A bill to improve access to physicians in medically underserved areas.

Mr. President, I am grateful for the distinguished majority leader's remarks and for the tremendous work he has done in helping to bring this bill to the floor at this time, without which I don't think we would be this far. I have to say this is one of the most important bills in our country at this time. I am very grateful to him, and grateful to all of those who worked on this bill.

I rise today, along with the distinguished majority leader, to introduce S. 2290, the Fairness in Asbestos Injury Resolution Act--the FAIR Act--of 2004. This is a substitute bill that Senators Frist, DeWine, Voinovich, Miller, Allen, Chambliss, Hagel, Domenici, and I have spent a great deal of time developing. I particularly want to commend Senator Specter and Judge Becker of the Third Circuit Court of Appeals for their efforts in bringing interested parties together to discuss the further development of this legislation. We are pleased to include many agreements from that mediation process in this bill.

Let me start by noting that the United States Supreme Court has sadly but appropriately characterized the asbestos litigation system in our country as ``an elephantine mass.'' The Wall Street Journal aptly called it ``a job-eating asbestos blob.''

Without question, we face a crisis of epidemic proportions.

First, our asbestos system is inequitable. In our lottery-like system, juries award enormous damages to a special few, many of whom are not impaired at all and have never suffered a day of sickness. In other words, our system makes millionaires out of people who are not sick and who may never become sick. Meanwhile, people who are truly sick from asbestos receive little or nothing.

Let me illustrate this point. In a recent Mississippi case, six plaintiffs who were not sick--not one day of sickness--were awarded a total of $150 million. The plaintiffs did not claim to have ever missed a day of work because of asbestos injury. They did not claim any medical expenses related to asbestos, and they did not have asbestos- related physical impairment. Meanwhile, truly sick asbestos victims under the Johns-Manville bankruptcy trust receive a mere 5 cents on the dollar. A jackpot justice system like the one we have is unfair, and it is unjust. That is happening all over because about 10 percent of the plaintiffs bar, the personal injury lawyers, I think to the irritation of the 90 percent, are forum shopping these bills in jurisdictions where they can get big verdicts for bad cases. Frankly, what is happening today on asbestos compensation should not take place in this great country of America.

In addition to the gross inequities with respect to who gets compensated, the system is so overwhelmed by claims that truly sick people can wait years and die before even getting their day in court.

The fact is, our courts are simply unable to handle the volume of asbestos litigation. Unless Congress acts to end the delays and the distortions caused by these voracious personal injury lawyers--as I say, only about 10 percent, maybe less than that, of the personal injury bar--our system will remain broken.

Another unacceptable feature of our current system is that most of the money that should be going to compensate the truly injured, guess where it goes? It goes into the pockets of the lawyers. One actuarial firm estimates personal injury lawyers bringing these cases will siphon more than $60 billion out of asbestos litigation before it is over, and that is a conservative estimate.

As unfair as the system is today, the future is even more grim. Excessive damage awards, along with the transaction costs associated with the lawsuits, deplete the financial resources of the defendant companies and send more and more of them into bankruptcy. Many of these businesses are union businesses. These union workers lose their jobs because we have not resolved this problem. As legal and financial resources are exhausted by those who are not sick, those who truly are afflicted with asbestos-caused diseases are less and less likely to be compensated.

According to the Rand Institute for Civil Justice, a very prestigious institute, ``about two thirds of the claims are now filed by the unimpaired, while in the past they were filed only by the manifestly ill.''

Our asbestos system does not only burden unfairness on the truly sick; it is also devastating to our economy. According to Rand, the number of claims continues to rise, with over 600,000 claims already filed. Typically, claimants filed against dozens of defendants; more than 8,500 companies have been named as defendants in asbestos litigation. With only a handful of the original asbestos manufacturing companies, the ones that are really liable, remaining today, new industries are being targeted for lawsuits.

For instance, it has been reported that the big three automakers ``are defending approximately 15,000 cases based on claims alleging injury due to exposure to asbestos in brakes and clutches.''

Even nonmanufacturers, businesses that just supply asbestos, are now facing claims. These include plumbing, heating, and automotive supply stores. As funds from asbestos companies continue to dry up, we can expect the enterprising personal injury bar to continue to target companies that have

tangential relations to the claims and little or no real culpability.

One company is one of the large insurance companies that has never insured for asbestos, never had anything to do with asbestos. Basically it has never had a claim for asbestos up until recently, but they have been dragged into 60,000 cases because they were one of the early medical teams that came to the conclusion that mesothelioma comes from asbestos exposure. They did medical evaluations that concluded and helped to make the cases for those who truly are suffering, people who now are getting five cents on a dollar. They have been dragged into 60,000 cases that they should not have been dragged into. They will win every one of those cases, no question about it. That last case they tried--and they did win it, by the way--cost $2 million just in defense fees alone. Times that by 60,000 and you get an idea of the nightmare that insurance company is going through all because of voracious--I think in some cases, dishonest, small percentage of the personal injury bar--personal injury lawyers who are bringing these cases.

Now, as funds from the asbestos companies continue to dry up, we can expect the enterprising personal injury bar to continue to target companies that have tangential relations to the claims but little or no real culpability or liability. Rest assured, without congressional action, the problem will not go away. Last year, a record 100,000 asbestos claims were filed. At least 70 companies have already gone into bankruptcy due to asbestos liability. By the way, many of those companies were union companies. Many union members lost their jobs.

