[Congressional Record (Bound Edition), Volume 149 (2003), Part 15]
[Senate]
[Pages 21111-21118]
[From the U.S. Government Publishing Office, www.gpo.gov]




  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
          RELATED AGENCIES APPROPRIATIONS ACT, 2004--Continued

  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. DeWINE. Madam President, my colleague from New York and other 
Members who are on the Senate floor have several amendments that I ask 
unanimous consent to have set aside. I anticipate speaking probably for 
about 10 minutes.
  Mr. SPECTER. Madam President, will the Senator from Ohio yield for an 
announcement?
  Mr. DeWINE. I yield.
  Mr. FRIST. Madam President, just for the information of our 
colleagues, we will have no more rollcall votes tonight. The plan at 
this juncture is that most likely we will have two stacked rollcall 
votes in the morning. That is subject to change. People should stay in 
touch with the cloakrooms. But for tonight, there will be no more 
rollcall votes.
  We will continue with amendments, and I ask Members to come to the 
floor so we can prepare for tomorrow. We will have stacked votes in the 
morning.
  The PRESIDING OFFICER. The Senator from Ohio.


                Amendment No. 1561 to Amendment No. 1542

  Mr. DeWINE. Madam President, I call up my amendment numbered 1561.
  The PRESIDING OFFICER. Without objection, the pending amendments will 
be set aside and the clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Ohio [Mr. DeWine] proposes an amendment 
     numbered 1561 to amendment No. 1542.

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

   (Purpose: To provide funds to support graduate medical education 
                   programs in children's hospitals)

       On page 61, between lines 14 and 15, insert the following:
       Sec. __. (a) In General.--To carry out programs to support 
     graduate medical education programs in children's hospitals 
     under section 340E of the Public Health Service Act (42 
     U.S.C. 256e et seq.), there are appropriated a total of 
     $305,000,000, including amounts otherwise made available in 
     this Act for such programs.
       (b) Offset.--Amounts appropriated under title III under the 
     heading ``Program Administration'' shall be reduced by 
     $15,000,000.

  Mr. DeWINE. Madam President, this amendment would increase the amount 
of pediatric graduate medical education funding to $305 million--up 
from the $290 million currently in the bill.
  I remind my colleagues that a sense-of-the-Senate amendment was 
attached to this year's budget resolution which indicated that 
children's graduate medical education should be funded at $305 million.
  This amendment would mirror the sense-of-the-Senate resolution which 
we have already adopted. That is all it would do. But I believe it is 
important that we provide these additional dollars.
  This funding for pediatric graduate medical education is truly a 
vital part of our efforts to protect children's health in this country.
  To date, children's hospitals, though they represent only 1 percent 
of all hospitals in the country, train 30 percent of all pediatricians 
and 50 percent of all pediatric specialists. They also provide hospital 
care to almost 50 percent of all seriously ill children in this 
country.
  Furthermore, children's hospitals serve as the health care safety net 
for low-income children in their respective communities and are often 
the sole regional providers of many critical pediatric services.
  These children's hospitals are often the only source of many 
pediatric specialty services, and it is their graduate training 
programs that make these services possible. Funding for pediatric 
graduate medical education helps provide our Nation with highly 
qualified pediatricians, pediatricians who can properly treat and care 
for our children when they are sick.
  Clearly, funding for GME in children's hospitals is a sound 
investment in children's health and provides stability for the future 
of the pediatric workforce. I urge my colleagues to join me in 
providing this additional $15 million in funding for graduate medical 
education in children's hospitals.
  Anyone who has had the occasion to take their child to a children's 
hospital, as I have, and to see the magical work these children's 
hospitals do, I think can appreciate the need for this amendment. To 
see the specialists descend on your child when you are concerned about 
that child's safety, maybe that child's life, is just something you 
really cannot describe.
  The children's hospitals will tell you that this graduate medical 
education money has been a lifesaver for them. It is essential that we 
provide this money through the appropriations process, frankly, because 
of a quirk in the law. It is a quirk in the law that we have to

[[Page 21112]]

do it through the appropriations process because they do not 
automatically get the money through the entitlement process because, 
obviously, they do not serve many Medicare patients. So it does not 
come to them automatically, as it does all the other hospitals in the 
country. So every year we have to go through this process.
  I am simply asking that the funds be increased to $305 million. It is 
the right thing to do. It is the proper thing to do. I ask my 
colleagues to support this very simple amendment.
  Madam President, I ask unanimous consent that this amendment be set 
aside for the time being.
  The PRESIDING OFFICER (Ms. Collins). Without objection, it is so 
ordered.


                Amendment No. 1560 To Amendment No. 1542

  Mr. DeWINE. Madam President, I now call up amendment No. 1560.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Ohio [Mr. DeWine] proposes an amendment 
     numbered 1560 to amendment No. 1542.

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

     (Purpose: To provide funds to support poison control centers)

       On page 61, between lines 14 and 15, insert the following:
       Sec. __. (a) In General.--To provide funding for poison 
     control centers under the Poison Control Enhancement and 
     Awareness Act (42 U.S.C. 14801 et seq.), there are 
     appropriated a total of $27,600,000, including amounts 
     otherwise made available in this Act for such centers.
       (b) Offset.--Amounts appropriated under title III under the 
     heading ``Program Administration'' for building alterations 
     and related expenses for relocation shall be reduced by 
     $5,300,000.

