Veterans Prescription Drugs Assistance Act

Mr. President, I rise today with my colleague, Senator Mike DeWine, to introduce legislation designed to prevent our nation's children and youth from succumbing to the dangers associated with underage alcohol use. The legislation that we introduce today, the STOP (Sober Truth On Preventing) Underage Drinking Act, will greatly strengthen our Nation's ability to combat the too often deadly consequences associated with underage drinking.

An initial examination of the problems presented by underage drinking is truly alarming. Alcohol is the most commonly used drug among America's youth. More young people drink alcohol than smoke tobacco or use marijuana combined. In 2002, 20 percent of eighth graders had drunk alcohol in the previous 30 days. Forty-nine percent of high school seniors are drinkers, and 29 percent report having had five or more drinks in a row, or binged in the past 2 weeks.

Tragically, we know that this year underage drinking will directly lead to more than 3,500 deaths, more than two million injuries, 1,200 babies born with fetal alcohol syndrome and more than 50,000 youths treated for alcohol dependence. We also know that the social costs associated with underage drinking total close to $53 billion annually, including $19 billion from automobile accidents and $29 billion from associated violent crime.

And while no one can argue with the tragic loss of life and significant financial costs associated with underage drinking, too few of us think of the equally devastating loss of potential that occurs when our children begin to drink. Research indicates that children who begin drinking do so at only 12 years of age. We also know that children that begin drinking at such an early age develop a predisposition for alcohol dependence later in life. Such early experimentation can have devastating consequences and derail a child's potential just as she or he is starting out on the path to adulthood. The consumption of alcohol by our children can literally rob them of their future.

The truly alarming and devastating effects of underage alcohol use are what initially led Senator DeWine and I to begin work to address this important issue. Over the last few months we have worked extensively with Representatives Roybal-Allard, Wolf, DeLauro, Osbourne and Wamp to craft the broad legislative initiative that we introduce today.

The STOP Underage Drinking Act creates the framework for a multifaceted, comprehensive national campaign to prevent underage drinking. Specifically, the legislation includes four major areas of policy development. First, the STOP Underage Drinking Act authorizes $2 million to establish an Interagency Coordinating Committee to coordinate all Federal agency efforts and expertise designed to prevent underage drinking. Chaired by the Secretary of Health and Human Services, this committee will be required to report to the Congress on an annual basis the extent to which Federal efforts are addressing the urgent need to curb underage drinking.

I am particularly pleased that one of the many items in this annual report to Congress will provide for the public health monitoring of the amount of alcohol advertising reaching our children. I have become increasingly concerned about the degree to which alcohol advertisements appear to target our Nation's children. It is my hope that the monitoring called for by this legislation will expose any unethical advertising practices that reach children. We must do all that we can to ensure that our children are not exposed to harmful and deceptive alcohol promotions.

In addition to the Federal coordination of Federal underage drinking prevention efforts, the STOP Underage Drinking Act additionally authorizes $1 million to fund an adult-oriented National Media Campaign against Underage Drinking. Research indicates that most children who drink obtain the alcohol from their parents or from other adults. The National Media Campaign against underage drinking will specifically seek to educate those who provide our children with alcohol about the dangers inherent in underage alcohol use. This media campaign will build upon the valuable underage drinking prevention efforts begun last year by the Ad Council, whose campaigns average an estimated $28 million in donated media from media outlets nationwide.

The legislation additionally authorizes $10 million to provide States, not-for-profit groups and institutions of higher education the ability to create statewide coalitions to prevent underage drinking and alcohol abuse by college and university students. This section will also provide alcohol-specific enhancement grants through the Drug Free Communities Program.

Lastly, the STOP Underage Drinking Act authorizes $6 million to expand research to assess the health effects of underage drinking on adolescent development, including its effect on the brain. This effort will additionally increase Federal data collection on underage drinking, including reporting on the types and brands of alcohol that kids consume.

I want to convey my belief that this legislation truly offers a historical, first step toward addressing the national tragedy represented by underage drinking. I pledge to work strenuously toward passing the STOP Underage Drinking Act and building on its strong foundation and I ask for the support of my colleagues for this critically important initiative.

Mr. President, I rise today with Senators Cochran, Durbin and Feingold to introduce The International and Foreign Language Studies Act of 2004.

In recent years, foreign language needs have significantly increased throughout the Federal Government due to the presence of a wider range of security threats, the emergence of new nation states, and the globalization of the U.S. economy. Likewise, American business increasingly needs internationally experienced employees to compete in the global economy and to manage a culturally diverse workforce.

Currently, the U.S. government requires 34,000 employees with foreign language skills across 70 federal agencies. These agencies have stated over the last few years, that translator and interpreter shortfalls have adversely affected agency operations and hindered U.S. military, law enforcement, intelligence, counter-terrorism and diplomatic efforts.

Despite our growing needs, in the 2000-01 school year, the number of undergraduate foreign language degrees conferred was only one percent of all degrees. In 2003, only 41 percent of undergraduates reported taking foreign language courses while only 18 percent reported having studied abroad. And yet, 79 percent of Americans believe that students should study abroad sometime during college.

At a time when our security needs are more important than ever, at a time when our economy demands that we enter new markets, and at a time when the world requires us to engage in diplomacy in more thoughtful and considered ways, it is extremely important that we have at our disposal a multilingual, multi cultural, internationally experienced workforce. The Dodd-Cochran International and Foreign Language Studies Act attempts to provide us with this.

The Dodd-Cochran International and Foreign Language Studies Act will increase undergraduate study abroad opportunities as they relate to programs designed to enhance foreign language proficiency and deepen cultural knowledge. The Dodd-Cochran bill will reinstate undergraduate eligibility for Foreign Language and Area Studies Fellowships. The Dodd-Cochran bill will encourage the Department of Education to engage in the collection, analysis and dissemination of data on international education and foreign language needs so that we know and understand exactly what our needs in this area are. And, most importantly, the Dodd-Cochran bill will demonstrate our nation's commitment to increasing the foreign language proficiency and international experience of our electorate by increasing the amount appropriated to international education within the Higher Education Act to $120 million each year.

The Higher Education Act authorizes the Federal Government's major activities as they relate to financial assistance for students attending colleges and universities. It provides aid to institutions of higher education, services to help students complete high school and enter and succeed in postsecondary education, and mechanisms to improve the training of our emerging workforce. This bill will help fulfill that mission.

Foreign language skills and international study are vital to secure the future economic welfare of the United States in an increasingly international economy. Foreign language skills and international study are also vital for the nation to meet 21st century security challenges properly and effectively, especially in light of the terrorist attacks on September 11, 2001.

I hope our colleagues who are not cosponsoring this bill will give it serious consideration. By working together, I believe that the Senate as a body can act to ensure that we strengthen our Nation's security and economy by capitalizing on the talents and dreams of those who wish to enter the international arena.

Mr. President, I rise today with Senators Stabenow and Lautenberg to introduce the Getting Results for Advanced Degrees (GRAD) Act.

The percentage of individuals pursuing graduate education has increased dramatically in recent decades as individuals seek the education and skills needed to participate in a technologically complex and global economy. In the last 25 years alone, graduate enrollment in the United States has increased by 39 percent. In the fall of 2000, there were 1.85 million graduate students enrolled in American schools.

The economic benefits of graduate education are significant. The median earnings of workers who possess a graduate or professional degree are more than 3\1/2\ times those of high school dropouts.

Despite the impact of graduate education on individuals' economic well being, and on the economic strength of our national economy as a whole, graduate education is, for many, financially out of reach. In 2001-02 the average graduate school tuition at public institutions was $4,491 and $15,233 at private institutions. In a 2002 borrower's survey, the average debt reported by graduate students was $45,900. This is an astounding figure.

To respond to the need for a highly educated workforce, I have put together a series of proposals that will make graduate education more accessible and affordable to qualified applicants regardless of income level, the Getting Results for Advanced Degrees Act (GRAD). The purpose of the GRAD Act is to encourage students to pursue graduate education and to assist them in affording it.

Specifically, the GRAD Act increases the authorization level of the Graduate Assistance in Areas of National Need (GAANN) program to $50 million and the Jacob Javits Fellowship Program to $35 million. The GAANN fellowship program helps to support graduate study in areas of national need such as chemistry, computer and information science, engineering, mathematics and physics. The Jacob Javits Fellowship Program helps support graduate study in the arts, humanities and social sciences.

To encourage greater participation by minority students in graduate studies, the Act creates the Patsy T. Mink Fellowship Program to offer assistance to underrepresented minority students pursuing a doctoral degree. The Patsy T. Mink Fellowship Program will help address the important problem of underrepresentation of students from certain minority groups in graduate education.

To help students afford the costs of graduation education, the GRAD Act expands the tax-exempt status of scholarships to treat reasonable room and board allowances as part of permitted higher education expenses. The Act revises the cost of attendance calculations for financial aid for students with dependents to reflect the true cost of living expenses for themselves and their children. The Act increases the amount of earnings students can set aside without having to apply those earnings to the cost of attendance. The GRAD Act also increases the unsubsidized Stafford loan limit for graduate and professional students from $10,000 to $12,500 so they are less likely to have to turn to more expensive private loans.

The Getting Results for Advanced Degrees Act will help students meet the financial challenges faced in pursuing graduate studies. The Act strengthens programs that support graduate students in areas of vital importance to our Nation and makes assistance available to underrepresented minority students pursuing a doctoral degree. By helping students to pursue and afford graduate education, the GRAD Act will help individuals, families and the nation as a whole, realize the important benefits of graduate education.

I hope more of my colleagues will join me in support of graduate education by signing on this bill. By working together, I believe that the Senate as a body can act to ensure that more individuals are able to pursue graduate education and assist our Nation in meeting the challenges faced in a global economy.

Mr. President, it is often said that small things can make a very large difference in our society. That saying certainly fits the subject I have come to speak briefly about this afternoon. That little thing in question that I am talking about is 3\1/8\ inches wide, 2\1/8\ inches long, and no thicker than one's fingernail. But it has a monumental impact on how millions of Americans live their lives each and every day. The object to which I am referring, of course, is the credit card.

We have come a long way from the day in 1950 when the Diner's Club issued the first universal credit card that allowed its holders to use credit at certain very select restaurants in New York City. Today, the credit card has become an indispensable part of how we do business in the United States, and across the globe, for that matter.

For many Americans, the main appeal of the credit card is convenience and flexibility. They allow us to go out and eat, go to a shopping mall, to the movies, and stop off at the grocery store on the way home, without folding a single bill or fumbling for loose change in their pockets. Credit cards allow people to shop for products on the Internet in a matter of seconds.

But for more and more Americans, credit cards serve a very different purpose. As the name implies, these cards provide access to credit. We are living in a time when real wages are failing to keep up with price increases, when health care costs and college tuition are on the rise. Millions of Americans are having difficulty making ends meet. For Americans who are strapped for cash, credit cards are much more than a convenience. They have become the only way they can afford basic necessities, such as food, gas, clothing, and medical care.

These Americans are not paying by credit card because they want to; they are doing so because they have no other choice. It is this function of credit cards that make them so appealing to American consumers, but I must also say it is this function that presents the greatest danger to them as well.

Today, the level of credit card debt in the United States is at record heights. Total consumer debt in America is over $2 trillion. Out of that, $735 billion is credit card debt. The average American household has over $9,000 worth of credit card debt. Let me repeat that. The average family living in the United States has over $9,000 of credit card debt. In comparison, the average family household income is just above $40,000.