Does anyone wonder why manufacturing may be going down in America? Blame those who are always on the side of the personal injury lawyers, just to mention one corruption of the law.

Of course, each bankruptcy does bring with it lost jobs, lost pensions, and weaker financial markets. The nonpartisan American Academy of Actuaries reports ``bankruptcies in corporate asbestos defendants have affected 47 states resulting in the loss of 52,000 to 60,000 jobs. With each displaced worker losing 25,000 to 50,000 in wage and 25 percent of their 401(k).'' In other words, their pensions.

Rand estimates this litigation will eventually result in a staggering 430,000 lost jobs. Where are our colleagues on the other side when it comes to jobs? Here is a way of saving 430,000 manufacturing jobs and most of them will vote against this bill. Why? I will get into that in a few minutes.

The Supreme Court repeatedly called upon Congress to take action, but years have slipped by and we have not resolved the problem. Unless we act now, three things are certain. One, there won't be enough money to compensate people who are truly sick from asbestos exposure; two, hundreds of thousands of working Americans are going to lose their jobs and their pensions as these businesses go bankrupt; and three, personal injury lawyers will continue to get richer and richer.

I am not against them getting rich when they bring honest cases. I am not against them doing well when they earn the money. But this is like rolling off the log the way the current tort system is so broken and out of whack.

We need a comprehensive solution that is fair and we need it now. That is why we are introducing the Fairness Asbestos Injury Resolution Act of 2004, called the FAIR Act, the Hatch-Frist-Miller Act. I am pleased we have been able to make changes in this bill from the bill we reported out of the Judiciary Committee. This bill will address the concerns that have been raised. This legislation offers a fair and efficient solution. The bill provides a clear net monetary gain for legitimate victims with faster and more certain compensation. In addition, the legislation is important to our economy by providing certainty to American businesses, retirement savings, and it will preserve jobs, as well.

The Americans injured by asbestos have waited long enough for a fair system of fair compensation. Many of them would not have to wait any longer once this bill passes.

Nor can American workers afford to wait around while they lose their jobs and their pensions and while they die from mesothelioma and other asbestos-related diseases. The only people who can afford to wait are those who profit from the sick and from the hard-working Americans.

S. 1125, the Fairness and Asbestos Injury Act, the FAIR Act, as reported out of the Senate Judiciary Committee, represented an unprecedented advance on a workable solution to the complex and difficult issues that have stalled previous attempts at similar legislation. Landmark agreements were reached on asbestos injury compensation cases such as medical criteria, and over 50 consensus- building changes were adopted overall. Nonetheless, a number of issues were left open for further discussion and additional concerns were raised that were not satisfactorily addressed by the committee. We did our best but we needed to make some of these changes, so we have.

Since the bill was recorded out of committee, various State courts and members of both parties have continued working.

The Hatch-Frist-Miller substitute bill being introduced reflects agreements on some of these difficult issues reached during these negotiations and attempts to address a number of concerns that have been raised but have not yet been subject to widespread agreement. In particular, the Hatch-Frist-Miller bill raises claims values. It streamlines the administrative system to be up and running quickly. It increases liquidity and upfront funding for faster compensation of claims, and if a fund runs out of money, that risk will be on the defendants and the insurers, not on the claimants.

These are some of the highlights of the numerous changes made to make a fairer system for claimants. I fully expect that passing this legislation is going to be an uphill battle due to the strong grip of the powerful personal injury bar. Personal injury lawyers, by the way, have already been well compensated with respect to asbestos litigation having already taken an estimated $20 billion for themselves so far in legal fees.

I have faith in the fairness and common sense of Americans. I believe they can see through the self-interest of personal injury lawyers who want to maintain a system that unduly benefits them. Americans will understand that without reform true victims of asbestos exposure, as well as businesses, employees and pensioners will pay the price.

I look forward to debating and further refining this important bill when we return from the April recess. This bill, as most bills, is not perfect. No piece of legislation is without some imperfection in the eyes of someone or some special interest. But if there is ever a case for not letting the perfect become the enemy of the good--and the very good, at that--it is this asbestos bill.

I am aware some will argue strongly this bill is too big, it is too costly. I am also aware some will argue this bill is too small and does not go far enough. But the truth is, if either of these perspectives fail, we will be left with the undesirable status quo. Unless we adopt something very close to what we are proposing, the victims of asbestos and those being asked to provide a fair level of compensation will continue to suffer--probably without anybody benefiting except the personal injury bar, and then a very small percentage of them.

When we take up this bill in the next few weeks, let us strive to achieve a proper balance between the interests of those afflicted and those individuals and firms who are called upon to provide the compensation for this important program.

Some say--I think somewhat cynically--many of our colleagues on the other side are not going to vote for this bill because no amount of money is going to make them satisfied because two of their major constituencies are against the bill, and have been, so far, against any bill. Some have said they are afraid the personal injury bar will not put up at least $50 million for John Kerry in this election if they vote for this bill. Others are saying without that money, they might not be able to elect John Kerry President. I think that is a pretty cynical approach, of course. But if it is true, or there is any truth to it, then it is pretty pathetic that they would let these hundreds of thousands of people go down the drain without just compensation, which we have in this bill, because of politics.

By the way, the other reason is because the AFL-CIO has not signed onto this bill. That is not quite true. There are a few unions that are for this bill. They know it is important. They know they are going to lose jobs, they are going to lose pensions, they are going to lose opportunities if these companies keep going bankrupt. About 70,000 jobs, it is estimated now, have been lost.

