, I promise you, all across the country who have 
told me about what it means when they cannot get coverage to take care 
of their children.
  I went down to Houston; and Sheila Jackson-Lee had a hearing she 
wanted to do with me. It dealt with mental health and children. It was 
unbelievable the number of people who came who wanted to speak about 
their desperate story with their own children. At this public hearing, 
the guy who was the head of the corrections system for one of the 
largest counties in the United States of America--I could not believe 
what he said--said: I am a law and order person. Nobody seemed to doubt 
that. And he said: I want to tell you, a lot of people believe that if 
these kids are locked up in our facilities, they have done something 
wrong. He said: I want to tell you--I think the figure he used was 40 
percent--40 percent of these kids, if they had gotten some help, would 
not even be in jail. They should not be locked up. It is the only place 
the parents can get any help for them.
  There was a time when we talked about how we institutionalized 
people, we warehoused people struggling with mental illness--adults and 
children in institutions. Now we are warehousing them in our jails, and 
many people should not be there--many children should not be there.
  So this legislation ends the discrimination for a broad range of 
mental illnesses that affect adults and children.
  This legislation has an exclusion for small business so that 
businesses are not covered unless they have 50 employees or more.
  This bill has been scored by CBO as costing no more than a 1-percent 
increase in premium. Then there is the benefit of what happens when we 
finally end the discrimination and what happens when we finally provide 
the coverage for people.
  We had testimony--my last point because I will have a chance to speak 
later--before the HELP Committee, I say to Senator Kennedy. There were 
a number of people who came in--I wish I could remember all of their 
names: doctors, psychiatrists, social workers--and they were talking 
about the aftermath of September 11. I am not mixing agendas. I am 
being as intellectually honest as I can.
  One woman, who worked with the firefighters, said: I want to tell you 
that given what people have gone through, you are going to have to have 
an infrastructure of mental health care. Her name is Dr. Kerry Kelly. 
She talked about her experiences with her onsite work as chief medical 
officer of the New York Fire Department. She just basically said: Look, 
we are going to need a lot of help for family members. And people have 
been saying that all across the country.
  So, I say to colleagues, please consider this legislation civil 
rights in ending discrimination. Colleagues, please consider this 
legislation as a way of finally providing the care to men, women, and 
children who, if they are provided with the care, can go on and lead 
good, productive lives. And, colleagues, also please consider this 
legislation preparedness legislation. The truth is, no longer, when we 
talk about health care for adults or health care for children, or 
public health, or what we have to do, can we not consider mental health 
part of the cake. It is part of how we deliver humane and dignified and 
affordable health care to people in the country.
  This is about as important a piece of legislation as I think we can 
pass. But, look, I have my biases. I came here as a Senator who has a 
brother who has struggled with this illness all of his life. When I was 
elected in 1990, I thought if there was one thing I would try to do, 
for sure, I would try to end this discrimination in coverage. For sure, 
I wanted to make sure that people were able to get the help they 
needed.
  I have had a chance to work with Senator Domenici for over half a 
decade. And I have had a chance to work with Senator Kennedy for over a 
decade. Now is the moment where we can pass this legislation as a part 
of this bill. And I think we can keep it in conference. This would be a 
huge step forward for our country.
  We need each other as never before. There is an ethic going on in 
this country about the ways we can help one another. I think that is 
all for the good in the most difficult of times. This would be the best 
possible way of living up to this value and this ethic, to adopt this 
amendment with an overwhelming vote.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Johnson). The Senator from Massachusetts.
  Mr. KENNEDY. Mr. President, first of all, I congratulate and thank 
our two leaders in this extremely important bill in the area of health 
policy--Senator Domenici and Senator Wellstone--for ensuring that the 
Senate will have an opportunity to address

[[Page 20891]]

one of the most compelling health care issues we are faced with in our 
society. I thank them for their constant support on this issue over the 
years.
  We have had debates on mental health parity on a number of different 
occasions, but with the shaping and the fashioning of this amendment, 
this really is the moment of truth on this issue. This is the time to 
take action.
  Senator Domenici and Senator Wellstone deserve all of our thanks for 
their leadership and the work they have done. I would also thank those 
who have been a part of the process in helping us develop the 
legislation, the scores of families who came and testified and shared 
some of the great personal challenges they have faced as they have 
dealt with the challenges of mental illness in their families, deserve 
a great deal of credit.
  We express to them that the best way we can ever thank them for being 
willing to share some of the great challenges they have faced over a 
lifetime of care and dedication and commitment--and in a number of 
instances financial ruin--is to have real parity in our health care 
system. This legislation will do that for us.
  I was listening to both of our colleagues and remember so much of the 
similar debate we had back in 1996 on the HIPAA legislation, when both 
Senator Domenici and Senator Wellstone brought these matters to the 
floor of the Senate at that time. A number of our colleagues spoke with 
great passion and great commitment, and we thought we had made a 
substantial downpayment in moving us irrevocably in that direction. 
But, nonetheless, we were not able to do so because there were those 
who were able to find ways of circumventing the legislation and finding 
ways of subverting both the intent and, for me personally, even the 
letter of the law. The Senate voted for it overwhelmingly, Republican 
and Democrats alike.
  Over the years, this body has been somewhat slow in finally 
responding to science rather than ideology. For years, those who were 
challenged mentally were too often put aside in our society and denied 
a position of respect and dignity. They were shunned. They were looked 
down on. They were pitied. They were, in many instances, abused. Their 
lot was not a good one in America.
  Then, more recently, that attitude has changed. I would like to 
believe there has been a new sense of respect for the valuing of 
individuals on the basis of their character rather than, as was used 
with these words, ``the color of their skin'' or their gender or their 
ethnicity or their disability. We have made important progress.
  What we have seen over time is corresponding progress in being able 
to deal with the challenges of mental illness. We have made real 
progress. Now there is really no excuse whatsoever. Now there is no 
reason whatsoever to deny the Senate the opportunity this afternoon to 
move toward true equality and true parity in terms of mental health.
  If we look at some of the mental disorders that are most common in 
terms of challenges to our communities, one is bipolar disorder, 
another is depression. Compare those to the physical disorders of 
hypertension and diabetes, common illnesses, common challenges we face; 
you find that the treatment success rates for these chronic diseases of 
bipolar disorder and depression far exceed those for hypertension and 
diabetes. This is true across the board. Not everyone understands it; 
not everyone believes it. But increasingly, the medical information and 
testimony and results indicate that mental illness is treatable. It is 
such a statement of hope for families to know that, if they get the 
appropriate treatment, they can free the individuals facing these 
challenges from some of the torments they are facing in the course of 
their lives. We have made enormous strides. We are making enormous 
strides.
  Our two colleagues share my belief that we are at the time of the 
light science century--with the mapping of the DNA, stem cell research, 
and all sorts of recent exciting medical breakthroughs. We view the 
opportunities for continued progress in this area, such as in the year 
of the brain, where we have had very profound research and discoveries 
on what impacts thought process in people's minds. We have made 
enormous progress, not only in understanding but also in dealing with 
these issues.
  The question is, why not have parity? It is so compelling and so 
necessary.
  I will digress for a moment and thank our colleagues for bringing 
this to our attention at this time in our country's history. All of us 
still are sensing the powerful emotions we felt on September 11. We 
know anxiety still exists for so many families, not only as a result of 
the particular enormous tragedy that was so devastating to so many 
families but also its impact on our Nation as a whole and, more 
recently, the challenges we are facing in terms of the dangers of 
Anthrax. We know it has only directly affected some 15 of our fellow 
citizens, but we know that the fear and the anxiety among our fellow 
citizens is significant.
  I dare say, this anxiety has impacted no group more than the children 
of our country. They are feeling this enormous anxiety. They are 
feeling it not only as a result of September 11; they are also feeling 
it with regard to the threats of Anthrax and the whole threat of 
bioterrorism. There is a lot of anxiety in America today.
  We don't expect this bill to solve all of the problems, but what it 
will do is give the stamp of the U.S. Senate. Any fair review in the 
reading of the record is going to reflect very clearly that there are 
ways of providing assistance to those who need the attention and the 
care and the guidance and the support and the treatments that are out 
there for American families.
  The most obvious ones are those that have been involved in the 
current rescue efforts at ground zero and their families. Having had an 
opportunity the other evening to talk to the head of the firefighters 
union and to listen to him for a short period of time, I could already 
see that the challenges that are going to be faced by so many of the 
families involved are going to be severe.
  We know that challenges still exists. We know now in recent years 
enormous progress has been made in understanding the very challenge of 
mental illness and mental disease. We know extraordinary progress has 
been made.
  The only reason for not accepting this amendment may be the issue of 
cost. It always comes around to the issue of cost. At least it comes 
around so often by those who want to resist legislation.
  That argument does not stand up in this case. We have experience in a 
number of the States on this issue. In our committee, this was raised 
as an issue. And we agreed to raise the exemption from companies with 
25 employees or less up to companies of 50 employees or less. That 
means approximately half of all working families in this country will 
effectively be covered, but there will still be many others left out. I 
regret that, quite frankly. But I am satisfied that if we get this in 
place and we have the results that I know will come, we will be right 
back in a very short period to extend the exemption from employers of 
less than 50 down to 25.
  The fact is, 23 States have passed parity laws. There is absolutely 
no evidence that any of them have experienced any significant increase 
in costs. We know that now as fact. We are not dealing with theories, 
estimates, or judgments by those who are opposed to it. We are dealing 
with facts. The facts are as I have stated; there has not been a 
significant increase in cost.
  The Senators from New Mexico and Minnesota would agree with me that 
with an effective program providing mental health parity, you are 
probably going to see a reduction in the cost of health care because 
when you treat the mental health challenges and the illnesses for 
individuals, more often than not, it has a very positive impact in 
terms of other physical disabilities.
  Those studies have been presented before our committee, and I am 
absolutely convinced that even though this is going to provide 
additional kinds of treatment for individuals who need it, the overall 
bottom line is going to be savings in health care expenditures. We

[[Page 20892]]

have seen examples of it. I won't take the Senate's time right now to 
go into those studies, but a very compelling case has been made.
  If you think back to it logically, you will see the reasons for it. 
The first reason is to assist families and individuals by increasing 
the nation's capability to provide mental health services to Americans 
who need it. It is a grave mark on our national consciousness if we 
have the ability to assist these families and we do not do so. This 
legislation will ensure that we are going to do it.
  Secondly, with the progress that has been made with these 
breakthrough treatments and medicines, we have the chance to make a 
important difference to our fellow citizens in their lives and the 
lives of their families and to have an enormous positive impact on our 
fellow citizens.
  Finally, this is not going to be an additional burden in terms of 
cost. This is a compelling case. It has been made eloquently and 
passionately by two of those who have given their commitments and the 
force of their arguments--Senators Domenici and Wellstone. They have 
made this case time in and time out. It is time for the Senate to act. 
It is essential that we act, and I hope this will pass overwhelmingly.
  The PRESIDING OFFICER. The Senator from Nevada is recognized.
  Mr. REID. Mr. President, I am happy to be a cosponsor of this 
amendment.
  First of all, I wish to express my gratitude for the leadership shown 
by Senator Wellstone and Senator Domenici. They brought to the Senate, 
with this unique partnership they have formed, something that will be 
long remembered. They are from different political parties, two 
individuals with different views on almost everything in political 
life. In the last 6 or 7 years in the Senate, they have brought 
together something that has been very dynamic. As a result of their 
leadership, laws have been changed in this country, attitudes have been 
changed in this country, and the entire United States owes a debt of 
gratitude to these two men.
  We have all had experiences with diseases where we may have said, 
yes, my cousin, my brother, my father, or my neighbor had this same 
disease--whether it is cancer, heart disease, whatever the condition--a 
medical problem with which we have all had experience. If we are honest 
with ourselves--and we are becoming so--if we talk about mental 
illness, it is the same thing.
  How many of us have relatives who have clinical depression? Lots of 
us. How many know of members of our families who have bipolar 
disorders? That is a relatively new term but something we understand. 
The same applies--whether it is cancer or heart disease, it applies to 
this.
  I have been stunned by how many people have been affected by a 
suicide. It is no secret in this body that my father committed suicide. 
It is no secret that it took a long time for me to acknowledge it 
publicly and talk about my father's death. But since I have, every 
place I go, people come to me and relate stories. For example, I was at 
a TV interview in Las Vegas. One of the anchors who did the interview 
said: May I speak to you afterward? I said sure, and I waited. Her 
brother committed suicide. Every place I go, people come up to me and 
say their mother, father, brother, or sister committed suicide. We know 
at least 31,000 people each year kill themselves. There are really more 
because there are automobile accidents and other kinds of ``accidents'' 
that are not counted, but they are suicides.
  Many people deny that their loved ones have committed suicide. I try 
to have them be as forthcoming as I should have been many years ago 
about my father. It affects us all.
  That is what this amendment is all about--parity, making sure that 
heart disease is treated no differently than depression that leads to 
suicide.
  There is a tendency of some to think these problems are identifiable 
at a given age. Well, the sad reality of it is that mental illness 
doesn't appear at any certain age. Children have mental disorders, 
mental problems. Teenagers develop them. People in their twenties and 
thirties have them.
  Here are two examples. There is a woman I have gotten to know in 
Washington--a 78-year-old widow. She is a very pretty woman. Her 
husband was extremely well educated. She has two sons. They both were 
happy, with good jobs, in good professions. While in their forties, 
they developed mental illness--both of them. Now she cares for her two 
sons. She is 78 years old. I visit her at least once a month. Some 
months they are in better shape than in other months. They are under 
medication and treatment. But it has affected her life dramatically.
  I often wonder what is going to happen. In fact, I don't know about 
the one son. One, I know, was happily married with children before he 
got sick. Now he is divorced. I often wonder what is going to happen to 
these men after this woman passes away.
  Another example is somebody I knew who was a great athlete in high 
school, a high school all-American, college all-American, a 
professional athlete. I wonder what happened to him. All of a sudden, I 
didn't see him on the roster and wondered what happened to him. He is 
in an institution--a mental institution. Who would ever guess it? I 
will not mention his name. Who would ever guess he would have been in a 
mental institution--this fantastic athlete, tough, hard, and so good. 
He is in a mental institution.
  I recognize that there needs to be more done so that we accept mental 
illness more. That is what this legislation is all about. That is what 
mental parity is. That is the name these two men--Senators Wellstone 
and Domenici came up with, ``mental parity,'' or mental fairness, to 
treat diseases the same, whether it is heart trouble or depression.
  We are doing better than we were. One reason we are doing better, in 
my opinion--the one to which I have devoted so much time, suicide--is 
we have a man who is the Surgeon General who is a tremendous person. 
All we had to do was talk to him about suicide and he knew something 
had to be done. Dr. Satcher has worked tirelessly, since he became 
Surgeon General, to bring about change. He has worked with us to make 
sure there was money to study the causes of suicide. We don't know why 
people commit suicide.
  You would think the suicide would be in States--and I say this 
without any denigration whatsoever--where it is dark and cold in the 
wintertime, such as North Dakota, Minnesota, South Dakota, these cold 
States, but it is not.
  It is not. Suicide is west of the Mississippi, in States where the 
Sun shines a lot, wide open plains and places for people to get 
outdoors. The 10 leading States in suicide are west of the Mississippi. 
We do not know why, but we are studying why, and we hope to learn more.
  In the Senate, we have passed resolutions recognizing the problems 
with suicide. We are appropriating some money now. We are doing better.
  To show this is a serious problem, I have a statement that indicates 
that a telephone survey conducted by the Pew Research Center of the 
people and the press a few days after the attacks on September 11 found 
that 71 percent of respondents reported being depressed, 49 percent 
said they had difficulty concentrating, and 33 percent reported 
insomnia.
  We have all talked to our friends and relatives who after this attack 
are having trouble sleeping. For the first time these people are having 
trouble sleeping.
  In another study conducted 3 weeks after the attacks, respondents 
said they were depressed, and 20 percent 3 weeks after of the events 
said they were having trouble sleeping.
  There should be full parity for mental illness. We have to make sure, 
as has been discussed today, that companies, businesses, and government 
do not try to figure out some way to get around this. They should not 
do that. It is the intent of this amendment that people with mental 
illness be treated as well, as fairly, and as equally as people with 
medical illnesses. That is the purpose of this legislation.
  If, in some subsequent time, someone is trying to figure out the 
congressional intent, the intent of this is to have mental parity, to 
have people who

