Winn Act

Mr. President, I rise today to introduce legislation aimed to address the disposal of chemical weapons by the military from World War II until 1970. A report titled, Off-Shore Disposal of Chemical Agents and Weapons Conducted by the United States, lists possible sites and types of munitions that may be found in Hawaii.

The Department of Defense has made tremendous strides in protecting the health and welfare of our citizens. However, it still is working on being better stewards of our environment. I am pleased the Army has taken preliminary steps to investigate these munition disposal sites in and around Hawaii. Given the health and safety threats that these munitions may pose, I am introducing legislation to ensure the Army will obtain a full accounting of the munitions found and the state of their condition. Furthermore, it requires the Army to monitor these areas for any health, safety, and environmental risks that these weapons may pose. Lastly, and more important, the Army will provide a report on remediation plans for these areas.

Sadly the issue of disposing hazardous ordnance and waste is not new to the State of Hawaii. Our citizens are keenly aware of the dangers that hazardous waste poses to the health and safety of the public and the environment. In fact, Departments of Defense installations are responsible for generating half of all hazardous waste in Hawaii. For these reasons, it is important for Congress to send the right message, specifically in this case, and ensure that the Army completes its survey, monitors the sites, and provides a plan for remediation. I urge my colleagues to join me in passing this important legislation to ensure that, if the Department of Defense is responsible for disposing of hazardous materials, wherever it may be, then it should be held accountable for monitoring and providing a plan for remediation.

Mr. President, I rise to introduce legislation to repeal a provision in the Deficit Reduction Act that will require people applying or reapplying for Medicaid to verify their citizenship with a U.S. passport or birth certificate. I thank my cosponsors of this legislation, Senators Obama, Bingaman, Inouye, Lautenberg, Jeffords, Kerry, and Lieberman for their support.

This provision must be repealed before it goes into effect July 1, 2006. We have arrived at this conclusion because it will create barriers to health care, and from information we have gathered from agencies, it is unnecessary and will be an administrative burden to implement. These are reasons for this legislation. The Center on Budget and Policy Priorities estimates that more than 51 million individuals in this country would be burdened by having to produce additional documentation. In 16 States--Arizona, California, Florida, Georgia, Illinois, Louisiana, Massachusetts, Michigan, Missouri, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, and Washington--more than a million Medicaid beneficiaries will be required to submit the additional documents to receive or stay on Medicaid. In Hawaii, an estimated 392,000 people who are enrolled in Medicaid will be required to produce the additional documentation.

The requirements will disproportionately impact low-income, racial and ethnic minorities, indigenous people, and individuals born in rural areas without access to hospitals. Due to discriminatory hospital admission policies, a significant number of African-Americans were prevented from being born in hospitals. One in five African Americans born during 1939-1940 do not have birth certificates.

We need to ensure that Medicaid beneficiaries are not discriminated against and do not lose access to care, simply because they do not have a passport or birth certificate. Data from a survey commissioned by the Center on Budget and Policy Priorities is helpful in trying to determine the impact of the legislation. One in 12 U.S.-born adults, who earn incomes less than $25,000, report they do not have a U.S. passport or birth certificate in their possession. Also, more than 10 percent of U.S.-born parents, who have incomes below $25,000, do not have a birth certificate or passport for at least one of their children. An estimated 3.2 to 4.6 million U.S. born citizens may have their Medicaid coverage threatened simply because they do not have a passport or birth certificate readily available.

Some groups are at a greater risk for losing their Medicaid coverage. Nine percent of African-American adults reported they did not have the needed documents. Seven percent of people over age 65 also report that they do not have birth certificates. Many others will also have difficulty in securing these documents, such as Native Americans born in home settings, Hurricane Katrina survivors, and homeless individuals.

It is difficult enough to get access to health care, let alone acquire a birth certificate or a passport before seeking treatment. Some beneficiaries may not be able to afford the financial cost or time investment associated with obtaining a birth certificate or passport. The Hawaii Department of Health charges $10 for duplicate birth certificates. The costs vary by State and can be as much as $23 to get a birth certificate or $87 to $97 for a passport. Taking the time and obtaining the necessary transportation to acquire the birth certificate or a passport, particularly in rural areas where public transportation may not exist, creates a hardship for Medicaid beneficiaries. Failure to produce the documents quickly may result in a loss of Medicaid eligibility.

Further compounding the hardship is the failure to provide an exemption for individuals suffering from mental or physical disabilities from the new requirements. I am really afraid that those suffering from diseases such as Alzheimer's may lose their Medicaid coverage because they may not have or be able to easily obtain a passport or birth certificate.

It is likely these documentation requirements will prevent beneficiaries who are otherwise eligible for Medicaid to enroll in the program. This will result in more uninsured Americans, an increased burden on our healthcare providers, and the delay of treatment for needed health care.

The hardships that will be imposed are unnecessary due to existing requirements that check immigration status. A 2005 study by the Health and Human Services Office of the Inspector General concluded there is no substantial evidence indicating that illegal immigrants claiming to be U.S. citizens are successfully enrolling in Medicaid.

