Community Cancer Care Preservation Act of 2006

Mr. President, the Commerce Committee is having a hearing this afternoon--and I have been at a portion of that hearing--dealing with the question of Dubai Ports World, which is a company largely owned by the United Arab Emirates. This is a company that has been given the green light by this administration to manage six of America's largest seaports.

This has caused a substantial amount of controversy and discussion. In the last couple of days some of that controversy has been resolved, at least in the minds of some, because the company owned by the United Arab Emirates has asked the administration for a 45-day review of the circumstances of this deal, and they will not take control of the management of the American ports for these 45 days.

It is rather unusual for a company to be asking that the United States Government do a 45-day review of the circumstances of whether a United Arab Emirates company should be managing America's ports. Speaking for myself, I don't need 45 days to understand this. I don't need 45 minutes to understand it. I know a bad idea when I see one.

The President has made up his mind. President Bush has said he will veto any legislation that is offered here in the Congress that would upset this deal which would allow the company owned by the United Arab Emirates to manage America's ports. If the President feels he should veto a piece of legislation, that is his right. He has not vetoed any bill since he became President of the United States, but if his proposition is he wants to veto a piece of legislation and turn over America's seaports, six of America's large seaports, to management by the United Arab Emirates, so be it. But I think the President would be making a very serious mistake.

Our country is under a terrorist threat. We get regular briefings on that in the Senate, and the American people know that from watching the news. We understand the terrorist threats take the form of threat to air travel because the terrorists, as we know, last used commercial jet airplanes to fly into the World Trade Center towers in New York City. We understand the threats at our airports. That is why when you go to the airport and try to board a plane they have you take off your belt, take off your shoes, and run you through a metal detector. There is great concern about the threat of terrorism and security at our airports.

There is also great concern about security at our seaports.

I have spoken, I am guessing, about a dozen times on the floor of this Senate about the security at our seaports since the time of the 9/ 11 attacks.

I recall shortly after 9/11 when a fellow from a Middle East country decided to ship himself in a container on a container ship. He got inside a container, and he got loaded on a container ship. Here was this man with a container. He had a cot to sleep on, he had a GPS device, a radio, a supply of water, and he was shipping himself, I believe, to Canada, and there was concern that he was a terrorist and he was going to enter the country by shipping himself in a container on a container ship.

I have spoken here, I suppose, almost a dozen times talking about the danger of having anywhere from 5.7 to 5.9 million containers coming into this country every year, millions of containers on a container ship coming into this country every year, and somewhere around 4 percent of them and perhaps as much as 5 percent are inspected; the rest are not.

I went to a port facility once. We don't have ports in North Dakota. But I went to a port facility to visit and see what the security was. They were showing me a container they had taken off a ship. The container they opened

happened to be frozen broccoli from Poland, bags and bags and bags of frozen broccoli. I said, How do you know what is in the middle of this container? I see there are bags of frozen broccoli. How do you know that is all that is here in the container? Well, we don't know. That is why we are inspecting this particular container. How many containers do you inspect? We know the answer to that. Out of every 100, 96 are not inspected.

That is a threat to our country's seaports.

What about a terrorist organization deciding they want to try to steal a nuclear weapon someplace? After all, there are tens of thousands of them--somewhere, we believe, between 20,000 and 30,000 nuclear weapons that exist in this world. Steal a nuclear weapon and put it in a container, on a container ship and run it up to a dock, appear at one of America's major cities. What about the prospect of that happening? Then we would not see 3,000 deaths. No, we would see 100,000 deaths or more.

Seaport security is a very serious issue.

Now, in the midst of all of these issues of national security, we hear that something called CFIUS--the Committee on Foreign Investments in the United States, composed of some 12 Federal agencies coming together as a committee, evaluating foreign investment in the United States--decided it is all right if this company called Dubai Ports World, a company owned by the United Arab Emirates, is allowed to manage six of America's largest ports, including ports in New York, New Jersey, Miami, Louisiana, and Maryland.

That is not all right with me.

I just came from a committee hearing where we had some people say, Well, you are going to offend somebody here. The United Arab Emirates is a country that has been very helpful to us in the fight on terrorism. The last thing we want to do is offend them.

What about offending common sense? Should we be offending common sense here in the Senate? I don't think so. Common sense would say to us when threatened by terrorist threats, security in this country ought to be security provided by the United States. We can't provide for our own security in our management of U.S. ports?

The United Arab Emirates is probably a perfectly wonderful country. It is not a democracy, I will tell you. And two of the hijackers on 9/ 11/2001 were UAE citizens. And the United Arab Emirates was only one of three countries that recognized the Taliban Government which played host to Osama bin Laden in Afghanistan.

Let me read something from the 9/11 Commission report. On page 137:

Early in 1999, the CIA received a recording that Osama bin

Laden was spending much of his time at one of several camps

in the Afghanistan desert south of Kandahar. At the beginning

of February, bin Laden was reportedly located at the vicinity

of Sheik Ali Camp, a desert hunting camp being used by

visitors from a Gulf State. Public sources have stated that

those terrorists were from the United Arab Emirates.

I will not read all of this.

According to the reports, the military was doing targeting work to hit the camp where Osama bin Laden was thought to be, to hit it with cruise missiles. But no strike was launched. And Mr. bin Laden apparently soon moved on and the immediate strike plans became moot.

