A bill to require that the Secretary of the Interior conduct a study to identify sites and resources, to recommend alternatives for commemorating and interpreting the Cold War, and for other purposes.

Mr. President, I rise today with colleagues Senator Kennedy and Senator Dayton to introduce the Leave No Child Behind Act of 2003, legislation that provides a comprehensive blueprint for addressing the needs of our Nation's children.

When Representative George Miller and I introduced the Act to Leave No Child Behind in the last Congress, in May of 2001, this Nation was looking at an unprecedented Federal budget surplus of some $5.6 trillion that Federal budget experts forecasted for the years 2002- 2011.

But, just 2 years later, that projected surplus is gone. Instead, Federal budget experts now predict a deficit of more than $2 trillion for those years, the worst fiscal reversal in our history.

Where did the money go?

Obviously, the current economic slowdown has had an impact insofar as it has caused a drop in Federal receipts. However, much of the surplus was lost to an enormous tax bill that contained mostly tax breaks for the largest companies and most affluent individuals, which was enacted during the spring of 2001.

And now, to make matters worse, the President is calling for more tax breaks, again, mostly to be enjoyed by the wealthy, which Federal budget experts estimate will cost $1.5 trillion over the next decade.

At the same time, the President has proposed to severely weaken our Nation's efforts on behalf of families and children, particularly poor families with children.

I listened to the President call for a more compassionate America in his State of the Union Address. Little did I expect that he was calling for others to be compassionate so that he would not have to be.

The budget that we received from the President earlier this month is the worst I have seen for families with children in decades.

Despite the fact that millions of parents struggle with the cost of child care, that the majority of States have long waiting lists, and that we vastly need to improve the quality of care, the President proposes to freeze child care assistance in each of the next five years.

At the same time, the President proposes to increase the number of hours that parents on welfare are required to work and increase the overall number of parents on welfare who are required to work. All of this is without a dime more for child care.

Who is going to watch these children? It is an undeniable fact that additional work requirements will cause an increase in the amount of child care parents need. And, additional hours of child care cost money.

The risk is that States will rob Peter to pay Paul. They will shift child care assistance from the working poor, many of whom might be former welfare recipients, to help those on welfare meet their child care costs. This makes no sense.

For Head Start, the President proposes a modest increase, barely enough to cover inflation despite the fact that Head Start reaches only 60 percent of eligible 3- and 4-year-old children and only 3 percent of eligible infants and toddlers.

In lieu of a real expansion in the program, the President proposes giving current Head Start funds used by community programs to States. This would mean that after 38 years of success, Head Start would no longer be a national program, with national performance standards, offering comprehensive services to our Nation's poorest children--those most likely to be struggling once in school.

Head Start works. Study after study shows the gains Head Start children make. Since Head Start graduates make up only 8 percent of incoming kindergarten students, it makes no sense to raid the Head Start money to reach the other 92 percent of children who are not in Head Start. And yet, that could very well be the result of the President's proposal.

What we know in our country is that many of our young people need a safe place to go after school, particularly at-risk youth who would otherwise be likely to go home alone, where in the absence of adult supervision, they are more likely to smoke, drink, have sex, or engage in crime. And yet, the President proposes to cut the 21st Century after-school program by $400 million. That cut would cause some 570,000 children to be discharged next year from after-school programs across America.

The President proposes deep cuts in Federal housing assistance, allowing States to receive foster care as a block grant instead of individual payments based on children actually in foster care, and potentially eliminating health insurance for millions of children through a block grant of Medicaid and the State Children's Health Insurance Program.

At the same time, according to the National Governor's Association, State economies are on the whole in the worst shape since World War II. States are operating with billions of dollars in the red with State constitutional requirements to balance their budgets.

It is clear what is going on here.

Instead of providing more resources to help States during these tough times, the President is raiding poverty programs for children and using that money to help pay for tax benefits for those who are at the very top of the income scale. This reckless policy only worsens the budget shortfalls facing so many States.

Children are one-quarter of our population. But, they are 100 percent of our future. It makes no sense to shortchange our investment in children.

America's children today are living under some staggering challenges. Nearly 12 million children live in poverty; over 9 million children have no health coverage; about 7 million children go home alone each week after school; and, nearly 1 million children are abused and neglected.

We can do better for our children. We should do better for children. We don't need another tax break for America's wealthiest citizens. What we need is a sound investment in our Nation's children.

The legislation we are introducing today is called, ``An Act to Leave No Child Behind.'' We are committed to this one principle beyond all others. Not just a slogan, but as a means to define an urgent national priority.

We need to make sure that we not only talk about leaving no child behind, but that we actually take steps to do so. Introducing this bill is the first such step.

Every word on every page is focused on the same purpose--lifting our children up, giving each child an opportunity, helping each child to have a safe and rewarding life.

Under the Act to Leave No Child Behind, every child in America would have health coverage. No child in America would go to bed at night aching from hunger. We would use our tax code to lift millions of children out of poverty--not provide more hand-outs for the most wealthy in this country.

It's time to ensure that every American child has an opportunity to attend Head Start, Pre-K, or quality child care to begin a lifetime of learning. It's time to ensure that every American child can read by 4th grade, and read at grade level. And, it's time to take dramatic new steps to address the needs of children who are abused and neglected every year.

Budget experts predict that the President's tax plan will give millionaires an average tax break of $88,800 each. For that same amount of money, we could fully fund Head Start and provide health insurance to every one of the 9 million uninsured children.

We have the resources. If we can afford to give $88,800 on average to every millionaire, then the question is really about priorities and political will--not resources.

If we join together, we can transform this Nation and give each and every child his God-given right to grow and flourish to all he can be, to his or her fullest potential so that all children can realize their dreams.

I ask unanimous consent to have a summary of the bill printed in the Record.

