Lifespan Respite Care Act of 2006

Mr. Speaker, I rise today in support of H.R. 3248, the Lifespan Respite Care Act. This important bipartisan legislation will for the first time establish a national policy to help our Nation's 50 million family caregivers, including 900,000 New Jersey family caregivers who provide daily care for their loved ones with disabilities and chronic conditions or illnesses.

Instead of an institutionalized setting, in-home family caregivers provide minute-by-minute special assistance to a loved one with a disability or a critical illness or a chronic condition. Mr. Speaker, family caregivers are remarkable people. They make extraordinary sacrifices to help those whom they love so dearly. I saw one such example firsthand almost 10 years ago when my mom was diagnosed with multiple myeloma. For 6 years, my dad cared for her as she battled cancer.

She lived longer than any of her doctors thought she would, and since she went to heaven 3\1/2\ years ago, our family has looked back on those extra monuments we had with our mom, and we treasured them, knowing that it was my dad's love and care which helped to make them possible.

There are tens of millions of family caregivers in this country who provide the same loving and compassionate care that we saw my dad provide for my mom near the end of her life. In our family we were fortunate to have a support structure of relatives and friends who were able to provide a break for my dad when he really needed one. That respite was crucial for him. For him to stay healthy himself, it enabled him to provide better care for my mom.

But there are countless caregivers around this country who are not blessed with that built-in support structure, and they are desperately in need of a break from time to time. Because while the benefits of in- home care can be significant for the family, compared with institutionalized care, the cost for the family caregiver, from emotional to financial, can be enormous.

All across the country there are people like Karen Pinter of Hillsborough, New Jersey, providing in-home care. Karen provides round the clock care for her 10-year-old autistic daughter, Jessica. For Mrs. Pinter, respite means receiving $40 once a week from the New Jersey Family Support Center so that she can hire a tutor for her daughter.

With a tutor, Karen Pinter can take a much-needed break so she can do simple things for herself and for her family that many of us take for granted, like writing out that week's grocery list or preparing dinner or paying bills or simply taking a break for herself.

Respite for Eugenia and Roger Gore of Scotch Plains, New Jersey, helps their family to make ends meet. Their family uses respite hours so their 13-year-old autistic son can attend an extended-day program at school so Mrs. Gore can work outside the home to help further support their family.

Now the Gore family uses their respite funds to enable Mrs. Gore to work outside the home. This helps alleviate a financial burden, but it does not allow their family the break that respite oftentimes would. Even as they applied to the State of New Jersey for support for some respite hours on a weekend so they could get that much-needed break for grocery shopping or to attend one of their other son's athletic games, unfortunately they were denied.

For caregivers providing intense and exhausting care 24 hours a day, 7 days a week, 365 days a year, the occasional short break can literally be a lifesaver. That is what respite care is. It is providing a break for caregivers.

Mrs. Pinter has told me that caring for a special needs child can be very joyful. It can also be very challenging, and she is right. Family caregivers suffer poor health and even higher mortality rates than non- family caregivers, according to some recent studies. For example, mortality rates among older caregivers are 63 percent higher than among older non-caregivers. Two-thirds of family caregivers report physical or mental health problems that are linked to their care giving.

Nationally, there is no coordinated approach that exists among different levels of government or advocacy groups to help those who need respite care to find it and to qualify for it and to pay for it.

The problem is that respite care is in short supply or it doesn't exist at all in some areas. This legislation that we are considering today would change that. The Lifespan Respite Care Act would improve coordination and access for respite care and recruit and train respite care providers. With $289 million over the next 5 years, the bill would also aid family caregivers in finding and paying for respite services through competitive grants to States to make quality respite care available and accessible, regardless of age or disability or family situation.

National and grassroots advocacy groups, including the AARP, Alzheimer's Association, Epilepsy Foundation, National Multiple Sclerosis Society, Paralyzed Veterans of America, The Arc of the United States, and United Cerebral Palsy, they all support this legislation.

Why does this legislative effort have such strong support from such reputable organizations and many others? Because we know respite care works. Respite care improves the health and well-being of caregivers and reduces the risk of abuse or neglect. Importantly, it also delays or even avoids more costly hospitalizations or placements in nursing homes or foster care.

Mr. Speaker, for over 2 years I have been working tirelessly with many of our colleagues on the Energy and Commerce Committee on both sides of the aisle to bring this bill to the floor. I want to thank Chairman Barton for his support and the ranking member of our committee, Mr. Dingell. I want to offer a special word of thanks to Chairman Nathan Deal for his support of this bill. I know his heart is very close to this effort. I want to thank the ranking member, Mr. Pallone, as well for his strong support of this legislation.