[[Page 20893]]

have mental illness treated the same as people with a medical illness.
  Again, I express my appreciation to the people who have us talking 
about this issue, Senator Wellstone and Senator Domenici. But for their 
advocacy, we would not be here today and we would not have been doing 
things in the past 5 years. It is because of them we are considering 
this amendment. I am personally indebted to them for the work they have 
done to help those with no voice, to help those with no lobbyists, to 
help those who cannot help themselves.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Mr. President, I ask unanimous consent to be added as a 
cosponsor of the amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. STABENOW. Mr. President, I am proud to be a cosponsor of the 
legislation and to add my name to this amendment. I join with others 
who have thanked Senator Domenici and Senator Wellstone for their 
diligence and dedication on what is an extremely important issue. It is 
extremely important to all of our families.
  I have been involved with mental health issues all of my adult life, 
starting when I was in the State House of Representatives in Michigan 
chairing the Mental Health Committee and writing legislation we have in 
place in Michigan for children, families, and adults. But today I rise 
in support of this amendment because of my personal situation.
  My father, who was an extremely loving and wonderful man, a 
businessman in business with my grandfather in a car dealership in Eau 
Claire, MI, when I was growing up, in his mid-thirties found himself 
being diagnosed a manic-depressive. At first, we did not know what that 
meant in terms of the highs and lows he was experiencing.
  At that time--it was the midsixties--there was very little available 
in the community. It mostly was hospitalization for anyone who had any 
kind of mental health problems. We did not have a lot of money. Our 
family was not a wealthy family, and we struggled with attempts to get 
my father adequate care.
  One of the things we learned as we moved through this disease with 
him was that mental illness is as physical as any disease that is now 
covered by our insurance system. If you are a manic-depressive, that 
means you have chemicals in your brain that are off balance. They 
provide too much of a stimulus that causes one to be awake, to go into 
a manic state; it causes then too less of a stimulus, so one goes into 
a depression and they may swing back and forth.
  Just as we have now developed medicines to help those who have cancer 
and diabetes or those who have Parkinson's or Alzheimer's disease--and 
we are moving on all kinds of fronts to develop new medications--we 
have medicine now for those who are diagnosed manic-depressive.
  When my father was finally able to find someone who understood his 
disease, there was something developed called Lithium, and he had the 
opportunity to begin taking that medication each month. He was able to 
go back to his normal life. He was able to work and function and be a 
part of the community because this was a physiological disease that was 
treatable by medication.
  We know, whether it is schizophrenia, manic-depression, or other 
diseases, that we are talking about imbalances in the brain. These are 
physiological changes. These are health problems, as much of a health 
problem as diseases that are covered by insurance.
  I cannot think of anything more basic than finally, in 2001, 
understanding in our health insurance system what we have now known in 
the medical community for years, and that is: If we provide treatment, 
we can treat those with mental illnesses as well as physical illnesses 
with great success.
  My colleagues have spoken to the fact if we do not do that, we will 
treat them in our jails, we will treat folks who are homeless and under 
the bridges sleeping at night. There will be some way that those who 
have mental illnesses will find themselves in situations where they 
will be reaching out, and we will be addressing it in some way in the 
community. The question is, do we do it in a positive way in the health 
care system where it needs to be addressed or will we be addressing it 
in some other way that is not positive?
  I hope we will all come together. It would be wonderful to see 
everyone coming to the Chamber and supporting this long overdue 
amendment on mental health parity. I hope my colleagues understand this 
has been worked out. This is a bill that has been balanced. For those 
concerned about small business, this is legislation addresses those 
companies with less than 50 employees being exempt, that there is a 
year delay--there is a lot that has been put together in this 
amendment.
  I compliment my colleagues who have worked so hard to come up with a 
balanced approach and yet proceed with the principle of mental health 
parity. In this day and age, shame on us if we do not understand the 
variety of ways in which someone can become ill and require our health 
system to address those equally. It is long overdue. I strongly urge 
adoption of this amendment.
  I again thank my colleagues who have come forward and have fought so 
diligently for this principle for so many years.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, I say to the Senator before she leaves 
the Chamber, I thank her very much for her remarks. I have been very 
amazed in the 5 or 6 years I have been involved with mental illness 
issues as it pertains to Federal policy, as it pertains to State law, 
the more I go out and meet people, whether it is in a townhall meeting 
where a lot of people from all walks of life come, or whether it is a 
special event where somebody is being honored and there is a lot of 
glitter around, or even if you go to New York for some kind of event 
and you are meeting the people of swank New York, wherever and 
whenever, you always have more than one person walk up and tell you 
about their family--schizophrenia, manic depression, clearly 
depression, especially among young people, always somebody brings that 
up.
  To be honest, it is so common as an illness that it is hard for this 
Senator to believe we are in this year, 2001, still letting people 
write insurance policies and act as if heart conditions and all the 
research that goes with it should be covered, even build hospital 
clinics because insurance companies are so willing to pay because that 
insurer carries all of his resources on his back and builds new 
hospitals, builds new clinics, builds new techniques, builds more 
research, but all of these people who walk up to us and tell us their 
story, there is no money, there is no coverage.
  Some people will take that as this is a big philosophical difference. 
They would say to Senator Domenici on the Republican side, why do you 
want to tell anybody what to do? Why do you want to tell insurance 
companies what to do?
  Frankly, I think when we started this process of what will insurance 
companies cover and what they will not, I asked a question of those who 
think this is philosophical: What if we would have said a heart 
condition is not covered by insurance. Why? Because the heart is part 
physical and it is part spiritual, and we do not know enough about it 
so let us not cover it.
  What do you think we would be doing today? Do you think we would get 
to 2001 in American chronology and we would still be having insurance 
companies say they are not covering heart conditions because 41 years 
ago they should not have covered heart conditions because, after all, 
it is part spirit and part physical?
  Those who oppose this legislation want to leave the millions of 
Americans with severe mental illnesses right where they have been for 
decades. They do not want to acknowledge there is treatment, that it is 
costly, that one can get well, and that it is defined as

[[Page 20894]]

brain disease in many parts of the medical community.
  It is not something that is unlike any other illness. It is very much 
like a lot of illnesses. It has a huge number of qualities that are the 
same as mental illnesses that we are so concerned about that we would 
not let an insurance company get by without covering them to the 
maximum. We would have them here and we would be citing them for some 
kind of contempt of America if they did that, I would think.
  So when the Senator from Michigan joins us and tells us the real 
facts, it begins to show signs that the message is getting through.
  Let me give one more example. When President Kennedy was the 
President, we were engaged in a very serious national effort with the 
severely mentally ill who were locked in cages. We could tell a whole 
story about that terrible part of American health care. As an ironic 
situation, I might say they are no longer locked in cages as they were. 
At that point in history, we decided that could not be done, they had 
to be let out.
  Now more of the seriously mentally ill are in jails in America than 
they are in hospitals. They are not in the cages. They are in jails 
because there is no place else to put them. They are getting arrested 
for malfeasance, most of it small. When it gets to the big crimes, we 
have a national argument about whether or not they are mentally insane 
when they commit mass murder.
  In any event, the reality of it is we decided way back then that we 
were going to treat the mentally ill differently. But what we thought 
would happen was that across America there would be clinics, there 
would be facilities built that would let the doctors treat the mentally 
ill in a modern, hospitable, decent manner, not in the dungeons of the 
past.
  Guess what happened. Nobody put up any money. Now one would say: 
Well, who should put up money? Either the Government ought to pay for 
some facilities or there ought to be some coverage if it is an illness 
so that the insurance companies would pay for it based upon it being 
carried by the mentally ill person. When they get sick, the insurance 
comes into play. With that, the private sector may build many 
facilities for the mentally ill. It is not going to happen until we do 
that.
  I thank the Senator so much for her remarks today. They were right 
on, from this Senator's standpoint, and very relevant.
  Ms. STABENOW. Will my friend yield?
  Mr. DOMENICI. I yield.
  Ms. STABENOW. One more time, I thank the Senator from New Mexico for 
his commitment on this issue and the way he is able to explain the 
importance of it.
  I stress, along with the Senator, if we had private insurance 
coverage, then the facilities would be there. They would know there is 
a way for this to be paid for and, in fact, as we do with other kinds 
of health insurance, the hospitals would know there is a reimbursement 
system, the physicians would know there is a reimbursement system, and 
they would know as well there would be for these mental illnesses.
  I thank the Senator for his wonderful commitment and leadership, as 
well as Senator Wellstone. I am hopeful we can move forward and that 
this can truly be a historic day.
  Mr. DOMENICI. I send to the desk a list of cosponsors. There were 65, 
plus the Senator from Minnesota and the Senator from New Mexico.
  The PRESIDING OFFICER. The cosponsors will be added to the amendment.
  The list is as follows:

                               Cosponsors

       Wellstone, Kennedy, Reid, Stabenow, Akaka, Baucus, Bayh, 
     Bennett, Biden and Bingaman.
       Boxer, Breaux, Byrd, Cantwell, Carnahan, Carper, Chafee, 
     Cleland, Clinton, Cochran and Collins.
       Conrad, Corzine, Daschle, Dayton, DeWine, Dodd, Dorgan, 
     Durbin, Edwards, Feinstein and Frist.
       Graham, Grassley, Harkin, Hatch, Hollings, Inouye, 
     Jeffords, Johnson, Kerry, Kohl and Landrieu.
       Leahy, Levin, Lieberman, Lincoln, Lugar, Mikulski, Miller, 
     Murray, Nelson (FL), Reed and Roberts.
       Rockefeller, Sarbanes, Schumer, Shelby, Snowe, Specter, 
     Thomas, Torricelli, Warner, Wyden and Stevens.

  Mr. DOMENICI. There are 154 organizations that indicate the time has 
come when we ought to do this, and I ask unanimous consent that this 
list of organizations be printed in the Record at this point.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  154 Organizations Supporting S. 543, The Domenici-Wellstone Mental 
                 Health Equitable Treatment Act of 2001

       Alliance for Children and Families, American Academy of 
     Child and Adolescent Psychiatry, American Academy of Family 
     Physicians, American Academy of Neurology, American Academy 
     of Pediatrics, American Academy of Physical Medicine and 
     Rehabilitation, American Academy of Physician Assistants, 
     American Academy for Geriatric Psychiatry, American 
     Association for Marriage and Family Therapy, and the American 
     Association for Psychosocial Rehabilitation.
       American Association of Children's Residential Centers, 
     American Association of Pastoral Counselors, American 
     Association of School Administrators, American Association of 
     Suicidology, American Association on Mental Retardation, 
     American Board of Examiners in Clinical Social Work, American 
     Congress of Community Supports and Employment Services 
     (ACCSES), American Counseling Association, American Family 
     Foundation, and the American Federation of State, County and 
     Municipal Employees.
       American Federation of Teachers, American Foundation for 
     Suicide Prevention, American Group Psychotherapy Association, 
     American Hospital Association, American Jail Association, 
     American Managed Behavioral Healthcare Association (AMBHA), 
     American Medical Association, American Medical Rehabilitation 
     Providers Association, American Mental Health Counselors 
     Association, and the American Music Therapy Association.
       American Network of Community Options and Resources, 
     American Nurses Association, American Occupational Therapy 
     Association, American Orthopsychiatric Association, American 
     Osteopathic Association, American Political Science 
     Association, American Psychiatric Association, American 
     Psychiatric Nurses Association, American Psychoanalytic 
     Association, and the American Psychological Association.
       American Public Health Association, American School 
     Counselor Association, American School Health Association, 
     American Society of Clinical Pharmacology, American 
     Therapeutic Recreation Association, American Thoracic 
     Society, America's HealthTogether, Anxiety Disorders 
     Association of America, Association for the Advancement of 
     Psychology, and the Association for Ambultory Behavioral 
     Healthcare.
       Association for Clinical Pastoral Education, Inc., 
     Association of Jewish Aging Services, Association of Jewish 
     Family & Children's Agencies, Association of Maternal and 
     Child Health Programs, Bazelon Center for Mental Health Law, 
     Catholic Charities USA, Center for Women Policy Studies, 
     Center on Disability and Health, Center on Juvenile and 
     Criminal Justice, and the Central Conference of American 
     Rabbis.
       Children and Adults with Attention-Deficit/Hyperactivity 
     Disorder, Childrens' Defense Fund, Child Welfare League of 
     America, Christopher Reeve Paralysis Foundation, Clinical 
     Social Work Federation, Commission on Social Action of Reform 
     Judaism, Corporation for the Advancement of Psychiatry, 
     Council for Exceptional Children, Council on Social Work 
     Education, and Dads and Daughters.
       Disability Rights Education and Defense Fund, Inc., 
     Division for Learning Disabilities (DLD) of the Council for 
     Exceptional Children, Easter Seals, Eating Disorders 
     Coalition for Research, Policy & Action, Employee Assistance 
     Professionals Association, Epilepsy Foundation, Evangelical 
     Lutheran Church in America Lutheran Ofc. for Governmental 
     Affairs, Families for Depression Awareness, Families U.S.A, 
     Family Violence Prevention Fund, Family Voices, and the 
     Federation of American Hospitals.
       Federation of Behavioral, Psychological & Cognitive 
     Sciences, Federation of Families for Children's Mental 
     Health, Friends Committee on National Legislation (Quaker), 
     Inclusion Research Institute, International Association of 
     Jewish Vocational Services, International Association of 
     Psychosocial Rehabilitation Services, International Community 
     Corrections Association, International Dyslexia Association, 
     Jewish Federation of Metropolitan Chicago, and Kids Project.
       Learning Disabilities Association of America, MentalHealth 
     AMERICA, Inc., NAADAC, The Association for Addiction 
     Professionals, National Association for the Advancement of 
     Colored People (NAACP), National Association for the 
     Advancement of Orthotics & Prosthetics, National Association 
     for Rural Mental Health, National Association of Anorexia 
     Nervosa and Associated Disorders--