These are two very large constituencies of the Democratic Party. I cannot blame Democrats for at least considering that they are concerned about this bill. But I think the union leaders know this is an important bill, and they know it is a good bill. Frankly, they do not want to have to make that decision during an election year.

Well, I do not care whether it is an election year or nonelection year; we cannot wait any longer. If we do not pass this bill and do the best we can do for these workers and for these companies, and for all concerned, in the way we have, these companies are going to have to come up with this whopping amount of money in this bill. They are the ones who are going to have to do it.

I saw yesterday in the Wall Street Journal they thought the Government was going to have to come up with lots of money. Well, some actually make a pretty good argument the Government should. We have made it very clear the Government is not going to. This is not going to be part of our deficit burden we have in this country. Let some make their effective arguments the Government knew asbestos was harmful, yet imposed it by regulation in our ships and in so many other ways. Be that as it may, we are not imposing this on Government. These companies are going to have to come up with this money. It has been a monumental effort by those of us who have fought this through to bring together enough money to be able--according to those who analyze the economics of this, those who are honest and decent in analyzing it--to pay the claims we have under the medical criteria in this bill. And the medical criteria happen to be fair as well.

Let me close. First of all, I hope that is not the reason why our colleagues vote against this bill. Unfortunately, I believe that probably is the reason--those two reasons. There may be others as well, but they are not justified after all the hard work that has been done by both Democrats and Republicans in bringing the bill this far.

Let me close by thanking the majority leader, Senator Frist, for the work he has done, and especially thank Senator Specter for his Herculean efforts in bringing the bill to its present form, and Judge Becker, for whom I have the utmost of respect and affection. I urge my colleagues to support this fair solution to a broken system that has languished far too long.

Mr. President, I yield the floor.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I thank the distinguished chairman. This might be the last time the Subcommittee on Immigration is on the floor, possibly, in the 108th Congress; and I want to thank the full Committee on the Judiciary staff, and I want to particularly offer my appreciation to the Democratic staff of the Committee on the Judiciary for their very fine work during this Congress and their efforts toward bipartisanship, and thank Nolan Rappaport on the Subcommittee on Immigration for his work on this legislation and others dealing with immigration concerns.

Let me share with my colleagues from an Associated Press article dated August 24: ``Before doctors like Mircea Rachita from Romania arrived in town, patients in this small town had to wait months for doctors' appointments. Now, underserved communities are finding good doctors easy to come by due to a visa waiver program which creates incentives for foreign-born physicians to work in communities American doctors may shun.''

Clearly there is room and need for a bill to improve access to physicians in medically underserved areas, and S. 2302 is the embodiment of that bill, along with a similar House bill.

The purpose of this bill is to make it possible for foreign doctors to provide medical services in geographic areas which have been designated by the Secretary of Health and Human Services as having a shortage of health care professionals. S. 2302 is almost identical to H.R. 4453, which I cosponsored with my colleague, the chairman of the subcommittee, the gentleman from Indiana (Mr. Hostettler).

H.R. 4453 passed the House on October 6 on the Suspension Calendar. The Senate bill has an additional provision which ensures that specialists sponsored by Federal and State agencies are placed in areas that have a shortage in that specialty. The additional provision requires the sponsoring agency to determine criteria for demonstrating a specialist shortage and to meet that criteria in order to sponsor the specialist, a way of broadening access to health care and recognizing the 44 million uninsured Americans who need access to sometimes public facilities that utilize these foreign doctors.

Aliens who attend medical school in the United States on J exchange program visas are required to leave the country afterward and reside abroad for 2 years before they can receive their visas to work here as physicians.

In 1994, Congress created a new temporary waiver of this 2-year foreign residence requirement which allowed States as well as Federal agencies to sponsor the doctors. It applied to foreign doctors who would commit to practicing medicine for no less than 3 years in a geographic area designated by the Secretary of Health and Human Services as having a shortage of health care professionals.

This program has been successful for 10 years in bringing highly qualified physicians to medically underserved areas. It sunsetted on June 1 of this year and created a chasm between the needs of those who need health care and the regulations of the Federal government. We now have brought those pieces together.

The first physician recommended for a waiver in Texas was Dr. Maria Camacho, a pediatric intensivist. Her services to the residents of Harlingen in Cameron County provide a level of health care to children that was previously unavailable in that county.

Dr. K.M. Moorthi is a nephrologist who was recommended for a waiver to serve at a facility in Pecos, Texas, in Reeves County. He works at a dialysis center. Patients requiring dialysis three times per week in that part of Texas used to have to travel more than 70 miles each way for the treatment. Now it is available in this county.

The bill will provide a 2-year extension for this waiver program. We started out with 1 year. I asked for 5 years. We compromised on 2 years. We have made progress.

It will also establish a pilot flexibility program which will allow a State agency to place a doctor at a location that has not been designated as underserved if the doctor, nevertheless, will serve patients from an underserved area. That is a very effective compromise to ensure that the patients, no matter where they are, get served whether they are in an underserved area or those patients that reflect that community.

The exception is limited to five doctors in each State. It targets rural underserved areas that typically get specialty medical care from a major medical facility that is not itself located within an underserved area.

Finally, the doctors who receive a waiver to come here with H-1B visas will not count toward the H-1B cap.

I urge my colleagues to consider this legislation as a very positive step for good health care in America and support it enthusiastically.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield such time as he may consume to the gentleman from Michigan (Mr. Conyers).

