[Congressional Record (Bound Edition), Volume 151 (2005), Part 22]
[Senate]
[Pages 30689-30709]
[From the U.S. Government Publishing Office, www.gpo.gov]




            DEFICIT REDUCTION ACT OF 2005--CONFERENCE REPORT

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate will resume consideration of the conference report to accompany 
S. 1932, which the clerk will report.
  The legislative clerk read as follows:

       Conference report to accompany S. 1932, an act to provide 
     for reconciliation pursuant to section 202(a) of the 
     concurrent resolution on the budget for fiscal year 2006.

  The ACTING PRESIDENT pro tempore. Under the previous order, there 
will be 5 minutes each for the Senator from New Hampshire and the 
Senator from North Dakota.
  The Senator from the great State of North Dakota.
  Mr. CONRAD. Mr. President, the legislation before us suggests that it 
is deficit reduction. There are three chapters to this book on 
reconciliation. You have to read all three chapters to understand the 
meaning of the book. The first chapter provides spending cuts of $40 
billion over 5 years. Those spending cuts disproportionately take from 
those who have the least among us. Chapter 2 provides $70 billion of 
tax cuts. So the combined effect of chapters 1 and 2 is not to reduce 
the deficit, it increases the deficit. And the tax cuts give to those 
who have the most among us.
  The Chaplain, in his prayer this morning, asked us to lead lives that 
will be living sermons--lives that will be living sermons. I do not 
know of any church that teaches to take from those who have the least 
among us to give to those who have the most among us.
  The third chapter in this book provides for a debt limit increase of 
$781 billion--one of the largest increases in the debt of our country, 
in the history of our country.
  This first chapter, as I have indicated, contains $40 billion of 
spending cuts over 5 years. But the second chapter will cut taxes by 
$70 billion over that same period. The net result is not deficit 
reduction; it is an increase in the deficit.
  If we are to focus just on this first chapter, and put it into 
perspective, here is what we see: spending cuts of $40 billion. It is 
almost indecipherable how much that is in relationship to what we will 
be spending over the next 5 years. We will be spending $14.3 trillion 
over the next 5 years. So our colleagues on the other side have managed 
to cut one three-hundred fiftieth--one three-hundred fiftieth--of the 
spending. But then in chapter 2 they are going to come here and 
eliminate that deficit reduction by the tax cuts--again, spending 
reductions from those who

[[Page 30690]]

have the least among us to give to those who have the most among us. 
And the extraordinary irony of all of this is that all of this--if this 
is implemented, the budget that is being passed--is building a wall of 
debt that is unprecedented in the history of our country.
  If this budget is actually implemented over the next 5 years, it will 
increase the debt of our country from $7.9 trillion to $11.3 trillion. 
This is not just my estimate, this is the estimate of the people who 
have written this package.
  This is from their own document. They say the debt of the country 
will increase each and every year by over $600 billion. This is before 
the baby boomers retire. If you like deficits and debt, if you want to 
pass on a massive debt to our children, this is your chance. Vote for 
this package.
  It took 42 Presidents 224 years to run up a trillion dollars of 
external debt, debt held by foreigners. This President has more than 
doubled that amount in 5 years. This is going in the wrong direction. 
The result is, we now owe Japan over $680 billion. We owe China almost 
$250 billion. We owe the ``Caribbean Banking Centers'' more than $100 
billion.
  In addition to the explosion of deficits and debt, these provisions 
in this chapter of the book are unfair to those who have the least 
among us: Medicaid cuts targeting low-income beneficiaries, child 
support enforcement cuts, foster care cuts, on and on it goes. The 
spending cuts are being done to make room for more tax cuts. House Ways 
and Means Committee Chairman Bill Thomas told a group of GOP lobbyists 
the spending cuts are necessary to make room for the tax-cutting 
legislation.
  I will be making points of order against this bill because we believe 
this bill has violated the rules of this body in instance after 
instance after instance, repeated violations of the rules. At the 
appropriate time, I will bring a point of order.
  I conclude as I began: This legislation, taken as a whole, all of the 
chapters of reconciliation, will increase the deficit and debt of our 
country, will have one of the largest increases in debt, $781 billion, 
in our Nation's history. In addition to that, this has the wrong 
priorities, taking from the least among us to give to those who have 
the most among us. That is wrong.
  I thank the Chair.
  The ACTING PRESIDENT pro tempore. The Senator from New Hampshire.
  Mr. GREGG. What is the time situation?
  The ACTING PRESIDENT pro tempore. The Senator from New Hampshire has 
5 minutes.
  Mr. GREGG. Mr. President, every so often in this body--and it is 
quite rare--we come to a point where a vote must be cast in order to 
determine whether the words you speak are going to be complied with. 
That is this vote. All of us in this Congress tend to talk about fiscal 
responsibility. We all are concerned about our children and the type of 
Nation we are going to leave them. We know that because of the 
retirement of the baby boom generation, our children will face huge 
financial stress from the costs of Government. We know that we have on 
the books approximately $44 to $55 trillion of unfunded liability in 
the area of Medicaid, Medicare, and Social Security accounts that 
benefit seniors. That huge number is a result of the fact that there is 
a huge generation about to retire called the postwar baby boom 
generation.
  The question for us, as stewards of this Nation and as stewards of 
our children and our grandchildren's future, is whether we are going to 
pass on to them this type of debt or whether we are going to step on to 
the turf of trying to address that issue before it overwhelms us. 
Whether our children have an opportunity to live as good as our 
generation has, to send their children to college, to own a home, to be 
able to live in an America which is prosperous, will be determined by 
whether we, as a government, are responsible in what debt and 
obligations we pass on to them.
  For 8 years, we have ignored this problem. Today we have an 
opportunity to address it. This will be the first time that this 
Congress in 8 years has stepped onto the turf, put our toe in the 
water--actually, we are going up to our ankles--to address the issue of 
future responsibilities and how we control the spending of the Federal 
Government in the outyears.
  We have addressed the issues on the appropriations side, 
discretionary spending, but we have refused, over the last 8 years, to 
address the issue of mandatory spending or entitlement programs. This 
is not a major step forward. I wish it was bigger. The Senator from 
North Dakota held up charts which show how unfortunate it is in its 
size, that it is not larger. He has pointed out that it is $40 billion 
on $14 trillion of spending. He calls that one three hundred fiftieth 
of a percent. It is actually about a half a percent of the spending 
during that period. But the point is, if we do not proceed at this 
time, if we do not go forward, it is still going to be $40 billion of 
debt that we pass on to our children. That is what this vote is about.
  It is not about the tax issue. This isn't a tax bill. It is not about 
the debt issue in the sense that it is not the debt extension vote. It 
is the one vote that we will have as a Congress to try to control the 
outyear debt of this country through restraining spending. It will be 
the first time that we have stepped forward on the issue of one of the 
major entitlements, specifically Medicaid. We don't do a great deal on 
the numbers side of Medicaid. I wish we had done a lot more, and I 
tried to do a lot more. But we do take significant steps in the area of 
policy, on how we address Medicaid by essentially taking what the 
Governors have proposed, in a bipartisan approach, and putting that 
language into this bill to give the Governors more flexibility as to 
how they deliver Medicaid in the States, thus allowing them to deliver 
more services to more people at less of a rate of growth.
  That is reflected in this chart. We can see that dedicated spending 
is going to go up 40 percent under this bill. It would go up 40 percent 
under the law, generally. We essentially reduce the rate of growth, not 
dramatically, but we put in place policies which will allow us to 
improve the system and care for more children more effectively.
  This is it, folks. This is the only chance we are going to have this 
year. It is the only chance in the last 8 years to actually step 
forward and do something about deficit spending on the entitlement 
side.
  This is our responsibility to our children. We should pass this bill, 
or else we should ask ourselves what type of public policy are we 
pursuing and what type of stewards are we of our children's future. 
This is the one vote we will have to reduce the rate of growth of the 
Federal Government.
  I believe we have now used the 5 minutes.
  The ACTING PRESIDENT pro tempore. The Senator is correct.
  Mr. GREGG. On both sides?
  The ACTING PRESIDENT pro tempore. The Senator is correct.
  Mr. GREGG. I ask unanimous consent that as we debate the issue of 
points of order, which the Senator from North Dakota is going to make, 
we have 4 minutes on both sides.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  The Senator from North Dakota.
  Mr. CONRAD. Has the Senator yielded?
  Mr. GREGG. Yes.
  Mr. CONRAD. Mr. President, could the Chair advise us, what is the 
parliamentary circumstance we confront? My understanding is I am to be 
recognized to make a point of order at this point.
  The ACTING PRESIDENT pro tempore. The Senator is correct.
  Mr. CONRAD. I thank the Chair.
  Mr. President, this bill contains many violations of the rules. We 
are here because the majority insisted on ramming through bad 
legislation at the last moment with little or no public scrutiny. This 
774-page bill was written behind closed doors with no

[[Page 30691]]

input from the minority. It was filed in the dead of night and voted on 
in the House at the crack of dawn. Then House Members left town.
  Let's remember that reconciliation is a special parliamentary process 
that allows legislation to be passed with fast-track procedures that 
restrict a Senator's right to debate and amend. Because of these fast-
track procedures, the Byrd rule was adopted to prohibit extraneous, 
nonbudget-related provisions from being included.
  The points of order that I am raising are all violations of the Byrd 
rule. I now raise these three points of order:
  One, striking the Medicaid medical liability provision, which allows 
hospitals to deny treatment to low-income individuals who are unable to 
pay. Not only is the majority raising copayments on low-income Medicaid 
beneficiaries, but they are shielding hospitals from medical liability 
if they refuse to treat those low-income people who are unable to pay. 
That is wrong.
  Two, striking the foster care provision that would prohibit 
grandparents from receiving foster care payments. The conference report 
includes a provision to overturn a Ninth Circuit Court case that 
allowed grandparents with limited incomes to receive foster care 
payments when parenting vulnerable children. That is as mean spirited 
as it is ill-conceived. We know that placing foster kids with their 
grandparents puts them in the most stable and healthy environment. 
Prohibiting support for grandparents who take in foster children is 
wrong.
  Three, I am also raising points of order against reports focusing on 
policy matters that do not belong in a reconciliation bill. These 
reports have no budgetary effect whatsoever and should not be here.
  I hope my colleagues will support these points of order so we can 
send this bill back to House. Let's use this opportunity to create a 
better product for the American people.
  Mr. President, I raise the point of order pursuant----
  Mr. GREGG. Will the Senator yield?
  Mr. CONRAD. Let me conclude first.
  Mr. GREGG. My question is whether I should make my statement before 
the Senator makes the point of order.
  Mr. CONRAD. That is fine.
  Mr. GREGG. Mr. President, the Senator from North Dakota has been 
cooperative and very fair, as he always has been when proceeding on 
these bills. He is a true professional. I know the Chair has been 
advised as to what the four points of order are.
  I have a parliamentary inquiry: Does the Chair deem the foster care 
point of order to be well taken if that question is put to the Chair?
  The ACTING PRESIDENT pro tempore. The Chair does not believe that 
particular point of order is well taken.
  Mr. GREGG. Basically, if I may continue, we would be dealing with 
three points of order as being well taken if they are put to the Chair?
  The ACTING PRESIDENT pro tempore. That is correct.
  Mr. CONRAD. Mr. President, might I inquire, on the other three points 
of order that I have raised, would the Chair rule that those points of 
order are in fact in order and appropriate?
  Mr. GREGG. Not at this time is the question.
  Mr. CONRAD. Yes.
  The ACTING PRESIDENT pro tempore. When it is time, under the rule, 
the Chair will in fact so rule.
  Mr. CONRAD. I thank the Chair. I thank my colleague. We have worked 
in a professional and cooperative way. I thank the Chairman for his 
inquiry.
  Mr. GREGG. Mr. President, the Democratic leader on the bill has every 
right to make a point of order. Clearly, the Chair will rule they are 
well taken. Let's talk about the substance quickly.
  They are essentially technical points of order. Two deal with reports 
and the other with an issue of liability which is very narrow, dealing 
with what people are told when they come into an emergency room. 
Essentially, the practical effect of doing these technical attacks on 
this bill will be that the bill must go back to the House of 
Representatives and the House of Representatives is going to agree and 
knock that language out. But the House is not here.
  So what is the real practical effect of this? It is that the Katrina 
money in this bill will not be spent. The TANF Program, the welfare 
program, will lapse. The Medicare physicians payments increase, which 
basically makes Medicare physicians whole, will not occur. Transitional 
medical assistance for families who worked their way off welfare will 
be lost. And the therapy caps for seniors who suffer strokes will be 
lost during this interim period.
  Why would we want to do that simply to go through a technical 
exercise? It makes no sense at all, other than the fact that the other 
side of the aisle wants to delay the process. But in the process of 
delaying for purely technical reasons--I mean, two reports are being 
challenged. We get thousands of reports in this institution. To delay 
the Katrina benefits for the people in the gulf coast region who have 
suffered is outrageous, over two reports.
  To potentially stop welfare payments for up to a month because the 
House cannot get back here is outrageous, over two reports. To stop 
transitional medical assistance is outrageous, over two reports. To say 
nothing of the other reports. I realize if we don't enact this bill by 
the end of this year, there are $18 billion worth of subsidies that are 
going to flow to corporate lenders which are totally inappropriate, 
which the HELP Committee has said we have to stop. But those subsidies 
will go to those lenders. The money will potentially be lost, and that 
money that was going to be used to reduce debt and give students more 
loans will be lost, potentially, unless we get this bill done by the 
end of the year.
  We have serious issues that have to be addressed. They should not be 
tied up over technicalities. That is what these points of order are 
about.
  Mr. BAUCUS. Mr. President, I support the point of order raised by 
Senator Conrad on the budget reconciliation bill. Under the Byrd rule, 
any provisions in a final budget reconciliation bill that are 
extraneous to changing the budget can be stricken. Section 6043, the 
emergency room copayments for non-emergency care provisions, clearly 
violates the Byrd rule.
  Section 6043 makes far-reaching policy changes never debated in the 
Senate that have no place in a budge reconciliation bill. Although the 
provision makes major changes to Medicaid, the Emergency Medical 
Treatment and Labor Act, EMTALA, and even State medical malpractice 
liability policy, it only generates net savings of $11 million over 5 
years, one-tenth of a percent of the original budget target.
  Section 6043 allows States to impose new higher costs for Medicaid 
patients seeking emergency room care and allows hospitals to turn 
patients away if they cannot pay when the hospital says there is no 
emergency. Under current law, Medicaid requires hospitals to provide 
access to emergency care when it is medically needed. In fact, Medicaid 
HMOs are required to cover care in cases where the individual 
reasonably believes there is an emergency, even when no emergency 
exists. And Federal law requires hospitals to screen and stabilize 
patients regardless of their ability to pay.
  Section 6043 turns current law on its head. It will deter emergency 
room use by Medicaid beneficiaries and make it harder to enforce the 
Federal guarantee of access to emergency care for all.
  The provision also includes language that makes it harder for 
patients to sue hospitals and doctors for poor treatment decisions 
about whether they need emergency care. This language would tip the 
burden of proof from a ``preponderance of the evidence'' to a ``clear 
and convincing'' evidence standard. The ``preponderance'' standard is 
the usual standard in State medical malpractice claims. It is a 
standard that strikes the balance between the patient and the provider. 
The ``clear and convincing'' standard tips the burden of proof toward 
the patient and makes it more difficult for a patient to prove his or 
her claim.
  Similarly, the provision also changes the standard of liability from 
the usual State standard of ``negligence'' to a heightened standard of 
``gross negligence.'' It is more difficult for a patient to prove 
``gross negligence'' than

[[Page 30692]]

