[Congressional Record (Bound Edition), Volume 152 (2006), Part 15]
[Senate]
[Pages 20350-20360]
[From the U.S. Government Publishing Office, www.gpo.gov]




   DEPARTMENT OF DEFENSE APPROPRIATIONS ACT, 2007--CONFERENCE REPORT

  Mr. STEVENS. Mr. President, I ask unanimous consent that 
notwithstanding the provisions of rule XXII, the Senate I proceed to 
the immediate consideration of the conference report to accompany H.R. 
5631, the Defense appropriations bill. I further ask unanimous consent 
that there be 2 hours of debate equally divided between the majority 
and minority, with that debate time not counting against the 30 hours 
postcloture, and that a vote on adoption of the conference report occur 
at 10 a.m. on Friday, September 29.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The report will be stated by title.
  The legislative clerk read as follows:

       The committee of conference on the disagreeing votes of the 
     two Houses on the amendment of the Senate to the bill (H.R. 
     5631), making appropriations for the Department of Defense 
     for the fiscal year ending September 30, 2007, and for other 
     purposes, having met, have agreed that the House recede from 
     its disagreement to the amendment of the Senate, and agree to 
     the same with an amendment, and the Senate agree to the same, 
     signed by all of the conferees on the part of both Houses.

  The PRESIDING OFFICER. The Senate will proceed to the consideration 
of the conference report.
  (The conference report is printed in the proceedings of the House in 
the Record of September 25, 2006.)
  The PRESIDING OFFICER. The Senator from Alaska. Mr. STEVENS. Mr. 
President, the time is equally divided, as I understand it.
  The PRESIDING OFFICER. The Senator from Alaska is correct.
  Mr. STEVENS. Mr. President, I am pleased to present the Defense 
appropriations conference report for fiscal year 2007 with my colleague 
from Hawaii, our cochairman, Senator Inouye.
  Two nights ago, in a strong measure of bipartisan support for our men 
and women in uniform, the House of Representatives passed this bill. 
There are only 4 days left in the fiscal year. The 2007 Defense 
appropriations conference report must be signed into law by the 
President before Saturday at midnight.
  Finishing debate on this bill tonight and passing it tomorrow morning 
will ensure that this bill will get to the President in time so there 
will be no lapse in money available to our men and women in uniform to 
conduct the ongoing activities throughout the world.
  This bill includes the continuing resolution for those appropriations 
bills which have not been completed. This continuing resolution, or CR, 
as we call it, was negotiated on a bicameral, bipartisan basis. It is 
what we call a clean CR. There is no other problem associated with this 
CR. It has been supported on both sides of the aisle, and we are 
grateful to the Members in both the House and the Senate for that 
approval.
  Our conference report represents a balanced approach to fulfilling 
the financial needs of the Department for fiscal year 2007. It provides 
$436.5 billion in new discretionary spending authority for the 
Department of Defense. This amount also includes $70 billion in 
emergency spending for early fiscal year 2007 costs associated with the 
operations in Iraq and Afghanistan and the global war against 
terrorism.
  The bill fully funds the 2.2 percent across-the-board military pay 
raise as proposed in the President's budget.
  This conference agreement also provides $17.1 billion for additional 
fiscal year 2007 reset funding for the Army and $5.8 billion for the 
Marine Corps. These are specific amounts identified by the services as 
necessary to meet their fiscal year 2007 equipment requirements.
  The additional reset funding provides for the replacement of aircraft 
lost in battle and the recapitalization and production of combat and 
tactical vehicles, ammunition, and communications equipment.
  In addition, the conference report provides $1.1 billion for body 
armor and personal protection equipment and $1.9 billion to combat 
improvised explosive devices.
  The bill also provides $1.5 billion for the Afghanistan security 
forces fund and $1.7 billion for the Iraq security forces fund. These 
funds will continue the training of indigenous security forces and 
provide equipment and infrastructure essential to developing capable 
security forces in Afghanistan and Iraq.
  The bill does not address the funding for basic allowance for housing 
within the military personnel accounts, sustainment, readiness and 
modernization funds contained in the operation and maintenance 
accounts, environmental funding, or Defense Health Program funding. 
These accounts will be conferenced later this year with the House 
Appropriations subcommittee responsible for those accounts. They are 
separate from this bill.
  Finally, I would like to note that the bill provides more than $3 
billion for National Guard and Reserve equipment to improve their 
readiness in combat operations as well as their critical role

[[Page 20351]]

in our Nation's response to natural disasters.
  I urge all Members of the Senate to support this bill. It supports 
the men and women in uniform who risk their lives for our country each 
day. By voting for this measure, we show our support for what they do.
  I also wish to thank my cochairman again, Senator Inouye, for his 
support and invaluable counsel on the bill.
  And before I recognize him, I would like to allocate 10 minutes of 
the time on our side to the distinguished Senator from Oklahoma. But I 
yield to my friend from Hawaii.
  The PRESIDING OFFICER. The Senator from Hawaii.
  Mr. INOUYE. Mr. President, I rise to express my strong support for 
the conference report on H. R. 5631. This bill, as the chairman has 
noted, includes some $436.6 billion for the Department of Defense, 
including $70 billion to help offset the cost of war in Iraq and the 
global war on terrorism for the first several months of fiscal year 
2007.
  I want to remind my colleagues that the bill does not include 
funding, as noted by the chairman, for the Defense Health Program or 
for environmental and real property maintenance and related programs.
  By agreement between the Appropriations Committees in both Houses, 
these amounts will be carried in the Military Construction bill which 
has not yet passed the Senate.
  Accounting for this change, the bill is $9.3 billion higher than the 
bill which passed the Senate. Of this amount, approximately $4.7 
billion is in emergency funding for the war on terror, and the balance 
is for regular appropriations.
  This bill provides for the essential requirements of the Department 
of Defense and is a fair compromise between the priorities of the House 
and the Senate.
  To my colleagues on the democratic side, I would say this is a good 
bill.
  It was fashioned in a bi-partisan manner and it funds our critical 
defense needs.
  Several items which were added to this bill by democratic amendments 
are addressed favorably in this conference report.
  The agreement urges the President to report his plans in the event of 
increased sectarian violence in Iraq. It urges the director of national 
intelligence to assess many elements of the potential for civil war in 
Iraq.
  It includes an additional $100 million to help eradicate poppies in 
Afghanistan and it addresses concerns raised in the Senate about 
increasing funding to find the leaders of al-Qaida.
  I point out to the Senate that all the members of the conference on 
both sides of the aisle supported this agreement.
  I fully support the bill that the Chairman is recommending, and I 
urge my colleagues to support the measure as well.
  The PRESIDING OFFICER. The Senator from Oklahoma is recognized.
  Mr. COBURN. Mr. President, I thank the Senator from Alaska for all 
his hard work and dedication on defense in this country and the hard 
work he put forward. This bill undoubtedly will pass this body, and 
probably unanimously. I will note that there were several things I have 
a criticism of in the bill and things I would like to have seen in it, 
but they are not there. But I also note that we are having trouble 
maintaining Abrams fighting vehicles, maintaining tanks.
  As we look at this bill, the $70 billion we are going to have for the 
war, that is an emergency and it is appropriate, there is no question 
about it. What is not appropriate in this bill--and this body passed 96 
to 1--is the fact that we agreed in this body that whatever the 
earmarks were in the bill, there ought to be a scorecard on them, on 
whether the earmarks met the mission of the Defense Department.
  There are going to be a lot of earmarks that are good, but a lot of 
them are stinky. There are 2,000 earmarks in the bill directed by 
Members of Congress--somewhere around $8 billion--and a large portion 
of those don't have anything to do with the mission of the Defense 
Department, and they have everything to do with us failing to do the 
things we should do in terms of prioritizing and making the hard 
decisions in this country.
  I am going to vote for the bill because of its importance for our 
country. But in this bill, you don't know who did the earmarks. They 
are very cleverly written. You cannot find out exactly what contractor 
they are going to. You don't know who is responsible. They are not 
listed. That is OK if we want to do things that way, but it is not OK 
if you are going to do that and not at least assess the effect of the 
earmarks.
  We passed in this Chamber, 96 to 1, that we would, in fact, ask the 
Defense Department to assist in how effective the earmarks are in 
accomplishing their mission. My disappointment is, that is not in the 
bill. If out of that $5 billion to $8 billion worth of earmarks, $2 
billion or $3 billion is waste, think what we could have done for the 
defense of this country. Think what we could have done for those who 
are depending on us and we cannot fully supply their needs, whether it 
is early childhood education, Head Start, or the AIDS drug assistance 
program, just to name a few.
  We will try again next year. We will try to get the earmarks 
published, out in the open, and into the sunlight, so the American 
people can see what we are directing, to whom we are directing it, and 
who is doing the directing. I will be back on every bill until we come 
clean with the American people on the political games we are playing 
with earmarks. We either need to have the agencies say what they are 
doing with them and whether they meet their mission or we need to be 
upfront on who is doing what, why, and what for.
  I appreciate the hard work of the chairman and Senator Inouye in 
terms of bringing this bill to the floor. More importantly, I 
appreciate those who dedicate their lives to this country by becoming a 
part of our Armed Services and setting an example we could very well 
learn from in this body when it comes to earmarks just by following 
their example of service, courage, and integrity.
  With that, I yield the floor.
  The PRESIDING OFFICER. Who yields time? The Senator from Iowa is 
recognized.
  Mr. HARKIN. Mr. President, I ask unanimous consent for time off of 
Senator Inouye's time.
  The PRESIDING OFFICER. Without objection, the Senator from Iowa is 
recognized.
  Mr. HARKIN. Mr. President, let me thank the chairman, Senator Stevens 
from Alaska, and his ranking member, the Senator from Hawaii, Mr. 
Inouye, for their hard work on this Defense appropriations bill. As a 
member of that subcommittee, I have been pleased to work with them and 
their very able and diligent staffs to shape a Defense appropriations 
bill that does indeed meet the needs of our times and provides the 
funding resources our military needs in these very trying times.
  Again, I express my support for the underlying bill, the Defense 
appropriations bill. Again, my gratitude goes to the Senator from 
Alaska and the Senator from Hawaii for all their hard work.
  Mr. KENNEDY. Mr. President, I welcome the decision of the Defense 
Appropriations Subcommittee conferees to support the Senate's request 
for a new National Intelligence Estimate on conditions in Iraq.
  Earlier this week, the American people were shocked to learn about an 
assessment from the intelligence community which unequivocally 
concluded that the war in Iraq is creating a new generation of 
terrorists. It was especially shocking, given the administration's 
repeated insistence that we are winning the war on terror and that 
America is safer because of the war in Iraq. That 5-month-old 
assessment addressed the impact of the Iraq war on the global threat of 
terrorism, outside of Iraq's borders.
  But what about Iraq itself? What is the collective assessment of the 
intelligence community about the prospects for success in Iraq versus 
the likelihood of full-scale civil war? The President insists that we 
are winning in Iraq

