{"database": "openregs", "table": "congressional_record", "rows": [["CREC-2000-12-15-pt1-PgS11816", "2000-12-15", 106, 2, null, null, "OMNIBUS APPROPRIATIONS BILL", "SENATE", "SENATE", "ALLOTHER", "S11816", "S11821", "[{\"name\": \"Edward M. Kennedy\", \"role\": \"speaking\"}]", null, "146 Cong. Rec. S11816", "Congressional Record, Volume 146 Issue 155 (Friday, December 15, 2000)\n\n[Congressional Record Volume 146, Number 155 (Friday, December 15, 2000)]\n[Senate]\n[Pages S11816-S11821]\nFrom the Congressional Record Online through the Government Publishing Office [www.gpo.gov]\n\n                      OMNIBUS APPROPRIATIONS BILL\n\n  Mr. KENNEDY. Mr. President, I expect to support the omnibus\nlegislation that will implement the final appropriations agreement for\nthis Congress because it makes the kinds of investments in education,\nhealth, and work opportunities that are needed by all American\nfamilies. In the long run, only through these basic investments can we\npreserve our capacity to keep our nation strong. I commend my\ncolleagues for their diligence in crafting legislation that respects\nthe highest priorities of the American people. Senator Harkin and\nSenator Specter have shown the power of bipartisan cooperation\nthroughout their work on this legislation. We have all benefitted from\nthe example and leadership of Senator Stevens and Senator Byrd as well.\n  While this legislation is not perfect and certainly is no substitute\nfor the unfinished work of the 106th Congress, it is good for the\nAmerican people, and it shows what is possible when we resolve to work\ntogether. In this sense, it offers considerable hope for the 107th\nCongress.\n\n                               EDUCATION\n\n  In the critical area of education and the nation's schools, this\nappropriations agreement is a resounding victory for parents and\ncommunities across the country. Congress has lived up to its commitment\nto increase education funding. We are taking a giant step forward to\nensure that children across the country receive the support they need\nto succeed in school and to make college more affordable for every\nqualified student. I'm proud to highlight a few of the key education\naccomplishments.\n\n  For the first time, communities across the country will qualify for\nover $1.2 billion in federal aid to address their most urgent school\nbuilding repair needs, such as fixing roofs, plumbing and electrical\nsystems, and meeting fire and safety codes.\n  Schools across the country will receive $1.623 billion, a 25 percent\nincrease over last year, to continue hiring and training new teachers\nto reduce class sizes in the early grades. This year's funding increase\nwill place 8,000 more teachers in classrooms, placing the goal of\n100,000 new teachers well within reach.\n  Teacher quality will improve as well this year. Schools will receive\n$485 million, a 45 percent increase over last year, to help teachers\nimprove their skills through professional development activities,\nreducing the number of uncertified and out-of-field teachers.\n  Title I of the Elementary and Secondary Education Act, which helps\ndisadvantaged students master the basics and achieve to high standards,\nis increased by $506 million, for a total of $8.4 billion.\n  We know that children are most likely to engage in risky behavior in\nthe hours just after school. Congress has responded by increasing\nsupport for after-school programs by 87 percent this year, to $851\nmillion. This increase will help more children stay out of trouble\nafter school and get extra help with their schoolwork.\n  The bill also provides an additional $91 million, for a total of $225\nmillion, to support state and local efforts to turn around low-\nperforming schools.\n  Vocational and technical education programs received $1.240 billion,\na $48 million increase, to improve programs that give students skills\nthey need in order to meet the demands of the new high tech workforce.\n  College students will also receive much needed support under this\nbill. The GEAR UP programs will receive $295 million, an increase of\n$95 million, and TRIO programs will receive $730 million, a $85 million\nincrease, to help more low-income and minority middle and high school\nstudents prepare for college and succeed in college.\n  Of all high school students in Boston, 80 percent of them now are\ntied into colleges. We have 12 different colleges that are tied into\nthe high schools, where they are not just taking the individuals who\nshow promise, which the TRIO Program does and does with extraordinary\nsuccess, but to try to take the whole class together and move the whole\nclass up. It is a relatively new concept and one which has worked very\nsuccessfully in the several pilot areas where it has been tried. We are\nfinding extraordinary response, positive response from colleges that\nengage in this undertaking, and extraordinary response from the\nschools. I think it will be one of the more important programs to\nenhance academic achievement for high school students.\n  This legislation will also enable more undergraduate and graduate\nstudents to pay for college through part-time work assistance because\nthe Federal Work Study program received a $77 million increase.\n  This bill also strengthens Pell Grants, enabling many more students\nto take advantage of them. The maximum grant is increasing by $450--\nfrom $3,300 to $3,750. Because there are so many young people who, even\nthough they are eligible for the maximum Pell Grant, just couldn't make\nit with the lower maximum, this is perhaps the most important\neducational enhancement we have. It recognizes that many children are\nadvantaged in their academic achievement and accomplishment but\ndisadvantaged in the amount of resources they have.