According to the CIA and defense officials, the reason the strike was not launched against bin Laden was that policymakers were concerned about the danger that a strike would kill a prince from the United Arab Emirates who was visiting with bin Laden.

The 9-11 Commission report also talks about an official airplane for the United Arab Emirates at a landing strip there. They believed the UAE officials were visiting with Mr. bin Laden. So apparently, any opportunity for this country to target Mr. bin Laden before 9/11 was in part fouled by the relationship between at least some in the Royal Family of the United Arab Emirates and Mr. bin Laden.

One of our Cabinet officers said, Well, this issue is not just about national security, but also about trade and about commerce.

Look, trade and commerce do not ever trump national security. If there are national security issues, then they have to be dealt with and have to be recognized.

We are told, Well, everyone signed off on this; there is not a problem here. But now we find out today that not everybody did sign off on this. Yesterday we found out that the Coast Guard expressed reservations about the deal in a secret report, which had already been made public. The report said:

There are many intelligence gaps concerning the potential

for DPW or PNO assets to support terrorist operations. That

precludes an overall threat assessment of the potential DPW

and PNO ports merger.

So don't tell me that the Coast Guard signed off on this. They raised questions about it, as they should have.

I have a GAO report that I showed a few moments ago in the Commerce Committee. This is the title of the July 2005 GAO report: ``The DOD Cannot Ensure its Oversight of Contractors Under Foreign Influence is Sufficient.''

If the Department of Defense cannot ensure proper oversight of foreign contractors, the Department of Homeland Security can? I don't think so. The Department of Homeland Security, after all, responded to Hurricane Katrina. Look at the mess they made with that. Now they are saying, even though the Department of Defense cannot ensure oversight of foreign contractors, Homeland Security is going to be able to do that with respect to the security of our ports? I don't think so.

So national security is an issue. And saying so is not a slap in the face at any country. It is just recognizing the obvious.

Something else that has not been talked about should be talked about. We have moved at a full gallop toward globalization. We are in a global economy, we are told. Well, the fact that we are in a global economy should not persuade us not to think. One of the questions ought to be raised by all is--aside from the national security interests, which are significant interests--one of the other questions is, why would our country not have the capability to provide its own port management, its own port security?

There are certain things we do that we know we must do. Again, go to the airport and see what they tell you about your shoes and belt and see a little 6-year-old boy spread-eagle against the wall being ``wanded'' and ask yourself: Why is that happening? Because we have decided there is a security threat at airports. Terrorists use a commercial airliner as a guided missile to destroy buildings in our country and to murder Americans. So we have issues of national security to respond to a threat with airport screening.

What about our seaports? Does anyone think there is any less danger with somewhere around 5.7 to 5.9 million containers coming into our country, with 96 percent of them not having been screened? Does anyone think there is less danger to America to have just one of those containers be pulled up slowly at an American pier or port or dock that has a weapon of mass destruction?

We are spending billions and billions of dollars building an antiballistic missile defense system that does not work, regrettably. We have spent billions of dollars and are spending billions more trying to hit a bullet with a bullet because we are concerned that a rogue nation or a terrorist will get hold of a ballistic missile, put on its tip a nuclear weapon, and send it to us somewhere around 15,000 miles per hour. By far, the more significant threat is for a ship to pull up at one of our docks at about 5 miles per hour, leaded with containers, most of which have never been inspected, containing in one circumstance a weapon of mass destruction. That is by far a more significant threat to our country.

I have spoken, I suppose, a dozen times over the years since 2001 about port security. Not because we have any ports in North Dakota, because we do not. But it is obvious to me that if you are going to begin to provide security for this country, we do not just do it by metal detectors at airports; we do it at seaports and rail security, as well. And with respect to seaports, it seems completely illogical to me from a national security standpoint that we would decide to turn over to foreign countries the management of our ports, our seaports.

People have said today: Are you kidding? This is done all the time, for God's sake. Get a life. This is going on

everywhere. You do not understand the global economy. We have had other countries managing our seaports.

This has become an issue that most American people recognize is a problem. But a number of Members in the Congress do not recognize it as a problem. Some do. But I heard opening statements at a committee hearing suggesting this debate is about racial profiling, it is about offending a good neighbor. Well, that is all nonsense. This is about demanding at least some level of common sense be used in establishing public policy.

The President says: We did the right thing. I have already made up my mind, he says, and we approved it. And I will veto anything that would overturn that approval.

Then he says, when asked by the company that is owned by the United Arab Emirates to review it for 45 more days, the President says: Yes, we will review it for 45 more days. But, again, he put out a statement today saying: I've already made up my mind.

At a committee hearing this afternoon, others on the committee said: Well, some of you have already made up your mind. Shame on you.

As I said, it would not take me 45 days to figure it out. It does not take 45 minutes to figure it out. We ought to, as a country, be able to find ways to manage our seaports. And we ought to, as a country, take responsibility for our own national security. After all, it is not every country in the world where you pin a little pin on the map that says: Here's target one, here's the bull's eye of the target for terrorists. They want to attack this country. This is where they want to attack. We understand that.

All of us feel fortunate we have not been attacked again since 2001. But we all know, as well, that there is much yet to do. Seaport security is one of those areas in which we have to do much better.