I also want to thank the over 180 national and State and local organizations who, under the direction of the National Respite Coalition and its chair, Jill Kagan, who is here in our Chamber today with us, we have worked tirelessly on behalf of the Nation's family caregivers on this issue. I want to thank Tom Fussaro from our staff in our office, and Eric Joyce from the Family Resource Network and the Epilepsy Foundation of New Jersey. And I particularly want to thank Mr. Langevin, the gentleman from Rhode

Island, who has been such a strong supporter and my partner in this legislation all along the way.

Finally, I want to thank my dad, who has provided our family and many others with a remarkable example of the loving care that a family caregiver can provide.

Providing relief to our Nation's family caregivers is long overdue, and I urge my colleagues to support this legislation. Today's action by this House will represent not only an important victory for family caregivers nationwide but also sends America's caregivers a very clear message: Your selfless sacrifice is appreciated, and help is on the way.

Mr. Speaker, today I rise in support of H.R. 3248, the Lifespan Respite Care Act. For over 2 years I have been working diligently with many of my colleagues on the Energy and Commerce Committee to bring this bill to the floor. Over 180 national, State and local organizations under the direction of the National Respite Coalition have worked tirelessly on behalf of the Nation's family caregivers to help us get to this point. This legislation will for the first time establish respite as a policy priority for the Nation's estimated 50 million family caregivers, who daily provide care for their loved ones with disabling or chronic conditions or illnesses.

Most caregivers freely and willingly provide this care out of love and commitment, but often at great cost to themselves physically, emotionally, and financially. One in five caregivers report that they are in fair or poor health; 43 percent report having a chronic health condition that requires ongoing medical care, putting themselves at great risk and jeopardizing their ability to provide continued care to their dependent loved ones. An estimated 46 percent to 59 percent of family caregivers are clinically depressed. A recent medical study found that older caregivers who were providing care for an elderly individual with a disability and experiencing caregiver strain had mortality rates that were 63 percent higher than non-caregiving controls.

Caregivers are stretched thin in others ways as well, often with lost income and multiple family responsibilities. Nearly half of caregivers--48 percent--providing care to child, adult or elderly family members who have chronic or disabling conditions, have other children under age 18. Forty-two percent have family incomes below 200 percent of poverty compared to 34 percent of women without family caregiving responsibilities. While most caregivers are employed, many are forced to make extreme financial sacrifices in order to continue to provide care. In an Iowa survey of parents of children with disabilities, a significant relationship was demonstrated between the severity of a child's disability and their parents missing more work hours than other employees. They also found that the lack of available respite care interfered with parents accepting job opportunities. Over the course of a caregiving ``career,'' family caregivers providing intense personal care can lose as much as $659,000 in wages, pensions and Social Security.

The cost to U.S. businesses is even more staggering. A new study by Metropolitan Life Insurance Company and the National Alliance for Caregivers found that U.S. businesses lose from $17.1 billion to $33.6 billion per year in lost productivity of family caregivers. Offering respite to working family caregivers could help improve job performance and employers could potentially save billions.

Still, many barriers exist to accessing respite--including a reluctance to ask for help, fragmented and narrowly targeted services, cost, and the lack of information about how to find or choose a provider. Even when respite is an allowable funded service and resources are available to pay, a critically short supply of well- trained respite providers may prohibit a family from making use of a service they so desperately need.

Restrictive eligibility criteria also preclude many families from receiving services or continuing to receive services they once were eligible for. A New Jersey mother of a 12 year old with autism was denied additional respite because she was not a single mother, was not at poverty level, and was not exhibiting any emotional or physical conditions herself. As she told us, ``Do I have to endure a failed marriage or serious health consequences for myself or my family before I can qualify for respite? Respite is supposed to be a preventive service.''

Respite, the most frequently requested service among family caregivers, offers a temporary break from the rigors of continuous care and helps sustain their own health and well-being. Others are able to tend to an emergency situation or personal health crisis. For a caregiver providing intense and exhausting care 24 hours a day, 7 days a week, 365 days a year, an occasional short break can literally be a life saver.

Respite reduces stress, enhances caregiver health and well-being, and ensures the safety and health of the loved ones in our care. Studies have shown that respite care for family caregivers has resulted in fewer hospitalizations for the children and elderly family members in care. Respite has also been shown to help reduce the likelihood of abuse and neglect and foster care placements. Research conducted by the ARCH National Respite Resource Center has also shown that respite can help keep marriages intact and enhance family stability. Another study found that if respite care delays institutionalization of a person with Alzheimer's disease by as little as a month, $1.12 billion is saved annually.

The bill authorizes $289 million over 5 years for competitive grants to States through Aging and Disability Resource Centers working in collaboration with State respite coalitions or other State organizations. These organizations provide or have expertise in respite to make

respite available and accessible to family caregivers, regardless of age or disability, through coordinated lifespan respite systems. This legislation would help States maximize the use of existing resources and leverage new dollars by building on current services and systems that States already have in place. The bill would help support planned and emergency respite, respite workers and volunteer training and recruitment, caregiver training, and program evaluation.