Due in large part to credit card debt, more Americans are filing for bankruptcy. Last year, over 1.6 million families declared they were bankrupt. For every one family that actually does file for bankruptcy, there are seven more whose debt suggests that they, in fact, should do the same.

Credit card debt does not affect all Americans equally. It is a growing burden that is disproportionately being borne by middle-income, low-income, and working-poor families. According to a recent report, during the 1990s, on average, the American family saw its credit card debt go up by 53 percent. The debt of middle-class families, those earning between $50,000 and $100,000 a year, went up 75 percent. For the older Americans, senior citizens, their average credit card debt went up 149 percent. Finally, for very low-income families, those making less than $10,000 a year, credit card debt grew by a shocking 184 percent.

Why is this happening? Why are millions of Americans drowning in credit card debt? There are some who would describe the numbers I just quoted as a matter of personal responsibility, that some Americans are spending way beyond their means and ultimately are paying the price.

I do believe personal responsibility is extremely important, but many of the victims of credit card debt today are not in that state because they bought a home entertainment system, an expensive vacation, or a plasma TV set.

Take Roberto Towler. Roberto was a professional accountant who was very careful to always pay his bills on time. In early 2000 he was forced to take 2 months off from work because of a back injury. The lost salary meant he had much less cash on hand than before. He had no alternative but to use his credit card for toiletries, clothes for his children, and groceries. He eventually was able to return to work and scale back the use of his credit card, but he found himself barely able to pay back his debt. Eventually Roberto was forced to file bankruptcy with $22,000 of credit card debt.

Many Americans have stories just like Mr. Towler. They work hard, they play by the rules, but after a few twists of fate suddenly find themselves in a tremendous debt. For those caught in the quicksand of debt, a credit card appears to be a lifeline. But, in reality, it only pulls them in deeper and deeper.

We often speak of the ill and infirm as living on borrowed time. These people are living on borrowed money.

In the middle of all this are credit card companies. If we demand responsibility from individuals, and we should, and we do demand it, then we also ought to demand it from corporations as well. Responsibility is not limited to those who are consumers alone.

The reason I am here today is because a good deal of the blame for the crisis in credit card debt we are seeing in America lies in the practices of credit card companies.

I am not someone who takes regulatory reform lightly. I am not a believer in regulation that stifles innovation or efficiency. But at the same time, when we see practices that are truly hurting working families around the country, I believe we have an obligation to act. Just what kind of practices are we talking about? Let me spell it out.

Let's start with interest rates. I am not naive about this. I certainly do not expect credit card companies to be terribly benevolent when it comes to interest rates. But what I expect, and what all Americans deserve, is honesty and fairness.

We have all seen print ads and commercials that advertise fantastically low interest rates, sometimes as low as zero percent. But what these commercials don't tell you is that these teaser rates, as they are called, often expire and rise considerably only after a few months.

If you slip up even once by failing to make a minimum monthly payment, your interest rate may go up even faster. Just one mistake can be enough to drive an interest rate up by nearly 30 percentage points. Of course that information is usually hidden in the fine print of a lengthy disclosure statement.

Most Americans would assume that their interest rates will stay low as long as they make their minimum monthly payments. Not so. Today, credit card companies don't just look at the bill that you pay them, they look at your entire financial picture in deciding how high your interest rate ought to be, how high a rate they ought to charge you.

I learned of a doctor in Illinois who had always paid his credit card bills on time and stayed within his credit card limits. Then one day he took a look at his bill and discovered that the interest rate on his credit card had jumped from 6 percent to nearly 17 percent. He asked the credit card issuer, why? The company said that he was now a higher risk.

What was the reason?

He had taken out a mortgage on his new home.

This is incredible to me. There are few things more rewarding to a family than buying their first home. We celebrate home ownership here in America. Apparently for credit card companies it's a reason to celebrate as well, because it's an excuse to charge higher interest rates.

Interest rates, of course, are not the only way credit card companies make money. In recent years, more and more companies have found another way to increase their bottom lines, by assessing exorbitant fees for the most minor of offenses. Miss a payment by a single day and you may be charged $30 or even $40 for that mistake. Gone are the grace periods that gave consumers some reasonable leeway.

Over the past 2 years, the amount of money generated by credit card fees has simply skyrocketed. In fact, the term ``skyrocketed'' may be something of an understatement. In 1996, the fees raised $1.7 billion for credit card companies. That's 1996. Last year the credit card companies raised $11 billion in fees alone, only 8 years later.

You might think that if credit card companies know that someone is a risk they would take some action to limit that person's spending, such as lowering their credit line. Or perhaps they might not issue a card to that person in the first place.

But there is a little secret the credit card companies don't want Americans to know. They are actively soliciting and signing up customers who are tremendous credit risks. They are soliciting these people not in spite of the risk, but because of it.

Contrary to what one might think, customers who cannot afford to pay their bills on time are the credit card companies' best customers--not their worst. Unbelievably, these customers who do pay on time are known within the credit card industry as ``deadbeats.''

Let me repeat that. Those who pay their credit card bills on time are known within the industry as ``deadbeats.'' Why is this? Because when people fail to pay their bills on time, that means more profits for the credit card industry, in the form of more interest charges and penalty fees.

How much more of a profit? Let's say you are the average American, with $9,000 in credit card debt, which is the case today. Let's say you stopped accumulating any more debt and decided you would pay it off by making the minimum monthly payment of 2 percent. Let's say further that your interest rate is 15 percent--which is just about the average today, I might add.

How long would it take you to pay off that debt? Five years? Ten years? Twenty years? It would take 39 years to pay off your debt. Over the course of those 39 years, you would pay $14,000 in interest payments alone, in addition to the $9,000 you owe. This is all assuming, of course, that your interest rate wouldn't rise over those years and that you wouldn't be hit with unexpected fees.

Credit card companies know this. They know their greatest chance of financial profit lies in those customers who have the least chance of paying their bills on time. That is why they continue to solicit these customers and that is why those who do pay on time are known within the industry as the deadbeats.

Last year, credit card companies mailed out 5 billion solicitations to about 200 million individuals in the United States. The average person received about one offer every other week. The average household received more than one per week. I guarantee that a great many of these people do not have sparkling credit ratings, yet these companies continue to send out offer after offer, hoping that yet another customer will take the bait.

Mr. President, I ask unanimous consent to have printed in the Record an article from the July 6, 2004 edition of the Wall Street Journal entitled ``Growing Profit Source for Banks: Fees from Riskiest Card Holders.''

This goes into the topic in greater detail.

What I find most troubling about this trend is that credit card companies have set their sights on the most vulnerable members of our society when it comes to debt--low-income individuals, the elderly, mentally retarded, and most recently, our children.

Go to any college campus in America and you are bound to come across a table where an enthusiastic sales person is offering free T-shirts, or sports bags, or Frisbees--almost anything in exchange for signing up as a credit card customer. According to a report on CBS News, the average college student is offered 8 cards in his or her first semester in college--8 credit cards. By the end of college, the average graduating senior has 6 credit cards in his or her name.

Why are credit card companies targeting college students so frequently? Because of their limited experience with financial matters, students tend to accumulate debt very quickly, and as a result, more and more of our young people are falling deeper and deeper into the financial hole from which they cannot escape.

In 1998, 67 percent of college students had a credit card. Today, 83 percent have credit cards. In 1998, the average college student graduated with $1,800 in credit card debt. Today the average college senior graduates with $3,000 in credit card debt.

I was shocked to learn that the fastest growing segment of our population that is forced to declare bankruptcy is people under the age of 25. Think of

that. The fastest growing group of people declaring bankruptcy are people under the age of 25.

When we think about bankruptcy, we generally envision middle-aged Americans with failed businesses, investments gone bad, perhaps medical bills that have spiraled out of control. The answer is not so. It's college kids, recent graduates.

Some time ago, a piece on ``60 Minutes II'' told a story of one student's circumstance, Sean Moyer. I have told the story on the floor before but I think it deserves being repeated.

Sean's life began to spin out of control as a result of huge debts racked up in 3 years of college. He could not get loans to go to law school, as he dreamed. His parents couldn't afford to pay his way.

Sean Moyer had 12 credit cards and more than $10,000 in debts. He had two jobs, one at the library, another as a security guard in a Holiday Inn, but he still could not pay the collectors who continually harassed him with letters and phone calls. In 1998, Sean Moyer took his own life.

Three years after his son's death, his mother still gets pre-approved credit card offers in Sean's name. According to his mother, one company preapproved Sean for a $100,000 credit card line.

How is the credit card industry doing as a result of these practices? These companies are thriving. Credit Card Management, an industry publication, reported that 2003 was the most profitable year for credit cards since the magazine began tracking the industry in 1992.

What makes matters even more astonishing is that this is happening when interest rates are at an all-time low. Yet, for millions of Americans, the interest rates they read about in the newspapers, those set by the Federal Reserve, bear absolutely no relationship whatsoever to interest rates that appear on their credit card bills.

Still, the industry wants more. In recent years, while they have been encouraging consumers to accumulate debt, credit card companies have simultaneously been lobbying Congress to change bankruptcy laws to make it harder and harder for people to have their debts forgiven. This amounts to a two pronged attack on working families in America--get people into as much debt as possible, and then change the rules of the game so they can't get rid of that debt.

It is time we stood up for consumers. It is time we restored a sense of responsibility to this industry.

I am here today to introduce the Credit Card Accountability, Responsibility, and Disclosure Act of 2004, also known as the Credit CARD Act. This bill takes aim at what I consider to be some of the more egregious abuses of consumers by credit card companies.

This bill takes some simple, common-sense steps to stop abusive practices, educate cardholders, and stiffen the penalties on corporations that violate the law.

First of all, I think we can all agree that it is reasonable for a consumer to be clearly notified if his or her interest rates are going up. That is not a radical idea, that is just common sense. My bill would require clear disclosure of any rate changes so there aren't any surprises for the average consumer.

I also don't believe a company should be able to retroactively change the interest rate on debt that already exists. If you want to raise interest rates, fine, but raise them on future debt, not existing debt. Our bill would prohibit any retroactive interest rate changes.

Second, I believe that companies should be rewarding people for responsible card use--not penalizing them. If you pay your bills on time, your interest rate shouldn't go up. If you pay off your balances in full, your company shouldn't be able to charge you any new fees. If you decide to cancel your card, your interest rate shouldn't go up. I am pointing out these facts because that is exactly what happens. My bill would codify all of these common-sense principles into law.

Third, my bill would protect some of the most vulnerable in our society--our Nation's youth--by implementing new requirements for issuing credit cards to people under the age of 21. We are not going to prohibit college students from getting cards, but we are going to make sure that companies can't simply give away cards to millions and millions of students who they know will rack up years and years worth of debt and potentially face bankruptcy and financial ruin before their working lives have barely begun.

If you apply for a credit card and you are under 21, under this bill you will need one of three things: A signature of a parent or guardian who is willing to take responsibility for your debt; information indicating that you have some other means of repaying any debt; or a certification that you have completed a credit counseling course. And if you are a credit card company that offers cards to students under 21, you will be required to comply with these requirements--or face serious penalties.

Finally, this bill requires companies to be honest with consumers by introducing some new disclosure requirements. The most important one is a box--prominently located on every single bill--containing four simple pieces of information: The total balance on your account; your minimum monthly payment; how long it will take to pay your bill if all you pay is the minimum monthly payment; and finally, how much you will have to pay over time--in both interest and principal--if you only make the minimum payments.

The reason for these disclosures is simple, and to many, probably obvious: To allow consumers to know exactly what it means to carry a debt, so they can decide whether or not to do so.