Mr. Speaker, I yield 3 minutes to the gentleman from North Dakota (Mr. Pomeroy), who I think understands the need for health care in rural America.

Mr. Speaker, how much time remains?

Mr. Speaker, I yield myself such time as I may consume.

In conclusion, I am very glad that the point that was made by the distinguished ranking member and the gentleman from North Dakota (Mr. Pomeroy) is that this is both a medical

bill, a health care bill, and it is an immigration bill. And is it not interesting that we can find an opportunity for bipartisanship around two very key issues.

I think it is also important to reemphasize the fact that we promote and encourage the education and training of individuals here in America in the medical professions, nurses, nurse practitioners, physicians, physician assistants and others that are the cornerstone of our health care system. But we know our hospital systems are overburdened. We know there are many, many people that are underserved. This bill serves a very valuable purpose.

Might I reemphasize the fact that we will give opportunities to hospitals that are located or designated as not an underserved area? It reaches out to serve the underserved, which is something we try to encourage our teaching hospitals to do, who typically are not in areas that can be considered that, so that the individuals get high-quality service. They will be able to utilize this legislation.

Mr. Speaker, in my concluding remarks, I think it is important to note that we do have before us an immigration bill. I was hoping before the conclusion of the 108th Congress we might be in a better position to really attack the question of comprehensive immigration reform. Many of us have had initiatives that have languished for a very long time. I cite for this body the Comprehensive Immigration Fairness Reform Act that really looked at immigration in a very comprehensive manner.

Probably over the next couple of months we will hear a raging debate on immigration, those for it, those against it. The debate on immigration can be a very tense and conflicted debate. It raises some of the most unpleasant aspects of many of those who are pro and con, in many instances, not being able to find common ground. I would encourage my colleagues to look at this forthrightly and understand that we can no longer turn the lights out and close the curtains on this very important issue.

We can no longer have a temporary guest program, albeit how well- intentioned this administration may be, the Flat Earth Theory that allows people to come in for 3 years and then suggest to them that they must then leave the country in order to, if you will, remain in a position to possibly have another job again. The guest worker program proposed by President Vincente Fox and this administration will not work. You will not get 8 million illegal immigrants in this country to accept that philosophy. Nor will you get to a point where you would like to be, a secure America, because we are not focusing on securing our borders. We are focusing on what I think is misdirected in a temporary guest worker program.

Comprehensive reform allows us to allow individuals to earn access to legalization, to document those who are here, and be able to be safe from terrorists by distinguishing those who have come here for economic opportunity as opposed to those who have come to do us harm. Why can we not understand that in a bipartisan way?

Now, let me say also, if we are going to do anything in the last hours of this session, make sure that we do something that helps legal immigrants who are here who for years who have been trying to reunite their families. We have passed out of the House in a bipartisan manner 245-I which would allow legal immigrants to reunite with mothers and fathers, husbands and wives or children. That would be a fair approach, and the Senate needs to help us, the other body, if I might say, needs to help us in that. Any discussion about H-1Bs clearly should be a discussion in recognizing that we must protect American jobs. We must protect American jobs in order to have an open and adequate discussion on immigration.

In conclusion, let me say this, Mr. Speaker, I would hope that our good friends who are dealing in the conference on issues of immigration reform would not pursue these in the 9/11 intelligence bill. Allow us to have a full, comprehensive debate and a full, comprehensive bipartisan approach to immigration reform that will last and will be invested in America and will make America work and comply with our principles of democracy and empowerment and equality.

Putting poison pills on an intelligence bill that deals with fixing the intelligence system is no way to go forward on a vital question of how we bring America together and answer the questions of those who say, what do you do about those illegal immigrants? Are you just going to affirm them for doing the illegal wrong thing? No, we are not. We are going to give them the opportunity to earn access to legalization while they are already here paying taxes, children in school, building houses and contributing to this economy.

Let us wake up America and stop the divisive debate on immigration and stand up for what we believe in.

This country was founded on immigration. How many of us can forget the early pinnings of this Nation; the turn of the century and the 1900s and immigrants coming from Europe? This is the very same.

Protect the borders, respond to those in Arizona and California and Texas who are concerned about the constant flow of illegal immigrants and the large deaths in the deserts. We do that by securing the borders, working with our friends in South and Central America, providing economic opportunity there, and working on a real immigration reform bill.

It saddens me that we come to the close of the 108th Congress when we could have sat down, looked each other in the eye, sat around the table and done the right thing.

I can only say that I applaud the J-1 visa legislation, a good sign of working together. It will help people in America, and I hope it will help us improve our health care system, but we can also heal a broken immigration system by doing the very same thing, looking each other in the eye and sitting around and putting the doctors to work, the political doctors to work, of good mind and good faith and make this country what it is, a country that believes in the Statue of Liberty's words: Bring us your poor and oppressed.

I thank the distinguished Speaker, and I ask my colleagues to support this legislation, and I hope the charge is that we will face immigration the way it should be, in a fair, equitable and balanced way.

Mr. Speaker, I yield back the balance of my time.

Madam President, I was struck by the fact that when my colleague from Alabama presented his chart on economic growth, it stopped at the end of last year and did not carry forward into this year. Of course, had it carried forward into this year, it would have shown a declining trend in economic growth and that is a matter, obviously, of very deep concern. In fact, there was a story last week, a Reuters news story last week, that said:

Top U.S. executives are pessimistic about next year's U.S.

economy. About 70 percent of the chief executives surveyed by

the Business Council projected flat to 2 percent U.S.

economic growth. More bearish than forecasts by major

economists, the Business Council survey, often seen as a

gauge of corporate sentiment, was released ahead of a meeting

of the group's members, about 125 CEOs from companies . . .

