Caribbean National Forest Act of 2003

Mr. President, I introduce a bill on behalf of myself, Mr. Chafee, Mrs. Boxer, Mrs. Murray, Mrs. Clinton, Mr. Corzine, and Mr. Lautenberg.

We are very fortunate to live in a democratic nation where we can express our opinions freely. That is what America is all about. We can attempt to influence the policies of our Government and even criticize them without fear of retaliation. We can debate important issues without fear of retaliation by anyone.

One of the most heated debates in the last two decades has been the issue of abortion. People on both sides of the issue feel extremely strong. They have argued, demonstrated, and protested with much emotion and passion. The issue is not going to go away soon. I doubt that one side will be able to suddenly convince the other to drop its deeply held beliefs.

However, there is a need and even an opportunity to find common ground. We can move toward a goal we all share, reducing the number of unintended pregnancies in America. It is possible. And it is necessary to come together and enact effective legislation to prevent unintended pregnancies, reduce the number of abortions performed in this country, and address the unmet health care needs of American women.

We can only find common ground by being honest with each other. We can find not only common ground but also common sense solutions in this legislation which I am introducing entitled ``Putting Prevention First.'' I am pleased that Senators Chafee, Boxer, Murray, Corzine and Lautenberg are joining me as cosponsors of this legislation.

The Putting Prevention First Act will help reduce the staggering rates of unintended pregnancies in America. It will reduce the rate of infection with sexually transmitted diseases, reduce the number of abortions, and improve access to health care for women.

Specifically, the Putting Prevention First Act will: No. 1, end insurance discrimination against women; No. 2, improve awareness and understanding of emergency contraception; No. 3, ensure that rape victims have information about emergency contraception and access to emergency contraception; No. 4, increase funding for the National Family Planning Program; No. 5, provide funding to allow States to implement a comprehensive approach to sexuality education that includes information about both abstinence and contraception; No. 6, expands teen pregnancy prevention programs; and, No. 7 allows States to expand Medicaid family planning services to low-income women without having to apply for a waiver from the Federal Government.

Nationwide, about one-half of all pregnancies are unintended and half of those end in abortion. This is not just a health problem; it is a public health tragedy. But it does not have to be this way. Most of the unintended pregnancies and resulting abortions can be prevented. We must work together to make that happen, we can find a common ground.

One of the most important steps we can take to prevent unintended pregnancies is ensuring that American women have access to affordable, effective contraception.

I have been on national radio call-in shows and talked about legislation I have worked on with Senator Snowe for so many years to provide for contraceptive equity. One time, a woman called and said: I don't believe in contraception. Well, my simple answer to her was: Then don't use them. But don't prevent others who have different beliefs from having the ability to use these contraceptives.

Today, numerous forms of safe and highly effective contraception are

available by prescription. If used correctly, they could greatly reduce the rate of unintended pregnancies.

One of the greatest obstacles to the use of prescription contraceptives by American women is their cost. Women are educated. They know that they work. They simply do not have the money.

Again, on a radio program, a woman called in and said: I have diabetes. I am pregnant. I didn't want to become pregnant. It is not good for me. She said: But my husband's insurance doesn't cover the pill.

It is amazing, but many insurance policies do not cover prescription contraceptives for women. But they do automatically cover tubal ligations, vasectomies, abortions, and other such things that are much more expensive than prescription contraception.

Now, we have made progress. Federal Employees have access to prescription contraception through the Federal Employees Health Benefits Program. But we shouldn't limit this benefit to just federal employees.

We know that women on average earn less than men, and yet they must pay far more than men for health-related expenses. According to the Women's Research and Education Institute, women of reproductive age pay 68 percent more in out-of-pocket costs for medical expenses than men, and, of course, that is largely due to their reproductive health care needs.

Because many women cannot afford the prescription contraceptives they would like to use, many go without. Far too often, this results in unintended pregnancies.

The high cost of prescription contraceptives is not just a problem for the millions of women without health insurance, but also for millions of American women who do have health insurance because many insurance plans that cover prescription drugs do not cover contraceptives. So women are forced to either do without contraceptives or pay for them out of pocket and, as I have given an example or two, many families simply cannot afford it. This is unfair to women and their families and it is a bad policy because it causes additional unintended pregnancies and adversely affects the health of women.

Since 1997, Senator Olympia Snowe and I have worked to remedy this problem. Today, as part of the Putting Prevention First Act, I am again proposing common-sense legislation that has received bipartisan support.

The Equity in Prescription Insurance and Contraceptive Coverage Act-- EPICC, as we call it--requires insurance plans that cover prescription drugs to provide the same coverage for prescription contraceptives. We are not asking for special treatment, only equitable treatment within the context of an existing prescription drug benefit. This legislation is simply the fair thing to do for women.