``negligence.'' Thus, the language changes the standard of liability to 
impose greater burdens on the injured patient and less accountability 
for the providers. This actually makes an end run around State medical 
malpractice liability law, lowering the standard of liability.
  Neither State medical malpractice law nor EMTALA standards were the 
subject of this bill. Neither was discussed in the Senate, even though 
both are of great concern to many in the Senate. This provision was 
never discussed or considered at any point in the Senate debate, in 
committee or on the floor. It was omitted from the Senate version.
  Given this section's extremely small pricetag and its oversize policy 
effect, this provision is ripe for exclusion under the Byrd rule. For 
these reasons, I support Senator Conrad's point of order to strike 
section 6043.
  Mr. CONRAD. Mr. President, how much time do I have remaining?
  The ACTING PRESIDENT pro tempore. There is 1 minute 29 seconds.
  Mr. CONRAD. Mr. President, some of these matters are technical 
matters. But we have rules in this body for a reason. This legislation 
has many violations of the rules. I have chosen a few to raise today. 
Why? Because, colleagues, we could be voting all day on my points of 
order against this bill. I have tried to reduce it to one vote to 
accommodate colleagues. I could be here raising 12 or 15 points of 
order and ask for a vote on every single one of them. I have not done 
that. Yes, some of these matters are technical, but they are because we 
have rules.
  I would say that the question of Medicaid liability is not a 
technicality. This is a question that allows hospitals to deny 
treatment to low-income individuals who are unable to pay. Not only is 
the majority raising copayments on low-income Medicaid beneficiaries, 
but they are shielding hospitals from medical liability if they refuse 
to treat those low-income people who are unable to pay. That is wrong.
  Let me just say, on the foster care matter, we have a difference with 
the Parliamentarian. I believe there is a violation.
  The ACTING PRESIDENT pro tempore. The Senator's time has expired.
  Mr. CONRAD. Again, I believe the foster care question that prohibits 
grandparents from receiving foster care payments is also well taken, 
but we understand there is a difference.
  I raise the point of order pursuant to section 313(b)(1)(A) of the 
Congressional Budget Act of 1974 against section 5001(b)(3) and section 
5001(b)(4) of the conference report because those provisions of title V 
regarding Medicaid produce no budgetary changes in outlays or revenues; 
and pursuant to section 313(b)(1)(D) of the Congressional Budget Act of 
1974 against section 7404 regarding foster care, and the portion of 
section 6043 beginning on page 92, line 19, through page 93, line 2, 
which relates to the negligent standard for hospitals and physicians 
who treat Medicaid patients because any changes in outlays or revenues 
associated with those two provisions are merely incidental to the 
nonbudgetary components of those provisions.
  I hope my colleagues will vote to sustain this point of order.
  Mr. GREGG. Mr. President, I move to waive section 313 of the 
Congressional Budget Act for consideration of sections 5001(b)(3), 
5001(b)(4), and the relevant sections of 6043 of the conference report 
to accompany S. 1932.
  I understand the Chair is going to rule that the fourth point of 
order relative to foster care is not well taken.
  I ask for the yeas and nays.
  The ACTING PRESIDENT pro tempore. Is there a sufficient second? There 
is a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The bill clerk called the roll.
  The yeas and nays resulted--yeas 52, nays 48, as follows:

                      [Rollcall Vote No. 362 Leg.]

                                YEAS--52

     Alexander
     Allard
     Allen
     Bennett
     Bond
     Brownback
     Bunning
     Burns
     Burr
     Chambliss
     Coburn
     Cochran
     Coleman
     Collins
     Cornyn
     Craig
     Crapo
     DeMint
     DeWine
     Dole
     Domenici
     Ensign
     Enzi
     Frist
     Graham
     Grassley
     Gregg
     Hagel
     Hatch
     Hutchison
     Inhofe
     Isakson
     Kyl
     Lott
     Lugar
     Martinez
     McCain
     McConnell
     Murkowski
     Roberts
     Santorum
     Sessions
     Shelby
     Specter
     Stevens
     Sununu
     Talent
     Thomas
     Thune
     Vitter
     Voinovich
     Warner

                                NAYS--48

     Akaka
     Baucus
     Bayh
     Biden
     Bingaman
     Boxer
     Byrd
     Cantwell
     Carper
     Chafee
     Clinton
     Conrad
     Corzine
     Dayton
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Harkin
     Inouye
     Jeffords
     Johnson
     Kennedy
     Kerry
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Mikulski
     Murray
     Nelson (FL)
     Nelson (NE)
     Obama
     Pryor
     Reed
     Reid
     Rockefeller
     Salazar
     Sarbanes
     Schumer
     Smith
     Snowe
     Stabenow
     Wyden
  The PRESIDING OFFICER (Mr. Martinez). On this vote, the yeas are 52, 
the nays are 48. Three-fifths of the Senators duly chosen and sworn not 
having voted in the affirmative, the motion is rejected.
  Mr. GREGG. Mr. President, I move to reconsider the vote.
  Mr. CONRAD. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, am I recorded?
  The PRESIDING OFFICER. The Senator is recorded.
  Mr. CONRAD. Mr. President, could we have order in the Chamber?
  The PRESIDING OFFICER. The Chamber will please be in order. Senators 
will please take their conversations off the floor.
  The Senator from North Dakota.
  Mr. CONRAD. Mr. President, it is my understanding I would now have 
the right to offer a second point of order.
  The PRESIDING OFFICER. The unanimous consent agreement did authorize 
that.
  Mr. CONRAD. Has the Chair ruled on the point of order?
  The PRESIDING OFFICER. The Chair is about to do so.
  Mr. GREGG. Mr. President, the Chair is about to rule on the points of 
order which were just offered, is that correct?
  The PRESIDING OFFICER. Correct. The point of order is sustained 
against section 5001(b)(3), section 5001(b)(4), and that portion of 
section 6043(a) proposing a new subsection (e)(4) to section 1916A of 
the Social Security Act as added by section 6041 and as amended by 
section 6042 of this act. The point of order is not sustained against 
section 7404.
  Mr. CONRAD. I thank the Chair. I now ask if it is in order that I 
would offer a second point of order under the unanimous consent 
agreement.
  The PRESIDING OFFICER. The unanimous consent agreement did so 
authorize.
  Mr. CONRAD. Mr. President, colleagues, I see no need to ask 
colleagues to cast another vote. Therefore, I will withhold on the 
second point of order and we could go right to passage of the 
reconciliation conference report.
  Mr. GREGG. I suggest that is a good approach.


                           third-party payors

  Mr. BOND. Mr. President, I rise to engage the chairman of the Finance 
Committee in colloquy regarding clarification of some Medicaid 
provisions relating to strengthening the government's ability to 
identify and collect payment from liable third party payors.
  Under current law, Medicaid is the payor of last resort. In general, 
federal law requires available third parties must meet their legal 
obligation to pay claims before the Medicaid program pays for the care 
of an individual.
  The conference report amends the list of third parties named in 
section 1902(a)(25) of the Social Security Act for which States must 
take all reasonable measures to ascertain the legal liability to 
include, among others, pharmacy benefits managers.
  Once only the back office to health plans, employers, and State 
governments, pharmacy benefit managers

[[Page 30693]]

have expanded their business model to include serving as risk-bearing 
entities under the Medicare Part D program.
  I would like to clarify that the addition of pharmacy benefit 
managers to the definition of liable third parties is in the instance 
when they are at risk for the underlying benefit, such as operating as 
a plan sponsor for purposes of providing health benefits or as a 
riskbearing entity under the new Medicare Part D program as a stand-
alone PDP. This addition is not meant to make pharmacy benefit managers 
liable when they are acting merely in an administrative capacity on 
behalf of a liable third party.
  Mr. GRASSLEY. I thank the Senator from Missouri. Yes, I want to 
clarify the intent is not to create an additional liability where none 
exists today. Pharmacy benefit managers mayor may not be liable third 
parties. It is dependent upon whether they are ultimately responsible 
for the payment of a claim. It is my understanding that the health plan 
or employer contracting with the pharmacy benefit manager is ultimately 
at risk for the underlying claim, so it is my belief this will not 
create new liability for the pharmacy benefit manager.
  Mr. BOND. I thank the Chairman.


  Bona Fide Services--Clarifying the Treatment of Distributor Service 
       Fees under the New Medicaid Pharmacy Reimbursement Metric

  Mr. LOTT. Mr. President, I again commend Chairman Grassley for the 
leadership role he has taken in crafting much needed reductions in the 
mandatory spending programs that fall under his jurisdiction as 
chairman of the Senate Finance Committee. Regarding the changes to the 
Medicaid pharmacy reimbursement formula, we both share a strong 
commitment to ensuring that the Federal dollar is spent in a wise and 
proper manner while maintaining patient access to their medicines.
  I do want to take this opportunity to clarify specifically how bona 
fide services fees, which are negotiated between a manufacturer and 
pharmaceutical distributor, should be treated under the new Medicaid 
pharmacy reimbursement metric.
  Manufacturers pay bona fide service fees for specific services 
provided by the distributor. Service fees are a relatively new business 
model to the pharmaceutical distribution industry and how they should 
be treated under Federal reimbursement programs first came into 
question as the new Average Sales Price, ASP, metric under the Medicare 
Modernization Act was being implemented. I am pleased to note that 
Congress specifically did not include service fees as a price 
concession to be incorporated into the ASP calculation and CMS 
subsequently confirmed that, ``Bona fide service fees that are paid by 
a manufacturer to an entity, that represent fair market value for bona-
fide service provided by the entity, and are not passed on in whole or 
in part to a client or customer of the entity should not be included in 
the calculation of ASP.''
  In light of this, I wanted to make it clear that it was not the 
Chairman's intent to have manufacturers include such bona fide services 
fees in the new Medicaid pharmacy reimbursement equation.
  Mr. GRASSLEY. The Senator from Mississippi is correct. It was not the 
intent of the conferees to suggest that by dropping bona fide services 
fees from the final agreement that those service fees should be 
included in the calculation of the Medicaid Average Manufacturer Price, 
AMP, based reimbursement methodology as established in the pharmacy 
reimbursement provisions of the conference agreement.
  I thank my colleague from Mississippi for seeking this clarification.


                  continued dumping Subsidy offset act

  Mr. CRAIG. Mr. President, I rise to commend Chairman Gregg on his 
leadership regarding the Deficit Reduction Act. The Budget Committee 
has had to make hard decisions and has labored to do so fairly. I have 
seen first-hand and appreciate the Chairman's dedication to the 
integrity of this process.
  On behalf of myself and Senator Burns, I would like to state for the 
record our understanding of the effect of the language in the bill 
regarding repeal of the Continued Dumping Subsidy Offset Act CDSOA.
  We understand that the bill requires distribution of all antidumping 
and countervailing duties finally determined, ultimately assessed on 
any and all imports of merchandise that are entered, or withdrawn from 
warehouse, for consumption by the deadline of October 1, 2007.
  Further, we understand that liquidation or assessment of duties need 
not occur prior to the deadline of October 1, 2007, as a condition of 
distribution and that the duties ultimately assessed will be 
distributed regardless of the date on which they are finally determined 
and collected.
  In other words, while appeals to U.S. courts or NAFTA panels or other 
proceedings at administrative agencies may prevent final assessment and 
collection of the duties owed until after the deadline of October 1, 
2007, so long as the imports are entered, or withdrawn from warehouse, 
for consumption by that date, the duties ultimately assessed will be 
distributed annually under the processes currently specified in law.
  Finally, we understand that subsection (b) specifies that the CDSOA 
shall operate ``as if'' there had been no repeal; meaning that Customs 
will maintain all existing aspects of the program codified at 19 U.S.C. 
Sec. 1675c, and contained in accompanying regulations, including all 
accounting procedures, all administrative and other mechanisms, and all 
infrastructure in place to collect, account for, track, and distribute 
duties on merchandise entered, or withdrawn from warehouse, for 
consumption by the deadline of October 1, 2007. And at all times we 
would expect that collections of duties are to be pursued aggressively 
by U.S. Customs and Border Protection.
  Mr. FRIST. It is my understanding that my colleague is correct in his 
interpretation of the language agreed to by the conferees. In essence, 
the Continued Dumping Subsidy Offset Act will remain in effect for all 
imports of merchandise that are entered, or withdrawn from warehouse, 
for consumption by the deadline of October 1, 2007. However, duties 
collected on products entering on or after October 1, 2007, will be 
deposited with the U.S. Treasury. Since the WTO has declared the CDSOA 
as putting us out of compliance with our WTO obligations, other nations 
have begun to retaliate against our exports. This will bring us into 
compliance with that ruling and hopefully will bring to an end the 
sanctions U.S. companies are currently facing.
  Mr. CRAIG. I thank the leader for that clarification and I appreciate 
all of his hard work in reaching this compromise language.
  Mr. SANTORUM. Mr. President, I rise today in support of S. 1932, the 
Deficit Reduction Act of 2005, but I want to take a few minutes to 
discuss a specific aspect of that bill--the reauthorization of the 
welfare reform law. As many of my colleagues have heard me say, I 
believe the 1996 welfare reform law is one of the great legislative 
successes during my time in the U.S. Senate. Since the bi11's 
enactment, welfare caseloads have been cut in half, more than 7 million 
individuals and 2 million families have exchanged a welfare check for a 
paycheck, and welfare reform has lifted 2.3 million children out of 
poverty.
  We must build upon this success to move the 2 million families that 
remain on welfare into the workforce by ending the Practice of simply 
extending the program and passing a legislative reauthorization of the 
welfare reform law. On January 24, 2005, I introduced S.6, the MORE 
Act, that included a reauthorization of TANF. A bipartisan 
reauthorization bill, S. 667, passed the Senate Finance Committee with 
my support on March 9, 2005. While I continue to believe that such 
reauthorization would have been best suited by moving the Senate 
Finance Committee reported bill, S. 667, under regular order; we 
unfortunately have been unable to reach an agreement with our 
colleagues on the other side of the aisle to bring this bill to the 
floor.
  After over 3 years of trying to move forward on this reauthorization, 
our colleagues in the House have included TANF reauthorization in their 
budget

[[Page 30694]]