My colleague who sat behind me some years, Senator Fritz Hollings from South Carolina, would come to the Senate and speak at great length about this. He would offer funding for more seaport security. It was routinely turned down. All of us offered this and were routinely turned down. We did not have the money. And we are inspecting 4 to 5 percent.

Someday, God forbid, if something happens at a seaport, we will all stand and scratch our heads and say: Why didn't we try to find a way to do this better, more inspections? Why didn't we understand that is more vulnerable even than airport security? Why didn't we figure that out?

This is an opportunity. I understand this will be controversial. I understand the President is going to be upset if the Congress takes action.

I will offer legislation today that is very simple. It does not tiptoe around 45 days and all these things. It just says this should not happen.

If that offends someone, I am sorry. But I do not want to offend common sense. And it seems to me, in this country there is a deep reservoir of common sense at the local cafe or down at the hardware store to say it would make the most sense, given the fact we are targeted by terrorists, it would make the most sense for our country to take responsibility for itself. This is not about globalism. It is not about the global economy. It is not about offending someone. It is about deciding as a country to assume responsibility for your security.

Let me make one other point. Yes, we need friends. Yes, we need the United Arab Emirates to be our friend and other countries as well to cooperate with us. But wouldn't it have been nice, for example, if we had more cooperation when Dr. Kahn in Pakistan was arranging to have nuclear materials and nuclear plans and nuclear parts sent around to North Korea and to Iran and to other countries? Our children will pay for that, unfortunately. And most of that material went through the United Arab Emirates' ports.

Wouldn't it have been nice if we had more friends? We need more friends. But, it seems to me, we ought not buy friendship by deciding that we will put a company controlled by the United Arab Emirates in the position of managing America's ports. Once again, this is merely common sense.

The GAO report of last summer ought to be instructive to us. If the Department of Defense cannot ensure its oversight of contractors under foreign influence, how on Earth can Homeland Security ensure oversight of a contractor that is owned by a foreign government in the Middle East? How on Earth can we expect that to happen?

I come to the Senate to talk a lot about trade. In this age of globalism people say: You are just a xenophobic isolationist stooge who does not get it. The world has changed. It is a global world. Everyone does everything everywhere.

It seems to me it is not inappropriate even in a global economy to pursue our own interests from time to time, and that is especially true when it deals with the subject of terrorism. Does the global economy mean that you outsource or offshore everything? Is there anything you cannot do without?

Some 15 years ago, I used to question Carla Hills, the trade ambassador, at various hearings. Managed trade was anathema to her, and it has been to virtually every administration. Yet virtually every country we do trade with has managed trade. They have managed trade with a set of objectives. I used to continually ask Carla Hill: Is there anything the loss of which would give you problems?

For example, if, in a completely open system of trade we lost our entire steel industry--it was gone, no steel mill and no steel produced domestically--would that give you a problem? The answer was, no, whatever happens, happens. That is nonsense. There are certain things that a country must hang on to to remain a strong economic power, a world economic power.

Maybe this, also, in addition to the national security issues--which I think are very important--maybe it is also an opportunity to wake up and answer the question: What is appropriate in a global economy? Is everything on the table? Everything for sale? Everything up for trading and grabs? Is offshoring just fine, notwithstanding what it means to the American economy?

Perhaps, if we use this opportunity to ask those questions, we will have done this country a favor.

In the meantime, I will introduce the simplest piece of legislation introduced on this subject. It simply says: ``Just say no.''

Mr. President, I am proud that I have introduced today along with Senators Clinton, Lautenberg, Nelson, and Boxer legislation that would guarantee that foreign governments cannot control the operations of the ports of the United States. I thank Senator Clinton for her leadership on this issue as we fight together, along with Senator Schumer and others, to keep the Port of New York/New Jersey safe.

I think we all know why public attention has been focused on this deal over the past 2 weeks. Our ports are the gateway to this country. They are the gateway for much that we eat, that we drink, that we wear, drive, and use on a daily basis. But just as they bring in goods we enjoy, the ports are also our Achilles' heel, the vulnerability that could be exploited in an attempt to bring us down if terrorists transport a nuclear, biological, or chemical weapon to our ports. That is why our legislation sets a new standard for the future control of our ports.

Our legislation would protect our national security by keeping our ports from falling into the hands of foreign governments. Our legislation bans foreign government-owned companies from operating in our ports and requires the President to report to Congress on how to manage national security risks arising from any existing port contracts. Our legislation would also end the secrecy associated with the Dubai deal by making the executive branch notify Congress as well as State and local officials of future deals. The legislation also includes a new public comment period.

Never again should the American public find out about a secret deal through the newspapers after the fact. Never again should Congress learn about the sale of a key U.S. infrastructure asset to a foreign state-owned company only after the deal is done. And never again can we compromise national security by turning our port operations over to another country, whether friend or foe.

Our message with this legislation today is clear: Never again.

I think all Americans instinctively know we cannot simply turn over our critical national security infrastructure such as terminal operations at our ports to a foreign government. Foreign governments act very differently than even foreign companies. Foreign governments act in their own national interests and in their own national security interests. Privately held foreign companies are controlled by stockholders and answer to the needs of the market, not the needs of a government. One must only study the way in which Venezuelan President Hugo Chavez has used his state-owned oil company to pursue the interests of the Government of Venezuela to understand that state-owned companies often behave very differently than publicly traded ones.