\n\n                             Early Learning\n\n  As we strengthen our commitment to quality education at the\nelementary, secondary, and college levels, a strong body of research\nchallenges us to broaden our commitment to education as well. Education\nis a continuum that begins at birth and continues long after\ngraduation. On the birth-to-kindergarten side, we have much work to do.\nFor the sake of each child, the nation, and our education system\nitself, all children must have access to the early learning\nopportunities that will enable them to enter school ready to learn.\n  Today, 12 million children under age five have mothers who work\noutside the home. Yet many of these children are assigned to waiting\nlists instead of quality early learning programs because federal\nfunding isn't adequate to meet existing needs, and more and more\nparents are accepting the responsibility of work under welfare reform.\n\n[[Page S11817]]\n\n In Massachusetts, 14,000 children are wait-listed, as are 200,000\nchildren in California. Today's minimum wage for a full-time worker is\n$10,720 per year. This doesn't begin to cover the cost of quality early\nlearning opportunities, which can be as high as ten thousand dollars a\nyear.\n  All of us remember a number of years ago when the Governors,\nRepublicans and Democrats, met in Charlottesville and announced goals\nfor the Nation in education. Their first goal is to have children ready\nto learn when they enter kindergarten and first grade, to build the\nskills they bring to school. The skills that little children need to\ndevelop as infants and toddlers self-confidence, self-awareness, some\ndegree of self-esteem, inquisitiveness in academics, and, interestingly\nenough, a sense of humor.\n  Eleven years ago, Senator McCain and I introduced the Military Child\nCare Act, which turned military child care into an early learning model\nfor the nation. Today's legislation takes three important steps toward\nbuilding on that success in civilian America.\n  First, it increases federal child care subsidies by 69 percent,\nenabling states to remove 150,000 children from waiting lists next\nyear. This increase was very much patterned upon the child care\ninitiatives of our colleague, Senator Dodd, and I am deeply grateful\nfor his leadership on this issue.\n  Next, this legislation enables 70,000 of the nation's most at-risk\nchildren to participate in Head Start, which is highly regarded because\nit delivers the promise of early learning so effectively. The\nlegislation also begins implementing the Early Learning Opportunities\nAct, which Senator Stevens, Senator Jeffords, and Senator Dodd and I\nsupported over the past two years. This new law provides for parental\neducation and support services, increased collaboration among early\nleaning providers, and incentives to improve the quality of early\nlearning services. Its goal is to help the nation build an effective\ninfrastructure of local councils to help each community evaluate how\nbest to put the research on infant and toddler brain development into\npractice.\n  The Head Start Program, the Early Head Start Program, and the new\nEarly Learning Opportunities Act included in this appropriations bill\nwill improve early learning in important ways. The Carnegie Commission\nand other experts who have studied the development of a child's brain\nin the early years, and made a series of recommendations. With this\nlegislation we are beginning now to follow up on these recommendations\nby investing in children at early ages. That is extremely important.\n  These steps show important momentum toward turning the research on\nchildren's brain development into sensible national policy, and we\nshould build on this momentum in the next Congress. We can learn much\nmore from the military's experience with early learning. We can build\nthese lessons into the Child Care and Development Block Grant when it\nis reauthorized in the next Congress. We can pass additional\nlegislation to turn the current patchwork of federal child care and\nearly learning programs into a seamless structure directed at one\ngoal--quality services to ensure that children enter school ready to\nlearn. We also must continue expanding Head Start until it is available\nto all children who need it.\n\n  The health funding in this bill is also a win for the American\npeople.\n\n                       GRADUATE MEDICAL EDUCATION\n\n  I will now address the excellent work that has been done under the\nbalanced budget act, or BBA, programs, in particular the funding level\nfor pediatric graduate medical education. This is not an area that has\na history of proper federal attention. Last year, it received $40\nmillion and virtually no funding prior to that time.\n  The Medicare Program has provided the funding for the training of\nmuch of the American medical personnel who, without question, are the\nbest trained medical personnel in the country. It was funded through\nthe Medicare system. The area of pediatrics never made it, so these\nchildren's hospitals, which train the majority of pediatricians, had to\nprovide the additional training services and educational services\nwithout the support available to every other physician training\nprogram.\n  That has been significantly corrected with this legislation. There\nare over 50 major children's hospitals across this country that will\nbenefit from this program. We can be sure that as a result of today's\nwork, the part of the medical profession that is focused upon caring\nfor children will be significantly advanced, and I commend the\nappropriators for this.