  Mr. DeWINE. Madam President, the amendment I am now offering would 
fully fund poison control centers at $27.6 million. That is an increase 
of $5 million from what the bill currently funds at $22.3 million.
  Members of the Senate, there are currently over 70 poison control 
centers nationwide. These centers have fielded over 1 million phone 
calls since January 2002, answering questions about poisonings, drug 
abuse, product contents, substance identification interactions, and 
adverse reactions. They can answer questions and concerns about what 
would typically be called poison products--things such as cleaners, 
bleaches, anything you would find in your home, any emergency a family 
might face. This is the most common poison exposure for children, 
children who typically ingest household products such as cosmetics and 
personal care products, cleaning substances, pain relievers, foreign 
bodies, and plants.
  Our Nation's poison control centers handle an average of one poison 
call every 15 seconds. Clearly, these centers provide a vital service 
to the parents and family members.
  The money we provide in this bill will go toward the continuation of 
the centers' work, as well as the maintenance of the toll-free 
nationwide poison control hotline. That number, of course, is 1-800-
222-1222. Let me repeat that: 1-800-222-1222. That is a number that 
anybody in this country now can call. Wherever you are, if you are on 
vacation, if you are in your own home, if you are visiting someone, you 
can pick up the phone and call that number, and you will go onto a 
poison control hotline.
  I have used it. My daughter has used it for her children. It is 
something that is so very valuable for a parent, anyone who has 
children. And certainly it is not just for somebody with children. It 
is for anybody who is in a position to be around someone who has 
ingested something and they don't know what it is.
  As anyone who has visited poison control centers can tell you, it is 
also now particularly important in a day and age when we worry about 
terrorism. Poison control centers have a particular meaning for us 
today.
  With the funding in the bill, and with the additional funding that 
would be provided by my amendment, we are not just making an investment 
in poison control; rather, we are making it easier to keep our 
children, our friends, and ourselves safe and healthier.
  I therefore urge my colleagues to support this very modest investment 
in our health. And I might say, the Federal Government is only a small 
partner in the poison control centers. When you go and visit the poison 
control centers around the country, what you will find is that they are 
funded many times by the local hospitals that pay for them themselves. 
They are funded by State and local government units. The money we 
provide is a small part of the overall money, but it is a very crucial 
and very important part of that contribution to keep these poison 
control centers going.
  This is a very modest amendment, but it is a very important 
amendment. I urge my colleagues to support it when we do, in fact, vote 
on the amendment.
  Madam President, I ask unanimous consent that this amendment be set 
aside.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                Amendment No. 1555 To Amendment No. 1542

  Mr. DeWINE. Madam President, I call up amendment No. 1555.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The assistant legislative clerk read as follows:

       The Senator from Ohio [Mr. DeWine] proposes an amendment 
     numbered 1555 to amendment No. 1542.

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

 (Purpose: To express the sense of the Senate concerning the Pediatric 
                          Research Initiative)

       On page 61, between lines 14 and 15, insert the following:
       Sec. __. To demonstrate the appreciation that the Senate 
     has for, and to further encourage, the efforts of the 
     Director of the National Institutes of Health in implementing 
     the Pediatric Research Initiative under section 409D of the 
     Public Health Service Act, it is the sense of the Senate 
     that--
       (1) the Director should continue the Initiative and 
     emphasize the importance of pediatric research, particularly 
     translational research; and
       (2) not later than January of 2004, the Director should 
     continue to report to the Committee on Health, Education, 
     Labor, and Pensions of the Senate and the Committee on Energy 
     and Commerce of the House of Representatives on the status of 
     the Pediatric Research Initiative, including--
       (A) the extent of the total funds obligated to conduct or 
     support pediatric research across the National Institutes of 
     Health, including the specific support and research awards 
     allocated by the Office of the Director through the 
     Initiative;
       (B) the activities of the cross-institute committee on 
     pediatric research in assisting the Director in considering 
     requests for new or expanded pediatric research to be funded 
     through the Initiative;
       (C) how the Director plans to budget dollars toward the 
     Initiative for fiscal year 2004;
       (D) the amount the Director has expended to implement the 
     Initiative since the enactment of the Initiative;
       (E) the status of any research conducted as a result of the 
     Initiative;
       (F) whether that research is translational research or 
     clinical research;
       (G) how the Initiative interfaces with the Off-Patent 
     research fund of the National Institutes of Health; and
       (H) any recommended modifications that Congress should 
     consider in the authority or structure of the Initiative 
     within the National Institutes of Health for the optimal 
     operation and success of the Initiative.


                    Amendment No. 1555, As Modified

  Mr. DeWINE. Madam President, further, I ask unanimous consent that 
the amendment be modified on page 2, line 8, to include the Senate and 
House Appropriations Committees.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The amendment, as modified, is as follows:

       On page 61, between lines 14 and 15, insert the following:
       Sec. __. To demonstrate the appreciation that the Senate 
     has for, and to further encourage, the efforts of the 
     Director of the National Institutes of Health in implementing 
     the Pediatric Research Initiative under section 409D of the 
     Public Health Service Act, it is the sense of the Senate 
     that--

[[Page 21113]]

       (1) the Director should continue the Initiative and 
     emphasize the importance of pediatric research, particularly 
     translational research; and
       (2) not later than January of 2004, the Director should 
     continue to report to the Committee on Health, Education, 
     Labor, and Pensions of the Senate, the Committee on Energy 
     and Commerce of the House of Representatives, the Senate 
     Committee on Appropriations and the House Committee on 
     Appropriations on the status of the Pediatric Research 
     Initiative, including--
       (A) the extent of the total funds obligated to conduct or 
     support pediatric research across the National Institutes of 
     Health, including the specific support and research awards 
     allocated by the Office of the Director through the 
     Initiative;
       (B) the activities of the cross-institute committee on 
     pediatric research in assisting the Director in considering 
     requests for new or expanded pediatric research to be funded 
     through the Initiative;
       (C) how the Director plans to budget dollars toward the 
     Initiative for fiscal year 2004;
       (D) the amount the Director has expended to implement the 
     Initiative since the enactment of the Initiative;
       (E) the status of any research conducted as a result of the 
     Initiative;
       (F) whether that research is translational research or 
     clinical research;
       (G) how the Initiative interfaces with the Off-Patent 
     research fund of the National Institutes of Health; and
       (H) any recommended modifications that Congress should 
     consider in the authority or structure of the Initiative 
     within the National Institutes of Health for the optimal 
     operation and success of the Initiative.