The Credit CARD Act also contains a number of additional disclosure requirements to bring more transparency to an industry that has clearly reaped benefits from the use of fine print and lengthy and confusing policy statements.

We are not asking for much here--only that companies be fair and straightforward with consumers. Let us see some real disclosures so Americans can understand what their bill means, how much they are being charged, and why.

No one wants credit cards to disappear. I certainly believe credit cards are tremendously valuable and worthwhile as long as they are handled responsibly. And no one wants people who need and deserve credit to have no way to get it. But we can't simply stand by as more and more Americans fall deeper and deeper into debt with no way out. We need to take some responsible action so that the credit card can still be a useful financial tool without being a ticket to financial ruin.

If we are going to pass bankruptcy bills in the Senate that demand more responsibility from consumers, shouldn't we demand more responsibility from creditors, as well? This bill, the Credit CARD Act, does just that, and I urge my colleagues in the Senate to adopt it.

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

Mr. President, I rise to introduce important legislation which I believe is vital to our economic security. I am proud to introduce this legislation, the Terrorism Risk Insurance Extension Act of 2004, with Senators Bennett, Schumer, Jack Reed, Hagel, Dole, Bunning, Crapo, Chafee, Harry Reid, and Ben Nelson.

As my colleagues know, the Senate hasn't been a model of legislative productivity this year. It has been a very difficult year--there has been partisan gridlock on a whole host of issues.

It is against this backdrop, the day that we adjourn for 6 weeks for the August recess which includes both conventions and campaigning, that I am proud to speak about an issue that has broad bipartisan support. That issue is an extension of the Terrorism Risk Insurance Act.

This critically important legislation has a history of bipartisan support and I am pleased to say that the robust support on both sides of the aisle still exists as we consider an extension of the program.

The original TRIA legislation was not an easy undertaking. But we persevered, negotiated, and had a frank exchange of views over numerous months and in the end, even though it was at times a laborious, difficult process, we produced a bipartisan bill that garnered 86 votes in this body on this critically important issue.

I worked closely with Democratic Senators Schumer, Sarbanes, Reed, and Corzine as well as Senators Bennett, Hagel, Phil Gramm, and many others on the Republican side to get this critical bill passed. That is the model that the Senate should follow more often and that is the model that we are following as we introduce a 2-year extension of the Terrorism Risk Insurance Act today which will provide continued economic security and stability and avoid potential chaos in the aftermath of a terrorist attack.

The September 11 tragedy resulted in disbelief, devastation, and economic dislocation. An attack on our country seemed unimaginable. Few believed any significant major terrorist attack would occur, no less the one as horrific and devastating as the one on 9/11.

September 11 changed everything, most visibly, of course, national and homeland security policy. But September 11 also fundamentally changed the way insurers looked at terrorism risks which suddenly started to resemble an act of war. As a result, after 9/11 the insurance market for terrorism nearly completely dried up. Coverage was unavailable. Many financial transactions weren't able to proceed. And construction workers and other hard-working Americans suddenly found themselves economic victims of terrorism.

In short, we wrote TRIA for a very simple reason: hundreds of thousands of American jobs and billions of dollars of business investment hung in the balance.

We worked together on a bipartisan basis to pass this bill including significant support from this administration which deserves its fair share of credit for enactment of the legislation in November 2002.

TRIA was created as a 3-year Federal program to help make sure the part of the commercial insurance marketplace, disrupted by 9/11, could work again. Most Americans don't even know that TRIA provides a crucial economic safety net for virtually every sector of our economy. Transportation, real estate, utilities, construction, travel and tourism, and financial institutions are just a few of the sectors that need TRIA to protect them against the economic devastation that would come because of a terrorist attack.

Under TRIA, the Government shoulders a share of the financial risk of future attacks. This makes sense--these attacks are against us as Americans, against our democracy, our way of life.

But TRIA also required insurers to offer terrorism coverage on commercial policies. In addition, insurance companies would have to bear an escalating financial burden in future years.

TRIA is working. This public-private ``shared loss'' mechanism is making terrorism insurance available to all businesses at a reasonable cost. Under TRIA, in the event of another terrorist attack, private insurers will still shoulder tens of billions of dollars of terrorism related risk.

What TRIA does is act as a backstop to the private commercial property-casualty insurance system. It gives the market some certainty by establishing, by law, a limit to insured terrorism losses for the insurance industry and the Federal Government.

The Mortgage Bankers Association recently surveyed its 40 largest commercial/multi-family mortgage banking firms. A substantial majority of them believe that TRIA has made terrorism insurance both more available and less expensive.

But the Mortgage Bankers also noted that failure to extend TRIA would probably hurt the commercial real estate market. If we let TRIA expire, we will see the same uncertain environment we saw before TRIA.

TRIA does not expire until the end of 2005. Now some may wonder why I am choosing today to join with Senator Bennett and others to introduce this legislation to extend the program.

The answer is that we cannot wait until next year.

The economic safety net that TRIA provides will begin to come apart as

early as this fall if Congress does not act.

In the next few months, commercial insurers and their policyholders will begin negotiating new policies. But any 12-month policy taken out after Jan 1 will include at least some time where TRIA doesn't exist if we let it expire.

If we let TRIA expire, business consumers are going to have a hard time getting the coverage they need. That can only hurt our economy, and I'm sure that all Senators share the goal of growing our economy.

If we don't act this year, insurers will have to evaluate every policy as if the backstop will not exist for part of the coverage period.

Senator Bennett and I and other colleagues propose a 2-year extension this year. That will help avoid destabilizing the insurance market, and, in turn, the national economy. It will give Congress, insurers, businesses, and Government officials time to gather all available, relevant data.

Collecting that data--without fear of market disruption--will help all of us develop a more permanent solution for managing our Nation's economic exposure to catastrophic terrorism.

I know there is plenty of partisan tension in the Senate this year. But keeping our country safe from the economic devastation of a terrorist attack is a critical priority. It is too important to be affected by partisan politics. We didn't let that happen last time, and I hope everyone can work on a bipartisan basis and follow the bipartisan model--rare in this body these days--to make sure it doesn't happen this time.

Mr. President, the legislation I am introducing today with Senators Cochran, Lincoln, Collins, Daschle, Jeffords, Clinton, Cantwell, and Johnson is entitled the Children's Dental Health Improvement Act of 2003. This legislation is designed to improve the access and delivery of dental health services to our Nation's children through Medicaid, the State Children's Health Insurance Program, (SCHIP), the Indian Health Services, IHS, and our Nation's safety net of community health centers.

The oral health problems facing children are highlighted in a landmark report issued by the Surgeon General and the Department of Health and Human Services, HHS, in 2000 entitled ``Oral Health in America: A report of the Surgeon General'' in which he observed that our Nation is facing what amounts to ``a `silent epidemic' of dental and oral diseases.''

In fact, dental caries, which refers to both decayed teeth or filled cavities, is the most common childhood disease. According to the Surgeon General,``Among 5- to 17-years olds, dental caries is more than 5 times as common as a reported history of asthma and 7 times as common as hay fever.'' In short, dental care is, as the Surgeon General adds,``the most prevalent unmet health need among American children.''

I was pleased to chair a hearing in the Health, Education, Labor and Pensions Committee on June 25, 2002, entitled ``The Crisis in Children's Dental Health: A Silent Epidemic'' in which the Surgeon General, Dr. David Satcher, testified. Dr. Satcher's testimony was strong and compelling.

In his words, ``Over 108 million children and adults lack dental insurance, which is over 2.5 times the number who lack medical insurance.'' Dr. Satcher also highlight the following information specific to the oral health problems in children:

There are striking disparities in dental disease by income. Poor children suffer twice as much dental cries as their more affluent peers, and their disease is more likely to be untreated. These poor- nonpoor differences continue into adolescence. One out of four children in America is born into poverty, and children living below the poverty line--annual income of $17,000 for a family of four--have more severe and untreated decay.

Other birth defects such as hereditary ectodermal dysplasias, where all or most teeth are missing or misshapen, cause lifetime problems that can be devastating to children and adults.

Unintentional injuries, many of which include head, mouth, and neck injuries, are common in children.

Intentional injuries commonly affect the craniofacial tissues.

Tobacco-related oral lesions are prevalent in adolescents who currently use smokeless--spit tobacco.

Professional care is necessary for maintaining oral health, yet 25 percent of poor children have not seen a dentist before entering kindergarten.

Medical insurance is a strong predictor of access to dental care. Uninsured children are 2.5 times less likely than insured children to receive dental care. Children from families without dental insurance are three times more likely to have dental needs than children with either public or private insurance. For each child without medical insurance, there are at least 2.6 children without dental insurance.

Medicaid has not been able to fill the gap in providing dental care to poor children. Fewer than one in five Medicaid-covered children received a single dental visit in a recent year-long study period. While recent CMS data indicate progress in this area with 1 million more Medicaid-eligible children now receiving annual dental care than was the case in 1996, there is still a long way to go to ensuring greater access. Although new programs such as the State Children's Health Insurance Program, SCHIP, may increase the number of insured children, many will still be left without effective dental coverage.

The social impact of oral diseases in children is substantial. More than 51 million school hours are lost each year to dental-related illness. Poor children suffer nearly 12 times more restricted-activity days than children from higher income families. Pain and suffering due to untreated diseases can lead to problems in eating, speaking, and attending to learning.

Over 50 percent of 5- to 9-year-old children have at least one cavity or filling, and that proportion increases to 78 percent among 17-year- olds. Nevertheless, these figures represent improvements in the oral health of children compared to a generation ago.

The Senate also heard the testimony of Dr. Burton Edelstein, founding director of the Children's Dental Health Project; Dr. Gregory Chadwick, president of the American Dental Association; Dr. Lynn Douglass Moundon, director of oral health in the Arkansas Department of Health; Ed Martinez, chief executive officer at San Ysidro Health Center in California; and, Dr. Timothy Shriver, president and chief executive officer of Special Olympics, Inc.

Dr. Edelstein underscored the need for more attention to this issue. As he said, ``The too-widespread belief that childhood dental disease has been vanquished states in contrast to the thousands upon thousands of toothaches and acute abscesses experienced daily by America's children--many as young as 2 years of age.''

In endorsing this legislation, Dr. Chadwick added, ``. . . we cannot forget the fact that millions of people in this country--particularly children--aren't getting even basic preventive and restorative dental care. These children are out there suffering.''

The Children's Dental Health Improvement Act of 2003 seeks to end that suffering. One important provision in the bill would grant States flexibility

to provide dental coverage to low-income children through the State Children's Health Insurance Program, or SCHIP, just as States currently are able to do through Medicaid.

Unfortunately, SCHIP law prohibits coverage of children for services unless they are completely uninsured. As authors Ruth Almeida, Ian Hill, and Genevieve Kenney of an Urban Institute report entitled ``Does SCHIP Spell Better Dental Care for Children? An Early Look at New Initiatives write'', ``. . . many low-income children are covered by employer-based or other private health insurance for their medical care, but do not have a comprehensive dental benefit. Because these children are privately insured, they are not eligible for SCHIP and cannot avail themselves of dental coverage under SCHIP. Expanding SCHIP to furnish dental services on a wraparound basis to private covered low-income children without dental coverage could help achieve broader improvements in children's oral health.''

For low-income children with medical coverage but no dental insurance through the private sector, their only option would be to completely dump their private coverage for their children in order to access SCHIP coverage.

