A bill to redesignate the facility of the United States Postal Service located at 48 South Broadway, Nyack, New York, as the "Edward O'Grady, Waverly Brown, Peter Paige Post Office Building".

Mr. President, I commend Senator Murray for her strong leadership in restoring funds for the Healthy Communities Access Program to improve the delivery of care to the uninsured. The program provides grants to coalitions of health providers to improve the coordination of care for the uninsured. Since its inception, we have seen an overwhelmingly positive response to the program. Through these grants, 150 communities have been able to increase care for the uninsured, reduce unnecessary health costs, and create innovative projects through collaboration and information-sharing. In Massachusetts, the Cambridge Health Alliance used its grant to launch an impressive outreach campaign to enroll 57,000 uninsured residents in a comprehensive and well-coordinated system of care. The Alliance has formed strong partnerships with local schools, law enforcement, and advocacy groups who work together to meet the needs of the most vulnerable members of the community.

The Healthy Communities Access Program embodies exactly the kind of innovative approach to improving the quality of health care that we need. Yet, despite its successes, the administration wants to zero out the program and the Omnibus Bill eliminates its funding. We should not allow the gains made in communities across the country to be lost because of this shortsightedness. I urge the Senate to approve this amendment and support our communities in this effective way to improve care for the uninsured.

Will the Senator yield for a moment? Does the Senator have the time?

I want to commend my friend from Rhode Island. As one of the authors of the S-CHIP Program, we gave the States an opportunity to use the money and then we provided, if they did not use the money, that States that were attempting to cover the children would have some access to it and then eventually it would go back to the Treasury.

We are finding out now that there are a number of States that are prepared to go ahead and insure these children. This program is so enormously important, because if you put it with the Medicaid Program, there is no real reason why any child in America isn't covered with some form of health insurance.

I commend the Senator from Rhode Island. This program was agreed to and accepted in a strong bipartisan way. As author, along with my friend from Utah, Senator Hatch, if we had just not provided this provision and let the States have a little more time to implement it, we would have a lot more children covered. This makes a great

deal of sense. It is focused and it is a successful program. The point the Senator from Rhode Island makes is that it will ensure that hundreds of thousands of more children will be protected with health insurance.

I thank the Senator.

What was the request?

Mr. President, I send an amendment to the desk.

Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. President, I yield myself 8 minutes.

Mr. President, this is a health amendment. It is related to the broad disparities that exist in health care in our society, which recently the President of the United States has recognized, and also our majority leader.

I will take a moment or two to demonstrate these very significant health disparities. This amendment is intended to support and expand some of the existing programs which are in effect and a number of which have been cut very deeply in this omnibus appropriations bill, to restore funding to the appropriations, and then also to meet some of the current needs.

Just very quickly, we have nearly one in four African Americans and one in three Hispanics who are uninsured compared to 16 percent of all Americans. The mortality rate for African Americans is 1.6 times higher than for Whites, a ratio that is actually identical to the ratio in 1950. That has not changed since 1950--the last 50 years. The African- American infant mortality rate is twice that of Whites. Diabetes afflicts Hispanics twice as much as Whites. Minorities are less likely to get heart medicines or cardiac surgery or even essential pain medications. African-American men suffer prostate cancer twice as often as White men.

This is the reality. And I could go on. There are very dramatic and significant disparities. Take, for example, the health disparities in HIV/AIDS. This chart shows the rate per 100,000 of the population. It is 81.9 among Black Americans, 34.7 among Hispanics, 9.4 among American Indians/Alaskans. And it is 8.4 among the White population. There is a tremendous disparity.

What we have seen is that the minority HIV/AIDS initiative faces a devastating cut in this omnibus bill. It is an 85-percent cut. Do we hear that? An 85-percent cut.

In 2002, there was $381 million available for the initiative. In the omnibus, it is $50 million. This amendment would put it at $540 million. It would take the $380 million and adjust it to the increased demands we are facing.

It is absolutely intolerable that we have seen this dramatic reduction in terms of outreach for services, for prescriptions, for caring among minority populations. I think it is one of the glaring deficiencies of this particular program.

Before continuing, I must make a brief comment on today's Washington Post article on the front page where they say the AIDS panel choice wrote of a ``gay plague''--a ``gay plague.'' ``Views of White House Commission Nominee Draw Criticism.''

