[Congressional Record (Bound Edition), Volume 153 (2007), Part 16]
[Senate]
[Pages 22588-22593]
[From the U.S. Government Publishing Office, www.gpo.gov]




                 SMALL BUSINESS TAX RELIEF ACT OF 2007

  The PRESIDING OFFICER. Under the previous order, the Senate will 
resume consideration of H.R. 976, which the clerk will report by title.
  The assistant legislative clerk read as follows:

       A bill (H.R. 976) to amend the Internal Revenue Code of 
     1986 to provide tax relief for small businesses, and for 
     other purposes.

  Pending:

       Baucus amendment No. 2530, in the nature of a substitute.
       Dorgan amendment No. 2534 (to amendment No. 2530), to 
     revise and extend the Indian Health Care Improvement Act.
       McConnell/Specter amendment No. 2599 (to amendment No. 
     2530), to express the sense of the Senate that Judge Leslie 
     Southwick should receive a vote by the full Senate.
       Thune amendment No. 2579 (to amendment No. 2530), to 
     exclude individuals with alternative minimum tax liability 
     from eligibility from SCHIP coverage.
       Grassley (for Ensign) amendment No. 2541 (to amendment No. 
     2530), to prohibit a State from providing child health 
     assistance or health benefits coverage to individuals whose 
     family income exceeds 200 percent of the Federal Poverty 
     Level unless the State demonstrates that it has enrolled 95 
     percent of the targeted low-income children who reside in the 
     State.
       Grassley (for Ensign) amendment No. 2540 (to amendment No. 
     2530), to prohibit a State from using SCHIP funds to provide 
     coverage for nonpregnant adults until the State first 
     demonstrates that it has adequately covered targeted low-
     income children who reside in the State.
       Grassley (for Graham) amendment No. 2558 (to amendment No. 
     2530), to sunset the increase in the tax on tobacco products 
     on September 30, 2012.
       Grassley (for Kyl) amendment No. 2537 (to amendment No. 
     2530), to minimize the erosion of private health coverage.
       Grassley (for Kyl) amendment No. 2562 (to amendment No. 
     2530), to amend the Internal Revenue Code of 1986 to extend 
     and modify the 15-year straight-line cost recovery for 
     qualified leasehold improvements and qualified restaurant 
     improvements and to provide a 15-year straight-line cost 
     recovery for certain improvements to retail space.
       Baucus (for Specter) amendment No. 2557 (to amendment No. 
     2530), to amend the Internal Revenue Code of 1986 to reset 
     the rate of tax under the alternative minimum tax at 24 
     percent.
       Webb amendment No. 2618 (to amendment No. 2530), to 
     eliminate the deferral of taxation on certain income of 
     United States shareholders attributable to controlled foreign 
     corporations.

  The PRESIDING OFFICER. The time until 1:40 will be equally divided 
between the Senator from Montana, Mr. Baucus, and the Senator from 
Iowa, Mr. Grassley.
  The Senator from Pennsylvania.


                           Amendment No. 2557

  Mr. SPECTER. Madam President, I have consulted with both of the 
managers about bringing up amendment No. 2557. I consulted with Senator 
Grassley, who advised that we would be going back on the bill at 12:45, 
but the distinguished Senator from West Virginia had extended his time. 
But I have been waiting here now for more than an hour. It would be my 
hope we could proceed with the consideration of this amendment. I am 
advised the managers want to see the amendment.
  I am advised, Madam President, that the Democrats are fine with my 
calling it up. I just want to be sure--
  Mr. SANDERS. Madam President, my understanding is that the Senator 
from Pennsylvania is correct. He can proceed.
  Mr. SPECTER. In that event, Madam President, I ask unanimous consent 
that the pending amendment be set aside so we may consider amendment 
No. 2557.
  The PRESIDING OFFICER. The amendment has already been offered.
  Mr. SPECTER. Yes. Fine.
  This amendment would eliminate the 1993 alternative minimum tax rate 
increase, a remedial step which I suggest to my colleagues is long 
overdue. The alternative minimum tax was created in 1969 in response to 
a small number of high-income individuals who had paid little or no 
Federal income taxes.
  Today, because of a lack of indexing for inflation, and the higher 
AMT tax rates relative to the regular income tax system, we have a 
parallel tax system which has grown far beyond its intended result.
  If there is no legislative action, the number of taxpayers subject to 
the alternative minimum tax will rise sharply from approximately 3.5 
million filers in 2006 to some 23 million in 2007.
  This issue has been before the Senate four times this year already. 
It will hit taxpayers in the moderate range excessively hard. The 
alternative minimum tax was increased in 1993 from 24 percent to 26 
percent for taxable income under $175,000, and from 24 to 28 percent 
for taxable income in excess of $175,000.
  There has been some question as to what is the offset and there is no 
offset, and none should be looked for where you have a tax which 
essentially was not expected to be imposed. There was no anticipation, 
no intention that this alternative minimum tax was going to produce 
additional revenue. So when the tax law is corrected so the additional 
taxes will not be imposed because of bracket creep--and this is 
designed to avoid that, and to redirect the alternative minimum tax to 
its original intent--that is exactly what tax fairness requires.
  Madam President, I ask unanimous consent that the full text of my 
statement be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                   Statement of Senator Arlen Specter