And making contraception more affordable and more available will enable more women to use safe and effective means to prevent unintended pregnancies. As I said, it is a goal we all share.

Contraceptive coverage is much cheaper than other services, including, as I have said, abortions, sterilizations, and tubal ligations that insurance companies routinely cover. The Federal Employee Health Benefits Program, which has provided contraceptive coverage for several years because of an amendment offered on this floor, has proved that adding such coverage does not increase the cost of a plan.

This commonsense, cost-effective legislation is long overdue. Promoting equity in health insurance coverage for American women, while working to prevent unintended pregnancies and improve the health of women, is by any means the right thing to do.

We should also take additional steps that would improve access to women's health care for poor and low-income women. Public health programs such as Medicaid and title X provide high-quality family planning services and other preventive health care to underinsured or uninsured individuals. Yet these programs are struggling to meet the growing demand for subsidized family planning services without corresponding increases in funding.

The Putting Prevention First legislation would increase the authorization for title X, and it would allow States to expand Medicaid family planning services to women with incomes of up to 200 percent of the Federal poverty level without having to apply to the Federal Government for a waiver.

This commonsense approach has long been championed by Senator Lincoln Chafee. My friend and cosponsor of this legislation knows that contraceptive use saves scarce public health dollars. Every $1 spent on providing family planning services saves an estimated $3 in expenditures for pregnancy-related and newborn care for Medicaid alone.

The Putting Prevention First Act would increase the awareness and availability of emergency contraception, an important yet poorly understood form of contraception. Approved for use by the Food and Drug Administration, emergency contraception pills work to prevent pregnancy, and they cannot disrupt or interrupt an established pregnancy. The emergency contraception pills work to prevent pregnancy, not to interrupt and disrupt a pregnancy. The availability of emergency contraception is very important for women who survive a sexual assault.

I can remember a young woman who worked for me, a teenager. She came to me and said: Could I see you in your office?

I said: Sure. What is the matter?

She said: I was jumped.

She was driving through a part of town alone. Some people pulled her car over and they raped her. I sent her to another friend of mine who is an OB/GYN.

It is difficult to imagine the physical, psychological, and emotional pain endured by a woman who is raped. In addition to the violent attack, she must also worry about the possibility she could become pregnant.

The availability of emergency contraception is important for women who survive a sexual assault. A woman could use emergency contraception in an emergency, such as if she has been raped and doesn't want to become pregnant.

Compassion is a word we have heard a lot from political leaders in recent years. Actions speak louder than words. Surely it would be compassionate to make emergency contraception available to a woman who is raped so she doesn't become impregnated by the thug who brutalized and traumatized her.

The Putting Prevention First Act includes a provision that has been advocated by Senators Corzine and Murray. This provision would require hospitals receiving Federal health dollars to provide information about emergency contraception and make it available to sexual assault survivors who are treated in the emergency room. Simply put, emergency contraception should be made available in an emergency room.

Emergency contraception and emergency rooms go hand in hand. Women who are the victims of rape should be informed of all their options, including emergency contraception.

If they choose that option, it should be available to them right then.

Emergency contraception has been studied extensively and is regarded as a safe and effective method to prevent unintended pregnancies. Its use has been recommended by leading medical authorities, including the American Medical Association and the American College of Obstetricians and Gynecologists. It has been approved by the Food and Drug Administration. An FDA advisory panel has recommended emergency contraception be made available without a prescription. This could prevent 1.7 million unintended pregnancies and 800,000 abortions in America each year.

Unfortunately, however, emergency contraception remains for the most part a well-kept secret. Most of the women who would use this to prevent an unintended pregnancy are unaware of its existence, and they don't know it is available, if it is available. Even many health care providers do not understand what emergency contraception is, how it works, and who can use it.

To reduce unintended pregnancies by raising awareness about emergency contraception, the Putting Prevention First Act includes a provision championed by Senator Murray that will provide funding to develop and distribute information about emergency contraception to public health organizations, health care providers, and the public. I commend Senator Murray and appreciate her allowing me to include this in my legislation.

These are some of the simple but necessary steps we can and should take to prevent unintended pregnancies. We should embrace these measures to protect the health of American women, prevent unintended pregnancies, and reduce abortion. It is time to put prevention first.

I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I rise today to introduce the Capacity to Learn for All Students and Schools (CLASS) Act of 2004, along with Senators Kennedy and Reed, to ensure that all of our students receive the high quality of instruction they need and deserve. We know that teacher quality is the single most important factor in determining the success of our school children. Children who consistently have access to good teachers are more likely to do well academically; those who do not are more likely to fall behind.