I would have thought, with all the debate and discussion we have had here on the floor, going back to the debate and discussion on Ryan White, and how we have debated and discussed the NIH budget and other issues relating to minority health, that we could have moved beyond this kind of serious stereotype of characterizing those with HIV or AIDS as part of a ``gay plague.'' Most of us thought this country had gone well beyond that kind of horrible insensitivity. I believe this appointment should be withdrawn. It is an insult to gay Americans, to those who have worked so hard to treat people with AIDS with sensitivity and support.

Removing one individual is not enough. We must maintain and expand our commitment to deal with the disease. When it comes to AIDS in the minority community, this appropriations bill is missing in action.

This amendment also provides some assistance to the NIH Center on Minorities and Health Disparities to try to make sure that the center, which coordinates a national research agenda on minority health is going to be adequately funded.

It also provides a very small and modest increase in the HHS Office for Civil Rights. Many members of the minority community are being excluded from treatment, care, and attention. It is difficult to think that is the case, but that is happening all over this country. The HHS Office for Civil Rights has more than 1,000 complaints on its desk that are being unanswered. We provide a few million dollars, from $33 million up to $48 million, to be able to deal with this.

Finally, one of the most important provisions in all of this pertains to programs that are directed to try to help meet the deficiencies in training minority health professionals and support historically Black schools. I just want to point out that in the Clinton year of 2000, funding was $93 million; in 2001, it was $109 million; and in 2002, it was $115 million; but the Bush request for this year is $10 million-- $10 million.

There has been an increase in the revised omnibus, but it still shows a blatant and flagrant failure to understand the serious problem in the declining numbers of minority health professionals. These series of programs and the centers of excellence that enable many minorities to make it to schools of professional training--in nursing, dentistry, and medicine--those programs would have effectively been closed down. And the scholarship programs which have been available to minority students effectively would have been drastically reduced.

It does seem to me, after all we have heard in the debates over the period of the last 2 weeks, on issues of affirmative action, on issues of civil rights, that the one area on which we could all come together is these extraordinary disparities in health care that have been out there. These are the same disparities that have been around for the last 50 years and, under this omnibus bill, programs that help to alleviate the disparities are being cut back or abandoned in a very significant and important way.

This amendment restores those funds and adds additional funding to it to make sure we have realistic levels of assistance to reduce disparities. It does seem that even though we have had debates that have been divisive over recent times, on issues of affirmative action and other judicial issues, we as a Senate ought to be able to come together and say that whether you are going to get care and attention on a particular sickness or disease should not depend on the color of your skin. That is what is happening.

Mr. President, I yield myself 2 more minutes.

Mr. President, that is what is happening. In too many instances we are finding that those whose skin is not white are being denied medical care. They are being denied the services which are so essential to individuals to improve their kind of health conditions.

This is an area we can do something about. We will have broad debates on

other kinds of policy issues, but in terms of reducing the disparities and having support for the tried and true programs, this amendment will advance that cause. I hope we can accept it and move on.

Mr. President, I withhold the remainder of my time.

Mr. President, I suggest the absence of a quorum and the time to be applied equally.

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, how much time remains?

I have 5 minutes remaining?

I yield myself 2\1/2\ minutes.

Mr. President, I would like to call attention to the Labor-HHS appropriations conference report from FY 2002 on the Minority HIV/AIDS Initiative.

What it shows is the appropriations for HIV/AIDS health programs for FY 2002--$123 million for HRSA; $96 million for CDC; $7 million for SAMHSA/Center for Mental Health Services; $57 million for SAMHSA/Center for Substance Abuse Treatment; $38 million to the Center for Substance Abuse Prevention; $50 million for the Office of the Secretary; $9.7 million for the Office of Minority Health. That adds up to $381 million.

The Senate fiscal year 2003 omnibus appropriations lists $50 million for the Minority HIV/AIDS Initiative, Office of the Secretary. That is it. It is all listed in very considerable detail in this 2002 report. On the other hand, under this fiscal year 2003, minority HIV/AIDS has just the $50 million, Office of the Secretary.

This is extremely important. The 2002 conference report illustrates exactly where the funding has been directed and the support for it. That is completely missing in this proposal.

Our amendment addresses these issues and provides the kind of support which will make an important difference in reducing the disparities in health care in our society.

Having listened to so many who have spoken so often in the last several days on civil rights, there may be differences on one issue or another affecting civil rights, but we should all come together on this issue to address the disparities in health care which exist. We should go beyond our differences.