[[Page 20352]]

but, remarkably, the intelligence community has not prepared a National 
Intelligence Estimate on conditions inside Iraq for more than 2 years. 
That must change.
  America is in deep trouble in Iraq, and it's mystifying that an 
Intelligence estimate focusing on the internal situation in Iraq has 
not been prepared since July 2004. We know that the President is 
determined to convince the American people that we are winning the war 
and that America is safer, but what does the intelligence community 
believe? The recent revelations about the April 6 estimate underscore 
the value and importance of obtaining the collective wisdom of the 
intelligence community to inform our policy judgments and to ensure 
that the American people have the facts, not just the political spin of 
the White House.
  Stopping the slide into full-scale civil war is our greatest 
challenge and highest priority in Iraq. The continuing violence and 
death is ominous. The UN reports that more than 6,500 civilians were 
killed in July and August alone. Militias are growing in strength and 
continue to operate outside the law. Death squads are rampant. Reports 
of torture in official detention centers remain widespread. Kidnappings 
are on the rise, and so are the numbers of Iraqis fleeing the violence.
  More than 140,000 American troops are on the ground. It's essential 
that we obtain--and obtain soon--a candid and comprehensive assessment 
from the intelligence community on whether Iraq is in or is descending 
into civil war and what can be done to stop the sectarian violence that 
is spiraling out of control.
  The stakes are enormously high for our troops and our national 
security, and completing a new NIE on Iraq should be one of Director 
Negroponte's highest priorities.
  After our Senate amendment requiring a new estimate was approved to 
this bill on August 3, Director Negroponte agreed to ask the 
intelligence community to prepare it.
  Certainly nobody has an interest in unnecessarily rushing the 
intelligence community. But it has been more than 2 years since an NIE 
on Iraq was prepared, and that's too long. It has been nearly 2 months 
since Mr. Negroponte announced his decision to ask the intelligence 
community to prepare a new assessment, yet the the first step--
determining the scope of the issues to be covered--is still not 
finished.
  With Iraq on the brink of a full-scale civil war, preparation of this 
intelligence assessment cannot be delayed any longer. With more than 
140,000 Americans under fire every hour of every day in Iraq, it's 
wrong to slow-roll this assessment. For the sake of our men and women 
in uniform, the intelligence community must move forward, and it must 
move forward soon.
  Earlier today I sent a letter to Mr. Negroponte with Senators 
Rockefeller, Biden, Levin, Reid, and Reed urging him to move forward 
and indicating that preparation and completion of this intelligence 
assessment cannot be delayed any longer.
  As the intelligence community finalizes the terms of reference for 
the new Iraq National Intelligence Estimate, Mr. Negroponte should be 
mindful of the specific provisions in this conference agreement, which 
urge him to follow the parameters set out in the Senate amendment to 
this bill. Under the amendment, the following issues would be included 
in the new National Intelligence estimate in Iraq:
  The prospects for controlling severe sectarian violence that could 
lead to civil war; the prospects for reconciling Iraq's ethnic, 
religious, and tribal divisions; an assessment of the extent to which 
militias are providing security and the extent to which the Government 
of Iraq has developed and implemented a credible plan to disarm, 
demobilize, and reintegrate the militias into the government security 
forces and is working to obtain a political commitment to ban militias; 
an assessment of whether Iraq is succeeding in creating a stable and 
effective unity government, and the likelihood that the government will 
address the concerns of the Sunni community; and the prospects for 
economic reconstruction and the impact it will have on security and 
stability.
  It is obviously important that we obtain an open and honest 
assessment from the Director of National Intelligence, particularly on 
the question of civil war, and my colleagues and I look forward to such 
an assessment. It is also our view that an unclassified summary, 
consistent with the protection of sources and methods, should be made 
available when the estimate is completed.
  We continue to believe the National Intelligence Estimate should be 
as thorough and comprehensive as possible. To this end, we would also 
benefit significantly by having it include the following areas:

       An assessment addressing the threat from violent extremist-
     related terrorism, including al Qaeda, in and from Iraq, 
     including the extent to which terrorist actions in Iraq are 
     targeted at the United States presence there and the 
     likelihood that terrorist groups operating in Iraq will 
     target U.S. interests outside Iraq; an assessment of whether, 
     and in what ways, the large-scale presence of multinational 
     forces in Iraq helps or hinders the prospects for success in 
     Iraq; a description of the optimistic, most likely, and 
     pessimistic scenarios for the stability of Iraq through 2007; 
     and an assessment of the extent to which the situation in 
     Iraq is affecting our relations with Iran, Saudi Arabia, 
     Turkey, and other countries in the region.