Mr. President, I rise with our colleague Senator Lieberman today to reintroduce two pieces of legislation intended to improve the process by which the Federal Government

acknowledges the sovereign rights of American Indians and their tribal governments. The first bill is called the Tribal Recognition and Indian Bureau Enhancement Act, or the TRIBE Act. The second bill I am introducing is a bill to provide assistance grants to financially needy tribal groups and municipalities so that those groups and towns can more fully and fairly participate in certain decision-making processes at the Bureau of Indian Affairs.

I offer these bills with a renewed sense of hope, knowing that they will contribute to the larger national conversation about how the Federal Government can best fulfill its obligations to America's native peoples. Senator Campbell and Senator Inouye have provided invaluable leadership on this issue. The bills I am reintroducing were the subject of a hearing before the Indian Affairs Committee last fall. While neither bill was reported out of Committee before the end of the last Congress, I hope that the Indian Affairs Committee will continue its work on these and related bills--including Senator Campbell's recently introduced tribal recognition bill--and will see fit to address the problems that currently plague the recognition process.

Currently, there are some 200 petitions pending at the Bureau of Indian Affairs by groups from throughout our Nation seeking Federal recognition as Indian tribes. Nine of these are in the State of Connecticut. These are in addition to the two tribes already recognized in our State: the Mashantucket Pequot tribe and the Mohegan Tribal Nation.

I want to emphasize that as a State, Connecticut has embraced its two established and federally recognized tribes--the Mashantucket Pequot tribe and the Mohegan Tribe. They have generated thousands of jobs for Connecticut residents--primarily in the gaming industry. In fact, Foxwoods Casino, owned by the Mashantucket Pequot Tribe, is the largest gambling casino in the world. Both tribes have delivered hundreds of millions of dollars into the treasuries of our State and towns dollars that have been used to help meet needs in housing, health care, education, and transportation for people throughout the State.

Like any large enterprise, these casinos have placed significant demands on the roadways, water systems, and police and fire departments. By some estimates, an average of 20,000 to 40,000 people visit these two casinos every day, seven days a week, 365 days a year.

Clearly, Federal recognition is an important legal status that can profoundly change both Indian and non-Indian communities. Our experience in Connecticut has taught us that Federal recognition is too important to be treated lightly.

I would not be back before the Senate to address this issue if I did not believe that there are serious defects in the process for tribal recognition. This is a significant issue for Connecticut, but it is also a matter of concern for the entire country. The tribal recognition process is broken. And the process is harming communities and tribes across the country.

The problems with the current recognition process have been well documented and I do not intend to restate all that has been said and written about the subject in recent years. Suffice it to say that it is widely recognized that the process is failing both tribal groups and other interested parties. The General Accounting Office, in a highly- critical study released in November 2001, summarized the problem when it concluded that ``because of weaknesses in the recognition process, the basis for BIA's tribal recognition decisions is not always clear and the length of time involved can be substantial.''

Senator Campbell, Chairman of the Indian Affairs Committee, has eloquently pointed out the irony that descendants of native peoples who have lived in North America for thousands of years are the only Americans that must be ``documented'' to prove their status. How much more bitter that irony has become now that a process established to be fair and considerate toward native peoples is, in many ways, working against them. Let me share with our colleagues some compelling facts, which I have referenced here on the floor of the Senate before.

Decisions on tribal petitions do not take months to make. They typically take years--and sometimes decades, thanks to understaffing and the demands of complying with FOIA requests and litigation. At its current pace, it will take well over 100 years for BIA to clear just its existing backlog of tribal recognition petitions. Can you imagine any group of Americans having to wait years or decades to have their legal rights vindicated? We would not and do not tolerate those kinds of delays in other areas of federal administrative law. Yet they are commonplace with respect to groups seeking Federal tribal status.

Tribes, towns, and other interested parties have often had their evidentiary submissions ignored. During consideration of two recent petitions, the BIA decided it would no longer accept evidence submitted on the petitions--but the agency failed to tell interested parties for eleven months. In the meantime, neighboring parties and other interested parties had spent large sums of time and money to submit voluminous additional evidence bearing on whether or not the petitions should have been granted.

In some cases, the seven mandatory criteria for recognition have been selectively ignored by BIA. In the case of the Eastern Pequot and Paucatuck Eastern Pequot petitions, two of the seven criteria for recognition were waived by the then-Assistant Secretary for Indian Affairs. According to published reports, he effectively ignored the recommendations of the historians and genealogists on his staff who had found that those criteria had not been met. In another case, there was a 70-year period during which a petitioner could produce no evidence that it continuously existed as a distinct community exhibiting political authority. The BIA's technical staff concluded that a 70-year gap was too long to support a finding of continuous existence. Despite the lack of evidence, the Assistant Secretary decided that continuous existence could be presumed, and so he went on to deem this criterion to be met and to recognize the tribe.

Again, the bottom line is that the recognition process is broken. Last year, one of our colleagues--a long-time champion for American Indian causes--called the current recognition process a ``scandal.'' I agree and I think it's bad public policy to allow Federal agencies to continue to make decisions when their decision-making procedures are so flawed.

The current process is arcane, burdensome, time consuming, difficult to understand, and too easily manipulated for political purposes. The evidence is overwhelming that the rules of recognition are being applied strictly for some and bent or ignored altogether for others. That's wrong. That's unfair. The Chairwoman of the Duwamish Tribe of Washington State has said she and her people ``have known and felt the effects of 20 years of administrative inaccuracies, delays and the blase approach in . . . handling and . . . processing the Duwamish petitions.'' Because the process is so complicated and so different from other, more familiar, administrative procedures, it is hard for people to have confidence in the BIA's decisions--especially when the BIA appears to be applying the rules differently in different cases.

The reforms proposed by the TRIBE Act are modest. The TRIBE Act will permit any Indian group in the continental United States that desires to be acknowledged as an Indian Tribe to file a petition with the BIA. If the group can satisfy the mandatory criteria for federal acknowledgment, then the group would be recognized.

