A bill to amend title XIX of the Social Security Act to extend medicare cost-sharing for the medicare part B premium for qualifying individuals through September 2005.

Mr. President, today I have introduced the Emergency Relief for Rural Borderlands Act.

This act deals with a problem which is probably well known to many of my colleagues--the insufficient number of H2-B visas available for temporary seasonal employment this year.

U.S. laws governing labor-based immigration have always maintained that employers must give priority to American workers. I support this philosophy, as I am sure the rest of my colleagues do as well.

I also acknowledge the reality that sometimes there are jobs that, for a variety of reasons, cannot be filled by American workers. This is a fact of life. We can see it on our farms, in our restaurants, and on our construction sites.

My legislation deals with one small sub-set of these foreign workers, temporary seasonal laborers under the H2-B visa program. H2-B guest workers may work in the United States for no more than 6 months, at the end of which they must return to their countries of origin. They fill critical gaps in the labor market, which in turn helps American companies to prosper year-round. They work at summer camps and resorts, for fisheries and for landscapers, and in many other non-agricultural pursuits.

My legislation does not propose to fix the H2-B crisis across the board. Some of my colleagues have introduced legislation to this end, and I would not presume to improve upon their proposals. My legislation represents, instead, a commitment to the needs of a unique geographical situation--rural borderlands.

In my State of Minnesota, and indeed across the country, rural areas continue to be challenged economically. It would be safe to say that there is a crisis in rural America today. To address the challenges faced by rural communities, I introduced the Rural Renaissance Act, and others in the Senate have also introduced legislation that is directed towards rural America. What the Rural Renaissance Act would do is help rural, small towns develop the infrastructure needed to expand communities and create jobs. It takes a long-term view of what is needed in rural America. But at the same time, there is another, temporary crisis for those in rural America who can't get the H2-B visa laborers they rely on. This kind of labor shortage is the last thing rural America needs.

Rural communities located near the border have a special set of challenges, which go beyond even what the rest of rural America is dealing with. Companies who are recruiting workers naturally target the cities and towns closest to them. But when a company is located near an international border, the pool of U.S. workers in close proximity is smaller than for companies located more centrally.

For example, take Warroad, MN, in Roseau County. Roseau, like many rural counties in Minnesota, is dealing with a number of challenges-- from out-migration of younger people leaving behind an aging population, to economic sluggishness, to inadequate infrastructure and even flooding issues. The town of Warroad, population 1,722, is located about 6 miles from the U.S.-Canada border. The largest company in Warroad is a first-class window manufacturer, Marvin Windows.

Because of its relationship to construction, the window industry has a seasonal element to it. During the summer, Marvin hires hundreds of American college students to work at its factory in Warroad. But when these students go back to school, there are short-term positions which need to be filled through December. For the last 8 years, Marvin Windows has relied on Canadian workers to fill these critical positions. This year, because of the early date when the cap on H2-B visas was reached, Marvin Windows is looking at a big gap in their employment--which not only could hurt their revenues this year, but also threatens to undercut their long-term reputation as a reliable supplier of windows.

I am aware that my colleague Senator Hatch has introduced legislation to remedy the H2-B visa shortage. I support this legislation. But as we have seen, there is not yet consensus on it.

Companies like Marvin Windows cannot afford to wait much longer. That's why I have proposed the Emergency Relief for Rural Borderlands Act. This legislation is admittedly less ambitious than Senator Hatch's legislation, or Senator Kennedy's bill. My legislation would simply observe the unique circumstances facing rural areas--which are challenged economically already--as well as the realities of the labor pool for companies located near our borders. My legislation would relieve these rural borderlands from the visa cap for this year only. Moreover, my legislation would only give relief to those companies who can demonstrate that they have relied on the program in the past, by limiting eligibility to only those companies which have made use of H2- B workers in at least 2 of the last 5 years.

My legislation is not a permanent fix, nor is it a comprehensive fix. I know that there are deserving companies that are not going to be able to qualify under my legislation. My legislation is only applicable this year, and I am sure we will need to revisit this issue again next year.

But if we in the Congress cannot reach agreement on a comprehensive solution for this visa shortage, perhaps the time has come to look at a more limited approach. Rural America has unique labor requirements, and borderlands have challenging recruitment conditions. If we begin by looking at the needs of areas that are both rural and close to the border, we can help the economies that stand to be hurt the most by the shortage in H2-B visas this year.

I urge my colleagues to support this legislation.

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

Mr. Speaker, I move to suspend the rules and pass the Senate bill (S. 2618) to amend title XIX of the Social Security Act to extend medicare cost-sharing for the medicare part B premium for qualifying individuals through September 2005.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks and include extraneous material on this legislation.

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

Mr. Speaker, I want to, first of all, commend the gentleman from Michigan (Mr. Dingell) and the gentleman from Ohio (Mr. Brown) for helping to expedite this piece of legislation. They could not be on the floor, so we have the distinguished gentleman from Massachusetts who is going to control their floor time, and I want to thank him for his help.

I am reluctantly doing this this evening, not because of the merits of the bill. I support the merits of the bill, but I do not support the procedure under which we are doing this and the reluctance of the other body to find a way to help pay for what we are about to do.