  The war in Iraq continues to be an immense strategic blunder for our 
country, and having the most thorough and comprehensive National 
Intelligence estimate possible will greatly inform the ongoing debate 
about our options for the future.
  A new National Intelligence estimate is long overdue. As John Adams 
said, ``Facts are stubborn things.'' It is abundantly clear that the 
facts matter on Iraq. They mattered before the war and during the war, 
and they matter now, as we try to deal effectively with the continuing 
quagmire.
  I urge my colleagues to support this conference agreement, and I look 
forward to obtaining the new National Intelligence estimate on Iraq and 
to obtaining it soon.
  Mr. President, I ask unanimous consent to have the letter to which I 
referred printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                      U.S. Senate,


                                               Washington, DC,

                                               September 28, 2006.
     Ambassador John D. Negroponte,
     Director of National Intelligence, Office of the Director of 
         National Intelligence, Washington, DC.
       Dear Director Negroponte: We welcome your response to our 
     July 26 correspondence and our August 3 amendment to the 
     Department of Defense Appropriations bill for fiscal year 
     2007 requiring an updated National Intelligence Estimate on 
     Iraq. An NIE focusing on Iraq has not been prepared in more 
     than two years, and we welcome your August 4 announcement 
     that you will ask the intelligence community to prepare this 
     document.
       As the intelligence community finalizes the terms of 
     reference for the new Iraq National Intelligence Estimate, we 
     draw your attention to a provision in the conference 
     agreement on the Department of Defense Appropriations bill 
     which urges you to follow the parameters set out in our 
     August 3 amendment on the NIE. Under the Senate amendment, 
     the following issues would be included:
       The prospects for controlling severe sectarian violence 
     that could lead to civil war;
       The prospects for Iraq's ethic, religious, and tribal 
     divisions;
       An assessment of the extent to which militias are providing 
     security and the extent to which the Government of Iraq has 
     developed and implemented a credible plan to disarm and 
     demobilize and reintegrate the militias into the government 
     security forces and is working to obtain a political 
     commitment to ban militias;
       An assessment of whether Iraq is succeeding in creating a 
     stable and effective unity government, and the likelihood 
     that the government will address the concerns of the Sunni 
     community;
       The prospects for economic reconstruction and the impact it 
     will have on security and stability.
       It's obviously important that we obtain an open and honest 
     assessment from the intelligence community, particularly on 
     the question of whether Iraq is in or is descending into 
     civil war, and we look forward to the assessment from the 
     intelligence community. It is also our view that an 
     unclassified summary of the judgments, consistent with the 
     protection of sources and methods, should be made available 
     when the NIE is completed.

[[Page 20353]]

       Additionally, we continue to believe the NIE should be as 
     thorough and comprehensive as possible. To this end, we would 
     also benefit significantly by having the following areas 
     addressed in a new Iraq NIE:
       An assessment addressing the threat from violent extremist-
     related terrorism, including al Qaida, ill and from Iraq, 
     including the extent to which terrorist actions in Iraq are 
     targeted at the United States presence there and the 
     likelihood that terrorist groups operating in Iraq will 
     target U.S. interests outside Iraq;
       An assessment of whether, and in what ways, the large-scale 
     presence of multinational forces in Iraq helps or hinders the 
     prospects for success in Iraq;
       A description of the optimistic, most likely, and 
     pessimistic scenarios for the stability of Iraq through 2007;
       An assessment of the extent to which the situation in Iraq 
     is affecting our relations with Iran, Saudi Arabia, Turkey, 
     and other countries in the region.
       The stakes are enormously high in Iraq, and having the most 
     thorough and comprehensive NIE possible will greatly inform 
     the debate about our options in Iraq.
       We look forward to hearing from you about the final terms 
     of reference for the new Iraq NIE and to receiving the 
     updated NIE. Certainly nobody has an interest in 
     unnecessarily rushing the intelligence community. But it has 
     been more than two years since an NIE on Iraq was prepared 
     and nearly two months since you announced your decision to 
     ask the intelligence community to prepare a new assessment. 
     With more than 140,000 troops on the ground in Iraq, 
     preparation of this intelligence assessment cannot be delayed 
     any longer.
           Sincerely,
     John D. Rockefeller IV.
     Joseph R. Biden, Jr.
     Carl Levin.
     Harry Reid.
     Edward M. Kennedy.
     Jack Reed.

  Mr. LEAHY. Mr. President, the Senate is poised to approve the fiscal 
year 2007 Department of Defense Appropriations conference report. Like 
past Defense Appropriations bills, there are things in this bill that I 
support and there are others that I disagree with. Without taking much 
of the Senate's time today I want to mention one small but very 
important provision in this bill.
  Section 9012 of the conference report states that no funds shall be 
made available for the establishment of permanent U.S. military bases 
in Iraq or to exercise U.S. control over any oil resource of Iraq. This 
language, which was sponsored by Senator Biden and which I strongly 
support, provides an important signal to the Iraqi people and to the 
sovereign government of Iraq that it is not the intent of the United 
States to control or maintain a permanent military presence in their 
country. It is especially important in light of the recent surveys 
which indicate that a significant majority of Iraqis want United States 
military forces to withdraw from their country.
  For many Vermonters and for people around the world who have concerns 
and suspicions about the Bush administration's intentions in Iraq, this 
makes clear that regardless of the disagreements among us over the 
continued deployment of U.S. troops in Iraq, we agree that they are not 
there to establish permanent bases or to control Iraqi oil resources.
  Mr. McCONNELL. Mr. President, on a related note, one portion of the 
much publicized National Intelligence Estimate that came out this week 
failed to capture much attention. It was a segment that said, ``We 
cannot measure the extent of the spread [of jihadist terrorism] with 
precision . . .'' This candid admission reflects just how difficult 
good intelligence is to come by. It also reflects why it is so 
important that this bill permits the CIA interrogation program to 
continue--because it provides valuable intelligence.
  Over the weekend, much was made about this selective leak of national 
security information. Some of our colleagues pounced on the media 
reports to bolster their argument that we should pull out of Iraq, pull 
out now.
  But whoever leaked this report somehow forgot to mention a key 
finding of the intelligence community. As anyone who read the 
declassified report knows, the findings are clear: If we defeat the 
terrorists in Iraq, there will be fewer terrorists inspired to carry on 
the fight elsewhere. But if we leave Iraq to the terrorists, it will 
only inspire more terrorists to join the fight.
  In other words, defeating terrorists in Iraq not only secures the new 
democracy there but prevents future attacks here.
  The New York Times editorial board rightly pointed out that ``[t]he 
current situation will get worse if American forces leave.''
  Mr. President, it is a banner day when the New York Times editorial 
board contradicts my colleagues across the aisle, and the Times is 
certainly right, at least in this regard: a policy of retreat will not 
stop terrorists there--or prevent attacks here.
  I have said it before, but it bears repeating. Terrorism against the 
United States didn't start on 9/11 or the day our troops entered 
Baghdad--But attacks here at home did stop when we started fighting al-
Qaida where they live rather than responding after they hit.
  We don't need to guess what will happen if we leave Iraq to the 
terrorists. We already have a real-world example of what will happen. 
Recall that Afghanistan was a wholly owned subsidiary of al-Qaida 
before 9/11. It was from there that they planned and executed--with 
impunity--attacks against the United States and our allies. Think what 
Iraq would be like if we let al-Qaida take possession of the country--
like bin Laden wants us to do.
  And remember what the 9/11 Commission concluded, and I quote: ``If, 
for example, Iraq becomes a failed state, it will go to the top of the 
list of places that are breeding grounds for attacks against Americans 
at home.''
  Mr. President, we know what will happen if we leave Iraq before the 
job is finished. That is simply not in dispute. Remember, bin Laden 
declared that, for him, Iraq was the ``capital of the Caliphate.'' We 
must not and we will not give him that victory.


                          Ryan White CARE Act

  Mr. ENZI. Mr. President, I rise again today to ask unanimous consent 
that the Senate pass S. 2823, the Ryan White HIV/AIDS Treatment 
Modernization Act, and I will make the formal request in just a few 
moments.
  I want to make a few comments first in hopes that some who have a 
hold on this bill will come down and lodge the objection themselves. 
Just last week we requested the unanimous consent agreement to pass 
this bipartisan, bicameral legislation as it passed out of the House 
Energy and Commerce Committee last week. At 9:30 tonight it will pass 
on the floor of the House, and I expect by significant margins. But 
five Senators from three States are blocking a vote to create a more 
equitable program for providing life-sparing treatment for individuals 
suffering from HIV and AIDS.
  Now, 2 days ago I made this same request to pass this critical 
legislation, and the five Senators who are holding up this legislation 
chose not to come to the floor to discuss their concerns or to debate 
their issues. Instead, the Senator from Minnesota, Mr. Dayton, was 
gracious enough to notify us of his objection, even though he stated he 
would vote for the bill.
  So today I ask again the Senators from New York, New Jersey, and 
California, those who have holds on this critical legislation, to come 
to the floor themselves and lodge their objections to explain why their 
parochial interests should be permitted to deny lifesaving care to 
people who don't live in their States.
  Now, I have a chart here that shows the New York and New Jersey 
situation. You can see that New York, under the current law, receives 
$509 per case above the national average. Under the reauthorization, 
they would still receive $304 above the national average per case. And 
not only that, at the end of the year, they have $29 million left over.
  In New Jersey, they get $310 per case above the national average. 
Now, under the reauthorization, they would still get $88 more per case 
above the national average, and they have a little slush fund at the 
end of the year: $17.7 million.
  These States have simply raised objections about what funds they will 
receive this year compared to last year. These States will still be 
overpaid per case, just no longer grossly overpaid. For example, New 
York is paid $509