As the son of two former teachers, I am well aware of the satisfactions and challenges that accompany a career in teaching. I have been a long-time and strong supporter of our devoted teachers and our public schools. Over the years, I have visited many schools throughout my home State of New Mexico and spoken with countless students and teachers. I frequently have witnessed the dedication of our teachers in preparing young people to lead meaningful and productive adult lives.

So many of us can look back on our own student years and recall a special teacher whose passion for learning ignited a similar passion in us, whose high standards caused us to set higher standards for ourselves, and whose commitment to education provided a model for our own lives. We need to ensure that all children have access to such special teachers. Many other Senators share my interest in this issue, including my colleagues on the HELP Committee. In fact, I am pleased to be introducing this bill along with the Senior Senator from Rhode Island. Senator Reed's PRREP Act is a great complement to the CLASS Act, and I look forward to working with him and other members of the Committee as we proceed toward reauthorization of the Higher Education Act.

The current act authorizes three types of competitively awarded grants: State Grants, Partnership Grants, and Recruitment Grants. The CLASS Act significantly increases funding for these programs, strengthens the provisions of the current law, and expands the learning and teaching capacity of students, teachers, and schools. I want to mention some of our critical educational needs and explain how the CLASS Act addresses those needs.

First, we need to ensure that all teachers are highly qualified, have strong teaching skills, understand scientifically based research and its applicability, and can use technology effectively in the classroom. The preparation afforded prospective teachers must enable them to meet the varied needs of our nation's students, of our schools and institutions of higher education, and of our competitive workforce.

The CLASS Act will address this need in a number of ways. For example, the CLASS Act establishes Academic Teaching Centers (ATCs). The ATCs provide a setting--a model teaching laboratory--for the integration of education and training, research, and evidence-based practice for teacher candidates, university professors, and master teachers. Modeled on academic health centers, ATCs offer prospective teachers with a system of practice-based support at initial levels of preparation, training during the first years of practice, and continued support in maintaining high levels of skill mastery. The ATC provides a clinical setting with an education and research mission, mentorship by expert practitioners, cross-pollination between practice and research, and high-quality services for its K-12 students.

The CLASS Act also authorizes a Professional Development Program (PDP) that encourages states to pursue alignment with National Board for Professional Teaching Standards, a tiered licensure system, multiple career paths, and opportunities for professional growth. The PDP will improve teacher recruitment and retention by increasing the attractiveness of a teaching career, encouraging teachers to enhance their competencies and skills, and reinforcing their efforts to advance in their profession. The CLASS Act also encourages clinical, field, induction, mentoring, and other professional development experiences.

Further, the CLASS Act requires rigorous standards for teacher certification or licensure designed to enhance teacher quality and to ensure that all prospective teachers meet the same high State standards. The act also expands programs that prepare prospective teachers to use advanced technology.

Second, we need to empower teachers and schools to provide access for all students to a high-quality general education curriculum, including minorities, students in high-need schools, and students with disabilities and limited-English proficiency. Our teachers need to be able to provide effective instruction to diverse student populations and to address special learning needs. We also need to recruit new teachers from underrepresented groups and to increase access to certification or licensure for other qualified individuals.

The CLASS Act will address this need by creating Centers of Excellence. The Centers of Excellence will increase minority teacher and principal recruitment, development, and retention. The act will also prepare teachers to provide access to the general education curriculum for all students, including students with disabilities and limited-English proficiency.

Third, we need to enhance the ability of schools, districts, and states to collect, analyze, and utilize data to improve schools and programs and to fulfill the requirements of No Child Left Behind and the Higher Education Act. Good data and data systems are the bedrock on which accountability is built. Yet present data and data systems are too often inadequate to meet the needs of our schools, districts, states, and nation. For example, in 2003 the General Accounting Office reported that states did not have complete or consistent criteria to determine the number of highly qualified teachers and that state data systems did not track the federal criteria.

The CLASS Act will address this need by strengthening accountability through improved assessment procedures that are valid and reliable, are aligned with reporting requirements, and allow for accurate and consistent reporting. The CLASS Act will also require a State-level needs assessment for Teacher Enhancement Grants to identify areas of greatest need and to specify a timetable for meeting identified needs. The needs assessment will assist States to identify teacher production needs in high-need academic subjects, such as mathematics and science; in high-need services, such as special education, bilingual education, and early childhood education; in high-need rural and urban areas; and in high-poverty, high-minority, and low-performing schools.

Further, the CLASS Act will create data systems designed to improve public education, including enhancing teacher preparation programs. State educational agencies can apply for new Data Systems Grants that enable them to develop or expand data systems that have the capacity to integrate and coordinate individual student data from educational and employment settings; to conduct analyses necessary for evaluating programs and policies and identifying best practices; and to facilitate alignment among schools, institutions of higher education, and employment settings. These data systems also allow teacher preparation programs to follow graduates as they proceed toward certification or licensure and into the classroom.

