Federal Contractor Extraterritorial Jurisdiction for Human Trafficking Offenses Act of 2005

Mr. President, I am pleased to join with my colleague from Louisiana, Senator Landrieu, in introducing the Access to Affordable Health Care Act, a comprehensive, seven-point plan that builds on the strengths of our current public programs and private health care system to make quality, affordable health care available to millions more Americans.

One of my top priorities in the Senate has been to expand access to affordable health care for all Americans. There are still far too many Americans without health insurance or with woefully inadequate coverage. As many as 45 million Americans--almost 16 percent of our population--are uninsured, and millions more are underinsured.

Health care coverage matters. The simple fact is that people with health insurance are healthier than those who are uninsured. People without health insurance are less likely to seek care when they need it, and to forgo services such as periodic check ups and preventive services. As a consequence, they are more likely to be hospitalized or require costly medical attention for conditions that could have been prevented or treated at a curable stage. Not only does this put the health of these individuals at greater risk, but it also puts additional pressure on our hospitals and emergency rooms, many of them already financially challenged.

Compared with people who have health coverage, uninsured adults are four times, and uninsured children five times, more likely to use the emergency rooms. The costs of care for these individuals are often absorbed by providers and passed on to the covered population through increased fees and insurance premiums.

Maine is in the midst of a growing health insurance crisis, with insurance premiums rising at alarming rates. Whether I am talking to a self-employed fisherman, a displaced worker, the owner of a struggling small business, or the human resource manager of a large company, the soaring costs of health insurance is a common concern.

Maine's employers are currently facing premium increases of as much as 20 percent a year. These premiums have been particularly burdensome for small businesses, the backbone of the Maine economy. Many small business owners are caught in a cost-squeeze: they know that if they pass on the premium increases to their employees, more of them will decline coverage. Yet these small businesses simply cannot afford to absorb double-digit increases in their health insurance premiums year after year.

The problem of rising costs is even more acute for individuals and families who must purchase health insurance on their own. Monthly health insurance premiums in Maine often exceed a family's mortgage payment. It is no wonder that as many as 150,000 Mainers are uninsured. Clearly, we must do more to make our health care system more efficient and health insurance more available and affordable.

The Access to Affordable Health Care Act, which we are introducing today, is a seven-point plan that combines a variety of public and private approaches to make quality health care coverage more affordable and available. The legislation's seven goals are:

No. 1. To expand access to affordable health care for small businesses;

No. 2. To make health insurance more affordable for individuals and families purchasing coverage on their own;

No. 3. To strengthen the health care safety net for those without coverage;

No. 4. To expand access to care in rural and under-served areas;

No. 5. To increase access to affordable long-term care;

No. 6. To promote healthier lifestyles;

And No. 7, to provide more equitable Medicare payments to Maine providers to reduce the Medicare shortfall, which has forced hospitals, physicians and other providers to shift costs onto other payers in the form of higher charges, which, in turn drives up health care premiums.

Let me discuss each of these seven points in more detail.

First, our legislation will help small employers cope with rising health care costs.

Since most Americans get their health insurance through the workplace, it is a common assumption that people without health insurance are unemployed. The fact is, however, that most uninsured Americans are members of families with at least one full-time worker. As many as 82 percent of Americans who do not have health insurance are in a family with a worker.

Uninsured working Americans are most often employees of small businesses. In fact, some 60 percent of uninsured workers are employed by small firms. Smaller firms generally face higher costs for health insurance than larger firms, which makes them less likely to offer coverage. Small businesses want to provide health insurance for their employees, but the cost of often just too high.

The legislation we are introducing today will help small employers cope with rising costs by providing new tax credits for small businesses to help make health insurance more affordable. It will encourage those small businesses that do not currently offer health insurance to do so and will help employers that do offer insurance to continue coverage for their employees even in the face of rising costs.

Our legislation will also help increase the clout of small businesses in

negotiating with insurers. Premiums are generally higher for small businesses because they do not have as much purchasing power as large companies, which limits their ability to bargain for lower rates. They also have higher administrative costs because they have fewer employees among whom to spread the fixed cost of a health benefits plan. Moreover, they are not as able to spread the risks of medical claims over as many employees as large firms.

Our legislation will help address these problems by authorizing Federal grants to provide start-up funding to States to assist them with the planning, development and operation of small employer purchasing cooperatives. These cooperatives will help to reduce health care costs for small employers by allowing them to band together to purchase health insurance jointly. Group purchasing cooperatives have a number of advantages for small employers. For example, the increased number of participants in the group help to lower the premium costs for all. Moreover, they decrease the risk of adverse selection and spread the cost of health care over a broader group.