                        Specter Amendment #2557

       Mr. President, I have sought recognition to discuss an 
     amendment to H.R. 976, the Small Business Tax Relief bill. 
     H.R. 976 will serve as a vehicle for legislation to 
     reauthorize the State Children's Health Insurance Program 
     (SCHIP) in the Senate. My amendment is identical to 
     legislation (S. 734) I offered on March 1, 2007, to bring the 
     Alternative Minimum Tax (AMT) back ``in line'' with the 
     regular individual income tax by reducing its rate back to 24 
     percent. The 1993 AMT rate increase has contributed greatly 
     to the problem of unintended taxpayers seeing increased tax 
     liability.
       The AMT is a flawed income tax system and there are many 
     arguments for full repeal. It is important to keep in mind 
     that the first version of the AMT was created in 1969 in 
     response to a small number of high-income individuals who had 
     paid little or no federal income taxes. Today, between a lack 
     of indexing for inflation and higher AMT tax rates relative 
     to the regular income tax system, we have a tax system which 
     has grown far beyond its intended result. Absent legislative 
     action, the number of taxpayers subject to AMT liability will 
     rise sharply from 3.5 million filers in 2006 to 23 million in 
     2007. According to the Congressional Research Service (CRS), 
     874,000 taxpayers in Pennsylvania will pay the AMT in 2007 if 
     no action is taken.
       The Senate has had ample opportunity to address AMT in 
     2007. The Senate has already rejected four efforts to provide 
     taxpayers with meaningful relief from the AMT in this first 
     session of the 110th Congress. However, all attempts have 
     been rejected: on July 20, 2007, I voted in support of a Kyl 
     amendment to the Education Reconciliation Bill, which would 
     have fully repealed the AMT; on March 23, 2007, I voted in 
     support of a Lott amendment to the Budget Resolution, which 
     would have allowed for repeal the 1993 AMT rate increase; on 
     March 23, 2007, I voted in support of a Grassley Amendment to 
     the Budget Resolution, which would have allowed a full repeal 
     of the AMT; and On March 23, 2007, I voted in support of a 
     Sessions Amendment to the Budget Resolution, which would have 
     allowed families to deduct personal exemptions when 
     calculating their AMT liability.
       This onerous tax is slapped on average American families 
     largely because the AMT is not indexed for inflation (while 
     the regular income tax is indexed) and taxpayers are 
     ``pushed'' into the AMT through so-called

[[Page 22589]]