I reserve the remainder of my time.

Mr. President, I yield myself 1 additional minute.

What do these cuts mean? They mean 10,000 minority women and children, including HIV-infected pregnant women, will lose medical care under title IV of Ryan White; 11,000 minority patients in the hardest hit cities will lose lifesaving drugs and critical medical care through title I of Ryan White; another 5,000 minority patients will lose medical care funded through State governments under title II of Ryan White. These are just some of what will happen unless we make major changes in the omnibus appropriations bill, and my amendment does that.

I withhold my remaining time.

I have 2 minutes which I will use.

That is fine.

Would the Senator be good enough to repeat?

I thank the leaders.

Yes.

Mr. President, I call up amendment No. 89 and ask for its consideration.

Mr. President, I rise to offer the 6-month Medicare and Medicaid extenders amendment No. 89 to H.J. Res. 2. The modified version of the amendment is at the desk. The modification assures that the cost of this amendment is fully offset by extension of the Customs user fee.

The current appropriations bill, like the extension of unemployment insurance we passed earlier, represents unfinished business from last year. We are dedicating so much time to deliberating this bill because we recognize our obligation to take care of issues we left unresolved in the last Congress. I stand before you today to discuss another obligation that we left unfinished. That is Medicare.

Virtually every Senator on both sides of the aisle has in the past expressed deep concern about the shortfalls of the Medicare system, particularly the lack of a long overdue prescription drug benefit.

Now, regardless of the many DSH solutions that have been proposed and debated, I think it is fair to say that all of us stand united in saying Medicare needs fixing. Now, does this amendment provide that long-awaited fix? No. But what it does do is effectively freeze Medicare in its 2002 state.

As badly as we all believe that Medicare was functioning last year because of the fiscal pressures, without action Medicare will be in even worse shape this year. Many of the Medicare and Medicaid provisions enacted in the Balanced Budget Act of 1999 or the Beneficiary Improvement and Protection Act of 2001 either expired at the end of fiscal year 2002 or will be expiring soon.

Last year, there was bipartisan interest, led by Senators Grassley and Baucus, in addressing many of these ill-conceived cuts. But that effort was caught up and procedurally tangled at the end of last year, and many of the cuts we were trying to avert will now go into effect. I believe a number of these cuts, once implemented, will be very difficult to reverse. Yet because of procedural roadblocks, we won't be able to address them, despite the overwhelming bipartisan majorities in this body to fix these cuts and their impact.

This is policy by default and by neglect, not by deliberative democracy. My bill provides a 6-month moratorium on this Medicare cliff to prevent irreversible deterioration of services for beneficiaries while Congress completes the unfinished debate from last year over a more comprehensive Medicare reform package. The measures in this amendment--with the exception of the physician payment update, which lasts from March 1 to September 30--are scheduled to be implemented from April 1 to September 30, 2003, the exact same time period as the other rural hospital provision that is already included in the omnibus.

The specific measures of this amendment include an inflationary update for hospitals and a continuation of the workforce add-on for nursing facilities that are trying to maintain nurses in a time of shortage. It also delays the automatic 15-percent home health cut. It prevents cuts in dialysis services, and it helps stroke victims by continuing a moratorium on the $1,500 cap for therapy services.

This amendment would also assure that hospitals serving a disproportionate share of Medicaid and Medicare beneficiaries, including teaching hospitals, are not crippled or even have services basically shut down while Congress debates this issue. It assures that doctors who have suffered a 5.4-percent cut last year, and are frozen at last year's rate by this omnibus bill, would get a 2-percent increase from last year's unacceptably low levels. It also extends the QI Program, which I know my colleague Senator Bingaman is very interested in; that provides support for low-income seniors who would otherwise be unable to afford Medicare premiums. These seniors will be kicked off Medicare on April 1. Once they are kicked off, it will be hard to identify and reinstate them unless Congress extends their eligibility.

Medicare+Choice plans are also increasing their premiums, cutting benefits, and withdrawing services. I believe beneficiaries need protections against these health plan deductions and we should debate and pass these protections in the coming year.

In the meantime, I am troubled by reports of plans pulling out of markets and leaving beneficiaries stranded. As you can tell from this chart, until we can act to help beneficiaries, this amendment provides for a 3-percent increase, increasing the 2 percent already scheduled, which will hopefully prevent further pull-outs and the disruption they cause to the continuity of care.