That is why our legislation bans foreign governments from owning, leasing, or operating any facilities in our ports. We believe that just as we would not turn over the operations of our airport facilities to a foreign government, why should we turn the operations of our ports, which are the biggest hole in our national security blanket, over to a foreign government.

The opponents of this thought process, of this bill, like to argue this is the reality of global trade. But the people making this argument are the same ones who constantly remind us that the world has changed since September 11 and that we must adapt our security response accordingly. Whatever happened before September 11, the world has changed since then and we cannot rely on our old methods of looking at the world in a traditional way.

One of the things the September 11 Commission told us was to think outside of the box. A simple envelope became a weapon of great injury when it was filled with anthrax; an airplane used to travel commercially or for pleasure was turned into a weapon of mass destruction. Think outside the box. And if we cannot think outside the box in the context of understanding how the ports in the United States, in the hands of a foreign government in an operational capacity, can have a security consequence, we are in trouble in this post-September 11 world. This is an area in which security must take priority over commercial transactions.

Make no mistake about it; the legislation is urgently needed, and I am writing the President today expressing my concern that this new 45- day review leaves the President with no authority to act to stop Dubai Ports World from taking control of United States port operations. I am not sure that is clear with this 45-day review. This transaction was set to close on March 2, and

we want to stop the clock now and make sure that 45-day investigative review period is precedent to the fulfillment of that agreement.

We also believe it is time to end the secrecy surrounding these deals. This secrecy apparently allowed the executive branch to ignore our own laws. These laws require a 45-day investigation of deals involving government-owned companies which could affect national security. Clearly a deal to turn over part of our port operations to a foreign government-owned company would impact national security. We know the Coast Guard warned the administration that there were intelligence gaps that made it impossible to determine the threats raised by the deal. Yet it is only now, after enormous external pressure, that this 45-day review period may be carried out. But starting an investigation that should have already been carried out under the law is not enough, and that is why, from my position on the Banking Committee, during hearings later this week, I plan to seek to discover why the law wasn't followed. I am looking forward to working with both the chairman and ranking member to come up with comprehensive solutions to these problems that emanated under the Committee on Foreign Investment in the United States.

As I said before, I am also concerned about the secrecy in this process. Many New Jersey residents have written or called me asking why the process in approving the deal was so secretive and why Congress was kept in the dark. It is clear to me, to the people of New Jersey, using their common sense, and to the American public that we must have transparency and openness as we address these national security issues.

Without our legislation, the committee that reviews this process doesn't even have to tell Congress about the deal until after it has made a decision. And even after they make a decision, they have no obligation to inform the American public. In the particular case of the Dubai Ports deal, the committee sent out no information and the press only learned about it when Dubai Ports World decided to put out its own press release. That is why our legislation would require the notification of Congress, State, and local authorities where appropriate, as well as a public comment period to allow the public impacted by any future deals to share their concerns with the Federal Government.

These are basic reforms which I think most Americans would agree seem necessary, almost obvious when it comes to protecting our ports. The fight to secure our ports cannot and will not end with this legislation.

Let me be clear: Our ports are not secure. I have been arguing on this for quite a long time as a former Member of the House of Representatives representing the Port of Elizabeth and Newark, the third largest port, the Port of New York/New Jersey and other ports on the eastern seaboard. For all the money the Nation has poured into improving our security, several critical links in the chain have been ignored, and this week the spotlight has shone brightly on one aspect of the problem: our ports, the port of entry for thousands of containers every day, holding everything from clothing to electronics. But these containers could also contain much more dangerous cargo such as a nuclear, chemical, or biological weapon.

The bottom line is we don't know what is in the vast majority of containers entering this country because despite repeated warnings from security experts from both within and without our Government, only 1 out of every 20 containers that passes through our ports is screened, and 95 percent receive no screening whatsoever other than a cursory glance at a cargo manifest.

It is crucial that we also develop a national transportation plan that includes a comprehensive strategy for protecting our ports. A weapon of mass destruction detonated in a shipping container at the Port of New York/New Jersey or any other seaport could cause tens of thousands of casualties and economic losses approaching a trillion dollars. According to the U.S. Coast Guard, $5.4 billion will be needed over the next 10 years for port security. Yet since the 9/11 attacks, Congress has provided less than $800 million.

This is not a new problem, and it should not be surprising that the administration has let this problem fester. They have continuously focused on the security of only one aspect of our critical infrastructure to the detriment of the rest. That is something we can no longer continue to accept.

In New Jersey we face the reality of failures in our national security every day when we look across the river at Ground Zero and mourn the loss of over 700 fellow New Jerseyans who died on September 11, 2001. The problem of port security is not in some distant future or some distant issue but an everyday reality, as we look at our own port which brings in hundreds of thousands of containers from around the world every day: 145 million tons last year from over 5,000 ships. This is a port that generates over 200,000 jobs and $25 billion of economic activity. It is a great economic engine. It is also a great risk.

In today's reality, a foreign government, if it were to be operating the facilities at one of those ports and simply wanted to do something as benign maybe as shutting it down at a critical moment, such as when we are sending supplies to our troops in the field--we use our commercial ports increasingly to send military equipment and supplies to back our troops in the field--imagine if it were shut down at a critical moment when we needed those supplies to be generated across the sea.

That is why we have to face these realities together. We must stand together across party lines and across States to fight for the safety and security of our families. Our ports are on the front lines in our fight against terrorism, and with this legislation, we say we will never again allow a deal which would compromise the national security of our ports, the safety of New Jersey, or the security of the United States.