     ``bracket creep.'' Temporary increases in the AMT exemption 
     amounts expired at the end of 2006. The Economic Growth and 
     Tax Relief Reconciliation Act of2001 increased the AMT 
     exemption amount effective for tax years between 2001 and 
     2004; the Working Families Tax Relief Act of 2004 extended 
     the previous increase in the AMT exemption amounts through 
     2005; and the Tax Increase Prevention and Reconciliation Act 
     of 2005 increased the AMT exemption amount for 2006.
       In addition to the well-known issue of the need to index 
     the AMT exemption amount for inflation, the AMT tax rate 
     relative to the regular income tax must also be addressed to 
     keep additional taxpayers who were never intended to pay the 
     AMT from being subject to its burdensome grasp. In 1993, 
     President Clinton and a Democrat-controlled Congress imposed 
     a significant tax hike on Americans through the regular 
     income tax. At the same time, the AMT tax rate was also 
     increased from 24 percent to 26 percent for taxable income 
     under $175,000 and from 24 percent to 28 percent for taxable 
     income that exceeds $175,000. These changes are now slamming 
     the middle-class and have only been made worse by the tax 
     relief enacted in 2001 and 2003. Ironically, by reducing 
     regular income tax liabilities without substantially changing 
     the AMT, many new taxpayers were pushed into these higher AMT 
     tax rates created in 1993. However, the problem is not the 
     2001/2003 tax relief, it was the 1993 tax increase.
       According to revenue estimates calculated by the Joint 
     Committee on Taxation, repeal of the 1993 AMT rate increase 
     would cost $425 billion over the 2007-2017 period. In tax 
     year 2007, 7.6 million filers would be removed from the AMT 
     if the '93 AMT rate is repealed; and 13.2 million filers will 
     be spared in 2017.
       Millions of taxpayers have been sucked into AMT liability 
     as a result of the 1993 AMT rate increase, and it would be 
     the wrong approach to ``fix'' the AMT by increasing taxes yet 
     again. In addition, some may argue that this amendment is 
     fiscally irresponsible because the lost revenue is not fully 
     offset. However, it is highly questionable to justify raising 
     taxes elsewhere to account for lost revenue that was never 
     intended to be collected.
       The AMT is a flawed income tax system and there are many 
     arguments for full repeal. At the very least, we should take 
     steps to undo past mistakes, most notably the 1993 AMT rate 
     increase. In what will likely be the final attempt to address 
     AMT before we head home to speak with our constituents during 
     the August recess, I implore my colleagues to cast an aye 
     vote for my amendment. Twenty-three million Americans are 
     counting on it.
       I ask consent to enter into the record several articles 
     published in the Wall Street Journal advocating for a repeal 
     of the 1993 AMT rate increase. This legislation is supported 
     by Americans for Tax Reform and by the National Taxpayers 
     Union. I ask consent to enter into the record letters of 
     support from Americans for Tax Reform (ATR) and the National 
     Taxpayer Union (NTU).

  Mr. SPECTER. It is a pretty simple, open-and-shut matter, and it does 
not take a whole lot of time to explain. I know the managers are not on 
the floor, but I did want to have the amendment considered, setting 
aside the other amendments, so we could engage in argument and be 
prepared to debate it further.
  Unless the Senator from Vermont indicates--with a hand gesture, a 
timeout, no argument at this time--I will be available to return to the 
floor when the managers consider it appropriate. But I wanted to get 
this on the record.
  Before departing, might I add my words of congratulations and 
admiration for the distinguished Senator from West Virginia. I hadn't 
planned to listen to his extended speech, but I wanted to be here at 
the moment it concluded, because sometimes when you are not here, half 
a dozen Senators precede you.


                Amendment No. 2627 to Amendment No. 2530

   (Purpose: To ensure that children and pregnant women whose family 
 income exceeds 200 percent of the poverty line and who have access to 
        employer-sponsored coverage receive premium assistance)

  Madam President, I have been asked to ask unanimous consent to 
temporarily set aside the pending amendment and call up amendment No. 
2627 for Senator Coburn.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report.
  The bill clerk read as follows:

       The Senator from Pennsylvania [Mr. Specter], for Mr. Coburn 
     and Mr. DeMint, proposes an amendment numbered 2627 to 
     amendment No. 2530.

  Mr. SPECTER. Madam President, I ask unanimous consent that the 
reading of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  The PRESIDING OFFICER. Who yields time?
  The Senator from Vermont is recognized.


                Amendment No. 2600 to Amendment No. 2530

  Mr. SANDERS. Madam President, I ask unanimous consent to set aside 
the pending amendment and call up amendment No. 2600, that the 
amendment be considered as read, and that it be set aside.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report.
  The bill clerk read as follows:

       The Senator from Vermont [Mr. Sanders] proposes an 
     amendment numbered 2600 to amendment No. 2530.

  The amendment is as follows:


                           amendment no. 2600

 (Purpose: To amend title XXI of the Social Security Act to limit the 
 use of funds for States that receive the enhanced portion of the CHIP 
        matching rate for Medicaid coverage of certain children)

       On page 83, strike line 2 and insert the following:
     level.
       ``(C) Use of funds.--Payments under this paragraph may only 
     be used to provide health care coverage or to expand health 
     care access or infrastructure, including, but not limited to, 
     the provision of school-based health services, dental care, 
     mental health services, Federally-qualified health center 
     services, and educational debt forgiveness for health care 
     practitioners in fields experiencing local shortages.''.