The legislation would also authorize a Small Business Administration grant program for States, local governments and non-profit organizations to provide information about the benefits of health insurance to small employers, including tax benefits, increased productivity of employees, and decreased turnover. These grants would also be used to make employers aware of their current rights under State and Federal laws. While costs are clearly a problem, many small employers are not fully aware of laws that have already been enacted by both States and Federal Government to make health insurance more affordable. For example, in one survey, 57 percent of small employers did not know that they could deduct 100 percent of their health insurance premiums as a business expense.

The legislation would also create a new program to encourage innovation by awarding demonstration grants in up to 10 States conducting innovative coverage expansions, such as alternative group purchasing or pooling arrangements, individual or small group market reforms, or subsidies to employers or individuals purchasing coverage. The States have long been laboratories for reform, and they should be encouraged in the development of innovative programs that can serve as models for the Nation.

The Access to Affordable Health Care Act will also expand access to affordable health care for individuals and families.

One of the first bills I cosponsored as a Senator was legislation to establish the State Children's Health Insurance Program, S-CHIP, which provides insurance for the children of low-income parents who cannot afford health insurance, yet make too much money to qualify for Medicaid. This important program has provided affordable health insurance coverage to an estimated six million children nationwide, including almost 13,000 who are currently enrolled in the MaineCare program. Even so, nationwide, millions of qualified children have yet to be enrolled in this program, many because their parents simply don't know that they are eligible for the assistance.

Our legislation builds on the success of this program and gives States a number of new tools to increase participation. The bill authorizes new grants for States and non-profit organizations to conduct innovative outreach and enrollment efforts to ensure that all eligible children are covered. States would also have the option of covering the parents of the children who are enrolled in programs like MaineCare. States could also use funds provided through this program to help eligible working families pay their share of an employer-based health insurance plan. In short, the legislation will help ensure that the entire family receives the health care they need.

And finally, to help make health coverage more affordable for low- and middle-income individuals and families who do not have employer- provided coverage and who are not eligible for the expanded public programs, our legislation would provide an advanceable, refundable tax credit of up to $1,000 for individuals earning up to $30,000 and up to $3,000 for families earning up to $60,000. This could provide coverage for up to 6 million Americans who would otherwise be uninsured for one or more months, and will help many more working lower-income families who currently purchase private health insurance with little or no government help.

The Access to Affordable Health Insurance Act will also help to strengthen our Nation's health care safety net by doubling funding over 5 years for the Consolidated Health Centers program, which includes community, migrant, public housing and homeless health centers. These centers, which operate in underserved urban and rural communities, provide critical primary care services to millions of Americans, regardless of their ability to pay. About 20 percent of the patients treated at Maine's community health centers have no insurance coverage and many more have inadequate coverage, so these centers are a critical part of our Nation's health care safety net.

The problem of access to affordable health care services is not limited to the uninsured, but is also shared by many Americans living in rural and underserved areas where there is a serious shortage of health care providers. The Access to Affordable Health Care Act therefore calls for increased funding for the National Health Service Corps, which supports doctors, dentists, and other clinicians who serve in rural and inner city areas.

The legislation will also give the program greater flexibility by allowing National Health Service Corps participants to fulfill their commitment on a part-time basis. Current law requires all National Health Service Corps participants to serve full-time. Many rural communities, however, simply do not have enough volume to support a full-time health care practitioner. Moreover, some sites may not need a particular type of provider--for example, a dentist--on a full-time basis. Some practitioners may also find part-time service more attractive, which, in turn, could improve recruitment and retention. Our bill therefore gives the program additional flexibility to meet community needs.

Long-term care is the major catastrophic health care expense faced by older Americans today, and these costs will only increase with the aging of the baby boomers. Most Americans mistakenly believe that medicare or their private health insurance policies will cover the cost of long-term care should they develop a chronic illness or cognitive impairment like Alzheimer's Disease. Unfortunately, far too many do not discover that they do not have coverage until they are confronted with the difficult decision of placing a much-loved parent or spouse in long-term care and facing the shocking realization that they will have to cover the costs themselves.

The Access to Affordable Health Care Act will provide a tax credit for long-term care expenses of up to $3,000 to provide some help to those families struggling to provide long-term care to a loved one. It will also encourage more Americans to plan for their future long-term care needs by providing a tax deduction to help them purchase long-term care insurance.