So what would happen if we didn't do anything? Well, as this chart shows, hospitals are already struggling to keep up with rising health care demands while trying to invest in the latest lifesaving technology. They would lose roughly $1 billion, including over $100 million in New York alone. Medicaid DSH hospitals, which take care of a disproportionately high number of uninsured patients, would lose an additional $100 million.

Meanwhile, this chart shows the increasing amount of uncompensated care that hospitals are forced to provide. Let me say a word about physicians, many of whom were forced to limit their Medicare practice due to last year's cut. This will--if we don't act, if we only implement what is in the omnibus bill--continue to bring about limitations in practice and decrease the numbers of patients who are served.

Skilled nursing facilities already facing worsening nursing shortages would lose $700 million. That amounts to about $32 per day per resident. And for the average nursing facility, this amendment amounts to about a $117,000 annual cut. That is enough to pay for two registered nurses, three licensed practical nurses, or five certified nursing assistants.

Home health agencies, which are so critical in allowing patients to be taken care of at home rather than in expensive inpatient facilities, would lose $500 million. These are just a few of the providers who form the fabric of our seniors' health care system. If we allow the fabric to fray, it will be much harder to weave it together again. As this chart shows, the fabric is already framed. Over the past year, I have talked to numerous providers from New York and from other States who are just on the brink of halting services, not only to Medicare patients but actually going out of business altogether. The common refrain I hear is that once these providers leave the Medicare system, they are not coming back, even if an eventual long-term solution is found. In other words, it is far easier, and I argue far cheaper, to preserve our current system and then strengthen it later than to allow the current system to be destroyed with the hope of rebuilding it in the future.

When a critically ill patient comes into the emergency room, he is first seen in the ER, stabilized, then sent to surgery, if required. Why? Well, we all know from watching television that the ER physician knows that surgery will take a while. If immediate measures are not taken, the patient could

die before the surgeon can even begin operating.

What we have with Medicare right now is a critically ill system, one which I know requires major surgery in the very near future to transplant the dying patient into once again a live and vigorous one. But until we are ready to do that operation, we need to take immediate action to stabilize the system and prevent it from collapsing before we are able to act.

This amendment will act as that stabilizer, will give us time to undertake the long-term task. I therefore urge my colleagues to support the amendment. Continued inaction will leave Medicare so irreversibly damaged that even the best healers among us will be unable to revitalize it. I look forward to stabilizing our patients and getting on to debating the right cure.

The Senator is absolutely correct. Health care is a primary provider of jobs in every State that I know of and certainly in the cities across the country. Our hospitals, nursing homes, home health programs, physicians offices are all providing employment. That is why it was so important that we tried to address this last year. We could not get past the procedural roadblocks, despite the best efforts of Senator Grassley and Senator Baucus. I supported their proposals. Now we have to act because we are on the brink of an emergency.

I want to make sure that the modified version of the amendment with the offsets we have found is at the desk because there seems to have been some confusion.

Yes, I will yield.

I thank the Senator from North Dakota. Clearly, if we do not act, doctors are going to start pulling out of Medicare in a month. Then we are going to have the rapid unraveling of the system, which we all fear. It is going to be much harder to put it together under the leadership of Senator Grassley and others who are addressing this issue.

The Senator is correct to point that out. That is not in the modified amendment. I apologize; the Senator has not gotten a copy of the modified amendment.

Mr. President, I agree with the Senator. As the Senator knows, as often happens around here, we have been working very closely with staff of the Finance Committee. Many of these provisions have been modified, and also we were able to fully offset the costs by extension of the Customs user fee, knowing full well that is a concern of many of my colleagues with respect to how this would be paid for. I will take the position it is such an emergency that we should find new money, if necessary, to give us the time to do this in a deliberative manner. But we do have the offsets, and the modified amendment provides for those offsets.

The teaching hospitals will certainly help defray some of the increasing costs that are not going to be taken care of otherwise.

The Senator's question is absolutely pertinent. We worked very hard through the night addressing that point. I have been informed by my staff, in consultation with the Finance Committee staff, that the amount is offset. Clearly, as I have said, I think this is such an emergency that we should spend new money, but we do have such an offset.

Mr. President, I ask unanimous consent that the modified amendment be accepted at the desk and be considered.

