A bill to extend the authority of the United States District Court for the Southern District of Iowa to hold court in Rock Island, Illinois.

Mr. President, I rise today to introduce the International Remittance Consumer Protection Act of 2004. This legislation extends basic consumer protection rights to those who send remittances, and it creates new avenues and incentives for federally insured financial institutions to provide remittance and basic banking services to those who currently do not use such institutions to send remittances.

The practice of sending remittances is not new. Immigrants to the United States traditionally have used remittances to provide financial assistance to family members who remained in their country of origin, but the practice has been largely overlooked; it has not been systematically studied and its implications have not been fully understood. The 2000 census shows that 30 million people in this country are foreign-born--the largest number in our Nation's history and the vast majority of them--22 million--are citizens or legal residents. More than 40 percent of our Nation's foreign-born population immigrated to the United States in the 1990s, and some 15.4 million, or more than half the immigrant community, have come from Latin American countries. Immigrants make a vital contribution to the economic and social life of our Nation.

In a recent study, Sending Money Home: Remittances to Latin America from the US, 2004, the Inter-American

Development Bank (IADB) found that nationwide over 60 percent of Latin American immigrants send remittances. On average, each immigrant sends $240 at a time, 12 times per year. Although these individual transactions are not large, they have constituted an aggregate amount of over $30 billion from America to our Latin American neighbors in this year alone.

In my State of Maryland, we have 175,000 immigrants from Latin America and the vast majority send remittances back home. According to the IADB's study 80 percent of Maryland's immigrants from Latin America send remittances. The typical sender remits an average of $245, 14 times per year--in other words, remittances are a monthly matter, with special gifts for Christmas and Mother's Day.

The subject of remittances has been a major interest of mine for some time. As chairman of the Banking Committee, in February, 2002, during the 107th Congress, I chaired what I understand was the first congressional hearing devoted exclusively to the subject. Dr. Manuel Orozco, a leading researcher on remittances at the Inter-American Dialogue, told the committee that remittances from the U.S. to Latin America had grown substantially--at that point to an estimated $20 billion in 2001--and that between 15 to 20 percent--$3-$4 billion--was being lost in fees and other transaction costs. Since Dr. Orozco testified, remittances to Latin America have grown by $10 billion, 50 percent, in just 3 years, and continued growth is expected.

That an estimated 15 percent to 20 percent of the money sent in remittances is diverted to fees and other transaction costs, often hidden from the remittance sender, is evidence of the abusive practices that exist in the remittance market. There are two primary factors that account for this abuse. First, studies have shown that people who send remittances tend to be relatively low-wage earners, with modest formal education and relatively little experience in dealing with this country's complex system of financial institutions. As a result they are susceptible to unscrupulous actors who can take advantage of them by charging all sorts of exorbitant fees, which are often hidden or misrepresented. The exchange rate conversion is often the mechanism for this abusive practice.

Second, remittances are currently not subject to the requirements set by Federal consumer protection law, including the disclosure of fees. There is no requirement that a remittance transfer provider disclose to the consumer the exchange rate fee that will be applied in the transaction. Without knowing the exchange rate fee that the company is charging, a consumer has little ability to gauge accurately the full cost of sending a remittance. As Sergio Bendixen, a leading researcher of public opinion and behavior, with a specialty among Hispanic consumers, testified before the Banking Committee: ``an overwhelming majority of Hispanic immigrants are unaware that their families in Latin America receive less money than what they send from the United States.'' Further, a remittance sender cannot effectively shop between remittance transfer providers. The lack of basic information limits the amount of competition in this market.

The legislation I am introducing today extends basic consumer rights to those who send remittances. Further, by requiring clear and understandable disclosures to the remittance sender of the cost of the remittance, thus presenting to the consumer the full cost of sending money, the legislation will enhance competition, which in turn should lead to an overall decrease in the cost of sending remittances. As Sergio Bendixen testified to the Banking Committee, ``Full disclosure should unleash market forces that, hopefully, will result in a significant reduction in the cost of sending cash remittances.''

This legislation amends the Electronic Fund Transfer Act (EFTA), which is the primary vehicle for providing basic protections to most persons who engage in electronic transactions, to cover remittances, and to provide the basic rights associated with EFTA to remittance transactions. The two most important components of EFTA are the requirement of full disclosure of fees and the establishment of a process for the resolution of transactional errors. These rights have been an integral part of the regulations that govern our banking infrastructure since EFTA's enactment in 1978. The new legislation will build upon the success of EFTA by extending these basic rights to remittance senders.

The cornerstone of this legislation is the requirement that remittance transfer providers make three key disclosures to their consumers: (1) The total cost of the remittance, represented in a single dollar amount; (2) the total amount of currency that will be sent to the designated recipient, and (3) the promised date of delivery for the remittance. These disclosures follow the core recommendations of the InterAmerican Development Bank, which in its publication, Remittances to Latin America and the Caribbean: Goals and Recommendations, states: ``Remittance institutions should disclose in a fully transparent manner, complete information on total costs and transfer conditions, including all commissions and fees, foreign exchange rates applied and execution time.''