[[Page 20354]]

more per AIDS case, as I showed my colleagues, than the national 
average and would get $304. They have been unable to spend $29 million 
in Ryan White funding. They can't spend the money they are taking in 
now. Yet those States' Senators still want more at the expense of many 
other States that are currently underfunded.
  Now, these States have not objected to the underlying policies. 
Again, I must emphasize that these couple of States have been grossly 
overpaid for years, receiving well over the national average per 
patient with HIV. Even under this new bill, they will continue to be 
overpaid, although not quite as much.
  Now, California is a little different situation. When the law was 
passed last time, we put some provisions into law, and we set a 
deadline for HIV/AIDS cases for fiscal year 2005 to have a conversion. 
Now, the Secretary opted to delay that until 2007 to give the States 
more time, and the CDC in 2005 urged all the States to transition 
immediately. California decided to transition in 2006. CDC offered 
resources and people in 2006 to help them make the transition. 
California declined.
  There is a deadline. California will lose $74 million in 4 years 
under the current law for not meeting the deadline. When we pass this 
bill, under the new law, California would gain $60 million over the 4 
years and have more time. So it is kind of a win-win situation for 
California. Under some of the formula, they were hoping, I think, to 
gain even more. But they can meet the deadline; extra help has been 
offered. So if they would take the extra help, they could meet that 
timeline, and under this bill, they would gain $60 million over 4 years 
instead of losing $74 million over that same 4 years by not complying 
with the transition language.
  This bill would ensure that every State in the Nation has the 
appropriate funding to care for their residents living with HIV and 
AIDS.
  Let me show you another chart. On the left-hand side, the States in 
red will have losses under the current law: 100,000 Americans get left 
out. This will happen on September 30 unless we pass a bill. On 
September 30, there will be huge penalties to these States. The bottom 
right shows the States that will gain under the reauthorization that we 
are doing, and you will notice that there are five States that will not 
gain, but only two of them are objecting. These five Senators who 
didn't come to the floor 2 days ago still continue to obstruct the 
Senate from passing a bill that can save more than 100,000 lives, 
including the lives of a growing number of women and minorities who are 
afflicted by this devastating disease.
  As you can see from this chart, without this new law, people across 
the country who are suffering from HIV and AIDS will be hurt unless we 
pass the new bipartisan, bicameral bill. That means that we have worked 
on this for a long period of time, and we have people from both sides 
of the aisle in agreement. We even have people on both ends of the 
building in agreement, and, in fact, the bill that the House is passing 
tonight is the same bill that we worked out and are ready to pass over 
here.
  So holding up passage of this new law is wrong. By doing so, these 
Senators are denying growing numbers of minorities and women living 
with HIV and AIDS equal protection under the Ryan White CARE Act.
  This chart shows Americans are at risk. More than half of the HIV/
AIDS cases are not counted under the Federal law in the States that are 
marked in red. Those are ones that are not getting half of the money 
that they need right now, half that they ought to have if the bill was 
fair.
  So we need to pass this bill. We need to pass this bill by September 
30. Let's see, today is the 28th. We only have 2 days to pass this 
bill. And if we don't pass the bill, a whole bunch of States are going 
to be penalized severely under the old law.
  I have gotten letters from several of the Senators who are worried 
about what is going to happen to their States under the old law come 
just 2 days from now. If the bill is not authorized by September 30, 
hundreds and thousands of people in the States and the District of 
Columbia will lose access to lifesaving services.
  Therefore, Senators from three States are holding up a bill that 
would help Connecticut, Georgia, Kentucky, New Hampshire, Pennsylvania, 
Delaware, Illinois, Maine, Oregon, Washington State, California, 
Hawaii, Massachusetts, Maryland, Montana, Rhode Island, Vermont, and 
the District of Columbia. Hundreds of thousands of people living with 
HIV and AIDS who live in these States will be needlessly hurt if a few 
Senators continue obstructing good policy.
  As you can see from the chart, more than half of the HIV/AIDS cases 
are not counted under current law. As we all know, the Ryan White 
Program provides critical health care services for people who are 
infected with HIV/AIDS. These individuals rely on this vital program 
for drugs and other services. We need to pass this legislation so that 
we can provide them with the treatment they desperately need.
  I urge the Senators who are holding up this bill to stop playing the 
numbers game so that Ryan White CARE Act funding can address the 
epidemic of today, not 2 days or 2 years ago.
  The HIV/AIDS epidemic of today affects more women, more minorities, 
and more people in rural areas in the South than ever before. While we 
have made significant progress in understanding and treating this 
disease, there is still much more to do to ensure equitable treatment 
for all Americans infected with HIV and AIDS. We must ensure that those 
infected with HIV and living with AIDS will receive our support and our 
compassion regardless of their race, regardless of their gender, 
regardless of where they live.
  Therefore, I urge my colleagues to support this key legislation and 
stop playing the numbers game so we can assist those with HIV in 
America.


                   Unanimous Consent Request--S. 2823

  Mr. President, I ask unanimous consent that the Senate proceed to the 
immediate consideration of Calendar No. 580, S. 2823, the Ryan White 
Act. I ask unanimous consent the Enzi substitute at the desk be agreed 
to, the committee reported amendment as amended be agreed to, the bill 
as amended be read the third time and passed, the motion to reconsider 
be laid upon the table, and that any statements relating to the bill be 
printed in the Record.
  The PRESIDING OFFICER. Is there objection?
  The Senator from Minnesota.
  Mr. DAYTON. Mr. President, reserving the right to object, I want to 
say that I thank the Senator for his courtesy and for warning me about 
his intention here tonight. I salute him for his leadership on this 
legislation, which I support, so I am in a bit of an awkward situation, 
as he has recognized. But I guess I would ask the chairman, if my 
information is correct, there are actually 14 States that would lose 
funding under the revised formula.
  As the chairman said the other day, there is a hold-harmless clause 
that is in effect, as I understand, for 3 years, and this is a 5-year 
reauthorization, so at that point these other States would lose 
funding.
  Does the chairman find it surprising that Senators from those States 
are doing what I think I would do if I were in that situation? I am 
grateful the formula adds money for Minnesota, but I find it 
unsurprising that they are doing what any of us I believe would do, 
which is to protect our States.
  My second question to the chairman is: Given that this is a $12.2 
billion reauthorization over 5 years, what would it cost in additional 
authorization to give these States over the next 5 years the same 
amount of money as they receive presently?
  Mr. ENZI. Mr. President, I thank the Senator for his reluctant 
objection, although it still counts as an objection.
  The PRESIDING OFFICER. Has the Senator from Minnesota objected?
  Mr. DAYTON. Mr. President, I am reserving the right to object. I 
directed two questions to the chairman, if I may, Mr. President.
  Mr. ENZI. Mr. President, I will go ahead and answer the questions, 
then,

[[Page 20355]]