[[Page 20895]]

     ANAD, National Association of Children's Hospitals, and the 
     National Association of Counties.
       National Association of County Behavioral Health Directors, 
     National Association of Developmental Disabilities Councils, 
     National Association of Mental Health Planning & Advisory 
     Councils, National Association of Protection and Advocacy 
     Systems, National Association of Psychiatric Health Systems, 
     National Association of Psychiatric Treatment Centers for 
     Children, National Association of School Nurses, National 
     Association of School Psychologists, National Association of 
     Social Workers, and the National Association of State 
     Directors of Special Education.
       National Association of State Mental Health Program 
     Directors, National Center on Institutions and Alternatives, 
     National Coalition Against Domestic Violence, National 
     Coalition for the Homeless, National Committee to Protect 
     Social Security and Medicare, National Council for Community 
     Behavioral Healthcare, National Council on Suicide 
     Prevention, National Depressive and Manic-Depressive 
     Association, National Down Syndrome Congress, and the 
     National Education Association.
       National Foundation for Depressive Illness, National Health 
     Council, National Hopeline Network, National Law Center on 
     Homelessness & Poverty, National Mental Health Association, 
     National Mental Health Awareness Campaign, National Multiple 
     Sclerosis Society, National Network for Youth, National 
     Organization of People of Color Against Suicide, and the 
     National Partnership for Women and Families.
       National PTA, National Therapeutic Recreation Society, NISH 
     (National Industries for the Severely Handicapped), 
     Presbyterian Church (USA), Washington Office, Samaritans of 
     The Capital District, Inc. Suicide Prevention Center, School 
     Social Work Association of America, Service Employees 
     International Union, Shaken Baby Alliance, Society for 
     Personality Assessment, and the Society for Public Health 
     Education.
       Suicide Awareness Voice of Education, Suicide Prevention 
     Advocacy Network, The Arc of the United States, Tourette 
     Syndrome Association, Unitarian Universalist Association of 
     Congregationalists, United Cerebral Palsy Association, United 
     Church of Christ, Justice and Witness Ministry, United Jewish 
     Communities, Volunteers of America, Yellow Ribbon Suicide 
     Prevention Program, and the Youth Law Center.

  Mr. STEVENS. Will the Senator yield?
  Mr. DOMENICI. I am pleased to yield to the Senator.
  Mr. STEVENS. Mr. President, I ask the Senator from New Mexico if this 
has been scored by the Office of Management and Budget?
  Mr. DOMENICI. Yes, it has.
  Mr. STEVENS. What would be its impact on fiscal year 2002?
  Mr. DOMENICI. No impact on the year 2002. We have made the bill 
operative and effective in 2003.
  Mr. STEVENS. Mr. President, I want to confer with the distinguished 
chairman of our committee, but we reached a firm agreement we would not 
exceed 686 for this year, and I do not know how that impacts taking on 
a bill that will start impacting 2003. What would be the impact in 
2003?
  Mr. DOMENICI. Over $150 million a year. We knew of the agreement and 
the binding nature of our agreement, and I felt bound by it in terms of 
how much money for 2002, and I think that is literally for 2002 but not 
2003, 2004, or 2005. So we changed the effective date to 2003 in the 
amendment before it was sent to the desk.
  Mr. STEVENS. I must express my reservation until we reach an 
understanding about how this will impact the agreement we made with the 
Office of Management and Budget and with the House on this bill. It 
does add outyear expenditures, as I understand it. The Senator has 
indicated it does not impact 2002. I reserve judgment on this 
amendment.
  I am a cosponsor of it. I think the bill itself is a worthy bill, and 
it basically is an entitlement program. It is not an appropriation, as 
I understand it.
  Mr. DOMENICI. The Senator asked me a question, and I want to answer 
this way: Frankly, most of this bill is going to be taken care of by 
insurance companies paying insurance bills, but there is some U.S. 
Government responsibility because it reduces the receipts in certain 
areas that would have otherwise come in because of the overall costs. 
We knew in 2002 it was subject to a point of order because, in fact, 
there is a cap in 2002. There is no cap for 2003 and the years beyond, 
and for that reason we do not believe a point of order lies in the 
outyears, nor do we think anybody is bound to reduce appropriations by 
that amount in the outyears.
  We are prepared at some point to exchange serious discussions, if 
anyone wants to do it, on this issue.
  I yield my time, and I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. WELLSTONE. Mr. President, I, too, thank the Senator from 
Michigan.
  Mr. WELLSTONE. Above and beyond the National Mental Health 
Association and the National Alliance for the Mentally Ill, there is a 
Fairness Coalition of Mental Health, and other children, education, law 
enforcement, and labor organizations all behind this legislation. There 
is a broad range of organizations supporting the legislation.
  I point out to colleagues the legalistic language of the bill. This 
bill is modeled after the Federal Employees Health Benefits Program in 
which we participate. It says to a group health plan: Do not treat 
mental health benefits differently from the coverage of medical and 
surgical benefits. You have to treat it the same way. The legislation 
does not mandate that a plan provide mental health coverage but says if 
you have mental health coverage, you have to treat it the same way or 
have the same coverage as for physical illness. That is why it is 
called a parity bill.
  There are still important steps to take, which I hope someday we 
will, so all the people in our country who have no coverage will be 
treated. This legislation for over 100 million would make an enormous 
difference.
  The cost to the Nation is enormous. Additional health care costs 
occur when people cannot get the coverage they need, and they wind up 
in the emergency room or it leads to other illnesses. There is a 
productivity loss from people who struggle with illness and get no 
help. There are the social costs of crime: When people do not get 
treatment, they cannot work or they wind up homeless. We have a lot of 
homeless people struggling with mental illness. When we treat children 
at a young age, it will have a huge impact on whether they have a life 
of misery where they could end up in trouble, more trouble, then 
incarceration, or whether they are treated and they can go on and live 
a very productive, happy, and healthy life.
  I visited a correction facility--and there are many facilities--in 
Tallulah, LA. I could talk about this forever. Mr. President, 95 
percent of the kids had not committed a violent crime. Too many were 
kids who struggled with mental illness. They should have been checked 
at the front end of assessment when a kid breaks and enters a house or 
steals a car. Remember, we are talking about anywhere from 10 percent 
to 20 percent of children in this country who struggle with this 
illness.
  Too many kids all across the country--and your police, law and order 
communities, law enforcement communities, will tell you this--do not 
get any treatment, there is no coverage, and they wind up incarcerated 
when they should not be incarcerated. Then what happens is almost 
indescribable. The kids are not able to defend themselves. Quite often 
they are brutalized. Then they come out of these facilities 
dysfunctional. But they never should have been in the facility in the 
first place. We never provided the care for them. There never was the 
coverage.
  I am sure there can be some good negotiation and things can be worked 
out in conference on offset, but I argue for $150 million more a year, 
or whatever the final costs would be. Is it not worth it to end the 
discrimination and provide the coverage to so many people, including a 
good number of whom are our loved ones, with the difference being life 
or death?
  In the words of Rabbi Hillel: If not now, when? When are we going to 
end the discrimination? This is a matter of civil rights. When are we 
going to have the health care plans that provide the coverage for 
people who are struggling with this illness, including many children? 
When are we going to make sure, with the plans now no longer able to 
discriminate, there will be an infrastructure of care in our 
communities, the delivery of the care will follow the money, and the 
money will be in the plans?

[[Page 20896]]

  This is more than worth it. We have 65 Senators supporting this 
legislation. This is bipartisan. If Senator Domenici and I are working 
on something together, it has to be bipartisan. I cannot even think of 
anything else on which we agree--I don't mean that; I am kidding.
  I urge my colleagues to support this measure.
  We use the word ``message.'' I hate the word. Everybody says: What is 
our message? What is our message. This would not be a bad statement. I 
think it would be good for our country--much less the people we can 
help, it would be good for our country--if the Senate went on record 
today supporting an amendment that I think is all about helping people, 
all about helping some vulnerable people, all about ending 
discrimination, all about calling for our country, America, to be a 
better country, all about calling on all of us to be our own best 
selves, all about making sure we provide care to people, many of whom 
up to now have not received any care.
  The consequences of the plans discriminating and not providing care 
are so tragic. People who struggle from depression and get no care take 
their lives. Children don't get any care and they wind up incarcerated 
when they could have a good life.
  The highest percentage of suicides is in the elderly population. 
Sometime soon I would like to get to Medicare. With Medicare, if you 
see your doctor apart from in-home care, you pay a 20 percent copay. 
But if you are struggling with depression--and the highest rate of 
suicide is in the elderly population--and you go to see a doctor, you 
pay a 50-percent copay. That is in Medicare. That is blatant 
discrimination. Why is depression less important than any other 
illness?
  We can help a lot of elderly people. We can help a lot of children. 
We can help a lot of people in our country. Most important of all, we 
can help ourselves as Senators. It would not be such a bad thing to 
have a strong bipartisan vote for something all about values, people 
helping one another and recognizing we can do better. As Bobby Kennedy 
would have said, we can do better as a nation.
  Please Senators, give this amendment your support. Let's pass it with 
an overwhelming vote.
  I yield the floor.
  Mr. REID. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant bill clerk proceeded to call the roll.
  Mr. CORZINE. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Reed). Without objection, it is so 
ordered.
  Mr. CORZINE. Mr. President, I rise today in strong support of the 
amendment offered by Senators Domenici, Wellstone, and Kennedy. It is 
an amendment which will ensure that people with mental illnesses are 
treated equally, fairly, and equitably, on parity with people who have 
physical illnesses. I do not think there are words that are strong 
enough to point out the rightness of this in our American health care 
system.
  Today, in America, two-thirds of our citizens with mental illness do 
not have access to mental health treatment, despite the fact that many 
have health insurance. For far too long, mental health consumers have 
been discriminated against in the health care system--subjected to 
discriminatory cost-sharing, limited access to specialties, and other 
barriers to needed services. In fact, many of them are just flat left 
out of the system.
  I have had some personal experience with this in my life. I know it 
is a very difficult trial even if one is not without resources. That is 
why I am pleased to be a cosponsor of the Mental Health Equitable 
Treatment Act, legislation that represents a critical step toward equal 
coverage for mental health services. This amendment, the one we are 
debating today, incorporates the text of that legislation. And I hope 
to be a cosponsor, as well, of the amendment.
  This amendment builds upon legislation enacted 5 years ago which 
sought to ensure parity between mental and other types of health care.
  That law took the first steps toward recognizing that mental illness 
is a serious yet treatable disease. I served on the board of the NYU 
Child Study Center which worked for the better part of a decade to 
diagnose, to learn diagnosis, and to make sure that we had treatment 
regimens that actually could attack this disease, based on science and 
with great and positive outcomes.
  It is because of those experiences and some in my own life that I 
commend Senators Wellstone and Domenici for their great leadership on 
this movement. It is a very powerful statement to our country that we 
care about everyone, and their tireless efforts should truly be 
commended because they will ensure that Americans with mental illness 
will have equal access to mental health services.
  Unfortunately, the law enacted several years ago has now expired. 
Frankly, everyone would agree that it included some loopholes that 
allowed health care plans to evade many of its goals. This amendment is 
designed to restore the law and to close those loopholes.
  Perhaps most importantly, the amendment would ensure true mental 
health parity by prohibiting inequitable copayments, deductibles, and 
inpatient and outpatient visit limits for mental health services.
  These are real issues for real people who are in these circumstances, 
not unlike circumstances people might have with their physical health. 
We know that people would not be tolerant of those kinds of activities.
  These are commonsense proposals which will make a real difference in 
people's lives and I hope my colleagues will support them.
  Earlier this year, many of us worked hard to pass a strong Bipartisan 
Patient Protection Act that would provide for strong health care 
protections for all uninsured Americans, the Patients' Bill of Rights. 
Many of these protections, however, will do nothing for mental health 
consumers if group health plans are allowed to continue discriminating 
between mental and other medical and surgical health care coverage.
  Advances in medical research have made great strides in our ability 
to treat mental illness. As a nation, we need to make sure that our 
insurance covers those advances. Without proper coverage, the benefit 
of this research will be unable to reach those who need it most.
  As a country, I heard Senator Wellstone say, we lose $300 million in 
missed days of work, health care costs and criminal justice costs in a 
given year as a result of untreated mental illness. We simply cannot 
afford to do that. It is a simple cost/benefit equation that tells us 
that we need to move forward on this.
  It is overwhelmingly on the side of making sure that parity is 
attended to. In attempting to find a treatment, those suffering with 
mental illness face countless obstacles, as we have discussed over and 
over. This amendment would reverse those discriminatory practices, 
ensuring that health insurance coverage is strong and fair.
  I am pleased that my home State of New Jersey has enacted a mental 
health parity law, but, frankly, it does not go far enough and flat out 
excludes children, our most vulnerable, from its coverage.
  In addition, because of the ERISA preemption, not everyone in New 
Jersey is covered by our own State law. Therefore, we need a strong 
Federal law that ensures mental health parity for all Americans.
  In a few weeks I will be introducing legislation that goes a step 
further. My bill will address the fragmentation of the delivery system 
by providing increased support to community mental health services. But 
this is a step we should take and we should take it now.
  I am proud of the leadership Senators Domenici, Wellstone, and 
Kennedy have provided to make sure that our Nation has addressed this 
issue through the years. It is imperative that we now bring to closure 
this debate about parity by including this amendment in this 
appropriations bill.