  Mr. DeWINE. Madam President, this amendment is a sense-of-the-Senate 
amendment expressing the importance of pediatric research at NIH. 
Specifically, this amendment says we should continue the work of the 
Pediatric Research Initiative. This is an effort I worked on with 
several of my colleagues and was included in the Children's Public 
Health Act of the year 2000.
  This initiative helps ensure that more funds can be dedicated to 
children's health research within the National Institutes of Health.
  Mr. SPECTER. Madam President, will the Senator yield for a question?
  Mr. DeWINE. I yield.
  Mr. SPECTER. Will the Senator from Ohio be willing to take a voice 
vote, at this point, accepting this amendment?
  Mr. DeWINE. I would be more than happy to do that.
  Mr. SPECTER. Madam President, I urge adoption of the amendment.
  The PRESIDING OFFICER. If there is no further debate, without 
objection, the amendment, as modified, is adopted.
  The amendment (No. 1555), as modified, was agreed to.
  Mr. SPECTER. I thank my distinguished colleague from Ohio and I thank 
the Chair.


                Amendment No. 1578 To Amendment No. 1542

  Mr. DeWINE. Madam President, at this point I call up amendment No. 
1578.
  The PRESIDING OFFICER. Without objection, the clerk will report the 
amendment.
  The assistant legislative clerk read as follows:

       The Senator from Ohio [Mr. DeWine], for himself, Mr. 
     Alexander, Ms. Stabenow, Mr. Grassley, and Mr. Voinovich, 
     proposes an amendment numbered 1578 to amendment No. 1542.

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

(Purpose: To provide funding for the Underground Railroad Education and 
                           Cultural Program)

       On page 74, line 1, strike ``$409,863,000, of which 
     $13,644,000'' and insert ``$406,863,000, of which 
     $10,644,000''.
       On page 76, between lines 11 and 12, insert the following:
       Sec. __. For necessary expenses for the Underground 
     Railroad Education and Cultural Program, there are 
     appropriated $3,000,000.

  Mr. DeWINE. Madam President, the amendment I offer now, along with 
Senators Alexander, Stabenow, Grassley, and Voinovich, will provide $3 
million in funding for the Underground Railroad Education and Cultural 
Act, a 1998 law that Senator Collins and I wrote together. The 
Underground Railroad Education and Cultural Act was designed to assist 
in establishing programs to research, display, interpret, and collect 
artifacts and other items relating to the history of the underground 
railroad. The bill before us now has unfortunately zero-funded this 
program. I believe we must correct that.
  Our amendment would provide $3 million for this program. As my 
colleagues know, the history of the underground railroad is a vital 
part of the history of our great country. In the 20 years or so prior 
to the Civil War, it is estimated--of course, no one will ever know 
what the true figure is--that more than 40,000 slaves used this 
underground railroad, as we refer to it, as a pathway to their ultimate 
freedom. It is a great story in the history of our country. It is a 
great story every schoolchild in America should know about.
  More than 150 underground railroad sites have been identified in my 
State of Ohio alone. But Ohio is not unique. All the States that border 
along the Ohio River and were actually considered to be border States 
have sites on the underground railroad. There were people all along on 
both sides who helped slaves escape. African Americans helped slaves 
escape. White Americans helped slaves escape. There were so many 
heroes.
  Their stories need to be told. There are many more other sites out 
there that frankly need to be identified, and their stories need to be 
told as well. These sites symbolize freedom for thousands and thousands 
of enslaved Americans. When I visit these sites, as I have with my 
family--in fact, I had the opportunity this August during our recess to 
visit several of them--it makes me pause and think about the sacrifice 
that was made by so many people. It reminds us of the history of this 
country. It reminds us of the horror of slavery, a part of our history 
that simply has to be told. But it also reminds us of the good part of 
that history; that is, the sacrifice made by so many people so others 
could be free.
  This program is very important. I urge my colleagues to join me in 
support of this funding request. This funding request will enable this 
story to be told and told in a better way.
  Madam President, I ask unanimous consent at this point that the 
amendment be set aside.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                      International HIV Initiative