The total cost disclosure will include the cost of the exchange rate conversion as well as all up-front fees. This single item will both give consumers a more accurate representation of the cost of the remittance transaction and allow consumers to more effectively compare costs between remittance transfer providers.

In order to calculate the cost of the exchange rate conversion, which is part of the total cost, the legislation requires that the Treasury Department post on its website, on a daily basis, the exchange rate for all currencies. At present the Treasury receives this information on a daily basis, but posts it only on a quarterly basis on the Treasury website. By posting the information daily, the Treasury could create a uniform and credible source for exchange rate information.

To calculate the cost to the consumer of the exchange rate differential, remittance transfer providers will use the difference between the previous business day's exchange rate, as posted on the Treasury website, and the exchange rate that the remittance transfer provider offers. Using the exchange rate posted by the Treasury will ensure that the exchange rate cost is calculated on a uniform basis. When the exchange rate cost is disclosed to the consumer as part of the total cost of the remittance transfer, the consumer will be better able to understand the full cost of the transaction and to shop between different remittance transfer providers.

In addition to fee disclosure requirements, this legislation establishes an error resolution mechanism so that consumers whose remittance transactions experience an error have a fair, open, and expedient process through which they may resolve those errors with the institution that conducted the flawed transaction. This basic right is already afforded to consumers who are protected by EFTA, and now this right will be extended to cover consumers who send remittances as well. Further, the legislation establishes an error resolution mechanism for remittance transfer errors that is responsive to the different types of errors that can occur in a remittance transaction and is reflective of the unique characteristics of the remittance market and its participants.

Under this legislation, a consumer has 1 year from the date that the remittance transfer company promised to deliver the money to notify the company that an error has occurred. The company is then required to resolve the error within 90 days. To resolve the error, the company must either (1) refund the full amount of the remittance that was not properly transferred, (2) resend that amount at no additional cost to the consumer or the designated recipient, or (3) demonstrate to the consumer that there was no error. The Federal Reserve Board is also granted the authority to establish additional remedies for specific situations that cannot be addressed by the three specific remedies that are described in the legislation.

It is urgent that we continue to encourage efforts to bring those who send remittances into the financial mainstream. In his testimony to the Banking Committee, Dr. Orozco pointed out that, ``About two-thirds of immigrants cash their salary checks in check cashing stores that charge exorbitant fees.

Many of these same immigrants then use what remains of their income to send remittances back home. In this common scenario, immigrants are penalized in both receiving and sending their earnings.'' In order to further bank those who are currently unbanked, the legislation that I am introducing today requires that the Federal banking agencies and the National Credit Union Administration provide guidelines to financial institutions regarding the offering of low-cost remittance transfers and no-cost or low-cost basic consumer amounts. This legislation also amends the Federal Credit Union Act to allow credit unions to offer remittances and to cash checks for persons who are in their field of membership but are not credit union members. The guidelines set out in the legislation will help educate the financial services industry about the importance and potential profitability of providing these services.

The sending of remittances in a fair and scrupulous manner is likely to be profitable for the institution that provides the remittance service, and indeed we have begun to see aggressive moves into the remittance market by many of the largest banking institutions. Individuals who send remittances but are currently unbanked represent an expanded and profitable customer base for financial institutions.

By its very nature, remittances is an issue that involves both the United States and other nations. As Professor Susan Martin of Georgetown University, who also testified at our hearing, told the Banking Committee: ``Until relatively recently, researchers and policy makers tended to dismiss the importance of remittances or emphasize only their negative aspects . . . but recent work on remittances show a far more complex and promising picture. . . Experts now recognize that remittances have far greater positive impact on communities in developing countries than previously acknowledged.'' In fact, the size of the remittance market is such that for six Central American and Caribbean nations--Nicaragua, Haiti, El Salvador, Honduras, Guyana and Jamaica--remittances constitute more than 10 percent of GDP; Haiti and Jamaica receive more in remittances than in revenues from trade. The World Bank estimates that Mexico receives more in remittances than it does in foreign direct investment. Reducing the costs of remittances is in the interest of both the United States and the countries that receive them.

Given the growing importance of annual remittance flows, we must work to increase their efficiency. One mechanism for accomplishing this objective, and for increasing the ability of financial institutions to offer remittances is linking our banking infrastructure with the banking infrastructures of other nations. The Federal Reserve operates an international automated clearing house system (ACHi) that is currently linked to seven countries, of which the vast majority are highly developed trading partners that receive relatively low levels of remittances. The ACHi was recently connected to Mexico, however, which will allow financial institutions throughout the United States, especially those institutions of smaller size, to provide remittance services more easily and cheaply to Mexico. This legislation directs the Fed to take into account the importance of remittance flows to other countries as it continues to expand the ACHi system. Linking the ACHi to countries that receive significant remittances has the potential to result in great benefits to consumers who send remittances from America as well as to those who receive the remittances around the world.

Finally, I am acutely aware of the need for better and more broadly available financial literacy and education for all Americans. I am pleased to report that in the last Congress, as part of the reauthorization of the Fair Credit Reporting Act, we established a Presidential Financial Literacy and Education Commission, which is charged with developing a national strategy to promote financial literacy and education. The Act addresses the issue of remittances by including in the commission's work a focus on increasing the ``awareness of the particular financial needs and financial transactions, such as the sending of remittances of consumers who are targeted in multilingual financial literacy and education programs and improve the development and distribution of multilingual financial literacy and education materials.'' The legislation that I am introducing today builds on that framework by instructing the bank and credit union regulators to work with the commission to specifically increase the financial education efforts that target those persons who send remittances.