I urge my fellow Senators on both sides of the aisle to join with us in this legislation.

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

Mr. President, I have sought recognition today to introduce the Community Cancer Care Preservation Act, which will ensure Medicare beneficiaries' access to community-based cancer treatment and provide Medicare reimbursement assistance for oncologists providing vital cancer care services.

Cancer takes a great toll on our friends, families, and our Nation. In the United States, cancer causes one out of every four deaths and was responsible for 570,000 deaths last year. In 2005, over 2 million new cases of cancer were diagnosed, the most prevalent of which were breast, prostate, lung, and colorectal.

While these statistics are daunting, the rate of cancer deaths in the United States has decreased since 1993. This decrease is the result of earlier detection and diagnosis, more effective and targeted cancer therapies, and greater accessibility to quality care provided by oncologists. These vital services have allowed millions of individuals to lead healthy and productive lives after successfully battling cancer.

In 2004, 42.7 million individuals were enrolled in Medicare; of those beneficiaries over 29 percent have had cancer during their lives, 12.5 million beneficiaries. With such a large percentage of our seniors facing this horrible disease, the need for access to community cancer care is critical.

Community cancer clinics treat 84 percent of Americans with cancer. Community cancer centers are free-standing outpatient facilities that provide comprehensive cancer care in the physician's office setting located in patients' communities. These clinics are especially critical in rural areas where access to larger cancer clinics is not available. They provide patients with earlier diagnosis, more effective cancer therapies, and innovative supportive care that reduces fatigue, nausea/ vomiting, and pain. The accessibility of treatment in the hands of skilled community oncologists has decreased the cancer mortality rate.

On December 8, 2003, the Medicare Prescription Drug Improvement and Modernization Act was signed into law by President Bush. This legislation contained numerous provisions that were beneficial to America's seniors and medical facilities; however, it also provided a reduction to Medicare's reimbursement for oncology treatment. The provisions sought to bring a balance to the reimbursement for the cost of cancer drugs and services. Previous to the implementation of the law, CMS reimbursed the cost of cancer treatment drugs at a very high level. This level provided sufficient funding to supplement the costs of care, storage of the prescription drugs, and the costs of cancer care services, which were not being provided adequate funding. The law enacted reimbursement reductions for the cost of prescription drugs while increasing the funding provided for cancer care services; however, that increase did not sufficiently offset oncologists' losses from the reduction in cancer drug reimbursement.

The Congressional Budget Office estimated that Medicare reimbursements to oncologists would be reduced by $4.2 billion from 2004-2013. PricewaterhouseCoopers estimates that reductions will reach $15.7 billion over that time. This increased reduction will have a debilitating effect on oncologists' ability to provide cancer treatment to Medicare beneficiaries, especially those in the community setting.

For 2006, the Centers for Medicare and Medicaid Services (CMS) estimates that the beneficiary reimbursement for services provided by community cancer care will be cut by 6.6 percent, a $200 to $300 million reduction. However, this reimbursement reduction may be larger than estimated. CMS did not factor in the delay in drug manufacturer price increases for cancer therapies and the bad debt of beneficiaries who may not pay their Medicare 20 percent co-insurance payment. When accounting for these reductions, the overall cut to cancer care will likely exceed $300 million.

The Medicare Prescription Drug and Modernization Act mandated a transitional increase of 32 percent in service fees in 2004, falling to 3 percent in 2005, and 0 percent in 2006. This was done to provide time for CMS to pay for essential unpaid medical services, such as pharmacy facilities and treatment planning. In 2005, CMS created a cancer care demonstration project as a quality enhancement initiative to examine the effects of oncology drugs on patients. This demonstration project also provided $300 million in critical funding because CMS had not increased the reimbursement for essential unpaid medical services. On June 29, 2005, I sent a letter with 38 other Senators to President Bush requesting an extension to the demonstration project through 2006. CMS, however, announced a new oncology demonstration project for 2006 that examines the quality of cancer care in relation to treatment guidelines, but at $180-$210 million less than the previous funding level.

Accordingly, I am introducing legislation to provide community oncologists with the tools to withstand the CMS reforms brought forth under the Medicare Prescription Drug and Modernization Act. The bill's $1.7 billion price tag, over the next 5 years, is a relatively small cost in the face of the vast reductions in CMS's reimbursement to oncologists. Let me briefly summarize the provisions of this legislation.

1. Sales Price Updates: Currently, CMS updates the prices for cancer treatment drugs quarterly. This delay in price updating forces community cancer clinics to often pay increased prices for prescription drugs for up to six months without increased reimbursement. This legislation requires the sales price for oncology drug reimbursement be updated as changes occur in the price to provide a more accurate reimbursement to oncologists for the cost of drugs. This will provide a reimbursement to oncologists that is fair and reflective of market costs.

2. Removal of the Prompt Pay Discount: The prompt pay discount is a discount from the wholesaler to the physician for prompt payment on prescription drugs. This is a benefit for physicians that operate an efficient and organized practice and allows them to gain extra revenue as an incentive for conducting business in that manner. The current average sales price for prescription drugs from CMS takes into account the prompt pay discount provided by wholesalers. The inclusion of these funds, which are not guaranteed unless the practice operates in a very efficient way, decreases the amount of reimbursement from CMS. My legislation would remove the discount from the CMS average sales price requiring CMS to reimburse oncologists at the price they pay for drugs without the inclusion of discounts.