  Mr. DeWINE. Madam President, I will at some point, as I indicated 
this morning, be coming to the floor and offering an amendment 
concerning President Bush's International Mother and Child Prevention 
of HIV initiative. As I indicated this morning, unfortunately the bill 
before us does fall short by $60 million what the President requested. 
The President requested $150 million in regard to the amount of money 
to be provided for this initiative. I will be talking about this later 
and will be offering an amendment concerning it. This is the most cost-
effective way to save lives.
  A number of my colleagues went with Senator Bill Frist to Africa. We 
returned just last week. We saw firsthand the good this program is 
already doing. For as little as $3, a pregnant woman can be given the 
help, the drugs she needs to ensure that her child will not be born HIV 
positive.
  The statistics are staggering. For a mother who is HIV positive, the 
odds are approximately 30 percent that she, untreated, will give birth 
to a child who will be HIV positive. We all know what that means, what 
horrible tragedy that is. In countries we visited such as Namibia and 
South Africa, there are now ongoing programs. Many of them, because of 
the initiative of President Bush and this Congress, are good people 
working, reaching out to these pregnant mothers who are HIV positive. 
They have reduced that percentage now down to 5 or 10 percent. If that 
mother can be given a drug prior to the birth of that child--as I said, 
it now costs as little as $2, $3, maybe $4--we can reduce the odds from 
30 percent to giving birth to a child who is HIV positive down to as 
little as 10 percent and possibly as low as 5 percent.
  That is why it is so very important that we restore the funding in 
this bill to the $150 million requested by President Bush. I will be 
coming to the floor

[[Page 21114]]

later on as we debate this bill and offering an amendment to restore 
the funding to the level President Bush requested. I will be back on 
the floor later on to do so.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New York.
  Mrs. CLINTON. Madam President, I commend and thank my colleague from 
Ohio who is always looking out for the children. This has been a 
mission of his, year in and year out. I thank him for the amendments he 
has just discussed because every one of them concerns the well-being of 
our children. I look forward to supporting these amendments. I 
particularly thank the Senator for amendment 1561 to restore the money 
for pediatric graduate medical education.


                Amendment No. 1565 To Amendment No. 1542

  Mrs. CLINTON. Madam President, I ask unanimous consent that amendment 
1565 be called up.
  The PRESIDING OFFICER. Without objection, the clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from New York [Mrs. Clinton] proposes an 
     amendment numbered 1565 to amendment No. 1542.

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

     (Purpose: To provide additional funding to ensure an adequate 
                  bioterrorism preparedness workforce)

       On page 36, line 16, strike the period at the end and 
     insert ``: Provided further, That the amount $6,252,256,000 
     under the heading `Health Resources and Services' shall be 
     deemed to be $6,272,256,000 of which the additional 
     $20,000,000 shall be available for carrying out sections 765 
     and 767 of the Public Health Service Act: Provided further, 
     That the amount $4,588,671,000 under the heading `Disease 
     Control, Research, and Training' shall be deemed to be 
     $4,631,871,000: Provided further, That the amount 
     $1,726,846,000 under the heading `Public Health and Social 
     Services Emergency Fund' shall be deemed to be 
     $1,756,846,000: Provided further, That the amount 
     $1,116,156,000 under the heading `Public Health and Social 
     Services Emergency Fund' shall be deemed to be $1,146,156,000 
     Provided further, That the amount $6,895,199,000 in section 
     305(a)(1) of this Act shall be deemed to be $6,988,399,000: 
     Provided further, That the amount $6,783,301,000 in section 
     305(a)(2) of this Act shall be deemed to be $6,690,101,000: 
     Provided further, That of the funds appropriated in this Act 
     for the National Institutes of Health, $93,200,000 shall not 
     be available for obligation until September 30, 2004.

  Mrs. CLINTON. Madam President, this amendment is intended to provide 
the money that is needed to ensure that at the Federal, State, and 
local levels, we have an adequate bioterrorism workforce. In order to 
do that, we have to fund the pipeline.
  This summer the Partnership for Public Service issued a report 
stating that 50 percent of our experts trained to respond to a 
biological or chemical attack will retire over the next 5 years. That 
puts our country and our public health at risk.
  Obviously, every one of us in this body is committed to making our 
country safer and providing the bioterrorism funding we have fought for 
since 9/11. And I appreciate the great support the Senate has given to 
increasing dollars to combat the threat of bioterrorism. But, 
unfortunately, our frontline defenders, who are our health 
professionals, are decreasing in number when we need them more than 
ever.
  According to the Office of Personnel Management, more than 2,600 
public health professionals in the Federal Government are eligible to 
retire in 2008, and that number could soar to more than 8,000 in just 
the next few years.
  Unfortunately, the shortage in personnel is not just Federal. It is 
already being felt at the State and county levels. In county after 
county in the public health departments, I have been given reports that 
so many of the staff members are being stretched thin and they are 
unable to do the work that is required. If we don't find ways to 
provide the resources to attract and pay for these professionals, we 
are going to be in a terrible dilemma not only if a horrible event or 
some kind of biological or chemical attack were to occur, but even with 
the outbreak of something like SARS, or something unpredictable that we 
may have never encountered before.
  The Bioterrorism Preparedness and Response Act that we passed in 2002 
does help with workforce training, recruitment and development. But 
with respect to what has occurred since 2002, we already know we have 
had increased demands on our public health system, and we have 
insufficient resources to expand personnel or, as these recent reports 
I have referenced indicate, keep pace at current levels.
  The CDC and other agencies need to do strategic planning. My 
amendment includes $5 million to fund an annual needs assessment, with 
a report to Congress, of Federal, State, and local bioterrorism 
personnel, conducted by the Institute of Medicine or another competent 
and independent authority.
  But even while we are looking longer term, we have immediate public 
health needs right now. I know that, for example, in New York, two 
Centers for Public Health Preparedness are located at SUNY Albany and 
Columbia University. They have already trained 10,000 people each year 
in bioterrorism preparedness. Many regions don't have these centers of 
excellence, and we have to figure out how we can get the resources and 
personnel to every part of our country.
  According to the Association of Schools of Public Health Preparedness 
and Prevention, the 19 nationwide Centers of Public Health Preparedness 
have asked the administration for $50 million--nearly double what the 
President's budget proposes. I think we should meet those requests, and 
my amendment would provide the funds to do that.
  My amendment also provides funds, in accordance with the 
recommendation of CDC's own National Advisory Committee on Children and 
Terrorism, to double the number of outbreak specialists in the Epidemic 
Intelligence Service. These EIS specialists are dispatched to respond 
to epidemics and bioterrorism.
  The resident expertise that we need in State and local public health 
departments is also crucial. My amendment would provide $25 million to 
the Epidemiology Program Office, the National Center for Infectious 
Diseases, and the Public Health Practice Program Office of the CDC to 
recruit and train 1,600 epidemiologists, 800 laboratory personnel, 800 
public health nurses, and 800 other public health professionals to work 
in State and local public health departments nationwide.
  The Council of State and Territorial Epidemiologists estimates that 
State and local public health departments need to hire 1,600 
epidemiologists over the next 10 years to prevent worsening shortages 
of State and local epidemiologists. It costs about $60,000 to train a 
public health professional. This proposal would spread that investment 
over 10 years.
  Finally, the amendment also provides $20 million for carrying out 
sections 765 through 769 of the Public Health Service Act to title VII 
to encourage personnel to enter epidemiology and bioterrorism detection 
careers.
  Title VII has been decimated each of the last 3 years. It has been a 
struggle to keep it even flat-funded from year to year. Unfortunately, 
the pipeline for epidemiologists and bioterrorism experts has suffered 
as a result.
  I hope to be able to work this out without the manager of the bill. I 
understand completely the many competing considerations he has to 
balance, but it is imperative that we start to meet these needs. If we 
pass this amendment today and get the money in the pipeline, we can 
begin to train and hire the doctors, nurses, and other public health 
professionals who are going to be necessary for us to deal with 
whatever we face in the future.
  Unfortunately, terrorists or epi- demics like SARS don't wait while 
the retirement notices are stacking up. I don't think we should either. 
This $93 million would be money well spent that would make us better 
prepared to deal with the incredible challenges that we confront as we 
try to ensure that our vigilance and our concern is matched by the 
expertise we need to actually