The congressional intent of the legislation is to ensure that respite becomes more accessible to all family caregivers in need, especially to those who currently do not qualify for any respite programs, who have no respite programs or providers in their areas, and those who do not know where to turn to find information on how to find and pay for respite. By using the broad term child or adult with special needs, Congress intended for the State to be highly inclusive and ensure that family caregivers of children and adults with developmental disabilities, cognitive, neurological, physical and mental health conditions and illnesses be equitably served. The focus for direct service delivery should be on those who currently may not qualify for respite under any State or Federal program or who have no service available, such as individuals under age 60 with multiple sclerosis, cancer, ALS, traumatic brain injury, and spinal cord injury, or children, adolescents or adults with behavioral, emotional or mental health conditions.

Just as importantly, Congress intended that States focus immediately on establishing coordinated lifespan respite systems that will serve all age groups equally. The Secretary should ensure that State agencies and ADRCs use the funds provided by this act to serve all age groups and disability categories equally and without preference. The Aging and Disability Resource Centers were established by the administration with the intention of being one-stop shops for all individuals with long- term care needs, making them logically a good place to administer lifespan respite systems, which are meant to be one-stop shops for respite services. However, many centers are still focusing on the elderly population or adults with physical disabilities and phasing in others at a later date. For the lifespan respite care effort to work most efficiently to coordinate all respite resources in the State, share and pool providers across age and disability groups, and to maximize use of current State respite resources, the ADRCs, in implementing this particular program, must start out with the goal of establishing coordinated respite systems of community-based agencies that will serve all age groups, including children.

Congress also intended lifespan respite to be coordinated at the State level. Many of the ADRCs in the States are serving only one county or region in the State. However, this legislation mandates the establishment of state lifespan respite programs, meaning that at least one ADRC in the State must function statewide, at least for the purposes of this legislation, with the assistance of a State respite coalition or other State respite agency to ensure coordination of resources at the State level, again for maximum efficiency and cost savings.

Legislative language is also clear in mandating a Federal coordinated approach. It directs the Secretary of Health and Human Services in implanting the program to have all agencies in HHS with respite programs or resources work collaboratively at every level, from developing program guidance and awarding grants and cooperative agreements, to monitoring and evaluation. Congress intends the following agencies to work together: the Administration on Aging, the Administration on Developmental Disabilities, the Substance Abuse and Mental Health Services Administration, the Administration on Children and Families, including the Office on Child Abuse and Neglect, Centers for Disease Control's Family Caregiving Initiative, the Maternal and Child Health Bureau, and other appropriate public health agencies in the Health Resources and Services Administration.

When considering a Federal agency to take the lead in implementation of this program, the Secretary of HHS should select an agency that is not limited in scope or mission by any age or disability category, has experience in serving all populations across disability and age groups, and will ensure that the ADRC is collaborating fully and sharing joint responsibility with a private or public nonprofit State respite coalition or organization in implementing a state lifespan respite program.

Mr. Speaker, I urge my colleagues to support this legislation. With 80 percent of long-term care provided by family caregivers, too many are shouldering the responsibility alone. At a minimum, they need respite to continue serving their loved ones at home where they belong.

Mr. President, I am proud that we are finally sending the Lifespan Respite Care Act to the President for his signature. After 4 years of bipartisan efforts, we are delivering a great victory for millions of American families providing care to a parent, child, or loved one.

Thank you to Senator Snowe who was the first lead Republican on the legislation and has been a champion for this bill and family caregivers.

Thank you to Senator Warner for his efforts on the bill. Your leadership will make a difference in the lives of so many American families.

I want to express my appreciation to Representatives Mike Ferguson as the primary sponsor of the House bill as well as Congressman Langevin. We would not be on the verge of enacting this bill without their work.

Deep appreciation and thanks to the Lifespan Respite Task Force, a coalition of 180 national, state, and local organizations under the direction of the National Respite Coalition. A special thank you to Jill Kagan of the National Respite Coalition for her leadership and invaluable assistance.

Today's passage represents a tremendous win: for ailing seniors, children, and loved ones being cared for at home; for family members providing a time-consuming, emotionally exhausting, and physically demanding labor of love; for our health care system; for our values; and for decisions based on evidence, not ideology.

Each year, 44 million Americans care for an adult family member who has a chronic illness or disability. Almost 4 million Americans with developmental disabilities, of all ages, live at home with their families.

These are our friends, neighbors, coworkers, loved ones; their work represents real struggle and hardship; extraordinary acts of love and generosity that we have a duty to honor and support.