\n  I am particularly pleased with the funding level for pediatric\ngraduate medical education. The legislation allocates $235 million to\nsupport medical education costs incurred by freestanding children's\nhospitals. This figure is nearly a 500 percent increase over last\nyear's appropriation of $40 million, and puts us much closer to fully\nfunding the program.\n  This program was created last year to address the historical\ninequities in federal support for graduate medical education activities\noccurring at independent children's hospitals. Until last year, the\nfederal government has paid for hospital costs related to physician\ntraining from Medicare. However, because children's hospitals generally\ntreat very few Medicare patients, they were historically and\ndramatically underpaid for teaching activities. Prior to enactment of\nthis program, children's hospitals were given just \\1/200\\th of the\nfederal support for teaching activities that other teaching hospitals\nreceived.\n  Children's hospitals, which represent less than one percent of all\nhospitals in the country, train approximately 30 percent of the\nnation's pediatricians and the majority of many pediatric specialists.\nIt is long past time for the federal government to support these\nactivities. Next year, it is my hope that we will achieve permanent,\nfull funding for this essential program.\n  Children's hospitals around the country will benefit from the\nincreased funds in this legislation. It will enable these important\ninstitutions to continue to be regional and national referral centers\nfor children around the country. It will support new and continuing\nresearch activities that benefit children and adults alike. And, most\nimportantly, it will help assure a steady supply of pediatricians and\npediatric specialists to treat the nation's children now and in the\nfuture.\n  With approximately 200 full-time employees in training at any one\ntime, Boston Children's Hospital has the largest teaching program among\nindependent children's hospitals. It has a top-notch faculty, and\nprovides excellent teaching, research and patient care. These funds\nwill assure its continued contribution to health of children in\nMassachusetts, the nation, and the world.\n\n                     NATIONAL INSTITUTES OF HEALTH\n\n  This bill also includes an increase of 13 percent for the National\nInstitutes of Health, raising the NIH budget to more than $20 billion.\nThese new resources will enable NIH to increase its support for the\nmedical research that is urgently needed to develop new cures for the\ndiseases that afflict millions of Americans.\n  Massachusetts is a leader in medical science. It receives more than\none out of every ten dollars that NIH spends on research grants--more\nthan any other state except California--and Boston receives more NIH\ngrant money than any other city in the nation.\n  Last year alone, doctors and scientists in Massachusetts were awarded\nmore than $1.5 billion in research grants from NIH. The new\nappropriations bill will increase this already impressive total by more\nthan $180 million, so that Massachusetts will receive an estimated $1.7\nbillion in NIH research grants in the coming year.\n  NIH supports essential research across the state. In Boston, research\nsupported by NIH very recently discovered an important relationship\nbetween the immune system and the brain that may lead to better\ntreatments for diseases like multiple sclerosis. In Worcester, NIH\nfunds are helping to build a new center for cancer research that will\nbecome a leader in this important field. In Cambridge, NIH will help\nsupport a major new center to study the nervous system, so that we can\nbetter understand brain diseases like Alzheimer's, schizophrenia and\ndepression. NIH grants are essential for funding the basic research\nthat is often considered too risky to be funded by private companies,\nand ensure that the results of this work are available to all\nresearchers.\n\n[[Page S11818]]\n\n  The investment that NIH makes in medical research is the foundation\non which the nation's thriving biotechnology industry is built. More\nthan 250 biotech companies in Massachusetts provide good jobs for\nthousands of professionals across the state, and contribute millions of\ndollars every year to the state's economy. New partnerships between\nuniversities and biotechnology companies form almost every day,\nembarking research ideas from the academic world to be developed\nrapidly into new medical breakthroughs that will improve the health of\npatients across the nation.\n  By helping develop new cures for deadly diseases and by fostering the\nimportant new industry of biotechnology, the renewed commitment to the\nNIH that we make here today is an investment that will pay dividends\nnow and for many years to come.\n\n                       Balanced Budget Reform Act\n\n  This legislation provides ``financial CPR'' for hospitals, home\nhealth agencies, nursing homes, and other important Medicare providers\naround the country. It also takes important steps to improve access to\nhealth care through CHIP and Medicaid, though more is needed.\n  Nearly one million senior citizens and persons with disabilities\ndepend on Medicare to provide high-quality care in Massachusetts. The\nhealth care industry is a critical component of the state economy.\nToday, we are saying that help is on the way.