[[Page 21115]]

deal with any problem that we may confront.
  Madam President, I ask that this amendment be supported, but I ask, 
too, that we look for a way to deal with this pipeline problem that is 
so critical to actually putting teeth into the preparedness that we 
have passed in this body and funded since September 11.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania is recognized.
  Mr. SPECTER. Madam President, there is no doubt of the tremendous 
need for preparation for bioterrorism. During the recess month, I spent 
most of it traveling through my State visiting first responders--
essentially fire departments, in conjunction with police departments 
and other county organizations that are being set up for response to 
potential bioterrorist attacks.
  When 9/11 struck, obviously, the U.S. was totally unprepared. I think 
the ranking member will recall that we had to have the hearing in the 
bowels of this building because we were kicked out of the other hearing 
rooms. We brought in the Centers for Disease Control and insisted that 
they give us an itemization of the various types of biological attack, 
what resources were currently available, and what additional resources 
we would need.
  We had a very tough time getting information from the Centers for 
Disease Control by the time they went through the alphabet soup. They 
had to get permission from HHS, and then Health and Human Services had 
to get permission from the Office of Management and Budget. Finally, we 
got the information informally. We could not get it formally. We got it 
informally.
  I have just been handed talking points and information and facts by 
my staff. The way the Senate functions is that these amendments come 
without any significant advanced notice. The Senator from New York was 
halfway through her argument before I got a copy of her amendment. I 
challenge anybody to read the amendment and follow it.
  Well, people can't hear me on C-SPAN because my microphone wasn't on.
  The point was that we did get a supplemental appropriations bill for 
approximately $3 billion. We had quite an extended discussion in the 
living quarters of the White House--something I probably ought not to 
talk about. But the President invited a group of us over and we got 
into a long discussion. There were those in the administration, 
according to an article published a day after Thanksgiving, that wanted 
to put it in next year's budget. They wanted to wait until 2002 to put 
it in 2003.
  Talking directly to the President, a number of us prevailed and put 
$3 billion into the budget at that time.
  We now have a very extensive itemization of funding. The CDC has $940 
million for State and local preparedness. Upgrading CDC capacity: 
$143,700,000. Pharmaceutical stockpile: $300 million. Smallpox 
vaccine--and it goes down to a full page. I ask unanimous consent that 
list be printed in the Record so I need not read it all.

----------------------------------------------------------------------------------------------------------------
                                  FY03                      Transfers       FY 2003       FY 2004      FY 2004
          Activity              Enacted       .65% ATB        to DHS      Comparable      Request       Senate
----------------------------------------------------------------------------------------------------------------
             CDC
 
State and Local Preparedness     $940,000          $6,110  ...........        $933,890     $940,000     $940,000
Upgrading CDC Capacity......      143,700             934         -584         142,182      143,700      143,700
Pharmaceutical Stockpile....      300,000           1,950     -298,050               0
Smallpox Vaccine............      100,000             650      -99,350               0
Anthrax Vaccine Research....       18,040             117  ...........          17,923       18,040       18,040
Planning for Preparedness          10,700              70  ...........          10,630       10,416       10,416
 Resp.......................
Deterrence..................        4,000              26  ...........           3,974        4,000        4,000
Public Health Preparedness          5,000              33  ...........           4,968            0            0
 Centers....................
Health Alert Network........  ...........               0  ...........               0            0            0
CDC Security PHSSEF.........       20,000             130  ...........          19,870            0            0
CDC Security (B&F non-add)..  ...........               0  ...........               0            0            0
Independent Studies.........        2,000              13  ...........           1,987            0            0
                             -----------------------------------------------------------------------------------
      Subtotal, CDC.........    1,543,440          10,032     -397,984       1,135,424    1,116,156    1,116,156
                             ===================================================================================
            HRSA
 