Mr. President, I suggest the absence of a quorum.

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I enjoyed very much the speech of my colleague from Pennsylvania, but it has almost no relevance to what is going on here at all. It was good for the amusement of the Chamber, but those numbers bear no relationship to the amendments that have been offered.

The Senator from Pennsylvania adds up some tote board scoring of costs that bear no relationship to the amendments on which we voted. These amendments were not spending for 10 years. These amendments were to restore cuts that have been made in the budget for this year. This does not have anything to do with spending for 10 years from now, or 5 years from now. So all those cumulative totals bear no relationship to what has occurred in the Senate.

The concern with deficits of the Senator from Pennsylvania is interesting, but it is a change for him because he supported the massive tax cuts that have opened up this chasm, where we have gone from a projection 2 years ago of $5.6 trillion of surpluses over the next decade to now being $2 trillion in the hole. Where was he in his concern for deficits then?

The assertion that each of these items that have been voted on can be totaled is erroneous as well. We cannot just take each of these amendments, every one of them which has been defeated, and total them. One amendment is offered, it is defeated. That money cannot be treated as though it has been spent. That is what the Senator from Pennsylvania has done. It defies logic. It defies reason. It defies the facts.

These amendments were not offered in total. They were offered one at a time. As they were defeated, another amendment was offered. So you cannot total them. And you certainly cannot make 10-year totals from any of them because they are 1-year pending proposals.

I am happy to yield to my colleague.

If I might ask the Chair, the Senator from North Dakota

sought recognition, was granted recognition, the Senator from North Dakota still has the floor; is that not the case?

That is correct. And I have yielded to my colleague, the Senator from North Dakota, for a question.

Mr. President, deficits inhibit growth and hurt the economic strength of the country. That is undeniable.

I yield the floor.

Mr. President, first of all, I thank our colleague from Arizona for taking the time to listen to our concerns, because this is a disaster of staggering proportion in our State. Let me just say it is the unanimous view of every elected official in the State of North Dakota, every single one, Republican and Democrat, that we must deal with this unfolding crisis.

Here is what has happened to this lake. This lake, by the way, is three times the size of the District of Columbia. This is a massive lake. It has risen dramatically, some 26 vertical feet, since 1992. It started rising then and, as you can see, it has been straight up since then. This is a flood unlike any other in our Nation's history. The reason for that is that there are only two closed basins in the entire United States. The drainage basin for this lake is the size of the State of Massachusetts. This lake, if it continues uncontrolled, will reach the size of the State of Rhode Island. That is not just conjecture. That has happened two times in history. Those two times were at times when North Dakota and Minnesota were unpopulated.

Already the cost to the Federal Government already of this lake rising has been over $350 million. Threatened structures have been moved. Highways have been raised. A massive dike protecting the town of Devils Lake has been increased twice already. The Federal Government is poised to raise it again. So the hard reality is that unless more is done, we face a catastrophic event.

The year before last, 50 miles outside this basin, there was an event where 18 inches of rain fell in 1 day. If that event had occurred 50 miles to the west, this lake would have gone up, according to the Corps of Engineers' calculations, by 3 feet, perhaps even more. That probably would have overwhelmed the road system, because we now have roads acting as dams, protecting homes, protecting people from catastrophic loss. If that event would have occurred in the middle of the night, it is entirely likely that lives would have been lost.

The consequences of a failure to act here are enormous. This lake, which is already three times the size of the District of Columbia, has had an uncontrolled release out of the east end twice before in its history. If it happened again, it would be devastating to the hundreds of thousands of people downstream.

I remind our colleagues, the first ones downstream are the people in North Dakota, in the towns of Valley City, Fargo, and Grand Forks.

We have insisted that water quality has to be met with any outlet procedure. The provision in this bill provides that the funds shall not become available unless the Secretary of the Army determines that an emergency exists with respect to the need for an outlet and reports to Congress that the construction is technically sound, environmentally acceptable, and in compliance with the National Environmental Policy Act; provided further that the justification for the emergency outlet shall be fully described, including the analysis of benefits and costs to which the Senator from Arizona referred. There will be a requirement that a cost-benefit analysis is done. Provided further that the plans for the emergency outlet shall be reviewed and, to be effective, shall contain assurances provided by the Secretary of State that the project will not violate the treaty between the United States and Great Britain relating to the boundary waters between the United States and Canada.