Millions of Americans send remittances to family members around the world, for a total far exceeding the $30 billion that goes to Latin America alone. Yet almost all of these transactions take place without the basic consumer rights and protections that apply to other electronic transfers. Consumers who send remittances are often immigrants and workers who earn modest wages, who are not aware of the full costs of each remittance, as a practical matter have no way of finding out and, as a consequence, in the aggregate pay billions of dollars in costs and hidden fees. They do not have available to them an established procedure for resolving transactional errors. This legislation rectifies this situation by extending to remittances the basic consumer rights established in EFTA. The bill also contains provisions that, when implemented, will allow more insured financial institutions to provide remittance services--and potentially at lower costs to consumers. The bill contains important provisions to help bring the unbanked--men and women without an account at a bank or credit union--into the financial mainstream. Taken together, these measures will increase transparency, competition and efficiency in the remittance market, while helping to bring more Americans into the financial mainstream.

A broad range of community, civil rights, and consumer groups have endorsed this legislation including the National Council of La Raza, the Mexican American Legal Defense and Educational Fund, the League of United Latin American Citizens, the Leadership Conference on Civil Rights, United Farm Workers of America, the Farmworker Justice Fund, the NAACP, Casa de Maryland, the National Federation of Filipino American Associations, the Asian Pacific American Labor Alliance, National Asian Pacific American Legal Consortium, Consumers Union, Consumer Federation of America, the National Consumer Law Center, the National Community Reinvestment Coalition, the Center for Responsible Lending, U.S. PIRG, ACORN, Woodstock Institute, and the National Association of Consumer Advocates.

I ask unanimous consent that the text of the Intemational Remittance Consumer Protection Act be printed in the Record, together with letters in support of the bill from the National Council of La Raza, the Mexican American Legal Defense and Educational Fund, the Leadership Conference on Civil Rights, Casa de Maryland, and a letter from Consumers Union, Consumer Federation of America, National Consumer Law Center, and U.S. PIRG.

Mr. President, today I am introducing a bill which will bring to a close the Federal acquisition of an important piece of privately held land, located within the federally designated desert tortoise reserve in Washington County, UT.

As some of my colleagues are aware, this is not the first time legislation has been introduced in an attempt to resolve this issue. In July of 2000, I introduced S. 2873, which was referred to and reported favorably by the Senate committee on Energy and Natural Resources. In addition, similar legislation was twice approved by the other body, both in the 106th and 107th Congresses. Nevertheless, we have been unable to bring this issue to resolution in the full Senate. For nearly a decade, the private property addressed by this bill has been under Federal control during which time the Federal Government has been enjoying the benefits of the private property without compensating the landowner. It is my hope that the time has come to finally resolve this issue.

In March of 1991, the desert tortoise was listed as an endangered species under the Endangered Species Act. Government and environmental researchers determined that the land immediately north of St. George, UT, was prime desert tortoise habitat. Consequently, in February 1996, nearly five years after the listing, the United States Fish and Wildlife Service, USFWS, issued Washington County a section 10 permit under the Endangered Species Act which paved the way for the adoption of a habitat conservation plan, HCP, and an implementation agreement. Under the plan and agreement, the Bureau of Land Management, BLM, committed to acquire all private lands in the designated habitat area for the formation of the Red Cliffs Reserve for the protection of the dessert tortoise.

One of the private land owners within the reserve is Environmental Land Technology, Limited, ELT, which had begun acquiring lands from the State of Utah in 1981 for purposes of residential and recreational development several years prior to the listing of the species. Moreover, in the years preceding the listing of the desert tortoise and the adoption of the habitat conservation plan, ELT completed appraisals, cost estimates, engineering studies, site plans, surveys, utility layouts, and right-of-way negotiations. They staked out golf courses, and obtained water rights for the development of this land. Prior to the adoption of the HCP, it was not clear which lands the Federal and local governments would set aside for the desert tortoise, although it was assumed that there were sufficient surrounding Federal lands to provide adequate habitat. However, when the HCP was adopted in 1996, the decision was made to include ELT's lands within the boundaries of the reserve primarily because of the high concentrations of tortoises. The tortoises on ELT land also appeared to be one of, if not the only population without an upper respiratory disease that afflicted all of the other populations. As a consequence of the inclusion of the ELT lands, the development efforts were halted.

With assurances from the Federal Government that the acquisition of the ELT development lands was a high priority, the owner negotiated with, and entered into, an assembled land exchange agreement with the BLM in anticipation of intrastate land exchanges. The private land owner then began a costly process of identifying comparable federal lands within the state that would be suitable for an exchange for his lands in Washington County. Over the last seven years, BLM and the private land owners, including ELT, have completed several exchanges, and the Federal Government has acquired, through those exchanges or direct purchases, nearly all of the private property located within the reserve, except for approximately 1,516 acres of the ELT development land. However, with the creation of the Grand Staircase-Escalante National Monument in September 1996, and the subsequent land exchanges between the state of Utah and the Federal Government to consolidate federal lands within that monument, there are no longer sufficient comparable federal lands within Utah to complete the originally contemplated intrastate exchanges for the remainder of the ELT land.