                Amendment No. 2571 to Amendment No. 2530

  Mr. SANDERS. Madam President, I ask unanimous consent that the 
pending amendment be set aside to call up Sanders amendment No. 2571, 
that the amendment be considered as read, and that it be set aside.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report.
  The bill clerk read as follows:

       The Senator from Vermont [Mr. Sanders] proposes an 
     amendment 2571 to amendment No. 2530.

  The amendment is as follows:


                           amendment no. 2571

  (Purpose: To establish an incentive program for State health access 
                              innovations)

       At the end of title I, insert the following:

     SEC. __. INCENTIVE PROGRAM FOR STATE HEALTH ACCESS 
                   INNOVATIONS.

       Section 2104, as amended by section 108, is amended by 
     adding at the end the following new subsection:
       ``(l) Incentive Program for State Health Access 
     Innovations.--
       ``(1) Establishment of state health access innovations 
     incentive pool.--
       ``(A) In general.--There is hereby established in the 
     Treasury of the United States a fund which shall be known as 
     the `CHIP State Health Access Innovations Pool' (in this 
     subsection referred to as the `SHAI Pool''). Amounts in the 
     SHAI Pool are authorized to be appropriated for payments 
     under this subsection and shall remain available until 
     expended.
       ``(B) Transfer of funds.--Notwithstanding subsection 
     (j)(1)(B)(i), from the amount appropriated for fiscal year 
     2008 under such subsection, $250,000,000 of such amount is 
     hereby transferred to the SHAI Pool and made available for 
     expenditure from such pool for the period of fiscal years 
     2008 through 2012.
       ``(2) Award of grants.--
       ``(A) In general.--The Secretary shall award grants to 
     eligible States from amounts in the SHAI Pool in accordance 
     with this subsection.
       ``(B) Eligible state.--For purposes of this subsection, an 
     eligible State is a State--
       ``(i) for which the percentage of low-income children 
     without health insurance (as determined by the Secretary on 
     the basis of the most recent data available) is less than 10 
     percent; and
       ``(ii) that submits an application for a grant from the 
     SHAI Pool for the purpose of carrying out programs and 
     activities that are designed to expand access to health 
     providers and health services for low-income children who are 
     eligible for medical assistance under the State plan under 
     title XIX (or a waiver of such plan) or child health 
     assistance under the State child health plan under this 
     title.
       ``(3) Requirements.--
       ``(A) Priority in awarding of grants.--In awarding grants 
     under this subsection, the Secretary shall give preference to 
     grant applications that--
       ``(i) propose innovative approaches to increasing the 
     availability of health care providers and services;
       ``(ii) create longer-term improvements in health care 
     infrastructure;
       ``(iii) have potential application in other States;

[[Page 22590]]

       ``(iv) seek to remedy shortages of health care providers; 
     or
       ``(v) result in the direct provision of health services.
       ``(B) Prohibitions.--The Secretary shall not--
       ``(i) award a grant to carry out programs or activities 
     which the Secretary determines would substitute for services 
     or funds provided by a State or the Federal Government; or
       ``(ii) disapprove any grant application on the basis that 
     programs or activities to be conducted with funds provided 
     under the grant would be provided through or by an entity 
     that otherwise receives Federal or State funding, such as a 
     Federally-qualified health center.
       ``(C) Term, amount, and number of grants per eligible 
     states.--
       ``(i) Term.--A grant awarded under this subsection may be 
     renewed each year for a period of up to 5 years, but in no 
     case later than fiscal year 2012.
       ``(ii) Amount.--No grant awarded under this subsection may 
     exceed $2,000,000 for any fiscal year.
       ``(iii) No limit on number of grants per state.--Nothing in 
     this subsection shall be construed as limiting the number of 
     grants that an eligible State may be awarded under this 
     subsection.
       ``(D) Annual aggregate limit.--The aggregate amount of all 
     grants awarded from the SHAI pool shall not exceed--
       ``(i) $50,000,000 in fiscal year 2008;
       ``(ii) $100,000,000 in fiscal year 2009;
       ``(iii) $150,000,000 in fiscal year 2010;
       ``(iv) $200,000,000 in fiscal year 2011; and
       ``(v) $250,000,000 in fiscal year 2012.''.