[[Page 20897]]

  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, before the Senator from New Jersey 
leaves the floor, might I say that there is no need to be personal 
about legislation, but I thank him for his comments.
  It is obvious that there are many who have been here for a short 
time, such as the Senator, who already understand that we can't go on 
as a nation fooling ourselves that schizophrenics are not sick, they 
don't have a disease; that serious depression, which is now causing 
suicide in numbers that just go off the map, we can't run around and 
say, well, for some reason, some purposes, it is an illness or a 
difficult disease, but for other purposes, well, in terms of whether 
they should have insurance, we will look the other way and act as if it 
isn't.
  We have had Senators who understand manic depression take the floor. 
Those are just two nice words. One means high; one means low. But you 
put that in the brain of a person, and it is not very normal. They have 
to be sick, and they are diagnosable. They are treatable. But here we 
are, the millennium is here, we are one year into it, and some people 
would still say: Let's play like it ain't so. Let's just wish it away. 
And certainly when it comes to health insurance, we just can't. We have 
to leave things alone no matter how backward it is, how disjointed it 
is, how unreal it is. We just have to look the other way.
  When will be soon enough? I think now. I will tell the Senator, in 
order to get it through here, we had to put it off a year in terms of 
its effectiveness. I would like it to be effective as soon as it gets 
passed, but it won't because we wouldn't have gotten a bill out of the 
Senate that would be subjected to some technical objections. I 
shouldn't say we wouldn't, but it would be difficult. We made a call 
and said that it is better 2 years from now than to leave it as it has 
been forever.
  So tonight you will be part of voting in an appropriations bill, and 
we will put on it covering the mentally ill of this land with parity or 
nondiscrimination of health insurance. We are going to exempt some 
small businesses. Somebody will argue about that: Why are you doing 
that? We can't get everything in one swoop. We really think the 
coverages by big corporations are where we are going to find out how to 
do this. So they are all going to be under it, whether it be Ford or 
Intel or whomever. Many of them include coverage already. But no more 
excuses. No more looking the other way.
  Frankly, in the State of the Senator from New Jersey, in 8 or 9 
years, there will be new mental health facilities built. You are going 
to ask: Who built this? We know not all are going to be built by the 
Federal Government because we don't build them. We never did enough 
since John Kennedy decided we should go another way with the mentally 
ill and try to be more humane. What is going to happen is private 
entrepreneurs are going to say, what is the insurance company going to 
pay when we take care of that depressive person for a week?
  If they pay enough, they are going to build the clinics just as they 
have built hospitals, just as they have built other health facilities. 
As of now, nobody accepts the responsibility. Everyone wants to look 
the other way. I am grateful that Senators who have been here a while, 
such as this Senator, the Senator who has just arrived, are all coming 
to the same conclusion this afternoon. Perhaps by 6 o'clock we will 
have passed this bill.
  It is very strange. It goes out in the country. I have been working 
for it. I expect the debate to go on for a couple weeks. That isn't 
going to happen. The reason it isn't is because 67 Senators signed this 
bill and we brought it up. I thank each one of them.
  I have a detailed statement that includes a number of approaches to 
this issue, including an analysis and summary of what the New York 
Times found when they analyzed mass killers. They analyzed 25 mass 
killers and found half of them had serious mental illnesses such as 
schizophrenia. There was no place to put them. They had been put in 
jails. Cops had arrested them. People had tried them on in prisons. But 
nobody took care of them. Then they ended up over in one of the Texas 
cities killing all the people in that Baptist church.
  We find that half of the mass killers in America are those kinds of 
people. There is no place to put them. Relatives don't know what to do. 
Neighbors say: Look at all this behavior. Isn't it strange? We will 
call a cop. The third time the cop is called, he says don't call 
anymore. What does that person who is desperately ill do?
  We invite these kinds of murders and mass killings that occur in our 
country. It is time to try something that may give these sick people 
another option.
  I have a quick set of facts about mental illness, the numbers on the 
kinds of mental illnesses that exist. I think it will help Senators who 
want to read the Record to understand the scope of this problem.
  I ask unanimous consent that it be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                     Quick Facts on Mental Illness

       Major Depressive Disorder--9.9 million American adults age 
     18 and older suffer from this disorder in a given year;
       Bipolar Disorder--2.3 million American adults age 18 and 
     older suffer from this disorder in a given year;
       Schizophrenia--2.2 million American adults age 18 and older 
     suffer from this disorder in a given year; and
       Obsessive--Compulsive Disorder (OCD)--3.3 million American 
     adults age 18-54 suffer from this disorder in a given year.
       16% of all inmates in State and local jails suffer from a 
     mental illness; 600,000-700,000 mentally ill individuals are 
     booked into a jail every year; 25% to 40% of America's 
     mentally ill will come into contact with the criminal justice 
     system.
       Suicide is currently a national public health crisis, with 
     approximately 30,000 Americans committing suicide every year.
       Of the 850,000 homeless individuals in the United States, 
     about \1/3\ or 300,000 of those individuals suffer from a 
     serious mental illness.
       In the developed world, including the U.S., 4 of the 10 
     leading causes of disability for individuals over the age of 
     five are mental disorders. In the order of prevalence the 
     disorders are major depression, schizophrenia, bipolar 
     disorder, and obsessive compulsive disorder.
       The direct cost to the United States per year for 
     respiratory disease is $99 billion, cardiovascular disease is 
     $160 billion, and finally $148 billion for mental illness.


                         efficacy of treatment

       Treatment for bipolar disorders have an 80 percent success 
     rate.
       Schizophrenia has a 60-percent success rate in the United 
     States today if treated properly.
       Major depression has a 65 percent success rate.
       Compared to several surgical procedures:
       Angioplasty has a 41-percent success rate.
       Atherectomy has a 52-percent success rate.

  Mr. DOMENICI. Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming is recognized.
  Mr. THOMAS. Mr. President, I rise to support the Senator from New 
Mexico in his effort. I have been an original sponsor of the bill he 
has had. In years past, I was chairman of this bill in Wyoming and 
worked on this for some time. As a good focus on rural health care is 
unique, this is another unique issue with which we need to deal. I urge 
support for the amendment. I thank the sponsors for their efforts.
  The PRESIDING OFFICER. The Senator from Minnesota is recognized.
  Mr. WELLSTONE. I thank the Senator from Wyoming for his support. It 
means a lot. His voice is important. I appreciate his mentioning that 
is not something that only applies to metropolitan America; it is 
important in rural America. I thank Senator Corzine as well. I will not 
take much time now.
  Senator Corzine asked that he be a cosponsor of the amendment. I 
believe Senators Byrd and Stevens, with the agreement that we now have, 
asked to be included as cosponsors. I ask unanimous consent they all be 
added as cosponsors.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WELLSTONE. I thank the Chair.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.

[[Page 20898]]


  Mr. SPECTER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SPECTER. Mr. President, I compliment the Senator from New Mexico 
and the Senator from Minnesota for their advocacy on this amendment. As 
I commented earlier in the debate on this amendment, I have cosponsored 
the authorizing legislation for the past two Congresses and had 
withheld cosponsorship of this amendment as a manager of this 
appropriations bill until I could see how it was going to be worked 
out. We are now in the process of working it out. I think we will be 
successful, but it is still too early to make a final commitment.
  What is occurring here is on the scoring for budgetary purposes, if 
it is on this bill, it is scored against this bill; and we are now up 
to the limit of our authorization. But we are now looking into the 
remedy of having it scored in another direction--that is technical--and 
an amendment is now being prepared that may cure that problem. It is 
not a commitment to cure the problem, but we will know shortly.
  In the interim, as a comanager of the bill, I do not intend to raise 
any point of order that this is legislation on an appropriations bill. 
Technically, that point of order can be raised. It does not have to be 
raised because of the difficulties of getting Senate consideration on 
this bill for a very protracted period of time. As the Senator from New 
Mexico, Mr. Domenici, outlined, I think it is not appropriate to raise 
a point of order that this is legislation on an appropriations bill. At 
least I do not intend to raise that point of order.
  This is a proposal that I believe has great merit. That is why I have 
cosponsored the authorization bill for the last two Congresses.
  At this time, I ask unanimous consent that I be added as a cosponsor 
to the Domenici amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SPECTER. Mr. President, Senator Harkin, the chairman of the 
subcommittee, and I are urging colleagues to come forward to offer 
amendments. It is now 4:25. We have only had one amendment offered all 
day. It is very important that we move ahead with the disposition of 
this bill.
  Last year, we had the bill out of committee on June 30 and it passed 
the Senate on July 27. Then we had months of negotiation in the 
conference committee, so that if we are to get this matter into 
conference and have a conference report, it is urgent that we proceed 
at this time.
  There is substantial funding for education, which has the consensus 
of the Senate. There is substantial money for the National Institutes 
of Health, and the public interest requires that we move ahead. If we 
do not finish our appropriations bills, there is the possibility--or 
perhaps probability--that the bills that are unfinished will be folded 
into a continuing resolution. That means that important funding will 
not be provided.
  Again, on behalf of Senator Harkin, my comanager, I urge our 
colleagues who have amendments to come to the floor. Perhaps Senator 
Harkin would like to italicize my urging.
  Mr. HARKIN. Mr. President, I will respond to my distinguished ranking 
member, my friend, that I believe we are making some good progress. A 
major amendment is being worked out right now. I hope we go to a voice 
vote shortly. I only know of one other amendment that might be pending. 
Quite frankly--hope springs eternal--I think we might be through with 
this shortly.
  Mr. SPECTER. Is the Senator suggesting that only one other amendment 
is pending and we may be in a position to go to third reading?
  Mr. HARKIN. I believe that might be the case. People may want to go 
home early tonight and have dinner with their families.
  Mr. SPECTER. What time does he think we might go to third reading?
  Mr. HARKIN. It depends on how long it takes to work out this 
language. We are waiting for Senator Dorgan. He had an amendment. I saw 
him a minute ago. Perhaps he will be out here shortly. I don't think 
that will take too long.
  Mr. SPECTER. Mr. President, we urge colleagues, if they have 
amendments to offer, to come to the floor and do so now.
  In the absence of any Senator seeking recognition, I suggest the 
absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURBIN. Mr. President, I know pending before the Senate now is 
landmark legislation. I commend my colleagues, Senator Paul Wellstone 
and Senator Pete Domenici, truly a political odd couple, one from the 
State of Minnesota and the other from New Mexico, who have come 
together on this important cause, both understanding the importance of 
our maturing as a nation when it comes to the issue of mental health.
  I am a strong supporter of the Mental Health Equitable Treatment Act 
which they are bringing to this legislation. I am pleased it is finally 
going to come for a vote. I know those two Senators, as well as 
Senators Daschle and Kennedy, have worked tirelessly to make this 
happen. I know advocates for the mentally ill have waited, frustrated 
and disappointed time and again, and had hoped this day might someday 
come. I recognize it is equally imperative we do not threaten this 
bill's passage by attaching amendments that may make it even more 
difficult in conference.
  With this in mind, I do, however, want to raise the subject of 
another amendment relating to mental health, and I ask my colleagues to 
consider it in the context of the underlying Wellstone-Domenici 
amendment.
  The issue I am about to discuss affects literally thousands of 
Americans every single year. This amendment of which I speak would be 
an improvement on the bill we are currently debating. However, I want 
to make it clear I will not be offering this as a second-degree 
amendment. I want to give to Senators Wellstone and Domenici every 
opportunity to bring their important bill through conference intact. 
Although I believe my amendment would be a worthy addition to theirs, I 
am going to save that cause until another day.
  Let me talk about this amendment and why I would have brought it to 
the floor. Some time ago I received a letter from a constituent in 
Illinois who in the 1980s suffered severe depression and received the 
kind of treatment which allowed her to return to work. I will call her 
Mary Smith. At the time, Mary had employer-sponsored health insurance 
through her husband's job, but in the fall of 1998 Mary and her husband 
lost this employer-based insurance coverage when her husband lost his 
job.
  Mary applied for comprehensive health insurance plans offered to 
individuals. Her application was declined because, as the insurance 
company noted, ``Due to her medical history of depression she did not 
meet the company's underwriting requirements.''
  Mary was turned down for health insurance due to a medical history of 
depression. She wrote me, and this is what her letter said:

       As I see it, we are being punished for accessing health 
     care. In 1987, when I was clinically depressed, I could have 
     chosen to avoid proper medical care, become unemployed and 
     received Social Security disability. I did not. I obtained 
     the help I needed and continued to support myself, my family 
     and contribute positively to society. Depression is a 
     treatable medical illness. Insurance companies must stop 
     their indiscriminate denial of this coverage.

  Sadly, Mary Smith is not alone. Each year more than 50 million adults 
in the United States suffer from mental illness, 25 percent of our 
adult population. Some 18 million Americans are affected by depression 
annually. One in five Americans has a mental disorder in any one year. 
Fifteen percent of the adult population use some form of mental health 
service during the year.