This legislation will expand and enhance access to respite care services to provide support and relief to these families providing care; to help ailing loved ones stay in their homes longer; and to control health care costs as respite care allows families to postpone or prevent expensive hospitalization and nursing care.

Today, the fastest growing illnesses in our country are chronic illnesses. And our health care system--already burdened by rising costs, aging infrastructure, a growing population of elderly, and upside-down incentives--is struggling to adapt systems designed to provide acute and immediate care.

Families have stepped into this breach. Family caregivers provide 80 percent of all long-term care in the U.S.--work that is virtually always unpaid but valued at more than $300 billion annually. That is more than the entire amount we spent on Medicare in 2004.

Today, we are sending a message to family caregivers: through extraordinary sacrifice, in a system plagued by problems, you are part of the solution--and today, finally, Congress is part of the solution, too.

Because of their responsibilities at home, studies have shown us that it is much more difficult for caregivers to find and maintain jobs. Many caregiving families are struggling to stay afloat. The cost to businesses is estimated in the tens of billions of dollars, including the cost for employees who leave jobs due to overwhelming responsibilities at home.

This labor of love often results in substantial physical and psychological hardship. Research suggests that caregivers often put their own health and well-being at risk while assisting loved ones. Many caregivers are exhausted and are more prone to illness themselves. One study found that caregivers

are 51 percent more likely to experience sleeplessness and 61 percent more likely to experience depression.

Caregiving stress can even lead to marital discord and divorce.

Often, this incredible struggle--with little support despite the heroic efforts of the organizations advocating for and providing respite care--leads to more costly out-of-home placements as a family's only alternative.

Across our country quality respite care remains hard to find. Where community respite care services do exist, there are often long waiting lists. And until the Lifespan Respite Care Act, no Federal plan has focused on respite care to coordinate among disparate and fragmented services.

Now, after years of work on both sides of the aisle and between the Senate and House, we are finally going to begin meeting the growing needs of family caregivers.

Respite care provides some much needed relief--for a few hours or a few days--from the daily demands of caregiving, which are vast. And we know respite care works.

In one study, 88 percent of caregivers said that respite care allowed loved ones to remain at home.

Nearly 100 percent believed respite care made them better caregivers and helped them manage the stress of this incredible responsibility and 80 percent even said respite care helped their marriages.

This act is about real family values and it is exactly what we should be doing in this chamber--no partisanship; understanding hardships and taking steps to help; common sense solutions that put families in charge, that provide the tools to improve their own lives and honor their loved ones, that serve our health care system and our values.

Families have stepped into the breach--and now with the Lifespan Respite Care Act, Congress is sending these families a lifeline.

This legislation will expand access to respite care; improve local coordination of services; and help families find out about what is available and how to get the care they need.

This legislation will make respite services equally available to all age groups and prioritize those with special needs who do not qualify for any other respite services or who cannot find appropriate quality respite care in their communities.

It is critical that HHS ensures that the funds provided by this act are used by State agencies and ADRCs--which to date have primarily served the aging population--to serve all age groups and disability categories equally and without preference and without waiting periods or a phase in of age specific groups.

This legislation will also facilitate a coordinated approach at the Federal level. To ensure this critical component and maximize our investment, the grantees selected to implement Lifespan programs must be able to demonstrate unequivocally that they are working collaboratively at every level--with agencies in HHS that have respite resources, including the Administration on Aging, the Maternal and Child Health Bureau, other public health programs in the Health Resources and Services Administration, the Substance Abuse and Mental Health Administration, the Centers for Medicaid and Medicare, the Administration on Developmental Disabilities, and the Administration on Children and Families.

But improving the services at the local, State, and Federal levels is not enough. All family caregivers, regardless of the age, disability, or chronic condition of their loved ones, should be able to access information on how and where to find a respite provider that meets their needs and on how to pay for services. The lifespan respite program grantees will identify all the current respite funding streams in the State and assist a family in determining, their eligibility for any existing private, State or federally funded respite program. If that family does not qualify for any existing services, the lifespan respite program may use its funds to help families pay for respite. No family should struggle to obtain information on how or where to find or pay for respite care.

I thank chairman Senator Enzi for his leadership on the HELP Committee. It has been a privilege serving under him over these last several years, and I am very grateful to him for pushing forward a very positive agenda for the people of our country.

I am very proud that we are finally able to reach agreement on the Lifespan Respite Care Act and send it to the President for his signature. This has been a bipartisan effort from the very beginning. I am grateful to Senator Warner who has made a real difference in his leadership on behalf of this bill. I am grateful to Senator Snowe who was the first lead Republican on this legislation and has been a champion. I want to express my appreciation to Representative Mike Ferguson as the primary sponsor of the House bill, as well as Congressman Jim Langevin. We would not be here on the verge of enacting this bill without their work.