\n  The Medicare, Medicaid and CHIP Beneficiary Improvement and\nProtection Act is the most significant relief package since passage of\nthe Balanced Budget Act in 1997. Medicare spending will total $30\nbillion over five years, and spending for Medicaid and the Children's\nHealth Insurance Program will total $6 billion. In fact, the net cost\nof the entire package is likely to be closer to $15 billion over five\nyears, because of the offsetting effect of savings achieved by a\nforthcoming regulation limiting the ability of states to obtain union\nfunded Medicaid payments.\n  The savings from the Medicaid regulation should be used to expand\ncoverage to low-income populations. I strongly support the provider\nrelief in this package, but I am disappointed that the Republican\nleadership opposed bipartisan efforts to enable states to extend health\nbenefits to low-income pregnant women and children who are legal\nimmigrants, but who would otherwise be eligible for CHIP and Medicaid.\nIn addition, the Republican leadership refused to include the\nbipartisan Grassley-Kennedy Family Opportunity Act, which would have\nenabled children with disabilities to obtain or maintain health\ncoverage through Medicaid.\n\n  Massachusetts providers have estimated that they will receive\napproximately $450 million--close to half a billion dollars--over the\nnext five years as a result of this legislation. While it is the most\nsignificant step Congress has taken to date to restore the unintended\ncuts made by the Balanced Budget Act of 1997, this Congress failed to\nfinish the job, and we will be back at it again in the 107th Congress.\n  The record budget surpluses now and projected for the years ahead are\nlargely due to the savings achieved by cutting Medicare payments in the\nBalanced Budget Act of 1997. Those cuts were expected to total $116\nbillion over five years, and nearly $400 billion over ten years--more\nthan double the amount ever enacted in any previous legislation.\n  In reality, these cuts are now estimated to total $200 billion over\nfive years and more than $600 billion over 10 years. These excessive\ncuts, combined with low payments from private payors and Medicaid\nprograms, have placed many outstanding health care institutions at\nrisk, and threaten quality of care for millions of elderly, disabled\nand low-income Americans.\n  In Massachusetts, two out of every three hospitals are losing money\non patient care. Community hospitals across the state are struggling to\nsurvive. Key providers are questioning whether to participate in HMOs,\nand HMOs are deciding to cut benefits and trim service areas.\n  Twenty-five percent of home health agencies in the state no longer\nserve Medicare patients, and 20 agencies have closed their doors since\nthe BBA was enacted. The remainder see fewer patients, and see them\nless often.\n  Forty-three nursing homes have closed in Massachusetts since 1998.\nOne in four are in bankruptcy. One in seven nursing positions are\nunfilled, because Massachusetts nursing homes are unable to compete for\nstaff.\n  Congress has been slowly restoring these Medicare cuts year-by-year.\nIn 1998, we included $1.65 billion in the FY99 Omnibus Appropriations\nbill for Medicare home health agencies as a stop-gap measure. The\nBalanced Budget Refinement Act of 1999 restored $16 billion over five\nyears. And the legislation we are voting on today takes an even more\nsignificant step toward fixing the problems created by the BBA. But it\ndoes not finish the job. In fact, it contains new cuts for hospitals\nand nursing homes. Clearly, we will need to revisit this issue in the\n107th Congress. There is no need to turn funding for entitlement\nprograms into an annual appropriations process, but that is precisely\nwhat this annual exercise has unfortunately become.\n  In addition to the much-needed provider relief contained in this\nlegislation, it also includes two other important improvements in\nMedicare benefits. First, it requires Medicare coverage of drugs that\nare not usually self-administered by a patient. This change restores\nand preserves coverage for certain drugs that are vital for senior\ncitizens and persons with debilitating chronic illnesses. This\nprovision will ensure that in determining whether a drug is usually\nself-administered, HCFA should only consider whether a majority of\nMedicare patients with the disease or condition actually administer the\ndrug to themselves, reversing a contrary 1997 policy. This improvement\nwill help assure that millions of elderly and disabled Americans have\ncontinued access to life-saving and life-improving drugs.\n  Second, the bill improves coverage for immunosuppressive drugs for\nMedicare patients who have had an organ transplant. These drugs are\nneeded to prevent rejection of the transplanted organ. Assuring\npermanent coverage will improve the quality of life for transplant\npatients, and assure a wiser use of scarce resources and scarce organs\nby helping patients to remain healthy after transplantation.\n\n                           CHIP AND MEDICAID\n\n  This legislation also includes several provisions that are important\nto working families whose children are eligible for CHIP or Medicaid.\n  First, the legislation includes a redistribution mechanism to assure\nuse of the funds allocated to insure low-income children through CHIP\nand Medicaid. The formula is fair, and it allows all states to benefit\nfrom unspent FY98 dollars in a manner that will assure continued\nenrollment of eligible children. Those states that have been slow to\nspend their initial CHIP allocation will now have additional time to\nspend their FY98 funds by reaching out and enrolling more children in\nthese programs. Those states that spent all of their FY98 dollars\nbecause they were able to get their programs up and running early will\nobtain additional funds to continue their momentum. The result is a\nwin-win for America's children.