[[Page 20899]]

Eight percent have a mental disorder. Seven percent have a mental 
health problem. Twenty-one percent of children ages 9 to 17 receive 
mental health services in a year.
  The problem Mary Smith faced is, under the current system of care in 
the United States, individuals who are undergoing treatment or have a 
history of treatment for mental illness may find it difficult, if not 
impossible, to obtain private health insurance, especially if they have 
to purchase it on their own and cannot rely upon group insurance 
through an employer.
  In part, this is a result of the Health Insurance Portability and 
Accountability Act that protects millions of Americans in the group 
health insurance market and affords very few protections for 
individuals who apply for private nongroup insurance. Approximately 9.6 
percent, or 26 million Americans, are insured in this private nongroup 
insurance market--26 million people.
  A 1996 GAO study found that insurance carriers denied up to 33 
percent of applicants for private health insurance because they had a 
preexisting health condition, including, of course, mental health 
conditions. HIPAA provides few protections for individuals who apply 
for insurance in the individual insurance market. Individuals without 
at least 18 months of prior continuous group coverage are not protected 
against discrimination and red lining. This issue is not about parity. 
It is not about mental health benefits. It is about discrimination. It 
is about red lining.
  Mary Smith was being told she could not get any health benefits, not 
just mental health benefits. She was denied all health insurance 
coverage because many years before she had successfully treated a 
condition of depression. She was not eligible to get hospital coverage 
if she needed surgery. She was not eligible for preventive care, such 
as a flu shot. She was not eligible for a doctor's visit. Had she 
become injured or ill, she would have received no care.
  Efforts to improve health care parity have focused on providing 
equality between mental health covered services and other health 
benefits, and I salute Senators Wellstone and Domenici for their 
leadership. These efforts are very important, and I strongly support 
them.
  Parity will not help individuals who do not have access to any 
affordable insurance coverage due to preexisting mental illness 
discrimination. Think of that for a moment. We are saying if you cover 
a person for other illnesses, in the Wellstone-Domenici amendment, you 
also have to provide mental health protection as well. I believe that 
is sound.
  Mary Smith never reaches that point. Mary Smith, whose husband lost 
his job, ends up in the private insurance market. She cannot even get 
into a private health insurance plan because the company, under the law 
today, can discriminate against her because she had treatment for a 
mental health problem.
  Individuals who seek insurance in the individual market are people 
such as Mary who are in periods of transitional employment, but they 
are also people who are self-employed. They are family farmers. I have 
many of them in my State. They are small business owners. They are 
recent college graduates who lose coverage under their parents' plan, 
and they are the children and spouses of self-employed people and those 
in transitional employment.
  Every person at risk, needing to buy private health insurance, is 
subject to this discrimination. If they had been treated for a mental 
illness, they could run into the same experience Mary Smith did.
  This type of discrimination is precisely why many Americans do not 
seek treatment for mental illness. Despite the efficacy of treatment 
options and the many possible ways of obtaining a treatment of choice, 
nearly half of all Americans who have severe mental illness do not seek 
treatment. They are not only concerned about the stigma in society, 
they are clearly concerned about the discrimination which is allowed 
under the law for those people who have turned for help.
  This reluctance to seek care is an unfortunate outcome of very real 
barriers. Foremost of these is the stigma that many in our society 
attach to mental illness and to people who have it. How many of us, or 
our family members or friends, have thought about what might happen if 
we went to seek therapy for anxiety, depression, or even marriage 
counseling? It is unconscionable that persons should have to consider 
not being able to get health insurance coverage because they did the 
right thing and were treated for a mental condition.
  Repeated surveys have shown that concerns about the cost of care are 
among the foremost reasons that people do not seek care.
  My amendment prohibits insurers from charging persons with 
preexisting health conditions higher premiums. This is because insurers 
use higher premiums to keep certain people locked out of the plan.
  The GAO interviewed one insurance carrier in my home State of 
Illinois which only charges 2 to 3 percent of its enrollees a 
nonstandard rate, but the rate they charge is double the standard rate.
  In some States, including Illinois, high-risk pools have been created 
to act as a safety net to ensure the uninsured have access to coverage. 
These safety nets are often expensive. For Mary Smith, this safety net 
would have cost her and her husband $700 a month for health insurance. 
They are a great deal for insurers; all sick people are in one pool.
  Risk pools undermine the underlying function of insurance to include 
a broad pooling of risk. They relieve insurers of responsibility.
  Mental disorders impose an enormous emotional and financial burden on 
ill individuals and their families. And when they go untreated, costs 
escalate. Mental disorders are costly for our Nation in reduced or lost 
productivity and in medical resources used for care, treatment, and 
rehabilitation.
  The National Institute of Mental Health estimates the annual cost of 
untreated mental illness exceeds $300 billion, primarily due to 
productivity losses of $150 billion, health care costs of $70 billion, 
and societal costs of $80 billion.
  Two years ago the Surgeon General issued a report on mental health. 
The report concludes that a broad range of treatments of documented 
efficacy exists for most mental disorders.
  Diagnoses of mental disorders are as reliable as those of general 
medical disorders. In fact, the success rate of treatment for disorders 
such as schizophrenia is at 60 percent; depression, 70 to 80 percent; 
and manic disorder, at 70 to 90 percent, surpassing those of other 
medical conditions. Heart disease, for example, has a treatment success 
rate of about 50 percent.
  Here is what we know: We know mental health is fundamental to our 
health. We know millions of Americans suffer from mental illness. We 
know treatment exists for mental illness. We know the treatment works. 
We know, despite the efficacy of treatment options, nearly half of 
Americans who have mental illness do not seek medical care. We know 
that reluctance to seek care is a result of real barriers, including 
stigma, discrimination, and of course financial obstacles which are 
treated by the Wellstone-Domenici amendment. We know mental disorders 
impose an enormous emotional and financial burden on sick individuals 
and their families and that untreated mental illness is costly for our 
Nation in lost productivity and medical resources. We know the private 
insurance system perpetuates barriers, reinforces stigma, throws up 
financial roadblocks, and undermines the health of millions of 
Americans who do the right thing and seek treatment.
  The amendment I was prepared to offer today, because of Mary Smith, 
would try to do the right thing. It is common sense. It doesn't cost 
anything. It does not solve all the inequities that individuals with 
mental health conditions face. But it does remove one of the many 
barriers to health care faced by those who have been treated for a 
mental condition. I think there is no more appropriate context in which 
to address this than a patient protection act.

[[Page 20900]]

  This amendment prohibits any health insurer that offers health 
coverage in the individual insurance market from denying an individual 
coverage because of a preexisting mental illness unless a diagnosis, 
medical advice, or treatment was recommended or received within the 6 
months prior to the enrollment date. Health plans can exclude coverage 
for mental health services but not for more than 12 months. The 
exclusion period must be reduced by the total amount of previous 
credible insurance coverage.
  It also prohibits plans in the individual market from charging higher 
premiums to individuals based solely on the determination that such an 
individual had a preexisting mental health conditions. It defines a 
preexisting mental health condition as including all clinical disorders 
and personality disorders diagnosed on Axis I or Axis II of the most 
recent edition of the American Psychiatric Association's Diagnostic and 
Statistical Manual of Mental Disorders. This broad definition would 
include mood, anxiety, eating, sleep, and adjustment disorders, 
clinical disorders such as mental retardation and autism, cognitive 
disorders such as amnesia and dementia, and sexual and gender identity 
disorders.
  These provisions apply to all health plans in the individual market, 
regardless of whether a State has enacted an alternative mechanism, 
such as a risk pool, to cover individuals with preexisting health 
conditions.
  The amendment does not mandate that insurers provide mental health 
services if they do not already offer such coverage. It does not 
prohibit health plans from establishing a waiting period for mental 
health services for individuals with a preexisting mental health 
condition of up to 12 months.
  All we are trying to do is to ensure that if you should go to a 
therapist or a psychiatrist or a psychologist or seek other mental 
health services, you do not have to worry that you or your family will 
not be able to get health insurance because you asked for help. It 
simply does not make sense, just because a person seeks treatment for 
mental illness, he or she is rendered uninsurable.
  I hope my colleagues will join me in this important initiative to 
ensure that such individuals are not discriminated against when 
applying for health insurance coverage. It is just the right thing to 
do.
  Mary Smith's letter is one of many we receive in our Senate offices. 
I am glad we picked this one and read it carefully and closely. I 
thought for a moment about how we could help this woman who did the 
right thing. Faced with a mental illness, she went to a doctor, and 
having gone to that doctor her life has improved. She stayed on the job 
and had a much better life. She could have applied for a government 
program and didn't do it. She wanted to stay in the workplace. Little 
did she know that a few years later when her husband lost his job, the 
fact that she was successfully treated for depression would ultimately 
mean they could not buy health insurance in the private market.
  How can we stand by as a nation and allow this kind of discrimination 
against people who are no more guilty of their condition than a person 
is guilty for the color of their eyes? It is something God has sent to 
them. In this situation I think we should consider the passage of 
legislation which would prohibit this discrimination once and for all 
and make certain, as the underlying Wellstone-Domenici amendment, this 
amendment would say we are going to treat mental illness in the 21st 
century much differently than we have in years gone by.
  I thank you for the floor and I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. SPECTER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WELLSTONE. Mr. President, I ask unanimous consent that Senator 
Daschle be included as a cosponsor of this amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WELLSTONE. Mr. President, since there was news today that Dr. 
Hyman is stepping down as Director of the National Institute of Mental 
Health, and since I believe we are going to pass legislation on 
antidiscrimination in mental health coverage which will be landmark and 
will make a real difference in the lives of people--and I have spoken 
plenty about the amendment already--I wanted to thank Dr. Hyman for all 
of his leadership. He has been an exceptional director.
  I have had a chance to work very closely with him through Ellen 
Gerrity, a fellow in my office. We are lucky enough to have her working 
with us. She worked for the IMH. I think Dr. Hyman has done a good job, 
along with Dr. Satcher, who is Surgeon General. He has done magnificent 
work. The two of them have done perhaps the best job we have seen in 
the history of our country of providing an education for people in the 
country. So much of mental illness is a brain disease. It can be 
diagnosed. It is very treatable.
  That is the good news. The bad news is there is a huge gap between 
what we know and what we don't know. We are trying to close that gap--
not all of it but a good part of it--with this piece of legislation.
  I thank Dr. Hyman. He is one of the people I have had a chance to 
work closely with in Washington. He is a good example of someone who, 
with a highly developed sense of public service, has made a huge 
difference.
  I thought I would use this opportunity to thank Dr. Hyman and wish 
him the very best as he moves on to be, as I understand, provost at 
Harvard University.
  We have had a number of Senators--I don't need to speak more--who 
have come to the floor and have spoken. I think what they have said is 
not only significant, but the way they have said it is significant.
  Senator Domenici always speaks about this issue with a tremendous 
amount of eloquence and a lot of knowledge. His wife Nancy Domenici--I 
don't think he would be offended if I said it--is probably every bit 
the leader he is. I don't want to say more, but she is every bit the 
leader he is.
  We have two Senators out here managing the appropriations bill who 
want to move us forward. After we have done the work to make sure we 
deal with rule XVI and germaneness--and we have done a lot of work on 
the budget point of order--I think they have been very gracious in 
letting us go forward. Senators Harkin and Specter are very supportive 
of this piece of legislation. Senator Thomas from the State of Wyoming 
came and spoke.
  It reminds me of 1996, I think it was, when we passed partial 
legislation. I remember Senator Simpson came out on the floor and spoke 
about a tragedy within his own family. I believe it was a niece who 
took her life at a young age. Senator Corzine came out on the floor and 
made it very clear that this issue means a great deal to him.
  Senator Reid spoke about his own experience, that his father took his 
life. Senator Harry Reid has been absolutely, in his own very quiet 
way, perhaps the most powerful Senator, in a positive way, on the whole 
issue of treating depression than anybody in the Senate.
  Senator Kennedy came out and spoke. He has devoted a good part of his 
career to this issue. He is the health care Senator, but, actually, 
long before we had this kind of coalition--and we have 150 
organizations supporting this piece of legislation. We have 
organizations such as the National Mental Health Association and NAMI--
the National Alliance for the Mentally Ill--that deserve a lot of 
credit, along with the whole coalition. If I went through all 150 
organizations, it would take a lot of time. But I personally think 
Senator Kennedy deserves a great deal of credit for being willing to 
light a candle a long time ago to speak to this awful discrimination.
  I also thank all of these different organizations because the truth 
is, when we started out on this matter over a half a decade ago, it was 
then an

[[Page 20901]]