Deep appreciation and thanks is due to the Lifespan Respite Task Force, a coalition of 180 national, State, and local organizations under the leadership and direction of the National Respite Coalition. A special thanks to Jill Kagan of the National Respite Coalition for her leadership and invaluable assistance.

As Senator Enzi said, this bill represents a tremendous acknowledgment of the families who are caring for their loved ones--for failing seniors, for children with disabilities, for a spouse who has been incapacitated by accident or chronic condition. Family members provide most of the support and the time-consuming physical labor and the emotionally exhausting input that really makes it possible to keep people at home.

You know, each year 44 million Americans care for an adult family member who has a chronic illness or disability. Almost 4 million Americans with developmental disabilities of all ages live at home with their families. Senator Coburn and I were talking earlier today--this is such a human issue that affects the lives and the fortunes and the feelings of so many of our fellow Americans.

What this legislation does is to expand and enhance access to respite care services. What are those for? Those are to give that wife who is caring for her ailing husband a few hours off a week. Those are for that father who devotes himself to his child with a disability, to have someplace to go to get a little bit of respite while his child is still well cared for.

Family caregivers provide 80 percent of all long-term care in the United States. But as Senator Coburn and I were discussing, you don't get real financial help unless you put your loved one in a nursing home. There is something wrong with that. That doesn't reflect our deepest values. The work that our loved ones do for all of us is unpaid but valued at more than $300 billion a year. That is more than the entire amount of money we spent on Medicare in 2004.

Today our Congress is sending a message to family caregivers: We recognize and we honor your commitment and in many instances your sacrifice. We know that because of this care many caregivers cannot keep their jobs.

It becomes too much of a burden. They struggle to stay afloat. They start selling off assets. This is a labor of love that often undermines the health of the very people who are providing it.

We found that many caregivers suffer physical symptoms, sleeplessness, depression. They feel like they are all alone.

This incredible struggle is one that we will see more and more of in our country because of our aging population. I am grateful that we are going to be passing this legislation and giving some assistance to these courageous men and women, these parents, these children, these grandparents, these spouses.

I hope, also, that in the new Congress we will address something else I talked to Senator Coburn about--that we can address this issue of caregiving, and particularly how to rearrange the incentives within our health care system, particularly through Medicaid, where 80 percent of the money is spent on 20 percent of the recipients; and that is mostly for long-term nursing care at the end of life. Many people would rather be home or rather be in a less-restrictive setting. If this is a statement of our concern, we need to follow that up.

This will provide what has been missing, improved coordination at the local level of services, helping families understand more about how to shoulder these burdens.

It is critical that Health and Human Services ensure that we serve all age groups, all disability categories, without preference, and that we begin to not just honor the love that we see and the sacrifices that are too often accompanying it but really provide some support.

I am deeply appreciative of all who have worked over the last year to make this legislation possible. I look forward to working with my colleagues on both sides of the aisle to continue to address these long-term needs and address how to help people stay at home, how to support their families who are doing the most important work there is.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Mr. President, I was asked to allow this bill to come up at this late hour in the Congress. This bill is going to pass. The goals of this bill are very worthy. As a practicing physician, and knowing the families whom I take care of and the family members they have, I know the burden that is placed on multitudes of people. When they do the better thing of keeping their loved ones in their own homes, in terms of quality of life, I have no argument with the intent and background of what is trying to be accomplished. But I want to make three points.

One is how this place operates. What we do at the end of the session is we try to run hundreds of bills through that very few people have thoroughly looked at, that drives all sorts of new spending, that does not get the privilege of the debate that the American people deserve on the priorities of how we spend their money. That needs to change. It is a terrible way to govern. It is inappropriate in the way we do it. It has more to do with the rules that we operate the Senate under than anything else. That ought to be changed. There is no question I am known for my desire to try to get our fiscal house in order. For example, this bill is great, but what the American people are never going to ask out of the almost $350 million that this bill authorizes, where is the money going to come from to pay for it? What priority is going to be decreased so that priority can be increased?

We have in the Social Security account a surplus this year. We have a $344 billion deficit. A lot of my friends would say that reflects the fact that we need to have pay-go and increase taxes. But during the last 2 years, I have held 49 hearings in the Federal Financial Subcommittee of the Committee on Governmental Affairs, where we have identified a pure $100 billion worth of waste, fraud or duplication in this Government, and no one wants to change that. It is easy for us to come out here and spend $300 million on a new program. But it is very hard for us to get together and do the hard work of eliminating the fraud, waste, and duplication.

There are two other programs that have money in them available for this, not the correct way, and not done as good as this bill does it. We haven't done anything in this bill to change those programs to redirect any of that money through. So now we are going to have three programs that have an impact in this area. Representative Ferguson has done a great job of bringing this up. But unless we change the culture of how we operate, we are going to enhance what we call the birth tax. When you are born today in this country, counting the unfunded liabilities for Medicare, Medicaid, and Social Security, you are born having liabilities of $435,000 on you the day you are born. We are adding a little bit to that. We are adding a little bit more and a little bit more.

