Equity for Our Nation's Self-Employed Act of 2004

Mr. President, I rise today to speak about an issue that is fundamental to our democracy. That issue is the right for each American to know that their vote has been cast and accurately counted. Earlier today, I introduced legislation, the Voting Integrity and Verification Act, which would provide each American with those assurances.

The United States Constitution is sacred to Americans and it is the envy of the free world. It preserves the rights and freedoms that Americans hold so dear. Our Constitution also guarantees the right of each American to vote. Central to the integrity of our democracy is the right for each American to participate in our democracy.

Democracy works best when each eligible voter participates. As a Nation, we learned in 2000 that even a Presidential election can be determined by handfuls of votes. I learned this lesson in my own 1998 U.S. Senate campaign against incumbent Senator Harry Reid. In one of the closest Federal elections that year, a mere 428 votes separated us after all votes had been counted statewide.

After the election I requested a recount in Clark County, the only county at the time using electronic voting machines. The result of the recount was identical to the first count. That is because there was nothing to recount. After rerunning a computer program, the computer produced the same exact tally.

I conceded to Senator Reid and was elected to Nevada's other Senate seat in 2000, but I was still troubled by the fact that Clark County voters had no assurance that their votes had been accurately counted. Innocent computer malfunctions or intentional tampering could have altered their votes without anyone ever knowing.

That is why I led the fight for voter verification paper trails in the Help American Vote Act (HAVA) that President Bush signed into law in 2002. A voter-verified paper trail would allow a voter to review a physical printout of their ballot and correct any errors before leaving the voting booth. This printout would be preserved at the polling for use in any recounts.

Unfortunately, the language that is contained in HAVA has not resolved this issue. Now, I am working to address this issue once and for all. By introducing the Voting Integrity and Verification Act, I want to ensure that HAVA is clear--voters must be assured that their votes will be accurate and will be counted properly. A paper trail provides just such an assurance.

A paper trail is not just a hypothetical answer to electronic ballot mishaps that may not ever happen. On January 6, 2004, a special election was held in Broward County, FL, for House District Seat 91. The margin of victory was 12 votes, but the machine failed to record the votes of 134 ballots. The results of this election have to be called into question, because the House seat was the only item on the ballot. It is doubtful that 134 voters would go to the polling place, stand in line, enter the voting booth but leave without casting a vote. Yet that was the explanation offered to explain the failure of the electronic voting machines to record 134 votes. This triggered an automatic recount under Florida law but there were no paper records with which to conduct a recount. Election workers were left to rerun the computer program. Just as happened in my Senate race, rerunning a computer program to conduct a manual ``recount'' did not change the outcome.

In Maryland on November 5, 2002, and in Fairfax County, VA, on November 4,

2003, voters who used electronic ``touch screen'' voting machines watched as the ``X'' they placed on the video screen next to one candidate's name appeared in a box for the other candidate. There were no verified paper ballots, so a recount was not possible. The voters who witnessed such an irregularity, and all voters who used those voting machines, have no assurances that the machine accurately recorded their vote. This calls into question any results determined by these machines and shows that there is no limit as to the number of votes that may have been miscounted.

It's not written in the Constitution this way, but it seems to me quite obvious that the right of citizens of the United States to vote shall not be denied on account of a lack of a paper trail. We must uphold the sanctity of our vote by making sure there is an accurate way to confirm and recount votes. I call on Congress to act swiftly to preserve America's faith in our election process and enact the Voting Integrity and Verification Act.

Mr. President, I rise today to introduce ``The Missing Child Cold Case Review Act of 2004,'' which will allow an Inspector General to authorize his or her staff to provide assistance on and conduct reviews of the inactive case files, or ``cold cases,'' involving children stored at the National Center for Missing & Exploited Children (NCMEC) and to develop recommendations for further investigations.

I am pleased that Senator Grassley joins me as the lead cosponsor of this bipartisan legislation. I thank him for his leadership in this area.

Speed is everything in homicide investigations. As a former prosecutor in Vermont, I know firsthand that speed is of the essence when trying to solve a homicide. This focus on speed, however, has led the law enforcement community to generally believe that any case not solved within the first 72 hours or lacking significant leads and witness participation has little likelihood of being solved, regardless of the expertise and resources deployed. With time, such unsolved cases become ``cold,'' and these are among the most difficult and frustrating cases detectives face because they are, in effect, cases that other investigators, for whatever reason, failed to solve.

Our Nation's law enforcement agencies, regardless of size, are not immune to rising crime rates, staff shortages and budget restrictions. Such obstacles have strained the investigative and administrative resources of all agencies.

More crime often means that fewer cases are vigorously pursued, fewer opportunities arise for follow-up and individual caseloads increase for already overworked detectives.

All the obstacles that hamper homicide investigations in their early phases contribute to cold cases. The National Center for Missing and Exploited Children--our Nation's top resource center for child protection--presently retains a backlog of cold cases involving children that law enforcement departments nationwide have stopped investigating primarily due to all these obstacles. NCMEC serves as a clearinghouse for all cold cases in which a child has not been found and/or the suspect has not been identified.