Hospital Preparedness.......      518,000           3,367  ...........         514,633      518,052      518,052
Education Incentives for           28,000             182  ...........          27,818       60,012       60,012
 Medical School Curriculum..
EMS for Children............  ...........               0  ...........               0       18,943            0
Poison Control..............  ...........               0  ...........               0       21,166            0
                             -----------------------------------------------------------------------------------
      Subtotal, HRSA........      546,000           3,549  ...........         542,451      618,173      578,064
                             ===================================================================================
   OFFICE OF THE SECRETARY
 
Transfers to DHS............       88,420             575      -87,845               0            0            0
Medical Research Corps......       10,000              65  ...........           9,935       10,000       10,000
Preparedness Planning.......        6,800              44  ...........           6,756        6,800        6,800
Operations..................       12,720              83  ...........          12,637       12,720       12,720
Advanced Research...........        5,000              33  ...........           4,968        5,000        5,000
Command and Control.........  ...........               0  ...........               0            0            0
National Security Early             9,500              62  ...........           9,438        9,500        9,500
 Warning....................
Secretary's Emergency               3,000              20  ...........           2,981        3,000        3,000
 Response Team..............
Media/Public Information....        4,800              31  ...........           4,769        4,800        4,800
Commissioned Corps                  2,000              13  ...........           1,987            0            0
 Revitalization.............
CyberSecurity...............       10,000              65  ...........           9,935       10,000       10,000
                             -----------------------------------------------------------------------------------
      Subtotal, OS..........      152,240             990      -87,845          63,405       61,820       61,820
CDC--Supplemental...........  ...........  ..............  ...........         142,000            0            0
SAMHSA......................  ...........               0  ...........               0            0            0
AHRQ........................        5,000              33  ...........           4,968            0            0
Pandemic Flu................  ...........               0  ...........               0      100,000      100,000
                             ===================================================================================
      Subtotal,                2,246,,680          14,603     -485,829       1,888,247    1,896,149    1,856,040
       Bioterrorism--PHSSEF.
----------------------------------------------------------------------------------------------------------------

  Mr. SPECTER. Madam President, then the Department of Homeland 
Security bill was passed by this body with some $29 million, which 
covers a great deal more funding.
  I appreciate the initiative taken by the Senator from New York and 
her diligence in coming up with this amendment in an area which, beyond 
any question, is of overwhelming importance, critical importance. I, 
frankly, do not know how to evaluate her request for $93 million 
additional in the context of all of the programs which are in 
existence.
  I think it is fair to state, and I think the Senator from New York 
has an abundance of experience in the executive branch, that the 
executive branch has better planning capabilities in integrating these 
items in the overall program. Not that the $93 million might not be 
well placed, well positioned and critical. It might be, I just cannot 
say. But I do know there has been extensive consideration by the 
executive branch, and I also know that the $93 million is not within 
the 302(b) allocation.
  I come back to this again and again on items which I concede are 
important, but we do not have the funds

[[Page 21116]]

within the budget resolution and within the allocation.
  I know the Senator from New York will not be surprised that there 
will be opposition to it. We will raise a point of order. But I do 
think the amendment serves a very useful function in identifying what 
the Senator from New York thinks are critical points that ought to be 
funded.
  I commit this to the Senator from New York--to have a hearing on the 
subject and to include the precise items which she has raised so that 
we will take them into account in our funding stream as we move into 
the next fiscal year.
  Mrs. CLINTON. Madam President, will the Senator from Pennsylvania 
yield?
  Mr. SPECTER. I do.
  The PRESIDING OFFICER. The Senator from New York.
  Mrs. CLINTON. Madam President, I wish to express my appreciation to 
the chairman for that offer. Perhaps even before the bill is totally 
wrapped up we could take a look at some of those categories of funding 
because what I am concerned about, as the Senator rightly referenced, 
is in all of the funding categories, these requests I have put in this 
amendment are coming from constituent agencies, such as CDC, that at 
least believe at this point in time that the money available for 
bioterrorism has not been sufficiently targeted to this personnel 
issue.
  I appreciate not only the kind offer of a hearing, because I think 
this is an issue that is going to go on for quite some time--it is not 
going to be resolved one way or another even if this amendment were 
successful--but also perhaps in the next several days if our staffs can 
look to see if there is a better opportunity to better target some of 
this funding to deal with this pipeline professional problem that is 
not only at the Federal Government level, but State and local as well.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. SPECTER. Madam President, I would be delighted to follow the 
suggestion made by the Senator from New York to take a look at them 
regardless of the outcome of the vote. It may be that the executive 
branch can learn from what the Senator from New York has found on her 
inquiries and can redirect some of the existing funds, or it is 
possible we could find some accommodation to this in the course of the 
conference.
  We will look very closely at the suggestions which the Senator from 
New York has made and see if we can find a way to accommodate them.