Twenty-eight of 47 Medicaid directors, surveyed by the Health and Human Services Inspector General, indicated that requiring documentary evidence of citizenship would delay eligibility determination. Twenty- five believe that providing additional evidence would result in increased eligibility personnel costs. State Medicaid Agencies would likely have to hire additional personnel to handle the increased workload with significant, additional administrative and financial costs. Twenty-one believe that it would be burdensome or expensive for applicants to obtain a birth certificate or other documentation.

In my home State, the Hawaii Primary Care Association estimates the administrative costs for our Department of Human Services will result in an increased cost of $640,000. Mr. John McComas, the Chief Executive Officer, of AlohaCare, stated, ``We anticipate that there will be significant administrative costs added to our already overburdened Medicaid programs. These

provisions are absolutely unnecessary and place an undue burden on the Medicaid beneficiary, to our entire Medicaid program, and ultimately to our entire state.''

I am frequently frustrated by the inability of the Congress to enact measures to improve health care for Americans. A misconceived provision to mandate these additional documentation requirements will cause real people real pain, and create public health and administrative difficulties. The provision in the Deficit Reduction Act will force every current and future Medicaid beneficiary to produce a passport or birth certificate. I look forward to my colleagues working with me to repeal this provision. I am hopeful that as my friends in the Senate go home during recess, they talk with their constituents at health centers, State Medicaid offices, and social service organizations, and hear how important it is to them for this legislation to be enacted to protect access to Medicaid.

Mr. President, I ask unanimous consent that the full text of the bill be printed in the Record, as well as letters of support and concern from AlohaCare, the Association of Asian Pacific Community Health Organizations, Maternal and Child Health Access, the Hawaii Primary Care Association, and Siren.

Mr. President, I rise to introduce the Consumer Assurance of Radiologic Excellence Act of 2006. This bill would improve the quality and value of diagnostic medicine. If the RadCARE Act is enacted, patients and providers alike will benefit from more efficient and accurate diagnoses and safer, more appropriate therapies, all afforded at a substantially decreased cost to the taxpayer.

Most of us feel anxious when we see the doctor, regardless of whether the evaluation reveals a problem. That is particularly true when we are concerned about cancer. How reassuring it is for us to believe that our physicians have available to them the full range of diagnostic tests and therapeutic procedures necessary to manage our care in the best way possible. We expect, too, that everyone who participates in our care is highly qualified to perform the services they provide. It is an expectation that each of us deserves to have but, all too often, is unrealistic.

Effective treatments are predicated on accurate diagnoses, and every treatment has the potential to cause harm. Missed, inaccurate, or delayed diagnoses can lead to unnecessary or dangerous therapies, with avoidable medical costs the least of the consequences. Physicians and patients should be able to trust that the technical providers such as the radiologic technologists, ultrasonography technologists, and medical radiation technologists who actually perform these tests are well qualified to do their jobs and have the appropriate credentials help to provide this assurance.

Cancer of many different types has become much more common; indeed, cancer is the second leading cause of death in America, behind only heart disease. Medical imaging tests play an increasingly important role in diagnosing a wide variety of malignant diseases and in determining the results of treatment. Radiation therapy is a common form of cancer therapy and used in more than half of all cancer cases. As our population ages, we should anticipate that such procedures and therapies will be performed with greater frequency on older Americans, with the cost borne more and more often by federally financed health care programs. For example, in 2004, Medicare paid over $1 billion for radiation therapy.

Improvements in health care often occur through technological innovations. For example, today's providers depend much more on diagnostic medical imaging than they did in the past, which has led to a rapid increase in the number of procedures performed, procedures that are not limited just to patients with cancer. Over 300 million radiologic procedures are performed annually in the United States, with 70 percent of Americans undergoing some type of medical imaging exam or radiation therapy treatment annually.

These innovations, while of undeniable potential benefit, come with substantial costs. Radiology costs are reaching over $100 billion annually; diagnostic imaging is one of the fastest growing cost areas in American health care. These costs are not limited to charges alone. Sedation, administered to facilitate a diagnostic imaging study, may compromise breathing or heart function. Therapeutic interventions based, in part, on these studies are fraught with potential complications, and the risk increases if the diagnostic information is incomplete or inaccurate. Similarly, a decision not to intervene carries its own risks, especially if the facts on which the decision is made are in error.

Congress has already taken some steps to assure the public that those who provide these services meet sufficient standards of technical proficiency. The Mammography Quality Standards Act of 1992 established standards for technologists performing one crucial diagnostic test; substantial quality improvement has been the result. The Consumer- Patient Radiation Health and Safety Act of 1981 encouraged the States to set standards for the technical competence of those who provide diagnostic imaging or radiation therapy services to patients but left compliance with those standards optional. Unfortunately, to date, nine States and the District of Columbia have enacted no regulatory statutes at all while, in a further six States, those regulations remain incomplete. Some provider disciplines have no specified standards of education, training, and experience at all. In fact, a provider with only a few hours of course work or a couple of weeks of on-the-job training may be responsible for obtaining the image a physician uses to diagnose your cancer or to deliver the radiation that is crucial to the treatment of your tumor. One doesn't have to be a doctor to recognize that this is not good medicine to rely solely on the good intentions of those who employ these providers.