reconciliation bill. Going into this process, I was concerned that some 
provisions in the House legislation regarding work hours, participation 
rates, child support enforcement and access to child care did not 
strike the appropriate balance needed to meet the needs of these 
families as they strive to move from welfare to work. I was pleased 
that the House had included provisions to encourage healthy marriages, 
promote responsible fatherhood, and support strong families. At the end 
of the day, the Deficit Reduction Act is not my preferred vehicle, but 
I am glad we are making some improvements in the program without 
upsetting the necessary balance.
  The conference report reauthorizes the welfare program--the Temporary 
Assistance for Needy Families program or TANF--through fiscal year 2010 
at its current funding level of $16.9 billion annually. The bill 
provides an additional $1 billion for child care over 5 years for a 
total of $2.917 billion annually. While I understand and have heard 
from many that they want a higher amount for child care, this bill will 
increase the investment in child care for working families by $1 
billion, and if we don't do this bill there will be no increase in 
child care at all. It is important to get this increase done this year.
  I am very pleased that the conference report provides $100 million 
annually for healthy marriage promotion, and $50 million annually for 
the promotion of responsible fatherhood. The need for these programs is 
clear. Children growing up in married, two-parent homes are less likely 
to be victims of abuse, engage in high risk behaviors, and suffer from 
emotional problems. Children who live absent their biological fathers 
are, on average, five times more likely to be poor, and at least two to 
three times more likely to use drugs, to experience educational, 
health, emotional and behavioral problems, to be victims of child 
abuse, and to engage in criminal behavior than their peers who live 
with both parents.
  However the benefits are also clear. Married families are 5 times 
less likely to be in poverty than are single-parent families. Adults 
benefit from marriage through lower mortality rates, better health, 
greater financial well-being, less suicide, greater happiness, and 
suffer less violence by intimate partners. Children with involved, 
loving fathers are significantly more likely to do well in school, have 
healthy self-esteem, exhibit empathy and pro-social behavior, and avoid 
high-risk behaviors such as drug use, truancy, and criminal activity 
compared to children who have uninvolved fathers. These grants can be 
used to provide information on the value of marriage, conflict 
resolution, relationship skills and financial management. Increasing 
healthy two-parent marriages is a proven means to reduce poverty and 
improve child well-being.
  This conference report also makes modest changes in the 
implementation of the TANF program. First, it updates work 
participation rates. The 1996 Welfare Reform Act, P.L. 104-193, 
contemplated that all states would meet a 50-percent participation rate 
by 2002. Because the current caseload reduction credit is based on the 
1995 caseload level, most States--including my home State of 
Pennsylvania--have an actual participation rate standard of zero. 
States currently achieve their credit because of their ability to count 
a decade-old caseload decline. The conference report updates the credit 
to the more relevant date of 2005, thereby ensuring that the intent of 
the 1996 welfare reform act is realized.
  The bill also closes a loophole on work participation rates. To avoid 
having to meet caseload requirements, some states set up separate 
programs and moved their harder-to-place clients to those programs to 
avoid the work requirements. The bill removes the ability to game the 
system by including these separate state programs in the work 
calculation, closing a loophole.
  I have seen a number of reports that indicate that this bill changes 
work requirements, narrows what is considered work, et cetera. I want 
to be clear that this bill maintains the current work requirements. The 
bill does not change the current-law standard of 30 hours and maintains 
the separate 20-hour standard for adults with a child six years of age 
and under. It also maintains current-law activities that count as work, 
including allowing 12 months for education and training. The measure 
leaves it to the states to determine whether activities may be counted 
as work activities, and how to count and verify reported hours of work.
  I have heard a number of my colleagues say that this bill ``cuts'' 
money from child support enforcement. I hope they go back and read the 
bill. The changes in child support actually increase child support 
enforcement and gets support to the families. The conference report 
includes provisions that increase States' ability to improve child 
support collection. Under current law, much of the child support that 
is owed to families on welfare is assigned to the State. The conference 
agreement would allow $423 million owed to families on welfare and 
those who have left welfare to go directly to those families--a 
significant improvement over current law.
  The supposed ``cut'' is a restoration of the current state-matching 
requirement. Currently, States are required to match certain Federal 
funds with state funds, showing a State investment in the child support 
enforcement program. However, States have been taking Federal funds 
from one grant and then using them as the ``Federal'' matching funds 
rather than using State funds. The conference report prevents States 
from ``double dipping'' by using Federal funds to draw down additional 
matching federal funds for child support enforcement.
  Additionally, the conference report provides $100 million for grants 
to ensure that the safety, permanence and well-being needs of children 
are met in a timely manner. The funds may also be used for the training 
of judges, attorneys, and other legal personnel in child welfare cases.
  The measure also provides an increase of $200 million for the Safe 
and Stable Families program. The purpose of this program is to enable 
States to develop, expand or operate coordinated programs of community-
based family support services for family preservation services, family 
reunification services, and adoption promotion.
  A number of organizations may have misunderstood the changes relating 
to the alleged ``cuts'' in foster care. There are two provisions 
relating to foster care that might have led to this misperception, so 
let me speak on them for a minute.
  First, the conference agreement restores long-standing foster care 
eligibility criteria relating to the Rosales v. Thompson decision. That 
decision from the Ninth Circuit Court of Appeals broadened eligibility 
for Federal foster care benefits to include almost every child in 
foster care in the nine affected States--California, Oregon, 
Washington, Arizona, Montana, Idaho, Nevada, Alaska and Hawaii--instead 
of only children removed from low-income homes that TANF is intended to 
help. The conference agreement again ensures the same policy applies 
nationwide. As this decision did not apply in Pennsylvania, this change 
does not affect my home State.
  Second, the bill limits the amount of administrative expenses when 
States are slow to place children in safe and suitable situations. I 
should be clear that this proposal does not reduce foster care benefits 
because the funds in question do not support payments to families. 
Instead, the proposal addresses how much Federal funding States may 
claim to operate their foster care programs and under what 
circumstances Federal funding may be claimed. Current law requires the 
placement of a child in a licensed foster family home or a child care 
institution as a condition of eligibility for federal foster care 
maintenance payments. As part of meeting this duty, States may make 
certain administrative claims on behalf of ``candidates'' for federal 
foster care. ``Candidates'' are children who have not been removed from 
their homes but are at imminent risk of removal.
  The proposal allows the State to claim Federal administrative funds 
for

[[Page 30695]]

up to 12 months while children are ``candidates'' for Federal foster 
care and the State is working to license the home as safe and 
appropriate for the child. In January 2005, the Department of Health 
and Human Services, HHS, issued a proposed regulation making this 
change. So States have been on notice that this issue was of concern 
for almost a year. Fourteen States have indicated that they would be 
affected by the proposed regulation; however Pennsylvania was not one 
of those States.
  In summary, millions of our fellow citizens have replaced the 
dependency on government handouts with the dignity and opportunity of 
work. Children and families will now have opportunities to strengthen 
their families through programs to support marriage and responsible 
fatherhood. Thousands of children will have access to childcare through 
the $1 billion in new funding. And we have strengthened our child 
welfare programs. On balance, I think the reconciliation bill, as it 
relates to welfare reform, is a step in the right direction. I remain 
committed to ensuring that work remains a gateway to opportunity for 
all Americans and urge my colleagues to support passage of S. 1932, the 
Deficit Reduction Act of 2005.
  Mr. KOHL. Mr. President, I once again rise to reluctantly, but 
adamantly, oppose the budget reconciliation bill before us today. I say 
reluctantly because the Senate ought to use the reconciliation 
procedure for the purposes for which it was intended: making difficult 
choices to reduce spending. We have an obligation to bring our Nation's 
budget back into balance so we don't saddle future generations with 
endless debt and economic ruin. However, this budget fails on every 
level to achieve this goal. And even worse, the budget cuts that this 
bill does make fall squarely on lower-income Americans who can least 
afford them.
  One provision in this conference agreement that I support relates to 
extension of the Milk Income Lost Contract, MILC, program. MILC, which 
expired at the end of the last fiscal year, provides countercyclical 
support for the Nation's dairy sector. It is targeted. It is fair. It 
is essential. Moreover, it enjoys the President's support. It makes 
sense as part of the balanced Agriculture package in this bill.
  But even this one bright spot is not enough to save this bill or the 
budget plan of which it is a part. This bill is just one piece of a 
fraudulent, fiscally, and morally bankrupt budget which I cannot 
endorse. While the conference agreement we are now voting on cuts 
almost $40 billion in spending, waiting in the wings is a tax-cut bill 
that will likely cost more than $70 billion in tax cuts for the 
wealthy. The math simply doesn't add up. You can't pass a bill to cut 
spending by $40 billion and follow it up with a tax bill that will cost 
more than $70 billion and claim you are reducing the deficit it's 
simply untrue and irresponsible.
  I am willing to make the hard choices to bring our budget deficit 
down, but this conference agreement does not reflect our Nation's 
priorities. I cannot support taking vital services away from families 
that need them the most--and use those cuts as a fig leaf to hide tax 
breaks for those who need them the least.
  I am particularly disappointed that the House and Senate conference 
committee has come back with an agreement that is actually worse than 
the original Senate-passed bill. This so-called compromise causes more 
harm to low-income Americans while shielding powerful special 
interests, such as pharmaceutical companies and the managed care 
industry, from any sacrifice.
  This conference report achieves much of its savings by requiring low-
income Medicaid beneficiaries to pay more out-of-pocket for health 
care, and taking away health care services for which many beneficiaries 
are currently covered. Even more egregious, negotiators dropped a 
common-sense provision in the Senate-passed bill that would have saved 
billions of dollars by eliminating a slush fund for private insurance 
companies in the Medicare prescription drug program.
  This bill before us also fails our Nation's students who are 
struggling to pay for college. Student loans help to ensure that every 
student in America can choose higher education regardless of his or her 
financial or social background. These programs are an investment in our 
future and an investment in a diverse, educated population who will 
lead this country in the 21st century.
  At a time of rising tuition costs, this conference report would 
actually make college less affordable. It would establish a fixed 
interest rate instead of maintaining today's lower variable rates--
leaving the typical student borrower, who has $17,500 in student loan 
debt, having to pay up to an additional $5,800 in order to repay his or 
her college loans. It is simply unacceptable to make the largest raid 
on the student aid program in history at a time when millions of 
families are struggling to keep up with skyrocketing tuition costs. And 
it is inexcusable to do this in order to pay for tax breaks for the 
wealthiest in our society.
  I urge my colleagues to reject this bill--and the irresponsible and 
cruel budget of which it is a part. It does not reflect the right 
budget priorities, and it certainly does not reflect the values of 
American families. And adding insult to injury, these harmful cuts will 
not even help our country dig its way out of a large and growing budget 
deficit. This bill will soon be combined with tax breaks for the 
wealthiest Americans that exceed, by tens of billions of dollars, the 
value of the cuts themselves, and leave our fiscal situation in even 
worse shape than before. We should reject this reckless budget plan and 
instead work to make the responsible choices that the American people 
expect.


                        expiring tax provisions

  Mr. BAUCUS. Mr. President, the Senate is wrapping up legislative 
business shortly, but there are a few expiring tax provisions that have 
unfortunately not been extended yet. Chief among them is the protection 
from the onerous alternative minimum tax, or AMT. Both the higher 
exemption level and the protection for personal nonrefundable credits 
expire on December 31, and because of this, 17 million taxpayers face a 
tax increase next year if we fail to act. Further, a great number of 
U.S. businesses rely on important tax credits, such as the research and 
development tax credit and the work opportunity tax credit, both of 
which expire at the end of the year. This is not the first time this 
unfortunate situation has occurred, but it is my hope and intention 
that as soon as the Senate reconvenes next year, that we would take up 
these items and ensure that they are extended without any intervening 
lapse. Is that also the intention of my good friend from Iowa, Chairman 
Grassley?
  Mr. GRASSLEY. I thank you, Senator Baucus for raising the issue. 
Providing relief from the alternative minimum tax for millions of 
American families is critically important. The alternative minimum tax 
is badly in need of reform and I know he is anxious to work with me on 
that important task. Until such time, we must provide annual relief to 
prevent further expansion of that tax's reach. I was proud that we were 
able to accomplish that objective as part of the tax reconciliation 
bill that passed the Finance Committee and the Senate at the end of 
November. I remain committed to seeing that AMT relief enacted into 
law. In addition, we should act quickly on other expiring tax 
provisions to provide simplification and certainty for individuals and 
businesses, alike.
  Mr. BAUCUS. I thank the Chairman for his statement. I look forward to 
working with him to pass legislation as quickly as possible to provide 
a seamless extension of these provisions. This will ensure the fewest 
disruptions for taxpayers and administrative problems for the IRS.
  Mr. HATCH. Mr. President, I rise today to express my support for the 
budget reconciliation bill conference report. As I have stated here 
during the different stages of debate on this year's budget, the most 
notable thing about this reconciliation bill is not the size of the 
reduction of the spending growth

[[Page 30696]]

but rather the fact that it effectively takes the foot off the 
accelerator of spending growth and begins to touch on the brakes.
  But to get us there, the conferees had to make some hard choices. I 
will be frank--I would prefer that we pass a bill similar to the one 
the Senate passed in November. That bill met our budgetary goals, and 
it struck the right balance. The conference report changes some social 
programs, and I understand the concerns many throughout Utah have 
expressed about how these changes will impact care.
  That is why I spoke with Health and Human Services Secretary Michael 
Leavitt last night to discuss how this bill might affect social 
services in Utah. His assurances that the budget bill will not hurt our 
more vulnerable citizens were key to my decision to support S. 1932. 
Secretary Leavitt, who spent more than a decade serving as Utah's 
Governor, also committed to maintaining a watchful eye over 
implementation of this law to make sure that all Utahns' interests are 
protected.
  So despite this, my paramount concern was that we act now to curb the 
growth in entitlement spending because it threatens every one of our 
children and grandchildren with an unbearable tax burden. This 
conference report marks the beginning of a much needed change--a change 
that must occur if we are to gain control of the fiscal future of this 
country. As many of my colleagues have pointed out, this conference 
report, if enacted, will represent the first time since 1997 that we 
have been able to reduce spending growth in entitlement programs.
  The conference report before us includes a reduction in Federal 
outlays totaling almost $40 billion over the next 5 fiscal years. This, 
I am pleased to see, is nearly $5 billion more than the Senate version 
of the bill that we passed last month. While I am certainly not happy 
with all of the individual changes in the conference report, I do like 
its direction toward more savings growth.
  One reason I am so anxious to turn the comer in slowing spending 
growth on these entitlement programs is that the long-term projections 
for Federal spending on the three largest entitlement programs--Social 
Security, Medicare, and Medicaid--are truly alarming. In fact, a new 
report released last month by the Heritage Foundation states that fully 
funding these three programs will force Federal spending, as a share of 
GDP, to increase from today's level of 20 percent to almost 33 percent 
by 2050.
  Moreover, according to the report, the cost of these three programs 
alone could jump from 8.4 percent of GDP today to 18.9 percent of GDP 
by 2050. Failing to curb the growth in these programs leaves us with 
three very unattractive and dangerous alternatives. The first would be 
to raise taxes dramatically. As we know, such a move would choke off 
economic growth and leave us vulnerable to economic recessions which 
would exacerbate rather than help the problem.
  The second alternative is equally untenable--eliminate all other 
spending, eventually to include all discretionary spending. This, of 
course, is absurd since our defense, homeland security, and other vital 
spending is included in this category. The final alternative is to 
continue to allow the deficits to continue to build up as we try to 
keep on financing the growing debt with loans from other countries.
  Therefore, our only real choice is to begin to slow down the growth 
in these programs. This conference reports does start us on this path.
  However, I acknowledge this conference report is far from perfect. It 
retains some flaws from the Senate version of the bill, and it came 
back from conference with some new flaws.
  That being said, I believe this legislation is a step in the right 
direction. The Medicare provisions are more in line with the Senate 
version, and overall it targets Medicare's resources to better serve 
our seniors and disabled. The conference report ensures that 
beneficiaries don't lose their doctors because of budget cuts, and it 
expands services while making significant budget savings in noncritical 
areas.
  While I do not agree with everything in this bill, I am pleased that 
the legislation restores the stabilization fund for the Medicare 
Advantage regional PPOs and allows the Medicare Part B penalty to be 
waived for international missionaries. It also will expand the Program 
of All Inclusive Care for the Elderly, PACE, to beneficiaries living in 
rural areas. PACE offers alternative services to individuals who may 
need nursing home care but want to live at home if possible. This 
provision will provide another important choice for long-term care 
services for beneficiaries in rural areas. I filed all three of these 
policies as amendments when the Finance Committee considered the budget 
reconciliation bill.
  For Medicare beneficiaries this legislation encourages preventive 
care for seniors and the disabled. Some of the important provisions in 
this area include the following: preventive screening tests for 
abdominal aortic aneurysm; exemption for colorectal cancer screening 
tests from the Medicare deductible; a 1.6-percent update to the 
composite rate for end stage renal disease, ESRD, services in 2006; and 
an expansion of Medicare reimbursement for services at federally 
qualified health centers, FQHC, by allowing them to provide diabetes 
self-management training services and medical nutrition therapy 
services.
  In addition, this legislation makes needed reforms to home health 
payments in order to reduce disparities in provider payment and improve 
quality and transparency. First, the bill calls for a 1-year, 5-percent 
add-on payment for home health agencies that serve rural beneficiaries 
which will help many home health agencies in Utah. Rural home health 
agencies have much lower Medicare margins than urban home health 
agencies, and as a Senator who represents a primarily rural State, I 
believe that this needs to be addressed. The legislation freezes home 
health payments in 2006. In its March 2005 report to Congress, the 
Medicare Payment Advisory Commission recommended this freeze in home 
health payments because Medicare pays home health agencies 
approximately 17 percent more than it costs agencies to provide home 
health services. Finally, the legislation also provides financial 
incentives to home health agencies that report quality data beginning 
in 2007.
  One of the most important provisions in this legislation protects 
physicians from a 4.4-percent scheduled reduction beginning on January 
1, 2006 and, instead, allowed the 2005 payment rates to continue 
through 2006. I am still committed to fixing this problem once and for 
all, and I hope that we may accomplish this in 2006 since this issue 
will need to be addressed once again since physicians are estimated to 
continue to receive negative cuts of approximately 5 percent from 2006 
to 2011. Congress needs to enact a long-term solution as quickly as 
possible.
  With regard to therapy services, for years Congress has worked to 
find a permanent solution to the problem of overutilization of therapy 
services. Although I have consistently supported a moratorium on 
therapy caps, this bill leaves a January 2006 expiration of the 
moratorium in tact, and I am committed to continue encouraging my 
colleagues to reinstate this important moratorium.
  Now, let me turn to Medicaid. This has been a tremendously successful 
program but also a very costly one. We have a responsibility to address 
the dramatic growth in spending, but I was not happy that some of the 
key provisions have not been considered thoroughly by the Senate. Given 
expressions of concern voiced to me by my constituents, I only 
reluctantly give my support to the overall measure.
  I would have preferred the Senate language, which did not change the 
law with respect to beneficiary eligibility. That is why I will be 
working closely with Secretary Leavitt and other Cabinet-level 
officials to ensure Utah is treated fairly as this law is implemented.
  I would like to take a couple of minutes to share my thoughts on some 
aspects of the Medicaid portion of this bill. One issue that was 
debated in both the House and the Senate was the real