Instead, the Children's Dental Health Improvement Act of 2003 creates an option for States to provide low-income families with the ability to receive wraparound dental coverage through SCHIP without having to completely drop their private insurance. This reduces the crowd-out of private insurance, which was a priority of the Congress during passage of SCHIP, and it provides low-income children with dental services that other children in the same economic circumstance are already receiving through SCHIP.

In implementing such a change, I want to make it clear that I am in strong support of providing additional funding to SCHIP to ensure that these services are provided without reducing current levels of SCHIP funding. With those additional funds, I strongly believe that SCHIP, just as Medicaid, should provide services to low-income children who are both uninsured and underinsured. Children need a comprehensive set of child health services, including dental services, to ensure their appropriate health and development.

However, coverage for these services is often not enough. Even when children do have dental coverage, the access to care is often sorely lacking. Medicaid is the largest insurer of dental coverage to children. Yet despite the design of the Medicaid Program to ensure access to comprehensive services for children, including dental care, the inspector general of the Department of Health and Human Services reported in 1996 that only 18 percent of children eligible for Medicaid received even a single preventive dental service. The same report shows that no State provides preventive services to more than 50 percent of eligible children. The factors are complex but the primary one is due to limited dental participation in Medicaid.

According to GAO, in its September 2000 report entitled ``Oral Health: Factors Contributing to Low Use of Dental Services by Low- Income Populations.'' ``Of 39 states that provided information about dentists' participation in Medicaid, 23 reported that fewer than half of the states' dentists saw at least one Medicaid patient during 1999.'' Even worse, a 1998 survey by the National Conference of State Legislatures indicates that fewer than 20 percent of dentists participate in the Medicaid Program nationwide.

The GAO concludes poor participation rates by dentists is due in large part to poor reimbursement rates in Medicaid. As the GAO points out, ``Our analysis showed that Medicaid payment rates are often well below dentists' normal fees. Only 13 states had Medicaid rates that exceeded two-thirds of the average regional fees dentists charged. . . .''

Clearly, Medicaid is chronically underfunded with respect to dental care. The Surgeon General's report notes, ``On average, state Medicaid agencies contribute only 2.3 percent of their child health expenditures to dental care, whereas nationally, the percentage of all child health expenditures dedicated to dental care is more than 10 times that rate, almost 30 percent.''

The good news is that many States, including New Mexico, have taken recent actions to improve the participation of dentists in the Medicaid Program by raising low payment rates and reducing administrative requirements. These efforts were highlighted by the GAO in its September 2000 report. To further encourage such efforts, the ``Children's Dental Health Improvement Act of 2003'' provides $50 million annually as financial incentives and planning grants to States to undertake additional improvements in their Medicaid Programs delivery of dental health services to children.

In addition to Medicaid and SCHIP, the Federal Government administers other health care programs providing dental services or providers for low-income children and their families, including services administered by community health centers and the Indian Health Service, or IHS. Unfortunately, both of these programs are underfunded and, as the GAO found, ``report difficulty in meeting the dental needs of their target populations.''

For example, the GAO found that ``HHS and health center officials report that the demand for dental services significantly exceeds the [urban and rural health] centers' capacity to deliver it. In 1998 . . ., a little more than half of the nearly 700 health center grantees funded under this program had active dental programs.'' This is also true for public health departments across the country.

To assist the health centers and public health departments with this need, the Children's Dental Health Improvement Act of 2003 provides $40 million to community health centers and public health departments to expand dental health services through the hiring of additional dental health professionals to serve low-income populations.

This is particularly a problem that needs to be addressed in areas with severe dental health professional shortages, such as New Mexico. For example, New Mexico ranked next to last in the Nation with just 32.1 dentists per 100,000 population in 1998, according to HHS. This compares to the national average of 48.4 per 100,000. Moreover, the number of dentists in New Mexico declined by 7 percent between 1991 and 1998 while the State's population grew 12 percent. The result was a 17 percent decline in dentists per capita during the period.

With regard to American Indian and Alaska Native populations, the need is so great and the funding so little that a comprehensive solution is requiring throughout the IHS system. With respect to the unmet need, the GAO notes that ``American Indian and Alaska Native children aged 2 to 4 years old have five times the rate of decay that all children have.''

Unfortunately, the GAO adds, ``. . . about one-fourth of IHS' dentist positions at 269 IHS and tribal facilities were vacant in April 2000. Vacancies have been chronic at IHS facilities--in the past 5 years, at least 67 facilities have had one or more dentist positions vacant for at least a year. According to IHS officials, the primary reason for these vacancies is that IHS is unable to provide a competitive salary for new dentists . . .''

The GAO continues, ``The IHS' dental personnel shortages translate into a large unmet need for dental services among American Indians and Alaska Natives. IHS reports that only 24 percent of the eligible population had a dental visit in 1998. The personnel shortages have also reduced the scope of services that facilities are able to provide. According to IHS officials, available services have concentrated more on acute and emergency care, while routine and restorative care have dropped as a percentage of workload. Emergency services increased from one-fifth of the workload in 1990 to more than one-third of the workload in 1999.''

To help alleviate this workforce shortage, the Children's Dental Health Improvement Act of 2003 provides IHS with the authority to offer multiyear retention bonuses to dental providers offering services through the IHS and tribal programs.

The bill also provides for some technical amendments to ensure that tribal organizations and community health centers are allowed to apply for school-based dental sealant funding from the Centers for Disease Control and Prevention, or CDC.

The legislation also has a new provision that addresses a technical and unintended problem with the implementation of provisions changing the way Medicare graduate medical education, or GME, is funded. As background in the Balanced Budget Act of 1997, or BBA, Congress recognized the unfairness of subjecting dentistry to GME policies based on the oversupply of physician specialists by exempting dental residency positions from caps placed on the number of residents supported by Medicare GME.

However, the two provisions in that law--both enacted primarily to alleviate the impact on hospitals that decrease physician slots--have had the opposite impact on hospitals that increase their dental residency positions. While successful in achieving the purpose of reducing the number of physicians being trained, these provisions have hurt dentistry and access to oral health care in the United States and are contrary to the congressional goal in 1997 to increase the number of postgraduate dental residency slots. As a result, the legislation would exempt dental residency training positions from the 3-year rolling average provision used to calculate the number of residents for Medicare GME payments.

The bipartisan legislation I am introducing today would improve the access and delivery of dental health services to our Nation's children through Medicaid, SCHIP, IHS, and our Nation's safety net of community health centers. These problems are well documented and call out for congressional action as soon as possible.

I would like to thank the American Dental Association, the American Dental Education Association, the American Academy of Pediatric Dentistry, the National Association of Community Health Centers, Inc., the National Association of Children's Hospitals, the American Dental Hygienists' Association, and the Children's Dental Health Project for their outstanding support and/or their technical advice on this legislation. This bill is a result of their outstanding work.

In particular, I want to thank Dr. Burt Edelstein, Libby Mullin, and Ann De Biasi of the Children's Dental Health Project for their vast knowledge and technical assistance on this issue. I want to thank Judy Sherman of the American Dental Association, Myla Moss and Jack Bresch of the American Dental Education Association, Dr. Herber Simmons and Scott Litch of the American Academy of Pediatric Dentistry, Karen Sealander of the American Dental Hygienists' Association, Dr. Jim Richeson and Judy Kloss Bynum of the Academy of General Dentistry, Dr. Stephen Corbin of Special Olympics, Inc., and Dan Hawkins, Chris Koppen, and Roger Schwartz of the National Association of Community Health Centers, Inc., for their valuable insight, technical advice, and continued support for this legislation. I look forward to working with them all to ensure that we achieve increased access to oral health care for our children.

In addition to those organizations, I would like to thank the following groups for their support of the bill, whether in the past session of Congress or this year. They include: the Academy of General Dentistry, American Academy of Child and Adolescent Psychiatry, American Academy of Oral and Maxillofacial Pathology, American Academy of Periodontology, American Association of Dental Examiners, American Association of Dental Research, American Association of Endodontists, American Association of Public Health Dentistry, American Association of Oral and Maxillofacial Surgeons, American Association of Orthodontists, American Association of Women Dentists, American College of Dentists, American College of Preventive Medicine, American Dental Trade Association, American Public Health Association, American Society of Dentistry for Children, American Student Dental Association, Association of Clinicians for the Underserved, Association of Maternal and Child Health Programs, Association of State and Territorial Dental Directors, Dental Dealers of America, Dental Manufacturers of America, Inc., Family Voices, Hispanic Dental Association, International College of Dentists--USA, March of Dimes, National Association of City and County Health Officers, National Association of Local Boards of Health, National Dental Association, National Health Law Program, New Mexico Department of Health, Partnership for Prevention, Society of American Indian Dentists, Special Care Dentistry, and United Cerebral Palsy Associations.

Mr. President, I ask unanimous consent for the text of the bill to be printed in the Record.

Mr. President, today, I am introducing a bill with Senators Daschle, Boxer, and Lincoln that will be jointly introduced by Representatives Ciro Rodriguez, Hilda Solis, and others in the House of Representatives entitled the ``Hispanic Health Improvement Act of 2003.'' This bill addresses the tremendous health disparities that confront the Hispanic community in our Nation.

Even if you know the statistics, they remain shocking. Over one- third, a 35 percent of Hispanic adults lack health insurance. Despite that passage of the Children's Health Insurance Program, 27 percent of Latino children remain uninsured, which is sharp comparison to 9 percent of white, 18 percent of black and 17 percent of Asian/Pacific Islander children.

In testimony before the Senate Health, Education, Labor and Pensions Committee on September 23, 2002, on Hispanic health issues, Dr. Glenn Flores, chair of the Latin Consortium of the American Academy of Pediatrics Center for Child Health Research, added: ``Among uninsured poor children in the U.S., Latinos outnumber all other racial/ethnic groups, including whites: there are 1 million poor, uninsured Latino children, compared with 766,000 white, and 533,000 African-American poor, uninsured children. Although 1999 marked the first time in many years that the proportion of uninsured Latino children actually decreased (from 30 percent to 27 percent), recent national data suggest that outreach efforts to enroll Latino children have largely been unsuccessful. A Kaiser Commission report found that only 26 percent of parents of eligible uninsured children said that they had ever talked to someone or received information about Medicaid enrollment, and 46 percent of Spanish-speaking parents were unsuccessful at enrolling their uninsured children in Medicaid because materials were unavailable in Spanish.''

In order to address the lack of health care coverage, the legislation would expand CHIP to cover pregnant women and parents of children enrolled in CHIP. The legislation provides $50 million in grants to community-based groups to improve outreach and enrollment of children in Medicaid and CHIP with the grants targeted to Hispanic communities.

In addition, the bill eliminates a number of enrollment barriers within Medicaid.

And finally, it provides States the option to enroll legal immigrant pregnant women and children in Medicaid or CHIP. This comes from legislation introduced by Senator Graham earlier in this Congress.

In addition to poor coverage rates, according to the Centers for Disease Control and Prevention, or CDC, the Hispanic population has morbidity and mortality rates that more often than not exceed that of any other ethnic groups. For example, age-adjusted mortality rates for diabetes are over 50 percent higher among Hispanic persons than non- Hispanic whites. HIV infection rates are over 3 times those of non- Hispanic whites. Tuberculosis rates among Latino children are 13 times that of whites.

The legislation addresses these problems in a number of ways. In the area

of access and affordability, our bill requires an annual report to Congress on how federal programs are responding to improve the health status of Hispanic individuals with respect to diabetes, cancer, asthma, HIV infection, AIDS, substance abuse, and mental health. The bill provides $100 million for targeted diabetes prevention, education, school-based programs, and screening activities in the Hispanic community.