Health insurance alone is not going to ensure good health. As noted author and physician Dr. Michael Crichton has observed, ``the future of medicine lies not in treating illness, but preventing it.'' Many of our most serious health problems are directly related to unhealthy behaviors--smoking, lack of regular exercise and poor diet. These three major risk factors alone have made Maine the state with the fourth highest death rate due to four largely preventable diseases: cardiovascular disease, cancer, chronic lung disease and diabetes. These four chronic diseases are responsible for 70 percent of the health care problems in Maine.

Our bill therefore contains a number of provisions designed to promote healthy lifestyles. An ever-expanding body of evidence shows that these kinds of investments in health promotion and prevention offer returns not only in reduced health care bills, but in longer life and increased productivity. The legislation will provide grants to States to assist small businesses wishing to establish ``worksite wellness'' programs for their employees. It would also authorize a grant program to support new and existing ``community partnerships,'' such as the Healthy Community Coalition in

Maine's Franklin County, to promote healthy lifestyles among hospitals, employers, schools and community organizations. And, it would provide funds for States to establish or expand comprehensive school health education, including, for example, physical education programs that promote lifelong physical activity, healthy food service selections, and programs that promote a healthy and safe school environment.

Finally, the Access to Affordable Health Care Act would promote greater equity in Medicare payments and help to ensure that the Medicare system rewards rather than punishes States like Maine that deliver high-quality, cost-effective Medicare services to our elderly and disabled citizens.

According to a study in the Journal of the American Medical Association, Maine ranks third in the Nation when it comes to the quality of care delivered to our Medicare beneficiaries. Yet we are 11th from the bottom when it comes to per-beneficiary Medicare spending.

The fact is that Maine's Medicare dollars are being used to subsidize higher reimbursements in other parts of the country. This simply is not fair. Medicare's reimbursement systems have historically tended to favor urban areas and failed to take the special needs of rural States into account. Ironically, Maine's low payment rates are also the result of its long history of providing high-quality, cost-effective care. In the early 1980s, Maine's lower than average costs were used to justify lower payment rates. Since then, Medicare's payment policies have only served to perpetuate the gap.

The Medicare Modernization Act of 2003 did take some significant steps toward promoting greater fairness by increasing Medicare payments to rural hospitals and by modifying geographic adjustment factors that discriminated against physicians and other providers in rural areas. The legislation we are introducing today will build on those improvements by establishing State pilot programs that reward providers of high-quality, cost efficient Medicare services. It will also establish a program to expand graduate medical education programs in rural and underserved areas of the nation.

Mr. President, the Access to Affordable Health Care Act outlines a blueprint for reform based on principles upon which I believe a bipartisan majority in Congress could agree. The plan takes significant strides toward the goal of universal health care coverage by bringing millions more Americans into the insurance system, by strengthening the health care safety net, and by addressing inequities in the Medicare system.

Mr. President, I am very pleased to introduce the ``Health Information Technology Act of 2005'' with my friend and colleague from Maine, Senator Snowe. This legislation will reduce costs for our businesses, improve systems for our providers, and improve quality of care for patients.

We know we need to reduce health care costs in this country. In 2004, United States national health expenditures, known as NHEs, amounted to $1.8 trillion, or about $6,300 per person, accounting for 15.8% of our GDP. This is almost twice the average among European Union countries.

And costs are expected to continue to skyrocket. The Center for Medicare and Medicaid Services, CMS, estimates that by 2013, NHEs in the United States will reach $3.4 trillion and account for 18.8 percent of our GDP.

It is without question that the increasing cost of employer-based health insurance hurts the global competitiveness of U.S. companies. General Motors now spends more than $1,500 per vehicle on health care costs, while their non-U.S. based competitors spend as much as $1,000 less.

Our large companies certainly aren't alone in struggling to meet the health care needs of their employees--the average member of the Small Business Association of Michigan, SBAM spends nearly $8,000 per employee per year on health insurance premiums. SBAM explains very clearly one of the reasons for these high costs: ``the way in which health care information is communicated is expensive, inefficient, and many times simply does not happen.''

The members of the Health Information Technology Leadership Panel, convened pursuant to the National Coordinator for Health Information Technology's Framework for Strategic Action, recently agreed that ``increasing health care costs pose a great and growing challenge to their industries and the broader U.S. economy..''.

But it's not just the level of health care spending--at the same time that we are spending twice as much as many other countries, 45 million of our citizens lack health insurance, and a recent national study by RAND suggests that U.S. adults receive only 55 percent of recommended care.