issue--it still is an issue of discrimination--but the problem was 
there was not exactly a political constituency that had any real clout. 
Then I think what has happened in the last 6, 7, 8, 9 years is that a 
lot of families have said: We are the ones who struggle with this 
illness--or we have a loved one who struggles with this illness--and we 
refuse to be treated as men and women of lesser worth. We are men and 
women of worth and dignity. We struggle with an illness just as any 
other illness. We are going to be advocating for ourselves.
  It has been the citizen politics, the citizen lobbying that has led 
to the result of--we have a dispute as to whether it is 65 or 67 
Senators who now support this. This piece of legislation passed out of 
the HELP Committee on a 21-0 vote. We made some compromises, but it is 
still an enormous step forward. I do not think it would have happened 
without the citizen politics.
  I say to the Presiding Officer--because we both represent the State 
of Minnesota--we represent a State that is a model State, as we are in 
many ways, but we passed full parity for both substance abuse 
addiction, which I think is terribly important--and I think that is the 
next piece of legislation on which we ought to work--and mental health 
and, by the way, with very little cost but with great benefit.
  The estimates of the amount of money we have saved in our State for 
people who now get the treatment and, therefore, are productive and go 
to work or do well in school and do well in their families verses what 
was going on before is just stunning and important. The problem is 
because of ERISA, a lot of the self-insured plans are not covered, so 
we still have 50 percent of the people not covered and, thus, the need 
for national community regulation.
  But I thank a lot of the people in Minnesota who both the Presiding 
Officer and I know well; and certainly Sheila and I have gotten to know 
them very well because we have had so many meetings with so many 
people.
  I mentioned the Kluesners earlier, Mary and Al Kluesner. I mentioned 
the Westins. But there are so many others who have met with us, who 
have met in public. There have been so many picnics on our lakes that I 
have attended with people. There are so many people who have told their 
own stories. They have made a huge difference.
  So again, colleagues, we have 65 or 67 Senators who support this 
measure. It is strongly bipartisan. We now have the support of the 
chair and ranking chair of the Appropriations Committee, and the chair 
and ranking chair of the Budget Committee. We have the whip who has 
spoken, and Senator Daschle, the Senate majority leader, who has asked 
to be a cosponsor. We have 150 organizations: Religious, children, 
labor, and health.
  We are close to adopting an amendment that I believe we can keep in 
conference. I am not trying to be coy, but I think if I had to have 
somebody in my corner, I would want Tom Harkin more than anybody else. 
He chairs this committee. If I had to have one person to fight for me, 
he would be the one.
  So I thank colleagues. We may have a lot more debate yet, but I think 
we are going to take this journey. I believe we are going to wind up in 
a good place where we are going to make our country better. We are 
going to make our country better by passing this.
  I see other colleagues in this Chamber, so I do not want to take any 
more time. I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas.
  Mr. GRAMM. Mr. President, I rise to speak on the pending Domenici 
amendment. I am opposed to the Domenici amendment. I am not going to 
force the Senate to vote on it this afternoon. I think it is clear 
where the votes are, but I want to explain the issues. I want to raise 
the issues in this debate so that they can be looked at by the House.
  I believe, based on what I have been told, the administration is 
opposed to the amendment. There is also a point of order against the 
second-degree amendment that will be offered directing scoring. That 
point of order will lie against the conference report if the bill comes 
back from conference with the directed scoring provision in it. I want 
to reserve my right to raise that point of order at that time.
  I want to be brief, but let me basically explain what we have here. 
What we have is an amendment that imposes a new mandate on the private 
sector of the economy. That mandate is a mandate where we decide what 
kind of health insurance Americans should have, and they are going to 
have it whether they want it or not; and we are going to override some 
70 years of negotiations between private employers and private 
employees as to what their health insurance looks like.
  We are going to mandate that if a company provides health insurance 
that has any mental health provisions in it, those benefits have to be 
treated the way benefits are for physical health or else the company 
may be prohibited from providing the policy.
  The Congressional Budget Office, in looking at this mandate, has 
estimated that what will happen is, premiums will go up, some companies 
will drop mental health coverage altogether, and others will continue 
to provide it under these new circumstances. Remarkably, they estimate 
that the adoption of this amendment, over a 5-year period of 
implementation, will drive up costs on the private sector of the 
economy by $23 billion. So we are about to impose $23 billion in costs 
on the private sector of the economy because we think we know better 
what private health contracts, negotiated between employers and 
employees, ought to look like.
  There is a budget problem here because the Congressional Budget 
Office estimates that by paying the $23 billion in additional health 
insurance premiums, that American industry and agriculture will end up 
paying lower wages than they would have paid, and that we will collect, 
over a 10-year period, over $5 billion less in taxes because of this 
amendment.
  The distinguished chairman of the Budget Committee informed the 
Senate that he would charge, in future budgets, that $5 billion against 
the Appropriations Committee if the amendment were adopted.
  We are now, as I understand it, in the process of writing an 
amendment that says that for the purposes of the budget, even though 
this amendment will cost over $5 billion, we are not going to count it.
  Without going on and on, let me raise the list of particulars. No. 1, 
who are we to be telling American workers and American business what 
kind of health insurance benefits they should have and how that package 
should be made up and what they should choose? What about workers who 
would rather have higher wages than to have this new benefit that we 
are deeming to be in their interest?
  What about the $23 billion of cost that we are going to impose on the 
private sector? I know the amendment is written so it does not start 
until 2003. The point is, that is $23 billion of cost over a 5-year 
period that will be borne by the private sector, $23 billion that could 
have gone to create more jobs, more growth, more opportunity.
  I simply raise two questions regarding the $5 billion of lost tax 
revenue because companies, as estimated by CBO, will pay lower wages 
when they are mandated to pay for these benefits: first, what about 
workers that would rather have those wages than the benefit? Shouldn't 
they have a choice, or are we granted such wisdom that we make the 
choice for them?
  Second, if it is going to cost $5 billion, have we not made an 
absolute mockery out of the budget process, made it a complete fraud by 
passing a law that says, yes, it costs $5 billion, but we are going to 
pretend that it does not cost $5 billion?
  That is basically the proposition that is before us. We are going to 
say, if you are going to provide mental health coverage, you have to 
provide it on par with physical health coverage or you can't provide 
it.
  The logical question is, isn't that something that people should 
decide about their own insurance? Isn't that the same decision that 
people make, in deciding do they want a new refrigerator, or do they 
want to send Johnny to college. They have tradeoffs on

[[Page 20902]]

which they have to make hard decisions? What about the people who are 
going to lose income? We are going to lose $5 billion in taxes over a 
5-year period. What about the people who lose billions of income?
  Maybe they would have wanted to spend on it something that would have 
had greater value to them. Maybe nobody cares whether they could have 
spent those billions better because we are going to spend it for them.
  Then the question becomes, if we are going to spend it, instead of 
being honest about it, we are simply going to pass a law that says, it 
costs $5 billion, everybody knows it costs $5 billion, and there is no 
debate about it costing $5 billion. But so that we don't have to worry 
about it, we are going to pass a law that says, while it costs $5 
billion, for budgetary purposes, we are going to act as if it doesn't 
cost $5 billion so we don't have to count it against appropriations in 
the future.
  I simply have to say, I would be ashamed of this amendment. This is 
bad law, bad principle, and bad precedent.
  If I thought we had more than 15 people who would vote against it, I 
would demand a vote. I would be happy for the world to know I am 
against it. I don't want to put my colleagues on the spot, but I am 
hoping that the House will not accept this amendment. The Senator who 
offered the amendment, 5 or 6 years ago, had a similar amendment that 
cost only $300 million a year. Rather than extending that, we are 
adding a full-blown mandate on the private sector.
  I am hoping something can be worked out. I hope we will not have 
directed scoring. We ought to pay for this in appropriations if we are 
going to do it.
  Finally, I am hoping the administration and the House will not go 
along with this amendment.
  I am sorry to have taken people's time. But I wanted to come to the 
Chamber and basically outline what is wrong with this amendment, and 
what is wrong with the procedure that we are following by directed 
scoring when we say we know it is going to cost $5 billion but we have 
decided that we are going to pretend that it doesn't. We are going to 
charge it against mandatory spending.
  In any case, I hope it will be fixed. It should be fixed. This is bad 
policy. It sets a bad precedent.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. WELLSTONE. I will respond very briefly, as one of the co-managers 
of the amendment. I thank the Senator from Texas. I actually don't mean 
that as sort of fake Senatorial courtesy. He has intellectual 
integrity, and I understand exactly what he is saying.
  Two quick points I will say to him: There is an argument on the CBO 
scoring of $1.3 billion over 10 years. I say to my colleague, I would 
challenge that. I believe Senator Domenici would as well. He is in a 
markup right now on another bill.
  I understand my colleague is going to reserve final judgment on the 
conference report, but the quarrel I have with it is with the 
assumption. The assumption that CBO is making, not $5 billion, $1.4 
billion over 10 years, the assumption that is being made is that with 
the mental health coverage ending the discrimination, that what 
employers will do is, therefore, in order to make up the cost, which 
CBO, by the way, said is minuscule, less than a 1 percent increase in 
premiums, will cut wages for employees. That is the assumption. And 
then, with less wages, there will be less that will be contributed to 
Social Security.


  For the record, I would challenge that assumption. I will challenge 
that assumption on the basis of what we have seen in States that have 
the mental health parity where that has not happened. For a lot of 
companies and a lot of employers, it is a very attractive proposition 
to offer this coverage because families are crying out for it.
  As to the second point, that the money is not going to be spent, we 
are not saying that there isn't going to be the expenditure of money. 
We are saying it is not going to lie against this bill. We are going to 
handle this just as anything else we do. We paid for the tax cuts. We 
will pay for this.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas.
  Mr. GRAMM. Mr. President, I will be brief. I am reading from the 
Congressional Budget Office cost estimate of August 22, 2001. The 
Congressional Budget Office estimates that the proposal will reduce 
Federal revenues in the initial year by $230 million and $5.4 billion 
over a 10-year period. That was the number I was using.
  I think there is no question about the fact that one of three things 
will happen. From my point of view, they are all bad.
  No. 1, some people will lose health coverage they already have 
because the company, in trying to escape the $23 billion of cost over 5 
years, can simply drop mental health coverage. That is bad.
  No. 2, the company can simply decide to not provide health insurance 
at all, which is perfectly legal. That is also bad.
  Then third, if companies lower wages or if wages don't grow as much 
as they would have grown because these higher premiums have to be paid, 
for many workers that is bad because there are obviously many who would 
rather have that income than to have the coverage, and we are making 
the decision for them.
  I respect the opinion of my colleague from Minnesota, who is for this 
benefit, but all I am saying is he may think it is a great idea, but 
there are probably a lot of working people in America who would rather 
not risk that coverage, or would rather keep the mental coverage they 
have, or would rather have higher wages.
  Finally, is the question about how we are going to do the budget. It 
seems to me that is a point where clearly--and I don't know the 
argument on the other side, other than the Appropriations Committee 
doesn't want to be saddled with the cost of paying for this program, 
which they view as a rider to the appropriations process, which I 
understand--that the taxpayers are going to be saddled with the costs. 
Somebody is going to have to end up paying that $5.4 billion.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. WELLSTONE. Mr. President, again, I appreciate what my colleague 
said. Initially, I was talking about the Social Security cost, not the 
overall cost. We have been very clear about the fact that it would 
require some investment of resources. The fact is, I again say to my 
colleague from Texas, there are plenty of examples of States that have 
moved forward. Quite to the contrary of wages going down, people have 
been supportive of it because this is not a small thing. This affects 
about 50 million adults in the country. Depression alone affects 18 
million.
  The reason we have 150 organizations--religious, labor, law 
enforcement, children, you name it--and the reason we have 65 Senators 
on this bill is that they have heard from people across the country, 
including Democrats, Republicans, and others, who have said this is 
what happened to me and my family because of the discrimination and 
because there is no coverage.
  If a health care plan is going to have mental health coverage, it 
ought to be treated the same as any physical illness. It is a matter of 
discrimination, of basically civil rights. Ending the discrimination 
and making sure people get coverage is what this is about.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri is recognized.
  Mrs. CARNAHAN. Mr. President, the attacks against America have 
unified our nation. There is a new spirit of bipartisanship, of 
civility, and of common purpose.
  Republicans, Democrats, and Independents are working together with 
the President to expedite legislation important to our efforts at home 
and abroad. Contentious issues have been set aside, in order to focus 
on the issues that unite us.
  Thus, it is with disappointment that I feel compelled to come to the 
Senate floor today to discuss a dispute between the State of Missouri 
and the

[[Page 20903]]

Health Care Financing Agency (HCFA) now known as the Center for 
Medicare and Medicaid Services, or CMS.
  The details of the dispute are complex, but the consequences are 
enormous. At stake is the health of Missouri's children, seniors, and 
other vulnerable citizens.
  The subject of this dispute is Missouri's provider assessment 
program, which is a tax on hospitals.
  States use the money generated from these taxes as their ``match'' 
for federal Medicaid dollars. Medicaid funds are then paid out to 
providers according to formulas established by state law.
  Over a decade ago, Congress became concerned that states were using 
provider taxes improperly to increase the federal contributions to 
Medicaid programs. In response, Congress enacted a law in 1992 that 
placed limitations on provider assessment programs.
  One specific limitation is that a provider assessment must not 
contain a ``hold harmless'' provision. This means that states may not 
guarantee that a hospital will receive back from Medicaid the amount of 
funds it paid to the state in provider taxes.
  In 1992, under the leadership of Governor John Ashcroft, now the 
Attorney General, Missouri complied with the federal law by enacting 
the Federal Reimbursement Allowance Program law. This law created a tax 
on hospitals, but contained no ``hold harmless'' provision. Governor 
Ashcroft signed the bill into law. Governor Carnahan continued the 
program, and Governor Holden is continuing it.
  For almost a decade, the program has been operating under the 
auspices of HCFA now CMS. During this time, 100 percent of the revenues 
generated by the tax have been dedicated to Missouri's Medicaid 
program. The program has made Missouri a national model for using 
Federal, State, and private resources to provide health care to as many 
needy citizens as possible.
  This long-standing and legal tax has assisted Missouri in creating a 
strong healthcare safety net for its children, pregnant women, and most 
vulnerable seniors.
  Much of Missouri's success can be attributed to expanded enrollment 
of eligible citizens in Medicaid. During the 1990's, the number of 
Missourians covered by Medicaid more than doubled, increasing from 
364,000 in 1990 to 839,000 in 2001.
  The number of children enrolled in Medicaid has grown at an even 
faster rate, increasing from 180,000 in 1990 to 474,000 in 2001.
  An important step in covering more children was the enactment of the 
State's Children's Health Insurance Program, also known as MC Plus. 
Under the leadership of Governor Carnahan, MC Plus was designed to 
cover children up to 300 percent of the poverty level. It is a national 
model. Due to MC Plus, parents who were working, but did not have 
access to health insurance through their employer, could now provide 
this precious resource to their children.
  The MC Plus program has made a difference in the lives of 75,000 
children in Missouri.
  This combination of initiatives has sharply reduced the number of 
Missouri citizens that lack health insurance. Between 1996 and 1999, 
the percentage of uninsured in Missouri dropped by more than one-third, 
falling from 13.2 percent to 8.6 percent. In 1999, Missouri has the 
fourth lowest percentage of uninsured citizens in the country.
  These tremendous accomplishments, however, could be in jeopardy from 
a bureaucratic squabble over the technicalities of Missouri's provider 
tax.
  For many years, HCFA has complained that the manner in which 
Missouri's provider tax revenues are distributed to health care 
providers violates federal law. During this entire period, HCFA has 
been threatening to terminate the program and recoup $1.6 billion from 
the State. Such action would devastate Missouri's health care program.
  Let's be clear about what is in dispute. HCFA has never alleged that 
the provider tax itself contains a ``hold harmless'' provision.
  Rather, HCFA--and now CMS--appear to believe that the State, under 
the leadership of then Governor Ashcroft, made a collusive arrangement 
with health care providers. CMS has suggested that state officials 
illegally agreed that each hospital would get back in Medicaid 
reimbursement at least the amount it paid in taxes.
  Missouri strongly disputes the allegation that there is a hold 
harmless arrangement between the State and its hospitals. And, in fact, 
the Federal Government has never provided Missouri with a shred of 
evidence that state officials engaged in illegal collusion with the 
hospitals. I repeat, not a shred of evidence.
  Instead of proving its case, HCFA continues to complain about the 
provider tax, threaten Missouri with legal action, and uses 
bureaucratic leverage to force Missouri to change its incredibly 
successful program.
  Mr. President, this is truly a case of form over substance. Missouri 
has created a program that pumps millions of dollars into health care 
coverage for its citizens. Missouri then distributes tax dollars to 
health care providers according to a state formula, which everyone 
agrees is consistent with Federal law.
  Yet, a set of health care bureaucrats in Washington seek to destroy 
this program. Why? Because they have a hunch--without any concrete 
evidence--that the people who designed the program almost 10 years ago, 
secretly conspired to circumvent the technicalities of federal law. 
This is a case of bureaucracy run amok.
  Ironically, this is the same agency that has recently changed its 
name so to shed its image that it cares more about rules and 
regulations than people. As a matter of fact, this administration 
announced when it took office that it would measure performance by 
looking at health care outcomes, not by compliance with bureaucratic 
requirements.
  Nonetheless, it is this administration that is now threatening to 
take action against the State of Missouri. It is doing so even when 
there can be no doubt that our program is working to provide better 
health care to kids, to seniors, and our most needy citizens.
  Of course, the timing of this threatened action could not come at a 
worse time. Our economic downturn is causing a great deal of distress 
in our communities. We are seeing significant job losses. State 
revenues are declining, and at the same time our citizens' needs are 
increasing.
  Why, I ask, at this time of national emergency, would the 
administration choose to attack a successful program that has provided 
health care security for so many?
  And why would the administration want to divert the State's attention 
from the task of helping Missouri get through this economic downturn?
  There really are no good answers to these questions.
  Senator Bond and I, Governor Holden, and other Members of the 
Congressional delegation are unified in opposition to the threatened 
CMS action. I strongly urge Secretary Thompson, CMS Administrator 
Scully, and other leaders in the administration to examine this issue 
with great care before taking an action that would cause so much harm 
to our State.
  Mr. President, I stand here with my fellow Missouri Senator to draw 
awareness to this important issue. I hope that CMS understands that we 
intend to take aggressive action to protect a highly successful program 
in Missouri.
  Mr. BOND. Mr. President, this is an issue that I brought to the 
attention of the chairman and ranking member of the Appropriations 
Committee when we marked up this bill in committee. I have been working 
over the past few years to protect the Missouri Medicaid program from 
the devastating impact of a potential recoupment of almost $2 billion. 
Confronted with such a recovery--or even a fraction of that amount--
Missouri would inevitably be forced to cut back on its Medicaid 
program, putting health care for many Missourians in jeopardy. I am 
hopeful that the State of Missouri and CMS can work together in good 
faith to find a resolution that protects the care that the Missouri 
Medicaid program provides to 479,091 children, 21,517 seniors