[[Page 30697]]

asset transfer rules. Under current law, Medicaid asset transfer rules 
are easily skirted--courses are offered to teach attorneys how to 
circumvent the law. This is plain wrong. The reforms in the Deficit 
Reduction Omnibus Reconciliation Act will make it more difficult for 
these transfers to occur and will allow more Medicaid resources to go 
to those who are in genuine need.
  Our current asset transfer policy is flawed. The policy not only 
allows for exploitation, it encourages it. The current statute has 
loopholes that allow wealthy seniors to qualify for Medicaid. Let me 
make one point clear--Medicaid exists to protect the most vulnerable, 
not the most wealthy.
  We need a fair, equitable policy. We need to protect the Medicaid 
Program for those who need it most. The legislation before us today 
addresses this situation by closing the loopholes in Medicaid. First, 
it prevents seniors from intentionally protecting their assets--people 
should not be allowed to hide their money in order to receive Medicaid 
nursing home coverage. Second, the bill changes the lookback period as 
well as the penalty period. Today, an older American can shelter half 
of his or her assets the day before applying for Medicaid.
  The conference report starts the penalty period clock when a senior 
applies for Medicaid, and the lookback period is changed from 3 years 
to 5 years. Currently, an older person will face a penalty if assets 
are transferred for the purposes of qualifying for Medicaid within 5 
years of applying for Medicaid. This provision significantly 
strengthens the asset transfer policy.
  The new law does not allow an individual with more than $500,000 in 
home equity to be able to qualify for Medicaid. It does provide State 
flexibility to increase the cap to $750,000. This is sound policy. 
Those with home equity over $500,000 should not take Medicaid money 
from those for whom the Medicaid Program was designed: low-income 
children, pregnant women, and individuals with disabilities. Also, the 
policy only applies to individuals. It does not apply to applicants who 
have a spouse or a dependent child at home. In theory, the State is 
supposed to be able to put a lien on that home anyway.
  Finally, seniors who have a hardship can apply for a waiver. The 
policy strengthens protections for seniors seeking an undue hardship 
waiver beyond current law or the Senate-passed version. I don't want to 
make it harder for people who really need the Government's help. But I 
do want to prevent seniors from intentionally taking advantage of the 
system. We need to protect Medicaid for those who need it most.
  I discussed this matter in great detail with the Utah Medicaid 
Director and was assured that, in my home State of Utah, individuals 
who are under suspicion for transferring assets inappropriately are 
always given the right to appeal if their request for Medicaid coverage 
is in question. I understand there are several States, such as Utah, 
who handle this matter in fair and thoughtful way.
  The budget reconciliation conference agreement also makes existing 
Federal reimbursement rates for drugs more accurate. It makes the 
average manufacturer price, AMP, of drugs available to the public so 
that pharmacists and wholesalers will get lower prices through greater 
competition, and excludes prompt pay discounts paid to wholesalers from 
the new pharmacy reimbursement rates.
  AMP is the average price at which manufacturers sell their drugs to 
wholesalers, but starting in 2007, the Federal Government will not pay 
more than 250 percent of the AMP of the lowest cost version of a 
generic drug. Under current law, the Federal upper limit is 150 percent 
of the lowest published price. The new payment rates are based on the 
existing rules governing generic drugs.
  The AMP data will also be made available to States and the public. 
This will create more transparency and competition in drug pricing. CBO 
has estimated that transparency will help reduce drug costs by hundreds 
of millions of dollars. Competition and transparency will bring prices 
down for consumers and protect the taxpayer from needless waste.
  The final bill also requires the Secretary to work with private 
companies that routinely monitor and track drug payment rates for 
private health plans. The Secretary will then be required to share this 
information, known as retail sales prices, with States. This will 
provide State officials with better information about actual market-
based prices, such as the rates paid by the Federal Employee Health 
Benefit Plans pay for prescription drugs. All of this information will 
provide greater accountability and ensure that Medicaid is paying 
pharmacists fairly for all drugs, and I am pleased that these 
provisions were included in the legislation.
  The Deficit Reduction Omnibus Reconciliation Act also contains 
important reforms that will provide Medicare beneficiaries, seniors, 
and the disabled with better options to manage their care. Under the 
Deficit Reduction Omnibus Reconciliation Act, States will now be able 
to provide home and community-based services as an optional benefit to 
seniors, the disabled, persons with a developmental disability, mental 
retardation, or a related condition. Coverage of these services will 
allow more individuals to receive better health care and other 
assistance. These services will also mean that more persons can remain 
in their homes, without needing to go into nursing homes. These reforms 
will help reduce spending by allowing individuals to receive the kinds 
of care they want, in the settings they prefer, at prices far below 
what Medicaid usually pays for nursing home care. In addition, no one 
who currently is receiving care through an institution will be forced 
to leave that institution in order to receive community-based care.
  The final conference report also will allow every State to establish 
a Long-Term Care Partnership Program. Long Term Care Partnership 
Programs allow individuals to protect a portion of their assets from 
Medicaid recoveries if they purchase long-term care insurance. 
Currently only four States (California, Connecticut, Indiana and New 
York) are allowed to have these programs. By expanding access to these 
programs, the new law will help create incentives for people to 
purchase long term-care insurance. Encouraging the purchase of long-
term care insurance will mean that more people will be able to pay for 
their own nursing care, and fewer will have to rely on Medicaid as a 
safety net to meet their long-term care needs.
  Another area that is addressed in this legislation is Medicaid 
beneficiary cost-sharing. There is a lot of misinformation about this 
provision, and I would like to explain this provision in more detail. 
Under current law, States may require cost-sharing but it is not 
enforceable. In other words, if a beneficiary does not pay his or her 
copayment, the health care provider is forced to absorb the 
beneficiary's copayment. This is why we have such difficulty 
encouraging providers to participate in the Medicaid Program. Many will 
not, and all Medicaid beneficiaries suffer as a result.
  I believe that the conference report includes reasonable policy that 
allows States to ask beneficiaries over the poverty line to participate 
in the cost of their own care. Let me make one clarification--the 
House-passed legislation required States to impose cost-share 
requirements on beneficiaries with no income. I do not agree with that 
policy, and it is included in this bill.
  A beneficiary who is above the poverty line may pay up to percent of 
his or her monthly income to the cost of their care, but that is only 
if the State decides to impose additional cost-sharing requirements. 
And let me assure my colleagues that no state is required to impose 
cost-sharing requirements on these beneficiaries. I will add that even 
the National Governors Association support reasonable responsible cost-
sharing. In fact, Governors testified before the Senate Finance 
Committee earlier this year and told committee members that they 
support this policy.
  I am aware that substantial concerns have been raised about the 
provision permitting States to provide Medicaid

[[Page 30698]]

coverage to children under age 19 through ``benchmark'' or ``benchmark 
equivalent'' coverage. In short, some fear this language might abrogate 
the right of those children to receive Early Periodic Screening, 
Diagnostic and Testing, EPSDT, benefits.
  For the benefit of my colleagues, I will ask unanimous consent that a 
statement just issued by Centers for Medicare and Medicaid Services 
Administration, Mark McClellan, M.D., Ph.D., be printed in the Record
  As Dr. McClellan has made quite clear, children through age 18 will 
continue to receive EPSDT. It is my hope this assurance will make many 
child advocates more comfortable with this bill.
  With regard to the welfare portion of the conference report, I was 
disappointed to see Congress's efforts to reduce the budget contain 
limitations on welfare, childcare, and child support policy. These 
vital programs should have been reauthorized through the normal 
legislative process, not tucked away in a protected budget 
reconciliation bill which is designed to reduce the Federal deficit. 
The welfare, childcare, and child support language included in the 
budget reconciliation bill has almost nothing to do with reducing the 
deficit and everything to do with changing the rules of these important 
programs without proper legislative scrutiny or debate.
  While I am completely frustrated with the Senate's inability to 
reauthorize the Temporary Assistance for Needy Families, TANF, 
legislation using the normal legislative process, I do not believe it 
is in the best interest of the participants of these programs to 
include sweeping policy changes in a bill designed to reduce the 
deficit.
  However, I am appreciative of Chairman Grassley's efforts to ensure 
that childcare funding was increased. Although the increase is limited 
to $1 billion over the next 5 years, I am hopeful we will be able to 
secure even larger increases in childcare funding in the near future. 
Providing quality childcare to low-income families is crucial when we 
are scrambling to help families become self-sufficient, and I am 
committed to ensuring the Federal Government continues to help these 
children and families.
  As well, I am appreciative of the chairman's efforts to secure 3 
years of supplement TANF grants. The State of Utah has been a large 
beneficiary of these grants, and as we work to meet the stricter TANF 
work requirements outlined in this bill, we will continue to have 
supplemental grants from HHS to help us train and prepare our TANF 
recipients.
  Now I would like to discuss the portion of the deficit reduction 
conference report that addresses the Continued Dumping and Subsidy 
Offset Act, which is commonly refereed to as the Byrd amendment. The 
Byrd amendment amended the Tariff Act of 1930 to require that duties, 
collected as a result of antidumping and countervailing duty laws, be 
distributed to the affected entities. At the time it was introduced, I 
supported this measure as a commonsense proposal.
  However, since that time, the World Trade Organization has allowed 
our trading partners to impose tariffs on various U.S. goods, and the 
Byrd amendment has gone from a commonsense solution to an impediment to 
U.S. companies' ability to sell their goods abroad.
  First, I must reemphasize my strong support for laws that not only 
make trade free but fair. Accordingly, I have spoken directly to the 
Secretary of Commerce, Carlos Gutierrez, and United States Trade 
Representative, Ambassador Rob Portman, about the vital importance of 
vigorous enforcement of our trade laws.
  Though I have never and will never advocate modifying our laws 
because of outside pressure, American companies and employees in Utah 
and all over the country have come to me and asked for my help in 
repealing the Byrd amendment. Currently, the United States is 
negotiating, as part of the Doha Round talks, a new trade regime in 
which international markets would become even more open to U.S. goods 
and services. If completely successful, the Institute for International 
Economics estimates that American households could gain as much as an 
additional $5,000 per year. If today's international trade barriers 
were reduced by just a third, the average American family of four would 
enjoy $2,500 per year in additional income, according to a University 
of Michigan study.
  Freer trade helps more than just Americans. The poorest countries 
stand to gain considerably. According to a Center for Global 
Development study, a successful conclusion to the Doha Round would 
result in an additional $200 billion flowing to developing nations, 
reducing poverty and economic hardship. Not to mention, the Institute 
for International Economics estimates that trade liberalization over 
the last 50 years has brought an additional $10,000 per year to the 
typical American household.
  In order to achieve our objectives in the Doha Round, many of our 
trading partners will be required to make substantial concessions on 
import duties and subsidies. However, those who oppose our noble goals 
could use our refusal to repeal the Byrd amendment as a means to hinder 
our negotiating strategy. Simply put, these opponents will state that 
if the United States cannot follow the existing rules of trade, rules 
which our Nation largely crafted and implemented, how can we be trusted 
if most trade barriers are repealed?
  Therefore, as I said before, I admire the Byrd amendment's 
commonsense approach, but I believe under the present circumstances the 
time has come for this legislation to be modified, in order to 
strengthen the ability of our Nation to achieve the larger goal of 
bringing down foreign barriers to U.S. goods and services.
  Therefore, I support the changes incorporated in the Deficit 
Reduction Conference Report. This legislation achieves a fair 
compromise by repealing the Byrd amendment; however, at the same it 
would permit Byrd amendment payments to U.S. companies through October 
1, 2007. This should provide an adequate time for companies to plan for 
the future while preserving a strong negotiating position for U.S. 
interests.
  Despite its shortcomings in some areas, this reconciliation package 
contains several very important provisions in the intellectual property 
area that benefit the Nation and my home State of Utah.
  I am pleased that a hard date for the transition from analog to 
digital television was included in the final package. This important 
provision will free up crucial radio spectrum that is currently 
occupied by broadcaster's analog television signals. Although the 
digital transition inevitably resolves a number of difficult issues, it 
also has several important benefits. It is my understanding that over 
$7 billion of the proceeds from the eventual auction of spectrum 
licenses is expected to be used for deficit reduction. Perhaps more 
importantly, the transition will provide both the necessary funding and 
available spectrum for public safety officials and emergency personnel 
across the country to upgrade their communications infrastructure. And, 
finally, a portion of the anticipated proceeds will be used for various 
programs intended to minimize any negative financial impact on 
consumers, rural broadcasters, and others affected by the transition.
  I am particularly pleased that a provision setting aside a small 
fraction of the proceeds to help fund the upgrade of television 
translator stations was included. This provision responds to a serious 
concern that I have had regarding the financial viability of upgrading 
the network of translator stations across Utah that are used to serve 
many of the rural communities in my home State. In the context of the 
debate over the digital transition, it came to my attention that 
upgrading these translators, which retransmit television signals to 
communities beyond the reach of the primary broadcast towers, would 
impose a substantial--and disproportionate--financial burden on 
broadcasters that were primarily located in mountainous western States. 
Due to the vast area covered by the Salt Lake City television market 
and the high

[[Page 30699]]

concentration of translator stations in the State, there was a 
substantial concern that upgrading the cost of these translators would 
be prohibitive. The approach taken in the reconciliation package is 
similar to the proposal contained in S. 1600, which I cosponsored with 
Senator Snowe, and I would like to take this opportunity to thank 
Senators Snowe, Stevens, and Inouye--and their respective staffs--for 
their help on this issue.
  As with other portions of this bill, there are aspects to the 
education provisions I support and others I don't. However, I am 
pleased overall with the significant amount of savings while still 
allowing for spending on important programs.
  The major area of savings comes from the reduction in corporate 
lender profits on student loans, in the form of a requirement that 
lenders rebate the Federal Government the difference between the 
borrower rate and the lender rate when the borrower rate exceeds the 
lender rate. In addition, guaranty agencies are required to deposit 1 
percent of their collections in the Federal Reserve Fund; there is a 
reduction of borrower origination fees by .50 percent for each award, 
and there is an elimination of the recycling of 9.5 percent loans.
  Even with these much needed savings, I disagreed with fixing the 
interest rate for undergraduate and graduate nonconsolidation borrowing 
at 6.8 percent, preferring a choice of a fixed or variable rate.
  However, I am very pleased with increasing grant aid for students 
studying math and science, named SMART grants. I was involved in the 
original creation of the SMART Grants Program through my work on the 
HELP Committee. These grants will give first year students awards of 
$700 and $1,300 for second year students, provided they have completed 
rigorous programs at the secondary level. Third and fourth year 
students may receive up to $4,000 in grant aid if they major in math, 
science, or foreign language.
  I know these programs will give Utah students, particularly those of 
low or moderate means, greater access to a college education and will 
boost our local and national economy as we seek to meet the demands of 
the 21st century workforce.
  Again, this legislation is not perfect. It is not a perfect answer to 
several of the social policy problems that confront our Nation. It is 
not a perfect answer to the growing Federal budget deficit either. It 
is not Draconian and it is not mean-hearted. This deficit reduction 
conference report is merely a good first step in stemming the tide of 
red ink that runs down the pages of the Federal budget, stealing 
taxpayer dollars to service a monstrous Federal debt and robbing our 
children of a safe and secure financial future. For these important and 
self evident reasons, I support this bill.
  I ask unanimous consent the statement issued by the Centers for 
Medicare and Medicaid Services Administration to which I referred 
earlier be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

Statement by Mark B. McClellan, M.D., Ph.D, Administrator, Centers for 
                      Medicare & Medicaid Services

       Questions have been raised about the new section 1937 of 
     the Social Security Act (SSA) (as added by the Deficit 
     Reduction Act of 2005) that permits states to provide 
     Medicaid benefits to children through benchmark coverage or 
     benchmark equivalent coverage. If a state chooses to exercise 
     this option, the specific issue has been raised as to whether 
     children under 19 will still be entitled to receive EPSDT 
     benefits in addition to the benefits provided by the 
     benchmark coverage or benchmark equivalent coverage. The 
     short answer is: children under 19 will receive EPSDT 
     benefits.
       After a careful review, including consultation with the 
     Office of General Counsel, CMS has determined that children 
     under 19 will still be entitled to receive EPSDT benefits if 
     enrolled in benchmark coverage or benchmark equivalent 
     coverage under the new section 1937. CMS will review each 
     State plan amendment (SPA) submitted under the new section 
     1937 and will not approve any SPA that does not include the 
     provision of EPSDT services for children under 19 as defined 
     in section 1905(r) of the SSA.
       In the case of children under the age of 19, new section 
     1937(a)(1) is clear that a state may exercise the option to 
     provide Medicaid benefits through enrollment in coverage that 
     at a minimum has two parts. The first part of the coverage 
     will be benchmark coverage or benchmark equivalent coverage, 
     as required by subsection (a)(1)(A)(i), and the second part 
     of the coverage will be wrap-around coverage of EPDST 
     services as defined in section 1905(r) of the SSA, as 
     required by subsection (a)(1)(A)(ii). A State cannot exercise 
     the option under section 1937 with respect to children under 
     19 if EPSDT services are not included in the total coverage 
     provided to such children.
       Subparagraph (C) of section 1937(a)(1) permits states to 
     also add wrap-around or additional benefits. In the case of 
     children under 19, wrap-around or additional benefits that a 
     state could choose to provide under subparagraph (C) must be 
     a benefit in addition to the benchmark coverage or benchmark 
     equivalent coverage and the EPSDT services that the state is 
     already required to provide under subparagraph (A) of that 
     section. Subparagraph (C) does not in any way give a state 
     the flexibility to fail to provide the EPSDT services 
     required by subparagraph (A)(ii) of section 1937(a)(1).