We have attempted to be environmentally sensitive and cost-friendly to American taxpayers, but also to respond to this burgeoning crisis in the Devils Lake Basin, a crisis that has already cost the taxpayers of the United States $350 million. If the growth of this lake continues, it has the prospect of costing the American taxpayers hundreds and hundreds of millions of dollars more.

We have already had to buy out an entire town. We have already had to buy out the town of Church's Ferry.

The next town on the list is Minnewaukan. There is the lake. It has already eaten up the playing field of the high school there. That is all under water. This entire town is now threatened.

American taxpayers have already had to buy out Church's Ferry. Next is Minnewaukan, and if this continues, Devils Lake, a town of 10,000, would potentially fall into the requirement of having to be bought out. The cost of that to the American taxpayers would be billions of dollars. That is the hard reality.

Let me close with this photo. We like to say this is the luckiest fellow in North Dakota because he just escaped the advancing flood. This is a lake that, as one Federal official came out and said: My God, this looks like an ocean. Indeed, it is huge, three times the size of the District of Columbia. If it continues to grow, we will see complete devastation for hundreds and hundreds of thousands of acres and for hundreds of thousands of people.

This is a picture of a home having to be burned because it was in line with the floodwaters before it could be moved. Of course it would have created a serious health hazard had it been allowed to go into the water. So homes all across this area had to be burned and hundreds have had to be moved.

This project needs to go forward to protect human life and to prevent a disaster of stunning proportion. If this lake escapes uncontrolled out of the east end, as it has twice in our history, we expect that the downstream people would have a very serious adverse health effect.

I asked one time, when I heard repeatedly the Corps of Engineers talk about the health effects that would occur, the illness that would be the result of an uncontrolled release of the water out of the east end, what kind of health problems would occur? They explained the water systems downstream cannot handle the dissolved salts that are in this lake. If it went out of the east end of the lake uncontrolled, thousands of people downstream would be made ill.

There are many things that need to be done. Additional storage in the upper basin, millions of dollars have been spent on that. Moving threatened structures, raising roads, millions of dollars have been spent on that. Raising the dike protecting Devils Lake, tens of millions of dollars have been spent on that.

But one part of an overall strategy to deal with this crisis is to provide for an outlet. As the Senator from Arizona correctly states, there is no assurance that will solve the problem, but it is our best hope to prevent a catastrophe of truly stunning proportion, one that would not only adversely affect the people of North Dakota but the people of Minnesota and the people of Canada as well.

I yield the floor.

Mr. President, I rise today to speak about the State Children's Health Insurance Program and to thank my colleagues for their willingness to work with me on restoring funding to this program that is essential to ensuring continued health care coverage for America's children.

For the past week, I have worked with my colleagues to secure this agreement that will restore $2.7 billion in expired, or soon to expire, SCHIP funding. This compromise, that has been endorsed by our Nation's Governors, would ensure that this funding remains in the program and continues to provide children with access to the care that is vital to their healthy development.

I appreciate the willingness of Majority Leader Frist, Finance Committee Chairman Grassley and Budget Committee Chairman Nickles to work with us in developing this agreement. Because of their commitment to finding a solution, we are able to move forward with this important policy.

I believe this agreement is the most appropriate way to restore the SCHIP funding. Because the budget resolution adopted by the House of Representatives does not include adequate budget authority to restore this funding, the floor amendment that I filed to the omnibus appropriations bill would be subject to a budget point of order in the House. Given the that this point of order would lie against the provision, the likelihood that the House would strip this during conference is great. In light of these circumstances, I believe that this agreement is the most appropriate way to ensure that this funding is restored.

The agreement that was struck would, in exchange for withdrawing the amendments that my colleagues and I filed to the omnibus appropriations bill to restore SCHIP funding--provide the support of the majority leader and Chairman Grassley and Nickles to make necessary changes that will remove the budget hurdles that have prevented this legislation from being enacted.

Specifically, Senator Nickles has provided his commitment to reallocate through the fiscal year 2004 budget process additional budget authority for SCHIP in fiscal year 2003 and fiscal year 2004. Senator Nickles, I am confident that under your leadership, the budget process will move smoothly and expeditiously and that we will be able to speed the adoption of this proposal in both the Senate and House of Representatives.