3. Quality Care Demonstration Project Extension: The quality care demonstration project provided information to CMS that was gathered by oncologists about the effects of oncology drugs on patients. This project was altered and funds were reduced provided to conduct the informational interviews to oncologists. The bill would extend the 2005 quality cancer care demonstration project through 2006. The project collects information from cancer patients on the effects of cancer treatment including fatigue, nausea/vomiting, and the treatment of these symptoms.

4. Increase in Payments for Oncological Drug Storage: The CMS reimbursement for oncology prescription drugs does not provide adequate funding for storage and care needs. The prescription drugs for cancer care often require special provisions including refrigeration and handling as some drugs that are highly toxic. These special provisions result in an increased cost, which is why my legislation provides a two percent increase in payments to account for the storage and care of oncology drugs.

5. Reports Regarding Cancer Care: The legislation would also require a report from the Secretary of Health and Human Services on a plan to increase the number of cancer patients in clinical trails and a Congressional Budget Office Report on the effects of the Medicare Prescription Drug Improvement and Modernization Act of 2003 on cancer care. These reports will assist Congress and the Administration in its future decisions impacting cancer care.

As Chairman of the Labor, Health and Human Services, and Education (LHHS) Appropriations Subcommittee, I have sought to increase funding for the National Institutes of Health (NIH) and the National Cancer Institute (NCI). Since becoming Chairman of the LHHS Subcommittee, the funding for NIH has increased from $11.3 billion in fiscal year 1996 to $29.4 billion in 2006, an increase of 147 percent, while funding for the NCI increased from $2.3 billion in fiscal year 1996 to $4.9 billion in 2006, an increase of 113 percent.

On February 16, 2005, I was diagnosed with stage IVB Hodgkin's lymphoma and had my first chemotherapy treatment two days later. I had a total of 12 treatments, my last on July 22, 2005, and tests following that final treatment concluded that I am cancer free. As a recipient of cancer treatment for Hodgkin's lymphoma cancer, I have an acute understanding of the problems that confront patients as well as physicians that administer their care.

This legislation provides Medicare reimbursement assistance for community oncologists and ensures Medicare beneficiaries' access to community-based cancer treatment. I encourage my colleagues to work with Senators Coleman, Isakson and me to move this legislation forward promptly.

Mr. President, I have sought recognition today to introduce the Community Cancer Care Preservation Act, which will ensure Medicare beneficiaries' access to community-based cancer treatment and provide Medicare reimbursement assistance for oncologists providing vital cancer care services.

Cancer takes a great toll on our friends, families, and our Nation. In the United States, cancer causes one out of every four deaths and was responsible for 570,000 deaths last year. In 2005, over 2 million new cases of cancer were diagnosed, the most prevalent of which were breast, prostate, lung, and colorectal.

While these statistics are daunting, the rate of cancer deaths in the United States has decreased since 1993. This decrease is the result of earlier detection and diagnosis, more effective and targeted cancer therapies, and greater accessibility to quality care provided by oncologists. These vital services have allowed millions of individuals to lead healthy and productive lives after successfully battling cancer.

In 2004, 42.7 million individuals were enrolled in Medicare; of those beneficiaries over 29 percent have had cancer during their lives, 12.5 million beneficiaries. With such a large percentage of our seniors facing this horrible disease, the need for access to community cancer care is critical.

Community cancer clinics treat 84 percent of Americans with cancer. Community cancer centers are free-standing outpatient facilities that provide comprehensive cancer care in the physician's office setting located in patients' communities. These clinics are especially critical in rural areas where access to larger cancer clinics is not available. They provide patients with earlier diagnosis, more effective cancer therapies, and innovative supportive care that reduces fatigue, nausea/ vomiting, and pain. The accessibility of treatment in the hands of skilled community oncologists has decreased the cancer mortality rate.

On December 8, 2003, the Medicare Prescription Drug Improvement and Modernization Act was signed into law by President Bush. This legislation contained numerous provisions that were beneficial to America's seniors and medical facilities; however, it also provided a reduction to Medicare's reimbursement for oncology treatment. The provisions sought to bring a balance to the reimbursement for the cost of cancer drugs and services. Previous to the implementation of the law, CMS reimbursed the cost of cancer treatment drugs at a very high level. This level provided sufficient funding to supplement the costs of care, storage of the prescription drugs, and the costs of cancer care services, which were not being provided adequate funding. The law enacted reimbursement reductions for the cost of prescription drugs while increasing the funding provided for cancer care services; however, that increase did not sufficiently offset oncologists' losses from the reduction in cancer drug reimbursement.

The Congressional Budget Office estimated that Medicare reimbursements to oncologists would be reduced by $4.2 billion from 2004-2013. PricewaterhouseCoopers estimates that reductions will reach $15.7 billion over that time. This increased reduction will have a debilitating effect on oncologists' ability to provide cancer treatment to Medicare beneficiaries, especially those in the community setting.