Faced with this problem, and in light of the high priority the Department of the Interior has placed on acquiring these lands, BLM officials recommended that the ELT lands be acquired by direct purchase: During the FY 2000 budget process, BLM proposed that $30 million be set aside to begin acquiring the remaining lands in Washington County. Unfortunately, because this project involves endangered species habitat and the USFWS is responsible for administering activities under the Endangered Species Act, the Office of Management and Budget shifted the $30 million from the BLM budget request to the USFWS's Cooperative Endangered Species Conservation Fund budget request. Ultimately, however, none of those funds were made available for BLM acquisitions within the Federal section of the reserve. Instead, the funds in that account were made available on a matching basis for the use of individual states to acquire wildlife habitat. The result of this bureaucratic fumbling has resulted in extreme financial hardship for ELT.

The lands within the Red Cliffs Reserve are ELT's main asset. The establishment of the Washington County HCP has effectively taken this property and prevented ELT from developing or otherwise disposing of the property. ELT has been brought to the brink of financial ruin as it has exhausted its resources in an effort to hold the property while awaiting the compensation to which it is entitled. ELT has had to sell its remaining assets, and the private land owner has also had to sell assets, including his home, to simply hold the property. This has become a financial crisis for the landowner. It is simply wrong for the Federal Government to expect the landowner to continue to bear the cost of the government's efforts to provide habitat for an endangered species. That is the responsibility of the Federal Government. Moreover, while the landowner is bearing these costs, he continues to pay taxes on the property. This situation is made more egregious by the failure of the Department of the Interior to request any acquisition funding for FY 2004, even though this acquisition has been designated a high priority by the agency. Over the past several years, ELT has pursued all possible avenues to complete the acquisition of these lands. The private land owner has spent millions of dollars pursuing both intrastate and interstate land exchanges and has worked cooperatively with the Department of the Interior. Unfortunately, all of these efforts have thus far been fruitless.

The bill that I am introducing today will finally bring this acquisition to a close. In my view, a legislative taking should be an action of last resort. But, if ever a case warranted legislative condemnation, this is it. This bill will transfer all right, title, and interest in the ELT development property within the Red Cliffs Reserve, including an additional 34 acres of landlocked real property owned by ELT adjacent to the land within the reserve, to the federal government. It provides an initial payment to ELT to pay off existing debts accrued in holding the property, and provides 90 days during which ELT and the Department of the Interior can attempt to reach a negotiated settlement on the remaining value of the property. I am aware that one of the difficulties in solving this issue is the high value of the lands to be acquired. Due to the absence of comparable lands within the state for exchange, the legislation also authorizes an interstate land exchange as a means of acquiring the property. In the absence of a negotiated amount, the Secretary of the Interior will be required to bring an action in the Federal District Court for the District of Utah to determine a value for the land. Payment for the land, whether negotiated or determined by the court, will be made from the permanent judgment appropriation or any other appropriate account, or, at the option of the land owner, the Secretary of the Interior will credit a surplus property account, established and maintained by the General Services Administration, which the land owner can then use to bid on surplus government property.

Unfortunately, when this bill has been introduced in the past, there has been occasional misunderstanding regarding the inclusion of the bill's reference to section 309(f) of Public Law 104-333, which requires all Federal appraisals and acquisitions of land within Washington County to be conducted ``without regard'' to the presence of an endangered species. This references does not create a new appraisal standard but rather restates the existing standard for all Federal land acquisition in Washington County, UT. Since its enactment, and without exception, the Department of the Interior has applied this standard to all its acquisitions in the county. This language was originally adopted to allay concerns that local landowners would not receive fair compensation for their property which was being acquired for government purposes. Some have supposed the inclusion of this language would constitute preferential treatment. To the contrary, the absence of this language would unfairly treat this landowner differently than every other landowner in the reserve whose land has thus far been acquired by the Federal Government. Moreover, its omission at this point would likely lead the Justice Department to argue that Congress did not intend for this statutory standard to apply.

The bill includes language to allow, as part of the legislative taking, for the landowner to recover reasonable costs, interest, and damages. It is important to understand that while Federal acquisitions should be completed on the basis of fair market value, when the Federal Government makes the commitment to acquire private land, the landowner should not have to be driven into financial ruin while waiting upon the federal government to discharge its obligation. While the Federal Government has never disputed its obligation to acquire the property, it has had the benefit of the private land for all these years without having to pay for it. The private landowner should not have to bear the costs of this Federal foot-dragging.

This legislation is consistent with the high priority the Department of the Interior has repeatedly placed on this land acquisition, and is a necessary final step towards an equitable resolution. The time for pursuing other options has long since expired and it is unfortunate that it requires legislation action. Without commenting on the Endangered Species Act itself, it would seem that if it is the government's objective to provide habitat for the benefit of an endangered species, then the government ought to bear the costs, rather than forcing them upon the landowner. It is also time to address this issue so that the Federal agencies may be single minded in their efforts to recover the desert tortoise which remains the aim of the creation of the reserve. It is time to right this wrong and get on with the efforts to recover the species and I encourage my colleagues to support the timely enactment of this important legislation.