Fourth, we need to improve teacher recruitment and retention. Each year, more of the nation's teachers leave the field than enter the profession. In fact, approximately one-third of teachers leave the field during their first 3 years, and almost half leave during their first 5 years. Moreover, the overall turnover rate for teachers in high-poverty areas is almost a third higher than the rate for all teachers. Some of our schools, such as the rural schools in New Mexico, face unique challenges in recruiting and retaining highly qualified teachers. These challenges include low salaries, geographic and social isolation, housing shortages, poor physical working conditions, a paucity of teacher preparation programs targeted to rural schools, limited opportunities for professional development, and the necessity for teachers to teach more than one grade or subject.

The CLASS Act will address this need in the following ways. Among other initiatives, the act will fund a wide range of teacher recruitment and retention strategies designed to put--and keep--highly qualified teachers in every classroom, including induction

and mentoring for beginning teachers and ongoing opportunities for professional growth and advancement.

Importantly, the CLASS Act will also create the Rural Education Recruitment and Retention Program to address the needs of rural districts by funding a range of recruitment strategies, such as tuition assistance, loan forgiveness, housing assistance, and financial incentives for working in areas of greatest need; as well as retention strategies, such as mentoring programs and ongoing opportunities for professional growth and advancement. In addition, the act encourages partnerships designed to meet the needs of rural schools.

Fifth, we need to better prepare students for postsecondary education and a competitive workforce. According to recent data, a majority of college professors and employers rate high school graduates' skills in spelling, grammar, writing, and math as only fair or poor. Too many students leave high school ill-prepared to meet the requirements of postsecondary education or the demands of high-skilled, high-wage employment. Half of all students entering higher education take at least one remedial course, and, according to the U.S. Chamber of Commerce, employers frequently report difficulty in finding qualified workers who have satisfactory skills. High school graduation requirements are often not aligned with the requirements governing college admission, obtaining a job, or enrolling in credit-bearing courses once in college. High school curricula and assessments often stress different knowledge and skills than are required by college entrance and placement requirements.

The CLASS Act will address this need by creating the data systems described above that are designed to improve public education and to facilitate alignment among schools, institutions of higher education, and employment settings. These systems will have the capacity to integrate and coordinate individual student data from educational and employment settings. The CLASS Act will also support programs that provide special certification in advanced placement (AP)-level or international baccalaureate (IB)-level content and pedagogy.

In conclusion, I would like to say that I am very pleased to introduce a bill designed to ensure that all of our students are taught by highly qualified and effective teachers. No task is more important.

Each child who falls behind diminishes the power of our society's future. I hope you will all join me in reinforcing our national commitment to teacher preparation and teacher quality.

I ask unanimous consent that the text of the bill and a summary be printed in the Record.

Mr. President, today, I am being joined by Senator Blanche Lincoln in introducing the Medicare Prescription Drug Improvement Act (MEND) of 2004, which aims to make various improvements to the recently enacted Medicare Prescription Drug, Modernization, and Improvement Act of 2003 (H.R. 1).

I said when we passed H.R. 1 that we could do better for seniors and that I would keep pushing to improve the Medicare drug bill. This bill is an important first step in that effort. It provides a better, more stable prescription drug benefit and lowers the costs of drugs for seniors. It also removes the giveaways to health plans and it will reduce the deficit. In short, this bill is a win for seniors, a win for good government, and a win for taxpayers.

I supported the new Medicare law, but this was not an easy decision. While this legislation takes important steps to add a drug benefit to the Medicare program and makes needed provider payment reforms, this legislation has many flaws that must be addressed. The legislation I am unveiling today takes steps in this direction.

Before I describe this new effort, I'd first like to highlight why I believe supporting the Medicare bill was the right decision, particularly for Medicare beneficiaries in my home State of North Dakota.

The first--and most basic--reason I supported this legislation is because it takes critical steps to add a drug benefit to the Medicare program. This benefit will provide America's seniors--for the first time--the opportunity to receive help with their medication costs. If seniors are satisfied with their current health care coverage, they do not have to sign up for this new benefit. But if they need extra help covering their prescription costs, the new Medicare drug benefit offers an important coverage option.

The second major reason I supported this legislation is because it provides a very generous benefit for lower-income seniors with incomes below 150 percent of the Federal poverty. Under the legislation, about 40 percent of seniors in North Dakota will get the vast majority of their drugs covered, with minimal out-of-pocket costs. This extra assistance will make a critical difference to lower-income seniors in my State, many of whom have told me that they are often faced with the choice of paying for their medicines or paying for food, rent and other living costs. In my view, this is a choice that no senior citizen should be forced to make. The legislation we passed took important steps to address this problem.