and hope this changes your mind on being the one willing to make the 
objection.
  Would I protect my State if my State were losing money? I think we 
are elected to the Senate by the people in our States, but our 
obligation is to the people of the United States. And were my State 
grossly overpaid on an average, and I was still going to be grossly 
overpaid afterwards, and my State couldn't use the money each year that 
it received, I think I would have a terrible time trying to object to 
this bill. I hope we do not play that kind of numbers game, we don't 
get that parochial on bills around here.
  Another bill I have been working on is the Older Americans Act, and 
it has a formula in it. Again, there are States that lose under that 
bill. But there are people who have been willing to work out a formula 
like we did on this. We must have run about 300 different programs 
trying to come up with something as equitable as possible. We even put 
in the 3 years hold harmless for people who were being grossly 
overpaid.
  I think we have come up with as reasonable a bill as we possibly can. 
We need to get it passed, and we need to get it passed by September 30 
so the penalties don't kick into effect for those States that have a 
big penalty coming up and that are desperately in need of making sure 
they get enough money to take care of the cases they presently have.
  Mr. COBURN. Will the chairman yield for a question?
  Mr. DAYTON. Mr. President, I haven't had my question answered.
  Mr. ENZI. I have one more answer that I need to do.
  The PRESIDING OFFICER. The Senator from Wyoming has the floor. His 
unanimous consent request is pending.
  Is there objection?
  Mr. ENZI. I will yield for some other questions as soon as I finish 
answering this question.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ENZI. There aren't 14 States that would lose money unless the new 
bill doesn't pass. There are only five States that will lose money 
under the new bill, the bill we are trying to get passed by unanimous 
consent--the bill that we are at least trying to be able to bring up by 
unanimous consent. We tried a number of different ways. There are just 
five States that are involved in losing money. Of those five, three 
have said we have to be fair. Two have said we don't care whether we 
are fair or not.
  Mr. DAYTON. If I may direct a question again to the chairman, how 
much would it cost in addition to the $12.2 billion for this 5-year 
authorization? What additional authorization would it cost to give 
those five States the same level of funding over the next 5 years that 
they would receive as of today?
  Mr. ENZI. Mr. President, I don't have that number. Like I say, we ran 
about 300 different iterations of different formulas. I will get the 
Senator that number.
  But there is 3 years hold harmless in this. You are talking about 5 
years hold harmless. Hold harmless means that the dollars don't follow 
the person, that the State gets the money even if they have run out of 
people with HIV/AIDS, and if there are decreasing numbers of them they 
should not continue to get those dollars. What you are asking is we 
continue to give those dollars even if we run out of people. All we are 
trying to do with this bill is make sure the dollars follow the person. 
You get more people, you get more money. You get less people, you get 
less money. It is take care of the people.
  It is not an economic development bill.
  Mr. DAYTON. Mr. President, I appreciate the answers of the chairman. 
I respect him very highly for what he has done. I must, however, object 
on behalf of my colleagues whom I believe are doing properly what they 
must and should do to protect their own States. So I do object.
  The PRESIDING OFFICER. Objection is heard. The Senator from Oklahoma.
  Mr. COBURN. Mr. President, it really strikes me strange, when we are 
talking about protecting money from States that already have full 
treatment programs, and people are dying across this country because 
there is inequity in the funding for those States. If that is the basis 
for an objection, that is an obscene objection.
  We are talking about people dying who have no access to medicines, 
who have no access to treatment, while we have--let me get to the 
specifics--while we have in New York alone, last year--the city of New 
York spent $9 million on hotel rooms averaging $329 a night to house 
people. They spent money, $2.2 million, on people who were dead, paying 
for rented rooms they weren't even in. And we are talking about 
objecting to fair treatment and access to care for people who have none 
now because we don't want to see the fluff associated with other 
programs decline.
  The President has asked us to pass this bill. On October 1, lots of 
changes take place. They are going to impact lots of people in lots of 
States.
  I find it unconscionable that somebody would have somebody object for 
them rather than to come down and defend their objection. If you object 
to making sure African-American women across this country have access 
to lifesaving drugs, you ought to come to the floor and say you object 
to that because that is what an objection means for this bill starting 
October 1. There is already a lack. There are people dying in three 
States right now because they have waiting lists for drugs for HIV for 
people who have no other resources to take care of themselves.
  Last year I offered an amendment on this floor, fully paid for and 
offset, for $60 million for additional ADAP funds that would have taken 
care of the very people who are going to suffer from this bill, and the 
very same Senators who are blocking this bill voted against those funds 
for those people who have no treatment today. There is something very 
wrong in the Senate when the leaders of the charge for this bill, with 
the exception of Senator Kennedy who has done miraculous work with 
Senator Enzi--the leaders in the charge for getting this bill and 
making sure everybody has equal access to care for HIV in this country 
are four conservative Senators.
  We ought to ask a question about that. Why are we down here fighting 
for this? We believe in equal treatment. We believe in equal access. 
Where are the people who claim all the time to defend that? Why aren't 
they here on the floor of the Senate?
  I want to make a couple of other points. The Labor-HHS bill that we 
are going to be voting on this fall has $1 billion in earmarks in it; 
$1 billion in earmarks. Most of it has zero, in comparison to saving 
somebody's life, like ADAP drugs and access to treatment if you are 
infected with HIV and you don't have any access to care whatsoever. We 
don't see anybody volunteering to give up their earmarks.
  Here is a stack of earmarks for New York State alone, last year in 
excess of $1.5 billion--over 600 earmarks. Nobody volunteered to give 
up the earmarks, the special projects that politicians get benefits 
from that sometimes do good and sometimes don't do good--nobody offered 
to give those up to pay for this loss. We want to continue to do what 
we are doing, having the privileges and prerogatives of a Senator or a 
Congressman to grease the skids of our own reelection with an earmark, 
but we will not give some of that up to make sure somebody in a State 
that is not having access, who is going to die in the next 3 months, 
has access to lifesaving drugs.
  That is an incrimination on this process. It is an incrimination on 
this body. Shame on us if we allow this to continue to be held up.
  New York State carried over $27 million. The Department of HHS--here 
is another. This past weekend, HHS spent $400,000 sending people--78 
employees--to Hollywood, FL, of which 2 out of the 3 days didn't have 
anything to do with the conference. It was a party. As a matter of 
fact, as a quote from the New York Times states, at the last AIDS 
conference in Toronto, 78 HHS employees went, and as the New York Times 
said, this was a star-studied rock concert, a circus-like atmosphere 
that

[[Page 20356]]

made it seem more like a convention and social gathering than a 
scientific meeting. For these and other reasons a number of leading 
scientists have stopped attending and some supporters claimed the 
quality of the presentations have declined at recent conferences.
  We can find more money. We can find money from earmarks. We can find 
money from conferences. We can find money from waste, fraud, and abuse. 
What we cannot find is the integrity to treat everybody equally in this 
country because we want to protect the parochial interests of our city 
or our State. That is wrong.
  It is wrong that they are not down here defending that immoral 
position. I challenge them to come down and defend it.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. BURR. Mr. President, I thank Chairman Enzi and Ranking Member 
Kennedy for an incredible amount of work, not just within our committee 
but in a bicameral way with the House. Seldom do we get the opportunity 
to come to the floor of the Senate fully knowing that the House is on 
board to every word that is in a bill, which means even with the 2 days 
that the chairman has suggested we have before this bill adversely 
affects thousands in this country, we could actually have it on the 
President's desk and signed. But we are tonight, at almost 9 o'clock, 
with four Senators on the floor, finding absent the Senators who object 
to us bringing up this bill. Why would they object?
  Senator Dayton said because they owe it to their States to get as 
much money as they possibly can and to not be equitable under a 
distribution formula.
  I tell you that could be the reason. But I think the reason they are 
not here is because their position is indefensible; to allow us to 
bring this bill to the floor one would challenge them on why they take 
the position that they do. Their position is indefensible because this 
formula is run on numbers.
  It is very simple. The chairman stated it to the Senator from 
Minnesota very clearly. For every patient you have you get dollars to 
make sure that you provide the services and the pharmaceuticals that 
are needed. If you don't have the people, if you don't have the 
infected patients, you should not get the money. What is the fear? The 
fear is, they know they don't have the people. Therefore, they will not 
get the money. So why not have the debate? Stall and see what happens.
  The chairman said there were a number of States--New York being the 
most egregious--where they received $2,122 per infected patient. The 
national average is $1,613. I represent the State of North Carolina. We 
have one of the fastest growing populations of HIV-infected individuals 
in the United States. Today what does North Carolina receive--$1,029 
per individual infected with HIV/AIDS. Can any Member who blocks this 
come to the floor and tell me that is equitable? Can any Member come to 
the floor and suggest to me that this funding, designed to provide the 
drugs that these people need to live is equitable? That New York should 
get $2,122 per person but North Carolina should get $1,129 per person? 
Can they tell me that is equitable? It is not only not equitable, it is 
unjust. It is unfair. It is wrong.
  You know what, the people in North Carolina say: We are tired. It 
can't happen anymore. You have to change it.
  I have a State who, annually, has individuals on the ADAP waiting 
list--individuals waiting in line to be eligible to get 
pharmaceuticals, to stay alive. This is not the vision of America we 
have been taught. We have been taught that we need to make sure that 
safety net is there. But the argument tonight is that we are going to 
be denied the safety net in some States so that others can keep feeding 
at the trough--whether they have the population or not.
  The people in North Carolina are tired of watching their State 
contribute the second highest percentage of dollars to the Ryan White 
Program but getting less Federal funding than States who barely 
contribute a dime on their own.
  They are tired of seeing African-American women in the South of the 
United States 26 times more likely to be HIV-positive than a White 
woman and to see States that deny them the ability to provide the drugs 
that these women need. They are tired of hearing about HIV-positive 
people in San Francisco and New York getting dog-walking services and 
massages when some of my constituents can't even get HIV drugs.
  They are tired of hearing terms such as ``double counting,'' ``hold 
harmless,'' ``duplication of names,'' ``grandfathered in.'' All of 
those terms translate to one word: unequal.
  What is so wrong with the concept that Ryan White dollars follow HIV-
infected individuals?
  Recently, I had individuals in my office. They suggested that 3 years 
was not enough time to account for the infected population, that in 
fact they are going to be penalized because they have more individuals 
who are infected with HIV/AIDS than what we count today.
  It is real simple. The chairman said 3 years hold harmless. They have 
3 years to produce those names to verify that they are eligible for the 
funds, and if they don't do that then, in fact, that money goes 
elsewhere. So what was their argument? Three years is not enough time.
  Every one of the individuals who is infected is enrolled in some type 
of program and service and receiving drugs and services. Clearly, if 
they receive those drugs and services on a regular basis, it is easy to 
account for who they are and where they are.
  In fact, if they are not there, the last thing you want to do is have 
a program that accounts by an individual's name. But, in fact, that is 
what we do with this formula.
  Right now, the Federal Government is giving exotic fruit to 
California and New York, and North Carolina is getting rotten apples. 
That is about the comparison. We allow them to have a Cadillac and, in 
fact, we don't even give those folks in North Carolina a car.
  The transition that is going on in America is that the infected 
population is in rural America, and many of them are showing up in the 
southeastern part of the United States. They are not in urban areas; 
they are not in what we consider title I or title II towns. We don't 
get the enhanced dollars because of the concentration in a big city. 
They are at the end of a dirt road. They are 30 miles from an AIDS 
clinic.
  When we look at how we service that newly infected population in the 
South, which is predominantly African-American women, it is not only 
where we get the money to supply the drug, it is where we get the money 
to provide the transportation so they can go to an AIDS clinic. Where 
do we get the money to provide the rest of the service for somebody who 
doesn't have a relationship with a health care professional? The 
closest thing they get to primary care is the day they walk in and get 
their drugs and they get a ``quickie'' check up. Then it is another 
process of a bus or a van or a friend who takes them to get it. But 
without that extra bit, they would never get the drug if, in fact, we 
didn't supply some type of transportation.
  In 2000, North Carolina had 12,489 people living with HIV/AIDS. There 
are 6,000-plus infected people more today than that 2000 statistic. I 
know how many there are in North Carolina because we keep their names. 
We track the individuals.
  We are not asking for more money than we have in infected patients. 
We are asking for this formula to be fair.
  Through December 2004, North Carolina was a State with the 14th 
greatest number of AIDS cases in the Nation, and the highest ranking 
State--the only State in the top 17--without a title I city that had 
enhanced reimbursement you get because of the size of the city and the 
infected population.
  In 2004, 66.7 percent of people living with AIDS in North Carolina 
were African American--the fifth highest rate in the Nation. The 
national average in 2004 was 39.9, and ours is 66.7.