This Congress should be taking serious steps to address our budget problems and our growing Federal debt. The President who just won reelection, 52 percent of the vote, has told America that deficit reduction will be one of his highest priorities, and I would like to have the other body begin to join this body and the President of the United States in making that a reality.

Senate 2618 is a good bill. It will extend for one year additional funding for the Medicare Qualified Individual Program, better known as the QI program. This program will allow approximately 160,000 low- income beneficiaries enrolled in the program to continue to receive assistance to pay for their Medicare part B premium which is optional. That is fair and appropriate.

We began to help subsidize those premium payments back in 1997, so we have been doing it now for the last 7 years. I support that. I think it is appropriate to help our low-income seniors help pay for their Medicare option part B coverage, but I also think we ought to have a way to help pay for that subsidy. This bill does not do that.

I think we need to begin to address the problem of mandatory automatic

entitlement growth, and to extend a program like this where we could have an offset to pay for it, in my opinion, is inexcusable.

It has been said that nobody notices a deficit until its weight finally collapses the government. I do not intend to ever let that happen, and we could be taking a small step to lessen that load today. Regrettably we are not.

Let me state what we have done in the last 2 weeks. Again, the underlying bill that we are passing is a good piece of legislation, and I support that. The Speaker of the House supports it. The majority leader supports it. The ranking member on the Committee on Energy and Commerce, the ranking member on the subcommittee, the subcommittee chairman, the full committee chairman, we all support it; but we found a way to pay for this bill. We found out that under existing law people that receive prescription drug benefits that are paid for by Medicare, the person that actually provides a prescription can file paperwork to get an automatic rebate from the drug manufacturer. It is in the law. We do not force the person who is providing the prescription to actually apply for the rebate. So we have some providers of prescriptions who for whatever reason do not fill out the necessary paperwork to get the automatic rebate that has already been negotiated.

The offset that we came out with in the House was to simply say that if there was a drug rebate that had already been negotiated, you had to file for it and receive it so you could give that rebate to the State and the Federal Government. That would save approximately $140 million over the life of the extension. The White House supported it. CNS supported it. The House supported it, but the other body did not support it. They wanted to extend the program but not provide an offset to help pay for the extension.

Now, I offered this afternoon to pull this bill back and try to work out something that when we first got back in the next Congress we could do the offset. The Speaker and the majority leader felt like we needed to go ahead and pass this bill this evening, and I am going to go ahead and do that. It is a good bill. It needs to be passed. We need to provide this additional supplemental assistance for low-income seniors to pay for their part B prescription drug benefit. But this is the last time as chairman of the Committee on Energy and Commerce that I am going to extend an entitlement program without some sort of an offset.

So for tonight we can say that this is the beginning of the Barton doctrine. I hope in the next year or so it becomes the Bush-Hastert- Frist, even the Pelosi, redoctrine, that we can work on a bipartisan basis, bicameral with the administration, that as we extend the existing entitlement programs and create new ones, we come up with a way to pay for them. But for this evening I rise to support the passage of this bill.

It will provide much needed assistance for 160,000 low-income seniors for the next year. In the next year, I am going to work with interested parties in the administration, the other body and this body to come up with reforms that continue these necessary benefits but also come up with a way to pay for them.

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

Mr. Speaker, I have no further requests for time, and I yield back the balance of my time.

Mr. President, today I am introducing, along with my colleague Senator Hagel, legislation that will help to address the severe workforce shortages within public health agencies throughout the United States. This bill, known as the Public Health Preparedness Workforce Development Act of 2004, provides financial help to both full and part-time students who are interested in pursuing a career in public health at Federal, State and local public health agencies.

Our Nation faces myriad public health threats and challenges, ranging from emerging diseases such as West Nile virus and SARS to the special needs of an aging population, from bio-terrorism to obesity, tobacco use and environmental hazards. The ability of the public health system to prevent, respond to, and recover from these challenges depends on adequate numbers of well-trained public health professionals in Federal, State, and local public health departments.

However, our public health system has an aging staff nearing retirement and there are not enough students graduating with training in public health disciplines to provide a consistent source of skilled employees to fill the void. The average age of the public health workforce is 47, 7 years older than the average age of the Nation's workforce. The ratio of public health workers to overall population has dropped from 219/100,000 in 1980 to 158/100,000 in 2000. There are already shortages of public health nurses, epidemiologists, environmental health workers, health educators and other public health professionals at Federal, State and local public health agencies. In my home State of Illinois, the Illinois Department of Public Health estimates that they are in need of at least 15 epidemiologists and are having trouble filling those positions.

Further evidence suggests that as much as 50 percent of the current public health workforce at the State level will be retiring in the next 5 years. Losing so many experienced public health workers at a time when the public health workforce should be expanding to meet increased needs presents a clear argument in favor of encouraging more students to enter the many academic fields related to public health such as epidemiology, health education, nursing and environmental health.