The answer is not to cut payments or to ask patients to take less care, but to ensure the right information is where it needs to be at the time it needs to be there so that providers can give the best possible treatment and care. That will both reduce costs and improve quality of care.

However, most of our Nation's health care providers don't have access to information technology and services because it's hard enough just to keep up with their daily costs, much less to invest in something new.

And, there's another reason providers haven't been quick to adopt these systems. The nature of our health care system means that in large part the value of these technologies--through the lower costs they will achieve--accrue to the payers of health care, rather than to the providers.

The costs of necessary information not being available are great. Too often, care is duplicated like an x-ray given twice, because an emergency room doctor didn't have the results of an earlier x-ray, or the best and most appropriate care isn't given. Our health care professionals can't possibly provide the best care if they don't have complete and accurate information about the patient sitting in front of them.

Multiple studies have found that as much as $300 billion is spent each year on health care that does not improve patient outcomes on treatment that is unnecessary, inappropriate, inefficient, or ineffective.

A March 2001 Institute of Medicine, IOM, study concluded that in order to improve quality, there must be a national commitment to building an information infrastructure. An October 2003 Government Accountability Office report found that the benefits of an electronic healthcare information system included improved quality of care, reduced costs associated with medication errors, more accurate and complete medical documentation, more accurate capture of codes and charges, and improved communication among providers enabling them to respond more quickly to patients' needs.

By providing the most appropriate care at the most appropriate time, we can reap huge savings. A January 2005 Report by the Center for Information Technology Leadership, CITL, found that moving to standardized health information exchange and interoperability would save nearly $80 billion annually in the United States.

The benefits of adoption and use of health care information technologies, systems and services will be widespread: employers will realize cost savings, clinicians will gain new electronic support tools and patient information to help guide medical decisions, and patients will benefit from a more efficient health care system and from a safer health care system with fewer unnecessary treatments and more attention to preventive care. And, taxpayers and our federal programs will benefit. Researchers have suggested that up to 30 percent of annual Medicare health care spending could be saved by eliminating unnecessary and duplicative procedures, and improving quality by eliminating errors.

The benefits of health information technologies and services become most compelling on an individual level. I met an extraordinary woman just a month ago. Renae Wallace, a small business owner in Kingsley, MI told me about her son Randall. Randall is just about to turn 8, but because he was born with complex heart and lung defects, he has seen the inside of a surgery room more times than most people see in a lifetime.

Renae takes her son to providers in Traverse City, Grand Rapids, and Ann Arbor. But because there is no way for these providers to talk to each other, she has to carry around a file two inches thick of medical records--X-rays, MRI scans, surgical notes--on Randall. Otherwise, the health care professionals who are taking care of Randall wouldn't have the benefit of the results of the treatment that Randall has gotten previously. Because they wouldn't have all the information they need, Randall might not get the most appropriate care. Renae has made sure that all of the providers taking care of her son have as much of the information as possible--but it would make a lot more sense if the doctors and hospitals and nurses were able to

have that information without Renae having to carry it around.

We need to ensure that our health care professionals have all of the relevant clinical information available to them in whatever setting a patient needs care, at the time the patient needs the care so that they can provide the best and most appropriate treatment possible. We know that adoption of health information technology can play a critical role in improving patient outcomes and at the same time greatly reduce costs. But it can't happen without the federal government playing a role.

The members of the Health Information Technology Leadership Panel concurred that without Federal leadership, neither their individual companies nor the industrial sector as a whole can achieve the breadth of HIT adoption that would be required to realize the needed transformation of health care.

The bill that Senator Snowe and I are introducing recognizes that both Federal leadership and Federal investment are necessary and appropriate. The focus of the investment provided by the ``Health Information Technology Act of 2005'' is on improving health care for patients with heart disease, cancer, stroke, diabetes, chronic obstructive pulmonary disease, asthma, and other diseases and conditions by driving transformation of systems in physician offices and other health care settings. Our bill includes a number of funding incentive approaches intended to improve health care through adoption of information technology.

First, we create a 5-year, $4 billion competitive grant program for hospitals, physicians, skilled nursing facilities, community health centers and community mental health centers to offset investments in new technologies and information services. Importantly, the grant program is funded by a mandatory appropriation from the Medicare trust funds. This is critical to ensuring that funds will actually be available for the grant program. It also makes sense as the trust funds will see savings through lower outlays due to less duplicative and unnecessary care.