Until we get together and say we are going to review this Government and get rid of the waste, fraud, and abuse, we are going to care as much about the person who is born today as we care about those who need some respite care, legitimate rest from the care of parents of those people they love, we will do a great disservice. We are doing a great disservice in this country.

Two weekends ago, I delivered a 9 pound 4 ounce baby to a woman whom I had delivered a baby to before. I had very well controlled her gestational diabetes. She had delivered a 9-pound baby before that. I thought about the 2\1/2\ minutes it took me, from the time I decided I couldn't deliver a baby in a normal way for her. It took me 2\1/2\ minutes from the time of that crunch when there was no way to get a baby out, with a heartbeat of 50 beats per minute--which is about 40 percent of what it should be--we have a baby in trouble; it took me about 2\1/2\ minutes to go around and get that baby out of that momma. We saved that baby's life.

Now, the corollary is, I had warning signals. I had indications that said things aren't going right. And this body, this Congress, this Government is not paying attention to the warning signals. The baby is going to die. Our country is going to drown in debt.

The processes by which we operate include not paying attention to the waste, fraud, and abuse and not making the hard choices on priorities, not offsetting, not deauthorizing something else that is not working where there are billions of things that are not working, and adding another problem. We are adding to that.

As a Senate, we are not ill-intentioned; we just are not paying attention to the warning signs. We are not paying attention to the fetal monitor of our country and the future for the next generations. It is just as laudable to care as much about the next two or three generations that come down the road as we care for those who need our help today, except this bill doesn't do that.

This bill is going to go by voice vote--and I have allowed it; I will not even vote against it--but I wanted this time to make this statement.

What will follow this bill today is a tragedy. We are going to spend another $17.5 billion on the tax-extender package that is getting ready to come through this place. We are going to pick up the bills mining companies owe and we are going to charge that to the rest of the people in this country. We are going to overspend on lots of things. We are not going to cut doctor's fees--and I am a doctor--but we are not going to pay for it. We are going to pay for it through gimmicks, and we are going to tell everybody that we are doing great things. In fact, we are being dishonest.

There are two cultural problems that have to change: We have to quit authorizing new programs unless we deauthorize other programs, and we have to reach across the aisle and say that we need to review everything we have, and whatever is duplicative, let's get rid of it and save these costs. If one does not work as well, put the money in the other and save the money.

Let's get rid of the fraud. We are paying out $38 billion a year to things we should not be paying for right now, and that is an underestimate because we have only looked at 60 percent of the Government in terms of improper payments. We still have a law that is not being followed by 40 percent of the agencies. They are not reporting their improper payments. We had a Pentagon that paid $6 billion in the last 5 years for contractors for performance bonuses, and they did not come close to reaching the performance basis for the bonus. That is our fault. That is us. We are charged with the responsibility of doing what is necessary.

The final point I wish to make is that if we keep nibbling around the edges on health care, we are going to find ourself in the biggest jam in the world. We have two choices: We are going to either have government-run health care or we are going to control the costs by basically allocating it at end of life and telling people what they cannot have. That is how most other countries do it. Or we will fix health care. We spend 16.3 percent of our GDP on health care, and $2.2 trillion is what we will have spent at the end of this year. That is 16 percent of our GDP. The closest country in the world spends 11 percent of GDP on their health care, and they don't have a government-run health care program.

Fully $1 out of every $3 we spend on health care today does not go to help somebody get well or keep them healthy. Our prevention programs, which is the key to our success in solving our health care problems, are abysmal. They are wasteful. They are not effective. We talk about diabetes, we talk about obesity, but we are inept in any type of consensus as to where we can make a difference in prevention. We have to address that issue, and I believe this is a fix around the edge. We need a comprehensive fix and a look at health care in America. We need to do it knowing the motivation.

Most people are surprised to learn that out of that $2.2 billion we spend on health care every year, $152 million is spent on things that nobody needs except providers to protect themselves from lawsuits. Now, we need a good trial bar. We need to be held accountable. But it has gotten so far out of hand that we are adding to the birth tax.

I beg my colleagues and the American people who are listening to this, let's get our act together. Let's start not just authorizing, let's deauthorize before we authorize. Let's fix health care. Let's do oversight in a way that saves money for the future. If we have eliminated the waste, we have eliminated the fraud, we have eliminated the duplication in this Government, we have to go to the American people and say: Shouldn't we pay a little more taxes now rather than ask for this birth tax?

Remember, the birth tax is over $400,000 per baby right now. Every baby I deliver, the first thing I see is a beautiful young child, and then in the back of my mind I wonder, how are you ever going to get out of this mess we have left you?