[[Page 20904]]

in nursing homes, and close to 30,000 pregnant women across the state.
  Mr. HARKIN. I appreciate and thank Senator Carnahan and Senator Bond 
for bringing this important issue to our attention. I am concerned that 
attempts to recoup Medicaid dollars from their state could jeopardize 
the health care it provides for hundreds of thousands of children, 
senior citizens, and pregnant women.
  Clearly, our first priority has to be the beneficiaries of the 
Medicaid program. At this time of economic uncertainty, the last thing 
this Government should do is put our most vulnerable citizens at 
greater risk.
  Again, I thank the Senators from the State of Missouri for raising 
this issue, and I look forward to working with them on this matter.
  Mr. SPECTER. I thank my colleagues from Missouri for bringing this 
important issue to the Senate's attention. I support their efforts and 
encourage CMS to work in good faith with the State to find a resolution 
to this matter that allows Missouri to continuing making progress in 
providing health insurance to its citizens.
  Mrs. CARNAHAN. I thank Senator Harkin and Senator Specter for their 
support on this issue.
  The PRESIDING OFFICER. The senior Senator from Missouri.
  Mr. BOND. I thank the Chair and my colleague, Senator Carnahan. We 
have talked about this a great deal. Over the last decade, Missouri's 
Medicaid Program has faced a series of difficult but important 
challenges.
  Not only has the program been forced to struggle with internal 
issues, such as transitioning to managed care, reaching out to 
Missourians who are eligible but not yet enrolled in the program, and 
providing adequate payment to health care providers who care for 
Medicaid patients. It has had to deal with a number of important 
challenges presented at the Federal level as well. Not the least were 
efforts by Congress, attempted in both 1995 and 1997, but foiled by me 
and other legislators and people in similar circumstances in other 
States, to limit States' abilities to make disproportionate share 
hospital payments to safety net hospitals.
  Another challenge has been to expand coverage to children in working 
poor families as called for by the creation of the Children's Health 
Insurance Program, or CHIP. I was an early supporter of this program 
and its efforts to expand coverage for low-income children. Missouri 
achieved this as part of its 1997 Medicaid waiver which is now in 
effect.
  In addition, in 1999, under the previous administration, the Centers 
for Medicare and Medicaid Services, CMS, then called the Health Care 
Financing Administration, HCFA, initiated an investigation of the 
Missouri Medicaid Program.
  Since HCFA began the process, CMS has carried on this effort, moving 
down the path to contend that Missouri may owe the Federal Government 
portions of the Medicaid funding the State received beginning in 1992 
based on concerns about whether the tax imposed on hospitals and 
nursing homes by the State of Missouri to help finance the Medicaid 
Program actually complies with Federal law.
  We all know that many States prior to 1992 tried to squeeze extra 
Federal funding by taking or accepting money from health care 
providers, essentially nursing homes and hospitals, in order to inflate 
artificially State level medical spending and, thus, increase the 
Federal share of costs in the joint State-Federal Medicaid Program.
  In 1991, of course, Congress passed the law to outlaw these 
contributions and to establish strict new controls on provider taxes. 
This law imposed a requirement on States that provider taxes be uniform 
and broad based, and it prohibited States from instituting hold 
harmless Medicaid schemes in which payments to a health facility, 
particularly including DSH payments, were directly or indirectly 
related to the amount of provider tax a facility pays.
  The State of Missouri believes it is fully in compliance with that 
law. CMS disagrees. Missouri does impose a tax on hospitals and nursing 
homes to finance a State's share of Medicaid expenses, but the State 
insists the tax is uniform and broad based.
  Furthermore, the payments the State makes to Medicaid providers 
recognize their proportion of indigent payments, but these payments are 
targeted to needy facilities and are in no way intended to facilitate 
or pay for compensation for the provider taxes by the facilities that 
receive the reimbursement.
  This is a unique setup in which the State sends Medicaid payments for 
some hospitals to a subsidiary of HMA, the hospital association, which 
then acts as an agent in distributing the funds.
  The CMS concerns about the Missouri situation center on this 
arrangement, and we have reason to believe they were on a course to 
attempt to seek $1.6 billion in repayments. This would be an enormous 
sum for the Missouri Medicaid Program whose annual budget in 2001 was 
only $3.5 billion, including both Federal and State funds.
  If this action were to be taken, it would devastate the Medicaid 
Program of the State of Missouri and the care it currently provides for 
over 479,000 children, 21,000 seniors in nursing homes, and close to 
30,000 pregnant women. That is absolutely unacceptable, and that cannot 
go forward.
  The State of Missouri already faces huge budget shortfalls due to 
overspending and, in the near term, will have difficulty even in 
maintaining the current programs and services which are so vitally 
needed. If CMS were to succeed in taking these funds back, Missouri's 
Medicaid Program and over 800,000 people currently served could be 
grievously harmed.
  I come to the Chamber today with my colleague from Missouri to raise 
this issue for the Senate. We have entered into a colloquy with the 
managers of the bill because we believe, as a result of raising this 
issue when we discussed it in the Appropriations Committee markup, that 
we started the process of bringing the State of Missouri and CMS 
together in good faith negotiations on the issue.
  We strongly urge them to come to a resolution that meets CMS's 
concerns but that protects the integrity of Missouri's Medicaid Program 
and the care it provides to some of Missouri's most vulnerable 
citizens.
  I appreciate the time of the Senate, and I appreciate the 
understanding of the managers of the bill. My colleague from Missouri, 
Senator Carnahan, and I look forward to seeing a successful resolution 
that will take care of the concerns of CMS, but also not take away the 
vitally needed Medicaid support for needy children, for the seniors in 
nursing homes, and for the pregnant women.
  I thank the Chair. I yield the floor.
  The PRESIDING OFFICER. The Senator from West Virginia.


                Amendment No. 2035 to Amendment No. 2020

  Mr. BYRD. Mr. President, on behalf of the distinguished senior 
Senator from Alaska and myself, I send an amendment to the desk.
  The PRESIDING OFFICER. The clerk will report.
  The senior assistant bill clerk read as follows:

       The Senator from West Virginia [Mr. Byrd], for himself and 
     Mr. Stevens, proposes an amendment numbered 2035 to amendment 
     No. 2020.
       At the end of the amendment add:
       (a) Notwithstanding Rule 3 of the Budget Scorekeeping 
     Guidelines set forth in the joint explanatory statement of 
     the committee of conference accompanying Conference Report 
     105-217, the provisions of the amendment that would have been 
     estimated by the Office of Management and Budget as changing 
     direct spending or receipts under section 252 of the Balanced 
     Budget and Emergency Deficit Control Act of 1985 were it 
     included in an Act other than an appropriations Act shall be 
     treated as direct spending or receipts legislation, as 
     appropriate, under section 252 of the Balanced Budget and 
     Emergency deficit Control Act of 1985, and by the Chairman of 
     the Senate Budget Committee, as appropriate, under the 
     Congressional Budget Act.

  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. BYRD. Mr. President, the amendment by Mr. Domenici is the text of 
S. 534, the Mental Health Equitable Treatment Act of 2001. This 
amendment would prohibit group health

[[Page 20905]]

plans and group health insurance issuers that provide both medical and 
surgical benefits and mental health benefits from imposing treatment 
limitations or financial requirements for coverage of mental health 
benefits that are different from those used for medical and surgical 
benefits.
  The problem Senator Stevens and I encountered in processing this 
amendment is that the Senate Appropriations Committee would be charged 
with approximately $1.5 billion over the next decade if this amendment, 
worthwhile as it may be, were to be adopted. Both Senator Stevens and 
I, I believe, are cosponsors of the underlying legislation, S. 534. I 
did not realize that legislation was going to be offered as an 
amendment to an appropriations bill, however, or I might not have 
cosponsored it. Because of the adverse impact on discretionary 
spending, we would be forced to oppose this amendment in its current 
form. In an effort to find a workable solution to the problem, this 
amendment would direct that any expenditures resulting from this 
amendment be charged to the committee of jurisdiction under the budget 
process. If this amendment is adopted, I will drop my opposition to the 
underlying amendment.
  Senator Stevens and I have spoken with the chairman and ranking 
member of the Budget Committee, and they are in agreement.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Alaska.
  Mr. STEVENS. I am pleased to join with the distinguished chairman of 
our committee in offering this amendment to the Domenici amendment.
  Senator Byrd and I have made a firm agreement to hold the line on the 
understanding we reached with the House of Representatives and the 
President of the United States to hold the total spending to $686 
billion this year. This amendment does not breach that agreement. I am 
talking about the Domenici amendment does not breach this agreement.
  Further, the amendment to the Domenici amendment will assure in 
future years, if there are caps continued under the Budget Control Act, 
that this amendment will not result in monies being assessed to our 
committee, as Senator Byrd has stated. They should properly be asserted 
to the committee of jurisdiction.
  I am of the firm opinion this is a good bill. I was a cosponsor of 
the bill. I did not expect it to be offered to an appropriations bill, 
but under the parliamentary situation I do not express objection to 
that. I do, however, think the Senate should be reminded once again we 
have a firm understanding with regard to the appropriations process 
this year, and if we hold to that understanding I think we will finish 
our bills in time to enjoy the holidays with our relatives. If we 
breach that agreement, we will be here for a long time.
  I am proud to serve with Senator Byrd, who is chairman, because we 
are two people who I believe keep our word. We have in this instance 
convinced the Senate to follow us in that regard. So I thank the 
Senator very much and am pleased to cosponsor the amendment.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. WELLSTONE. Very quickly, I know Senator Domenici is in a markup 
on the energy and water bill, along with Senator Harkin.
  I thank my two colleagues for their amendment. I think it just adds 
to the strength of the bill. It is very important to have their 
support. So I thank both of them for their work.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. SPECTER. Mr. President, I thank the distinguished chairman of the 
full committee, Senator Byrd, and the ranking member, Senator Stevens, 
for their assistance in moving ahead with this very important 
amendment.
  Parity for mental health has been an objective of about two-thirds of 
the Senators for many years. Through today's action, I think we are on 
the road to getting that accomplished. So I salute my colleagues and 
thank my colleagues for their cooperation and good work.
  The PRESIDING OFFICER. Is there further debate on the second-degree 
amendment?
  If not, the question is on agreeing to amendment No. 2035.
  The amendment (No. 2035) was agreed to.
  Mr. STEVENS. I move to reconsider the vote.
  Mr. SPECTER. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The question is on agreeing to amendment No. 
2020, as amended.
  The amendment (No. 2020), as amended, was agreed to.
  Mr. SPECTER. I move to reconsider the vote.
  Mr. WELLSTONE. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. SPECTER. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll. Mr. HARKIN. Madam 
President, I ask unanimous consent that the order for the quorum call 
be rescinded.
  The PRESIDING OFFICER (Ms. Cantwell). Without objection, it is so 
ordered.