In addition, the Medicare drug benefit will provide substantial assistance to those with catastrophic drug costs. Specifically, after a beneficiary spends $3,600 out-of-pocket, Medicare will pick up 95 percent of the cost. This catastrophic coverage is an important component of the bill, which we estimate will help nearly 11 percent of North Dakota seniors better afford high-cost medications.

As we move forward on implementing this new benefit, it is my strong hope that it will improve health care coverage for the millions of seniors across the Nation who are struggling to afford life-saving and life-enhancing medications.

Finally, another major reason that I supported the Medicare bill is that it includes a whole host of rural provider payment reforms that I authored along with Senator Craig Thomas from Wyoming and Representative Earl Pomeroy from my State of North Dakota. These measures take important steps to address payment disparities that were causing rural health care providers to receive significantly less reimbursement than their urban counterparts. Over the next 10 years, these payment changes will improve funding to the rural health care system by more than $20 billion. It is my hope that these important provisions will help ensure health care providers can continue offering quality and affordable health care services to rural communities in my State and across the Nation.

Those are positive aspects of the recently enacted Medicare legislation. But, as I said when we passed it, the bill also had a number of significant flaws. The bill I am introducing today addresses these flaws and makes some important improvements to the new Medicare law.

To be clear, my new legislation does not include every change I would like to make to the Medicare law. To do that, we would need to spend hundreds of billions of dollars. Given the Federal budget deficit we are facing, this is simply not possible.

But it is possible to make some common-sense improvements to the bill. And that is what my legislation does. Let me describe it in further detail.

The first area of my bill will include new measures to reduce the costs of prescription drugs. We know that drug costs have skyrocketed over the last few years. This is a real problem for seniors and others across the Nation who are having increasing trouble affording their medications.

It is also a problem for the Medicare program, which will face increasing cost pressures when we add the new drug benefit. Given this situation, we must take steps to reduce and control drug costs. My legislation would do that in two ways.

First, it would allow pharmacists and licensed wholesalers to reimport less expensive drugs from Canada. The Medicare bill gives the Department of

Health and Human Services authority to allow this reimportation, but it put roadblocks in place that will effectively ensure reimportation never happens.

My bill would remove these roadblocks and allow reimportation to begin immediately. If at any time a reimported drug is found to be unsafe, the Secretary would have authority to immediately suspend reimportation of this product.

The second thing my bill would do to reduce costs is to allow the Secretary of HHS to negotiate with drug companies to lower the costs of medications in the new drug benefit.

As my colleagues know, the Medicare law specifically prohibits the Secretary from directly negotiating with pharmaceutical companies to lower drug prices. We know that allowing the government to negotiate in other programs, like the VA, has significantly lowered costs. There's no reason we shouldn't also allow it in the new Medicare drug benefit.

In addition to taking steps to reduce drug costs, my legislation also includes measures to improve the stability of the Medicare drug benefit.

Under the new Medicare benefit, I am concerned that seniors may face different drug costs, different drug formularies, and different approved pharmacies as they switch from plan-to-plan every year. If we know anything, we know that seniors want certainty.

One way to fix this is to allow seniors to stay in the drug plan of their choice for more than 1 year--even if it is a ``government fallback plan.'' My legislation includes this change.

Another shortfall of the new Medicare law is that it prohibits seniors from purchasing supplemental insurance to assist with costs not covered by the new benefit. My legislation would lift this restriction and give seniors another choice for covering their medication costs.

Beyond that, my legislation also includes new measures to ensure seniors retain access to the local pharmacy of their choice. In many communities, the local pharmacist is the most accessible source of health care services. Given this, my bill contains measures to protect local pharmacy services.

Specifically, it would require that the Medicare program allow seniors to go to their local pharmacy to get their prescriptions filled, rather than forcing them to receive their drugs by mail-order or forcing them to go to a pharmacy in a nursing home or hospital that may not be as accessible. My hope is that this provision would ensure that seniors can continue to visit their local pharmacist.

My legislation would also authorize $500 million that could be used to help pharmacists cover the costs of educating seniors about the new drug plan choices. This funding would provide pharmacists a one-time payment for providing information to seniors as they enroll in the new benefit.

My bill also includes other measures to provide seniors with better information about the new drug benefit. Specifically, it would require drug plans to provide seniors with detailed information about what drugs will be covered--before the seniors signs up. It also would require that plans inform seniors of any changes to these covered drugs--either through the telephone, by mail or on the Internet.

My legislation would also take other steps to protect seniors by repealing the premium support demonstration project that is set to begin in 2010. Although seniors will be able to choose whether they want to enter private plans under this demonstration, I believe it is a step in the wrong direction toward privatizing the program and could drive up premiums for those in fee-for-service. Given this, my bill will repeal this privatization demonstration.