[[Page 20357]]

  I would like to think there would be 100 Senators down here talking 
about the outrage; that they would look at the racial disparity in 
this, the regional disparity; and that they would be down here arguing 
that this program has to be changed. It is not happening, and 72 
percent of the new North Carolina cases in 2005 were minorities. It may 
be that the 66.7 percent of the infected population is, in fact, the 
low watermark, not the high watermark as we begin to see those new 
cases of minority individuals.
  For those of us who are here arguing tonight that this should be 
changed, we recognize the fact that women of color in the South are 26 
times more likely to be HIV-positive than White females.
  This is an alarming trend that this Nation ought to turn around. We 
have a lot to do in 2 days--now a night and a day. We want to make that 
September 30 deadline.
  It is clear that individuals in New York want to maintain the $2,100 
per case and not accept the $1,613 average. The individuals in New 
Jersey want to keep their $1,923 and not settle for the $1,613 that is 
the national average. They are willing to suggest that is an equitable 
tradeoff with North Carolina that gets $1,129 per individual infected 
by HIV.
  It is time that we show the leadership that we have to point out to 
people who are holding this up that we cannot let them hide behind some 
defense that ``I can't lose for my State'' money that they cannot prove 
goes in their State to save the lives of people who are dying in my 
State because they can't get the pharmaceutical products they need.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Alabama.
  Mr. SESSIONS. Mr. President, I thank Senator Enzi, our chairman, for 
his great leadership and persuasive remarks earlier on this important 
issue.
  My good friend, Dr. Coburn, has personally treated people with AIDS 
and has dealt with women who have had babies with AIDS. It is a matter 
deeply important to him.
  Senator Burr is a force in our committee. He works extremely hard. 
His remarks go to the core of what we are all about here. He explained 
it in great detail. I am so appreciative of that.
  I will just say a few things that I believe are important.
  Senator Dayton, I must tell you that my good friend Senator Enzi is a 
very fair man. If the chairman were asked, Chairman Enzi, why should 
New York give up anything? Why shouldn't they insist on keeping the 
special position they have?
  Let me ask this question: How did New York get that special position? 
How did it happen? They came to the Congress a number of years ago. 
They said: We have an extraordinary problem in New York. Our problem is 
great. We have this growing problem with AIDS, and we need extra money.
  The Nation said: We believe you are hurting, New York. We believe you 
have a special problem, and we will give you special money, extra 
money. You will get more than the rest of the country because it 
appears that the disease is more centered there and is spreading most 
rapidly there.
  That was a good and decent thing for the country to do. It made sense 
that this bill passed. I am not disputing that. But I am telling you 
right now, as a representative of the people of the State of Alabama, 
having talked to the leadership that deals with AIDS in my State, they 
are really upset. They cannot imagine how it is possible that now my 
State and the entire Southern region is showing a faster increase in 
AIDS than any other region of the country--the South has the highest 
rate of increase of any region in the country. I will show this chart. 
It is actually beginning to surge here. It is a crisis in our State. 
Even this new bill, as Chairman Enzi said, still provides more money 
per patient for a big-city State than we would get in Alabama, even 
though our AIDS rate increase is higher by far than the Northeast or 
other areas.
  How can that be justified? I know the people of New York say that New 
York City deserves more money to protect itself from terrorists because 
terrorists are more likely to attack New York. They complain about 
this. But the truth is, they get a lot more money in New York for that 
protection than the rest of the country gets. I think current 
legislation will give them even more for it. Why? Because the terrorist 
threat is more real. Well, the AIDS threat is real here; more real in 
Alabama. And it is falling on poor people and it is falling on the 
African-American community and it is falling hardest on African-
American women.
  Senator Burr said that, and that is an absolute fact. The numbers 
bear it out without any doubt whatsoever. I believe a fair proposal is 
on the floor of the Senate. I believe if we had any pretense of passing 
legislation that deals fairly and objectively with the deadly disease 
of AIDS, we need to pass this legislation. It is absolutely not right 
to continue this disproportionate shifting of revenue from States all 
over America to big cities that are getting almost twice as much in 
some instances as the poorer States and the rural States. It is not 
right to continue that. We need to fix that.
  The chairman didn't overreact. Maybe next time, if we can't get this 
bill passed, we ought to pass a bill that makes it completely level 
across the board and not leave some of these States with a continued 
advantage. They have had an advantage for years and years now. I 
suggest that we need to work on that and work on it hard.
  Let me point out again the yellow line which represents the increase 
in the South--far higher than the Northeast and the West. That is where 
the big cities are that are getting the biggest amount of money per 
patient, not just more money total but more money per patient.
  We have all read reports of abuses of those moneys and some of the 
worst things they are doing in some of those centers. Senator Coburn 
mentioned the great conferences they go to where they have rock 
concerts and spend this money that they claim they do not have, I 
guess, to treat people who are sick.
  Let's look at the next chart just to make one more point about what 
this legislation that Chairman Enzi and the committee hammered out is 
trying to do. There are 1.185 million Americans living with HIV/AIDS, 
and 250,000 of them do not know they are infected. One of the greatest 
things we can do is to make sure that people who are infected with HIV/
AIDS know it as soon as possible. Treatment will commence immediately. 
It can mean years of extra life, years of extra healthy ability to live 
a normal life if we diagnose them early.
  This bill provides new moves toward early diagnosis, early detection, 
and early testing. It absolutely is the right thing to do.
  I was in my home State talking to some of our AIDS people who work on 
a daily basis. They told me about a lady who came in pregnant, and they 
did a test on her. She was 7 months pregnant. She was positive for HIV. 
That was a tragedy, of course. But that child, given the right 
treatment, is almost certain to be born without AIDS because she was 
diagnosed as having it before the child was born. Had she not been 
diagnosed, there would have been a 50-50 chance that the child would 
have been born with AIDS. What a tragedy which was averted in that 
instance. They began to talk to her. They ended up talking to her 
boyfriend. He agreed to be tested. They found out that he was positive. 
He didn't know that. Had he known that, he would never have infected 
the lady. I am convinced of it. Most people are going to protect 
themselves and their partners if they know they have AIDS.
  There are a lot of reasons for early detection. One is that it will 
help reduce the spread of AIDS because most people would not want their 
partners to be infected. And it would allow them to get on medication 
at the earliest possible time. So we made some real progress in that 
area. It can save lives and money in the long run.
  I salute the chairman. How the Senator has time to work all the bills 
he is leading members on in the HELP committee, I do not know. It is a 
tremendous challenge and the Senator does it with good humor and 
consistent efforts to do right thing.