                  Amendment Nos. 1561, 1560, and 1578

  Mr. SPECTER. Madam President, I wish to turn for a few moments to the 
amendments offered by the Senator from Ohio. I did not take time to 
respond before the Senator from New York offered her amendment. She was 
very patient in waiting while the Senator from Ohio went through quite 
a long list of his amendments.
  He has offered three amendments which are well directed and I think 
meritorious when he talks about the historical impact of the 
underground railroad. That is a matter of importance in education and 
it comes right into Pennsylvania where currently the development 
project in Lancaster has found remnants of the underground railroad. 
The House of Representatives has put in $2.235 million.
  When the Senator from Ohio talks about poison control centers for $5 
million, again he is on a good point. And when he talks about graduate 
medical education, he is not bringing it up to last year's level, he is 
adding money. This is an item which this Senator spent a lot of time 
on, as did Senator Harkin. There was no funding for this in 1999, and 
in the year 2000, to start, it was slightly under $40 million, and then 
when I chaired the subcommittee, with the concurrence of Senator 
Harkin, we made an enormous increase to $234 million for fiscal year 
2001.
  We then added $50 million in 2002 to $284 million, and it was at $290 
million in 2003. The administration made a request for slightly under 
$200 million, and in a tough way we found $90 million more.
  When you take them out of administration, there are going to be a lot 
of people unemployed, and I do not know that we can direct that 
unemployment solely to Ohio--I wish the Senator from Ohio were here--if 
it would be possible to target that unemployment to the Senator's 
State. But if you take out $22 million from administration--that is a 
nice fat target to say take it out from administration. But there are 
very substantial impacts when that money is taken out.
  I am going to confer with the Secretary of the Department of 
Education to see exactly what will happen, how many people will be 
affected, specifying perhaps how many people from Ohio will be 
affected.
  When the Senator from Ohio wants to add $60 million to the mother-to-
child transmission, I think that is a very important item, but the fact 
is we now have a grand total in the Labor-HHS bill directed toward AIDS 
in excess of $14 billion. When the statement is made we are just going 
to bring it back up to the President's request, in fiscal year 2003, 
this was a $40 million item. The President asked for $150 million for 
this year, and we found $90 million to accommodate.
  Bear in mind that we do this in a context where the administration 
has come in on many items far under what they were last year. For 
example, graduate medical education, to which the Senator from Ohio 
wants to add $15 million, we added $90 million over what the President 
requested. So perhaps the Senator from Ohio would like us to go back to 
the President's request on graduate medical education, and we would 
have ample money to put in $60 million more to bring it up to the 
President's request on the mother-to-child transmission.
  I say that only by way of demonstrating that it is just not so easy 
to come up to the President's request on a given item when many times 
the President's request was far under what we are at the present time. 
The idea of level funding is very important in the appropriations 
process so you do not make drastic changes. People can live with what 
they got last year without accounting for inflation, but if you want to 
drop, as the President's budget did on graduate medical education, from 
$290 million to $199 million, that is going to be very tough to absorb. 
We took that into account.
  The Constitution places the appropriations process in the Congress. 
That is something which is frequently overlooked.
  The President obviously has an important role because he has to sign 
the bill, or we have to pass them without his signature, if we can do 
that.
  This bill is very carefully crafted. Perhaps it is easy to see that I 
have to oppose the amendments by the Senator from Ohio. Perhaps there 
can be some accommodation to some of the smaller amounts but that, too, 
is difficult. Although the Senator from Wisconsin said a million 
dollars was not very much money, quoting Everett Dirksen, a million 
here and million there--maybe Everett Dirksen said a billion here or a 
billion there, but if for Dirksen it was a billion here and a billion 
there, then make it Arlen Specter, a million here and a million there, 
it all adds up.
  I yield to my colleague from Iowa.
  Mr. HARKIN. I thank my chairman, friend and able leader on this 
appropriations bill. I think we all wish we had a little bit more 
302(b) allocation but that is for another time and place.
  Earlier today I spoke about offering an amendment that would 
basically prohibit the administration from moving ahead on implementing 
a proposed rule that would basically undermine and do away with the 40-
hour workweek that we have had in the Fair Labor Standards Act since 
1938. Earlier this spring, the administration proposed some rule 
changes. Not one hearing was held on it.
  As we looked through these proposed rules this summer and dug into 
them, it would drastically undermine the ability of working families, 
working men and women in America, to get justly compensated for 
overtime work in the future.
  I was talking to one of my colleagues today about this, and he said 
to me, I have not really had a big clamor in my

[[Page 21117]]

State for these changes. I got to thinking about it. I got to thinking 
I really have not had anybody in the past year or 2 years ago, or 
earlier this year--I have seen no real groundswell or anything about 
the fact that these rules as they exist now need to be changed. I do 
not know where this comes from. All of a sudden they are proposing this 
massive change in the way people's work is defined in this country and 
whether they are exempted from overtime pay or not.
  So I have an amendment that I drafted that basically is just very 
simple. It says:

       None of the funds provided under this Act shall be used to 
     promulgate or implement any regulation that exempts from the 
     requirements of section 7 of the Fair Labor Standards Act of 
     1938 (29 U.S.C. 207) any employee who is not otherwise 
     exempted pursuant to regulations under section 13 of such act 
     (29 U.S.C. 213) that were in effect as of September 3, 2003.