\n  The legislation also enables states to immediately enroll uninsured\nchildren who are potentially eligible for CHIP or Medicaid in the\nproper program, while awaiting confirmation of actual eligibility. This\nstep is important for improving enrollment rates. Unfortunately, the\nbill limits its applicability to children found only through outreach\nin primary and secondary schools. There is bipartisan support for a\nbroader proposal that would have extended presumptive eligibility to a\nvariety of other programs where uninsured eligible children or their\nparents are likely to be identified, including child care resource\ncenters, child support agencies, housing agencies, and homeless\nshelters. We will pursue this and other CHIP and Medicaid outreach and\nenrollment improvements next year.\n  Finally, the legislation extends for one additional year the\nTransitional Medical Assistance program, which allows families who are\nleaving welfare for work to maintain Medicaid coverage during the\ntransition. Most post-welfare jobs do not offer health insurance. We\nmust do all we can to see that ``ending welfare as we knew it'' does\nnot contribute to America's already shameful uninsured rate.\n\n[[Page S11819]]\n\n                   LOW INCOME HOME ENERGY ASSISTANCE\n\n  I'm pleased that this year's final budget agreement includes $1.4\nbillion to help families heat their homes this winter under the Low\nIncome Home Energy Assistance Program. Massachusetts needs this 28\npercent increase in its block grant to help more families cope with\nhigher heating costs this winter. Combined with LIHEAP emergency funds\nthat the Clinton Administration has already made available in\nanticipation of this winter's needs, I am hopeful that the regular and\nemergency LIHEAP funding contained in this budget deal should enable\nlow-income families to heat their homes throughout the winter that is\nalready upon us. I regret that this year's budget agreement does not\ncontain expected advance funding for the winter of 2002, so that\nfamilies can plan ahead for heating assistance next year. I intend to\ndo all I can to see that Congress corrects this omission as part of a\nsupplemental spending bill early next year or as part of the broader\nnational energy policy reevaluation likely to begin in the new\nCongress. For this winter, though, today's budget agreement remains a\nsignificant step forward for LIHEAP and the families who depend on it.\n\n                         NEW MARKETS INITIATIVE\n\n  The New Markets Initiative is another key bipartisan agreement\nincluded in this legislation. I am pleased that the Congress has joined\nPresident Clinton in his efforts to revitalize those communities that\nhave been left behind at this time of record prosperity, and I commend\nSpeaker Hastert for his leadership in reaching this agreement.\n\n  This initiative increases the low-income housing tax credit, which is\nlong overdue in light of its strong bipartisan support. With the\ngrowing regional and national economy, housing prices are rising faster\nin Massachusetts than in any other state. We must increase production\nin new affordable housing units to meet the overwhelming demand, and an\nincrease in the credit is critical. The agreement also accelerates the\nprivate activity bond cap, which will also support increased\ndevelopment of affordable housing, as well as industrial development.\n  The initiative also creates 40 Renewal Communities and 9 new\nEmpowerment Zones--all of which provide tax incentives for development\nin those parts of the country that have struggled while others have\nprospered.\n  Overall, this final budget agreement includes so many major\nachievements--from Class Size reduction to Pediatric Graduate Medical\nEducation to dislocated worker assistance to New Markets development--\nthat the value of each part will only become apparent over time. Yet\neven as we celebrate the progress made by this legislation, we must\nalso recognize that it is only a small part of the work that the public\nexpects us to complete. I share the concern of many of my colleagues\nthat the unfinished agenda of the 106th Congress is so long.\n  We still lack a Patients' Bill of Rights, leaving HMO's free to\nsacrifice families' health needs in favor of their own economic\ninterests.\n  We still lack a prescription drug benefit for seniors, leaving our\nparents and grandparents vulnerable to drug-company extortion for drugs\nthey need to stay alive.\n  We still lack a plan to reduce medical errors, leaving thousands of\nhospital patients to die needlessly each year.\n  We still lack a fair minimum wage, leaving people who work full time\nall year in difficult jobs to raise their children in poverty.\n  We still lack common-sense gun laws, leaving school children\nvulnerable to ambush.\n  We still lack strong laws against hate crimes, leaving the most\nvulnerable people in our society open to the most brutal acts\nimaginable.\n  We still lack basic fairness in many of our immigration laws, leaving\nour proud heritage and noble ideals out in the cold with so many\nhuddled masses.\n  We still lack the most basic protection for women's work, leaving\nmore women to raise their children in poverty because they consistently\nearn less than their male colleagues.\n  We still lack a plan to protect people's privacy in the digital age,\nleaving our medical, consumer, and other personal information exposed\nto market demands.