The grant program would authorize funding for the: purchase, lease, and installment of computer software and hardware and related services; upgrade of existing computer technology; purchase communications capabilities necessary for clinical data access, storage, and exchange; services associated with acquiring, implementing, operating, or optimizing the use of new or existing computer software and hardware and clinical health care informatics systems; provision of education and training for staff on information systems and technology designed to improve patient safety; and purchase, lease, subscription, integration service of clinical decision support tools that provide ongoing continuous quality improvement functions.

Second, we allow accelerated depreciation of qualified health care information system expenditures in 2005-2010.

Third, we adjust Medicare payments to providers who use HIT that improves the quality and accuracy of clinical decision-making. We begin by addressing payments for treatment of Medicare beneficiaries with heart disease, cancer, stroke, diabetes, and chronic obstructive pulmonary disease because we know these conditions consume a large portion of our Medicare resources.

We know that the Medicare program will reap the benefit of providers using health information networks. The Office of the National Coordinator for Health Information Technology said on March 2 of this year that the annual savings attributable to widespread electronic health record adoption are likely to lie between 7.5 percent-30 percent of annual health care spending.

It only makes sense to establish new payment codes to account for the costs of purchasing and using health information technology and services with patient-specific applications.

Our legislation also will make it much easier for physicians and other health care professionals to treat patients by reducing the communication barriers that currently exist. The ``Health Information Technology Act'' provides that the Secretary shall adopt data standards for interoperability between providers and links funding to the adoption of those standards.

We know that electronic health care information systems can reap huge benefits. The GAO found these systems improve quality of care, reduce costs and improve communication among providers.

But we also know that we can't expect our health care providers to make this investment alone as they struggle to meet their daily needs. Our country must have a national commitment to building an information infrastructure, and the Federal Government needs to step up to the plate and provide much-needed funds to get the ball rolling.

We could only have dreamed about clinical computerized information systems when the Medicare and Medicaid programs began. Today, we have them at our disposal. The sooner we get them into our hospitals, physician offices, nursing homes, community health centers and community mental health centers, the sooner our patients, providers, and pocketbooks will see the rewards.

I am very pleased to announce the support of the following organizations: American College of Physicians, Federation of American Hospitals, National Council for Community Behavioral Healthcare, the National Association of Children's Hospitals, American Heart Association, National Rural Health Association, National Business Coalition on Health, American Academy of Family Physicians, National Association of Community Health Centers, American Health Care Association, IBM, Health Vision, Healthcare Information and Management Systems Society, eHealth Initiative, AdvaMed, American Health Information Management Association, Verizon, Altarum, Michigan Health and Hospital Association, Automation Alley, Small Business Association of Michigan, Detroit Chamber, Michigan State Medical Society, Detroit Medical Center, Marquette General Health System, Oakwood Healthcare System, Henry Ford Health System, MPRO, Michigan's Medicare Quality Improvement Organization; Microsoft Corporation, Axolotl Corp, Delmarva Foundation, Dell Inc, DiagnosisOne, Greenway Medical Technologies, HealthInsight, Healthgate, Inland Northwest Health Services, Kyrptiq, Lumetra, Medical Review of North Carolina, Misys Healthcare Systems, National Alliance for Primary Care Informatics, Partners Healthcare System, Siemens Corporation, Philips Medical Systems, WebMD Corporation, and the Virgin Islands Medical Institute.

I am also very pleased to have the support of the AFL-CIO, Trinity Health, NextGen, The Society of Thoracic Surgeons, American Association of Homes and Services for the Aging, St. John Health, Michigan Primary Care Association, the American Health Quality Association, and Comtek and look forward to receiving their forthcoming letters.

I ask unanimous consent to have the text of the bill and additional material printed in the Record.

Mr. President, today I join my colleague, Senator Stabenow of Michigan, in introducing the ``Health Information Technology Act of 2005'', which will serve to improve the quality of health care through implementation of information technology; IT, in hospitals, health centers and physician practices throughout the country. At a time when the Institute of Medicine (IOM) has reported that up to 98,000 Americans die each year due to medical errors, we cannot afford to wait. When we also consider the escalating cost of health care in this country, we must recognize that this level of growth in spending has created a crisis. Information technology is one solution, and this legislation will assert the federal government's role in providing leadership in this area and provide financial incentives to spur rapid adoption of information technology in medicine. Our legislation is necessary because as a nation we face two stark problems.