In addition, the legislation specifically addresses the problems facing communities along the U.S.-Mexico border, a 2,000-mile stretch of land that contains 11 million people, 5 of the 7 poorest metropolitan statistical areas in the country, and disease rates in some areas that are extraordinary. If the region were a state, the border would rank 1st in the number of uninsured, last in terms of per capita income, and 1st in a number of diseases.

As Dr. Francisco Cigarroa, president of the University of Texas Health Sciences Center at San Antonio, noted in testimony at the hearing last year on Hispanic health, ``Germs respect no INS regulations. We truly must work with our neighbors to the South if we are to avoid a major influx of new conditions and diseases. It can be seen so clearly on a map. Just as there are `rivers of commerce' there are `rivers of infectious disease' and though they may start at the Border, they are eventually seen all the way to the northern Border that we share with Canada.''

In response, the bill provides $200 million to border communities to improve health services and infrastructure along the U.S.-Mexico border.

The numbers I have cited thus far indicate what we do know. Almost as much of a concern is what we do not know with respect to the status of Hispanic health in this Nation. According to one study, only 22 percent of all articles published in major medical journals included non- English-speaking patients.

The bill provides funding to do additional research and work on reducing health disparities in this Nation. The various provisions include efforts to improve the recruitment and retention of Hispanic health professionals and programs that support training health professionals who can provide culturally competent and linguistically appropriate care. With respect to training more minority health professionals, Dr. Cigarroa said at last year's hearing, ``We should do this because it is the smart thing to do. If we fail to take steps to address the gap between the health of the majority population and the health of the Nation's rapidly growing minority populations, we are on a court leading to a collision. We are far too great a nation to allow this to happen.''

Representative Ciro Rodriguez, chairman of the Congressional Hispanic Caucus, and I, have worked together on this legislation to respond to the challenge before us with regard to coverage, access, and health disparities in the last Congress and have reintroduced the bill with the hope to move it forward this year.

Before closing, it should be noted that while the legislation puts forth a number of initiatives to address what are disproportionately Hispanic problems, each section of the bill, including those to reduce the number of uninsured and to improve access to care, would improve the overall health of our entire Nation regardless of race or ethnicity.

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

Mr. President, I have sought recognition today to introduce the Prescription Drug and Health Improvement Act of 2004, which is legislation designed to reduce the high prices of prescription drugs. Americans, specifically senior citizens, pay the highest prices in the world for brand-name prescription drugs. With 43 million uninsured Americans and many more senior citizens without an adequate prescription drug benefit, filling a doctor's prescription is unaffordable for many people in this country. The United States has the greatest health care system in the world; however, too many seniors are forced to make difficult choices between life-sustaining prescription drugs and daily necessities.

The Centers for Medicare and Medicaid Services estimate that in 2003 per capita spending on prescription drugs rose approximately 12 percent, with a similar rate of growth expected for this year. Much of the increase in drug spending is due to higher utilization and the shift from older, lower cost drugs to newer, higher cost drugs. However, rapidly increasing drug prices are a critical component.

High drug prices, combined with the surging older population, are also taking a toll on State budgets and private sector health insurance benefits. Medicaid spending on prescription drugs increased at an average annual rate of nearly 20 percent between 1998 and 2001. Until lower priced drugs are available, pressures will continue to squeeze public programs at both the State and Federal level.

To address these problems, my legislation would reduce the high prices of prescription drugs to seniors by: one, allowing the Secretary of Health and Human Services, HHS, to negotiate prescription drug prices with manufacturers; and two, eliminate the coverage gap in the Medicare Prescription Drug Program. The bill's $400 billion price tag over the next 10 years would be offset by, three, reducing medical errors, increasing the use of medical technology, and, four, increasing the use of non-physician providers in primary and preventive health care.

Prescription Drug Negotiation: This legislation would repeal the prohibition against interference by the Secretary of HHS with negotiations between drug manufacturers, pharmacies, and prescription drug plan sponsors and instead authorize the Secretary to negotiate contracts with manufacturers of covered prescription drugs. It will allow the Secretary of HHS to use Medicare's large beneficiary population to leverage bargaining power to obtain lower prescription drug prices for Medicare beneficiaries.

Price negotiations between the Secretary of HHS and prescription drug manufacturers would be analogous to the ability of the Secretary of Veterans Affairs to negotiate prescription drug prices with manufacturers. This bargaining power enables veterans to receive prescription drugs at a significant cost savings.

In my capacity as chairman of the Veterans' Affairs Committee, I introduced the Veterans Prescription Drugs Assistance Act, S. 1153, which was reported out of committee on June 20, 2004.

This legislation would broaden the ability of veterans to access the Veterans Affairs Prescription Drug Program. All Medicare-eligible veterans will be able to purchase medications at a tremendous price reduction through the Veterans Affairs' Prescription Drug Program. In many cases this would save veterans who are Medicare beneficiaries up to 90 percent on the cost of commonly prescribed medications. Similar savings would be available to America's seniors from the savings achieved using the HHS bargaining power, like the Veterans Affairs bargaining power for the benefit of veterans.

Medicare Coverage Gap Elimination: The bill would eliminate the coverage gap, also known as the ``doughnut hole,'' for beneficiaries in the Medicare prescription drug program. Beginning in January 2006, Medicare beneficiaries with an individual income of over $13,470 and couples with an income over $18,180, 150 percent of the poverty level, will pay a monthly premium, approximately $35, a $250 deductible, and coinsurance of 25 percent up to an initial coverage limit of $2,250, but then do not receive coverage until they exceed $5,100 of total spending. Specifically, Medicare beneficiaries will have to make out- of-pocket payments for prescription drug purchases from $2,250 to

$5,100 in total spending. After $5,100 in total spending, the coinsurance payment for those beneficiaries is 5 percent. Medicare beneficiaries below 150 percent of the poverty level do not have a gap in drug coverage. My legislation would eliminate the gap in coverage for those over 150 percent of the poverty level in the Medicare prescription drug program, by extending the 25 percent beneficiary coinsurance payment from $2,250 to $5,100 in total spending.

This provision comes at an expected cost of $400 billion over 10 years, which will be paid for through savings from reducing medical errors, increasing the use of medical technology, and increasing the use of non-physician providers in primary and preventive health care.

Reducing Medical Errors and Increasing the Use of Medical Technology: The bill provides grants for demonstration programs to test best practices for reducing errors, testing the use of appropriate technologies to reduce medical errors, such as electronic medication systems, and research in geographically diverse locations to determine the causes of medical errors. The implementation of automated prescription drug dispensers will prevent adverse drug reactions, which in turn can cause further illness resulting in increased care needed to correct the error. The utilization of electronic records will reduce the incidence of repeat medical tests, which will result in significant cost savings.

On November 29, 1999, the Institute of Medicine, IOM, issued a report entitled ``To Err is Human: Building a Safer Health System.'' The IOM report estimated that anywhere between 44,000 and 98,000 hospitalized Americans die each year due to avoidable medical mistakes. However, only a fraction of these deaths and injuries are due to negligence. Most errors are caused by system failures. The IOM issued a comprehensive set of recommendations, including the establishment of a nationwide, mandatory reporting system; incorporation of patient safety standards in regulatory and accreditation programs; and the development of a non-punitive ``culture of safety'' in health care organizations. The report called for a 50-percent reduction in medical errors over 5 years.

After the report was issued, I held a series of three Labor, Health and Human Services Appropriations Subcommittee hearings on medical errors: Dec. 13, 1999--to discuss the findings of the Institute of Medicine's report on medical errors; Jan. 25, 2000--a joint hearing with the Committee on Veterans' Affairs to discuss a national error reporting system and the VA's national patient safety program; Feb. 22, 2000--a joint hearing with the Health, Education, Labor and Pensions Committee to discuss the administration's strategy to reduce medical errors.

After hearing from Government witnesses and experts in the field on medical errors, I included $50 million in the fiscal year 2001 Senate Labor, Health and Human Services and Education for a patient safety initiative. In the Senate report, I also directed the Agency for Healthcare Research and Quality, AHRQ, to: one, develop guidelines on the collection of uniform error data; two, establish a competitive demonstration program to test ``best practices''; and three, research ways to improve provider training.

The committee also directed AHRQ to prepare an interim report to Congress concerning the results of the demonstration program within 2 years of the beginning of the projects. The fiscal year 2002 Senate report directed AHRQ to submit a report detailing the results of its initiative to reduce medical errors. HHS combined both reports into one, which it submitted to me earlier this year.

Since fiscal year 2001, the Labor/HHS Subcommittee has included within the Agency for Healthcare Research and Quality funding for research into ways to reduce medical errors. The fiscal year 2002 appropriation was $55 million, in fiscal year 2003 another $55 million was provided, and in fiscal year 2004 the appropriation was increased to $79.5 million.

The bill seeks to assist development of private sector technology standards to reduce medical errors by examining information technology, providing grants, and coordinating implementation by private sector entities. This would help ensure that this Federal investment will help further the national health information infrastructure by sharing the information collected through these demonstration projects with other health facilities nationally. These efforts would help reduce medical errors and bring the Nation's health systems into the 21st century with a projected cost savings of $150 billion over 10 years.

Primary and Preventive Care Services: The bill includes provisions for the use of nonphysician providers such as nurse practitioners, physician assistants, and clinical nurse specialists by increasing direct reimbursement under Medicare and Medicaid without regard to the setting where services are provided. The services provided by non- physician providers would insure that patients would receive benefits and services to which they are entitled without compromising the high standards of medical care. The use of these health care professionals would provide a significant cost savings to health care systems.

The bill creates a medical student tutorial program providing grants to encourage students early on in their medical training to pursue a career in primary care and provides grant assistance to medical training programs to recruit such students. This program is advantageous for medical students by providing valuable primary care experience, while offering services at a lower cost to primary care facilities. The savings from this provision is estimated at $250 billion over a 10-year period.

I believe this bill can provide desperately needed access to inexpensive, effective prescription drugs for America's seniors. The time has come for concerted action in this arena. I urge my colleagues to move this legislation forward promptly.

Mr. President, I seek recognition today to introduce the Small Business Economic Stimulus Act of 2004. In recent months, there have been clear signs that America's economic downturn has ended and that we are entering a period of renewed growth and prosperity. Yet not all of the economic news has been good. As I travel through Pennsylvania, I still hear from too many companies that they cannot afford to make needed investments in equipment or research at this time. As they postpone such investments, they also push off into the future the economic growth and opportunity that would flow from them. As a result, I continue to meet far too many Pennsylvanians who are out of work. Thus while the economy is improving, it is still incumbent upon us in Congress to do everything in our power to aid this recovery and grow jobs. There is more we can do.

The bill I introduce today, the Small Business Economic Stimulus Act of 2004, will help American companies take the steps they need to grow and hire. Since small businesses create approximately 75 percent of new jobs in America, my bill focuses on the needs of small business in particular. My bill has three parts. Part one renews and extends three tax provisions which are crucial to encouraging new investments in R&D and equipment. Part two provides greater resources to trade offices and trade promotion with a particular emphasis on programs that will enable America's small businesses to better compete in foreign markets. Part three creates a structure for association health plans which will enable small businesses to negotiate less expensive health plans for their employees, thereby saving money while continuing to provide coverage. Together, these provisions amount to a targeted, measured, yet crucial shot in the arm for American small business and the American economy.