  Mr. SANDERS. Madam President, as my colleagues know, this 
legislation, the SCHIP legislation, includes a $3 billion incentive 
pool, and the purpose of this pool is to provide States with the 
funding they need to do outreach efforts in order to attract children 
into the program. The reality is, however, a number of States today 
have already enrolled 90 percent of their kids into the SCHIP program, 
and with the passage of this bill, more States will soon be at that 
level.
  Further, we want to provide strong incentives for States below the 
90-percent enrollment to reach that level.
  This amendment, in order to incentivize States to reach that level of 
90 percent, would allow States to apply for multiple grants of up to $2 
million each when they achieve an enrollment rate of greater than 90 
percent of children below 200 percent of poverty. These grants would 
help assure the children we enroll in SCHIP have a place to go to 
receive medical care and to find the personnel they need to provide 
that care. These grants would come from a pool of money--the State 
Health Access Innovations Pool--of $250 million, about 8 percent of the 
$3 billion incentive pool. This money will be used to find innovative 
approaches to increasing the availability of health and providers and 
services and would result in the direct provision of health services.
  The reason for this initiative is pretty clear. In Vermont and in 
many other parts of this country, one can, in fact, have health 
insurance and yet find it quite difficult to buy or to find providers 
of that service. So what we are saying is let us make sure that when 
our kids do have health insurance, there will be doctors, there will be 
dentists, and there will be other health care providers. This is a good 
amendment, and I certainly hope it will be supported.
  The other amendment I have offered, amendment No. 2600, is a simple 
amendment to Section 111 of the Children's Health Insurance Program 
reauthorization. Section 111, as my colleagues know, applies to certain 
qualifying States that expanded their Medicaid Program to cover kids 
prior to the enactment of CHIP in 1997. I wish to commend the Finance 
Committee for working language into the current bill that will no 
longer penalize these ``early expansion States'' and will allow States 
to cover children between 133 percent and 300 percent of the Federal 
poverty level to be covered under the CHIP program.
  My amendment simply states that payments to States to cover these 
children who were previously covered under Medicaid be used solely to 
fund health care-related activities. Specifically, the language states 
that payments may only be used to provide coverage or to expand access 
for health care infrastructure, including but not limited to the 
provision of school-based health services, dental care, mental health 
services, federally qualified health centers, and educational debt 
forgiveness for health care practitioners in fields experiencing local 
shortages.
  This amendment is a simple provision that will specify that States 
benefiting from an increased match must use these funds for health care 
and will allow States to address coverage issues as well as the crucial 
area of expanding access to services, something that particularly 
affects rural and inner city communities. I urge support for this 
amendment.
  Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. GRASSLEY. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                  Drug Company Payments to Physicians

  Mr. GRASSLEY. Madam President, I would like to take a few minutes 
today to discuss an important issue that affects all Americans who take 
prescription drugs. Specifically, I am going to speak about the need 
for greater transparency in the payment that doctors who bill Medicare 
and Medicaid receive from drug companies.
  Over the past few years, it became apparent during my inquiries into 
the Food and Drug Administration that drug companies pay physicians for 
a variety of different reasons. Indeed, some of our leading 
physicians--doctors who have significant influence in their medical 
fields--receive tens of thousands of dollars every year from drug 
companies. For some, these payments can make up a considerable amount 
of their annual income.
  The payments can take the form of honoraria for speaking engagements, 
payments to sit on advisory panels, and funding for research. Further, 
drug companies spend about $1 billion a year to fund educational 
courses that doctors are required to take every year called Continuing 
Medical Education, or CME.
  In April, the Finance Committee staff prepared a report on 
pharmaceutical companies' support of Continuing Medical Education. This 
report found that some educational courses supported by drug companies 
have become veiled forms of advertising that encourage off-label use of 
drugs.
  Let's review how this works. Right now, it is possible for a doctor 
to attend a CME--continuing medical education--course sponsored by a 
drug company. That same company can make payments to doctors who will 
teach the course, and the doctor who teaches the course can discuss the 
findings of research paid for by the company. Now, that may sound like 
a conflict and unethical, but that is how it happens. The whole field 
is connected by a tangled web of drug company money.
  To try and understand this a little better, I have been exploring the 
money doctors get from drug companies, especially the doctors who work 
as academic researchers. Most universities require their academic 
researchers to report outside income. I have sent letters to a handful 
of universities to understand how well such a reporting system actually 
works. I haven't received all the information yet, but I can comment on 
some of the things I have already found.
  Most universities require professors to report outside income that 
may create a conflict of interest with their research. This means that 
if a doctor at a university is receiving money from a company either 
for research, speaking fees or to sit on an advisory panel, then they 
have to report that income. But there appears to be a couple of 
problems, and let's say a couple of problems with the whole system, as 
I found out.
  The only person who knows if the reported income is accurate and 
complete is the doctor who is receiving the money. The university 
doesn't necessarily police its own people to make sure they are 
reporting everything