                      Unanimous Consent Agreement

  Mr. HARKIN. Madam President, I ask unanimous consent that the list I 
will send to the desk, once this consent has been granted, be the only 
first-degree amendments to H.R. 3061, the Labor-HHS appropriations 
bill; that these amendments be subject to relevant second-degree 
amendments; that upon disposition of all amendments, the bill be read 
the third time and the Senate vote on passage of the bill. That upon 
passage, the Senate insist on its amendments, request a conference with 
the House on the disagreeing votes of the two Houses, and the Chair be 
authorized to appoint conferees on the part of the Senate, with this 
action occurring with no intervening action or debate.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The list of amendments follows:

                        First Degree Amendments

       Bayh: Mark to market.
       Bingaman: Retirement; Hispanic education programs.
       Byrd: Relevant; relevant to the list.
       Clinton: SAMSHA--mental health for public safety officers; 
     mental health services for children.
       Daschle: Relevant; 3 relevant to the list; firefighters' 
     collective bargaining.
       Dorgan: Customs related.
       Dodd: Children's Mental Health; EMS; Kids and terrorism.
       Feingold: Defibrillators.
       Graham: Ecstasy use.
       Harkin: Relevant; relevant to the list; managers' 
     amendments.
       Kennedy: Bioterrorism.
       Reed: Relevant; mark to market
       Reid: Relevant; relevant to the list.
       Torricelli: 3 lead poisoning; 2 assistance for dislocated 
     workers; SOS anthrax emergency response.
       Wellstone: Mental health parity.
       T. Hutchinson: Charitable giving.
       B. Smith: Research; relevant; relevant to list.
       DeWine: 4 Safe and Stable Families.
       Collins: LIHEAP; substance abuse/homeless; relevant.
       Sessions: Wage index; foreign school loans; misuse of AIDS 
     funds.
       Murkowski: Relevant; national security
       Nickles: 2 Relevant; 2 relevant to list.
       Brownback: Human cloning ban; embryo research; human-animal 
     hybrid embryo; 12 relevants.
       Domenici: Mental health parity (S. 543).
       Enzi: School construction; mental health.
       Gramm: Diabetes research funding; relevant; relevant to 
     list.
       Gregg: 2 mental health; school renovation; relevant/health.
       Kyl: Impact aid; relevant.
       Specter: 2 Relevant.
       Lott: 3 relevant; 3 relevant to list.
       Cochran: Relevant.
       Snowe: 3 relevant.
       Santorum: HUD.
       Grassley: Relevant.

  Mr. HARKIN. This is a finite list of amendments we now have before 
the committee.
  I am authorized by the majority leader to announce there will be no 
further votes this evening.
  Mr. SPECTER. Madam President, I urge all of our colleagues to move 
ahead promptly tomorrow to offer amendments. The list is a very long

[[Page 20906]]

list and, as is frequently the case, a great many of the amendments 
listed are placeholders. We would appreciate our colleagues advising 
which amendments they intend to offer and specify what amendment it is 
so we can move ahead. It is very important we complete action on this 
bill if we are to complete a conference in a time where we will finish 
during the current session before the holiday season.
  Last year, it took months for the conference to be resolved between 
the House and Senate. We urge our colleagues to come to the floor 
tomorrow when we start action on the bill, which I understand is to be 
at 10:30, to proceed to offer amendments.
  I yield the floor.


                           Amendment No. 2024

  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DORGAN. I have an amendment at the desk for immediate 
consideration.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from North Dakota [Mr. Dorgan] proposes an 
     amendment numbered 2024.

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

(Purpose: To provide for mandatory advanced electronic information for 
          air cargo and passengers entering the United States)

       At the end of the bill, insert the following:

             TITLE __--INFORMATION ON PASSENGERS AND CARGO

     SEC. __01. MANDATORY ADVANCED ELECTRONIC INFORMATION FOR AIR 
                   CARGO AND PASSENGERS ENTERING THE UNITED 
                   STATES.

       (a) Air Cargo Information.--
       (1) In general.--Section 431(b) of the Tariff Act of 1930 
     (19 U.S.C. 1431(b)) is amended--
       (A) by striking ``(b) Production of Manifest.--Any 
     manifest'' and inserting the following:
       ``(b) Production of Manifest.--
       ``(1) In general.--Any manifest'';
       (B) by indenting the margin of paragraph (1), as so 
     designated, two ems; and
       (C) by adding at the end the following new paragraph:
       ``(2) Additional information.--
       ``(A) In general.--In addition to any other requirement 
     under this section, every air carrier required to make entry 
     or obtain clearance under the customs laws of the United 
     States, the pilot, the master, operator, or owner of such 
     carrier (or the authorized agent of such owner or operator) 
     shall provide by electronic transmission cargo manifest 
     information specified in subparagraph (B) in advance of such 
     entry or clearance in such manner, time, and form as the 
     Secretary shall prescribe. The Secretary may exclude any 
     class of air carrier for which the Secretary concludes the 
     requirements of this subparagraph are not necessary.
       ``(B) Information required.--The information specified in 
     this subparagraph is as follows:
       ``(i) The port of arrival or departure, whichever is 
     applicable.
       ``(ii) The carrier code, prefix code, or, both.
       ``(iii) The flight or trip number.
       ``(iv) The date of scheduled arrival or date of scheduled 
     departure, whichever is applicable.
       ``(v) The request for permit to proceed to the destination, 
     if applicable.
       ``(vi) The numbers and quantities from the master and house 
     air waybill or bills of lading.
       ``(vii) The first port of lading of the cargo.
       ``(viii) A description and weight of the cargo.
       ``(ix) The shippers name and address from all air waybills 
     or bills of lading.
       ``(x) The consignee name and address from all air waybills 
     or bills of lading.
       ``(xi) Notice that actual boarded quantities are not equal 
     to air waybill or bills of lading quantities.
       ``(xii) Transfer or transit information.
       ``(xiii) Warehouse or other location of the cargo.
       ``(xiv) Such other information as the Secretary, by 
     regulation, determines is reasonably necessary to ensure 
     aviation transportation safety pursuant to the laws enforced 
     or administered by the Customs Service.
       ``(3) Availability of information.--Information provided 
     under paragraph (2) may be shared with other departments and 
     agencies of the Federal Government, including the Department 
     of Transportation and the law enforcement agencies of the 
     Federal Government, for purposes of protecting the national 
     security of the United States.''.
       (2) Conforming amendments.--Subparagraphs (A) and (C) of 
     section 431(d)(1) of such Act are each amended by inserting 
     before the semicolon ``or subsection (b)(2)''.
       (b) Passenger Information.--Part II of title IV of the 
     Tariff Act of 1930 is amended by inserting after section 431 
     the following new section:

     ``SEC. 432. PASSENGER AND CREW MANIFEST INFORMATION REQUIRED 
                   FOR AIR CARRIERS.

       ``(a) In General.--For every person arriving or departing 
     on an air carrier required to make entry or obtain clearance 
     under the customs laws of the United States, the pilot, the 
     master, operator, or owner of such carrier (or the authorized 
     agent of such owner or operator) shall provide, by electronic 
     transmission, manifest information specified in subsection 
     (b) in advance of such entry or clearance in such manner, 
     time, and form as the Secretary shall prescribe.
       ``(b) Information.--The information specified in this 
     subsection with respect to a person is--
       ``(1) full name;
       ``(2) date of birth and citizenship;
       ``(3) sex;
       ``(4) passport number and country of issuance;
       ``(5) United States visa number or resident alien card 
     number, as applicable;
       ``(6) passenger name record; and
       ``(7) such other information as the Secretary, by 
     regulation, determines is reasonably necessary to ensure 
     aviation transportation safety pursuant to the laws enforced 
     or administered by the Customs Service.
       ``(c) Availability of Information.--Information provided 
     under this section may be shared with other departments and 
     agencies of the Federal Government, including the Department 
     of Transportation and the law enforcement agencies of the 
     Federal Government, for purposes of protecting the national 
     security of the United States.''.
       (c) Definition.--Section 401 of the Tariff Act of 1930 (19 
     U.S.C. 1401) is amended by adding at the end the following 
     new subsection:
       ``(t) Air Carrier.--The term `air carrier' means an air 
     carrier transporting goods or passengers for payment or other 
     consideration, including money or services rendered.''.
       (d) Effective Date.--The amendments made by this section 
     shall take effect 45 days after the date of enactment of this 
     Act.

  Mr. DORGAN. Madam President, this is an amendment I discussed on the 
floor briefly earlier today. I shall be brief again. I understand under 
ideal circumstances this amendment would be placed somewhere else, at 
some other time, perhaps in some other bill. It is an amendment that is 
critically important and should have been done last week. It should now 
be law. It should already be providing protection to the American 
people today but is not.
  I am angry about that because the Congress should not have missed 
this opportunity last week. I don't intend to let the Congress miss 
this opportunity at any point along the way. I will offer it, and if it 
is not finally a part of this bill when signed by the President, I will 
offer it to every bill.
  Let me describe the circumstance. I am chairman of an appropriations 
subcommittee and I held a hearing a few weeks ago and had the 
Commissioner of the Customs Service and the Commissioner of the 
Immigration Service testifying before that subcommittee. One of the 
things they talked about was the need to provide security with respect 
to who is coming into our country. A country cannot be secure unless it 
has some notion of border security. We have millions of people coming 
into our country each and every year. They are guests of ours, coming 
in on a visa given by our country.
  When people come to our country, we welcome them. We want them to 
visit our country, but we also want to be sure the people who are 
coming to our country from foreign lands are people we want to have as 
guests. There are some we want to keep out: Those involved in terrorist 
activities, those who have had association with terrorist groups, known 
and suspected terrorists. We do not want to welcome them into our 
country. We want to keep them out. That is the whole purpose of border 
security.
  We have around 80 million people who come to this country every year 
on some 400,000 international flights. I repeat, on 400,000 
international flights we have some 80 million people disembark to visit 
the United States. There are just over 100 major air carriers flying 
those passengers into our country. We have an arrangement with 95 of 
those air carriers to voluntarily provide the United States Customs 
Service with advance passenger lists of who is coming to visit our 
country. The Customs Service runs that list

[[Page 20907]]

against a list the FBI has, the Customs Service has, and 21 different 
agencies of law enforcement, to evaluate which of these passengers, if 
any, should not be allowed into our country, which of them are on the 
suspect list, and which are on the list of known or suspected 
terrorists.
  We have the majority of the airline carriers and the majority of the 
names of passengers being given to our law enforcement authorities in 
the form of an advance electronic passenger list. It is called the 
Advance Passenger Information System. It is a voluntary, not mandatory, 
system covering 85 percent of the international air passengers that are 
not already pre-cleared by Customs. It works fine except we have a 
number of carriers from countries that do not participate.
  Let me list a few: Saudi Arabia, Egypt, Jordan, and Pakistan, just to 
name a few.
  One would ask whether we should be getting advanced passenger 
information from these countries. The answer is yes. In fact, the 
Senate said yes last week. The Senate was prepared to adopt this 
amendment last week as part of the counter-terrorism bill, which is 
where it should have been. In conference it was knocked out. It went to 
conference with the U.S. House. Some were worried more about committee 
jurisdiction than they were about security. So they knocked it out.
  The result was, when the President signed that counter-terrorism 
bill, it did not have this provision that makes mandatory the Advanced 
Passenger Information System.
  What does that mean? It means that today about 219,000 international 
air passengers arrived in the United States--today, Tuesday. About 
34,000 are pre-cleared by U.S. Customs agents stationed abroad who run 
an APIS-type check as part of the clearing process, 156,000 are pre-
screened through APIS while they are in flight, leaving approximately 
29,000 whose names are not provided to the Customs Service until they 
arrive because their carriers do not participate in the Advanced 
Passenger Information System. Why? Because the Congress last week 
decided not to include that requirement in a conference report.
  The President wants this requirement. The Customs Service wants the 
requirement. All the Federal law enforcement authorities want the 
requirement. We get it on 85 percent of international air passengers. 
And the ones we don't get it from are Pakistan, Kuwait, Saudi Arabia, 
Egypt, and Jordan, just to name a few.
  I ask the question: Does it promote this country's security to 
require those air carriers to provide the same information that 
virtually every other air carrier in the world provides to us? The 
answer is clearly yes.
  We are less secure today than we should be because the Congress 
knocked out my provision in that conference committee. That provision 
was not in the counter-terrorism bill when the President signed it, 
despite the fact that the Senate supported it. The Senate said yes. But 
it was knocked out in conference.
  I intend to offer this to any vehicle I have the opportunity to offer 
it to. I know that it doesn't necessarily belong on an appropriations 
bill. But it belongs in law in this country. It belongs there now. It 
should be there now. It should be providing security for this country 
now with respect to the 29,000 people who entered this country today 
whose names were not provided under the Advanced Passenger Information 
List. It makes no sense to me to be in this situation.
  Some would say, well, this really inconveniences and mandates the air 
carriers to do this. No, it does not. Most of the air carriers do it 
voluntarily, and they have a good relationship with our country. But 
some air carriers decided that they will not do it. The Customs 
Commissioner and others indicate that we ought to make it mandatory. I 
agree with that.
  Since September 11, things have changed. It is not profiling. It is 
not profiling in any way to ask for an advanced list of passengers who 
are going to visit our country as guests in our country. But we are 
trying to profile those who are terrorists and suspected terrorists. 
Let's admit to that.
  One of the goals that we have in all of our efforts with respect to 
increasing security at our borders is to determine who the people are 
who associate with terrorists and known terrorists or suspected 
terrorists, and try to keep them out of our country. Unfair? I don't 
think so, not in the circumstance where thousands of Americans have 
been killed-- cold-blooded murder by terrorists who decided to use an 
airplane as a weapon of destruction; not at a time when terrorists sent 
anthrax-laced letters around this country through the mail system and 
people die.
  I ask that we include this amendment in this appropriations bill. I 
hope those who are talking about their committee jurisdiction will 
understand that this isn't about jurisdiction. It is about security. 
This isn't about trying to protect your little area. It is about common 
sense to try to protect this country's borders. The Advanced Passenger 
Information System works. It has worked for a long while. It provides 
this country names that are important to secure our borders, except 
that it doesn't do it in all instances. In the instances where it 
fails, it is critically important to give this country critically 
important information in order to give this country some assurance and 
some comfort.
  I understand that we will probably deal with this amendment tomorrow. 
I wanted to offer it this evening.
  Mr. HARKIN. Madam President, I believe this amendment which I am 
pledged to cosponsor should become law. It is very reasonable for the 
United States to require that airlines provide information about their 
international travelers coming to the United States so customs can be 
able to check if any of the passengers are of special concern.
  We are going to considerable lengths to improve the safety of our 
aviation system and to improve our ability to better protect our 
borders. Requiring that international airlines provide some basic 
information about their passengers and their cargo is very reasonable.
  I understand some airlines are concerned about the small costs 
involved. Some airlines might have other reasons to not comply. But 
with 85 percent compliance with the voluntary requirements, clearly the 
burden is well within reason. There is no question, given the realities 
of our world, this should be required information for any international 
flight coming to the United States.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. REID. Madam President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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