The legislation simply requires better notice to Indians and non- Indian groups. It provides for better fact-finding and it requires the Secretary to publish a complete explanation of final decisions regarding documented petitions. The bill improves the recognition process in the following specific ways: first, it would authorize $10 million per year to better enable the Bureau of Indian Affairs to consider petitions in a thorough, fair, and timely manner. Second, it would provide for improved notice of a petition to key persons who may have an interest in a petition, including: the governor and attorney general of the state where a tribe seeks recognition; other tribes; and elected leaders of towns in the vicinity of a tribe seeking recognition, third, it would require that a petitioner meets each of the seven mandatory criteria for federal recognition

spelled out in the current Code of Federal Regulations, and fourth, it would require that a decision on a petition be published in the Federal Register, which would include a detailed explanation of the findings of fact and of law with respect to each of the seven mandatory criteria for recognition.

I want to emphasize what this legislation would not do. It would not revoke or in any way alter the status of tribes whose petitions for federal recognition have already been granted. It would not restrict in any way the existing prerogatives and privileges of such tribes. Tribes will retain their right to self-determination consistent with their sovereign status. Finally, and perhaps most importantly, the TRIBE Act will not dictate outcomes or micro-manage the agency.

As I have often said, I believe that every tribal Government that is entitled to recognition should be recognized and should be recognized in an appropriately speedy process. But I also think we have to make sure that the BIA's conclusions are accurate so there won't be endless questions and disputes over the Bureau's decisions. Every recognition decision carries with it a legal significance that should endure forever. Each recognition decision made by the BIA is a foundation upon which relationships between tribes and States, tribes and towns, Indians and non-Indians will be built for generations to come. We need to make sure that the foundation upon which these lasting decisions are built is sound and will withstand the test of time. We as a Nation cannot afford to build relationships between sovereigns on the shifting sands of a broken bureaucratic procedure.

Let me close with a word about the second bill I am introducing. This bill will provide grants to allow poor tribes and municipalities an opportunity to effectively participate in important decision-making processes. When the Federal Government, through the Bureau of Indian Affairs, makes decisions that will change communities, it is only right that the government should provide a meaningful opportunity for those communities, whether tribal or non-tribal, to be heard.

As we consider how best to reform the process for tribal recognition, we ought to be guided by the firm principles embedded in the bills I am offering here today: fairness, openness, respect, and a common interest in bettering the quality of life for all Americans. I look forward to discussing these and other ideas with Chairman Campbell, Senator Inouye, and my colleagues here in the Senate, tribal leaders, and others who believe the time for reform has come.

Mr. President, today I am proud to introduce with Senator Snowe a bipartisan bill that will repeal a rider in the Omnibus Appropriations Conference Report. After the Conference Committee met and behind closed doors, this special interest rider gutted the organic standards just recently enacted by U.S. Department of Agriculture. Thirty four Senators, and counting, from both parties are joining me to repeal this special interest provision and restore credibility to the USDA organic standards.

I understand this special interest provision was inserted into the bill on behalf of a single producer who essentially wants to hijack the ``organic'' certification label for his own purposes. He wants to get a market premium for his products, without actually being an organic product.

This provision will allow producers to label their meat and dairy products ``organic'' even though they do not meet the strict criteria set forth by USDA, including the requirement that the animals be fed organically grown feed. This approach was considered and outright rejected by USDA last June. The entire organic industry opposed this weakening of the organic standards. If beef, poultry, pork and dairy producers are able to label their products as ``organic'' without using organic feed, which is one of the primary inputs, then what exactly is organic about the product?

This provision is particularly galling because so many producers have already made the commitment to organic production. For most, this is a huge financial commitment on their part. I have already heard from some large producers--General Mills, Tyson Foods--as well as scores of farmers from Vermont and around the country who are enraged by this special loophole included for one company that does not want to play by the rules.

My legislation strikes this rider from the Omnibus Appropriations Act and I hope to move it through Congress quickly before it does gut the organic meat and dairy industry. We need to send a message to all producers that if you want to benefit from the organic standards economically, you must actually meet them. When I included the ``The Organic Foods Production Act'' in the 1990 farm bill, it was because farmers recognized the growing consumer demand for organically produced products, but needed a tool to help consumers know which products were truly organic and which were not. The Act directed USDA to set minimum national standards for products labeled ``organic'' so that consumers could make informed buying decisions. The national standard also reassured farmers selling organically produced products that they would not have to follow separate rules in each state, and that their products could be labeled ``organic'' overseas.

The new standards have been enthusiastically welcomed by consumers, because through organic labeling they now can know what they are choosing and paying for when they shop. This proposal to weaken the organic standards would undermine public confidence in organic labeling, which is less than a year old.

Getting the organic standards that are behind the ``USDA Organic'' label right was a long and difficult process, but critically important to the future of the industry. Along the way, some tried to allow products treated with sewer sludge, irradiation, and antibiotics to be labeled ``organic.'' The public outcry against this was overwhelming. More than 325,000 people weighed in during the comment period, as did I. The groundswell of support for strong standards clearly showed that the public wants ``organic'' to really mean something. Those efforts to hijack the term were defeated and this one should be too.

Consumers and producers rely on the standard. I hope more members will cosponsor my bill and send a message to special interests that they cannot hijack the organic industry through a rider on the spending bill. We need to fix this mistake and restore integrity to our organic standards.

Mr. President, I proudly rise today to introduce the Hometown Heroes Survivors Benefits Act of 2003. I thank Senators Graham of South Carolina, Collins, Jeffords, Sarbanes, Schumer, Durbin, Landrieu, Nelson of Florida, Clinton and Snowe for joining me as original cosponsors of this multi-partisan legislation that will improve the Department of Justice's Public Safety Officers' Benefits, PSOB, Program by allowing families of public safety officers who suffer fatal heart attacks or strokes to qualify for Federal survivor benefits.