[[Page 20358]]

  The Senator is exactly right on this important issue. I thank the 
Senator for his leadership. We must pass this reform. We must have 
equity in distribution of the money. It absolutely needs to show a 
shift of resources to the most threatened area of our country--that is 
the South, our poor, our African American community, and particularly, 
African American women.
  I yield the floor.
  The PRESIDING OFFICER (Mr. DeMint). The Senator from Wyoming.
  Mr. ENZI. Mr. President, I thank the Senator from Alabama for his 
kind comments and even more so for his passion and understanding on 
this issue. I thank the others who have spoken.
  We had given those who are objecting to the Senate completing this 
bill an hour to state their case; no one showed up. We were pretty sure 
of that based on the fact they had one of the Members who is not 
running for office to be the one to object. They sent someone from a 
State that actually gains by having the bill completed. That tells 
something about how willing they are to defend the position they have 
on this bill.
  This bill is critical to people all over the United States. There are 
HIV/AIDS families in every single State asking Congress to pass this 
bill and to pass it immediately.
  Thirteen States, on September 30, will have huge losses in revenue. 
We are getting more calls, naturally.
  This is not just a bill. This is not just policy. This is life and 
death to people across this country
  We have heard people are on waiting lists that cannot get drugs 
because the money does not follow the person. The money goes to the 
States that had the money before. This bill readjusts that so the 
people who need the drugs get the drugs. It sounds like an American 
principle to me.
  As I mentioned before, there are other bills we work on where we are 
changing the formula. I have been very fortunate the people working 
with those bills have said, yes, we have to be fair. We always 
transition into these things. This is no exception. Three years of 
hold-harmless. That means they get the same amount of money whether 
they deserve it or not for 3 years, while they count again to see if 
they have more or less people affected.


                          standards conversion

  Mr. SANTORUM. Mr. President, I realize that Senator Enzi has been 
working with Senator Kennedy and others to craft this underlying 
bipartisan, bicameral product. Already today, he has discussed how the 
bill will ensure more equitable treatment, target key resources, and 
save lives through treatment. However, he has also mentioned that 
someone from California is holding up the bill, due to concerns about 
converting their HIV system to standards created by the Centers for 
Disease Control and Prevention. I am curious about that, given that 
Pennsylvania, like California, is also in the process of converting its 
system. How long have States under current law to change their system?
  Mr. ENZI. The 2000 reauthorization stated that States need to have 
CDC accepted HIV data as early as 2005 but not later than 2007. 
Therefore, States have already had seven years to make this change.
  Mr. SANTORUM. How many more years will California and Pennsylvania 
have to make that change?
  Mr. ENZI. Under the bipartisan, bicameral product, California and 
Pennsylvania will have 4 more years to make the change. Thus, you both 
will have had over a decade to convert your systems. However, in fiscal 
year 2011, only CDC standards for HIV cases will be used for the 
funding formula.
  Mr. SANTORUM. So, I understand that you have given States like my own 
Pennsylvania more time to change their system, so that they don't have 
losses just due to system issues when people still need care. What 
would Pennsylvania and California lose if those States did not receive 
the 4-year extension you are proposing?
  Mr. ENZI. According to a February 2006 report by the GAO, 
Pennsylvania would lose $9 million and California would lose $18.5 
million in 1 year. With this bill that allows those States to still 
count the people that matter while the systems are transitioning, 
Pennsylvania would instead gain $4.8 million and California would gain 
$15.4 million.
  Mr. SANTORUM. Will CDC provide assistance to States that need to make 
this change? How will the Federal Government assist?
  Mr. ENZI. CDC has offered to provide assistance to States throughout 
the process. In fact, I recently confirmed today that CDC has already 
offered California technical assistance--up to six staff for up to 6 
months--to help them make this change. Further, given some confusion 
about that technical assistance, I have asked CDC to send a letter to 
California, restating that they would provide that assistance.
  Mr. President, Senator Hatch was the chairman of this committee when 
the original Ryan White HIV/AIDS treatment bill went through. He is the 
one that selected the name of Ryan White. He has an explanation of how 
that came about and the differences this bill has made and the urgency 
with which this needs to be done right now.
  Mr. HATCH. Mr. President, I rise to support the effort to call up and 
immediately adopt S. 2823, the Ryan White HIV/AIDS Treatment 
Modernization Act.
  Adoption of this legislation offers us the opportunity to make a 
difference in the lives of the hundreds of thousands of people in the 
United States who are living with HIV/AIDS. We should not let this 
opportunity pass.
  I am pleased to have joined HELP Committee Chairman Enzi and Ranking 
Minority Member Kennedy, Majority Leader Frist, and Senators DeWine and 
Burr in introducing this reauthorization bill.
  As my colleagues are aware, I was the author of the original 
legislation along with Senator Kennedy and we introduced the first bill 
on this issue in the 101st Congress. The Ryan White Comprehensive AIDS 
Resources Emergency Act of 1990 was signed into public law on August 
18, 1990 and became--excluding Medicaid and Medicare--the United 
States' largest Federally funded program for the care of those living 
with HIV and AIDS. It was a lot of hard work. But it was a lot of hard 
work for a very important cause.
  Let us take a moment to remember one of the reasons why we did all 
that hard work in the first place. His name was Ryan White. Ryan was 
born in Kokomo, IN, in 1971. Three days after his birth, he was 
diagnosed with severe hemophilia. Fortunately for Ryan and his parents, 
there was a new blood-based product just approved by the Food and Drug 
Administration called Factor VIII, which contains the clotting agent 
found in blood.
  While he was growing up, Ryan had many bleeds or hemorrhages in his 
joints which were very painful. A bleed occurs from a broken blood 
vessel or vein. Think of a water balloon. When the blood has nowhere to 
go, it swells up in a joint and creates painful pressure. Twice a week, 
Ryan would receive injections or IVs of Factor VIII, which clotted the 
blood and then broke it down.
  In December of 1984, Ryan was battling severe pneumonia and had to 
have surgery to have 2 inches of his left lung removed. Two hours after 
the surgery, doctors told his mother that he had contracted AIDS as a 
result of his biweekly treatment with Factor VIII. He was given 6 
months to live.
  Ryan White was a fighter. He was determined to continue at his school 
and live life normally. But in 1985, not many people knew the truth 
about AIDS. Not very much was known about AIDS at all. Most of the so-
called facts that people claimed to know were speculation. So Ryan 
faced a lot of discrimination, mostly based on the unknown.
  Ryan was soon expelled from his high school because of the supposed 
health risk to other students. His situation became one of the most 
controversial cases in North America, with AIDS activists lobbying to 
have him reinstated while attempting to explain to the public that AIDS 
cannot be transmitted by casual contact.
  After legal battles, Ryan and his mother settled with the school to 
have