In its report to Congress this March, MedPAC--the Medicare Payment and Advisory Commission--recognized that, while the issue is complex, technical excellence in diagnostic imaging and radiation therapy plays a central role in improving the public health and lowering costs of care. The RadCARE Act seeks to implement those recommendations that speak to credentialing of technical providers and brings to completion work begun with the Consumer-Patient Radiation Health and Safety Act.

Many will benefit if we pass the RadCARE Act. Better diagnostic images will help physicians to make faster, more accurate diagnoses or, alternatively, to exclude problems from further consideration. Risks such as sedation-related complications and radiation exposure will decrease. Patients will receive therapies that are more considered, precise, and safe. Provider and consumer confidence in the health care process will rise. Qualified technologists will be recognized for their professional achievements and motivated to improve their practice. Taxpayers, even if they are fortunate enough not to require diagnostic or therapeutic radiologic services, will appreciate that their tax dollars are not being wasted on poor quality, repetitive diagnostic examinations or unsafe therapies.

Could the RadCARE Act have unintended, adverse consequences? Some argue that meaningful credentialing of these technical providers will decrease access to care--that it is better to have non-credentialed providers than none at all. Certainly, establishing and maintaining a health care workforce that is adequate in size is an important goal for us to achieve. I would make the case, though, for quality--that bad information is worse than no information at all. It is reassuring to note that, in those States that do regulate this type of technical practice, the number of practitioners has remained stable. To further address this concern, the RadCARE Act gives the Secretary of Health and Human Services the flexibility necessary to modify regulations promulgated under this legislation, so that access to services is not compromised but standards are preserved.

Some fear that credentialing technical providers will increase health care expenses by inflating personnel costs. Again, in those jurisdictions that regulate this type of technical practice, wage inflation has not occurred. Regardless, while I believe that workers should be compensated, fairly and proportionately, for the work that they do, the cost savings from delivering care correctly far outweigh any potential cost increase that might result from higher salaries.

Others are concerned that the RadCARE Act could infringe on the States' right to regulate health care practice or that Congress lacks the capacity to define the standards of practice that should apply. The Act does not codify any particular State action; rather, it provides a substantial economic incentive to the States to establish, at least, minimum standards, an action for which there is precedent in the Mammography Quality Standards Act and one that is consistent with current public and private sector initiatives, such as ``pay for performance,'' that tie reimbursement to recognized best practices. Similarly, the RadCARE Act does not specify what standards should be followed but gives the Secretary the opportunity to derive those standards from those most qualified to provide them: the professional community. Indeed, the Act is supported by the Alliance for Quality Medical Imaging and Radiation Therapy, a consortium of over 275,000 technical professionals.

I invite my colleagues to join me and Senator Kennedy as sponsors of this bill to increase the quality and value of these important diagnostic procedures and lessen the possibility of life-threatening medical mistakes.

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

Mr. President, today, I am introducing legislation to overhaul the Mine Safety and Health Act to make this Nation's mines the safest in the world. The recent events at the Sago mine in Tallmansville and the Alma Mine in Mellville, WV, and the death of a miner of Pikeville, KY, demonstrates that improvements need to be made in all areas of mine safety. The West Virginia disasters remind us of the one at the Pennsylvania Quecreek mine where on July 24, 2002, a mining machine broke through an abandoned section of the mine, unleashing 60 million gallons of groundwater and trapping 9 miners. Some 78 hours after the accident, all 9 miners were pulled safely from the mine. Unfortunately, the 12 men at the Sago mine were not as lucky.

A recent article in the Pittsburgh Post Gazette stated: ``The rest of the world will move on. In the weeks and months to come, there will be other disasters, other wars, other political scandals. But for the families of the 12 men who died inside the mine in Tallmansville, WV, for the one who survived, for their relatives and friends, for the investigators searching for the cause of the mine explosion, for the people of these coal-rich hills 100 miles south of Pittsburgh, Sago will be a daily litany. Some questions about the January 2 accident may never be answered.''

Mining is a dangerous business. There have already been 4 coal mine accidents since the January 2, 2006, Sago disaster. One on January 10, when a miner was killed in Kentucky after a mine roof cave-in, another on January 19, when 2 miners became trapped at

the Alma mine in Melville, West Virginia, and two more accidents on February 1, 2006, where a miner was killed at an underground mine when a wall support popped loose, and a second fatality when a bulldozer struck a gas line at a surface mine sparking a fire and killing the operator. Last year, the safest year on record, there were 22 fatalities in underground coal mines, in 20 separate accidents with 4 men killed in my home State of Pennsylvania; 3 in West Virginia; 8 in Kentucky and 7 in other States.

The Sago mine had 208 citations, orders and safeguards issued against it in 2005, with nearly half of these violations cited as ``significant and substantial''. Eighteen of the violations were cited as ``withdrawal orders'', which shut down activity in specific areas of the mine until problems were corrected.

While the budget for mine safety and health has increased by 42 percent over the past 10 years, these increases barely keep pace with inflationary costs. This has forced the agency to reduce staffing by 183 positions over that same time period. In FY 2006, the final appropriation was $2.8 million below the budget request and $1.4 million below the FY 2005 appropriation due to the 1 percent across- the-board reduction that was required to stay within the budget resolution ceiling.

I chaired a hearing on January 23, 2006, that included testimony from Federal mining officials and mine safety experts from labor, business, and academia, which resulted in many of the proposals in my legislation.