Then they cite a number of the large companies in the country, saying generally CEOs are a bit more pessimistic, referring to the difference of opinion between executives and economists.

The U.S. economy actually grew at a 3.3 percent annual rate in the second quarter of this year. Now these chief executives are projecting a flat to 2-percent growth. My colleagues on the other side, if you bring these uncomfortable facts to their attention, they say, well, you are talking doom and gloom. But how are we going to realistically deal with our problems if we do not face what our problems are?

I want to address one question, because the previous presentation talked as though the only relevant factor is economic growth. It never addressed job growth. It only addressed job growth in the sense of saying if you had economic growth, you would have job growth. If you didn't have economic growth, you would have job loss. But the problem is more complicated than that, the problem we are confronting right now. I want to point out a couple of factors in that regard.

This chart shows how unemployment has moved in previous postwar recoveries, and how it is moving in this one. What it shows: Of course, you obviously get a downward trend in employment as you go into a recession. Then you try to come out of a recession. Of course, recessions are measured by economic growth figures. In the average of postwar recoveries, this is what has happened with respect to employment. We have had this kind of growth. So we have had a good, rising trend in employment.

In this recession, this is what has happened to employment. There is a huge gap here in terms of the recovery with respect to jobs. That is why we are so concerned about jobs. That is why we continuously stress that point.

This figure was underscored earlier in the conversation we had about the number of long-term unemployed, which has jumped so substantially. One question becomes, Why are we not getting the jobs? I think one answer to that is to be found in these two charts. What we see in recent years is a sharp increase in productivity. In other words, that is what a worker can produce for each hour of work. But we do not see an increase in worker wages. Productivity is growing much faster than worker wages. The workers who are producing more for each hour worked are, in effect, not sharing in the benefits and their wages are running virtually constant.

One might ask, What happened in other recessions? What usually happens is that worker wages, as you come out of the recession, rise commensurate with their share of the economy, which is about two- thirds. But here is what is happening this time. The worker wages are not rising, but the corporate profits are rising 65 percent. So most of the benefit from the economic growth in this partial recovery is not going to the workers, but it is going to corporate profits. This is in marked contrast with previous recoveries. I want to underscore that point. This is a very different pattern than we have seen in the past. Of course, part of the reason for that is the policies of this administration.

Then the counterargument is made on the other side: If you give the corporation these profits, they will invest them and therefore strengthen the economy, build the economy and create jobs. But here is what has happened in this Bush administration. These are the growth rates of plant and equipment investment by U.S. corporations. As you can see, it actually is down, negative during this Bush administration, compared with previous administrations in which it was a positive figure. So what is happening is the benefits are being skewed away from the workers, but those receiving the benefits are not investing them in the economy in order to build businesses and create jobs. That, of course, explains in part, in my view, why there is such a tremendous lag in this recovery in terms of producing jobs. There is no way you can get around the fact.

I listened earlier. No one actually challenged any of the figures or facts about the employment situation. There is no way you can get around the fact that this is the first administration in 75 years not to have a net gain of jobs in the course of the administration. They are still down 825,000 jobs from where they were when they came into

office. They are down 1.6 million jobs in the private sector and they are down 2.7 million manufacturing jobs.

My colleague from Alabama says we have produced this year a gain of 93,000 jobs. He says that is a good thing. It is a good thing in the sense that we want to be positive in producing manufacturing jobs. It is not such a good thing if you put it in the context of the fact that we have lost 2.7 million jobs since January of 2001. If you put the figure in context, I am relieved that we gained a few manufacturing jobs this year. That is certainly better than losing them. But if you are looking at the record of this administration, the fact is in the course of this administration they have lost 2.7 million manufacturing jobs.

You can come to the floor and say we gained 93,000 manufacturing jobs this year, and that is a good thing. As far as that statement goes, it is a good thing. But it is in the context of the fact that we lost 2.7 million jobs over this time period, over the entire time period. That also relates, of course, to the points that are being made now about the gain in jobs that has taken place--well, the month that is usually used by my colleagues on the other side is, I think, August of 2003. I am pleased and relieved that we have gained some jobs. But the fact remains these job gains have tailed off in recent months.

The other side would have a story to tell if they had sustained job gains. They might have gotten out of the hole and actually produced more jobs, a net gain of jobs in the course of their administration. The Treasury Secretary was projecting it would create a huge number of jobs. It has not happened.

As this chart indicates, we are on a descending line month to month in terms of job creation going back to the beginning of this year. That is the concern about jobs.

It is fine and good to come to the floor and show economic growth charts, although one would have hoped that the chart would have carried out into this year and not stopped at the end of last year.

Second, one has to take into account what people are now saying about what to expect on economic growth, and particularly the story from last week about the Business Council meeting. The leading U.S. corporation chief executives met in Irving, TX, where the top U.S. chief executives said they are pessimistic about next year's economy. About 70 percent of the chief executives surveyed by the Business Council projected flat to 2 percent U.S. economic growth.

That is why we are concerned. That is why the public is concerned. That is why working people are concerned. They feel it.