Mr. President, today I rise to introduce a bill that will ensure that cancer patients continue to have access to the treatment and care they desperately need in their communities.

In Missouri alone, the number of new cancer patients is estimated to reach almost 30,000 this year. For the Nation, we're talking well over 1.3 million. And the numbers continue to climb every year. These numbers are in addition to patients currently living with cancer. Many of them are surviving--and thriving--because of new tests, new treatments, and care they receive in community cancer centers across the country.

Many of these patients will turn to hospitals in their communities for lifesaving treatment. Hospital outpatient departments are a critical part of the cancer care delivery system that provide a significant portion of the cancer care across the country.

However, this vital care is in jeopardy because this year, the Centers for Medicare and Medicaid Services, CMS, has implemented drastic reductions in reimbursements for cancer services, including chemotherapy. These cuts are forcing cancer centers across the country to reconsider how they are providing care or accept reimbursement that fails to cover their costs.

I was recently contacted by Wes Thompson, Director of Radiology at Ray County Memorial Hospital in Richmond, MO. For those of you unfamiliar with Missouri, Richmond is a small town with a population of about 6,100 approximately 50 miles east of Kansas City. Ray County Memorial Hospital is the sole referral center for chemotherapy treatment for the rural residents outside of Kansas City.

In 1999, Wes' wife died of cancer at the age of 26. She happened to be a patient of the pharmacist, Robert Courtney, who has been convicted of diluting thousands of chemotherapy treatments for profit over the last several years. Wes will be receiving a monetary settlement from the legal proceeding involving Robert Courtney and he would like to donate it to the Ray County's oncology program in his wife's name. Unfortunately, cuts in reimbursements by Medicare for chemotherapy treatment will force Ray County Memorial Hospital to discontinue outpatient cancer treatment on January 1, 2004. And, that is devastating news to the community.

This is a department that treats over 250 patients a year across three counties. 60-70 percent of their patients are Medicare beneficiaries and about 40 percent of their patients are indigent. Many of these cancer patients would receive no care at all if Ray County Memorial closed the doors of the cancer program. And yet, that's exactly what they are considering. Their cancer program can't stay afloat when every chemotherapy treatment they give is reimbursed by Medicare at less than their costs. There are a lot of expensive drugs involved in the treatment of cancer. The heavy dependence on drugs has a lot to do with why the cuts are devastating to cancer care in particular.

At Ray County Memorial, the first round of cuts last year meant that hospital overall took a loss of over $150,000. This year's cuts will result in the loss of approximately $200,000-$300,000 for oncology services alone.

As of January 1 of next year 250 patients in rural Missouri will be forced to drive to Kansas City to receive cancer treatment. Oncologists at Ray County Memorial Hospital estimate that 40 percent of the patients they treat will be unable to make the trip to Kansan City area facilities to receive their treatment--either because they lack the transportation or the help to get there and back, or they are too sick or too weak to endure that trip. As a result of this cancer center closing, 80-100 people will die from cancer with no treatment and no hope. Of course Ray Memorial Hospital will continue to give these people loving care and try to make them as comfortable as possible, but they will be unable to treat their cancer anymore.

This is not a problem unique to Ray County Memorial Hospital. Due to cuts in Medicare reimbursement for cancer treatments hospitals across Missouri and across the county that provide outpatient cancer care-- large or small, rural or urban--are struggling to continue to provide this care. These cancer centers work every day to ensure that the thousands of Americans diagnosed with cancer are receiving the best care possible.

I also have the privilege of representing Truman Medical Center, distinguished in its own way--for providing free care to so many. While Truman Medical Center sees only about 300-350 newly diagnosed cancer patients each year, about 70-75 percent of them are indigent. For these patients, they provide some 1,500-2,000 treatments of chemotherapy each year . . . and starting in January of this year, Medicare is reimbursing for many of these at levels dramatically below Truman's costs. And there are so many others.

In rural areas, where it is often hard to recruit physicians, it is the community cancer centers that provide all the chemotherapy and other services that help ensure that cancer patients don't have to travel long distances for the care they need. This is particularly important in cancer treatment, where life saving treatments often result in difficult side effects in the short term.

These cancer centers are also often the early adopters of some of the newest and most complicated drug regimens that cancer patients need today. And not only are they a ``safety net'' for rural patients, they are often the safety net for Medicaid and uninsured patients.

And yet, these are the very institutions that have been suffering under

what is essentially an experiment underway by the Centers for Medicare and Medicaid Services, CMS. I know that this isn't anyone's favorite agency, but I expect more under a Republican Administration.

For a number of years now, CMS has been trying to bring a new payment system to these hospitals. Each year this experiment brings a new set of rules and payments--for the hospitals to sort through and try to implement.

But this isn't just an administrative burden that takes our caregivers away from their payments. In the last two years, this payment system has resulted in significant payment reductions for a setting of care that can now barely meet its costs.

My own Missouri institutions tell me they're considering closing their indigent care programs or worse, closing their doors altogether.