The first of these is a serious patient safety problem. The good news is that solutions exist: We have the technological ability to dramatically reduce medical errors and thus save lives. Many have heard about how drug interactions can be avoided by software systems which check a patient's prescriptions for hazards. Yet there are so many other applications which can improve health. For example, by reviewing and analyzing information, a health provider can help a patient better manage chronic diseases such as diabetes and heart disease, and avoid adverse outcomes.

Our second major problem is the escalating cost of health care. Costs are reduced when tests don't have to be repeated and data isn't delayed. In fact, a patient may obtain faster, higher quality care when, for example, multiple practitioners can review diagnostic test results right at their desktops. In an age where millions of Americans share family pictures over the internet in seconds, isn't it long past time that a physician should be able to retrieve an x-ray just as easily?

The President certainly recognizes the disparity in technology in health versus other parts of our economy. He has declared a goal for every American to have an electronic medical record within 10 years. I concur--we need this and more. In fact, once that record is in place we can do so many things better. From preventing drug interactions, to managing chronic diseases, to simply helping providers operate more efficiently. Most of us have been told at one time or another, ``we're waiting to get the test results mailed'', or ``we're still waiting for your chart''. Health care is one of the last bastions of such inefficiency.

The bad news is that high start-up costs and a lack of standards have prevented us from reaping the benefits of new technologies. I am certainly looking forward to the progress we will make with Dr. David Brailer heading the new Office of the National Coordinator for Health Information Technology at the Department of Health and Human Services. The President has made technology implementation a priority, and there is no doubt that a lack of standards has prevented IT adoption by many health care providers. One must know that a system purchased will be compatible with others, and that--no matter what may happen in the future to a vendor--the huge investment one makes in building an electronic medical record won't be lost. In other words, your system must be able to communicate with other systems, and your investment in building electronic medical records must be preserved. So when a patient moves, their electronic ``chart'' should be able to move right along with them, and their continuity of care shouldn't be interrupted.

Yet standards alone aren't enough. Today many providers are struggling to make these investments, and for those which serve beneficiaries of Medicare, Medicaid and SCHIP, it can be exceedingly difficult.

The legislation which we are introducing today will bring the solution within our reach. In the last Congress I worked with Senator Bob Graham to introduce legislation which provided a grants program to give assistance to hospitals and long term care facilities to enable investment in IT. As I join today with Senator Stabenow to introduce this legislation, we have made several crucial enhancements to the previous bill. The legislation now includes both federally-qualified health centers and community mental health centers as eligible to receive IT grants. In addition, physician practices can also participate. All three are key treatment environments where both costs and errors must be addressed.

Our new legislation even provides an alternative to those for-profit providers who do not wish to apply for a grant. Under this bill, such providers will be able to expense the cost of a qualified system.

The legislation supports expenditures for a variety of expenses required to implement health care information technology. These include such components as computer hardware and software, plus installation and training costs. In addition, when installed we require that every system must meet the HHS Secretary's interoperability standards.

We know we will realize significant savings through information technology. On that there is bipartisan consensus. Yet as providers are facing even declining payment rates, they also are told they must institute changes in the way they practice, including implementing information technology. We know that much of the savings in health care IT will accrue to the patient and payer--in such aspects as fewer duplicate tests, greater efficiency, and better health management. Thus it is appropriate that the Federal Government would assist with the often prohibitive start-up costs--particularly for those who serve beneficiaries of Medicare, Medicaid and SCHIP.

I again want to stress the first goal of this legislation: To help build a safer medical-delivery system. The great successes of our health care system are largely due to our highly committed and talented health care professionals. The problem we are addressing today is not theirs, but is an endemic weakness of the system they depend upon. However, to utilize the solution, the Federal Government must step forward and provide the leadership necessary to make system changes a reality.

When the Medicare and Medicaid programs began, we could only have dreamed about computerized clinical information systems. Now, today, we have this technology at our disposal, and I strongly believe that we cannot afford to delay implementation. I hope my colleagues will join us in support of this legislation so we may soon achieve the goals of improving patient safety and reducing our escalating health care costs.

Faced with uncertainties in electricity energy markets, turmoil in the Middle East, the need to cut back on the fossil fuel emissions linked to global warming, air pollution that contributes to high rates of asthma and fills even our national parks with smog, the United States must diversify its energy supply by promoting the growth of renewable energy.

Since 1999, Las Vegas electricity rates have increased by 50 percent. In the same time period, natural gas prices across Nevada rose 45 percent. We need to change the energy equation. We need to diversify the nation's energy supply to reduce volatility and ensure a stable supply of electricity. We must harness the brilliance of the sun, the strength of the wind, and the heat of the Earth to provide clean renewable energy for our Nation.