For 2006, the Centers for Medicare and Medicaid Services (CMS) estimates that the beneficiary reimbursement for services provided by community cancer care will be cut by 6.6 percent, a $200 to $300 million reduction. However, this reimbursement reduction may be larger than estimated. CMS did not factor in the delay in drug manufacturer price increases for cancer therapies and the bad debt of beneficiaries who may not pay their Medicare 20 percent co-insurance payment. When accounting for these reductions, the overall cut to cancer care will likely exceed $300 million.

The Medicare Prescription Drug and Modernization Act mandated a transitional increase of 32 percent in service fees in 2004, falling to 3 percent in 2005, and 0 percent in 2006. This was done to provide time for CMS to pay for essential unpaid medical services, such as pharmacy facilities and treatment planning. In 2005, CMS created a cancer care demonstration project as a quality enhancement initiative to examine the effects of oncology drugs on patients. This demonstration project also provided $300 million in critical funding because CMS had not increased the reimbursement for essential unpaid medical services. On June 29, 2005, I sent a letter with 38 other Senators to President Bush requesting an extension to the demonstration project through 2006. CMS, however, announced a new oncology demonstration project for 2006 that examines the quality of cancer care in relation to treatment guidelines, but at $180-$210 million less than the previous funding level.

Accordingly, I am introducing legislation to provide community oncologists with the tools to withstand the CMS reforms brought forth under the Medicare Prescription Drug and Modernization Act. The bill's $1.7 billion price tag, over the next 5 years, is a relatively small cost in the face of the vast reductions in CMS's reimbursement to oncologists. Let me briefly summarize the provisions of this legislation.

1. Sales Price Updates: Currently, CMS updates the prices for cancer treatment drugs quarterly. This delay in price updating forces community cancer clinics to often pay increased prices for prescription drugs for up to six months without increased reimbursement. This legislation requires the sales price for oncology drug reimbursement be updated as changes occur in the price to provide a more accurate reimbursement to oncologists for the cost of drugs. This will provide a reimbursement to oncologists that is fair and reflective of market costs.

2. Removal of the Prompt Pay Discount: The prompt pay discount is a discount from the wholesaler to the physician for prompt payment on prescription drugs. This is a benefit for physicians that operate an efficient and organized practice and allows them to gain extra revenue as an incentive for conducting business in that manner. The current average sales price for prescription drugs from CMS takes into account the prompt pay discount provided by wholesalers. The inclusion of these funds, which are not guaranteed unless the practice operates in a very efficient way, decreases the amount of reimbursement from CMS. My legislation would remove the discount from the CMS average sales price requiring CMS to reimburse oncologists at the price they pay for drugs without the inclusion of discounts.

3. Quality Care Demonstration Project Extension: The quality care demonstration project provided information to CMS that was gathered by oncologists about the effects of oncology drugs on patients. This project was altered and funds were reduced provided to conduct the informational interviews to oncologists. The bill would extend the 2005 quality cancer care demonstration project through 2006. The project collects information from cancer patients on the effects of cancer treatment including fatigue, nausea/vomiting, and the treatment of these symptoms.

4. Increase in Payments for Oncological Drug Storage: The CMS reimbursement for oncology prescription drugs does not provide adequate funding for storage and care needs. The prescription drugs for cancer care often require special provisions including refrigeration and handling as some drugs that are highly toxic. These special provisions result in an increased cost, which is why my legislation provides a two percent increase in payments to account for the storage and care of oncology drugs.

5. Reports Regarding Cancer Care: The legislation would also require a report from the Secretary of Health and Human Services on a plan to increase the number of cancer patients in clinical trails and a Congressional Budget Office Report on the effects of the Medicare Prescription Drug Improvement and Modernization Act of 2003 on cancer care. These reports will assist Congress and the Administration in its future decisions impacting cancer care.

As Chairman of the Labor, Health and Human Services, and Education (LHHS) Appropriations Subcommittee, I have sought to increase funding for the National Institutes of Health (NIH) and the National Cancer Institute (NCI). Since becoming Chairman of the LHHS Subcommittee, the funding for NIH has increased from $11.3 billion in fiscal year 1996 to $29.4 billion in 2006, an increase of 147 percent, while funding for the NCI increased from $2.3 billion in fiscal year 1996 to $4.9 billion in 2006, an increase of 113 percent.

On February 16, 2005, I was diagnosed with stage IVB Hodgkin's lymphoma and had my first chemotherapy treatment two days later. I had a total of 12 treatments, my last on July 22, 2005, and tests following that final treatment concluded that I am cancer free. As a recipient of cancer treatment for Hodgkin's lymphoma cancer, I have an acute understanding of the problems that confront patients as well as physicians that administer their care.

This legislation provides Medicare reimbursement assistance for community oncologists and ensures Medicare beneficiaries' access to community-based cancer treatment. I encourage my colleagues to work with Senators Coleman, Isakson and me to move this legislation forward promptly.

Mr. President, I rise today to introduce, along with Senators Snowe, Akaka, Kerry, Durbin, and DeWine, the College Pathway Act of 2006. The intent of this bill is to provide a means of addressing the critical issue of college access and postsecondary academic success. College access for all will continue to be a struggle until the predictors of successful college performance are assimilated into high school curricula. The degree to which high school students are successfully prepared for college continues to be at the forefront of educational concerns. Reports abound repeating the same message: our high school students, particularly students from low-income and minority populations, are not being adequately prepared for the challenges of postsecondary education. The College Pathway Act seeks to foster alliances among the interested and integral stakeholders in the educational arena to create consistency in content and assessment standards between P-12 and higher education. We do this by encouraging the establishment of P-16 Commissions. We must rise to the challenge and forge a pathway to enhance both college access and academic success.