You may come to the floor and say everything is a rosy scenario. But if you are long-term unemployed, you know it is not a rosy scenario. Long-term unemployed now as a share of the unemployed is at the highest figure it has been--over 20 percent now for 24 straight months.

Trying to portray a rosy scenario is not going to take care of the problem of the long-term unemployed. We tried to do something about that in the Senate. We tried to extend the unemployment benefits, but that was beaten back, regrettably. People who exhaust their benefits and aren't able to find a job find themselves in dire circumstances in terms of meeting the needs of their families.

I think we have a serious job unemployment situation. I think we need to face it. I don't think it helps to simply try to brush it away, paper it over. These trend lines, regrettably, are not working in the right direction.

Now, with this forecast from these top U.S. executives of the Business Council, we can see that we face an even greater challenge as we move towards 2005.

I simply close with the observation that this administration has not produced a net gain of jobs in the course of its tenure. You have to go all the way back to Herbert Hoover to find an administration, whether Democrat or Republican, through that period that failed to produce a net gain of jobs in the course of that administration. That, of course, is one of the very key reasons this election that comes before us on November 2 is so important for the future of our country.

I yield the floor.

Madam President, will the Senator yield for a question?

Was the Senator disappointed by the jobs figures for the month of September of 96,000?

The Senator has to go back to March of this year to get the kind of job figures he is talking about.

The concern is that these job figures are coming down like this. It seems to me that the Senator has to face the fact that this is where the job figures have been trending over the last 6 months.

No.

I would like to answer the question he just put to me.

Not in the last 3 or 4 months, earlier in the year. Employment, again for the last 4 months, totaled 400,000 in the last 4 months. So it has averaged about 100,000 a month.

He inherited a very strong economy in terms of the number of people who were working. And participation in the labor force was up very high. We broke records in terms of job production in the 1990s in the number of people we put to work.

Madam President, during the last several years, I have been deeply concerned with the rise of antisemitism in countries throughout the world, including countries that have traditionally been among the world's strongest democracies.

Today, as Jewish people across the world celebrate Passover, a festival of freedom and redemption, I rise to again call attention to growing antisemitism and to urge a renewed effort to combat this serious problem, both at home and abroad.

Although some of my colleagues might not be aware, I have had the opportunity to visit the State of Israel seven times, as mayor of Cleveland, Governor of Ohio, and as a Member of the Senate. I will always remember visiting Yad Vashem on my first visit in 1980, and again on several other visits, and the Diaspora Museum in Tel Aviv in 1982. That experience truly brought home to me the horrors of the Holocaust and the role antisemitism played in leading to the Holocaust.

I vowed I would do everything in my power to make sure it would not happen again. Frankly, I never thought during my lifetime I would have to try to keep that vow. Unfortunately, antisemitism's deadly, ugly head is rising again. Working with other groups, I am determined to do everything I can do to stop it. There must be zero tolerance of antisemitism.

In May of 2002, following a disturbing number of antisemitic incidents in Europe, I joined members of the Helsinki Commission in a hearing to examine the rise of antisemitic violence in Europe. I was shocked by the reports I heard. Now, nearly 2 years later, the news is not much better. The first 3 months of 2004 have seen numerous acts of antisemitism abroad.

For example, in Toulon, France, on March 23, 2004, a Jewish synagogue and community center were set on fire. In St. Petersburg, Russia, on February 15, 2004, vandals desecrated approximately 50 gravestones in a Jewish cemetery, painting them with swastikas and antisemitic graffiti.

Antisemitic incidents are not unique to Europe. In Australia, on January 5 of this year, antisemitic slogans and symbols were burned into the lawns of Tasmania's Parliament House.

In Toronto, Canada, over the weekend of March 19, 2004, vandals attacked a Jewish school, cemetery, and area synagogues, painting swastikas and antisemitic slogans on the walls of the synagogue and on residential property in a predominantly Jewish neighborhood nearby.

This alarming trend has not gone unnoticed. The high number of antisemitic incidents in Europe and other parts of the world has caused the United States, working with our allies and international organizations such as the Organization for Security and Cooperation in Europe, to take action.

Efforts to highlight growing antisemitism began in earnest following the Helsinki Commission hearing in May 2002, to which I have just referred. During that hearing, I called on the

OSCE to conduct a separate session on antisemitism during the annual meeting of the OSCE parliamentary assembly in Berlin in July 2002. I was pleased this did in fact take place. Delegates to this meeting also unanimously passed a resolution calling attention to the dangers of antisemitism, which I cosponsored. I was honored to be in Berlin for the meeting, joining Representative Chris Smith, who serves as chairman of the Helsinki Commission and continues to be a great leader on this issue. We are very fortunate to have Chris Smith heading the Helsinki Commission in the House of Representatives. He is doing a wonderful job. Work continued upon our return with letters to the President and Secretary of State, underscoring the importance of a strong U.S. commitment to the fight against global antisemitism.

Last June, former New York City Mayor Rudy Giuliani led the U.S. delegation to the first conference of the OSCE dedicated solely to the issue of antisemitism.

The conference took place in Vienna, bringing together parliamentarians, officials, and private citizens from all 55 OSCE participating states. This conference was the product of much hard work and would not have been a reality without the strong support of Secretary of State Colin Powell, Under Secretary of State for Political Affairs Mark Grossman, and our Ambassador to the OSCE, Stephan Minikes. Stephan Minikes, by the way, I think is the most outstanding ambassador the United States has sent to the OSCE in a very long time.