My office is hearing stories from around the country, about hospital administration arming their doctors with lists of the most expensive drugs and what CMS is now reimbursing them. Why do this if you aren't trying to influence a doctor's decision about what to prescribe? Pharmacists are under pressure to review dosing regimens to see where they can cut corners. Some drugs are just not being given in these community centers. Others that used to be given free of charge until their Medicare codes were assigned now aren't given at all.

In some cases, hospitals are sending patients to the nearest physician's office, where inexplicably, Medicare is paying more for the same drugs. But sometimes theses offices aren't nearby. Other times, hospitals are getting patients returned to them with complications that have arisen--and now have to be admitted for overnight stays and close monitoring.

How scary for a cancer patient? Sometimes with only months to live, to be told that it could take nine months before the next breakthrough drug can be given because it's just too expensive. To be told that the hospital where you've gotten to know your doctors and nurses after weeks of chemotherapy is now closing its doors. To be told that you now have to drive miles for care, away from friends and family who have helped care for you when you return feeling nauseous and weak from treatments.

These stories are accumulating--all because of a failed CMS experiment. So should we terminate the experiment and start over with a payment system that actually reflects that cost of providing this care? Yes, of course.

But that would take time--and while the time honored tradition here in Washington of debate and compromise for long term reform is a worthy one--these community cancer centers around the country continue to rack up the stories of compromised care and reduced access for patients, and time is one luxury many cancer patients simply do not have.

And this brings me to my legislation, which is measured, timely, and focused on the most immediate of needs. And, written so as to recognize the budgetary constraints facing us.

This legislation would set a payment floor for some of the most costly drugs given in the outpatient community centers today. This bill isn't limited to cancer drugs. But cancer is one of those diseases that relies so heavily on new drugs for treatment that tend to be costly drugs, so the impact of this experiment has been felt here more. The bill provides this relief immediately--so that in January 2004, these hospitals can start receiving increased payments that at least cover more of their costs.

This payment floor, by the way, was set not on the basis of these centers' true costs. Instead, recognizing the little time they have and the immediacy of their need, they have settled for payment rates advocated by various members of Congress over the last year--as it began to be clear how devastating an impact this experiment could have.

This bill, for example, wouldn't help them cover the costs of the pharmacy services they provide, so critical to ensuring safe and effective care in the hospitals. Again, these costs are especially significant for cancer patients, where mixing highly toxic chemotherapeutic agents using special equipment and wearing protective gear, reviewing protocols and checking for patient risks and side effects are all more intensive efforts. It recognizes these services by asking for a study of these costs, so that they may be recognized in longer term solutions that we develop over the next year or so.

The legislation I introduce today will provide hospitals like Ray County Memorial Hospital and Truman Medical Center, and so many around Missouri and across the country the immediate relief they need to be able to treat their patients.

I look forward to working with my Finance Committee colleagues to ensure that the provisions of this legislation and the immediate relief that it provides are incorporated in anything we do on Medicare.

We have learned our lessons the hard way in home health. This crisis in community cancer centers promises to reach similar proportions if we don't act now.

Madam President, I rise to introduce the Family Caregiver Relief Act of 2003--my legislation to help those who face the crushing consequences of caring for a chronically ill family member. While we stand up for America, we must also stand up for what America stands for. That means strengthening the safety net for those who need it most. That means standing up for American families.

Families are hurting. The economy is weak. Many are holding down two jobs to make ends meet, going into debt to put kids through college, or finding and paying for health insurance.

Some families are facing extraordinary challenges. They are caring for a loved one with special needs which could be a child with autism, or cerebral palsy, a parent with alzheimer's, or a spouse with multiple sclerosis. These families struggle every day to take care of their loved ones.

I want to give help to those who practice self-help. My bill would provide a tax credit of up to $5,000 for family caregivers. This tax credit would help people pay for prescription drugs, home health care, specialized day care, respite care, transportation to chronic care or medical facilities, specialized therapy, including occupational, physical, or rehabilitational therapy, and other specialized services for children, including day care for children with special needs.

Family caregivers face so many stresses--emotional, physical, and financial stresses of caregiving. They face long days, supporting a family--while caring for a loved one with a chronic condition. A dad might have to work two jobs to meet the costs of care which places strains on marriage and relationships with other family members.

Caregivers also face high costs for medications, home health care, adult day care, physical therapy, durable medical equipment like a wheelchair, day care for children with special needs, and medical bills from care with specialists.

People who care for chronically ill family must patch together whatever care they can afford. Too often they go into debt, use their college accounts or their retirement savings or go without the care their loved ones need.

I have heard from families from around Maryland who are facing these strains, who are trying to make ends meet, and who are caring for a loved one who is chronically ill or needs assistance with activities of daily living.

The Hart family from Baltimore has a 2 year old son named Jackson who was born with severe brain abnormalities. He has the motor skill development of a 4 month old. He has daily seizures, so he needs total, round the clock care. The emotional cost of caring for a severely disabled child are incalculable and the financial costs are crushing. For the Harts, the costs include: $650 a month for day care for medically fragile children; $1,400 for a wheel chair; and, $700 for a special shower chair--since Jackson can't sit up in the bath. My proposal would help them meet these costs by providing them with a tax credit of $2,750.