\n  Also left unresolved are major Medicare and Social Security reforms\nthat must be enacted now if we are to avoid a crisis for the seniors of\n2025 and beyond. I also believe that we should still address how to\nprovide some tax relief for many families who bear a particular\nfinancial burden because they need to provide long term care for their\nloved ones.\n  Every item on this list remains of vital importance to the nation. I\nmust elaborate on a several of them.\n  Unfortunately, the leadership of the 106th Congress turned its back\non America's families who are raising children with disabilities. The\nFamily Opportunity Act has sweeping bipartisan support in both\nchambers, including more than three-fourths of the Senate. There is no\nreason that this legislation should not have become law this year.\nAlthough Congress let American families down this year, I look forward\nto working with Senator Grassley again next year to ensure that no\nfamily in this nation has to turn down jobs, turn down raises, or give\nup custody of their disabled child to get the health care each child\ndeserves.\n\n  Few issues touch Americans more deeply than quality health care for\nthemselves and their loved ones. This Congress failed to fulfill its\nresponsibility to act on three great health issues. It did not pass a\nstrong, effective patients' bill of rights to end the abuses of managed\ncare and other insurance programs. It did not provide coverage of\nprescription drugs under Medicare. And it did not significantly expand\ninsurance coverage for the uninsured. Now it is up to the new Congress\nthat will assemble in January to do better. These three issues should\nbe top priorities.\n  Prompt passage of a patients' bill of rights is critical for every\none of the 161 million Americans with private health insurance\ncoverage. Every day that Congress fails to act more patients suffer.\n  A survey by the School of Public Health at the University of\nCalifornia found that every day--each and every day--50,000 patients\nendure added pain and suffering because of their actions of their\nhealth plan. For 35,000 patients, needed care is delayed, or even\ndenied all together. Thirty-five thousand patients have a specialty\nreferral delayed or denied. Thirty-one thousand patients are forced to\nchange doctors. Eighteen thousand patients are forced to change\nmedications because of HMO abuses.\n  A survey of physicians by the Kaiser Family Foundation and the\nHarvard School of Public Health found similar results. Every day, tens\nof thousands of patients suffer serious declines in the their health as\nthe result of the action--or inaction--of their health plan.\n  Whether the issue is diagnostic tests, specialty care, emergency room\ncare, access to clinical trials, availability of needed drugs,\nprotection of doctors who give patients their best possible advice, or\nwomen's ability to obtain gynecological services--too often, in all\nthese cases, HMOs and managed care plans make the company's bottom line\nmore important than the patient's vital signs. These abuses should have\nno place in American medicine. Every doctor knows it. Every patient\nknows it. And in their hearts, every member of Congress knows it.\n  The House passed a Patient Bill of Rights--the Norwood-Dingell bill--\nthat effectively addressed these abuses. A solid bi-partisan majority\nof Congress supported the legislation. It is endorsed by 300 groups\nrepresenting doctors, nurses, patients and advocates for women,\nchildren, and families. But in the Senate, it has been blocked by the\ninsurance industry and the Republican leadership. The new Senate, the\nnew Congress, and the new President have an obligation to pass this\nlegislation into law.\n  This is an issue which hopefully, given the strong voting and\ninterests of our colleagues and their constituents, we will be able to\nresolve in a bipartisan way during the next Congress.\n  The Congress' failure to provide prescription drug coverage to our\nnation's senior citizens is also unacceptable. Senior citizens need a\nstrong drug benefit under Medicare. They earned it by a lifetime of\nhard work. They deserve it. And Congress and the new President owe it\nto them to act.\n  Too many elderly Americans today must choose between food on the\ntable\n\n[[Page S11820]]\n\nand the medicine they need to stay healthy or to treat their illnesses.\nToo many senior citizens take half the pills their doctor prescribes,\nor don't even fill needed prescriptions --because they can't afford the\nhigh cost of prescription drugs.\n  Too many seniors are paying twice as much as they should for the\ndrugs they need, because they are forced to pay full price, while\nalmost everyone with a private insurance policy benefits from\nnegotiated discounts. Too many seniors are ending up hospitalized--at\nimmense cost to Medicare--because they aren't receiving the drugs they\nneed at all, or can't afford to take them correctly. Pharmaceutical\nproducts are increasingly the source of miracle cures for a host of\ndread diseases, but millions of senior citizens are being left out and\nleft behind because Congress fails to act.\n\n  The crisis that senior citizens face today will only worsen if we\nrefuse to act, because insurance coverage continues to go down, and\ndrug costs continue to go up.\n  Twelve million senior citizens--one third of the total--have no\nprescription drug coverage at all. Surveys indicate that only half of\nall senior citizens have prescription drug coverage throughout the\nyear. Coverage through employer retirement plans is plummeting.\nMedicare HMOs are drastically cutting back. Medigap plans are priced\nout of reach of most seniors. The sad fact is that the only senior\ncitizens who have stable, reliable, affordable drug coverage are the\nvery poor on Medicaid.