Finally, my bill includes additional measures that will help reduce spending and protect the financial integrity of the Medicare program.

In particular, the legislation will include measures to expand the chronic care management demonstration project in the Medicare law.

Today, roughly 5 percent of seniors account for about 50 percent of the entire Medicare budget. The Medicare law will test providing coordinated care to these beneficiaries, which many believe will help improve quality of care and reduce costs. My legislation will build on this effort by providing additional resources to expand chronic care management to more areas of the country. I believe this will save money for Medicare and improve health outcomes for these seniors.

Finally, my new legislation will eliminate provisions in the Medicare law that provide unfair, extra payments to private plans. Specifically, it will repeal a new $8.9 billion taxpayer subsidy to bring more private plans into the market. It will also address inequities that currently allow HMOs to receive significantly higher payments than traditional Medicare--for serving the exact same patient. These policies are simply a waste of money.

According to unofficial estimates by the Congressional Budget Office, eliminating these private plan overpayments could result in significant cost savings. Under my plan, these cost savings would be used to reduce the Federal budget deficit, which has reached record levels this year.

This is a basic overview of the provisions that will be included in my new legislation--the Medicare Prescription Drug Improvement Act (the MEND Act).

I believe this legislation will take significant steps toward improving the new Medicare law. I would like to thank Senator Lincoln for joining me in this effort and I look forward to working with my colleagues on this important legislation.

Mr. President, I rise today along with my colleagues, Senators Lautenberg, Stabenow, and Mikulski, to introduce legislation, the Preserving Access to Affordable Drugs (PAAD) Act. This legislation is essential to ensuring that no senior who has existing prescription drug coverage receives less coverage once the Medicare prescription drug program goes into effect.

The Congressional Budget Office has estimated that as many as 1.7 million retirees could lose their employer-based prescription drug benefits as a result of the new Medicare prescription drug benefit. Also as a result of the new law, hundreds of thousands of seniors currently enrolled in state pharmacy assistance programs (SPAPs) will be forced out of those programs and into a private Medicare drug plan. Additionally, approximately six million seniors who are dually eligible for Medicare and Medicaid will lose access to their Medicaid prescription drug benefits, which are more generous and provide greater access to a variety of drugs than the Medicare benefit will. And, despite the fact that the new Medicare law has huge gaps in coverage, seniors who choose to enroll in the new drug benefit will be prohibited from purchasing Medigap coverage to pay for prescription drugs not covered by the new Medicare benefit.

No senior should be made worse off by the new Medicare law. The law should expand benefits--not rescind them. The PAAD Act will make critical changes to the Medicare law to ensure that the above-mentioned benefits are safeguarded.

First, the PAAD Act will preserve retiree prescription drug benefits by allowing employer contributions to count towards the out of pocket threshold. Under the Medicare law, retirees with employer-based coverage would receive less of a subsidy from Medicare than seniors without such coverage. This lower subsidy creates a disincentive to employers to continue to provide these benefits and will lead to a significant reduction in employer-based benefits. The PAAD Act will ensure that employer-based plans receive the same subsidization as the Medicare prescription drug plans.

Second, the PAAD Act will restore language that I added to the Senate-passed Medicare bill to allow states with pharmaceutical assistance programs to administer the Medicare prescription drug benefit to Medicare beneficiaries enrolled in these programs. This will ensure a seamless transition for these seniors and will ensure that they maintain the generous prescription drug coverage that many states, including New Jersey, offer.

Third, the PAAD Act will enable states to supplement the Medicare prescription drug benefit for the neediest Medicare beneficiaries, those dually-eligible for the Medicaid program. Under current law, Medicaid wraps around Medicare, paying for copayments and premiums, for those beneficiaries who are extremely sick and poor. Under the new Medicare law, states will be prohibited from using Medicaid to wrap around the Medicare drug benefit for these seniors, stripping them of access to needed prescription drugs. The PAAD Act will ensure that states can provide supplemental Medicaid prescription drug coverage to complement the Medicare drug benefit for seniors who are dually eligible for Medicare and Medicaid.

Fourth, the PAAD Act will restore seniors' access to supplemental drug benefits through the Medigap program. Seniors should be allowed to improve the Medicare drug benefit if they so choose.

Finally, the PAAD Act will also eliminate the risky demonstration program to privatize Medicare, a program which if not eliminated is likely to impact my state of New Jersey. Under the new Medicare law, seniors who live in areas where a large number of seniors are enrolled in Medicare managed care plans could end up in this privatization scheme. This new program is slated to go into effect in 2010. But, if it were to go into effect today, Gloucester, Burlington, Camden and Salem Counties in New Jersey would likely be chosen to participate in it.