  Mr. BINGAMAN. Mr. President, across the country, more than 6 million 
children live with relatives, and of those, 4.5 million live with 
grandparents. A majority of relatives providing care for children are 
not part of the child welfare system. In fact, only a quarter of all 
relatives caring for a child receive either a foster care payment or 
another source of payment. Most relatives do not receive any Federal 
financial support, and sadly, nearly 20 percent of all grandparents 
raising their grandchildren live in poverty.
  Unfortunately, the conference agreement on the Deficit Reduction Act 
of 2005 severely cuts Federal assistance to foster care funding and 
makes it significantly harder for relatives to provide care for a 
child. I believe this is a step in the wrong direction, and I oppose 
these cuts.
  Kinship care is an important option for permanency for children in 
the child welfare system and often appropriate when adoption is not 
possible. Subsidized guardianship makes it possible for a relative to 
step in and care for a child. In my State of New Mexico, subsidized 
guardianship is available, and nearly 10 percent of children live with 
nonparent relatives. Grandparents and other relative caregivers are 
often the best chance for a loving and stable childhood for a child in 
their care, and it is important that we acknowledge their hard work and 
dedication.
  I commend grandparents and other relatives who step forward to care 
for a child. Their efforts help keep children out of foster care and 
provide safe, permanent and stable homes, often at great personal 
sacrifice. Supportive programs like subsidized guardianship allow 
caring relatives to provide care that they may not otherwise be able to 
give, and help children exit foster care into the care of nurturing 
relatives. I would like to express my gratitude and appreciation for 
the invaluable care provided by relatives for children in need.
  Mr. KOHL. Mr. President, I join many of my colleagues today in 
expressing sincere disappointment in the conference report to the 
budget reconciliation legislation. I could certainly echo the 
sentiments that we have already heard regarding the Medicaid and TANF 
provisions included in this conference report--two sections that will 
directly penalize hard working families, and prevent many from moving 
towards self-sufficiency. Or I could repeat the comments that this 
report represents not a compromise between the House and Senate bills, 
but an abuse of power that will harm rather than help, millions of 
families.
  While I share my colleagues' dissatisfaction with this conference 
report, I would like to highlight a section that may have been 
overlooked. The conferees made interesting decisions in the area of 
child support--they chose to include provisions that would allow States 
to ``pass through'' child support payments to families, provisions that 
I have fought to pass for several years. Yet in the same conference 
report, they chose to make deep cuts to the Child Support Enforcement 
Program, cuts that may inhibit States ability from actually passing 
through those child support dollars.
  I believe the inclusion of the child support ``pass through'' 
provisions is

[[Page 30700]]

one of the few successes of this legislation. These provisions are 
similar to those included in S. 321, the Child Support Distribution 
Act. Senator Snowe and I have worked together for the past several 
years on this legislation, which allows States to ``pass through'' more 
child support collections to the families that need them, rather than 
send those dollars to the Federal Government.
  Specifically, the conference report has three major provisions 
related to the Child Support Distribution Act. The conference report 
eliminates pre-assistance assignment rules--families applying for the 
Temporary Assistance to Needy Families program would no longer be 
required to turn over their right to child support that accrues before 
they are receiving assistance. In addition, the Conference Report gives 
states the option to distribute more child support to families who have 
left assistance. Finally, for families currently receiving assistance, 
it allows States to let families keep more child support, rather than 
sending it to the Federal Government.
  These changes were included in the bipartisan, Senate Finance 
Committee-passed welfare reauthorization legislation. It is 
unfortunate, given the wide support for these provisions, that the cuts 
contained in this bill will place such a financial burden on the States 
that they will unlikely be able to actually pass through the funding to 
the families.
  The original House bill included a 40-percent cut to Federal child 
support funding. Thus, it would seem that the $5 billion cut included 
in the conference report before us is somehow less significant. This 
could not be further from the truth. According to the Congressional 
Budget Office, this conference report would mean that more than $8 
billion in child support payments would go uncollected over the next 10 
years. I will say that again so that my colleagues are clear: $8 
billion in funds will not go to hardworking, single parent families; $8 
billion that is owed to these families, that they rely on to meet their 
children's needs.
  These payments would go uncollected because the conference report 
retains a provision that 74 of my colleagues voted against last week. I 
offered a motion to instruct that asked conferees to reject the 
provisions in the House bill that would restrict the ability of States 
to draw down matching funds on child support incentive payments. In 
addition, I sent a letter to conferees that was signed by 49 Senators 
asking that this restriction not be included in the conference report.
  I have heard some of my colleagues argue that this is simply closing 
a loophole, that this funding source was not what Congress intended. I 
say to my colleagues that this is not the case. The reforms made to the 
child support system in 1998 created the performance-based system that 
has been proven to be so successful. Since this system was put in 
place, States have doubled their collection rates and have 
significantly improved their performance on every other measure.
  The changes in this conference report would undo these successes. In 
fact, the cuts will actually drive up costs in other programs, such as 
TANF, food stamps, and Medicaid. That is why these cuts are opposed by 
the National Governors Association, the National Association of 
Attorneys General, and the National Conference of State Legislatures, 
among others.
  It is highly ironic that the conference report gives States the 
option to pass through more child support to families that deserve it, 
while also passing on a financial burden that will directly restrict 
their ability to do so. This bill will hurt millions of families, and 
it should have been defeated.
  Mr. LEVIN. Mr. President, we all know that times have been getting 
tougher for low- and middle-income working families. Compared to 5 
years ago, more Americans now live in poverty, the median household 
income has dropped, and more live without the security of health 
insurance. Clearly, Congress should be adopting budget policies aimed 
at improving these troubling trends. But instead, this misguided budget 
reconciliation conference report would make things worse.
  This legislation takes funds from important programs like Medicaid, 
student loans, child support enforcement, foster care assistance, and 
Supplemental Security Income for the elderly and disabled poor. The 
stated purpose of these nearly $40 billion in cuts and harmful program 
changes is to trim the deficit, but we all know that these savings will 
not ultimately be used toward that goal; they are designed to pave the 
way for the $50 billion to $100 billion in new tax cuts that the 
majority will attempt to push through early next year. We should not be 
making cuts to vital services simply so the President and the majority 
can finance more tax cuts that mainly benefit the wealthiest among us.
  Under this bill, families that rely on Medicaid will face significant 
increases in the costs for access to health care services and 
medications, which will lead many of our most vulnerable citizens to 
forgo needed care. The Congressional Budget Office, CBO, estimates that 
the increases in Medicaid copayments and premiums and the reductions in 
Medicaid benefits will total $16 billion over the next 10 years. Also 
of particular concern to Michigan is a provision that eliminates the 
State's provider managed care assessment. When that provision goes into 
effect, it will cost Michigan $280 million per year.
  The conference agreement also makes things worse for those who use 
student loans. Despite already soaring education costs, this conference 
report cuts funding for student loan programs by $12.7 billion over 5 
years, nearly one-third of the total cuts imposed by this legislation. 
Most of these reductions are achieved by increasing interest rates and 
fees paid by students and parents. In the fight for global 
competitiveness, a highly educated workforce is one of America's best 
assets. It is shortsighted to cut investments in education.
  This legislation will make also substantial changes to the Temporary 
Assistance for Needy Families, TANF, program. The changes include 
imposing harsh new work requirements without providing nearly enough 
childcare assistance. The CBO estimates that States will need over $12 
billion in new funding over the next 5 years to maintain current 
childcare programs and meet the new work requirements by increasing 
participation in welfare-to-work programs. The conference agreement, 
however, includes just $1 billion in childcare funding over the next 5 
years. The shortfall means that many States will need to scale back 
childcare slots for poor working families not on welfare, forcing 
families to choose between lower quality, less stable childcare or not 
working at all.
  Unfortunately, this conference agreement also contains a House 
provision that would repeal the Continued Dumping and Subsidy Offset 
Act, CDSOA, of 2000, despite an overwhelming 71 to 20 Senate vote 
instructing conferees to reject the provision. The CDSOA was enacted in 
2000 to enable U.S. businesses and workers to survive in the face of 
continued unfair trade by allowing Customs to distribute duties 
collected on unfairly traded imports to those U.S. companies and 
workers injured by continued dumped and unfairly subsidized imports. I 
do not believe we should repeal this law, nor do a bipartisan majority 
of Senators.
  Additionally, under this bill, Federal funding for child support 
enforcement will be cut about $1.5 billion over the next 5 years. As a 
result, the CBO estimates that $2.9 billion in child support owed to 
children will go uncollected over 5 years.
  The hardships that will be caused by this legislation are significant 
and broad-reaching. Yet the three-part budget reconciliation package 
that includes this conference report will not even make a dent in our 
deficits. Both the House and Senate have passed tax reconciliation 
bills that cut revenues far more than this bill cuts spending. As most 
grade school math students can tell you, when you bring in less money 
than you spend, you will end up in trouble. And that is where the 
President's tax policies have put us today.
  We have got over $8 trillion in debt. Financing further tax cuts with 
debt is

[[Page 30701]]

simply fiscally irresponsible. In the most recent fiscal year, we spent 
over $350 billion just to pay the interest on our debt. That is 14 
percent of the Federal Government's spending last year. We simply 
cannot afford to continue building up this massive debt.
  One of a few positive aspects about this conference report is the 
inclusion of an extension of the Milk Income Loss Compensation, MILC, 
Program, which was set to expire this year. Milk is Michigan's largest 
agricultural commodity, and the MILC Program has been essential in 
preserving our dairy farms in times of dairy price declines.
  Mr. President, the reconciliation process is supposed to bring 
Government programs and tax policies passed over the years in line with 
the broader budgetary goals of the Congress. It should be a fiscal 
sanity check, making sure our policies support our goals. At a time 
when one in six American children lives in poverty, our budget goals 
should be to help, not hurt, the neediest among us. Our goals should 
also focus on reducing the mountain of debt that we are leaving for our 
children and grandchildren. Unfortunately, by cutting vital programs to 
finance tax cuts that mainly benefit the wealthy, this legislation 
moves us in the wrong direction on both counts. I will oppose this 
conference report.
  Mr. ALEXANDER. Mr. President, today the Senate approved the Deficit 
Reduction Omnibus Reconciliation Act of 2005. I voted in favor of this 
bill because it is the first comprehensive deficit reduction 
legislation approved by the Senate since 1997, and it will save $39.7 
billion over the next 5 years. This is an important first step toward 
containing the unsustainable growth of entitlement programs and putting 
us on the road to a balanced budget.
  None of us is happy about everything that is included in a big bill 
like this. One area in which I am disappointed is language 
reauthorizing the welfare reform program, also known as Temporary 
Assistance for Needy Families, TANF. This is a program that needs to be 
reauthorized on a more permanent basis, instead of the temporary 
extensions that have been approved year after year.
  In thinking about reauthorization of welfare reform, I believe three 
things need to happen. First, States need more authority to decide what 
will work best in their State. Second, States need more flexibility to 
allow educational activities to count toward work hours. I have been 
told by TANF offices in Tennessee that if they can get TANF recipients 
into school, they do not see them on the welfare rolls again. Third, we 
need more money for child care. If the TANF program is going to require 
poor parents--including single mothers--to work, these parents must 
have safe child care for their children. Last year, I supported--and 
the Senate passed by a vote of 78 to 20--an amendment to increase child 
care funding by $6 billion. This bill only includes a $1 billion 
increase for child care.
  Unfortunately, the welfare reform language included in the deficit 
reduction bill falls short in all three of these areas. I would have 
preferred that the Senate hold a full debate on TANF reauthorization, 
with Senators able to offer amendments. However, I understand that the 
Senate conferees felt that the deficit reduction bill represented the 
best chance of reauthorization after years of delay and temporary 
extensions.
  In the coming year, I look forward to working with Chairman Grassley 
and other colleagues to craft legislation that addresses some of these 
shortcomings and continues the successful transformation of the TANF 
program that began with enactment of the landmark welfare reform law in 
1996.
  Mr. FEINGOLD. Mr. President, this budget reconciliation package that 
arrived from the House-Senate conference will leave our country's 
budget and the American people in a far worse state of affairs than 
they are today. I am disappointed that congressional leaders have 
chosen to use the budget reconciliation process to achieve 
controversial goals that will make life harder for those Americans in 
greatest need of help, and I will oppose this legislation.
  As I stated when this bill passed the Senate, using reconciliation to 
push through legislation that will worsen our budget deficit and add 
billions more to the mountain of debt our children and grandchildren 
will have to pay is a perversion of a process designed to expedite 
measures to reduce the deficit.
  Reconciliation was intended to help facilitate the enactment of 
measures to reduce the deficit and therefore secure the Nation's 
financial stability. It is ironic that it should be used to enact 
measures that not only aggravate our budget deficits and increase our 
massive debt, but also makes cuts to programs that help many Americans 
maintain their financial security.
  There are substantial and unprecedented changes to the Medicaid 
program included in this bill. Rather than cut the wasteful, $10 
billion Medicare Advantage slush fund that gives superfluous payments 
to insurance companies, conferees have chosen to cut benefits and shift 
costs onto the poorest in America. Usage of Medicaid is expected to 
drop significantly, forcing beneficiaries to become sicker and 
eventually utilize emergency room care. In fact, the Congressional 
Budget Office estimates that 17 million people will pay more for health 
services under Medicaid over 10 years, half of whom would be children. 
Is this how we want to take care of the needy in our society? This will 
be harmful not only to those in need of health care, but also to our 
hospitals, which will be burdened with more patients who are unable to 
pay. This shift of health care costs from the Government to Medicaid 
beneficiaries will only cost our hospitals and taxpayers more money in 
the long run--and this is being done under the guise of saving money 
and balancing our budget.
  Perhaps the most worrying changes to our health care programs are the 
statutory changes to Medicaid and Medicare. This conference agreement 
institutes systemic limitations on services that will have effects for 
decades to come. Included in the bill are provisions that will force 
unlimited charges onto the poor for their health care where previously 
there were protections for those in near poverty. As if loss of these 
protections were not enough, this will also allow health care providers 
to deny health care to people too poor to afford these charges.
  This legislation also freezes Medicare payments to home health care 
providers. Home health is the most cost-efficient and comfortable way 
to provide long term care. By freezing home health care payments, 
access will drop, and many of the sickest in our country will be denied 
this option.
  In addition to cutting into people's health care, this report cuts 
into welfare and child care funding on which many American families 
depend. Last week, the Senate passed a motion to instruct conferees 
that urged welfare reauthorization to be removed from the budget 
package. I voted for this motion, which passed overwhelmingly. Despite 
the success, the House chose to include welfare reauthorization anyway. 
This was done under the radar in a move that was largely unseen by 
people who will be affected by the changes. And the changes are 
significant. This reauthorization represents the largest change in 
welfare policy since 1996, and it will impose expensive new work 
requirements on states with no additional funding provided. So those on 
welfare will be working more hours, and what will they do with their 
children? Child care funds have been cut by $1 billion in this bill. 
This is $7.4 billion less than CBO estimates to be the cost to states 
of meeting the new work requirements, and more than $11 billion less 
than what states will need to ensure that their current child care 
programs can stay afloat through all the additional changes in the 
budget package. These are unconscionable cuts to programs that serve as 
safety nets for the most vulnerable.
  I am also deeply troubled that almost one-third of the savings in the 
budget reconciliation bill come at the expense of the student loan 
program. I regret that a portion of the savings within the student loan 
program is achieved by increasing fees paid by student and parent 
borrowers. While I may support