The bill I introduce today will permanently extend the research and development tax credit. The R&D tax credit, which expired on June 30, has proven to be of enormous value to American business. We all understand the importance of research and development to the American economy. Most leading American companies owe their market dominance to the innovations coming from R&D labs. Yet R&D is expensive, and it is often among the

first items to be cut when budgets get tight. The R&D tax credit serves America by providing an economic incentive to companies to continue to invest in the R&D that will provide the growth and opportunities of the future.

Studies have shown that the R&D tax credit significantly increases research and development expenditures. The marginal effect of $1 of the research credit creates approximately $1 of additional private research and development spending in the short-run, and as much as $2 of extra R&D spending in the long run. This is good for the American economy and the American taxpayer. In fact, one study estimates that a permanent research credit would result in our gross domestic product increasing by $10 billion after 5 years and by $31 billion after 20 years.

In addition, the extension of the R&D tax credit will have benefits beyond the purely economic. For example, the research and development tax credit has proven to be critical to the U.S. biomedical research arena. The tax credit has contributed to many successes in U.S. scientific research and innovation, such as rapid progress in finding cures for life threatening diseases such as AIDS, cancer and multiple sclerosis. Today's diseases--Alzheimer's, AIDS, heart, liver and kidney disease, prostate cancer and arthritis--are complex and are in the final stages for research breakthroughs. If we allow the incentives to invest in medical progress to lapse, the consequence may be irrevocable and society may rue that decision for years to come.

Given the importance of the R&D tax credit, it makes little sense for Congress to continue to renew it for short terms. The investment of funds in research and development is not a temporary fix but something that should be consistently encouraged. Towards this end, my bill permanently extends the R&D tax credit. Such a permanent extension will send a strong signal to American companies that the value of R&D is recognized here in Washington. The permanent extension will also provide greater certainty to companies seeking to make plans years in advance.

My legislation will also renew two less well known but important tax provisions which encourage capital investments. My bill extends for another year a provision that allows companies to take an immediate 50- percent depreciation on purchases of qualified equipment and machinery. This accelerated depreciation is currently set to expire in December, 2004; equipment purchased thereafter would be subject to standard depreciation tables. My bill provides that necessary equipment purchased between December 2004 and December 2005 will continue to qualify for the accelerated depreciation.

The availability of accelerated depreciation--especially at the high rate of 50 percent--makes an enormous difference to companies contemplating large capital investments. Companies which simply could not afford these investments under standard depreciation face a dramatically altered balance sheet once the accelerated depreciation is factored in. Investments that did not previously make economic sense will now be economically advantageous. As these investments are made, companies will grow and hire. This change in the balance sheet will reap a concrete benefit in jobs and growth.

In addition, my legislation extends the section 179 exclusion at the current level of $100,000 through December 2007. This is another esoteric sounding provision that will produce very real economic benefits. Under this provision, companies can immediately expense, that is, recognize as an expense to be deducted from revenues for tax purposes, up to $100,000 invested in equipment and machinery. The standard section 179 deduction is only $25,000. Once again, this provision will have the effect of making investments economically advantageous when they otherwise would not be. The greater capital investment thereby fostered will lead to greater growth and job opportunities.

Beyond these tax incentives, my bill also seeks to help American business through our trade policy. My legislation focuses on two programs in particular which help small businesses find markets for their products abroad. My bill includes an increase in funding of $27 million for the U.S. Trade and Development Agency, USTDA. The USTDA has proven to be critical to small businesses seeking to sell their products abroad. The USTDA helps American businesses study and identify opportunities in foreign markets so that they can determine which options will be profitable. To a small American business facing a very large global economy, the USTDA serves as an accessible and inexpensive international sales department.

USTDA's unique public-private partnership truly extends the effectiveness of taxpayers' dollars. Historically, $35 worth of exports are generated for every dollar invested by USTDA. As a result, $21 billion in U.S. exports have been shipped overseas in concert with USTDA's programs.

My legislation also includes $5 million in funding to promote the benefits available under the Export Trading Company Act of 1982. This legislation was enacted to stimulate U.S. exports by authorizing the Secretary of Commerce to issue export trade certificates of review to groups of small businesses. A certificate of review protects the holder and the members identified in the certificate from State and Federal Government antitrust actions and from private treble damage antitrust actions for the export conduct specified in the certificate and carried out in compliance with its terms and conditions.

Given the realities of international trade, these antitrust exemptions are crucial. In order to compete in a challenging foreign market such as China, for example, it is extremely advantageous to have a full-time sales representative on the ground there. Yet few small businesses can afford to hire full-time representatives and send them to China. The antitrust exemptions in the Export Trading Company Act of 1982 would enable a group of small businesses to band together to hire a sales representative, open an office, and pursue the other necessities of international trade.

The Export Trading Company Act is good legislation which solves a critical problem. Yet few American businesses exploring international trade are aware of the opportunities under this act, let alone take advantage of them. As a result, the enormous economic opportunities created by this law continue to go unrealized. I think that a minimal investment in marketing and promoting this act will pay for itself many times over in increased exports, growth and jobs.

Finally, my bill includes a provision that will enable small businesses to join together to negotiate more affordable health care plans for their employees. This provision will provide an enormous economic boost to America's businesses--with the saving they gain from better health insurance rates they can invest, grow and hire. Yet this provision also provides clear benefits beyond the purely economic. By making health insurance more affordable, this provision will help reverse the growth in the ranks of the uninsured.

According to a poll conducted by the Kaiser Family Foundation, Americans worry more about rising health care costs than they do about terrorist attacks. There is a reason for such concern. More than 43 million Americans under age 65 lack health insurance coverage. The ranks of the uninsured consist primarily of working families with low and moderate incomes--not just the unemployed. Nearly 26 million individuals are employed and still are without health care coverage.

My bill will give small businesses the same market-based advantages when negotiating health insurance for their employees that large companies and unions currently enjoy. As independent entities, small businesses have little leverage when they negotiate with health insurance providers, and the situation they face is often one of take it or leave it. Even when small businesses band together in local purchasing pools, the group is often not large enough to attract new insurance companies with less expensive plans.

My act will allow small businesses to join together in large national pools under the auspices of bona fide associations and either purchase insurance from a provider or self-insure the same way that large employers and unions do. For example, the American Restaurant Association could negotiate a plan on behalf of the hundreds of thousands of employees who work for its member businesses. Once the plan is in place, each individual restaurant could

choose to participate in this plan at much better rates than they could ever have negotiated on their own.

I thank Senator Snowe for her leadership and hard work on this issue of association health plans. On March 6, 2003, Senator Snowe introduced S. 545, the Small Business Health Fairness Act of 2003. This long and very detailed bill addresses all of the issues needed to make association health plans a reality. I signed on as a cosponsor of S. 545 on June 9, 2003, and I have included the text of S. 545 in my bill.

It is my sincere hope that the economic recovery will continue and will pick up steam in the months to come. There is great reason for optimism. But our optimism must not blind us to the continuing problems that Americans face. There are measures that Congress can take--today-- which will help our businesses to grow, hire new employees, and provide health insurance to these employees at a more affordable rate. These measures will, in the long run, more than pay for themselves. We must take these steps and do our part. I hope that my colleagues will join me in supporting the Economic Stimulus Act of 2004.

Mr. President, every year, I spend time driving across the State of South Dakota, and every year, I hear unbelievable stories from my constituents about the growing health care crisis in South Dakota and across America. One issue that comes up repeatedly in my travels is South Dakota's dental shortage.

The statistics speak for themselves. Almost one-third of my State's 66 counties have been designated Dental Health Professional Shortage Areas. In total, over 97,000 South Dakotans live in a county that does not have enough dentists to meet the needs of the population. Nationally, 25 million Americans reside in such shortage areas.

South Dakota has only one dentist for every 250 square miles, which means that many South Dakotans must travel more than 100 miles to visit a dentist. To see a pediatric dentist, parents often have to travel up to 400 miles. I've heard stories of families driving clear across the State so that their children can receive urgent dental care. Comparatively, Minnesota's rate is 28 square miles per dentist. Massachusetts's rate is less than 2 square miles per dentist, and here in Washington, DC, the rate is 0.1 square miles per dentist.

In addition, the dentists my State does have are getting older. A study conducted in South Dakota found that roughly half of the dentists currently practicing there are over 50 years old, and that 30 percent plan to retire within 10 years. Nationally, more than 20 percent of dentists will retire in the next 10 years, and the number of dental graduates by 2015 may not be enough to replace them.

The problem in Indian country is even worse. Indian pre-school children have 5 times the rate of dental decay experienced by other children in their age group. Despite this great need, the Indian Health Services estimates that one-third of its dental positions are vacant.

A report by the Government Accounting Office in 2000 found that, while several factors contribute to the low use of dental services among low-income individuals, the most important factor was the inability to find a

dentist to treat them. That is simply unacceptable.

Another report by Oral Health America in 2003 found that the United States does poorly in several areas that measure access to dental care. In fact, in the report's assessment of dentist availability, the majority of States received a grade of C or lower. The report card also found that those with the greatest need have the hardest time finding care; 18 states received a failing grade for the availability of dentists who provide significant services under Medicaid, contributing to an alarming D grade for the entire nation.

In an effort to address this urgent problem, I have been working with representatives from the South Dakota Oral Health Coalition to develop a legislative remedy at the Federal level. The culmination of that effort is the bill I am introducing today, the Dental Health Provider Shortage Act. Together with Senator Collins--herself a longtime supporter of expanding access to dental care--I am proud to introduce this bill, which would help to expand the number of dentists and dental hygienists, both nationwide and in rural and underserved areas.

Specifically, the Dental Heath Provider Shortage Act would work to increase the overall number of dentists and dental hygienists by providing faculty loan repayment programs for dentists who agree to teach, especially in general and pediatric training programs. It would also provide incentives for dentists and dental hygienists to work in rural and underserved areas by expanding both the National Health Service Corps and the Indian Health Service; providing support to Community Health Centers, which play a critical role in the delivery of dental care; and helping these centers and other providers that work in underserved areas to expand their practices. Finally, to encourage participation in State Medicaid programs, the bill would provide funding for states to simplify the Medicaid enrollment and payment process.

In this day and age, people should not be forced to travel great distances--let alone more than 100 miles--just to see a dentist. We can and must do better. The Surgeon General's report, ``Oral Health in America,'' reinforced that oral health is essential to the general health and well-being of all Americans. In its ``Call to Action,'' the report challenged the Nation to build a health infrastructure that can effectively meet the oral health needs of all Americans. By passing the bipartisan Dental Health Provider Shortage Act, we can begin to do just that.

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

Mr. President, I am pleased to introduce today the Advancing FASD Research, Prevention, and Services Act. For many years now, I have met and worked with people whose lives have been profoundly affected by the consumption of alcohol during pregnancy. Prenatal exposure to alcohol can cause a wide range of serious, life-long problems known as Fetal Alcohol Syndrome Disorders. Individuals with FASD can have a low IQ, behavioral impairments, growth retardation, facial abnormalities, and birth defects. About 40,000 children are born with FASD each year.

A great deal of progress has been made in raising awareness of the dangers of alcohol consumption during pregnancy, but much more needs to be done. The bill I am introducing today addresses the need for more research, better screening systems to identify children with FASD, effective prevention programs, and enhanced access to treatment and support services. It is my sincere hope that this bill--when combined with the tireless efforts of parents, health professionals, teachers, and countless others--will help prevent FASD and support the children and families who are living with its consequences. I ask unanimous consent that a fact sheet containing a description of the bill be printed in the Record.

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

Mr. President, 8 months ago, the Republican leadership pushed through Congress a lemon of a Medicare prescription drug bill that has been breaking down part by part since the day it was passed.