I want to begin by thanking each of our Nation's brave firefighters, emergency medical rescuers and law enforcement officers for the jobs they do for the American public day in and day out. Our public safety officers are often the first to respond to any crime or emergency situation. On September 11, the Nation saw that the first on the scene at the World Trade Center were the heroic firefighters, police officers and emergency personnel of New York City. These real-life heroes, many of whom gave the ultimate sacrifice, remind us of how important it is to support our state and local public safety partners.

I commend Congressmen Etheridge, Weldon, Hoyer and Oxley for their leadership and fortitude during the last Congress on an identical bill in the House. I look forward to working with them again during the 108th Congress on this important legislation.

Last year, both the House and Senate versions of this legislation received the endorsement of the Fraternal Order of Police, National Association of Police Organizations, Congressional Fire Services Institute, International Association of Arson Investigators, International Association of Fire Chiefs, International Association of Fire Fighters, National Fire Protection Association, National Volunteer Fire Council, North American Fire Training Directors, International Fire Buff Associates, National Association of Emergency Medical Technicians, American Ambulance Association, the American Federation of State, County and Municipal Employees, along with over 50 additional national organizations. I thank all of these organizations for their unwavering support for this legislation.

Public safety officers are among our most brave and dedicated public servants. I applaud the efforts of all members of fire, law enforcement, and rescue organizations nationwide who are the first to respond to more than 1.6 million emergency calls annually whether those calls involve a crime, fire, medical emergency, spill of hazardous materials, natural disaster, act of terrorism, or transportation accident without reservation. They act with an unwavering commitment to the safety and protection of their fellow citizens, and are forever willing to selflessly sacrifice their own lives to provide safe and reliable emergency services to their communities. Sadly, this dedication to service can result in tragedy, as was evident by the bravery displayed on September 11, 2001, when scores of first responders raced to the World Trade Center and the Pentagon with no other goal but to save lives.

Every year, hundreds of public safety officers nationwide lose their lives and thousands more are injured while performing duties that subject them to great physical risks. And while we know that PSOB benefits can never be a substitute for the loss of a loved one, the families of all our fallen heroes deserve to collect these funds.

The PSOB Program was established in 1976 to authorize a one-time financial payment to the eligible survivors of Federal, State, and local public safety officers for all line-of-duty deaths.

Two years ago, Congress improved the PSOB Program by streamlining the process for families of public safety officers killed or injured in connection with prevention, investigation, rescue or recovery efforts related to a terrorist attack. We also retroactively increased the total benefits available by $100,000 as part of the USA PATRIOT Act.

The PSOB Program currently provides approximately $262,000 in benefits to the families of law enforcement officers, firemen, emergency response squad members, and ambulance crew members who are killed in the line of duty.

Unfortunately, the issue of covering heart attack and stroke victims in the PSOB Program was not addressed at that time.

When establishing the PSOB Program, Congress placed only three limitations on the payment of benefits. No award could be paid, first, if the death was caused by the intentional misconduct of the officer or by such officer's intention to bring about his own death; second, if voluntary intoxication of the officer was the proximate cause of such officer's death; or, third, to any person otherwise entitled to a benefit if such person's action was a substantial contributing factor to the death of the officer.

In years following, however, the Justice Department began to interpret the Program's guidelines to exclude from benefits the survivors of public safety officer who die of a heart attack or stroke while acting in the line of duty, arguing that the attack must be accompanied by a traumatic injury, such as a wound or other condition of the body caused by external force, including injuries by bullets, smoke inhalation, explosives, sharp instruments, blunt objects or other physical blows, chemicals, electricity, climatic conditions, infectious diseases, radiation, and bacteria. Barred are those who suffer from occupational injuries, such as stress and strain.

Service-connected heart, lung, and hypertension conditions are silent killers of public safety officers nationwide. The numerous hidden health dangers dealt with by police officers, firefighters and emergency medical personnel are widely recognized, but officers face these dangers in order to carry out their sworn duty to serve and protect their fellow citizens.

Our multi-partisan bill would effectively erase any distinction between traumatic and occupational injuries. The Hometown Heroes bill will fix the loophole in the PSOB Program to ensure that the survivors of public safety officers who die of heart attacks or strokes in the line of duty or within 24 hours of a triggering effect while on duty regardless of whether a traumatic injury is present at the time of the heart attack or stroke are eligible to receive financial assistance.

I was serving my first term in the Senate when this program was established, and I firmly believe that this is what Congress meant for the survivors of our Nation's first responders to receive through the Public Safety Officers Benefits Program.

Heart attack and cardiac related deaths account for almost half of all firefighter fatalities between 45-50 deaths and an average of 13 police officer deaths each year. Yet the families of these fallen heroes are rarely eligible to receive PSOB benefits.

In January 1978, special Deputy Sheriff Bernard Demag of the Chittenden County Sheriff's Office in Vermont suffered a fatal heart attack within two hours of his chase and apprehension of an escaped juvenile whom he had been transporting. Mr. Demag's family spent nearly two decades fighting in court for workers' compensation death benefits all to no avail. Clearly, we should be treating surviving family members of officers who die in the line of duty with more decency and respect.

Public safety is dangerous, exhausting, and stressful work. A first responder's chances of suffering a heart attack or stroke greatly increase when he or she puts on heavy equipment and rushes into a burning building to fight a fire and save lives. The families of these brave public servants deserve to participate in the PSOB Program if their loved ones die of a heart attack or other cardiac related ailments while selflessly protecting us from harm.