[[Page 30702]]

provisions in this agreement that eliminate unnecessary subsidies for 
lenders, the money saved through this elimination should go toward 
making college more affordable and increase grant aid such as Pell 
Grants. I regret that this money is not funneled back towards increased 
aid for America's students.
  This agreement also increases the maximum subsidized loan amounts 
that first and second year students can borrow and increases the 
maximum amount of unsubsidized loans that graduate students can borrow. 
While increasing loan limits will help students cover the costs of 
their education, I find it disheartening that we as a Congress are 
pushing more of a financial burden on these students as tuition rates 
around the country increase. Rather than cutting money from the student 
loan program and requiring students to borrow more and pay more in 
fees, we should instead be working to find ways to make a college 
education affordable to all students.
  While I welcome the addition of some new grant aid for Pell-eligible 
students, I have heard concerns from my constituents in Wisconsin that 
the requirements accompanying the increased aid will make the program 
difficult to administer and could exclude many of the Pell-eligible 
students from receiving this aid. One requirement for freshman and 
sophomore Pell-eligible students to receive this aid is the condition 
that the student must have completed a ``rigorous secondary school 
program''. Under the agreement, the Secretary of Education determines 
whether or not the student has fulfilled that requirement. What is not 
clear, however, is how the Secretary will actually measure which 
programs are deemed rigorous and therefore which students will receive 
the aid. I am concerned that students who attend disadvantaged schools 
will not be eligible for the aid under the wording in this agreement.
  Another troubling aspect of the new grant aid is the requirement that 
students attend school full-time during their first year of college. 
This provision would eliminate many Pell-eligible students who attend 
school part-time and work part-time. Again, I think this sends the 
wrong message to our youth who are considering attending college and 
attempting to finance their education.
  We can do better for young Americans in Wisconsin and around the 
nation by working to increase aid in an inclusive manner and working to 
make a college education more affordable to all. These cuts to the 
student loan program are another reason that I will vote to oppose this 
conference agreement.
  If there is a silver lining to this sham of a budget reconciliation 
package, it is the conference committee's decision to retain the 
Senate's extension of the Milk Income Loss Contract, MILC, program and 
reject cuts to Food Stamps. Even this support for these two vital 
programs is tempered by short-sighted cuts to other agriculture 
programs such as the limits placed on conservation programs that assist 
farmers in their stewardship of the land.
  I will not support using reconciliation to enact harmful, 
controversial policies that will worsen budget deficits and increase 
the debt. No matter how many pieces you slice it into, the 
reconciliation instruction in the budget resolution will leave us with 
bigger deficits, not smaller ones.
  This budget sends the message that those living in poverty are 
Congress' lowest priority: and this reveals a profound lack of empathy 
and kindness for the most defenseless in our society. When Congress and 
the White House become serious about cleaning up the fiscal mess they 
created, and when they are willing to spread the burden of that clean 
up across all programs--defense and non-defense discretionary programs, 
entitlements, and the spending done through the Tax Code--I am ready to 
help. But so long as we see reconciliation measures that cut aid to 
those most vulnerable, and cuts to Government spending is done on the 
backs of the poor, I must oppose them.
  Mr. SPECTER. On a close call I have decided to vote for the 
conference report on the reconciliation bill because the benefits 
slightly outweigh the disadvantages in evaluating the tradeoffs.
  I start with the proposition that the savings of $40 billion over 5 
years in the conference report is closer to the $35 billion passed by 
the Senate than to the $50 billion cuts passed by the House of 
Representatives. This deficit reduction amounts to less than one-half 
of 1 percent of total Federal spending, an estimated $13.8 trillion 
over the next 5 years.
  Medicaid was a special concern where the conference report of a $4.8 
billion reduction was much closer to the Senate figure of $4.3 billion 
than to the House cut of $11 billion. While I would have preferred 
targeting different reductions, the conference report does give the 
States flexibility in the use of Medicaid funds so that the States will 
be in a position to ameliorate hardships resulting from the proposed 
reductions.
  It was important that the conference report included $1 billion in 
additional budget authority in fiscal year '07 for the Low Income Home 
Energy Assistance Program, LIHEAP, which the Congressional Budget 
Office estimates will result in $625 million in outlays as we approach 
the fiscal year 07 winter season which is likely to be very harsh. It 
is anticipated that there will be an additional $2 billion for fiscal 
year '06 added to LIHEAP in the Defense appropriations bill although 
that is not a certainty because the Senate will not act on that bill 
until after the vote on reconciliation.
  I am further encouraged by the elimination of some $700 million on 
cuts for the Food Stamp Program and the rejection of the House passed 
$5 billion reduction in child support enforcement to aid local 
governments which finally came in at a $1.5 billion cut.
  After visiting many first responders around the State, I was pleased 
to see the reconciliation bill add $1 billion for first responders who 
will be very important in any prospective emergency situation.
  I was also pleased to see the one year moratorium on inpatient 
rehabilitation hospital provisions which require 50 percent of Medicare 
beneficiaries to meet certain ailment criteria for 2 years.
  I was opposed to the repeal of the Continued Dumping and Subsidiary 
Offset Act, CDSOA, program but there was finally a compromise to give 
the program 2 more years.
  Of special significance to Pennsylvania was the addition of $998 
million for the Milk Income Loss Compensation, MILC, Program which is 
very important to the financial status of nearly 9,000 dairy farms in 
the State.
  In making judgments on legislation like the reconciliation bill, we 
are really faced with a Hobson's choice. None of the options is 
desirable. We are constantly choosing among the lesser of the evils.
  In the overall context of discretionary spending which is involved in 
the reconciliation bill and in the appropriations bill for Labor, 
Health and Human Services and Education, there are palpably 
insufficient funds available for such domestic programs. As chairman of 
the Subcommittee on Labor, Health and Human Services and Education, it 
was my responsibility to structure legislation that came within the 
allocations approved by the Budget Committee and Appropriations 
Committee.
  With a 1-percent cut at the outset and another projected one percent 
across the board cut and the failure to keep up with inflation, the 
subcommittee sustained a cut in real dollars approaching $7 billion. At 
the conference on the bill for the Departments of Labor, Health and 
Human Services, and Education, I said publicly that I would not support 
the bill unless my vote was indispensable for its passage. If the bill 
is not passed, we face the alternative of a continuing resolution which 
will be $3 billion less than the bill, so there is no alternative, as a 
matter of basic arithmetic, but to support the bill.
  I have already put my Senate colleagues on notice, including the 
leadership, that I will not support next year's budget unless there is 
adequate funding for domestic discretionary programs

[[Page 30703]]

with special emphasis on Labor, Health and Human Services, and 
Education. I will also work to correct any inequities or hardships 
which result from the reconciliation bill.
  Mr. WYDEN. Mr. President, I cannot support the devastating cuts to 
health care that are in the budget reconciliation conference report. I 
have fought to slow health care spending, but that is not what is in 
this conference report. This conference report slashes and burns the 
health care countryside like the barbarians descending on Rome. This 
conference report is not about reform or creating a decent health 
system for the poor and for seniors--it is about dismantling the system 
as we know it.
  For starters, the Senate-passed bill increased drug rebates so that 
Medicaid beneficiaries would get better prices on their drugs. The 
Senate bill increased the minimum rebates that drug manufacturers are 
required to pay the Medicaid Program for drugs. The Senate package also 
contained a provision that would have expanded the rebate to include 
managed care drug plans. None of these improvements, which would have 
produced savings of $10.5 billion over 10 years and have helped ensure 
Medicaid participants get better prescription drug prices, is included 
in the conference report.
  The conference report reopens the Medicare Modernization Act, MMA,--
not to make improvements in the drug benefit but to push those with a 
little more income to pay higher Part B premiums sooner. It seems to me 
that given the confusion, the unhappiness, the need for more and better 
counseling for seniors on their choices, and the need to assure cost 
containment in the Part D drug benefit, you should have gone farther 
than what is in the product before us and made real improvements. One 
improvement that won a majority of 51 votes on the Senate floor was an 
amendment I offered with Senator Snowe to allow Medicare to use its 
purchasing power to benefit seniors. Giving Medicare that power would 
have produced a real benefit for seniors, but that is not included 
here. ``
  The home health cuts in this conference report will hurt a service 
that is vital to seniors. The conference report freezes home health 
payments for a year. Home health care has been demonstrated to be cost 
effective alternative to institutional care in both the Medicare and 
Medicaid Programs. In Oregon, what is proposed here will compound the 
negative impact of other cuts. Since 1997, when Congress first enacted 
cuts in home health, Oregon has lost 30 home health agencies. Oregon's 
home health agencies' profit margins are already at a negative 21.75 
percent, and 33 of 60 home health agencies are in rural areas. I fear 
what will happen to Oregon's seniors when home health agencies' 
payments are frozen, but their costs keep going up.
  The conference report increases copayments and premiums for the poor. 
I happen to believe that everyone should pay something on the spot for 
care unless they destitute, but the increases required here will force 
people who can get care today to for go care tomorrow. Oregon has 
learned from experience in this area. When Oregon instituted strict 
copayment and premium payment policies 55,000 people dropped off 
Medicaid, and most of those were people with chronic health problems, 
like high blood pressure and diabetes. The reconciliation bill says 
States can increase substantially the copayments that many Medicaid 
beneficiaries are required to pay to access health services and 
medications. Sure, there will be savings, but they will be achieved 
because people just won't get care or just won't seek care. That is 
not, in my view, good public health policy, and completely undermines 
the purpose of Medicaid.
  The conference report makes it harder for people to qualify for 
Medicaid long-term care. The conference report embraces the House 
provisions that restrict eligibility for Medicaid long-term care 
services and squeeze more savings out of those who need Medicaid. These 
provisions are far more onerous than the Senate passed bill, casting a 
wide net that will force every applicant to prove they had not 
transferred assets years before a disabling accident, stroke, heart 
attack, broken hip, or diagnosis of Alzheimer's disease simply in order 
to catch a few who intentionally transfer assets. These provisions even 
go after to middle-class Americans who make modest gifts to relatives 
like their grandchildren or who contribute to charity. How can anyone 
expect the average American who experiences a decline in their health 
years after having made a contribution to charity or given their 
grandchild some money toward a college fund to keep records on all of 
this? People won't be able to document many of the things they will be 
required to so that families or nursing homes will end up eating the 
money during the period in which their loved ones are not qualified.
  Lastly, the conference report negates a court decision concerning 
disproportionate share payments. One of the lawsuits brought on this 
issue was brought by a number of Oregon hospitals. The result of 
orturning the decision in this case is that many hospitals will be 
harmed because those people who are part section 1115 waivers as an 
``expansion population'' would no longer be counted for the purposes of 
calculating Medicare disproportionate share payments. This harms safety 
net hospitals.
  There are many other reasons to reject this conference report, but 
the truly harmful health care provisions stand out starkly among a sea 
of damaging provisions. These, alone, are reason enough to reject this 
budget document.
  Mr. CORZINE. Mr. President, I rise today to pay tribute to the 2\1/2\ 
million grandparents acting as primary caregivers to their 
grandchildren. The situation may occur as a result of a death in the 
family, a parent being away in the military, or the effect of abuse and 
neglect.
  I commend grandparents and other relatives who step forward to care 
for these children, often at great personal sacrifice, providing an 
alternative to foster care and giving them a safe, stable home. 
Supportive programs like subsidized guardianship help children exit 
foster care into the permanent care of caring and nurturing relatives.
  In my State of New Jersey, 8 percent of the children live with 
nonparent relatives. Grandparents and other relative caregivers are 
often the best chance for a loving and stable childhood for the 
children in their care, but their hard work and dedication often go 
unnoticed.
  I am deeply saddened that today the Senate made cuts in the budget 
that would deprive so many kinship caregivers of critical Federal 
support. We should be expanding support for these caregivers, not 
reducing it.
  Mr. President, today I offer my formal acknowledgement and deepest 
appreciation for the ongoing service of these caregivers to our country 
and our Nation's most valuable asset, our children. I commend 
Generations United for their hard work in helping improve the lives of 
our children.
  Mr. LEAHY. Mr. President, it has been said that a great test of 
morality is what people do when they have power. The fast-track budget 
reconciliation rules mean that the majority party can essentially do 
whatever it wants in a reconciliation bill if they act in lockstep. The 
reason is simple. Reconciliation debates in the Senate can only last 20 
hours and the final version of the bill--a reconciliation conference 
report--only can be debated for 10 hours.
  The majority party can even orchestrate a single meeting with 
conferees and immediately gavel it over almost when it starts, doing 
everything behind the scenes with no consultation and without sharing 
drafts of even sweeping policy changes in proposed major laws.
  They not only can do such things, they just did them.
  But let me start at the beginning. The President's budget proposal 
for programs under the oversight of the Judiciary Committee, issued in 
February of this year, called for a user fee on the manufacture and 
importation of gunpowder and other explosives of two cents per pound. 
The President requested that Congress enact these user fees--some 
called it a tax--to raise $600

[[Page 30704]]