Specifically, the legislation that I am introducing today amends the Mine Safety and Health Act by requiring: 1. MSHA to release the internal review and accident investigation reports to the House and Senate authorizing and appropriating committees, within 30 days of completing their investigation of a mine disaster. 2. MSHA to publish formal rules for conducting accident investigations and hearing procedures. 3. That fines for a flagrant violation be increased from $60,000 to $500,000; defining that violation as a reckless or repeated failure to make reasonable efforts to eliminate a known violation of a standard that substantially and proximately caused, or reasonably could have been expected to cause death or serious bodily injury; and prohibiting the reduction of penalties by an administrative law judge for any violation termed as ``flagrant or habitual''. 4. That no fine less than $10,000 can be assessed for a safety violation that could cause serious illness or injury, and no less than $20,000 can be assessed to a habitual violator for a violation that could significantly and substantially contribute to a safety or health hazard. 5. MSHA inspectors to follow-up on all violations no later than 24 hours. 6. MSHA to ensure that the ventilation and roof control plans are reviewed on a quarterly basis. 7. That mining companies be subject to a fine of no less than $100,000 if MSHA officials are not informed of a disaster within 15 minutes of an accident. The MSHA Director may waive the penalty if it is found that failure to give notice was caused by circumstances outside the control of the mine operator. 8. That mine representatives not be present during accident investigation interviews with miners. 9. MSHA to train all mine personnel in the proper usage of wireless devices and do refresher training courses during each calendar year. 10. That rescue teams do training exercises twice a year and conduct emergency rescue drills at operating mines--on a surprise, unannounced basis. 11. That communications between rescue teams be strictly confined between the command center and the team members. 12. MSHA to have a central communications Emergency Call Center--which includes manned telephone operation with all calls answered by a live operator, 24 hours a day, seven days a week. This provision will apply to all types of mining operations. To assist in implementing and operating the Emergency Call Center, MSHA shall--on a quarterly basis-- provide the Center with a mine emergency contact list. 13. That wireless Emergency Tracking Devices be made available to each miner by the operator which will enable rescuers to locate miners in case of an accident. 14. That wireless text messaging or other wireless communications devices be made by the operator and shall be worn by underground personnel to enable rescuers or mine operators to communicate with underground personnel. 15. MSHA to place secondary telephone lines in a separate entry in order to increase the likelihood that communications could be maintained between miners and those on the surface in the event of an emergency. 16. That strategically placed oxygen stations be provided to miners with four days of oxygen--in the section of the mine where miners are working. 17. That fines will be increased from $5,500 to $55,000 for operators who fail to correct a violation. 18. That an operator who knowingly exposes workers to situations likely to cause death or serious bodily injury or willfully violates a mandatory health or safety standard will have fines increased from $25,000 to $250,000. 19. That if any person gives advance notice of the mine inspection the fine will be increased from not more than $1,000 to not more than $20,000. 20. That if any person makes a false statement regarding complying with the MSHA Act the fine will be increased from $10,000 to $100,000.

All metal, non-metal and coal mines as defined in section 3 of the Act, shall be subject to a user fee of $100.00 for each penalty assessed, to be collected by MSHA and deposited into its account to augment funding above fiscal year 2006 enacted appropriations, for the following activities: reimburse operators for the costs of training, research and development, rescue teams, safe rooms, and other miner safety supplies and equipment, and supplement MSHA funding of technical support, educational policy and development, and program evaluation and information activities.

These amendments that I have proposed to the Mine Safety and Health Act will improve the conditions in this Nation's mines. The provisions set forth in this legislation will provide increased protections for miners; put in place new equipment and technology to locate miners working underground; increase their oxygen supplies and speed up rescue operations so that the tragedy of the last few months will be not be repeated. I ask that you join me in cosponsoring this legislation.

Mr. President, in recent years, we have become increasingly aware of the great challenges facing our Nation as our population ages. While much discussion revolves around health care, social security, and pension systems, there is another daunting challenge that is rarely addressed in a comprehensive way.

I am referring to the challenge of senior transportation.

We Americans love our automobiles. From the time most of us were old enough to drive, we have been behind the wheel. Cars mean freedom--not in some grand philosophical sense--but in the real and practical sense that matters to us in our everyday lives. Having a car, and being able to drive it, means the freedom to go where we want, when we want.

But as we age, we will find it harder and harder to use the freedom given to us by automobiles. Because as we age, our abilities decline, and driving becomes less and less simple. And then the day comes when we wonder whether we should keep driving at all, and if we don't, how we will get about our daily lives.

That day has already come for millions of our senior citizens.

All around the Nation, older Americans are struggling to stay active and independent while their ability to drive themselves declines. A few live in communities with well-developed public transportation services geared to our senior citizens, but most do not. Many seniors drive as long as they can, perhaps longer than they think they should, simply because they feel they have no alternative.

That is why I am today introducing the Older Americans Sustainable Mobility Act of 2006. Despite its rather

awkward name, this legislation has a great purpose. It would create a 5-year demonstration project, overseen by the Administration on Aging, to establish a national, nonprofit senior transportation network to help provide some transportation alternatives to our aging population. The goal of this network is to build upon creative, successful models that are already showing how the transportation needs of older Americans can be met in a manner that is economically sustainable.