First responders across the country now face a new series of challenges as they respond to millions of emergency calls this year. They do this with an unwavering commitment to the safety of their fellow citizens, and are forever willing to selflessly sacrifice their own lives to protect the lives and property of their fellow citizens. It is time for the Senate to show its support and appreciation for these extraordinarily brave and heroic public safety officers by passing the Hometown Heroes Survivors Benefit Act.

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

Mr. President, I rise today to address an issue of importance to all Americans, the quality and safety of health care in the United States.

Numerous studies have identified serious shortcomings in the quality and safety of health care. However, addressing these shortcomings and improving health care outcomes in a complex health care system requires long-range strategies and specific goals.

The Medicare program, as one of the largest purchasers of health care, is ideally situated to take a leadership role in encouraging quality improvement. Currently, however, Medicare's payment methods and regulations provide few incentives to pursue innovative quality improvement strategies and to reward those who achieve exemplary performance.

Traditional Medicare pays most physicians according to a fee schedule and pays hospitals according to a DRG-based payment system. Medicare+Choice plans are paid a capitated rate and, in turn, pay physicians using a range of approaches, from salary to capitation to fee-for-service, none of which directly reward enhanced quality.

Attempts to adjust Medicare payments to reward performance improvements in safety and quality have been hampered, in part, by the lack of measures and data for assessing performance. Although the Centers for Medicare and Medicaid Services recently began an initiative to develop voluntary consensus performance measures for 10 clinical conditions for hospitals, standardized measures of quality for hospitals and providers do not otherwise exist.

As the Senate considers a new Medicare prescription drug benefit and additional measures to reform the Medicare program, it is more important than ever that we consider also measures to ensure that these new benefits are provided as safely and effectively as possible.

That is why I am today introducing a bill charging the Institute of Medicine with performing a study to evaluate leading health care performance measures and options to implement policies that align performance with payment in Medicare.

We have learned much about health care quality in the last several years. The Institute of Medicine, in its studies entitled ``To Err Is Human,'' and ``Crossing the Quality Chasm,'' has identified the health care safety and quality shortcomings that exist and the need for improvement. In a recent study performed at the request of Congress, ``Leadership by Example,'' the Institute of Medicine identified the leadership role that Government can take in improving health care quality in government sponsored health care programs and those in the private sector.

The bill that I am introducing today, and the study that will result, represents the next step toward improving health care quality and safety in the United States. It is an important step and one that we must take in order to ensure that Medicare beneficiaries receive the highest quality health care services available. I urge my colleagues to join me in supporting this legislation.

Mr. President, there is no question that our need to improve the Medicare program by adding prescription drug coverage for beneficiaries is extremely important, as this debate indicates.

But, our discussions would not be complete if we neglected another major Medicare improvement which is also long overdue, and that is the need to improve the climate in which providers strive to provide high quality services to patients.

Medicare's anticipated regulations--three times longer than the U.S. tax code--prevent providers from delivering health care efficiently and beneficiaries from receiving the care they need.

Complex Federal regulations and reams of paperwork require physicians to spend hours each day filling out government forms rather than caring for their patients. The array of Federal Medicare rules with which physicians must comply is overwhelming. Doctors are required to complete claims forms, advance beneficiary notices, certify medical necessity, file enrollment forms, and comply with code documentation guidelines. Indeed, these rules and mandates are not only extensive, they are constantly changing and they may be interpreted differently in different regions of the country.

The complexity of the rules and the variation in their interpretation has prompted outcries from all centers of our country. In fact, I have heard loud and clear from the physicians in my home State of Utah about the severity of the problem.

Leon Sorensen, Executive Vice President of the Utah Medical Association, recently wrote to me and said:

``The Utah Medical Association has long been concerned

about the unnecessary burdens placed upon physicians by the

voluminous regulations of Medicare. Not only does compliance

with these regulations take physicians' time away from

patients, but also the regulations contribute to the high

cost of medical care while contributing little of value. They

discourage physicians from participating fully in Medicare.

They are often punitive in nature rather than an educational.

They use tactics that would not be tolerated by businesses or

government if applied to them.

An example is the practice of extrapolating a small sample

of billing errors over the physician's entire practice,

making the physician liable for payback of thousands of

dollars of ``overpaid'' claims when demonstrated over

billings may amount only to a few dollars. If this process

were used by the IRS in a tax audit, the public outcry would

be deafening.

Medicare also requires that alleged ``overpayments'' to

physicians by repaid within 60 days, even if a physician

chooses to appeal Medicare's allegations. When assessed a

Medicare overpayment, the only way physicians can appeal is

to subject their practices to another audit, using a

``statistically valid random sample.'' Statistical sample

audits can shut down a physician's practice for days,

preventing physicians from treating patients. Physicians are

forced to settle with Medicare rather than be subjected to

such unfair scrutiny.

Any defense against this kind of administrative abuse is

extremely costly, time consuming and often ineffective.

Indeed, failure to follow Medicare's complex rules--or just the perception of such failure--can result in an audit of a physician's billing records, withholding of payments and crippling of a physician's practice.

And, physicians are not the only individuals affected by these rules. Medicare beneficiaries are affected--both directly and indirectly--by Medicare's onerous rules and burdensome paperwork. Both patients and providers are confused by obscure paperwork and apparently conflicting rules. Physicians have difficulty understanding how to bill for their services and beneficiaries find it difficult to understand the forms and billing information that they receive. Indeed, the administrative costs associated with managing this paperwork and the fear of harsh consequences in response to clerical errors has led some providers to consider whether they should continue to participate in the Medicare program.

The problem has not escaped the attention of the administration and addressing it is a priority for President Bush and it should be for Congress also. Secretary Thompson has said, ``Patients and providers alike are fed up with voluminous and complex paperwork. Rules are constantly changing. Complexity is overloading the system, criminalizing honest mistakes and driving doctors, nurses, and other health care professionals out of the program.''