million over the next five years. Because of that White House proposal 
on gunpowder and other explosives, the budget resolution of the other 
body called for the Judiciary Committee to meet a target of $600 
million.
  The Senate-passed budget resolution did not require any cuts to be 
made by the Judiciary Committee. This is the usual approach for the 
Judiciary Committee since the Committee controls few, yet very 
important, mandatory spending programs. For example, it is difficult to 
make significant reductions to mandatory programs, including: pensions 
for U.S. Judges; the Crime Victim's Trust Fund; salaries of U.S. 
Marshals; the Radiation Exposure Compensation Trust Fund; the Copyright 
Owners' Fund; the diversion control fee account of the Drug Enforcement 
Agency; border patrol salaries and expenses; the assets forfeiture fund 
for U.S. Marshals, and other sources. It is also difficult to increase 
Patent and Trademark Office fees or Copyright Office fees since there 
is not a compelling reason to do so.
  In the end, in order to comply with the budget resolution, the 
Judiciary Committee of the Senate and the Judiciary Committee of the 
other body were required to come up with $300 million in revenue or to 
make $300 million in cuts.
  The first casualty in this process was the White House proposal to 
tax gunpowder and other explosives. There was little support by the 
majority party for even making half the President's proposed increases 
in the gunpowder tax. Many other alternatives were considered by the 
majority party.
  Finally, a proposal was worked out in the Judiciary Committee that 
had my support, and the strong support of universities and many 
business leaders. For example, the National Association of State 
Universities and Land-Grant Colleges, Motorola, Oracle, Sun 
Microsystems, Texas Instruments, Intel, Microsoft, Hewlett-Packard, 
Qualcomm, for high-tech workers. The House also included immigration 
fees in their proposal.
  However, after an aborted conference meeting which started at 9 p.m. 
last Friday night, and ended a few minutes later, what has the Majority 
party proposed as a compromise on the immigration fees? They came up 
with increasing fees on all citizens to get into federal courts and 
into bankruptcy court. The bankruptcy fee increase raises some ironies. 
The increase in fees for citizens trying to seek judicial relief 
narrows access to courts.
  So we have gone from the President's proposal to tax gunpowder and 
other explosives and mysteriously ended up with a tax on citizens to 
get into federal court and bankruptcy court. Nevertheless, the majority 
party--as long as they are in lockstep together--has nearly absolute 
power in a reconciliation bill that enjoys only limited debate. History 
will record what they have done with that power.
  What is especially unfortunate is that the version of the 
reconciliation bill reported out by the Senate Judiciary Committee, and 
approved by the full Senate by unanimous consent to the Budget 
Reconciliation Act, was a bipartisan amendment offered by Senator 
Specter and myself to allocate the extra $278,000,000 in revenue 
provided from the Judiciary Committee markup on reconciliation to 
supplement funding that is demonstrably needed for the Bulletproof Vest 
Partnership Fund, programs authorized by the Justice For All Act, and a 
Copyright Royalty Judges Program.
  The Judiciary Committee markup on its reconciliation title provided 
$278,000,000 more in revenue than was mandated by the Budget Resolution 
instructions.
  The Specter-Leahy Senate proposal approved by the full Senate--would 
have provided $60,000,000 over the next five years for such initiatives 
as the Bulletproof Vest Partnership Program, to help law enforcement 
agencies purchase or replace body armor for their rank-and-file 
officers.
  Recently, concerns over body armor safety surfaced when a 
Pennsylvania police officer was shot and critically wounded through his 
new vest outfitted with a material called Zylon, which is a registered 
trademark. The Justice Department has since announced that Zylon fails 
to provide the intended level of ballistic resistance.
  Unfortunately, an estimated 200,000 vests outfitted with that 
material have been purchased--many with Bulletproof Vest Partnership 
funds--and now must be replaced. Law enforcement agencies nationwide 
are struggling to find the funds necessary to replace defective vests 
with ones that will actually stop bullets and save lives. Our Senate 
Judiciary provisions would have funded those efforts. Unfortunately, 
the majority party dropped this language.
  Our Senate Judiciary language--approved by the full Senate--also 
provided more than $216,000,000 for programs authorized by the Justice 
For All Act of 2004, a landmark law that enhances protections for 
victims of Federal crimes, increases Federal resources available to 
State and local governments to combat crimes with DNA technology, and 
provides safeguards to prevent wrongful convictions and executions.
  The Senate Judiciary Committee language also would have funded 
training of criminal justice and medical personnel in the use of DNA 
evidence, including evidence for post-conviction DNA testing. It would 
have promoted the use of DNA technology to identify missing persons. 
With these funds, State and local authorities would have been better 
able to implement and enforce crime victims' rights laws, including 
Federal victim and witness assistance programs.
  State and local governments would have been able to apply for grants 
to develop and implement victim notification systems to share 
information on criminal proceedings in a timely and efficient manner. 
That language would have helped improve the quality of legal 
representation provided to both indigent defendants and the public in 
State capital cases.
  Last, but certainly not least, our amendment provided $6,500,000 over 
five years for the Copyright Royalty Judges Program at the Library of 
Congress. The Copyright Royalty Distribution Reform Act of 2004 created 
a new program in the Library to replace most of the current statutory 
responsibilities of the Copyright Arbitration Royalty Panels program. 
The Copyright Royalty Judges Program was supposed to determine 
distributions of royalties that are disputed and set or adjust royalty 
rates, terms and conditions, with the exception of satellite carriers' 
compulsory licenses. The Senate-passed language would have helped pay 
the salaries and related expenses of the three royalty judges and three 
administrative staff required by law to support this program.
  Unfortunately, instead of raising more funds than we needed through 
widely supported increases in immigration fees and using them for these 
law-enforcement and other programs we are instead going to increase the 
cost of access to federal courts and not fund any of these other 
priorities.
  What may be the most troubling aspect of this abuse of power is that 
by substantially increasing fees to get into federal courts the 
majority party raised $253 million more in revenue than it needed to 
meet the reconciliation target. That means that all the above 
priorities in the Senate-passed bill including bulletproof vests for 
law enforcement, use of DNA technology to identify missing persons, and 
better enforcement of crime victims' rights laws could have been 
included at only slightly reduced levels of support.
  The Republican Congress has missed a great opportunity in this abuse 
of power.
  Mr. LEAHY. Mr. President, I also must express my opposition to the 
irresponsible domestic budget policy that has been forwarded by the 
majority party. The Senate is being asked to approve spending and 
budget bills that make deep cuts to programs that serve some of our 
country's neediest citizens. A time of year typically signified by 
wishes of goodwill towards all, it is difficult to be anything but 
outraged by this attack on critical components of our social safety 
net.
  While many in the majority party have claimed that these bills are 
needed in order to reduce the deficit, with

[[Page 30705]]

the knowledge that the leadership will make passing massive tax cuts 
benefiting some of the wealthiest among us a priority during the next 
session, this argument is simply disingenuous.
  Instead of putting the country on the road to fiscal security, these 
bills expose the agenda of the majority that blatantly undermines 
American families and make clear where the priorities of the majority 
party lie. It is not with the family that relies on Medicaid for their 
health insurance, the student who, without student aid, cannot afford 
to attend college, or the mother who needs childcare so that she can go 
to work and put food on the table for her family. Nor is it with the 
single mother who has been abandoned without child support, the 
grandparent raising their grandchild on a fixed income, or the worker 
who has lost his or her job and is trying to be retrained.
  No, the priorities of this majority party consistently lie with the 
powerful special interests and big drug companies. At every opportunity 
the Republican leadership has had to choose between supporting the 
American people or wealthy corporate interests, and they have sided 
with the corporate interests. Even by the standards of this first 
session of the 109th Congress, with the consistent erosion of consumer 
protections and support for American working families, these bills sink 
to new lows. As a result, dozens of health, education, labor, and human 
services programs will be cut and millions of people who rely on these 
programs will suffer.
  Some of the most egregious policies in these bills expose the 
disparity between the treatment of big drug companies and those 
individuals who must rely on Medicaid as their primary form of health 
care. With numerous options on the table, the Republican leadership 
chose to use the budget reconciliation bill to increase Medicaid co-
payments and premiums, potentially eliminated federal standards for 
comprehensive Medicaid care, and created highly restrictive rules 
governing the transfer of assets for those who require care in a 
nursing home. Rather than do away with an unnecessary multi-billion 
dollar slush fund for insurers and drug companies, a small group of 
Congressional budget writers has chosen to freeze home health payments 
that ensure seniors are able to receive care in the comfort of their 
own homes.
  In addition, this year's Labor, Health and Human Services, Labor-HHS, 
appropriations bill shortchanges our country's rural health programs. 
For instance, the bill eliminates five programs, including funding for 
Rural EMS and Health Education Training Centers, which are critical to 
the fragile network of the rural health care infrastructure.
  One of the most disappointing aspects of the Labor-HHS Bill was the 
treatment of the National Institutes of Health, NIH. Not since 1970 has 
the NIH been provided an increase as small as the one contained in this 
bill. As a result, the vital medical research being done around the 
country, including in my home state at the University of Vermont, will 
suffer. The search for cures to innumerable diseases will be slowed and 
foreign competitors will be given a chance to exploit our short-
sightedness.
  Not only will this Congress take the step of cutting education for 
the first time in ten years, these will be the biggest cuts in history 
to student loan programs. A remarkable $12.7 billion will be cut from 
student aid programs so that there will be no increase to the Pell 
Grant for an astonishing fourth year in a row. While making changes to 
eliminate loopholes in student loan lending laws, it appears that small 
lenders that specialize in providing comprehensive loan counseling to 
students have been given short-shrift. It appears that from almost 
every angle, students are assaulted by these policies.
  For those education programs that are lucky enough to escape the 
knife, they will either be frozen or given minimal increases. I am 
curious to know how our Nation's schools can be expected to meet and 
exceed the standards set forth in the No Child Left Behind Act, when 
Congress is content to slash funding by three percent, leaving these 
programs to sink more than $13 billion below their authorized levels. 
It has been almost 5 years since Congress passed this legislation, and 
we have consistently failed to meet our commitment to students, parents 
and teachers.
  In what is becoming a hallmark of this Republican leadership, these 
conference reports are loaded down with controversial legislation 
approved by neither body. Despite bipartisan support for legislation 
approved by the Senate Finance Committee earlier this year, Senators 
are being asked to approve a five-year reauthorization of the Temporary 
Assistance to Needy Families Program that would impose strict new 
working requirements with only nominal new funding for child care 
support. At the same time Congress asks single mothers to work longer 
hours, it cuts money for child support enforcement, dollars that are 
used to track down deadbeat dads.
  Though it is a sad commentary on the current state of affairs when 
one of the lone bright spots for health and human service programs is 
that this bill includes no cuts to the Food Stamp program, I would be 
remiss if I did not mention my appreciation that this program remained 
unscathed. While protecting Food Stamps should be hailed as a victory, 
the Community Food and Nutrition Program, a modestly sized program that 
helps support anti-hunger advocacy groups, was not so fortunate. The 
work being done on the local levels by these groups is extremely 
important, and it is my hope that these funds will be restored next 
year.
  The programs and services I have mentioned are but a few of the 
dozens of cuts that will negatively impact families across the country. 
As we usher out the final days of 2005 and the 1st Session of the 109th 
Congress, I am saddened that the last actions of this body will be to 
pass such harmful bills. After more than 30 years in the Senate, I know 
that we can do better and it is my sincere hope that when we return 
next year, we will reverse the wayward direction set by such policies 
and implemented by such legislation.
  Mr. DODD. Mr. President, for most Americans, the holiday season is a 
time for giving. But for the Congress, it seems, the holiday season is 
also a time for taking, at least judging by the budget reconciliation 
legislation before this body.
  Americans around the country, are concerned about their economic 
security. Whether they work in a factory or behind a desk, they are 
feeling increasingly vulnerable to the volatilities of the global 
economy. While American families are concerned about economic security, 
this budget reconciliation legislation would cut the safety net that 
protects them. The burden would fall most heavily on working Americans, 
in particular, on low-income parents and children, the elderly, and 
people with disabilities. Moreover, while supporters of this bill cite 
fiscal discipline as the rationale for making harmful cuts, when this 
bill is considered in combination with its companion tax reconciliation 
legislation, the total package would increase the deficit rather than 
reduce it. For these reasons I cannot support this funding cut 
reconciliation bill.
  I have been a strong proponent of fiscal responsibility throughout my 
service in this body. I have introduced and supported pay-as-you go 
budget rules; supported the landmark Gramm-Rudman-Hollings budget 
process reforms; and, during the 1990's, voted to balance the budget 
for the first time in 30 years. This budget reconciliation legislation, 
does not advance the cause of fiscal responsibility. Every penny saved 
in funding cuts and then some will be spent on new tax breaks, most of 
which will benefit a small number of affluent individuals who neither 
need nor seek such reckless largesse from their leaders in Washington. 
The Senate has already approved $60 billion worth of tax cuts over the 
next 5 years, and the House has approved more than $90 billion.
  Under the Bush administration, our National debt has grown from $5.7 
trillion to more than $8 trillion. The portion of that debt held by 
foreign creditors has more than doubled. And our

[[Page 30706]]

Federal budget has fallen from a $236 billion surplus in 2000 to a $319 
billion deficit in 2005. The Republican budget reconciliation package 
would only make this record of fiscal recklessness worse.
  The cuts in this bill, if enacted, would make it harder for working 
Americans to find a job and afford such basic needs as health care and 
child care. At a time when international competition demands that we 
invest in our people and our society, this bill radically scales back 
our Nation's crucial commitments. At a time when we should be expanding 
access to higher education for all Americans, this bill puts college 
further out of reach for many students. And at a time when many 
businesses and millions of Americans cannot afford even the most basic 
health care coverage, this bill passes the buck, and the burden of 
paying, onto those who are already struggling to afford care. Instead 
of offering solutions, this bill offers more lip service to a failed, 
partisan ideological agenda that weakens our Nation's long-term 
strength.
  Perhaps most controversially, the bill before us would make the 
biggest changes to Temporary Assistance to Needy Families, TANF, policy 
since 1996, going even beyond the provisions in the House-passed 
reconciliation bill. The Republican majority hopes to ram through these 
changes without any debate or consideration by this body. This is no 
way to run a country by not just ignoring those in the minority, but 
actively trampling over dissenting views.
  Children in low-income families will suffer the most. This section of 
the bill creates new, unrealistic work requirements for TANF recipients 
that would effectively amount to a backdoor way of cutting funds. It 
authorizes $2.5 billion less this year for child care than what is 
necessary to keep pace with inflation, which, over the next 10 years, 
will create a more than $11 billion shortfall and cause an estimated 
255,000 children to lose care. It cuts child support enforcement, which 
will reduce child support collections by $8.4 billion over 10 years. 
And it completely eliminates Federal foster care support for 
grandparents and other relatives who care for children who have been 
abused or neglected and removed from their parents.
  These cuts reflect a fundamental lack of understanding by the 
Republican majority of the struggles most Americans face every day. 
Moreover, they are based upon a faulty economic rationale. Though our 
overall economy grew somewhat between 2000 and 2004, those who 
benefited from that growth are mostly at the top of the income pyramid. 
Indeed, the number of children living below one-half of the poverty 
line rose by nearly 1.5 million. Somewhere, the link has been broken, 
and not all families are sharing in our Nation's economic growth. 
Instead of looking for solutions, the cuts in this bill would 
exacerbate the problems faced with courage every day by American 
families. If history is any guide, the families forced off of TANF 
would be those who, without a lifeline, are the most likely to fall 
into deep poverty. Child care assistance helps working parents keep 
their jobs and parents who have lost their jobs find new ones. If 
adequate child care and other supports are not available to low-income 
workers, the TANF rolls will increase again. We would be taking a step 
backward in helping people move from welfare to work. We should be 
constantly innovating and strengthening our policies in this area, not 
blindly cutting them in favor of unaffordable tax policies, as this 
reconciliation package would do.
  In addition, this reconciliation bill would also reduce health care 
coverage and increase costs for some of the most vulnerable members of 
our society. Most troublingly, this conference agreement proposes to 
increase co-payments and premiums for Americans who rely on Medicaid 
for their health care. Under this agreement, low-income Medicaid 
beneficiaries would be forced to pay more for their needed health care 
services and medicines. This, despite the fact that a recognized and 
growing body of evidence demonstrates that ill Medicaid beneficiaries 
will likely forego medical treatment in the face of increases in co-
payments. Such decisions often lead to greater health problems, and 
larger health care costs, later on. On top of these co-payment 
increases, this package will additionally allow States to increase the 
premiums that Medicaid beneficiaries must pay to enroll in the program 
in the first place.
  Also deeply troubling about this agreement is its granting to States 
the ability to decrease the scope of their Medicaid programs. The 
Federal Government currently requires State Medicaid programs to adhere 
to a set of standards that ensure comprehensive health care coverage 
for Medicaid beneficiaries. This agreement will significantly lower 
these standards and will allow States to lessen needed coverage for 
those most in need.
  As alarming as these provisions are, just as galling is what this 
bill lacks. The Senate-passed reconciliation package rightly contained 
two significant and cost-saving provisions that are absent from the 
package currently before us. First, the Senate bill sought to increase 
the rebates that pharmaceutical manufacturers must pay the Federal 
Government for medicines provided to Medicaid beneficiaries. Second, 
the same bill achieved $10 billion in savings by eliminating the so-
called ``stabilization'' fund designed to encourage preferred provider 
organizations to participate in the Medicare program. Both of these 
valuable provisions have gone missing in this conference agreement.
  Finally, in addition to weakening the safety net that allows 
Americans to weather tough times, this budget reconciliation 
legislation also shortchanges the millions of families trying to send 
their children to college. It provides no general increase in need-
based aid. Instead, it limits the increase to a narrowly defined subset 
of students who may or may not demonstrate as much need as their peers. 
In fact, there are so many restrictions on who qualifies for the 
increased Pell funds that I question how many students will actually 
receive it.
  This version of reconciliation also ignores a number of other 
provisions that were important to the Senate: loan forgiveness for 
child care workers, protections as we open up distance learning, and 
more consumer information for students that are consolidating loans. 
All of these provisions have disappeared. Instead we are left with a 
narrowly crafted bill that does not help all students achieve their 
college dreams. In my opinion, this bill represents a lost opportunity 
for students and a lost opportunity for this body to assist them.
  The conference agreement before us today ignores the values and 
concerns of ordinary Americans. Instead of investing our resources 
intelligently in the priorities that will make America strong and 
secure into the future like education, health care and the fight 
against terrorism it weakens important safety net provisions, decreases 
health care coverage and increases cost burdens, and reduces access to 
higher education. America needs priorities that reflect our values as a 
country and that prepare our people, especially our children, for a 
future of freedom, prosperity and security. Regrettably, this 
reconciliation legislation falls far short.
  Ms. MIKULSKI. Mr. President, the spending cut bill before us is 
shameful. I have always said that it is my job to look out for the day-
to-day needs of Marylanders and the long-term needs of the Nation. I am 
sorry to say this bill does neither. In the holiday season, this bill 
makes draconian spending cuts in critically important programs. This is 
not done for balancing the budget, which I support. It is done to pay 
for more tax cuts to the superwealthy.
  These spending cuts don't only hurt hard-working Americans. They chip 
away at the very foundation of the American dream and do so at the 
worst possible time. For example, we face unprecedented challenges from 
increased global competition. Our country has always had the ability to 
rise above these challenges because of America's incredible capacity to 
innovate. It is our responsibility to empower Americans to innovate. 
Unfortunately, this