The Vienna conference was a step in the right direction. I believe Mayor Giuliani best captured the significance of the event when he remarked:

The conference represents a critical first step for

Europeans who have too frequently dismissed anti-Semitic

violence as routine assaults and vandalism. Antisemitism is

anything but routine. When people attack Jews, vandalize

their graves, characterize them in inhumane ways, and make

salacious statements in parliaments or to the press, they are

attacking the defining values of our societies and our

international institutions.

While the Vienna conference provided a solid foundation, followup to the meeting is absolutely essential. As such, the OSCE will convene a second conference on antisemitism in Berlin later this month. I believe this meeting is urgently needed, and I am pleased Secretary Powell has asked me to serve as a member of the U.S. delegation to this critical gathering.

Again, this meeting in Vienna would not have happened without the strong support of our Secretary of State and his team at the State Department.

In Berlin, our goal is to ensure we move beyond rhetoric and move forward to institutionalize the fight against antisemitism in the OSCE. We hope to put in place an action plan to formalize a process to identify, monitor, and measure efforts to combat antisemitism in each of the 55 OSCE participating states, including the United States.

Too often, as the Presiding Officer knows, there is a lot of talk at these meetings but no action. If we are to be successful in our effort, we must establish a commitment to action--action that can be monitored. This is the message I have continued to stress.

Last July, I wrote to those individuals who joined Mayor Giuliani as members of the U.S. delegation to the Vienna conference, including Abraham Foxman of the Anti-Defamation League, Mike Levin of the National Conference on Soviet Jewry, David Harris of the American Jewish Committee, and Dave Mariaschin of B'nai B'rith, asking them for recommendations for action, things that can be done to encourage tangible steps rather than just dialog. They came back to me with recommendations for the Berlin conference which I then sent to Secretary of State Colin Powell.

Madam President, I ask unanimous consent that my letter to Secretary Powell, including the proposed agenda for the Berlin conference, be printed in the Record.

Madam President, I am pleased the State Department has taken these suggestions into consideration in working to prepare the agenda for the Berlin conference. There has been a great deal of effort to ensure this conference meets my expectations and others', and it is my sincere hope this meeting will help move toward the goal of zero tolerance for antisemitism in the world today. While I believe we must do all we can to encourage our allies and partners abroad, as well as our international organizations, such as the OSCE, the United Nations, and the EU to combat antisemitism, it is important we redouble our efforts at home to call attention to this problem.

Tomorrow the Senate Foreign Relations Committee will conduct a hearing to examine antisemitism in Europe. This continues discussion on the issue following a hearing that took place last October. While this is significant, we can and we ought to do more.

Today I introduce legislation calling attention to the growing problem of antisemitism abroad. This bill, called the Global Antisemitism Review Act of 2004, urges the United States to continue to strongly support efforts to highlight antisemitism through bilateral relationships and interaction with international organizations, such as the Organization for Security and Cooperation in Europe.

Further, the legislation requires the Secretary of State to submit to Congress an annual report on acts of antisemitism worldwide. The report will include a description of the following for each foreign country; in other words, we are going to have a report on each one of the 55 members of the OSCE.

First, a description of physical violence against or harassment of Jewish people or community institutions, such as schools, synagogues, or cemeteries, that occurred in that country; second, the response of the government of that country to such attacks; third, actions by the government of that country to enact and enforce laws relating to the protection of the rights to religious freedom with respect to Jewish people; and finally, the efforts made by that government to promote antibias and tolerance education.

The last point I think is so important. If we are truly to be successful, it is imperative we work to promote tolerance and bring about a change in the hearts and minds of those people responsible for acts of antisemitism and other hate crimes. We can do something about their mouths, their hands, and their feet, but the real challenge for us is to change their minds and their hearts.

Last year, both the Senate and the House of Representatives passed resolutions calling on the State Department to thoroughly document acts of antisemitism worldwide. This bill would take it one step further. I believe it is essential, and I urge my colleagues to join me in supporting swift passage of this legislation which will underscore the high priority Congress and the U.S. Government have given to zero tolerance of global antisemitism.

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

Mr. Speaker, I rise today to join my fellow colleagues in support of S. 2302, also known as H.R. 4156. I first would like to thank Senator Conrad and Congressman Jerry Moran for sponsoring this important piece of legislation. I would also like to thank the committees jurisdiction for their quick actions in allowing this bill to come to the floor.

Mr. Speaker, over the tenure of my congressional career I have come to the floor repeatedly to demand that Congress act to address the needs of the medically underserved and to ensure that we do everything possible to eliminate arbitrary barriers which give rise to healthcare disparities.

As there is a vast amount of research on the subject of rural physician recruitment and retention, this bill is by no means a comprehensive policy. Rather, the purpose is to be a temporary stop gap measure to allay the crisis of rural health and healthcare providers.

Mr. Speaker, more than 51 million Americans live in areas classified by the U.S. Office of Management and Budget (OMB) as nonmetropolitan. They comprise one-fifth of the U.S. population. Rural populations are found to be older, poorer, sicker, less educated and to have a perception of worse health status than their urban counterparts.

They also have higher infant mortality and injury-related mortality rates, fewer hospital beds and physicians per capita, and are much less likely than urban residents to have private or public health insurance. Moreover, while the number of individuals living below the poverty line is disproportionately high in rural areas, the number receiving Medicaid benefits is disproportionately low.

In a study of the utilization rates of 28 categories of medical services, found that, with the exception of major surgical procedures, urban residents received between 20 percent and 30 percent more of each type of service than did rural residents.