The bill that Senator Grassley and I introduce today would allow an Inspector General to provide staff support to NCMEC for the purpose of conducting reviews of inactive case files to develop recommendations for further investigation and similar activities. The Inspector General community has one of the most diverse and talented criminal investigative cadres in the Federal government. A vast majority of these special agents have come from traditional law enforcement agencies, and are highly-trained and extremely capable of dealing with complex, criminal cases.

Under current law, an Inspector General's duties are limited to activities related to the programs and operations of an agency. Our bill would allow an Inspector General to permit criminal investigators under his or her supervision to review cold case files, so long as doing so would not interfere with normal duties. An Inspector General would not conduct actual investigations, and any Inspector General would only commit staff when the office's mission-related workloads permitted. At no time would these activities be allowed to conflict with or delay the stated missions of an Inspector General.

From time to time a criminal investigator employed by an Inspector General may be between investigations or otherwise available for brief periods of time. This act would also allow those resources to be provided to the National Center for Missing & Exploited Children. Commitment of resources would be at a minimum and would not materially affect the budget of any office.

We have before us the type of bipartisan legislation that should be moved easily through the Senate and House. It is supported by the Department of Justice Office of the Inspector General. I applaud the ongoing work of the National Center for Missing & Exploited Children and hope both the Senate and the House will promptly pass this bill to provide NCMEC with the resources it requires to solve cold cases involving missing children.

I ask unanimous consent that the text of the Missing Child Cold Case Review Act of 2004 be printed in the Record.

Mr. President, today I introduce an important piece of legislation that will correct an oversight from the Balanced Budget Act of 1997. In 1997, Congress created a new diabetes benefit under Medicare--diabetes self-management training--but did not create a new provider group to deliver it. Congress assumed that the existing diabetes education programs in hospitals would be able provide services to all who were in need.

Certified Diabetes Educators, CDEs, were not given the ability to bill Medicare directly for diabetes self-management training when Congress passed the new benefit in 1997 because they did not feel there was a need to create a new provider since CDEs could work within a hospital setting and receive reimbursement through hospital billing. However, due to changing health care economics, hospital diabetes self- management training programs have been closing at an alarming rate, forcing patients to seek other avenues for obtaining diabetes self- management training, such as clinics and stand-alone programs.

While small in scope, the Diabetes Self-Management Training Act of 2004 will correct this oversight to ensure our Nation's seniors with diabetes have access to this important benefit.

Diabetes education is very important in my State of Nebraska. According to the Nebraska Health and Human Services System, about five percent of Nebraska's adults have diagnosed diabetes--or about 60,000 people. An additional 20,000 Nebraskans probably have diabetes but have not been diagnosed. While diabetes rates continue to grow at an alarming rate, lack of access to diabetes-self management training, which is critical to controlling diabetes and preventing secondary complications, has also become a chronic problem. Despite the fact that twenty percent of Medicare patients have diabetes, and about a quarter of all Medicare spending goes to treat diabetes and diabetes-related conditions, less than one-third of eligible patients are currently receiving the benefit.

Because CDEs are not able to bill Medicare directly for diabetes self-management training, patients have limited options for obtaining the training they need to successfully manage their disease and prevent expensive and debilitating complications. The potential for complications is enormous. If patients with diabetes cannot gain access to diabetes self-management training, serious complications will arise, such as kidney disease, amputations, vision loss, and severe cardiac disease. In fact, half of all Medicare dialysis patients suffer from diabetes.

By improving access to this important benefit, I believe we will take an important step toward helping patients control their diabetes, which will not only save the Medicare program the significant costs associated with the complications from uncontrolled diabetes, but more importantly it will dramatically improve the quality of life for the millions of Medicare beneficiaries with diabetes. That is why I am so proud to introduce this bi-partisan legislation, the Diabetes Self- Management Training Act of 2004, along with my colleague Senator Hutchison.

Throughout the Medicare debate last year, one of the top considerations for all Senators was the cost of the legislation and the long-term solvency of the Medicare program. In fact, we passed new programs in that legislation to begin studying new health care delivery models like Medicare that will improve the outcomes for beneficiaries with chronic diseases. While I strongly supported those new demonstration programs, we need not wait to begin helping our seniors.

With diabetes already directly affecting so many seniors, and the baby boomers on the horizon, we cannot afford to deny seniors access to proven programs like diabetes self-management training any longer. I look forward to working to pass this legislation and help those with diabetes.

Mr. President, today I am introducing legislation to create a national commission to study the potential establishment of a National Museum of the American Latino Community in Washington, D.C.

I am pleased to introduce this measure today, and I am joined by my colleagues Senators Barbara Boxer, Kay Bailey Hutchison, and Jeff Bingaman, all of whom have worked extensively with the Hispanic community on issues of importance.