\n  Prescription drug costs themselves are out of control. Since 1996,\ncosts have grown at double-digit rates every year. Last year, the\nincrease was an unacceptable 16 percent, while the increase in the CPI\nwas only 2.7 percent. No wonder access to affordable prescription drugs\nhas become a crisis for so many elderly Americans\n  In the face of this declining coverage and soaring cost, more and\nmore senior citizens are being left out and left behind. The vast\nmajority of the elderly are of moderate means. They cannot possibly\nafford to purchase the prescription drugs they need if serious illness\nstrikes.\n  Fifty-seven percent of seniors have incomes below $15,000 a year, and\n78 percent have incomes below $25,000. Only 7 percent have incomes\nabove $50,000 a year. The older they are, the more likely they are to\nbe in poor health--and the more likely they are to have very limited\nincome to meet their health needs.\n  Few if any issues facing the next Congress are more important than\ngiving the nation's senior citizens the health security they have been\npromised. The promise of Medicare will not be fulfilled until Medicare\nprotects senior citizens against the high cost of prescription drugs,\nin the same way that it protects them against the high cost of hospital\nand doctor care.\n  Despite the gaps in Medicare and the abuses of many private insurance\nplans, those who have insurance coverage from these sources are still\nmore fortunate than the 43 million of their fellow citizens who have no\nhealth insurance at all.\n  It's a national disgrace that so many Americans find the quality of\ntheir health determined by the quantity of their wealth. In this age of\nthe life sciences, the importance of good medical care in curing\ndisease and improving and extending life is more significant than ever.\nDenying any family the health care they need is unacceptable.\n  Every other industrialized society in the world except South Africa\nachieved that goal in the 20th century--and under Nelson Mandela and\nThabo Mbeki, South Africa has taken giant steps toward universal health\ncare today. But in our country, the law of the jungle still too often\nprevails. Forty-three million of our fellow citizens are left out and\nleft behind when it comes to health insurance.\n  The dishonor roll of suffering created by this national problem is a\nlong one.\n  Children fail to get a healthy start in life because their parents\ncannot afford the eyeglasses or hearing aids or doctor's visits they\nneed.\n  A young family loses its chance to participate in the American dream,\nwhen a breadwinner is crippled or dies because of lack of timely access\nto medical care.\n  A teenager is condemned to go without a college education, because\nthe family's income and energy are sucked away by the high financial\nand emotional cost of uninsured illness.\n\n  An older couple sees its hope for a dignified retirement dashed, when\nthe savings of a lifetime are washed away by a tidal wave of medical\ndebt.\n  Even in this time of unprecedented prosperity, more than 200,000\nAmericans annually file for bankruptcy because of uninsured medical\ncosts. And the human costs of being uninsured are often just as\ndevastating.\n  In any given year, one third of the uninsured go without needed\nmedical care.\n  Eight million uninsured Americans fail to take the medication that\ntheir doctor prescribes, because they cannot afford to fill the\nprescription.\n  Four hundred thousand children suffer from asthma but never see a\ndoctor. Five hundred thousand children with recurrent earaches never\nsee a doctor. Another five hundred thousand children with severe sore\nthroats never see a doctor.\n  Thirty-two thousand Americans with heart disease go without life-\nsaving and life-enhancing bypass surgery or angioplasty--because they\nare uninsured.\n  Twenty-seven thousand uninsured women are diagnosed with breast\ncancer each year. They are twice as likely as insured women not to\nreceive medical treatment before their cancer has already spread to\nother parts of their bodies. As a result, they are 50 percent more\nlikely to die of the disease.\n  Overall, eighty-three thousand Americans die each year because they\nhave no insurance. The lack of insurance is the seventh leading cause\nof death in America today. Our failure to provide health insurance for\nevery citizen kills more people than kidney disease, liver disease, and\nAIDS combined.\n  Passage of the CHIP program in 1997 opened the door of health\ninsurance to a large majority of the 10 million uninsured children--but\ntoo many children eligible for CHIP and Medicaid have still not been\nenrolled. Legislation I sponsored with Congressman John Dingell would\nhave substantially increased enrollment of eligible children in CHIP.\nIt would have encouraged states to make more children eligible, and\nwould have provided assistance to the low and moderate income uninsured\nparents of these uninsured children. This legislation received a vote\nof the majority of the members of the Senate, but it was defeated on a\nprocedural motion.\n  Today, our opportunity to end these millions of American tragedies is\ngreater than ever before. Our prosperous economy gives us large new\nresources to invest in meeting this critical need. Recently, some\nRepublicans in Congress have finally joined Democrats in urging our\ncountry to meet the challenge of providing health coverage to the 43\nmillion Americans who are left out and left behind. President-elect\nGeorge Bush and Vice President Al Gore both campaigned on a pledge to\nexpand health insurance coverage for the uninsured. I regret that this\nCongress did not take substantial steps to end this American tragedy,\nbut it should be at the top of the agenda of the new Congress and the\nnew Administration.