This last point is important. Senior transportation is a complex and expensive logistical problem. We cannot expect to address this problem by creating a brand new, expansive, Federal Government program that requires the commitment of vast sums year after year in order to succeed. We can't afford that, and that really isn't what older Americans want.

What older Americans want is what most of us have and take for granted--the freedom and mobility that our automobiles provide.

My legislation would build upon models that have demonstrated how senior citizens can stay active and mobile even after they stop driving. One such model is ITNAmerica, which has been operating in my home State of Maine since the mid-1990s and has since branched out to communities across the Nation. ITNAmerica uses private automobiles to provide rides to senior citizens whenever they want, almost like a taxi service. Riders open an account which is automatically charged when the service is used. Riders can get credits for rides through volunteer services, through donations--and this is what I think is most intriguing--by donating their private car to the program after they have decided that they should no longer drive.

Kathy Freund, the founder of ITNAmerica, sees this as a way of taking something people see as a liability, and turning it into an asset. Through Kathy's extraordinary vision and hard work, ITNAmerica has developed a model that works because it allows older Americans to make the transition away from driving themselves without asking them to sacrifice their independence, or to learn at an older age how to navigate public transportation systems that may simply be inappropriate for their needs, or widely unavailable in many parts of the country. They can still be mobile, they can still go where they want and when they want, and they can go by car.

Senior citizens will often keep their vehicles long after they have stopped driving. I am sure you have seen these vehicles in your State as I have in mine. You will see them sitting in driveways--unattended and poorly maintained, sometimes not driven for many months at a time. In this form, these cars are ``wasting'' assets. But ITNAmerica has found that the value of these cars can be unlocked by allowing seniors to exchange them for rides. That is why my bill calls for the creation of a once-in-a-lifetime tax benefit for seniors who exchange their cars for rides, valued at the amount of the ride-credit they are provided.

One of my senior citizen constituents, June Snow from Falmouth, ME, has been using the system that I described--the ITNAmerica system-- since 1995, when her eyesight began to fail. At first, she used the program only to get into the city, Portland, and only after dark, when she found it more difficult to drive. But more recently she has traded her car for rides, and now she depends on the system to go everywhere she needs to go. She finds that the program allows her to get around town, to run errands, and do the things she has to do and wants to do without worrying about whether she will be able to get safely from one place to another. She told me: It's not like riding a bus, where you have to work with their schedules, and they won't stop and help you with your groceries. They won't make you get your feet wet walking through the snow to the bus stop.

But what she loves most is the personal attention she gets from the drivers, most of whom are volunteers. ``They help you to the door, and they even carry your bundles and put them in the trunk,'' she says.

My bill also creates a limited-time matching grant program to help communities establish sustainable transportation alternatives for seniors as part of a national network. Programs that wish to compete for these matching grants must be able to show that they can become self-sustaining after 5 years, and that they can operate after that period without reliance on public funds. So what I am proposing, is that we just provide some seed money as a catalyst, to get these programs going, with the full expectation--indeed the requirement--that they become self-sustaining without any public funds after the initial period. My bill also provides smaller grants to help transportation providers acquire the technology they need to connect to this network, and grants to encourage efforts to get the baby boomers more involved in supporting transportation alternatives in their communities. The total cost of these grant programs would be only $25 million over the full 5 year period. Then the program sunsets, and these wonderful transportation programs that would be created all over the country would be sustainable on their own without public funding.

The challenge of providing transportation alternatives to our Nation's senior citizens is literally growing by the day. The bill I am offering is one step toward a reasonable, practical, solution to this important challenge. I think all of us know of neighbors and family members who reach their senior years and really shouldn't be driving anymore but are very reluctant to give up those car keys because there are simply no workable alternatives for them. This bill would provide those alternatives, and I urge my colleagues to support the legislation.

Mr. President, I am pleased today to be joined by Senators DeWine, Dorgan and Bond in introducing legislation that will save lives by increasing the number of kidneys available for transplantation. Our bill addresses relatively new procedures that did not exist when the National Organ Transplant Act--NOTA--was passed more than two decades ago. No Federal dollars will be needed to implement it. More importantly, it will make it possible for thousands of people who wish to donate a kidney to a spouse, family member or friend, but find that they are medically incompatible, still to become living kidney donors.

Kidney paired donations involve two living donors and two recipients--the intended recipient of each donor is incompatible with the intended donor but compatible with the other donor in the arrangement. For example, person A wants to donate her kidney to her husband, person B, but cannot because of a biological incompatibility. Likewise, person C wants to donate to his wife, person D, and cannot because of a biological incompatibility. However, testing reveals that A and D are biologically compatible, and C and B are biologically compatible. Therefore, a paired kidney donation can be made whereby A donates to D and C donates to B. Every paired donation transplant avoids burdening the kidney waiting list and increases access to organs for all kidney transplant candidates.