Congress has considered legislation over the past few years to provide relief from this regulatory burden. Former Senator Frank Murkowski should be given great credit for drafting S. 452, the ``Medicare Education and Regulatory Fairness Act of 2001''--legislation that he introduced in the Senate on March 5, 2001 but which never came to a vote.

The legislation that I am introducing today, the ``Medicare Education Regulatory Reform and Contracting Improvement Act of 2003,'' MERCI, builds on that initiative. It will improve the Medicare program for beneficiaries and providers alike by clarifying regulations, rewarding quality and by enhancing services. I am introducing this legislation today because the need for Medicare regulatory reform remains. In fact, the need for Medicare regulatory reform has never been greater. In addition, the regulatory reform that I am proposing in MERCI fits hand in glove with the reforms that we have

proposed in S. 1, the ``Prescription Drug and Medicare Improvement Act of 2003.'' The reformed Medicare program must include reformed regulations if it is to provide efficient service to beneficiaries.

Let me take a moment to review a few of the important provisions in this bill. The educational provisions of the MERCI Act are designed to decrease Medicare billing and claims payment errors by improving education and training programs for Medicare providers. It includes also provisions that will improve communication between the Department of Health and Human Services and Medicare providers. Furthermore, the bill will improve communication with Medicare beneficiaries by providing for central toll-free telephone services to require free, appropriate referrals to individuals seeking information or assistance with Medicare.

The MERCI Act includes regulatory reform provisions that are designed to reduce waste, fraud and abuse in Medicare; provisions that are just and fair for beneficiaries, contractors, and providers. Among other things, the bill eliminates retroactive application of regulatory changes and expedites the appeals processes for beneficiaries, providers, and suppliers of Medicare services.

Finally, the MERCI Act will improve Medicare contracting; increasing competition, improving service and reducing costs by providing for a competitive bidding process for Medicare contractors that takes into account performance quality, price and other factors that are important to beneficiaries.

Medicare beneficiaries and Medicare providers have been suffering from burdensome and confusing regulations for too long. It is time that they received some mercy. The time for Medicare regulatory reform has come and the bill that I am introducing today provides that mercy. MERCI, the ``Medicare Education, Regulatory Reform and Contracting Improvement Act of 2003'' takes a common sense approach to providing relief for the Medicare beneficiaries and providers who have been suffering this burden for so long.

I believe that MERCI will improve the delivery of health care services to Medicare beneficiaries by enhancing the efficiency of the Medicare program for all concerned.

Finally, I would be remiss if I did not thank Chairman Grassley and Senator Baucus for working with me to include the MERCI legislative language in S. 1, the ``Prescription Drug and Medicare Improvement Act of 2003.'' Senators Grassley and Baucus have worked for many years to reform Medicare's complex regulations, as have I, and their agreement to include this language is appreciated greatly.

And so, it is with a great appreciation for my colleagues who have worked with me on this legislation and for those who have worked on similar legislation in the past, that I urge my colleagues in the Senate today to join me in addressing the needs of Medicare beneficiaries and providers by supporting this legislation.

Mr. President, the U.S. Postal Service provides a vital and important communication link for the Nation and the citizens of my home State of Iowa. Rural Letter Carriers play a special role and have a proud history as an important link in assuring the delivery of our mail. Rural letter carriers first delivered the mail with their own horses and buggies, later with their own motorcycles, and now in their own cars and trucks. They are responsible for maintenance and operation of their vehicles in all types of weather and road conditions. In the winter, snow and ice is their enemy, while in the spring, the melting snow and ice causes potholes and washboard roads. In spite of these quite adverse conditions, rural letter carriers daily drive over 3 million miles and serve 24 million American families on over 66,000 routes.

Although the mission of rural carriers has not changed since the horse and buggy days, the amount of mail they deliver has changed dramatically. As the Nation's mail volume has increased throughout the years, the Postal Service is now delivering more than 200 billion pieces of mail a year. The average carrier delivers about 2,300 pieces of mail a day to about 500 addresses.

Most recently, e-commerce has changed the type of mail rural letter carriers deliver. This fact was confirmed in a GAO study entitled ``U.S. Postal Service: Challenges to Sustaining Performance Improvements Remain Formidable on the Brink of the 21st Century,'' dated October 21, 1999. As this report explains, the Postal Service expects declines in its core business, which is essentially letter mail, in the coming years. The growth of e-mail on the Internet, electronic communications, and electronic commerce has the potential to substantially affect the Postal Service's mail volume.

First-Class mail has always been the bread and butter of the Postal Service's revenue, but the amount of revenue from First-Class letters is declining. E-commerce is providing the Postal Service with another opportunity to increase another part of its business. That is because what individuals and companies order over the Internet must be delivered, sometimes by the Postal Service and often by rural letter carriers. Currently, the Postal Service had about 33 percent of the parcel business. Rural letter carriers are now delivering larger volumes of business mail, parcels, and priority mail packages. But, more parcel business means more cargo capacity is necessary in postal delivery vehicles, especially in those owned and operated by rural letter carriers.

When delivering greeting cards or bills, or packages ordered over the Internet, rural letter carriers use vehicles they currently purchase, operate and maintain. In exchange, they receive a reimbursement from the Postal Service. This reimbursement is called an Equipment Maintenance Allowance, EMA. Congress recognizes that providing a personal vehicle to delivery the U.S. Mail is not typical vehicle use. So, when a rural letter carrier is ready to sell such a vehicle, it's going to have little trade-in value because of the typically high mileage, extraordinary wear and tear, and the fact that it is probably right-hand drive. Therefore, Congress intended to exempt the EMA allowance from taxation in 1988 through a specific provision for rural mail carriers in the Technical and Miscellaneous Revenue Act of 1988.