I appreciate the concern and the intent of those supporting this bill. This bill has come to the Senate in the

wrong way. This bill should have had its authorization offset. This bill does address a very real need, but there are a lot of very real needs out there that we need to do that we cannot do and we cannot fund because we are not doing our job.

Our country is at a crossroad. The fetal monitoring alarm is on. The baby's heartbeat is low. It is time to do what is necessary. The debt burden cannot be swallowed, the unfunded liabilities cannot be handled. It is up to us to change that. Let's lower that birth tax. Let's get rid of that. Let's work together to do the things we can do to lessen that impact on the generations to come.

I reserve the remainder of my time.

I yield back the remainder of my time.

Mr. President, I thank Senator Enzi for the opportunity to speak today on this critical piece of legislation, as well as to commend the Senator from New York, Senator Clinton, for her advocacy and leadership on this most critical issue which is paramount to millions of families across this country, and to Senator Warner, who has also been a leading advocate and champion of this legislation. I certainly want to commend them both for making sure this legislation is coming to the forefront of the Congress in the final days and which, ultimately, will lead to its passage.

I, also, want to express my commendations to the sponsor in the House of Representatives, Congressman Mike Ferguson, because this is clearly a very critical issue. He understands firsthand, personally, from his own family circumstances, how important care giving and respite services are for caregivers and how it is so essential and vital to our Nation's families.

I know how important this is. In fact, I introduced the first legislation recognizing National Family Caregivers Week back in 1986. It is more than 20 years that I have been involved in such endeavors. There is no question--and it has been irrefutable across this country-- about the necessity of providing more support to those who provide support to families, to ailing family members. The fact is the need is more than $300 billion a year. We, also, know that it takes a tremendous toll on families to provide that care day in and day out.

That is why I think we do have a Federal responsibility and obligation to ensure that we can coalesce those resources that can make it easier and to mitigate the impact on those family members who are providing around-the-clock care.

When I first became involved in this issue in the House more than 20 years ago, I took it upon myself to visit homes throughout my congressional district in the State of Maine. What I saw was incredible. I saw 80-year-olds taking care of 80-year-olds, doing the most incredible things, medically and otherwise, to provide round-the- clock care to their ailing family members. It was clear to me then that we needed to do more to provide the respite support for family members so they can have the ability to have support outside the family which is critical for them, so they can continue to keep their ailing family member at home but at the same time having the kind of care which is so essential to help them get better.

That is what this is all about. It is helping those who need our help. Certainly, to have the support of the type of facilities and services that exist in a particular community which can address their needs and who they can turn to for advice is absolutely instrumental. It, also, leads to a higher quality of life for many because they can be at home, where they can be provided home care. They can be at home and get the kind of support that otherwise would be necessary if they had been institutionalized or hospitalized.

In addition, such care can also result in substantial cost savings to the family, to the Government, and to the community, in fact.

I think it is in our national interest to provide these benefits. I think, frankly, the support of such care has been all too limited. This is long overdue. That is why I commend Senator Clinton and Senator Warner and some others who have given their support to this type of initiative.

We, clearly, have a Federal obligation and responsibility to focus on the kind of respite care that is so essential for allowing people to take care of their ailing family members in a home setting. It certainly eases and mitigates the impact on the Federal costs, whether it is on Medicaid or Medicare. It can save families thousands of dollars a year.

This is something that is in our national interest. I think it is also crucial that we ease the burden of this responsibility which is placed on caregivers as well. It is critical that they have access to better information on services and be able to provide it. They are heroes in every sense of the word.

We think about life expectancy today and how many years caregiving will be provided by the American family. It can be 17 years, at the minimum, for an elderly parent. I think it gives a dimension to the issue and the problems that are at stake if we fail to provide the kind of support which is necessary.

That is why I have introduced legislation, the Refundable Dependent Care Tax Credit. For example, I think we should provide the type of incentives and support to families that enables them to take care of their loved ones at home.

When I first visited homes where people were providing this kind of care, I was absolutely astonished at the level of care these individuals were providing their family members. It occurred to me then, and it is one that has remained with me ever since, that we have to do everything conceivably possible to amass the resources and the support for these family caregivers.

When you think of the dimensions of the problem, when you think about the demographics in America and the life expectancy, it is all the more crucial that the Federal Government play a role. That is exactly what this legislation is all about. It will provide the kind of resources that are going to be important, it will provide grant support, it will increase the availability of appropriately trained respite care providers and volunteers--again, another aspect to the entire spectrum of resources I think we need to provide these families who are providing the caregiving support.