I know of a a couple in Baltimore where the wife is in the final stages of Alzheimers. She was a school teacher and once spoke 5 languages. Now, she can only say a few words. She needs 24 hour-a-day care which costs almost three thousand dollars a month. Their retirement savings are gone though this couple is only in their early sixties. My bill would only provide a tax credit of five thousand to this couple. I know that this would help this couple as they face the challenges of her final days.

My last example is a woman in Potomac, MD who is caring for her husband who has multiple sclerosis. He can no longer talk, walk, stand or feed himself. She works full time to support them and cobbles together whatever home care she can afford. She is not able to afford respite care to run errands, or take herself to the doctor. This couple made a commitment in sickness or in health.

These are just a few examples of the stresses facing thousands of American families. One in five Americans has multiple chronic conditions. About 26 million people in this country care for a family members who is chronically ill or disabled.

My legislation is supported by groups who see everyday the human cost of family caregiving, including: Autism Society of America; Cystic Fibrosis Foundation; National Organization for Rare Disorders; Easter Seals; United Cerebral Palsy Associations; Arc of the United States; National Health Council; National Council on the Aging; Paralyzed Veterans of America; Family Voices; National Respite Coalition; National Family Caregivers Association; and National Alliance for Caregiving.

One of my first milestones in the Senate was the enactment of the Spousal Anti-Impoverishment Act to change the cruel rules of Medicaid so that families would not have to go bankrupt before Medicaid would pay for nursing home care for a spouse. Under this law, the spouse living in the community could keep the family home, keep a car, and keep some income each month to live on. This law helped one million people. But this was only a down payment.

Not much has been done since then except the National Family Caregiver Support Program and long-term care insurance for federal employees. I was proud to sponsor and work on both of these bills on a bipartisan basis to get them signed into law.

Now it is time to help family caregivers. They are the backbone of the long term care system in this country. They must be a priority in the Federal law books and the tax code.

I thank Senators Clinton, Corzine, Sarbanes, Johnson, Lautenberg, Murray, Kennedy, Landrieu, Dayton, and Harkin for cosponsoring the Family Caregiver Relief Act.

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

Mr. President, I am pleased to join Senator Enzi in introducing the Elder Fall Prevention Act of 2003. Falls are a serious public health problem that affect millions of seniors each year. This bill expands research and education on elder falls to help keep seniors safe and in their own homes longer.

The facts are staggering. One out of every three Americans over age 65 falls every year. In 2000, over 10,200 seniors died and approximately 1.6 million seniors visited an emergency department as a result of a fall. Falls are the leading cause of injury deaths among seniors, accounting for 64,000 traumatic brain injuries and 340,000 hip fractures each year. Falls can be financially disastrous for families, and falls place a serious financial strain on our health care system. By 2020, senior falls are estimated to cost the health care system more than $32 billion.

These facts do not begin to tell the story of what falls can mean for seniors and their loved ones. Falls don't discriminate. Kay Graham was the victim of a fall. Many of us have friends or relatives who have fallen. A fall can have a devastating impact on a person's physical, emotional, and mental health. If an older woman loses her footing on her front porch steps, falls, and suffer a hip fracture, she would likely spend about two weeks in the hospital, and there is a 50 percent chance that she would not return home or live independently as a result of her injuries.

Last year, I chaired a hearing of the Subcommittee on Aging on the problem of elder falls. The Subcommittee heard testimony from Lillie Marie Struchen, a 91-year-old woman who had recently fallen in her bathroom when she slipped on the tile. Lillie Marie could not reach the panic button in her apartment, and it took her some time before she could get to her feet and call for help. Lille Marie was lucky. She recovered from her fall and returned to her normal routines. She shared with the Subcommittee some steps that she and her family had taken to prevent future falls, knowing that she may not be so lucky next time.

These falls, like the ones that Lillie Marie and thousands of others suffer from each year, can be prevented. With some help, there are simple ways that seniors can improve the safety of their homes and make a fall far less likely. Home modifications like hand rails in the bathroom, rubber mats on slippery tile floors, and cordless telephones that seniors can keep nearby can make a big difference. Well-trained pharmacists can review medications to make sure that two drugs do not interact to cause dizziness and throw a senior off balance.

That's what this legislation is about--getting behind our Nation's seniors and giving help to those who practice self-help. This bill creates public education campaigns for seniors, their families, and health care providers about how to prevent falls. It expands research on elder falls to develop better ways to prevent falls and to improve the treatment and rehabilitation of elder falls victims. This legislation also requires an evaluation of the effect of falls on Medicare and Medicaid, to look at potentially reducing costs by expanding coverage to include fall-related services.

Reducing the number of falls will help seniors live longer, healthier, more independent lives. This bill has the strong support of the National Safety Council and has been supported in the past by over 30 national and local aging and safety organizations. I look forward to working with Senator Enzi and my colleagues on the Health, Education, Labor, and Pensions Committee to get this bill signed into law.

Madam President, in the United States, especially when you live in the eastern United States, you take water and the availability of water for granted. Probably the only thing that is ever thought about is: Do we have a big enough reservoir? Or are those aqueducts getting too old that feed New York and northeastern America?