That provision allowed an employee of the U.S. Postal Service who was involved in the collection and delivery of mail on a rural route, to compute their business use mileage deduction as 150 percent of the standard mileage rate for all business use mileage. As an alternative, rural letter carrier taxpayers could elect to utilize the actual expense method, business portion of actual operation and maintenance of the vehicle, plus depreciation. If EMA exceeded the allowable vehicle expense deductions, the excess was subject to tax. If EMA fell short of the allowable vehicle expenses, a deduction was allowed only to the extent that the sum of the shortfall and all other miscellaneous itemized deductions exceeded two percent of the taxpayer's adjusted gross income.

The Taxpayer Relief Act of 1997 further simplified the tax returns of rural letter carriers. That Act permitted the EMA income and expenses ``to wash,'' so that neither income nor expenses would have to be reported on a rural letter carrier's return. That simplified taxes for approximately 120,000 taxpayers, but the provision eliminated the option of filing the actual expense method for employee business vehicle expenses. The lack of this option, combined with the dramatic changes the Internet is having on the mail, specifically on rural letter carriers and their vehicles, is a problem I believe Congress must address.

The mail mix is changing and already Postal Service management has, understandably, encouraged rural letter carriers to purchase larger right-hand

drive vehicles, such as Sports Utility Vehicles, SUVs, to handle the increase in parcel loads. Large SUVs are much more expensive than traditional vehicles. So without the ability to use the actual expense method and depreciation, rural letter carriers must use their salaries to cover vehicle expenses. Additionally, the Postal Service has placed 11,000 postal vehicles on rural routes, which means those carriers receive no EMA.

These developments have created a situation that is contrary to the historical Congressional intent of using reimbursement to fund the government service of delivering mail, and also has created an inequitable tax situation for rural letter carriers. If actual business expenses exceed the EMA, a deduction for those expenses should be allowed. To correct this inequity, I am introducing a bill today that reinstates the ability of a rural letter carrier to choose between using the actual expense method for computing the deduction allowable for business use of a vehicle, or using the current practice of deducting the reimbursed EMA expenses.

Rural letter carriers perform a necessary and valuable service and face may changes and challenges in this new Internet era. We must make sure that these public servants receive fair and equitable tax treatment as they perform their essential role in fulfilling the Postal Service's mandate of binding the Nation together.

I urge my colleagues to join Senators Bingaman, Daschle, Bunning, Rockefeller, Snowe, Thomas, Smith of Oregon, Conrad, Graham of Florida, Kerry, Breaux, Lincoln and myself in sponsoring this legislation.

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

Mr. President, I rise today to introduce the Long-Term Care and Retirement Security Act. This legislation, which I sponsored in the 106th and 107th Congress with my distinguished colleague from Florida, Senator Bob Graham, would ease the tremendous cost of long- term care.

The bill that Senator Graham and I are re-introducing today would allow individuals a tax deduction for the cost of long-term care insurance premiums. Increasingly, Americans are interested in private long-term care insurance to pay for nursing home stays, assisted living, home health aides, and other services. However, most people find the policies unaffordable. The younger the person, the lower the insurance premium, yet most people aren't ready to buy a policy until retirement. A deduction would encourage more people to buy long-term insurance.

Our proposal would also give individuals or their care givers a $3,000 tax credit to help cover their long-term care expenses. This would apply to those who have been certified by a doctor as needing help with at least three activities of daily living, such as eating, bathing, or dressing. This credit would help care givers pay for medical supplies, nursing care and any other expenses incurred while caring for family members with disabilities.

One family that would benefit from this legislation is the Gardner family of Waterloo, IA. Ruth Gardner is a 70-year-old mother of nine who suffers from a degenerative tissue disorder, Scleroderma, atrial fibrillation, congestive heart failure and is a breast cancer survivor. For the last 3 years her nine children, their spouses and numerous grandchildren have worked tirelessly to fulfill Ms. Gardner's wish of spending her last months with dignity and respect at home.

While Ms. Gardner's wish may seem small, the task of managing her care is not. Each week family members meet to organize their schedules in an effort to provide over 20 hours of daily care for Ms. Gardner. Working relentlessly, and at a considerable cost, the Gardner family manages to provide around-the-clock care while balancing both work and their family lives. All this effort comes at a great cost, both emotionally and financially. The Gardners have been able to locate some funding to help support the care for Ms. Gardner; however, the family continues to bear considerable costs. These costs include weekly nursing visits that cost $102 per visit, emergency response service at $30 a month, daily hospice service at $32 an hour and not to mention the hours and hours of personal time donated by the family.

The Long-Term Care and Retirement Security Act would help the 22 million family caregivers like the Gardners. A $3,000 tax credit would help to pay for Ms. Gardner's monthly hospice care, weekly nurse visits or help to hire a nurse to cover some of the time that the family currently donates. This legislation would also help the increasing number of families placed in the difficult situation by allowing them to purchase long-term care insurance. Had this legislation been enacted earlier, long-term care insurance would

have been an affordable option for Ms. Gardner, alleviating the difficult situation that her family currently faces.

As it has in the past, the bill that Senator Graham and I are introducing today has been endorsed by both the AARP and the Health Insurance Association of America. A companion bill sponsored by Representatives Nancy Johnson, Karen Thurman and Earl Pomeroy is pending in the House of Representatives.

An aging nation has no time to waste in preparing for long-term care, and the need to help people afford long-term care is more pressing than ever. I look forward to working with Senator Graham and our colleagues in the Senate to get our bill passed into law as soon as possible.

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

Mr. President, I ask unanimous consent that the Committee on Commerce, Science, and Transportation be authorized to meet on Wednesday, July 23, 2003, at 9:30 a.m. on Public Interest and Localism in SR-253.

Mr. President, I ask unanimous consent that the Committee on Energy and Natural Resources be authorized to meet during the session of the Senate, on Wednesday, July 23 at 10 a.m. to consider pending calendar business.