[[Page 22591]]

they are supposed to report. It seems that some of these academics are 
getting so much money coming in from so many different companies they 
need an accountant to be sure everything is reported accurately.
  Second, these disclosures are usually kept secret. So if there is a 
doctor getting thousands of dollars from a drug company, payments that 
might be affecting his or her objectivity, the only people outside the 
pharmaceutical industry who will probably ever know about this are the 
people at that very university, if they are even keeping track of it, 
and we don't know that they are keeping track of it. But most Americans 
never get a fair chance to see this information.
  To give one example, I sent a letter to the University of Cincinnati 
asking about how much money the drug companies have been paying one of 
their psychiatrists, Dr. Melissa DelBello. Back in May, The New York 
Times reported on the research done by Dr. DelBello to see if 
adolescents could be treated for bipolar disorder with a powerful drug 
called Seroquel, which is manufactured by Astra Zeneca. The study was 
funded by Astra Zeneca and showed that Seroquel was a good choice for 
treating bipolar disorder in children. Dr. DelBello's study was later 
cited by a prominent panel of experts who concluded that drugs such as 
Seroquel should be a first-line treatment for children with bipolar 
disorder.
  Here is where it gets interesting. After Dr. DelBello released her 
study, Astra Zeneca began hiring her to give several sponsored talks. 
Another doctor told The New York Times he was persuaded to start 
prescribing drugs such as Seroquel after listening to Dr. DelBello. But 
when the reporter from the New York Times asked Dr. DelBello how much 
money she got from Astra Zeneca, she told the paper: ``Trust me. I 
don't make much.''
  Well, I decided to find out how much, and I went directly to the 
University of Cincinnati who, by the way, has been extremely 
cooperative, helpful, and responsive. Soon I figured out just how much 
``not that much'' money is. Dr. DelBello's study, which helped put 
Seroquel on the map, was published in 2002. That next year, she got 
more money than she has ever received from the pharmaceutical 
companies--at least that is what the documents that I have say.
  In 2003, Astra Zeneca alone paid her a little over $100,000 for 
lectures, consulting fees, travel expenses, and service on advisory 
boards. In 2004, Astra Zeneca paid her over $80,000 for the same 
services.
  Now I am not saying this money was a payoff or suggesting there is 
something inherently bad with accepting drug company money, but let me 
tell you what Dr. Steven E. Hyman, provost, Harvard University and 
former Director of the National Institute of Mental Health, said.
  He said these payments could encourage psychiatrists to use drugs in 
ways that endanger patients' physical health. Specifically, he said of 
doctors:

       We don't connect the wires in our own lives about how money 
     is affecting our profession and putting our patients at risk.