But I am here to suggest there are parts of these great United States where there is a huge shortage of the kind of water we need day by day for our daily activities: to drink, to use for our families, and for the everyday use of our people.

First, I show you a little chart with blue and white areas on it. All of the blue areas on this chart of the United States, believe it or not, are areas in these United States where saline--that is, salty-- aquifers exist; that is, salty water either in large ponds or underground in large pools.

So while we are running out of water, at the same time we have been blessed in that we have plenty of water available if we do something about it. And I propose that we do something about it. I have a bill that I hope will do something about it.

This second chart shows what would be a proposed Tularosa Basin desalination facility. I show it because this is not a new concept. As a matter of fact, this Tularosa Basin is a huge underground water basin in New Mexico. Much of it is very salty, large quantities are not so salty, and then large quantities are of minor salt content.

The legislation I am introducing is to try to make a leap of technology for it directs the Secretary of the Interior to undertake at this program, for lack of a better way to do it, what we call a demonstration program, but it would be one that would be easily adopted anywhere. We ask that it have a capability of 100,000 gallons so that the research would not be carried out at an academic level but really usable.

The Secretary is supposed to work with the greatest laboratories in the Nation that have access in this regard to develop new desalination technology and a plan. The facility should be completed within 3 years. The water from this facility will be disposed of to communities in and around this basin and in and around the county of Otero. We authorize the money necessary for it. I have a detailed statement indicating why we are doing this along with the bill and an extra bill which goes to the desk, one for reference and one for retention.

I am quite confident that a new method of desalination beyond that one that we all hear about is going to be forthcoming. I believe one of the laboratories--probably Sandia National Laboratory in Albuquerque, but not certain, but probably--will make the breakthrough so that we will not be using the old system that we might have been trying for as long now as the occupant of the chair is of age. I even remember that system being used when I first came to the Senate. We were experimenting with it in the city of Roswell under a Government program, and we stopped the program because it was too farfetched.

We have come a long way. Just as we have serious problems cleaning water of other pollutants, and we have old-fashioned ways of doing it, very modern technology is being applied. As an example, we all know there is a big problem in some parts of America where arsenic which is found in the normal topography, normal ground of the surrounding area and has been consumed by whoever lived there for years with no harm--we are going to have to remove it now to some very minuscule content per thousand gallons. In order to do that the old-fashioned way, the costs are enormous. But believe it or not, because of science, we might be able to do that job--albeit some of it should not have to be done at all--for a tenth of the cost.

We are hopeful that same new breed of technology will apply to taking salt out of inland water or ocean water.

Mr. President, as I say, I rise today to introduce a bill that has the potential to supply vast quantities of water to a thirsty New Mexico and a number of Western States. New Mexico and the West face a critical lack of water, but through the program contained in my bill, the faucets could be ready to flow.

Most Western States already have large quantities of water. However, the water contains such high levels of salt that it is simply unusable. My bill proposes to turn untapped resource into potable water that cities, towns, farmers, industry, and nature can use to meet their needs. This bill provides the opportunity for use to utilize brand new technology that may save the West.

This piece of legislation directs the Secretary of the Interior to undertake a desalination demonstration program in the Tularosa Basin located in southern New Mexico. Additionally, it requires collaboration between the Bureau of Reclamation, an established leader in desalination research and development, and the Department of Energy. Our national laboratories are at the forefront of science in many areas including water technology. The collaboration between these two departments would bring together the best minds and the most experienced technicians. This bill would further task the Bureau of Reclamation and the Department of Energy with evaluating current technology, advising on how to proceed with additional research, developing a research plan and confirming project and operation costs in a real-world application. Finally, the bill authorizes the building of a facility where advances in technology could be tested.

The bill authorizes appropriations of $1.5 million for development of a desalination technology plan which will utilize the experiences of present facilities and programs to build the facility and guide its research. It further authorizes $30 million to construct the desalination facility, $6 million for each of fiscal years 2004 through 2010 for research programs at Sandia National Lab associated with the facility, and $10 million for each of the fiscal years 2004 through 2010 for research and development of desalination technologies.

Only 3 percent of the world's water is fresh and much of that is stored in the ice that caps the Earth's poles. We must develop the technology to economically utilize the rest of that water. Today, most of the world's desalination plants are applied to sea water. As I states before, much of the west and, indeed, the Nation, sits on saline aquifers. The facility I propose will develop and test the technologies to best access and utilize this inland water.

Currently, Sandia National Lab and the Department of the Interior are looking for optimum sites to locate the facility and are developing a feasibility study for the program. The sites are all in or around the city of Alamogordo, NM. The designers envision a 13,000 square foot facility that can process up

to 100,000 gallons of water per day. It will draw researchers from around the country and play an essential role in alleviating the pressures on our water resources.

Mr. President, let me also say that I have a broader vision for what can be accomplished with desalination. This is only the first step. This is a serious issue, not only for New Mexico, but the world. More than half the world's population will face severe water shortages in the next 50 years. We must get started on this problem.

I have no doubt that this legislation will help to push forward the state of the art to ensure that we have access to the most precious of resources. Let's take the first step.

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