The Hispanic community is the fastest growing ethnic group in the United States, and in my home State of Utah, Hispanics now account for nearly 10 percent of the population. Utah is a wonderful mosaic, encompassing a diverse number of peoples and cultures, and in fact, the latest census shows that Utah's Hispanic population has nearly doubled since 1990. But this phenomenon is not just happening in Utah.

It is clear we are seeing remarkable growth in our Nation's Hispanic population. And with this growth, we need to recognize and find ways to better highlight the accomplishments of Latinos over their rich history in America. We need to express the importance of diversity, pride, and the sharing of the cultures that contribute to the vibrancy and splendor of our Nation.

Every day we are reminded of the fact that Latinos are among our Nation's largest minorities, and numbers do have meaning. It is my belief that Latinos in America exhibit a strong desire--a commitment to building a nation where people are judged by their actions and not by their accents. They believe in the work ethic, patriotism, the importance of families, the free enterprise system, and the value of faith; they believe in these things and they experience these tenets, as they live them day in and day out here in America.

I believe strongly in preserving the sanctity of the heritage of cultures, and we should treasure these gifts. I believe that all Americans are enriched by learning to view the history of our Nation through the prisms of other cultures and languages.

When American and foreign tourists visit Washington, They expect to gain a better understanding of our collective history and culture. They see exhibits that educate visitors about our Nation's miraculous technological achievements, our military sacrifices and accomplishments, and the documents establishing the most sacred tenets of our democratic traditions. Yet, as demonstrated by the efforts to establish the National Museum of the American Indian and the National Museum of African American History and Culture, the lessons taught by our institutions are incomplete.

Children who visit museums in Washington should have the opportunity to learn the full history of who we are and who we are becoming as Americans. Nearly 40 million U.S. residents share a cultural heritage that is only beginning to be understood as wholly American, yet few of the exhibits in the Smithsonian's and other museums in Washington commemorate American Latino cultural contributions.

This legislation would take the next step toward ensuring that the lessons taught by our premier institutions for the arts and humanities include a better representation of American Latino cultural contributions. I hope that we will soon be able to say that the Nation's Capital truly exhibits America's rich cultural diversity.

I would like to note that Representative Xavier Becerra has introduced a companion bill in the House of Representatives, and I am honored to introduce this companion legislation in the Senate. I hope this measure will be approved by the Senate in short order.

Mr. President, I rise today with Senator Nelson to introduce an important piece of legislation that will dramatically improve the quality of diabetes care under the Medicare program.

Diabetes is a serious, debilitating chronic illness that afflicts more than 18 million Americans, including eight million Medicare beneficiaries. An additional eight million seniors suffer from a condition known as ``pre-diabetes'' that, when left untreated, will develop into diabetes. Diabetes' devastating complications--kidney failure, blindness, lower extremity amputation, heart disease and stroke--result in significant costs to the program. Although beneficiaries with diabetes comprise only 20 percent of the Medicare population, diabetes related complications account for more than 30 percent of medicare expenditures.

This is indeed troubling, and there is much that can be done to reduce the burden of diabetes and prevent these costly complications. Diabetes self-management training, DSMT, helps people with diabetes learn the skills they need to manage the daily regimen of diet, exercise, meal planning, medication and monitoring necessary to keep blood sugar under control. Certified Diabetes Educators, CDEs, are highly trained healthcare professionals--often nurses, pharmacists, or dieticians--who specialize in helping people with diabetes develop these skills. A CDE must be a licensed health care professional, possess a minimum of two years of professional practice experience in DSMT, have provided a minimum of 1,000 hours of DSMT to patients in the past five years, and have passed a rigorous national examination.

The value of DSMT is well documented. The Diabetes Prevention Program study of 2002 demonstrated that participants, all of whom were at increased risk for developing type 2 diabetes, were able to reduce that risk by implementing the lifestyle changes taught as part of DSMT. Additional studies have found that patients with diabetes achieved significantly better outcomes when taking part in comprehensive diabetes management programs.

Congress recognized the value of DSMT when it provided for this benefit under the Balanced Budget Act of 1997. At that time, CDEs were able to provide DSMT through hospital-based programs, billing under the hospital's provider number. Unfortunately, hospital-based DSMT programs are closing at a rate of two to five per month, leaving people with diabetes without access to this life-saving benefit. Our legislation would correct this problem by allowing CDEs to be recognized as providers under the Medicare program for the purposes of providing DSMT. This would provide CDEs with the flexibility they need to ensure that beneficiaries can access these critical services.

As it is, the Centers for Medicaid and Medicare Services, CMS, estimates that only 30 percent of beneficiaries are utilizing the benefit. More must be done to increase access to life-saving DSMT programs. Our legislation will help to accomplish that goal.

Diabetes already poses a serious burden for the Medicare program. As the 76 million baby-boomers age into the Medicare program, the cost of diabetes related complications could seriously undermine the financial stability of the Medicare program. We must act now to strengthen Medicare to ensure that beneficiaries with diabetes have the tools they need to prevent diabetes complications.