First, we learned drug companies were raising the prices of many drugs, erasing what little discounts the administration's drug card program might have offered.

Next, we learned the administration concealed its cost estimates, misled Congress, and threatened the Medicare actuary with termination for trying to respond to Congressional requests for information.

Then, we heard that some seniors who enrolled in the program were going to see reductions in other benefits, such as food stamps.

Later, days after the Drug Card program began, seniors from across the country began to report that it was too confusing and studies revealed there were lower prices available from major online pharmacies.

Finally, we learned that the HHS website established to help seniors navigate their way through the labyrinth of the myriad cards was riddled with false information.

The most recent discovery, however, is the most troubling of all, because what we're talking about is not policy breakdown, but policy sabotage.

Let me explain: Every senior has his or her Medicare Part B premium withdrawn from their Social Security check. But when the increase in health care inflation began to outpace seniors' Social Security cost of living adjustments, Congress protected seniors by making it impossible for a senior's Medicare premiums to go up more than the value of his or her Social Security COLA. It's called the ``hold harmless'' protection, and it makes a simple promise to seniors: The cost of health care will not come at the expense of the cost of living.

We have now learned that behind closed doors and in the dark of night, Republican leaders undermined this promise. Like Part B premiums, the new prescription drug premiums will come out of a senior's Social Security check. But unlike in traditional Medicare, the new drug bill does not protect seniors with a ``hold harmless'' provision.

It was never mentioned in the debate and no one has stepped forward to take responsibility in the months since. But if we don't fix the problem, it will eventually result in the decimation of seniors' Social Security annual cost of living adjustment.

Never have these protections been more important. In the past several years, the consumer price index, on

which Social Security COLAs are pegged, has remained very low. At the same time, the cost of health care has been skyrocketing by double- digit percentages. In the 4 years of this administration, the cumulative increase in the Medicare monthly premiums will be at least $26, nearly twice as much as in the prior eight years under the Clinton administration. In addition, the Medicare Part B premium increase for 2005 is projected to be $114, the largest ever.

For seniors on a fixed income, every dollar counts. The hold harmless protection is the only thing standing in the way of lower and lower Social Security checks.

But the Republican leadership chose not to protect seniors in this drug bill, despite the fact that the cost of pharmaceuticals is increasing even faster than the cost of health care overall. Medicare Part D premiums are expected to rise 7.5 percent per year. The result will be a steady erosion of Social Security checks, and real damage to seniors' ability to pay their bills and keep up with inflation.

According to a new report by the Joint Economic Committee, one in four seniors will lose a quarter of their COLA just on Medicare premium increases by 2007. In 2014, nearly two in three seniors will see the same level of loss. And those most vulnerable will be the ones most severely harmed. For an elderly woman with a monthly benefit of $500, the increase in Medicare premiums will take an average of 60 percent of her COLA from 2007 to 2010, and an average of 66 percent from 2011 to 2014.

Let's not mince words. This is the worst kind of bait and switch. We cannot stand by and allow seniors to be cheated out of their cost of living increases in exchange for a confusing drug benefit that fails to bring down the cost of drugs.

Today, I am introducing the Social Security COLA Protection Act of 2004 to make sure that senior citizens continue to receive a COLA that helps them keep pace with inflation. This bill would restore seniors' protections and ensure that no more than 25 percent of their annual COLAs could be taken away by increases in Medicare premiums. The remaining 75 percent would be secure. For a senior citizen receiving a $600 monthly benefit, this bill would protect more than $2,200 over the next 10 years. That's money seniors will need to cover increases in clothing, food, housing and energy prices.

We're not talking about adding an extra benefit to Social Security. We're talking about protecting seniors' existing benefit from a drug plan that appears now to be little more than a wolf in sheep's clothing.

This wasn't the prescription drug bill seniors were promised. Upon the passage of this bill, President Bush said, ``Some older Americans spend much of their Social Security checks just on their medications. . . . Elderly Americans should not have to live with those kinds of fears and hard choices. This new law will ease the burden on seniors and will give them the extra help they need.''

As we have seen so often, there has been a gap between what this administration promised, and what it delivered. In the guise of easing one burden on seniors, the administration has added yet another.

I wish the White House and the Republican leadership in Congress had listened more closely to some of the voices of seniors during the debate last Fall. One man from Nashville, Tennessee looked at the details of this bill and asked, ``Do you think anybody in Washington has any idea what people on a limited income have to do to live?''

If the authors of the prescription drug bill truly understood what seniors on fixed incomes must go through, they never would have passed it.

Democrats are fighting to make things right again. We do understand the struggles of America's seniors and the burden drug costs put on their finances. Seniors were promised a real prescription drug benefit for Medicare. The Republicans' prescription drug bill has proven to be tragically inadequate. The COLA protection bill we are introducing today represents an important step in repairing the damage, and Democrats will keep fighting until seniors get the help they were promised and the benefit they deserve.

I want to thank the Joint Economic Committee Democrats for their efforts to identify and highlight this problem. Senator Jack Reed is the senior Democratic Senator on the Committee, and the lead cosponsor of the COLA protection bill. Senator Patty Murray joined us in highlighting the problem yesterday. She is also a cosponsor, along with five other Senate Democrats.

This is truly a bicameral effort. My South Dakota colleague, Stephanie Herseth, is sponsoring the House bill. This is the first bill she is introducing in Congress, and I am proud that she is helping lead this fight for seniors in South Dakota and across the country. Many other House Democrats are joining her in this effort.

Senator Reed will be inserting the JEC report into the Record. I encourage my colleagues to read it. I ask unanimous consent to print in the Record a fact sheet on the bill that was prepared by Representative Pelosi's office, as well as a document prepared by the House Ways and Means Committee staff that provides several illustrative examples of how the bill would work, how much retirees would save if it becomes law, and what percentage of Medicare enrollees will benefit. I also ask unanimous consent that the text of the bill be printed in the Record.

We will continue our effort to protect America's seniors and address the problems created by last year's prescription drug bill when Congress returns in the fall.

Mr. President, recent media reports indicate that at least two companies are actively considering plans to import Brazilian ethanol into the United States duty-free through the Caribbean Basin. These reports have generated understandable anxiety within the farm community.

Cargill, the Minnesota-based agri-business giant, has confirmed that it is considering importing 63 million gallons of Brazilian ethanol into the United States each year. And it has been reported that Chevron-Texaco, one of the largest oil companies in the United States, is planning construction of a plant that will enable it to import 50 million to 100 million gallons of ethanol.

Farmers in South Dakota and throughout the Midwest are concerned that such import schemes could threaten the growth of the domestic ethanol industry and undermine our effort to establish ethanol as a major domestic energy source. They should be concerned. These import plans would establish a dangerous precedent for other importers and dramatically undercut the ability of the pending Renewable Fuels Standard to enhance our national energy security and boost farm income.

The key to the next growth spurt in the domestic ethanol industry is bipartisan legislation I wrote with Senator Dick Lugar (R-IN) that would set mandatory annual production targets for ethanol for the next 10 years. Senator Lugar and I proposed the Renewable Fuels Standard, or RFS, 4 years ago as a means to grow the domestic ethanol industry in a way that both encourages investment in new community-sized ethanol facilities and expands markets for farmers. We remain hopeful that this proposal will clear Congress before adjournment this year.

Under our proposed RFS, domestic ethanol demand would grow from 3 billion gallons per year in 2004 to more than 5 billion gallons in 2012, providing ethanol plants and farmers with a steady growth schedule that encourages investment in this domestic industry. This RFS would create over 214,000 jobs, increase farm income by $1.3 billion annually, and save the U.S. $4 billion in imported oil each year.

Plans to import ethanol threaten these benefits by injecting an element of market uncertainty into the RFS discussion that could dampen investment in community-sized ethanol facilities. Ethanol importation would put the producers of Brazilian sugarcane in direct competition with American corn growers. That is why today Senators Lugar, Hagel, Nelson, and I are introducing legislation to clarify that ethanol imports will not count toward the RFS targets. This bill will ensure that farmers and domestic ethanol investors will get the full benefit of the RFS, and it tells Cargill and Chevron accountants not to count on the new demand created by the Renewable Fuels Standard to justify any scheme to import ethanol.

I understand that corporate executives feel an obligation to their shareholders. My obligation is to South Dakota farmers, ethanol producers, and motorists who view increased ethanol demand as a means to establish greater control over their economic and energy future.

I have fought my entire public career against outright opposition and indifference from the giant corporate interests whose balance sheets don't consider the value-added contribution of local economic development. This situation is no different. As a result of our efforts, Chevron won't get to import as much oil and refine and sell as much high-priced gasoline as they may like, and Cargill won't get to import ethanol and compete against South Dakota producers.

The RFS program is designed to stimulate domestic production and enhance U.S. energy security, not to create a market opportunity for foreign ethanol. The bill I am introducing today will help make sure that rural communities are able to attract investment capital to produce clean burning energy, create quality jobs for their kids, and expand local tax bases to accommodate better schools and community services.

Mr. President, I ask unanimous consent that the text of the bill and additional material be printed in the Record.

Mr President, I ask unanimous consent that additional material be printed in the Record.

Mr. President, as we all painfully know, the United States has broken its word to Indian people, disregarded its treaty obligations, and breached its fiduciary trust responsibility. Litigation has been filed, and administrations of both political parties say the right thing, but then do not follow through to redress legitimate grievances. The concepts of sovereignty and government-to- government dialog are acknowledged, only later all too frequently to be ignored.

This sad history was elevated to a new level of concern this spring by the resignation of Mr. Alan Balaran as Special Master in the Cobell class action against the Department of the Interior. On April 5, 2004, Mr. Balaran made some very serious charges against the Department of the Interior in his official letter of resignation. He alleged that energy companies, abetted by the Department of the Interior, routinely pay Indian people less than they pay others for oil and gas easements. He further alleged that Interior officials regularly put the interests of private companies ahead of the Department's fiduciary responsibility to Indian people.

These are disturbing charges leveled by an individual knowledgeable about the long history of trust mismanagement. Congress must get to the bottom of this situation to fully satisfy our own fiduciary responsibility to Indian people.

It is clear that neither the executive branch nor the Congress's hands are clean on the trust management issue. And this not a partisan failure. It is a governmentwide failure that requires independent review.

I am, therefore, today introducing legislation to create a National Commission on American Indian Trust Holdings. This Commission will be unique in several respects. First, it will be composed of 10 prominent U.S. citizens. Two individuals will each be appointed by the President, Senate majority leader, Senate minority leader, Speaker of the House, and House minority leader to place the Commission beyond politics. Second, it will have the resources to hire the technical expertise needed. Professionals with expertise in land and resources management, accounting, Federal Indian policy, and trust law, among other disciplines will be included.

The Commission will build upon past efforts without duplicating past efforts.

Finally, the Commission will be charged with the responsibility of reporting to the President and the Congress within 1 year on: One, how to recoup, if possible, any damages that have resulted from the breach of fiduciary responsibility; and, two, how to prevent any such breaches in the future. We are looking for specific recommendations on how to fairly account for past mistakes, how to find closure on the trust issue, and how to prevent those mistakes from again happening in the future.

The overall goal of the Commission is to fully and completely examine the very serious charges made by Mr. Balaran, as outlined in his letter to Judge Lamberth. The Commission would also be authorized to examine other breaches of trust and to report back to the Congress and such executive departments as may seem appropriate.