Postsecondary education is an important aspiration for most students and the future strength of our economy and workforce will largely depend on the postsecondary educational attainments of students across the country regardless of ethnicity or economic status. High school preparation is a major part of the problem. Published reports on the status of this topic stress the lack of preparedness of high school graduates for postsecondary education. Most will need remedial help in college. More than 70 percent of high school graduates enter two and four year colleges, but at least 28 percent immediately take remedial English or math courses. At some point during their college years, 53 percent of students will take one remedial English or math class if not more. For low-income and minority students, the percentage is higher. States require a certain number of English and math courses to be completed prior to graduation, however, the certainty of course content reflecting the knowledge and skills important for college success is not ensured.

Students find themselves taking high school courses lacking in rigor and challenging content, particularly in the areas of math and science. If asked, 39 percent of students who have gone on to a postsecondary institution will admit they were not adequately prepared for college and there were gaps in their overall preparation. College instructors estimate that 42 percent of their students are not adequately prepared. The quality and intensity of the secondary school curriculum are the most significant predictors of college success; and are more significant than race, socioeconomic status, secondary school grade point average, or ACT and SAT scores. These findings are particularly significant for minority groups enrolling in college. Students who engage in challenging secondary coursework will attend and persist in pursuing higher education at a greater rate than those who follow programs of study that are not rigorous in content. All states have English and mathematics standards and assessments at the high school level, yet assessment standards and tests often do not reflect the demands put on students in postsecondary education and in the workplace. High school curricula must be aligned with college entry requirements. The American Diploma Project states that the challenge ahead is to create a system of assessments and graduation requirements that considered together signify readiness for college and work. We, as Federal policymakers, have an essential role to play in making this a reality and creating college access for all.

In part, the misalignment between postsecondary institutions and high school stems from current governance systems in place for P-12 educational systems and higher education. Both systems are generally governed, financed and operated differently. This gap must be bridged between the two systems. Creating a pipeline of shared information between the two entities and the business community will promote an exchange of necessary and useful information. Working to align standards from the early grades through grade 12 recognizes that skill acquisition and content assimilation build one upon the other and acknowledges that high-school graduation and college success is a culmination of preparation originating in the beginning years of school. Aligning curricula

across school levels creates a more seamless education and ensures that students are prepared for each subsequent grade with particular attention to math, science, and engineering. Aligning P-12 and postsecondary education would reduce the number of students who arrive at college needing remedial coursework.

The need to develop high-quality data systems is also critical to improving high school student outcomes. Accountability for high school graduation numbers and drop-out rates is critical to addressing education reform in our high schools. Currently reports have indicated that the quality of high school graduation and drop-out data is often not reliable and does not reflect the actual numbers.

Tracking student growth over time using longitudinal student-unit databases will provide the most accurate information for policy decisions and assessments. Furthermore, information provided about student achievement over time can be linked to teachers, programs and schools serving those students. The National Governor's Association (NGA) recently convened a Task Force on State High School Graduation Data--which included representatives from the American Federation of Teachers, the Business Roundtable, the Council of Chief State School Officers, the Education Commission of the States, the Educational Testing Service, the Education Trust, the National Association of State Boards of Education, the National Conference of State Legislatures, the National Education Association, Standard and Poor's and the State Higher Education Executive Officers--to make recommendations about how States can develop a high-quality, comparable high school graduation measure, as well as complementary indicators of student progress and outcomes and data systems capable of collecting, analyzing, and reporting the data States need. The task force members concurred as a group on their mission and devised a compact to implement efforts to guide States in developing high quality data-systems ideally using a longitudinal student unit record data system. This compact was signed by 51 governors in all States and Puerto Rico. The ultimate goal is better outcomes for students. Better information can lead to better policies and program implementation. Our bill therefore includes incentives for States to develop or enhance such data systems.

The College Pathway Act supplies a remedy to the critical issue of the disconnect existing between high school outcomes and college expectations. Through the formation of partnerships between P-12 and higher education systems in the States, academic success in postsecondary education becomes the priority agenda item for reform. We anticipate that P-16 Commissions will bring about an increase in the percentage of academically prepared students, particularly low-income and minority students, and a decrease in the percentage of college students requiring remedial coursework, particularly with respect to math, science, and engineering.

The College Pathway Act of 2006 awards grants to States to establish P-16 Commissions in order to align P-12 outcomes with postsecondary institutions' expectations. The Commissions under the leadership of the governor or governor's designee, will convene stakeholders of the statewide P-12 education and higher education community, and may include parent groups, State legislative representatives, and particularly members of the business community. The commissions' goal to create a mission addressing college preparation will be the first and critical step of this process.

Many States across our country have already seen the wisdom of a P-16 commission and have been working on goals and implementation. The results, although preliminary for many States, are vastly encouraging. Our bill will provide support both to States with existing P-16 bodies, or States seeking to establish such commissions. It will give priority to the States also seeking to establish or enhance data systems.

The College Pathway Act of 2006 can offer States an opportunity to craft a vision that will reach all students over time so that their educational pathway of access to and success in college will be ensured.

I urge my colleagues to act favorably on this measure. I ask unanimous consent that the text of this bill be printed in the Record.