Kidney list donations involve three individuals: a living donor; the recipient of the living donor's kidney, who is allocated the organ through the waiting list; and the donor's intended recipient who receives an allocation priority on the kidney waiting list. In this circumstance, a person intends to donate a kidney to a recipient but is found to be medically incompatible, and there are no other donor- recipient pairs available for a simultaneous paired donation. The person donates his or her kidney, and the kidney is allocated to a medically suitable patient on the national Organ Procurement and Transplantation Network--OPTN--waiting list according to OPTN organ allocation policy. The donor's originally intended recipient then receives allocation priority through the national system to receive a deceased donor kidney, thus fulfilling the donor's original intent to donate to a particular person. It is estimated that clearing the way for these procedures will not only save lives, it would save Medicare tens of millions of dollars each year in avoided costs for renal dialyses of these patients. By permitting living paired donations, this bill will also have the effect of increasing the number of kidneys available to patients already on the kidney waiting list.

The legislation we are introducing removes an unintended impediment to kidney donations by clarifying ambiguous language in Section 301 of the National Organ Transplant Act--NOTA. That section has been interpreted by a number of transplant centers to prohibit such donations. In Section 301 of NOTA, Congress prohibited the buying and selling of organs. Subsection (a), titled ``Prohibition of organ purchases,'' says: ``It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration. . . . '' The legislation we are introducing does not remove or alter any current provision of NOTA, but simply adds a line to Section 301 which states that paired donations do not violate it. When we originally enacted NOTA we expressly exempted several other actions from the valuable consideration provision, such as expressly permitting reimbursement of travel and subsistence costs for living donors, and for reimbursement of their lost wages. We did not know to include paired kidney donation events with these exceptions because they were not being performed then.

Congress surely never intended that the living donation arrangements that permit either a kidney paired donation or a kidney list donation be impeded by NOTA. Our bill simply makes that clear. A number of transplant professionals involved in these and other innovative living kidney donation arrangements have proceeded in the reasonable belief that these arrangements do not violate Section 301 of NOTA, and they are being performed in many states already. This legislation is necessary because some have questioned whether these paired donation situations might somehow involve valuable consideration in that the mutual promises to donate could be considered a thing of value being given in exchange for an organ. We do not believe that this is the case. Certainly, Congress never intended to impede paired donation when it outlawed buying and selling of organs.

There is no known opposition to this legislation. It is supported by numerous medical organizations, including the United Network for Organ Sharing, the American Society of Transplant Surgeons, the American Society of Transplantation, the National Kidney Foundation and the American Society of Pediatric Nephrology.

It is important that we make the intent of Congress explicit so that transplant centers which have hesitated to implement paired donation programs can feel free to do so; and in order that the Organ Procurement and Transplant Network, which is operated by UNOS under contract with the U.S. Department of Health and Human Services, may implement a national registry of pairs who need to find other compatible pairs so that their loved ones can get the transplant they so desperately need.

The experts in the field of organ donation and transplantation estimate that our legislation will result in well over 2,000 additional transplants annually and that Medicare would save millions in kidney dialysis costs. By its own estimate, Medicare spends more than $55,000 annually for each dialysis patient, which equates to more than $3.6 billion per year. Savings to Medicare due to removal of an additional 2,000 patients from the dialysis program through living kidney donation would exceed $110 million. Since the median waiting time for each patient is four years, removal of each patient translates into a total Medicare savings of $220,000.

It is our hope that the Senate will promptly act on this necessary legislation.

Mr. President, I rise today to introduce a bill that will help struggling communities, like Aroostook County in my home State of Maine, take full advantage of the special tax incentives for creating economic growth and community revitalization in empowerment zones. The bill enables those economically depressed communities, already taking advantage of these incentives, to secure the full 15 years of targeted growth originally granted to the areas first designated as empowerment zones.

I believe all empowerment zone communities need 15 years to reverse the decades of decline that originally impacted their economies. I have long supported empowerment zone incentives, and I believe that these targeted tax incentives provide struggling communities the best chance for sustained, long lasting economic renewal. In Maine, I have seen first hand empowerment zones' ability to revitalize faltering communities, with new jobs, and the creation of the economic activity needed for vibrant and strong cities and towns.

Empowerment zones are vital to the health of rural Maine. The story of Aroostook County demonstrates how decades of decline can force people to leave rural areas in order to find better, more stable, employment opportunities. Since the 1960s, difficult economic circumstances have caused a continuous decline in Aroostook County's population. In 1994, Loring Air Force Base closed, the major employer in Aroostook County at the time, further decimating the area's already struggling economic base and population. The Pentagon wrote, in their assessment of closure at Loring that, ``closing Loring Air Force Base would result in a population loss of approximately 22,000 persons, (the) direct and indirect employment loss of nearly 9,900 jobs, and regional income loss of just over 92 million dollars.'' Today, over 11 years after the Air Force left Aroostook County, the population hovers near a sparse 73,000 people with 14 percent of these households still living in poverty.

In 1994, Congress designated the first empowerment zones setting 2009, a 15-year timeframe, as the date that these tax incentives would expire. The 2009 expiration date of empowerment zone status was held firm for Round II communities designated in 1997, and the Round III communities designated in 2002; granting communities like Aroostook County, which was designated in 2002, as little as 7 years to use tax incentives to reverse decades of decline and economic neglect.

Unfortunately, Aroostook's economic problems will not be fixed within the 7 short years this area qualifies for empowerment zone tax incentives. Instead a long-term and lasting commitment of at least 15 years is necessary to help Aroostook communities work their way to stronger economic prosperity. Many communities, like Aroostook County, that were unable to qualify for empowerment zone status until 2002 are in need of the long-term 15-year commitment in which to address their stubborn causes of poverty.