Many words have been spoken over many years about trust responsibility and the breach of trust and fiduciary obligations, but very little concrete action has resulted from these words. Mr. Balaran's charges should be a wake-up call to all civic-minded Americans to demand that fairness be restored to the administration of Indian trust accounts. I sincerely hope that, given the track record of the past 10 years, an independent panel of distinguished Americans will be given an opportunity to succeed where the executive and legislative branches have fallen short. Their review will at least get to the bottom of Mr. Balaran's charges. And perhaps we can use the results of this examination to generate momentum for exploring the larger trust issues.

I ask unanimous consent that Mr. Balaran's letter of resignation and the text of the bill be printed in the Record.

Mr. President, I rise today to introduce the Veterans Eye Treatment Safety Act of 2004, or VETS Act, which will protect the eye care of our veterans by providing that only licensed physicians may perform eye surgery at Department of Veterans Affairs (VA) facilities or under contract with the VA.

Presently, 49 out of 50 States prohibit optometrists from performing surgery. Oklahoma is the only State that allows optometrists to perform laser surgical procedures. Recently, Oklahoma enacted a law expanding existing law to allow optometrists to perform nonlaser surgical procedures such as cataract surgery.

Under the VA credentialing practice, optometrists have been granted laser surgery clinical privileges within the VA Medical Center. The VA's credentialing practice allows medical practitioners to be granted privileges to perform procedures within the VA system that they are authorized to perform in the State in which they are licensed. Thus, an optometrist licensed in Oklahoma can be granted clinical privileges to perform laser surgery at the VA. In 2003, the VA allowed at least three optometrists to perform laser eye surgery at multiple VA hospitals throughout the Nation.

This practice is inconsistent with the policies of the Army, Navy, and Air Force, which do not allow optometrists to perform eye surgery. The VA, which also treats TRICARE beneficiaries, is the outlier. If a military retiree, a TRICARE beneficiary, needs laser eye surgery, only a licensed medical doctor or doctor of osteopathy could perform it, as required by the Army, Navy, and Air Force. However, if that same TRICARE beneficiary seeks treatment at a VA facility--as is his or her right--it is possible that an optometrist could perform the surgery. In this case, such person would receive a lower standard of care than the Department of Defense would allow in a military treatment facility. This VA credentialing practice regarding eye surgery creates two standards of care: a high standard of care for active duty personnel, dependents, and TRICARE beneficiaries when seen in a military treatment facility, and a lower standard of care for TRICARE beneficiaries and veterans if treated in the VA system.

The VA's practice is questionable. Optometrists typically do not have the requisite training and experience to perform eye surgery. Only one school of optometry in the United States offers courses in laser eye surgery. To become certified, optometrists must complete two courses at this school, with less than 40 hours of training, and perform only four supervised surgeries. In contrast, ophthalmologists during medical school, internship, and residency complete between 9,000 to 12,000 hours of training and education before practicing without supervision.

The Veterans Eye Treatment Safety Act of 2004 provides that only licensed medical doctors, licensed doctors of osteopathy, or licensed dentists whose practice is limited to oral or maxillofacial surgery may perform eye surgery at Department of Veterans Affairs facilities or under contract with the department. This legislation is narrowly targeted and does not prevent optometrists from performing noninvasive, nonsurgical procedures--the procedures that optometrists are trained and qualified to perform. The bill simply ensures that only licensed physicians can perform invasive, surgical procedures on our veterans.

The VETS Act has been endorsed by the Vietnam Veterans of America, the National Gulf War Resource Center, the American Medical Association, the American Academy of Ophthalmology, the American Osteopathic Association, and the American College of Surgeons. Additionally, the Veterans of Foreign Wars and the Blinded Veterans Association have written letters to the Department of Veterans Affairs opposing allowing optometrists to perform surgery.

This bill is a patient safety measure that protects our veterans. It protects the law of 49 States, preventing the will of one from becoming the law of the land. We must send a clear message to the VA that veterans should receive the same quality eye care that ordinary citizens receive.

I would like to thank Senator Cantwell, Senator Hollings, Senator Feinstein, and Senator Sessions for cosponsoring this important legislation. I urge all of my colleagues to join me in supporting this bill that will protect the ocular safety of our veterans--ensuring that they receive the same high level of care that almost all Americans and members of the armed forces receive.

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

Mr. President, I rise today to introduce two bills that would ensure fiscal accountability throughout the Judicial and Legislative Branches of the Federal Government: the Judicial Branch Financial Accountability Act of 2004 and the Legislative Branch Financial Accountability Expansion Act of 2004. These bills would strengthen the financial management of both branches by requiring them to prepare annual financial statements and have them independently audited.

These bills also build on S. 2680, the Financial Accountability Expansion Act of 2004, that Senator Akaka and I introduced on July 16, 2004, to expand independent audit requirements to the remainder of the executive branch that currently is not covered under the Chief Financial Officers Act or the Accountability of Tax Dollars Act. Taken together, this legislative package would ensure--for the first time-- that all agencies and entities in the entire United States Government are subject to stringent financial audit requirements.

Congressional efforts to improve financial management and to reduce the waste, fraud and abuse of taxpayer dollars began almost 25 years ago with the enactment of the Federal Managers Financial Integrity Act of 1982, which intended to strengthen internal controls and accounting systems. Another important financial management reform initiative was the Chief Financial Officers Act (CFO) of 1990. Among other things, the CFO Act created 24 CFO and deputy CFO positions in cabinet departments and major executive branch agencies, and required the annual preparation and audit of financial statements.

I would briefly like to mention that the Department of Homeland Security, which has 180,000 employees and a budget of over $30 billion, is the only cabinet level department not now subject to the CFO Act. In order to address this problem, on August 1, 2003, I was joined by Senator Akaka in introducing S. 1567, the Department of Homeland Security Financial Accountability Act, which would subject the department to the same financial management practices currently required of all other major Federal agencies. The Senate passed S. 1567 in November 2003, and the House of Representatives passed its version, H.R. 4259, on July 20, 2004. It is my hope and expectation that final congressional action on this legislation will occur in the near future.

The CFO Act improved the financial management of cabinet departments and major Federal agencies; however, it did not address the fiscal policies and practices of the rest of the executive branch. Therefore, in 2002, I was the Senate sponsor of the Accountability of Tax Dollars Act (ATDA). This legislation, which became law on November 7, 2002, amended the CFO Act to require agencies with budget authority of over $25 million to prepare annual financial statements and have them independently audited. Due to the enactment of the ATDA, an additional 76 agencies are now subject to requirements for annual audited financial statements.

The ATDA also provided authority to the Director of the Office of Management and Budget (OMB) to waive or exempt certain agencies from the act's requirements. The OMB director may waive these requirements during the first 2 years of implementation if an agency lacks the budgeted resources or requires additional time to develop financial management practices and systems. The OMB director may exempt agencies with budget authority under $25 million if it is determined that there is an absence of risk associated with the agency's operations.

To improve upon the legislative changes Congress enacted in 2002, the Financial Accountability Expansion Act of 2004, which I introduced last week, would further expand the requirements of the CFO Act to every remaining entity in the executive branch. Each executive branch agency or entity, regardless of its size or budget authority, would be subject to the financial oversight and accountability that annual, independently audited financial statements provide. In order to assist small agencies that may not have adequate financial resources or personnel to comply with these requirements, this bill would authorize the Secretary of the Treasury to enter into one or more contracts on behalf of the agency, or multiple agencies through ``bundling,'' for the preparation and independent audit of the financial statement.

To begin the process of expanding audit requirements through the Executive Branch, on July 19, 2004, I was joined by Senator Akaka in introducing S. 2688, the Executive Branch Financial Accountability Reporting Act of 2004, which would require the Director of the Office of Management and Budget (OMB) to submit a report to the relevant congressional committees that lists all Federal entities not currently required to prepare annual, independently audited financial statements. We were pleased that the Governmental Affairs Committee favorably reported this bill on July 21, 2004, and we intend to work with our colleagues to expedite Senate passage of this important legislation.

Although significant progress has been made in strengthening financial accountability of the executive branch, similar audit requirements in the judicial and legislative branches are woefully inadequate or completely lacking. At a hearing held on July 8, 2004, by the Governmental Affairs Subcommittee on Financial Management, the Budget, and International Security, which I chair, we heard surprising testimony that the judicial branch does not conduct annual audits of its financial statements. Similarly, many entities in the legislative branch do not prepare annual financial statements, and many that do prepare financial statements do not have them independently audited.

As part of the Contract with America in the 104th Congress, the financial statements of the House of Representatives have been annually audited by an independent accounting firm. While several other legislative branch entities voluntarily comply with the requirements of the CFO Act--the Government Accountability Office and the Congressional Budget Office--these agencies of Congress are not statutorily required to do so. I find it disturbing that the United States Senate does not hold itself to the same standards of financial accountability that it imposes on the executive branch of government. The financial activities of all entities established by and within the legislative branch--such as the Senate Disbursing Office, the Capitol Police, the Library of Congress, the Government Accountability Office, the U.S. Botanic Garden, and the Architect of the Capitol--should be subject statutorily to the oversight provided by an independent financial statement audit.

In fiscal year 2004, the Congress appropriated over $3.5 billion for the legislative branch and approximately $5.2 billion for the judicial branch. To ensure that these two co-equal branches of government are subject to independent audit requirements similar to the executive branch, the legislative package I introduce today includes two bills to strengthen the financial management practices of the Federal courts and legislative entities.

The Judicial Branch Financial Accountability Act of 2004 that I introduce today would require the Federal judiciary to have independent audits of annual financial statements covering

all accounts and activities. In deference to a co-equal branch of government, the bill would require the Judicial Conference of the United States, the principal policy-making body for the administration of the U.S. Courts, to determine whether the U.S. Supreme Court, the U.S. Court of Appeals for the Federal Circuit, the U.S. Court of International Trade, and other judicial branch entities, should submit separate financial statements, or whether there should be a single consolidated statement that is independently audited.

To ensure that judicial branch entities have the procedures and resources in place to comply with the requirements of this act, this bill would require the submission of a report regarding the act's implementation to the appropriate committees in the Senate and House of Representatives. This report is to be submitted not later than 90 days after the date of the bill's enactment, and is to include any legislative recommendations that may be necessary to carry out the provisions of the act. Similar to the requirements imposed by OMB on executive branch entities, this bill would require the completion and public release of the audited financial statement not later than 45 days after the end of the fiscal year.

The second bill I introduce today--the Legislative Branch Financial Accountability Expansion Act of 2004--would require that each House of Congress and each legislative agency or other entity prepare financial statements that must be independently audited. In order to ensure that entities in the legislative branch have the procedures and resources in place that are necessary to fulfill this requirement, the bill requires each House of Congress and each legislative agency or other entity to submit a report to the appropriate committees in the Senate and House of Representatives regarding the implementation of the act. The report is to be submitted within 90 days of the date of enactment, and is to include whether the establishment of a special office is necessary to carry out the act's requirements, as well as any legislative recommendations that may be necessary.

Within 60 days after the submission of this report, each House of Congress is to establish an office to prepare the financial statement. Each legislative agency or other entity is also required to establish an office, or designate an individual if that is more appropriate, to prepare the financial statement. An independent audit of the financial statement is to be completed and made public within 45 days after the close of the applicable fiscal year.

I am sensitive to how other co-equal branches of the Federal Government conduct their fiscal affairs. Therefore, these bills defer to the leadership of these branches to determine the most appropriate means of implementing annual independent audits of financial statements. In light of these sensitivities, I recognize that these bills represent the first step toward improving the financial accountability of the entire Federal Government. I look forward to working with my colleagues to provide the best legislative solution to ensure full and equal accountability for the use of taxpayer dollars.

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