Further, Chairman Grassley has agreed to move this policy through his committee as soon as the necessary changes are made to the budget allocations. Again, under his strong leadership, I am confident that we will get this done.

Finally, Majority Leader Frist has agreed to place the legislation on the

Senate calender as soon as it is reported from the Finance Committee.

I might add that while I am aware that this agreement was forged in the Senate, the underlying policy proposal was developed through a bipartisan, bicameral process led by Senators Grassley and Baucus last fall. I hope that the House of Representatives will work with us to make the necessary changes to the fiscal year 2003 and fiscal year 2004 budget allocations and to see this vital policy enacted in a timely manner.

Since 1997, States have made historic progress in their effort to insure low-income children under SCHIP. In fact, the National Center for Health Statistics just released data this month showing that the percentage of children 17 years of age and younger with health insurance has increased from 86.1 percent in 1997 to 91.2 percent during the first half of 2002. During this same period of time, statistics show the percentage of children insured by government programs, such as SCHIP, also increased to 27.2 percent. While these statistics are encouraging, a great deal of work remains if we are to address the critical issues of affordability and accessibility of health insurance, especially as they relate to health care for our children.

These compelling statistics reinforce the necessity that Congress must act to restore the expiring SCHIP funds. If we delay, we could jeopardize the substantial progress that has been made since 1997 in increasing the number of insured children in America. It is estimated that without restoration of this funding, almost one million children could lose health insurance coverage.

How it works it this, once passed, the policy would restore $2.7 billion in SCHIP funding that has either reverted to the Treasury or is scheduled to revert to HHS for redistribution. On October 1, 2002, $1.2 billion reverted to the Treasury in unspent SCHIP funding from 1998 and 1999. If we do not recapture this funding, it will be lost to the program. Our agreement allows the States to reclaim this unspent money and provides until the end of fiscal year 2004 to spend it on health insurance provided by SCHIP.

It also strikes a compromise between States that have spent all of their 2000 and 2001 allotments, and those that have not, by dividing the funding evenly between them. Those States that have not spent all of their allocations would be able to retain half of their funding, while the remaining States would receive additional allotments from the redistributed funding.

It also rewards those States that used Medicaid to expand access to health care for low-income children prior to the creation of SCHIP, by allowing them to access some of their SCHIP funding to serve this population. This compromise has the endorsement of the National Governors Association and children's health advocates from across the country.

In my home State of Maine, this proposal would allow the State to keep $13.4 million in SCHIP funding and would provide until the end of fiscal year 2004 to spent, I do not know about your State, but in Maine $13.24 million will help provide health care assistance to a lot of children, children who otherwise would not have access to immunizations, well-baby visits and yearly check-ups.

While my colleagues and I have agreed to forgo the appropriations process as the vehicle to move this package, we certainly have not abandoned our effort to restore the funding. If fact, we are more committed then ever to seeing the SCHIP funding restored and have added the support of the majority leader and chairs of the Finance and Budget Committees. Adding their endorsement to this effort, which already has garnered strong bipartisan support, will help to speed its passage.

In closing, I wish to highlight a quote from Secretary Thompson when his agency released the positive new data I referenced earlier regarding the level of health insurance for children in our country. He said:

More and more children are getting the health care they

need, thanks in large measure to our success in working with

states to expand health coverage through the SCHIP program.

We are giving governors the flexibility they need to continue

to expand coverage to more children, and our strategy is

paying off for children and parents alike.

This strong endorsement of SCHIP should act as an impetus to getting this policy enacted and ensuring that we do so in a timely fashion. Again, I appreciate the support of my colleagues and look forward to working with you as we move forward to enact this policy.

Mr. President, I would like to join in the colloquy that has just been held because it comes under the jurisdiction--or at least some of it--of the committee that I chair.

I thank my colleagues for their attention to this important children's health care policy. They are correct that something must be done to address the funds that have and will revert to the treasury in the near future. They are also correct to note the constraints within the omnibus bill. I strongly support the State Children's Health Insurance Program. It is a program that provides heath care for over 16,000 low-income children in my state.

Senators Chafee, Snowe, and Rockefeller are looking to address a necessary maintenance issue within S-CHIP. As Senator Snowe noted, I worked very closely with Senator Baucus, Senator Chafee, Senator Rockefeller, Chairman Tauzin, and Representative Dingell on a bipartisan, bicameral proposal that would have addressed expired S-CHIP funds.