Businesses operating within empowerment zones receive a 20-percent wage credit for the first $15,000 they pay in wages to local residents. Other tax incentives encourage businesses, and industries, to further commit to these communities. Companies with businesses in empowerment zones are eligible for an additional $35,000 worth of 179 business expensing--making these long-term business obligations more attractive, affordable, and likely. Empowerment zones are also eligible for expanded tax exempt financing for building the infrastructure communities need to attract long-term developers and business partners.

To qualify for empowerment zone status, communities develop comprehensive strategic plans that depend on these tax incentives to help them transform their economies. Each community's plan focuses on establishing long-term partnerships between private businesses, nonprofits, State, local, and Federal Government agencies, to help develop the local economy. Together these parties use the community's strategic blueprint to implement interconnected projects that address the factors creating the area's economic sickness. These types of projects focus on building needed business and industrial infrastructure, developing an educated workforce and diversifying local economies away from a reliance on one employer or industry.

In 2002, Aroostook County was designated an empowerment zone based on population loss, one of only two empowerment zones designated because of population decline. The county formed the Aroostook Partnership for Progress to spearhead their empowerment zone strategy, initiatives, and projects.

Since its formation, the Partnership for Progress has steadfastly dedicated their time and resources to create a projected 1,500 new jobs and negotiated over $1.2 million worth of investments into Aroostook County. These numbers indicate the ability of empowerment zone incentives to drive investment and strengthen local businesses in the area.

Through the Aroostook Partnership for Progress, and the businesses working in the empowerment zone, are making significant progress--the factors causing poverty in this rural part of Maine can not be eradicated quickly. Aroostook County's strategic plan will take time to implement as infrastructure, industry, and other projects create greater economic capabilities and diversification. Though Aroostook County is working valiantly to overcome the factors causing their economic decline they will need more than 9 years to overcome 40 years of difficulties. I know that there are many other struggling Round II and Round III empowerment zone communities, like Aroostook, who need the maximum order to reverse the poverty and underdevelopment also plaguing those areas.

I urge my colleagues to recognize the importance of making a long- term commitment to communities using empowerment zone incentives to work their way out of long-term poverty. I hope that each Senator will support the communities in their States, currently undertaking the painful process of economic transformation, by supporting passage of this economic development bill.

Mr. President, I rise today to introduce a bill regarding immigration: the Welcoming Immigrants to a Secure Homeland Act of 2006.

As a border State Senator and the son of immigrants, I have a unique perspective on immigration. I understand the need to provide a secure homeland for my constituents who see the problems caused by illegal entries into our country every day. I also understand the need to welcome immigrants to our country, so that America remains a country where hardworking, entrepreneurial, and intelligent immigrants can prosper. My perspective is the basis for the WISH Act.

I believe we can welcome immigrants to a secure homeland by addressing five areas.

First, we must improve security at our international borders. On November 17, 2005, I introduced the Border Security and Modernization Act of 2005, S. 2049. That bill calls for improvements to our port of entry infrastructure, increased Department of Homeland Security, DHS, and Department of Justice personnel, new technologies and assets for border security, increased detention capacity, and additional Federal assistance for States. I believe these actions will provide the necessary increased security at our borders.

Second, we must improve enforcement of our immigration laws. The WISH Act addresses this situation by increasing the number of DHS personnel who investigate human smuggling laws, employment of immigrants, and immigration fraud. My bill also increases penalties for violations of immigration laws and provides for a system to verify a worker's employment eligibility.

Third, we must create a new guest worker visa that is easier to obtain and lets individuals who want to come to the United States to work know that if they are hardworking and industrious, we want them in America. The WISH Act creates such a visa, which is valid for up to 9 years if the guest worker remains employed. After the applicant has worked in the United States for 6 of those years, he or she may apply for permanent resident status. An applicant's spouse and unmarried minor children may be admitted to the United States with the guest worker. To ensure that such visas are issued only to legitimate guest workers, my bill requires applicants to provide information on his or her criminal history, gang membership, immigration history, and involvement with groups that have engaged in terrorist acts, genocide, persecution, or plans to overthrow the United States. It also provides for the completion of all necessary background checks.

Fourth, we must account for the millions of undocumented aliens residing in the United States. I believe that the vast majority of these aliens are honest, hard-working individuals who are contributing to our country in positive ways, so the WISH Act allows them to obtain the guest worker visa I just mentioned without leaving the United States if he or she pays a fine. This will allow for these aliens, and their immediate families, to remain in the country doing the work they already do. In order to provide for their timely and orderly transition into legal guests, my bill requires undocumented aliens to apply for this visa or leave the United States. Failure to take one of those actions means they will be removed from the United States and will be unable to return. For aliens who have been working in the United States for at least 5 years before enactment of the WISH Act, my bill allows them to apply for any visa, adjustment of status, or immigration benefit except adjustment of status to that of a permanent resident after they have worked as legal guests for 5 years. However, such applications may not be granted until the alien has returned to his home country.