With at least 20 percent of the population living in rural areas, less than 11 percent of the Nation's physicians are practicing in nonmetropolitan areas. Today, more than 2,500 physicians were needed in nonmetropolitan areas to remove all nonmetropolitan health professional shortage area (HPSA) designations for primary care. More than twice that number are needed to achieve a 2,000-1 ratio in those HPSAs. This is the current situation and does not factor in the aging physician population serving rural areas, nor does it factor in the statistical designation dealing with counties as the main reference point.

As a medical doctor, I understand that nonmetropolitan physicians derive a larger share of their gross practice revenue from Medicare and Medicaid patients than metropolitan physicians. These public programs pay physicians at lower rates than private insurers. There is a decreased ability in nonmetropolitan areas to perform economically enhancing procedures (hospitals with decreasing obstetrical and surgical units, etc.), which further decreases relative reimbursement rates. Thus, nonmetropolitan physicians, on average, work more and earn less than their metropolitan counterparts.

Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs) in designated HPSAs and medically underserved areas (MUAs), and differential Medicare payments to qualifying rural areas have helped to enhance reimbursement. But currently, the mandate that States pay RHCs and FQHCs their reasonable costs under Medicaid is being phased out. Medicare managed care program reimbursement to RHCs has threatened to be lower than the current reimbursement. Both of these payment changes will put providers in jeopardy.

Mr. Speaker, I along with my Congressional Black Caucus counterparts have consistently pushed the Congress for more equitable fee reimbursement and to fully fund Title VII and Title VIII health profession training program. We have also called for the strengthening, expansion, and reauthorization of these programs in our minority health bill H.R. 3459, the Healthcare Equality and Accountability Act, which I look forward to moving on the 109th Congress.

S. 2302/H.R. 4156 acknowledges that international medical graduates, through State initiated J-1 visa programs, have initially met some unmet needs of rural areas. But Mr. Speaker, I would like to highlight a recent study published by the Council on Graduate Medical Education that stated that although international medical graduates have made an important contribution to the provision of medical care in some rural areas, training these graduates is an inefficient way to expand physician supply in rural areas. Although many inner city hospitals are dependent on international medical graduates for providing care to underserved urban populations, more direct avenues exist for meeting the needs of these hospitals. The funds would be better targeted to programs that increase the flow of U.S. health professional graduates to underserved rural areas.

Therefore, Mr. Speaker while I strongly support the underlying bill, I again call on Congress to move legislation in the 109th that will do the following.

Increase ORHP funding for research related to physician recruitment, retention and networking should be supported and enhanced.

Reevaluate how designation of HPSAs and MUAs are given so the designated areas accurately reflect underserved status.

Increasing the Title VII funding for AHECs and health education training centers should be supported and enhanced.

Encourage and mandate that medical schools confront their obligation to target admissions and training to underserved populations, both rural and urban, in the primary care professions.

Encourage medical school environments to encourage individuals into primary care and encourage early and long-term rural exposure to positive rural physician role models, and such educational programs should be adequately funded.

Increase scholarship programs to place medical students with mentoring physicians in rural or remote practices during an elective or vacation period should be encouraged.

Support medical schools' and residencies' efforts to integrate community orientation and a team approach to health care. To achieve the full benefit of this effort, there needs to be further infrastructure building of rural allied health teams and rural communities' commitment to meeting the challenges of a changing health care system.

Encourage family practice residencies to offer rural electives, rural emphasis and rural training tracks.

Direct the Bureau of Health Professions (BHP) funding for residencies that are building rural-based programs and funding for those programs that have a history of producing

rural physicians should become a staple rather than be at the mercy of national budget politics. An aggressive plan to increase funding should be sought.

Increase support by the BHP to primary care residencies to be continued and enhanced.

Decrease professional isolation by supporting teleinformatics and outreach education programs of states and by the use of nonphysician providers.

Increase retention through more appropriately rural-trained candidates.

Identify care needs at the community level. Use state and federal funds to assist rural hospitals where access to care would be threatened by hospital closure and physicians would be further deprived of opportunities to utilize their professional skills.

Develop and use innovative delivery systems that emphasize coordination and cooperation among providers, institutions and communities.

Develop programs allowing rural clinicians to undertake periodic rotations through academic hospital services (with locum tenens backup) in order to learn or update procedures.

Provide for those areas that do not qualify for RHC or FQHC status but still are faced with the disproportionate numbers of Medicare and Medicaid patients, there should be enhanced Medicare and Medicaid payments to rural providers.

Evaluate the enhanced reimbursement available through RHC and Community Health Center designations needs to be adequately maintained to retain providers and avoid decertification as the area's needs are met. If the same level of Medicare and Medicaid and uninsured patients persists and the area is decertified because of an adequate supply of physicians, a cycle will develop leading to economic unfeasibility, provider dissatisfaction and lower retention rates.

Mandate the States to pay RHCs and FQHCs reasonable costs under the State's Medicaid program.

Ensure that Medicare managed care reimbursement must equal or exceed the RHC and FQHC Medicare reimbursement.

Increase the supply of primary care providers in rural areas by lessening speciality and geographic differentials in physician income.

Establish relocation grants, especially for remote areas, to defray the costs of moving and setting up a practice.

Mr. Speaker, in the 109th Congress I will introduce a bill that codifies these recommendations among others and will hopefully begin the process of ensuring that we provide healthcare for all Americans within or close to current expenditures.