  I think this is a rather interesting assessment by Dr. Hyman.
  But let me continue. Just last March, several leading physicians 
released a study on pharmaceutical company payments to physicians. They 
published this study in the Journal of the American Medical 
Association, one of the most prestigious journals in medicine. I would 
like to quote what they concluded about the need to provide public 
disclosure of these payments to doctors:
  Full disclosure would better allow the public to appreciate the 
relationship between industry and the health profession.
  And so, for the sake of transparency and accountability, shouldn't 
the American public know who their doctor is taking money from? After 
all, anybody can go on the Internet and see who is funding the 
campaigns for federally elected officials. Because doctors are expected 
to look out for the health and well-being of their patients, shouldn't 
we hold doctors to similar standards?
  In fact, some of this is already occurring. Minnesota requires drug 
companies to report any payments they give to doctors in that State. I 
think that is a good thing. Apparently, so do the citizens of 
Minnesota.
  I think what we really need is a national program that will require 
all drug companies to report when they make payments to doctors. I 
don't think it would be all that hard for those companies to do. After 
all, companies have to make sure they know where every penny is going. 
So it should not be that hard to report some of it to the Federal 
Government and to the American people. Besides, they are already doing 
it in Minnesota.
  In closing, I plan to continue my inquiry into drug company payments 
to doctors. In addition, I look forward to working with my colleagues 
in the Senate, as well as members of the pharmaceutical industry, to 
establish a national reporting system.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Salazar). The Senator from Maryland is 
recognized.
  Mr. CARDIN. Mr. President, I ask unanimous consent to be recognized 
for 7 minutes, and if the Chair would notify me when I have used 6 
minutes.
  The PRESIDING OFFICER. The Chair will do so. Without objection, it is 
so ordered.
  Mr. CARDIN. Mr. President, I take this opportunity to speak in favor 
of the Children's Health Insurance Program and its reauthorization, 
which is the legislation that is before us. We hear the numbers that 6 
million children benefit from the program today--over 6 million--and 
this will provide for an additional 3 million children.
  I want my colleagues to know that each one of these people are 
people, they are families, and they are affected by what we do here 
today. I take this time to acquaint my colleagues to Deamonte Driver. 
He was a 12-year-old who didn't live far from here--6 miles from here--
in Prince Georges County, MD. He had a tooth problem. His mother tried 
to get him help. He had no insurance, and he fell through the cracks. 
He had a brother, Dashawn Driver, who had six decaying teeth. They 
tried to get help for him. The mother thought the older brother was in 
worse shape than Deamonte. He started having headaches and was rushed 
to the emergency room. They found out his problem--he could not get to 
a dentist--was an abscessed tooth.
  Before this, a social worker made 20 phone calls in an effort to try 
to get dental care for the Driver family, without success. They could 
not find a dentist willing to treat someone without insurance or in the 
Medicaid system. Deamonte ended up needing emergency surgery, which 
cost $250,000, and he ended up losing his life because the system did 
not provide care for a 12-year-old.
  Mr. President, we can certainly do better than that. Dr. Koop, a 
former Surgeon General of the United States, said, ``There is no health 
care without oral health.'' Medical research has shown the linkage 
between plaque and heart disease. We know now that gum disease can be a 
signal of diabetes or a liver ailment or a hormone imbalance. We have 
to do better than we are doing today.
  Dental disease is the most common childhood ailment in the United 
States to date. One out of five children between the ages of 2 to 4 
will have some form of decaying teeth. By the time they reach 15, three 
out of five will have tooth decay.
  There is an imbalance as far as the racial effects. Racial minorities 
are much more likely to sustain untreated tooth decay. Forty percent of 
African-American children have untreated tooth decay.
  I thank my colleague, Senator Bingaman, for his leadership on these 
issues and for introducing legislation and moving forward to try to 
provide better oral health care for children. I thank Senator Snowe for 
her leadership. I thank Senator Baucus and Senator Grassley for 
including initiatives in the legislation that is before us that will 
help the States meet this challenge--the $200 million included in the 
bill. That will have a major impact to try to help American families.

[[Page 22592]]

  We have an important opportunity before us in the legislation that we 
are considering to help our children, not only to continue the benefits 
for 6.6 million children but so that we can add another 3 million out 
of the 9 million who currently have no health insurance.
  We have to do more, but this is our opportunity today, and we have to 
take advantage of it. Our health care system is in crisis.
  Earlier this week, I introduced the Universal Health Coverage Act, 
which would require everybody in this country to have health insurance. 
I think it is essential that we address the major problems in our 
country of so many people being without health insurance. We should 
start with the children, and we can do that with the legislation that 
is before us.
  Why is that important? Well, we know that children who are enrolled 
in the Children's Health Insurance Program or have insurance are much 
more likely to get primary health care. They won't use the emergency 
rooms as much. If you don't have insurance, you have no choice but to 
go to the emergency room. We have improved health care outcomes if the 
child has health insurance. We know they are much more likely to have 
immunization and primary health care.
  I want to comment that--again, talking about families and 
individuals--the Finance Committee held a hearing on the Children's 
Health Insurance Program. The Bedford family from my city of Baltimore 
came down here and testified.
  Mrs. Bedford said:

       We no longer have to decide whether a child is really sick 
     enough to warrant a doctor's visit.

  The Bedford family enrolled in the Children's Health Insurance 
Program in Maryland. The program is working. Without this legislation, 
we will have to reimpose freezes on enrollments and people will lose 
coverage. It happened in my State. This is a bipartisan bill, and I 
compliment my colleagues for bringing forward a bill that we can get 
enacted into law.
  In Maryland, we started a program on July 1, 1998. About 38,000 
children were enrolled at first, and we are up to 101,000 children 
enrolled today. Maryland will get an increase in this bill from $67 
million to $189 million. We will be able to enroll 42,000 more children 
in the State of Maryland. It is an important program.
  I also compliment the committee for including outreach so that we can 
reach families who don't know how to enroll, or whether they are 
qualified to enroll, so we can get more families and children enrolled 
in the children's health care program.
  Mr. President, I urge my colleagues to take advantage of the 
opportunity that we currently have before us. This is an opportunity in 
which we can make major progress in dealing with those children in our 
community who will either lose their coverage because we take no 
action, and those who currently have no insurance whom we can get 
enrolled in this program. It is a valuable program. We have an 
opportunity to move forward. So I urge my colleagues to support the 
fine effort of the Senate Finance Committee in bringing forward this 
legislation.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri is recognized.