Lastly, we must create a more welcoming environment for students and visitors to our country. Before the horrific events of September 11, 2001, the United States was a preferred place for foreign students to attend school. This

was beneficial to our country because students came to the United States to study, but they stayed here to work. They did business with colleagues they met at U.S. schools. Our country was obtaining some of the most brilliant minds not only from within our borders but from across the world. Unfortunately, restrictions and limitations put on visas in recent years have forced many of the business leaders of the next generation to attend school in other more welcoming countries. To reverse this trend, the WISH Act allows full-time foreign college and graduate students to work and travel while studying in the United States and provides for foreign students who graduate from a U.S. college with honors to stay in the United States to work after graduation.

I am personally involved in this issue both because I represent a border State and because I remember the day, when I was 5 or 6 years old, that my parents learned that the lawyer who advised them about citizenship was wrong and my mother was an illegal alien. Federal officials came to our house to arrest my mother while my father was at work. It was a frightening situation for my entire family that occurred through no fault of my mother, who had lived in America for more than 30 years as an exemplary citizen and who was told by an attorney that she was an American.

I believe that we can, and must, do our best to prevent situations like this from occurring in the future. I believe that the measures in the WISH Act, together with the measures in my Border Security and Modernization Act, will play an important role in that effort, and I am pleased to introduce this bill today.

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

Mr. President, today I rise to introduce and present to my colleagues the Wireless Innovation Act of 2006. I am pleased to be the lead sponsor of this legislation, and I want to thank my colleagues Senator Kerry and Senator Sununu for working with me on this important issue.

The goal of the Wireless Innovation Act is to unleash the power of advanced technological innovation to facilitate the development of wireless broadband Internet services. Specifically, our legislation allocates certain areas within the broadcast spectrum that are otherwise unassigned and unused, known as white spaces, for wireless broadband services.

Unfortunately today, many people, from rural areas to big cities, either do not have access to broadband Internet service or simply cannot afford it. Our legislation will enable entrepreneurs to provide affordable, competitive high-speed wireless broadband services in areas that otherwise have no connectivity to broadband Internet. Additionally, in areas where broadband access currently is provided, either from a Cable modem or DSL connection, our legislation will allow for a third alternative choice for consumers.

The Wireless Innovation Act encourages the most robust and efficient use of this Nation's spectrum. After the transition to digital television is complete in February of 2009, 64 percent of the spectrum allocated to broadcast television use in the Richmond, VA, area will be vacant. Instead of sitting dormant, this valuable spectrum can be used to provide greater Richmond area residents with affordable wireless broadband, which some estimate to be as low as $10 per month. These white spaces exist in virtually every geographic area of the country, and I believe it is a valuable public resource that should be used for the benefit of all American consumers.

I recognize and fully appreciate the value that our television broadcasters serve in each and every local community. That is why our legislation protects incumbent local television stations from potential interference that may be caused using white spaces. In fact, my legislation ensures that all unlicensed devices must comply with the clear rules established by the Federal Communications Commission so there is no interference to licensed systems. These rules, along with the power of technology, can protect the television broadcast stations from any harmful interference.

Using white spaces to deliver wireless broadband across the country creates a new opportunity for innovators and entrepreneurs to provide a competitive broadband service at extremely low cost. This is especially compelling in rural areas where distance is so frequently the enemy of wire-line networks and the primary reason for the high cost of rural broadband deployment.

At a time when the United States is lagging behind much of the world in broadband penetration--and more than 60 percent of the country does not subscribe to broadband service primarily

because it is either unavailable or unaffordable--our legislation would put this country one step closer to closing the economic digital divide and achieving ubiquitous broadband Internet access throughout the country.

Providing a way to encourage the widespread adoption of broadband Internet access is vital to helping us keep pace with the new global economy. The benefits to Americans will include more jobs, better access to information and commerce, increased productivity, improved healthcare delivery, and more access to education and videoconferencing.

While the foreseeable benefit of this legislation is facilitating the development of wireless broadband services, the true beauty of unlicensed spectrum is that it allows for continued advancement and innovation, yielding benefits that are unimaginable today. A decade ago, no one could have imagined WiFi Internet access and yet, through the use of unlicensed spectrum, it was created. Four years ago, I worked on legislation with Senator Boxer to make more unlicensed spectrum available in the upper spectrum bands for further advancement and deployment of WiFi services. The Federal Communications Commission followed our lead and eventually made this spectrum available. Since then, WiFi has flourished.

Today, WiFi Internet access can be found in consumers' homes, Starbucks Coffee shops, book stores, entire cities such as Alexandria, VA, and even here in the Senate Office buildings. The Telecommunications Industry Association estimates that sales of WiFi equipment reached $4.35 billion in 2004, and predicts spending on WiFi infrastructure will increase to $7 billion in 2008. It is now time to enable the next generation of wireless innovation by allowing these white spaces to be used for next generation wireless broadband services.

A guiding principle I have followed throughout my time in public service is that the Internet should remain as accessible as possible to all people in all parts of the country forever. That is why I sponsored the Internet Tax Nondiscrimination Act, signed by the President in December 2004. That guiding principle is also what leads me, together with Senators Kerry and Sununu to introduce the Wireless Innovation Act today. With passage of this legislation, we can move forward to create an alternative that promotes broadband adoption using advances in technology and spectrum efficiency.

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