  So this is an amendment that I will be laying down sometime tomorrow. 
I mention again that this proposed rule change could affect up to 8 
million workers, but the first wave of people that will be affected by 
this rule change will be women who are working in salaried positions 
that today would be paid overtime if they worked more than 40 hours a 
week. These would be women who work as bookkeepers, accountants, 
secretaries, nurses, nurse's aides, a whole host of different 
occupations. I say women because the way that theworkforce is 
structured, where the salary level is, they will fall in that lower 
spectrum of salary level where it will be above the minimum but it will 
be in the range where they will now be exempted from overtime work. 
That will be the first wave. That is just the first people who would be 
affected by it.
  After that, there would be many other people affected by it--police 
officers, firefighters, first responders, and others.
  There is no carve-out in the proposed rules and regulations for 
police, firefighters, and emergency personnel. They are thrown in with 
everybody else. So somehow I keep hearing this kind of a rumor or 
statement that keeps floating around that, oh, police officers will not 
be affected.
  Well, would someone show me in the proposed rules where it says that 
police officers will not be affected? It is nowhere in there. So I do 
not know what they are talking about. They are thrown in with everybody 
else.
  Again, I do not want to take too much more time. I will lay down the 
amendment tomorrow morning at the appropriate time. For the life of me, 
though, I cannot understand why the administration is proposing this 
drastic change when there has been no big groundswell for the change.
  I have heard some people in this room say we have to change it 
because it has not been changed since 1938. That is nonsense. We have 
changed the Fair Labor Standards Act several times since 1938. In fact, 
a number of times this has been changed without taking away overtime 
for people in our country. So to say it has not been changed since 1938 
is simply erroneous. A number of times we have addressed ourselves to 
new types of work, new definitions, new people in the workforce, by 
changing some of the definitions. In every case in which these 
definitions were changed they were changed to make it easier, to 
include more people in the overtime provisions, not to exclude people.
  For example, the Department of Labor revised the overtime regulations 
in 1940, 1949, 1954, 1958, 1959, 1961, 1963, 1967, 1970, 1973, 1975, 
and 1981. In not one of those instances was the framework narrowed to 
exclude more people from overtime protections. These changes were made 
basically to enlarge, enhance, and to better define who was covered, 
and that is why it never really invoked much debate or consternation 
because we recognized that we wanted to protect people for overtime 
pay.
  The minimum salary threshold has been raised seven times since 1938. 
So to say that somehow we have never touched this since 1938 is 
absolutely wrong. What is correct is that since 1938 we have not 
circumscribed, we have not narrowed, the definitional framework to 
exclude more people from overtime pay.
  That is what these proposed regulations would do, and that is why the 
Senate has to speak strongly, I hope next week sometime, in supporting 
this amendment that would basically prohibit them from moving ahead 
with this kind of a regulation.
  I would point out that the House of Representatives narrowly defeated 
this 213 to 210, with a number of Republicans supporting not allowing 
the administration to proceed with these changes in rules. So, again, I 
hope next week we can have a further debate. I intend either tomorrow 
or Monday to again point out the people who are going to be affected, 
what it means for their families and their income. What it basically 
means is that we are going to have people working longer hours but they 
are not going to be compensated for it.
  As I said, many of them are women who are now paying for childcare. 
Well, now they have to pay to keep their children in daycare maybe 
longer but they do not get any extra pay for that.
  So that is why this proposed change in rules and regulations is one 
that we have to say no to. We have to make sure we continue to protect 
and enhance the 40-hour workweek and make sure people who work over 40 
hours, if they want to work over 40 hours or if they are compelled to 
work over 40 hours, are justly compensated with it for time and a half 
over 40 hours.
  I yield the floor.
  Mrs. FEINSTEIN. Madam President, I plan to offer an amendment to the 
fiscal year 2004 Labor-HHS appropriations bill that seeks to offer 
States an alternative Medicaid FMAP formula while allowing States to 
remain in the current formula structure if they choose. This amendment 
is vital to providing some relief to States who have been shortchanged 
by hundreds of millions of dollars under the current FMAP formula for 
the cost of providing Medicaid services. The amendment will not 
penalize any State who wishes to remain under the current formula. It 
simply allows States to opt into a new formula that better reflects 
States' need. This new FMAP is only for Medicaid expenditures in excess 
of fiscal year 2003 Medicaid expenditure levels.
  For States who opt to go with the new formula, per capita income is 
replaced with a ratio of the most recent 3-year averages of total 
taxable resources, TTR, as determined by the U.S. Department of the 
Treasury, and persons below the poverty level. The multiplier is also 
lowered from 0.45, used in the current FMAP formula, to 0.40. For the 
period 2004-2013, the new formula has a maximum increase of one 
percentage point per fiscal year above the current FMAP formula for the 
prior year. Once a State opts to go with the new formula, they will not 
be able to switch back to the current FMAP formula. However, they will 
be held harmless at the FMAP rate they would have gotten under the 
current formula, prior to the Jobs and Growth Tax Relief Reconciliation 
Act of 2003, for the current year. States opting for the new formula 
will have Medicaid expenditures, up to the fiscal 2003 levels, matched 
at the current FMAP formula and with expenditures above the fiscal 2003 
levels matched at the new formula FMAP.
  In a study released in July 2003, GAO found that the formula used to 
calculate the portion of each State's Medicaid expenditures that the 
Federal Government will pay--the FMAP--often widens the gap between 
individual States and the national average. Under the current formula, 
21 States move farther from the average State's funding ability after 
the Federal match is added. In fact, 4 of the 21 States--California, 
Florida, Hawaii, and New York--have below-average funding ability 
before Federal matching is added and move farther below the average 
after Federal matching aid is added.
  Since Medicaid was enacted in 1965, the Federal match rate has been 
determined by a State's per capital income. In its study, GAO found 
that per capita income is a poor proxy for determining both State 
resources and the low-income population. The Feinstein amendment will 
give States the option to choose a formula that is based on a

[[Page 21118]]

combination of the State's total taxable resources and population below 
the poverty level.
  The PRESIDING OFFICER. The Senator from Alabama.

                          ____________________