To continue to improve the health of our people, we must have a well- trained and dedicated public health workforce. But developing and maintaining the necessary human capital is already a challenge and promises to continue to be a challenge in the future. Our bill would help alleviate this dangerous shortfall of public health professionals by providing scholarships or loan repayments for full and part-time students in public health and for workers with previous public health training who agree to serve at the Federal, State and local level.

The scholarship program will provide scholarships to eligible graduate, undergraduate and community college students to pursue a course of study to prepare to serve in the public health workforce.

The loan repayment program is designed to help pay for education loans incurred by individuals currently employed or about to be employed in a Federal, State or local public health agency.

The grants for the loan repayment program to political jurisdictions at the State and local level will provide funds to the appropriate agencies to operate the loan repayment program.

The bill is supported by the Association of State and Territorial Health Officials, the National Association of City and County Health Officials, the American Public Health Association, and the Council of State and Territorial Epidemiologists.

I urge my colleagues to join me in this effort to strengthen the capacity of our Nation to respond to public health threats now and in the years to come. The Public Health Preparedness Workforce Development Act of 2004 will help provide the public with the educated and well- trained public health workforce to meet the health challenges of the future.

Mr. President, the bipartisan No Child Left Behind Act enacted two years ago contains the right set of education reforms for America's public schools. It raises academic standards and calls for better teachers and smaller classes. It supports periodic testing for all children, so that teachers can assess learning needs early, before major problems develop. It also calls for supplemental services and after-school programs for children who are lagging behind academically. It focuses schools on the hardest-to-teach children, and holds schools accountable for the performance of all children, whatever their race or background.

These basic principles in the No Child Left Behind Act have broad bipartisan support. But as we all know, reforms without the resources needed to implement them cannot succeed. Since the law was enacted in 2002, the Bush administration has consistently withheld the resources needed to fulfill the basic promises of the Act. The Administration's budget for the coming fiscal year leaves 4.6 million children behind. It underfunds the President's school reform law by over $9.4 billion.

Even worse, because of the administration's low priority for education, over 7,500 school districts received notice last week that their Federal funds under the No Child Left Behind Act will be cut back this fall. As a result, thousands of school districts across the nation won't even be able to maintain their current quality of education, let alone improve it. Schools that serve the neediest children will be hurt the most.

Every school district in Massachusetts faces a cut in Federal education funding this fall. The city of Lawrence has a 27 percent poverty rate, and it faces a $1.2 million cut in school aid. It can't afford the loss of 20 teachers. The city of Springfield has a 28 percent poverty rate. It faces a cut of $1.4 million, which means that over 1,000 needy children won't get the supplemental services they're counting on. We cannot in good conscience allow these cuts to go forward.

Today, Congressman George Miller in the House of Representatives and I are introducing ``The No Child Left Behind Appropriations Support Act of 2004'' to provide $237 million in emergency resources needed this fall to stop the cuts called for by the Administration in funds for school reform. Over 70 Members of Congress have now joined our letter to the Appropriations Committees requesting that emergency funds be provided. With deep and widespread cuts in local education funds, it will be much more difficult to achieve the school reforms that are so urgently needed in communities across the country.

Clearly, Congress needs to act. I urge my colleagues on both sides of the aisle to join in seeing that these critically needed resources are made available to our schools.

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

Mr. President, I rise today to introduce the End Stage Renal Disease Modernization Act, designed to improve the quality of care and quality of life for the more than 300,000 Americans with end stage renal disease (ESRD).

To avoid death, patients with ESRD must receive a kidney transplant or undergo dialysis. As you know, the shortage of organs makes transplantation a limited option for the vast majority of patients. Therefore, most rely upon 3-4 hour dialysis treatments three times a week to save their lives.

Congress must honor its commitment to Americans with ESRD by bringing the Medicare ESRD program into the 21st Century. As we recognized in other areas of health care, education serves as a valuable tool in the fight of any chronic disease. ESRD is no exception. This bill would establish educational programs to teach individuals about the factors that lead to chronic kidney disease, the precursor to kidney failure, and how to prevent it, treat it, and avoid kidney failure. It would also support programs for patients once they have kidney failure to assist them in developing self-management skills that could dramatically improve their quality of life.

Another important factor that influences patients' quality of life is the method of dialysis they select. Although most patients must receive in-center hemodialysis, some can benefit from home dialysis. In rural communities, like so many in North Dakota, home dialysis proves an important option for patients who do not have dialysis facilities near their homes. In

this measure, we would require HHS to determine how to provide incentives for home dialysis.

The bill also incorporates provisions to provide for an annual update mechanism from legislation that my colleague Senator Santorum and I introduced at the beginning of this Congress. As we have discussed many times in this Chamber, the ESRD Program is the only major Medicare reimbursement system that does not have an annual update mechanism to adjust the payment rates for changes in input prices and inflation.

Since the inception of the Medicare ESRD program, we have made enormous strides in extending the lives and the quality of life of patients with kidney failure. If we are to continue that course, we must allow the program to keep pace with advances and changes in the delivery of services. We must also ensure that patients receive the best information possible so they can make informed choices and provide incentives that promote the highest quality of care. The End Stage Renal Disease Modernization Act is a comprehensive bill that moves the program in that direction. Thus, I urge my colleagues to join with me in sponsoring this important legislation.