                       Ethics and Lobbying Reform

  Mrs. McCASKILL. Mr. President, I rise today to say I am proud, very 
proud. I came to Washington hoping that we could make a difference in 
terms of the way business is done here. And I will be honest, I had 
some moments of doubt over the last 6 months. There were times that I 
wandered around the floor of the Senate, and even among my own party 
and the other party, and I heard kind of a murmuring of discontent over 
the ethics reform that we passed back in January. I got nervous that we 
weren't serious about it, that we really weren't going to push the kind 
of cleansing of things that we have done in the legislation before us 
on which we are about to vote.
  This isn't hard, what we are doing. We are trying to live like 
everybody else in America. Most Americans don't have a corporation they 
can call for a ride on a jet plane. Most Americans don't have somebody 
who wants to pay for a fancy trip. Most Americans really don't have the 
ability to decide that one group in their State gets money when others 
don't. But we did here. That was wrong.
  That is why I am so proud of this legislation. Is it perfect? No. I 
will wait--probably in vain--for that piece of legislation that we pass 
that is perfect. But because of our process, because of the glorious 
nature of a democracy, it is always a matter of give and take, always a 
matter of finding compromise to find that piece of legislation that can 
get enough votes so that we can send it to the President's desk. That 
is what this process was.
  Now, I have some friends--and, frankly, some people I agree with--on 
the other side of the aisle who are unhappy with some of the provisions 
in this bill. They are willing to look at the bundling provisions, the 
ban on travel and gifts, and the ban on corporate jets. They are 
willing to overlook the revolving door reforms--reforms in terms of 
sneaking provisions into conference bills without them ever being in 
either piece of legislation in the House and Senate, and focus in on 
just the inadequacies of the earmark reform.
  Well, would I have liked it to be a 67-vote point of order rather 
than a 60-vote point of order? Yes, I would have. Would I have wished 
for a system maybe that was even more transparent? Yes. But this is 
major reform. I will tell you that there are a few Senators who do not 
participate in the earmarking process, and I am not here to pat them or 
myself on the back for the fact that we do not do that.
  I will say I think it is interesting that the phrase ``the fox in the 
henhouse'' was used as to the provisions in this bill. You know, there 
is a saying, ``all hat and no cattle.'' Well, I think that maybe this 
is the time to use the phrase ``all foxes and no hens,'' because if you 
step back from this issue of earmark reform, it is not complicated. It 
is pretty easy. As one of the cartoons said, ``We have met the enemy 
and it is us.''
  All we have to do to achieve the transparency that we need is for 
every Senator to put every earmark request that they are making on 
their Web site. I will say it again. All we have to do is have every 
Senator put every earmark request they are making on their own Web 
site. And then it won't be hard to make sure that the chairman of the 
committee or the majority floor leader have, in fact, certified all of 
the earmarks. I am a little offended that there is some assumption that 
these chairmen and the majority leader would go out of their way to not 
tell the public there is a congressionally directed expenditure in the 
bill and will try to hide it. They are going to be caught if they do 
that. It is going to become public.
  Then you will have the kind of accountability that really works 
around here. So I was disappointed when I heard that one of the Members 
of the other Chamber said he thought he could put earmarks in this 
conference report because we needed to vet it. It is not our job to vet 
them. It is not the Parliamentarian's job. They don't have the staff to 
do this. That is the job of the people of the United States because, 
guess what. It is their money.
  This is a strong ethics bill. Even though I was a cosponsor along 
with the Senators who spoke against this on the earmark reform, I want 
to say this goes a long way in the right direction. It is a great 
effort. I am proud of Senator Reid, Senator Feinstein, Senator 
Feingold, Senator Obama, and all of the other Senators who worked on 
this bill, and many on the Republican side have as well. I think we are 
going to pass it by a big number today. It is a moment we should all be 
proud of, an accomplishment we should herald, and we should remember 
that if we are worried about foxes, we ought to check in our own closet 
for that fox outfit before we start pointing the finger at anybody.
  I yield back the remainder of my time.

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