Frankly, we need to have more respite care providers. It eases the burden on these family members so they can do other things in the day, what is required in daily living, that they have the ability to know they can fall back on the type of support which will provide the continuity of care and the level of care their family members certainly deserve. I think this legislation goes a long way in providing that kind of support and eases the burden on those family members who are so devoted to their loved ones.

I think, frankly, we will have to do more. That is why, as we are looking at a tax incentive in the overall tax package, we have to give some review to the notion of having a tax credit that is refundable for providing this kind of dependent care. I think it is going to be a wave of the future, frankly, given the dimensions of this problem which is certainly lurking on the horizon.

I want to, again, commend Senator Clinton for her leadership in making this possible and to Senator Warner and, of course, Congressman Ferguson, in the House, and all those who supported it--and Chairman Enzi, as well, for his leadership in making sure that the passage of this legislation will become a reality when you consider I think the enormity and the magnitude of the care and support that it will give to families who most deserve it.

I yield the floor.

Mr. President, I rise in strong support of S. 1245, the Gynecologic Cancer Education and Awareness Act, better known as Johanna's Law. This bill needs to be signed into law as quickly as possible.

Johanna's Law creates a national public awareness campaign to increase the knowledge of both women and their health care providers concerning gynecologic cancers. This national campaign will include written materials for the public on gynecologic cancers and public service announcements to encourage women to discuss with their physicians their risks of

gynecologic cancers. In addition, women will be directed on where to get additional information on the early warning signs and risk factors associated with gynecologic cancers.

The legislation also requires the Secretary of Health and Human Services, HHS, to submit a report to Congress on the past and present activities of the agency to increase awareness on all cancers, including gynecologic cancers. The report also would include information on what HHS is doing to educate health care professionals on these cancers. Once this report is submitted to Congress, the Secretary of HHS is required to develop and submit a strategy for improving efforts to increase awareness and public knowledge on gynecologic cancers. When developing this strategy, the Secretary is encouraged to consult with qualified public sector groups, including non-profit organizations.

Finally, this legislation authorizes $16.5 million to be appropriated for this program from fiscal year 2007 through fiscal year 2009.

I am extremely supportive of this legislation, and have worked to see its enactment this week.

Why is this bill important?

The stories of two very special women will answer that question. They have, I believe, made a huge difference in passing this legislation.

The first person is Grace Warren, who handled health care issues with great skill for Congressman Ralph Hall of Texas for many years. Ms. Warren is one of those Hill staffers who is well known for her institutional knowledge and her professionalism. She is widely respected and loved on both sides of the aisle.

Unfortunately, Grace's career on Capitol Hill was cut short in November 2003, when she was diagnosed with ovarian cancer. She retired from the House of Representatives last year, and passing this legislation became her passion.

Ms. Warren made a compelling case to both my office and the Senate HELP Committee on why this legislation needs to be signed into law this year. While Ms. Warren believes that this bill won't do anything for those women who have already been diagnosed with gynecologic cancers, she recognizes that it will make a huge difference for other women because it will help educate them on the early warning signs of gynecological cancers, such as abdominal swelling, gastrointestinal disturbances, lower back pain and abnormal bleeding.

The second person whom I would like to acknowledge is Ms. Fran Drescher who also must deserve great credit for getting this legislation through the Congress. Her commitment to having this bill signed into law has been very impressive to me.

Ms. Drescher has tirelessly visited with Members of Congress this entire week and will be staying in town until this legislation is passed by both Houses of Congress.

While I have known Fran for many years, it was gratifying to be reminded of her tremendous enthusiasm and her commitment to women's health. Ms. Drescher is extremely articulate when she is advocating for Johanna's law. And that is because as a cancer survivor herself, she is strongly committed to educating women about awareness and early detection of gynecologic cancers.

It was painful for me to hear her story. Over a period of 2 years, Ms. Drescher tried to get a diagnosis for her symptoms. She saw eight doctors before being told that she had uterine cancer.

This should never happen.

Ms. Drescher recognizes that women must know the early warning signs of all gynecologic cancers and which tests are available because women cannot assume that these tests will be offered to them.

In addition, she is the author of the book Cancer Schmancer which discusses how she beat uterine cancer. Her dedication and commitment have made a tremendous difference and we all greatly appreciate her efforts.

Both Ms. Warren and Ms. Drescher are truly amazing women who have shown a selfless dedication to making a difference in the lives of others.

It is for Grace Warren, and Fran Drescher, and the many, many other women who will be challenged by gynecological cancers that we must pass this legislation.

I strongly support this bill because I want women and their health care providers all to be educated about the early warning signs of these cancers.

I want a screening test to be developed so that it will be easier to diagnose gynecological cancers in the early stages of the disease.

I am tired of women having limited health care options because of late stage diagnosis. This must change.

But, I am hopeful that we can start to make a difference in the lives of all women the minute that this bill is signed into law. I urge my colleagues to support Johanna's Law.