[[Page 30707]]

bill represents the wrong priorities for this country, not those held 
by the vast majority of Americans.
  Nowhere do individual and national priorities more closely converge 
than funding for education. Education has always been our country's 
greatest engine for climbing the ladder of opportunity. It is also the 
greatest engine for our national aspiration: that each generation will 
have a better life than the one that came before. International trade 
and outsourcing have already shuttered several of our industries and 
threaten to do the same to others. Other countries are investing 
heavily to train and educate their people. They are manufacturing 
products less expensively than could be done here at home, often due to 
their weak labor and environmental protections. That is why we must 
preserve America's remarkable lead in the amazing race to innovate. To 
do this, we must realize that innovation starts with a well-educated 
population.
  Unfortunately, this bill makes the biggest cuts to student loan 
programs in history. For the fourth year in a row, the maximum Pell 
grant will remain the same. And while Pell grants stagnate, interest 
rates for student loans will increase. Republicans have also made it 
more difficult for students to consolidate their loans so that they 
will end up paying more for college. So not only is there less student 
aid available but this bill actually makes it tougher to qualify for 
need-based aid so that it will only go to a small group of students, 
decreasing the number of low-income people who are eligible to receive 
aid. It also gives private lenders and banks an unfair advantage over 
more cost efficient Federal loan programs, which increases costs for 
taxpayers.
  These cuts couldn't come at a worse time. College tuition is on the 
rise and financial aid isn't keeping up. Pell grants cover only 40 
percent of average costs at a 4-year public college. Twenty years ago, 
they covered 80 percent. Our students are graduating with so much debt 
it is like their first mortgage. College is part of the American dream; 
it shouldn't be part of the American financial nightmare. Families are 
looking for help. And I am sad to say the Republicans don't offer them 
much hope. This bill has all the wrong priorities. Instead of easing 
the burden on middle-class families and increasing student aid for all 
students, they want to help out big business cronies with lavish tax 
breaks.
  We need to do more to help middle-class families afford college. We 
need to increase the maximum Pell grant to $4,500 and double it over 
the next 6 years. We need to make sure student loans are affordable. 
And we need a bigger tuition tax credit for the families in the middle 
who aren't eligible for Pell grants but still can't afford college.
  My family believed in the American dream. They believed there is no 
barrier to having hopes. Through hard work and sacrifice, everyone 
should be able to pursue a higher education. But belief in the American 
dream is shrinking. There is not a dream deficit, there is a wallet 
deficit. There is not a talent deficit, there is an opportunity 
deficit. And at a time when the opportunity ladder is already creaky 
and shaky, the Republicans are trying to tear down this ladder by 
making massive cuts to student aid. Sadly, this will cripple our 
Nation's ability to innovate and compete in the global market.
  Those aren't the only bad things in this bill. It also slashes health 
care. I believe that every American should have the right to affordable 
health care, especially as they get old and need it the most. 
Unfortunately, this conference report cuts a net $6.9 billion in 
existing Medicaid spending. This will force beneficiaries to pay higher 
premiums and receive less health care coverage.
  I am particularly alarmed by the bill's changes to eligibility for 
long-term care coverage for elderly Americans needing care. This bill 
would require the government to look back at a senior's assets for the 
past 5 years and consider the value of their home to be eligible for 
long-term care. This is unfair. We should be supporting our elders, not 
punishing them.
  And that is not all. As temperatures drop and heating prices rise, 
this bill will literally leave Marylanders and Americans in the cold. 
Oil companies are now making record profits. Republicans beat back each 
of our attempts to eliminate tax giveaways to these same companies. Now 
energy prices are soaring and the bill falls $1.3 billion short in 
funding the Low-Income Home Energy Assistance Program. LIHEAP helps 
hard-working Americans afford to stay warm. But it won't have enough 
funds to do this next year.
  The reconciliation bill also suspends important Federal housing 
programs that preserve affordable housing. Republicans are prioritizing 
additional tax cuts for the superwealthy by killing a program to 
preserve affordable housing for working families. They too will be left 
out in the cold. The Millennium Housing Commission cited a lack of 
affordable housing as the primary cause of homelessness. So here again, 
the spending cut bill serves to squash our aspirations.
  When many of our families first moved to the United States, they were 
drawn to the promise of a better life--the ``American dream.'' They 
could aspire to a better life for themselves, their families, and their 
kids. They knew that hard work could make that dream a reality. For 
many generations, this country allowed each generation to be better off 
than the one before it. If we follow the course laid out before us 
today, our children are not going to be able to say the same thing.
  Mr. President, America can do better. We must look out for both the 
day-to-day needs of those who have elected us and also the Nation's 
long-term interests. This bill does neither. I strongly oppose this 
bill and urge my colleagues to do the same.
  Mr. KENNEDY. Mr. President, as we all know, the Budget Reconciliation 
Act contains an appalling number of devastating cuts that will hurt 
millions of Americans. But I do commend the conferees for including the 
Family Opportunity Act, which will remove the barriers in current law 
that penalize families struggling to stay together and make ends meet 
when their children have high health costs because of disabilities.
  For the past 6 years, Senator Grassley and I have worked with many 
parents and leaders in communities across the country to reach this 
milestone. Countless parents, family members, citizens, friends, 
neighbors, and colleagues face this problem today. As they make very 
clear, the Nation is failing families with severely disabled children 
by not giving them access to the health care they need to stay home and 
live in their communities. Many of them have been on the front lines in 
raising the Nation's awareness of their plight, and they have been 
fearless and tireless warriors for justice, and this legislation could 
not have happened without them. Today, their long wait is nearly over.
  The Family Opportunity Act is for them. It allows families of 
children with severe disabilities to purchase health care coverage 
under Medicaid, without first having to impoverish themselves or give 
up custody of their disabled children.
  Almost 1 in 10 children in America has significant disabilities. But 
many do not have access to even the most basic health care they need, 
because their private health insurance won't cover them. Often, their 
needs are treated as ``exclusions'' in their policies--no coverage for 
hearing aids, for services related to mental retardation, for physical 
therapy, for services at school, and on and on.
  That is why this legislation is so important--these children will now 
have access to these needed services and have a genuine opportunity at 
least to achieve full potential.
  When we think of disabled children, we tend to think of them as 
disabled from birth. But fewer than 10 percent of such children are 
born with their disabilities. A bicycle accident or a serious fall or 
illness can suddenly disable even the healthiest of children. Many of 
them with significant disabilities do not have access to even the most 
basic health services, because their families can't afford them.
  No longer will these families be forced to become poor, stay poor, or

[[Page 30708]]

even do the unthinkable by putting their children in institutions or 
giving up custody of them, so that their children can qualify for 
Medicaid.
  Families of special needs children often have to turn down jobs, turn 
down raises, or turn down overtime pay to keep a child eligible for 
benefits under Medicaid.
  No longer will parents be forced to give up their children or give up 
being part of our Nation's economy.
  This bill will change the life of 13-year-old Alice in Oklahoma, who 
was disabled because of multiple dystrophy. Under this bill, she will 
be able to have a personal assistant living at home with her family. 
She will be able to go to her neighborhood school.
  This bill will change the life of Johnny in Indiana, who has a severe 
mental illness and needs numerous mental health therapies and drugs. 
His mother will no longer be forced to give up custody of him in order 
to obtain the treatment he needs. Her goal of being a productive 
citizen and keeping her son at home will no longer be denied because 
her son will now have the health care and support he needs.
  This bill will transform the life of Abby in Massachusetts, who is 6 
years old and has multiple disabilities. Her parents are deeply 
concerned about her future if the existing buy-in State program for 
Medicaid is weakened. Without the buy-in, her parents would be 
bankrupted by her current medical bills. Now Abby and her family will 
have real opportunity to grow and work and prosper.
  The legislation also gives States greater flexibility to enable 
children with mental health disabilities to obtain the health care they 
need in order to live at home and in their communities, instead of 
being placed in institutions.
  It establishes Family to Family Information Centers in each State to 
help parents find the resources they need to meet the unique health 
care requests of their disabled children.
  Six years ago this week, President Clinton signed the Ticket to Work 
Act into law. That legislation demonstrates our commitment to give 
adults with disabilities the right to lead independent and productive 
lives, without giving up their health care.
  Today we make the same commitment to children with disabilities and 
their families.
  These provisions will undoubtedly be among the most important bills 
passed by this Senate. It closes the health care gap for the Nation's 
most vulnerable population, and enables families of disabled children 
to be equal participants in the American dream. It will truly change 
lives, and I commend my colleagues in both the House and the Senate on 
both sides of the aisle for their dedicated and their leadership that 
have made this day possible at long last.
  Mr. ROCKEFELLER. Mr. President, last week I came before this body to 
highlight the potentially harmful effects of budget reconciliation on 
our Nation's working families. I asked my colleagues to hold firm 
against the special interests in order to protect the Federal guarantee 
of Medicaid benefits for the 50 million Americans who depend on this 
vital program for health care. When the Medicaid motion to instruct 
conferees passed by a vote of 75 to 16, I thought the Senate was 
serious about preserving access to health coverage for children, 
pregnant women, the elderly, and disabled across our country.
  However, my hope quickly faded when the budget reconciliation 
conference report was released earlier this week. Instead of providing 
more assistance to families in need, the reconciliation conference 
report includes even greater cuts than those passed in the House of 
Representatives to vital safety net programs like Medicaid.
  Under this conference bill, the early and periodic screening, 
diagnostic, and treatment, EPSDT, benefit, which provides children with 
access to necessary immunizations, checkups, and preventive services, 
is eliminated. This means that low-income children--no matter how 
poor--will no longer be guaranteed vision, hearing and dental 
screenings; coverage for eyeglasses; therapy services, medical 
equipment that will allow them to attend school; or any other Medicaid 
services. Without access to this comprehensive benefit, many children 
will not get the vital medical care they need and will develop medical 
conditions that could have been prevented.
  The reconciliation language also begins to erode Federal laws 
protecting Medicaid recipients from burdensome cost-sharing. Under this 
bill, States would be allowed to index nominal cost sharing amounts by 
medical inflation, which grows at least twice as fast as wages. States 
would also be allowed to charge co-insurance up to four times higher 
than the 5 percent co-insurance allowed today. This means that Medicaid 
beneficiaries could pay as much as 20 percent of the cost of any 
Medicaid service--which for some would consume their entire monthly 
income. Such cost-sharing requirements are unacceptable for a safety-
net program designed to help working families when times get tough.
  This bill gives States the green light to vary benefit packages based 
on factors such as geography and disease. If enacted, Medicaid 
recipients will no longer have equal protection under the law. Instead, 
residents in rural areas of a State could receive fewer Medicaid 
benefits than those living in more populated, urban areas. Individuals 
with diseases that are expensive to treat may receive a narrower set of 
benefits than those with diseases that are less expensive to treat. 
And, if residents and diseases are treated differently in a State, then 
providers can also be reimbursed differently depending on their 
geographic location and the types of patients they treat. Such a 
haphazard benefit system will lead to more emergency room visits by 
beneficiaries and decreased provider participation in the Medicaid 
program. It would appear that, for some of my colleagues on the other 
side of the aisle, the vote in favor of the motion to instruct 
conferees was nothing more than a procedural motion--more rhetoric than 
substance, more posturing than true concern--because many of the 
Medicaid provisions included in the budget reconciliation package got 
even worse after the Senate voted overwhelmingly in opposition to 
increased beneficiary cost-sharing, barriers to eligibility and 
enrollment, and any other provisions that would undermine the Federal 
guarantee of Medicaid coverage.
  In all my time in the Senate, I cannot remember a time when we have 
considered such drastic cuts to safety-net programs that threaten to 
devastate working families. These are families who struggle to eat and 
pay their bills, let alone pay for much needed health care services; 
families of limited means who have done their best to contribute to a 
system that is now essentially turning its back on them. The cuts 
contained in this budget reconciliation conference report are 
reprehensible.
  This country has a moral obligation to help our fellow Americans in 
their time of need. We should not offer billions of dollars in 
additional giveaways to the wealthiest Americans and special interests 
at the expense of working families already struggling to make ends 
meet.
  I believe we can do better. Hard-working Americans deserve better; 
low-income children deserve better; the elderly, the disabled and 
parents who want to see their children go to college and succeed 
deserve better. We have a responsibility, Mr. President, and I would 
hope we would live up to that responsibility.
  Mr. VITTER. Mr. President, I am pleased that we have passed the 
Deficit Reduction Act today. It is a good first step to curbing run 
away spending in our entitlement programs, and it provides essential 
Medicaid relief to hurricane victims in my state.
  However, I am deeply concerned with the provision in the bill that 
repeals the Continued Dumping and Subsidy Offset Act, also known as the 
Byrd amendment. Many of my colleague and I signed a letter to the 
conferees urging that this repeal be excluded from the final bill. This 
important law helps counter unfair trade practices of other

[[Page 30709]]

countries by using revenues from duties collected to compensate injured 
industries. In Louisiana, most of our seafood industries have been 
severely affected by illegal dumping from China and other nations, and 
the Byrd amendment is one of the few things that could effective help 
the families in these industries, who are now also reeling from 
Hurricanes Katrina and Rita, to survive in their business and maintain 
our unique culture and way of life.
  I have been very frustrated with the Commerce Department and the 
Customs Department efforts to comply with the Byrd amendment as it 
stands now. Commerce does not properly set the duty collection rates, 
and Customs is severely lax in collecting tariffs that are due. Seafood 
tariffs uncollected stand at over $200 million from China alone right 
now. As these tariffs are not collected as they should be, illegal 
dumping continues, and our seafood and other industries are not being 
paid what they are due under the law.
  This bill supposedly has a phase out of CDSOA for 2 years, in which 
pending cases are supposed to be paid. I fear with the current record 
of collections and distribution, this 2 year phaseout won't give much 
relief. I do not feel that this phaseout is adequate, and the repeal 
this important law should not have been included in this bill. It is 
not right to use industries that are victims of illegal trade practices 
to carry a large burden of balancing the budget.
  I urge my colleagues to help me force the bureaucrats to do their 
work, collect these tariffs, and make the already due payments under 
the Byrd amendment. While the law may be unwisely repealed in this 
bill, the previously due payment should be paid and paid quickly.
  Mr. GREGG. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The question is on agreeing to the motion to concur in the House 
amendment with the Senate amendment.
  The clerk will call the roll.
  The legislative clerk called the roll.
  The yeas and nays resulted--yeas 50, nays 50, as follows:

                      [Rollcall Vote No. 363 Leg.]

                                YEAS--50

     Alexander
     Allard
     Allen
     Bennett
     Bond
     Brownback
     Bunning
     Burns
     Burr
     Chambliss
     Coburn
     Cochran
     Coleman
     Cornyn
     Craig
     Crapo
     DeMint
     Dole
     Domenici
     Ensign
     Enzi
     Frist
     Graham
     Grassley
     Gregg
     Hagel
     Hatch
     Hutchison
     Inhofe
     Isakson
     Kyl
     Lott
     Lugar
     Martinez
     McCain
     McConnell
     Murkowski
     Roberts
     Santorum
     Sessions
     Shelby
     Specter
     Stevens
     Sununu
     Talent
     Thomas
     Thune
     Vitter
     Voinovich
     Warner

                                NAYS--50

     Akaka
     Baucus
     Bayh
     Biden
     Bingaman
     Boxer
     Byrd
     Cantwell
     Carper
     Chafee
     Clinton
     Collins
     Conrad
     Corzine
     Dayton
     DeWine
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Harkin
     Inouye
     Jeffords
     Johnson
     Kennedy
     Kerry
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Mikulski
     Murray
     Nelson (FL)
     Nelson (NE)
     Obama
     Pryor
     Reed
     Reid
     Rockefeller
     Salazar
     Sarbanes
     Schumer
     Smith
     Snowe
     Stabenow
     Wyden
  The VICE PRESIDENT. On this vote, the yeas are 50, the nays are 50. 
The Senate being equally divided, the Vice President votes in the 
affirmative, and the motion to concur in the House amendment with a 
further amendment is agreed to.
  Mr. FRIST. I move to reconsider the vote.
  Mr. McCONNELL. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.

                          ____________________