One of the goals of medicine is to do no harm. The new Medicare law violates that tenet. My legislation is critical to preserving and protecting existing prescription drug coverage while expanding it to those who currently lack such coverage. I look forward to working with my colleagues to pass this legislation and improve prescription drug benefits for all seniors.

Mr. President, I rise today to introduce legislation, the Safe Healthcare Reporting (SHARE) Act, which Senator Lautenberg and I have developed to add nurses and other licensed health care professionals to the National Practitioner Databank.

In 1986, Congress passed legislation that established a national databank, the National Practitioner Databank (NPDB), to track licensing, disciplinary, and medical malpractice actions taken against U.S. physicians. While the NPDB has served as an important source of information on physicians, it fails to incorporate critical information on millions of non-physician licensed health care professionals, including nurses.

The recent case of Charles Cullen, a New Jersey nurse who has claimed responsibility for as many as 40 murders carried out at multiple hospitals in New Jersey and Pennsylvania over the last decade, has highlighted the need for a national reporting system on nurses and other licensed health professionals. As the health care workforce becomes increasingly mobile, such a system would be an invaluable resource to health care employers seeking information on potential employees.

The SHARE Act will help break the chain of silence currently plaguing our health care system. This chain of silence prevented critical employment history on Cullen--including five firings and at least one suspension--from ever reaching his future employers. While Charles Cullen kept killing people, hospitals kept hiring him. They didn't know his history. They didn't understand the risk he posed to patients. This is because hospitals and other employers are reluctant to share employee information because they are afraid of being sued.

The goal of our legislation is to make sure that hospitals know--to make sure that employers have access to critical information on health care practitioners. It will ensure that adverse employment actions, licensing and disciplinary actions, and criminal background information are available to all health care employers. The SHARE Act mandates that hospitals and other health care entities report adverse employment actions taken against employees who violate professional standards of conduct. This would include things like drug diversion and falsification of documents.

Importantly, the legislation protects health care employers from suit when they, in good faith, report information that they believe is truthful. Any employer who reports false information in an effort to smear a nurse's record would receive no protection under our bill. In fact, anyone who abused the information reported to the databank would be fined by the Federal Government.

Health care employers, such as hospitals and nursing homes, would be required to report to the National Practitioner Databank, which currently provides such information on physicians. They would also be required to report to the appropriate state licensing board. In turn the State licensing board would report the results of its investigations and licensing or disciplinary actions to the databank. The legislation also encourages nurses and other health care professionals to report suspected activities to state boards by providing whistleblower protections to those individuals.

The SHARE Act also ensures that a practitioner who is subject to reporting is informed of the report, offered a hearing on the issue, and allowed to comment on the report.

I believe that this legislation is a critical first step toward improving access to important information on our health care workforce. Since 1986, the Federal Government has required hospitals to report employment information on physicians. It's time we include nurses and other health care professionals that provide direct patient care. In fact, the average nurse spends more time at a patient's bedside than the patient's physician. We simply must ensure that the person at the bedside is competent and professional.

I look forward to working with my colleagues on both sides of the aisle to move this bill through Congress and get it to the President's desk. We must and we can improve patient safety and the integrity of our health care system. This bill takes an important step toward that goal.

Mr. President, I rise today to introduce the Preparing, Recruiting, and Retaining Education Professionals Act of 2004 to ensure high quality preparation, induction, and professional development programs for teachers, early childhood education providers, principals and administrators in order to improve learning and achievement for all students.

As Congress turns to the reauthorization of the Higher Education Act, we need to increase support for prospective, new, and experienced educators in early childhood education programs, elementary schools, and secondary schools.

My legislation challenges teacher preparation programs to make improving student achievement the engine that drives all activities, training, and support for teachers. The goal here is not to be punitive but to put students and their achievement first.

We know that strong teaching skills make a difference. Studies have shown that students who attend classes taught by high-quality teachers perform significantly better on assessments. The No Child Left Behind Act requires that all teachers be highly qualified. To be so deemed, in general, a teacher must hold a bachelor's degree, be fully certified by a State, and demonstrate content knowledge of the subjects taught by the 2005-2006 school year. New teachers must meet this standard now. Yet, according to the U.S. Department of Education, only 54 percent of our Nation's secondary school teachers were highly qualified during the 1999-2000 school year. The percentage of highly qualified teachers varies widely by State and by subject matter. For example, a 2003 survey by the Council of Chief State School Officers found that only my home State of Rhode Island, Nebraska, New Jersey, North Dakota, and Minnesota have more than 80 percent of their math teachers with college majors in math and full certification. Seven States report having more than 10 percent of their teachers on waivers; that is, teaching with emergency, temporary, or provisional licenses.