\n  The minimum wage ranks at the top of the list as well. Our leader, in\na meeting of our Democratic caucus, indicated this afternoon that one\nof his great disappointments in this session is failing to provide an\nincrease in the minimum wage for the 13 million Americans who need and\ndeserve an increase. The last time we increased it was 1997. We have\nhad unparalleled economic prosperity before and since. We have had\nrecord low unemployment. We have had stability in inflation. It is\ninexcusable that we have not increased the minimum wage for these\nworkers. I am strongly committed to working with our colleagues to\naddress that situation in the new Congress.\n  I join our Democratic leader in expressing my deep disappointment in\nthe failure of this Congress to increase the minimum wage. A fair\nincrease is long overdue. It is urgently needed to improve the lives of\nover ten million hard-working, low-wage earners in this country. It is\nshameful that Congress is holding the increase hostage to tax cuts for\nthe wealthy. It is even more shameful that Congress recently acted to\nraise its own pay for the third time\n\n[[Page S11821]]\n\nin four years--yet they have not found time in the past three years to\ngive any pay increase at all to the lowest paid workers.\n\n  The long period of inaction comes at a time when the country as a\nwhole is enjoying unprecedented prosperity--the longest period of\neconomic growth in the nation's history and the lowest unemployment\nrate in three decades. In these strong economic times, Congress should\nnot be acting like Scrooge.\n  Millions of low income workers have dedicated their lives to building\nthis strong economy. Yet, in many cases they have been forced to labor\nfor increasingly longer and longer hours, with less and less time to\nspend with their families, and without sharing fairly in the nation's\nprosperity. Poverty has almost doubled among full-time, year-round\nworkers since the late 1970s--from about 1.5 million then to almost 3\nmillion in 1998--and an unacceptably low minimum wage is part of the\nproblem.\n  Minimum wage employees working 40 hours a week, 52 weeks a year, earn\nonly $10,700 a year--$3,400 below the poverty line for a family of\nthree. At that rate, minimum wage workers now fail to earn enough to\nafford adequate housing in any area of this country. Waitresses,\nteacher's aides, child care workers, elder care workers and all other\nemployees deserve to be paid fairly for the work they do. No one who\nworks for a living should have to live in poverty.\n  By failing to increase the minimum wage, Congress has broken its\npromise to American workers. We are denying them just compensation for\ntheir many contributions to building a strong nation and a strong\neconomy.\n  We have broken our promise to women, since 60 percent of minimum wage\nearners are women.\n  We have broken our promise to people of color, because 16 percent of\nthose who would benefit from a minimum wage increase are African\nAmerican and 20 percent of those who would be helped are Hispanic.\n  We have broken our promise to children, because 33 percent of minimum\nwage earners are parents with children. In America today, 4.3 million\nchildren live in poverty, despite living in a family where someone\nworks full-time, year-round.\n  And we have broken our promise to the American family, because too\nmany parents are required to spend more and more time away from their\nfamilies to make ends meet. On average, Americans are working 416 more\nhours in 1999 then they were in 1979.\n  Each year we fail to act on the minimum wage, families across the\ncountry fall farther behind. As the result of not implementing the\ndollar increase we first proposed three years ago, when the clock\nstrikes midnight on the December 31st, minimum wage workers will have\nlost over $3000 because of the inaction by Congress. Today, the real\nvalue of the minimum wage is now $2.90 below what it was in 1968. To\nhave the purchasing power it had in 1968, the minimum wage would have\nto be at least $8.05 an hour today, not $5.15.\n  We will never give up or give in on this issue, because it is an\nissue of fundamental fairness. We will be back next year with a new\nbill to raise the minimum wage. I hope that the new Congress will act\nas quickly as possible to pass a fair increase that reflects the losses\nsuffered as the result of our shameful inaction this year.\n  President-Elect Bush has emphasized many of these priorities, and I\nlook forward to working with him. The lesson of the legislation before\nus today is that when we fail to consider each other's ideas, only\ngridlock results--but when we work together for the nation's good, the\nresult is the kind of progress that makes us all proud to serve the\nAmerican people.\n  The PRESIDING OFFICER (Mr. Abraham). The Senator from Nevada.\n\n                          ____________________"]], "columns": ["granule_id", "date", "congress", "session", "volume", "issue", "title", "chamber", "granule_class", "sub_granule_class", "page_start", "page_end", "speakers", "bills", "citation", "full_text"], "primary_keys": ["granule_id"], "primary_key_values": ["CREC-2000-12-15-pt1-PgS11816"], "units": {}, "query_ms": 58.32741199992597, "source": "Federal Register API & Regulations.gov API", "source_url": "https://www.federalregister.gov/developers/api/v1", "license": "Public Domain (U.S. Government data)", "license_url": "https://www.regulations.gov/faq"}