The proposal reflected a balanced approach to redistributing S-CHIP funding taking into account that some states are spending through their existing allotments and other states are ramping up their programs and will need additional funding in the years to come.

This proposal did not pass the Senate last year, but it is a fair approach to redistributing S-CHIP funds. Unfortunately, I can not support including this policy at this time. The omnibus bill is a poor vehicle for this necessary maintenance.

I am sympathetic to the intent of this policy, although this is neither the time nor the place to address this issue. The Senate and the House have an agreement with the Administration to keep the omnibus appropriation bill under $750 billion. The S-CHIP policy costs over $1.2 billion in budget authority in 2003. An amendment of this nature would break that agreement and that is simply not acceptable. I appreciate Senator Snowe's, Chafee's and Rockefeller's willingness to accept this reality.

I assure my colleagues that I will work with them in the near future to update the S-CHIP redistribution policy in the near future as chairman of the Finance Committee. It my understanding that Senator Nickles, the chairman of the Budget Committee, is also interested in a regular order approach and that he is interested in putting money aside in the budget to address the needs of S-CHIP.

With this in mind, I believe the most appropriate way to address this issue is to work with the Chairman of the Budget Committee, Senator Nickles, to secure sufficient funding for this bipartisan S-CHIP proposal and then to address it in the Finance Committee. I will also continue my work with Energy and Commerce Committee Chairman Tauzin, so the Senate and the House can move forward in a coordinated fashion.

I assure my colleagues that I will work with them once the budget resolution for fiscal year 2004 has been adopted to move legislation quickly through the Finance Committee that reflects a bipartisan, bicameral two-year agreement on S-CHIP.

Yes.

Mr. President, if there is a question before the Senate, I do not want to interfere.

Mr. President, it is my understanding I have 15 minutes.

Mr. President, I yield myself 5 minutes, and then I will yield Senator Kyl 5 minutes.

I want my colleagues to reject this amendment. I, like the Senator from New York, agree we need to strengthen and improve Medicare, and I proved that last year with a bipartisan bill on Medicare give-back. Working with Senator Baucus, we put together a $43 billion bill that would have improved health care in rural America and address many of the issues the Senator from New York wants to address as well.

While I support addressing the needs of all Medicare providers, I cannot support doing it in this way in the amendment being proposed. We have to do this in a comprehensive, studied, and targeted way.

Everyone agrees that Medicare needs improving, and most of us would agree that Medicare payments need to be updated, but we do not have agreement on how that should be done. Some, including this Senator, believe that at least some providers need more money, but other Senators who might disagree with me say that providers are doing well and that their funding should be reduced.

Even very recently, we had the nonpartisan Medicare Payment Advisory Committee last week make recommendations to Congress calling for reductions in some provider payments.

I do not take these recommendations as gospel truth, and they are not going to govern my decisionmaking, but I believe we have a responsibility in the Finance Committee to examine all of these issues closely. More important, the only way we get anything done in this body is by a bipartisan approach. So we have to build a consensus before we pass a one-size-fits-all policy such as the one before us. I believe the place to do that is the Finance Committee. We will do our homework. That means listening to providers, beneficiaries, and experts to craft payment adjustments that ensure access to services for Medicare beneficiaries.

I will certainly ensure that the Finance Committee consider my colleague's proposal. The two Medicare provisions in this omnibus bill are limited in time and duration. They target the cases with the most widespread support--physicians as well as rural and small urban hospitals--while we can do it. These two items stand the best chance of being preserved through conference and in negotiation with the White House.

If this bill turns into some sort of Christmas tree for additional health care provisions, then the reality is that these provisions are likely to come out of the bill entirely, and we will not be helping anybody. Consequently, particularly doctors are going to have to wait until spring or summer. Let's not let the best be the enemy of the good.

That is why I suggest we keep with the compromise in the bill and expect our committee, which we will do, to bring forth recommendations.

I yield the floor.

How much time do I have remaining?

Okay. I yield 5 minutes to the Senator from Arizona and then 3\1/2\ minutes to the Senator from Pennsylvania.

The Senator from Arizona used his 5 minutes, and I have yielded 3\1/2\ minutes to Senator Santorum.

Of my time?

If it is not more than 30 seconds and we can get the show on the road, let's do it.

I yield the remaining time to the Senator from Pennsylvania.

Mr. President, I yield back the remainder of my time.