Mr. President, I rise today to introduce a bill with Senators Feinstein, Cantwell, Snowe, Jeffords, Lieberman and Kerry that expands the existing Section 45 production tax credit for renewable energy resources to cover all renewable energy resources. Our legislation accomplishes this by ensuring that geothermal, incremental geothermal, solar, open-loop biomass, incremental hydropower, landfill gas, and animal waste to the list of renewable energy resources that would qualify for a production tax credit.

Our legislation also makes the production tax credit permanent to signal America's longterm commitment to renewable energy resources. The existing production tax credit will expire at the end of the year. Since it inception in 1992, the production tax credit has expired and been renewed three times--in 1999, 2001, and 2004. Development of wind energy has closely mirrored these renewal cycles. Clearly, the private investment necessary to develop renewable energy resources requires the business certainty afforded by a long-term extension of the production tax credit. Our bill allows for co-production credits to encourage blending of renewable energy with traditional fuels and provides a credit for renewable facilities on Native American and Native Alaskan lands.

In northern Nevada, the Pyramid Lake Paiute Tribe is working with Advanced Thermal Systems to develop geothermal resources on Indian lands that will spur economic development by creating business opportunities and jobs for tribal members.

This legislation also provides production incentives to not-for- profit public power utilities and rural electric cooperatives, which serve 25 percent of the Nation's power customers, by allowing them to transfer their credits to taxable entities. The good news is that the production tax credit for renewable energy resources really works to promote the growth of renewable energy.

In 1990, the cost of wind energy was 22.5 cents per kilowatt hour and, today, with new technology and the help of a modest production tax credit, wind is a competitive energy source at approximately 5.5 cents per kilowatt hour. In the last 5 years, wind energy has experienced a 30 percent growth rate. The production tax credit provides 1.8 cents for every kilowatt-hour of electricity produced. Similar to wind energy, this credit will allow geothermal energy, incremental hydropower, and landfill gas to immediately compete with fossil fuels, while biomass will follow closely behind. The Department of Energy estimates that we could increase our geothermal energy production almost tenfold, supplying ten percent of the energy needs of the West. As fantastic as it sounds, enough sunlight falls on 100 square miles of southern Nevada that--if covered with solar panels--could power the entire Nation.

Let's never lose sight of the fact that renewable energy resources are domestic sources of energy, and using them instead of foreign sources contributes to our energy security. Renewables provide fuel diversify and price stability. After all, the fuel--from the wind, the sun, and heat from the core of the earth--cost nothing. And they provide jobs, especially in rural areas that have been largely left out of America's recent economic growth. The production tax credit for renewable energy resources is a powerful, fast-acting stimulus to the economy. According to the Western Governors Association, the Department of Energy's Initiative to deploy 1,000 Megawatts of concentrated solar power in the Southwestern area of the United States by the year 2006 would create approximately 10,000 jobs and estimated expenditures of more than $3.7 billion over 14 years.

Nevada has already developed 200 megawatts of geothermal power, with a longer-term potential of more than 2,500 megawatts; this development will provide billions of dollars in private investment and create thousands of jobs. Our production tax credit means immediate economic development and jobs.

In the U.S. today, we get 2 percent of our electricity from renewable energy sources like wind, solar, geothermal, and biomass. But the potential for much greater supply is here. For example, Nevada could use geothermal energy to meet one-third of its electricity needs, but today this source of energy only supplies 2 percent. I am proud to say that Nevada has adopted one of the most aggressive Renewable Portfolio Standards in the Nation, requiring 15 percent of the State's electricity needs be met by renewable energy resources in 2013.

After pouring billions of dollars into oil and gas, we need to invest in a clean energy future. Fossil fuel plants pump over 11 million tons of pollutants into our air each year. Federal energy policy must promote reductions in greenhouse gas emissions. By including landfill gas in this legislation, we systematically reduce the largest single human source of methane emissions in the United States, effectively eliminating the greenhouse gas equivalent of 233 million tons of carbon dioxide.

Medical studies have revealed an alarming link between soot particles from power plants and motor vehicles and lung cancer and heart disease. The adverse health effects of power plant and vehicle emissions cost Americans billions of dollars in medical care, and our cost in human suffering is immeasurable. Simply put, the human cost of dirty air is staggering. If we factor in environmental and health effects, the real cost of energy becomes apparent, and renewable energy becomes the fuel of choice.