Agenda

Agenda Item 2: S. 391--A bill to enhance ecosystem protection and the range of outdoor opportunities protected by statute in the Skykomish River valley of the State of Washington by designating certain lower- elevation Federal lands as wilderness, and for other purposes.

Agenda Item 3: S. 434--A bill to authorize the Secretary of Agriculture to sell or exchange all or part of certain parcels of National Forest System land in the State of Idaho and use the proceeds derived from the sale or exchange for National Forest System purposes.

Agenda Item 4: S. 435--A bill to provide for the conveyance by the Secretary of Agriculture of the Sandpoint Federal Building and adjacent land in Sandpoint, Idaho, and for other purposes.

Agenda Item 5: S. 452--A bill to require that the Secretary of the Interior conduct a study to identify sites and resources, to recommend alternatives for commemorating and interpreting the Cold War, and for other purposes.

Agenda Item 6: S. 714--A bill to provide for the conveyance of a small parcel of Bureau of Land Management land in Douglas County, Oregon, to the county to improve management of and recreational access to the Oregon Dunes National Recreation Area, and for other purposes.

Agenda Item 9: S. 1003--A bill to clarify the intent of Congress with respect to the continued use of established commercial outfitter hunting camps on the Salmon River.

Agenda Item 10: H.R. 417--To revoke a Public Land Order with respect to certain lands erroneously included in the Cibola National Wildlife Refuge, California.

Agenda Item 11: H.R. 622--To provide for the exchange of certain lands in the Coconino and Tonto National Forests in Arizona, and for other purposes.

Agenda Item 12: H.R. 762--To amend the Federal Land Policy and Management Act of 1976 and the Mineral Leasing Act to clarify the method by which the Secretary of the Interior and the Secretary of Agriculture determine the fair market value of certain rights-of-way granted, issued, or renewed under these Acts.

Agenda Item 13: H.R. 1012--To establish the Carter G. Woodson Home National Historic Site in the District of Columbia, and for other purposes.

In addition, the Committee may turn to any other measures that are ready for consideration.

Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on Wednesday, July 23, 2003 at 9:30 a.m. to hold a Business Meeting.

Mr. President, I ask unanimous consent that the Committee on Foreign Relations be authorized to meet during the session of the Senate on Wednesday, July 23, 2003 at 2:45 p.m. to hold a hearing on Iraq: Status and Prospects for Reconstruction--Next Steps.

Mr. President, I ask unanimous consent that the Committee on Health, Education, Labor, and Pensions be authorized to meet in Executive Session during the session of the Senate on Wednesday, July 23, 2003.

Agenda

S.__, Patient Safety and Quality Improvement Act of 2003

Presidential Nominations: Daniel Pipes, of Pennsylvania, to be a Member of the Board of Directors of the United States Institute of Peace; Charles Edward Horner, of the District of Columbia, to be a Member of the Board of Directors of the United States Institute of Peace; Stephen David Krasner, of California, to be a Member of the Board of Directors of the United States Institute of Peace; Eric Dreiband, of Virginia, to be General Counsel of the Equal Employment Opportunity Commission.

Any additional nominees cleared for action.

Mr. President, I ask unanimous consent that the Committee on Indian Affairs be authorized to meet on Wednesday, July 23, 2003, at 10:00 a.m. in Room 485 of the Russell Senate Office Building to conduct a hearing on S. 556, a Bill to Reauthorize the Indian Health Care Improvement Act.

Mr. President, I ask unanimous consent that the Committee on the Judiciary be authorized to meet to conduct a markup on Wednesday, July 23, 2003, at 9:00 a.m. in Hart Room 216.

Mr. President, I ask unanimous consent that the Committee on the Judiciary be authorized to meet to conduct a hearing on ``Oversight Hearing: Law Enforcement and Terrorism'' on Wednesday, July 23, 2003, at 10:00 a.m. in the Hart Senate Office Building Room 216.

Agenda

The Honorable Robert S. Mueller, Director, Federal Bureau of Investigation, Department of Justice, Washington, DC; The Honorable Asa Hutchinson, Under Secretary for Border & Transportation Security, Department of Homeland Security, Washington, DC.

Mr. President, I ask unanimous consent that the Committee on the Judiciary be authorized to meet to conduct an Executive Nominations hearing on Wednesday, July 23, 2003, at 2:00 p.m. in the Dirksen Senate Office Building Room 226.

Agenda

Panel I: Senators.

Panel II: Rene Alexander Acosta to be Assistant Attorney General, Civil Rights Division, United States Department of Justice and Daniel J. Bryant to be Assistant Attorney General, Office of Legal Policy, United States Department of Justice.

Mr. President, I ask unanimous consent that the Senate Committee on the Judiciary Subcommittee on Antitrust, Competition Policy and Consumer Rights be authorized to meet to conduct a hearing on ``Agriculture, Consolidation and the Smithfield/Farmland Deal'' on Wednesday, July 23, 2003, at 4:00 p.m. in Room 138 of the Dirksen Senate Office Building.

Agenda

Panel I: Senator Tim Johnson.

Panel II: Mr. Joseph Sebring, CEO, John Morrell, Inc., Cincinnati, OH; Mr. William Hughes, Administrator, Division of Agricultural Development, Wisconsin Department of Agriculture, Trade and Consumer Protection, Madison, WI; Dr. Luther Tweeten, Agriculture Consultant, Columbus, OH; Mr. Russ Kremer, President, Missouri Farmers' Union, Jefferson City, MO; Mr. Patrick Bell, Farmer, Kenansville, NC; and Mr. Michael Stumo, General Counsel, Organization for Competitive Markets, Winstead, CT.

Mr. President, I ask unanimous consent that the Subcommittee on Housing and Transportation of the Committee on Banking, Housing, and Urban Affairs be authorized to meet during the session of the Senate on July 23, 2003, at 2:30 p.m. to conduct a hearing on ``Enhancing the Role of the Private Sector in Public Transportation.''