The Preparing, Recruiting, and Retaining Education Professionals Act modifies and strengthens the current State, partnership, and recruitment grants contained within title II of the Higher Education Act to focus on improving teaching skills of prospective, new, and experienced teachers and early childhood education providers as well as improving the capacity of principals to provide instructional leadership and classroom support for teachers.

My legislation ensures States hold institutions of higher education and entities that provide alternative routes to State certification equally accountable for preparing highly qualified teachers and highly competent early childhood education providers via reforms to ensure preparation program effectiveness. The goal is to provide teachers and early childhood education providers the scientific knowledge of teaching skills needed to understand and respond effectively to diverse student populations, including students with disabilities, limited- English proficient students, and students with different learning styles or other special learning needs; the ability to integrate technology into the classroom; strategies to effectively use assessments to improve instructional practices and curriculum; and an understanding of how to communicate with and involve parents in their children's education.

The Higher Education Act's existing partnership grants are strengthened by improving the effectiveness of the teaching skills and learning practices taught through inclusion of academic departments such as psychology, human development, or one with comparable expertise in the disciplines of teaching, learning, and child and adolescent development. Partnerships are expanded to include pre-service clinical, field, or practicum components whereby the prospective teachers receive close supervision and mentoring. A residency program would be created to provide ongoing training support during new teachers' first 3 years. Professional development opportunities would have to be provided for experienced teachers to encourage continual retraining to further their skills. Managerial skill development is also included to improve the capacity of principals to provide instructional leadership and classroom support for teachers.

The time for action is now because too few of the teachers that we have prepared choose to enter the schools and stay. According to the National Commission on Teaching and America's Future, after 3 years, 33 percent of beginning teachers have left teaching and after 5 years, 46 percent have left. Not surprisingly, the turnover rate in high poverty schools is approximately one-third higher than the rate for all teachers. During the 1999-2000 school year, 232,000 new teachers were hired, but schools lost more than 287,000--a net loss of 24 percent. Teacher attrition undermines teacher quality and drives teacher shortages. Investing in the preparation of our educators and their continued professional development is critical for addressing these needs which, in turn, will improve outcomes and results for all children.

One of the primary reasons for such high attrition, according to the Commission, is the lack of support once a teacher is hired. Approximately one-third of those teachers who expressed dissatisfaction cited poor administrative support, a lack of faculty influence and inadequate planning and collaboration time. By providing mentoring and support during the pre-service experiences, the early years of teaching, and through ongoing professional development opportunities for experienced teachers, we can substantially reduce the terrible turnover rates that our Nation experiences.

There are also extensive teaching vacancies in schools nationwide. The General Accounting Office has found that 23 of 37 State officials reported teacher shortages in high-need subject areas such as mathematics, science, bilingual education and special education.

My legislation focuses recruitment activities where high teacher turnover and shortages exist, where there is great difficulty meeting academic standards, or where there is great difficulty demonstrating that teachers are highly qualified. The grants also allow funds for outreach to encourage recruitment in inner city and rural areas.

The State, partnership, and recruitment grants are currently funded at only $90 million a year--far too little of an investment for this critical enterprise. The stakes are too high, not just in terms of meeting the highly qualified requirements of No Child Left Behind, but for real kids in real classrooms. My bill significantly boosts this funding, authorizing $500 million for these vital programs.

The PRREP Act is supported by a diverse array of education organizations, including the American Association of Colleges for Teacher Education, American Psychological Association, Center for Civic Education, Council for Exceptional Children, Higher Education Consortium for Special Education, National Association of Elementary School Principals, National Association of Secondary School Principals, National Association of State Directors of Special Education, National Association for the Education of Young Children, National Council of Teachers of English, National Council of Teachers of Mathematics, National Science Teachers Association, and National PTA.

I urge my colleagues to join me in this essential endeavor by cosponsoring this legislation and working for its inclusion in the reauthorization of the Higher Education Act.

I ask unanimous consent that the text of this legislation be printed in the Record.

Additionally, I am pleased to be joining Senator Bingaman, who is introducing the CLASS Act. This legislation shares the PRREP Act's spirit of improving teacher preparation and therefore, student achievement. In addition to encouraging the development of data systems to measure teacher quality, the CLASS Act authorizes pilot studies to evaluate the impact of teacher preparation programs on student achievement and to identify the specific practices that result in achievement gains. The legislation also seeks to improve minority teacher recruitment and retention.

The PRREP Act, Senator Bingaman's bill, and the bill we joined Senator Kennedy in introducing last year--S. 1793, the College Quality, Affordability, and Diversity Improvement Act--will all go a long way toward ensuring the high quality preparation, induction, and professional development that our Nation's educators--and students-- deserve.