America's abundant and untapped renewable resources can fuel our journey into a more prosperous and safer tomorrow without compromising air and water quality. Renewable energy is a critical component of a successful, forward-looking, and secure energy policy for the 21st Century.

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

Mr. President, I rise today to introduce the Federal Contractor Extraterritorial Jurisdiction for Human Trafficking Offenses Act of 2005, which builds upon bipartisan efforts to combat the abhorrent practice of human trafficking.

Human trafficking is unfortunately among the fastest growing international criminal activities. According to the U.S. State Department's 2005 Trafficking in Persons Report, 600,000 to 800,000 victims are transported across international borders each year. These victims often come from the world's most vulnerable populations and regions affected by wars or humanitarian disasters.

With the promise of well-paying jobs, victims are often enticed to foreign countries, where upon arrival, their passports or travel papers are confiscated, and they are forced, many times beaten, until they agree to work without pay or serve as prostitutes. The perpetrators of human trafficking are typically motivated by profits derived from the use of forced labor or commercial sex exploitation. Because one of the common motivations of trafficking is forced prostitution: 80 percent of the victims are women and 50 percent of the victims are children.

In 2001, awareness of human trafficking grew in London during a murder investigation where the victim was a small African boy. While trying to determine the identity of the victim, investigators discovered that, in London alone, 300 African children between the ages of 4 and 7 could not be accounted for. That staggering statistic provides an insight into the pervasiveness of child trafficking and demonstrates that it can occur in all countries, including the most affluent.

This issue has long been a concern of mine. Nearly 6 years ago, I learned of a human trafficking ring that enslaved foreign workers and smuggled them to the U.S. Commonwealth of the Northern Mariana Islands, CNMI. The workers were forced to work in factories or serve as prostitutes. Senators Frank Murkowski, Jeff Bingaman, and I introduced S. 1052 to tighten immigration law in the CNMI to prevent future human trafficking rings. Although our bill passed the Senate, it was not taken up in the House.

Unfortunately, that was only one of numerous human trafficking conspiracies discovered within the United States. The State Department estimates that 14,500 to 17,500 human trafficking victims are brought into our country every year.

We cannot address this issue without recognizing the efforts of my friend and departed colleague, Senator Paul Wellstone, who through his leadership, the Victims of Trafficking and Violence Protection Act of 2000, P.L. 106-386, was enacted. This law first established our Nation's commitment to the prosecution of traffickers and the protection of victims of trafficking.

Since 2000, and the passage of this Act, there has been a surge in government activity relating to the prevention and prosecution of human trafficking offenses. In 2003 alone, there were approximately 3,000 convictions of human traffickers worldwide.

We have learned a great deal more about the conditions under which members of a population are likely to become victims of trafficking. Those who are displaced from their homes or suffering from poverty are much more likely to become victims of trafficking. Unfortunately, military forces and organizations charged with protecting and providing for vulnerable populations have, at times, actually encouraged the trafficking of humans.

There have been instances in the Congo and in Bosnia where increased demand for prostitution and forced labor caused by foreign peacekeeping troops and humanitarian aid workers accelerated the exploitation of already vulnerable populations.

There have even been reports where contractors, working on behalf of the United States Government, have contributed to, and even participated in, the trafficking of humans abroad. Nothing is more contrary to the freedoms we cherish than the trafficking of humans, which is why I introduce today the Federal Contractor Extraterritorial Jurisdiction for Human Trafficking Offenses Act.

My bill closes a loophole in U.S. criminal law. Under current law, Federal contractors who engage in human trafficking offenses abroad are subject to prosecution in the United States only if ``employed by or accompanying the Armed Forces.'' The bill closes this loophole by permitting the prosecution of Federal contractors of ``any executive agency.''

I believe all U.S. contractors should be treated the same, and all should be held to the same standards. A paycheck from the United States should never be used to purchase a human life.

I wish to point out that this legislation respects the sovereignty of foreign governments to prosecute these crimes locally. If a prosecution has occurred or is pending by the foreign government, U.S. authorities are precluded from prosecuting except upon approval of the U.S. Attorney General.

Rather, my measure authorizes the prosecution of a U.S. contractor who engages in human trafficking abroad but flees the foreign country to avoid prosecution. This happened, according to at least one report, where an employee of a Federal contractor in Bosnia bought a woman to serve as a sex slave. This individual fled the country after local authorities discovered the crime, and he returned to the U.S. to avoid prosecution. My bill would empower U.S. prosecutors to bring such an individual to justice.

Mr. President, I ask by unanimous consent that the text of my bill be printed in the Record.