[[Page 20359]]

separate restrooms and use disposable silverware from the cafeteria. He 
agreed to drink from separate water fountains and no longer used the 
high school gymnasium.
  But those concessions didn't stop much. Students vandalized his 
locker. Some restaurants threw his dishes away after he left. A bullet 
was even fired into his home.
  Later, Ryan transferred to a different school where he was well-
received by faculty and students who were fully educated into the 
nature of HIV. Ryan was a great student with an exceptional work ethic 
and perseverance. He was respected by his fellow students because of 
his admirable traits. They understood he was a human being--just like 
them, but living with a terrible disease.
  Before he died on April 8, 1990, Ryan White worked to educate people 
on the nature of HIV and AIDS, to show that it was not a lifestyle 
disease and that, with a few precautions, it was safe to associate with 
people who were HIV-positive. His character sought to overcome stigma. 
He became an inspiration to patients and advocates throughout the 
United States and the rest of the world.
  By the spring of 1990, over 128,000 people had been diagnosed with 
AIDS in the United States and 78,000 had died of the disease.
  The Ryan White CARE Act was originally enacted in 1990 in response to 
the need for HIV primary care and support services. At that time, the 
focus of public policy was on research, public education, surveillance, 
and prevention. The CARE Act was the first approach developed to help 
people with HIV and AIDS to obtain primary care and support services to 
save and improve their lives. There is no doubt that the CARE Act has 
played a critical role in the Nation's response to the AIDS epidemic.
  The CARE Act was reauthorized in 1996 and 2000 to address the fact 
that the epidemic continued to spread and that primary care and support 
services provided through the act were still vitally important to 
people living with HIV and AIDS.
  Today, more than 944,000 cases of AIDS have been reported to the 
Centers for Disease Control and prevention, the CDC. Nearly 530,000 
men, women, and children have died as the epidemic has spread over the 
last 25 years to both new populations and new geographic areas.
  The public health burden and the economic burden of the AIDS epidemic 
have not been reduced since the CARE Act was passed. The continued need 
for services grows faster than the resources available.
  Steady expansion and shifted demographics of the epidemic and the 
increasing survival rates for people living with AIDS have increased 
the stress on local health care systems in some areas. This strain is 
felt both in urban centers, where the epidemic continues to rage, and 
in smaller cities and rural areas, where the epidemic is expanding 
rapidly.
  This reauthorization bill addresses those inequities and reevaluates 
funding formulas so that money for the program follows the epidemic. It 
keeps money for the AIDS Drug Assistance Program--known as ADAP--within 
ADAP, and even grants States flexibility to transfer funds to ADAP when 
they have demonstrated need. Currently, funds for the ADAP supplemental 
pool are frequently dipped into for other purposes, resulting in 
inadequate funding and waiting lists. It also protects States and 
eligible metropolitan areas from suffering catastrophic losses in 
funding.
  I know that it is never easy to revise a bill that contains funding 
formulas. No matter what changes we make, they will always raise issues 
and questions. But let us move beyond the narrow fight and work for the 
greater good.
  We have been talking a lot about numbers and codes and case counts 
and reporting data, but we need to remember that there are actual real 
people being affected by this, real people who need our help. Hundreds 
of thousands of people continue to live affected with and die from this 
disease, and we need to bring out all the tools within the Federal 
arsenal to help fight for them.
  As of December 31, 2005, the Utah Department of Health reported a 
total of 1,907 people living with HIV and AIDS in the State of Utah. 
Many of these individuals rely on Title II funding from the Ryan White 
Program to receive health care, vital medications and support services.
  These individuals are also counting on me to fight for their 
continued access to care and services that have such a big impact on 
their survival and quality of life. We in Congress are being counted on 
to work together on behalf of the nearly 1 million people living with 
HIV/AIDS in our country.
  The last reauthorization period for the Ryan White Program expired in 
2005. It is incredibly important that we reauthorize the program again 
now in order to continue providing the care that is so critical to 
these populations and alleviate strain from shifts in the epidemic felt 
by health care providers.
  There are real people counting on us. We need to move forward in 
reauthorizing the only Federal program that helps the neediest of 
people living with this devastating disease. This bill extends the 
availability of vital services, and it includes changes that intend to 
fix discrepancies that have resulted in Ryan White funds not following 
the epidemic.
  This is a good bill and I urge my colleagues to support it.
  Mr. ENZI. I am very distressed. I have had a lot of success on other 
bills we are trying to get through. People have been willing to listen 
to reason and understand the urgency of a lot of the issues, 
particularly in the health area, but also in the education, labor, and 
pensions area.
  As a committee, we work on these things across the aisle and across 
the building. As a result, we have had 12 bills signed by the 
President. Of those 12 bills, we have only spent about 2 hours total in 
the Senate debating them because we work across the aisle and across 
the building. We work on important issues. We solve the parts we can 
and we bring them here. This is one of those where we thought we had 
the parts solved that we could. There are a lot of moving parts to a 
lot of these things. We work to get as much consensus as we can, but 
occasionally we reach a sticking point like this.
  I am really disappointed we have reached a sticking point like this 
where people are going to die. If, by tomorrow, we have not passed this 
bill and in case we go longer than tomorrow, I am going to ask the 
leader to file cloture on this bill so we can see if five Senators can 
hold up a Senate bill.
  If we leave tomorrow or the next day, it won't ripen yet, but it can 
ripen as soon as we can get back. We can spend the time debating it, 
and those States that are losing money on September 30, while they will 
not be able to retrieve all the money they will lose, they will have 
some breathing room for the future.
  I am desperate. I usually do not have to do that sort of thing. I am 
willing to do it on this bill. I am very distressed. Usually we are 
able to get agreement. We went a long ways toward giving concessions to 
those States.
  In all fairness, if you do not have the cases, you really should not 
have the money tomorrow, let alone 3 more years. We have tried to be 
reasonable. We have tried to help out States. We have run a bunch of 
formulas to make it as fair as we possibly could and to protect the 
States as much as we can, but it is time to be fair to the people with 
HIV/AIDS and to be fair to the families of people with HIV/AIDS.
  I ask unanimous consent that a Washington Post article be printed in 
the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               [From the Washington Post, Sept. 28, 2006]

                 Lawmakers Argue Over AIDS Funding Bill

                           (By Erica Werner)

       Washington.--House members from rural areas and the South 
     clashed with big-city lawmakers Thursday over who should get 
     a bigger share of federal money to care for AIDS patients.
       ``It's shameful and disgraceful,'' shouted Rep. Eliot 
     Engel, D-N.Y., denouncing amendments to the $2.1 billion Ryan 
     White CARE Act that could take millions of dollars out of New 
     York's health care coffers.
       The HIV/AIDS epidemic is moving,'' countered Rep. Joe 
     Barton, R-Texas. ``This is a

[[Page 20360]]

     very fair compromise. It begins to treat all states on an 
     equal footing.''
       The House was expected to vote on the bill later in the 
     evening. A two-thirds vote was needed for passage.
       Even if it passes the House, the bill faces uncertain 
     prospects in the Senate before Congress recesses at the end 
     of the week to campaign for re-election. Senators from New 
     York, New Jersey and California are blocking it.
       Supporters said the election-year updates were needed 
     because of how AIDS has changed since the Ryan White law 
     first passed in 1990. Once a big-city epidemic infecting 
     mostly gay white men, the disease is now prevalent in the 
     South and among minorities.
       By some measures federal funding has not kept up, and 
     states like California, New York and New Jersey get more 
     money per patient than Alabama, Kentucky or North Carolina.
       The Ryan White amendments, the first since 2000, make a 
     number of changes aiming to spread money more equally around 
     the country.
       While current law only counts patients with full-blown 
     AIDS, the revision also would count patients with the HIV 
     virus who have not developed AIDS.
       That change would favor parts of the country where the 
     disease is a newer phenomenon, which tend to be southern and 
     rural areas.
       New York state stands to lose $100 million over the five 
     years of the bill. New Jersey would lose $70 million.
       Alabama, by contrast, would get an increase from $11 
     million a year to about $18 million a year.
       ``The problem is that the population of those needing 
     services has grown, but the funding for Ryan White programs 
     has not grown with it,'' said Rep. Henry Waxman, D-Calif. 
     ``That means if we're going to give to some people who are 
     very deserving, we're going to take from others who are very 
     deserving.''
       California and some other states are worried about a change 
     in the bill that mandates counting HIV patients by name 
     instead of codes. Some states used code-based systems out of 
     concern for patient privacy. California could lose an 
     estimated $50 million in the last year of the bill, when the 
     name-based system would take effect, because it won't be 
     prepared to make the transition.

  Mr. ENZI. I have a unanimous consent that has been agreed to by the 
majority and minority leader. I yield back all time on the Defense 
appropriations conference report.

                          ____________________