A bill to amend title 10, United States Code, to provide for uniformity in the awarding of disability ratings for wounds or injuries incurred by members of the Armed Forces, and for other purposes.

Mr. President, over the past weekend, our Nation observed Veterans Day, a day to commemorate the connection between the American people and America's veterans. This connection is something that the American people are always aware of at the bottom of their hearts, though it may not always be in the front of our minds as we go about our daily lives.

We Americans often define ourselves by the freedoms we enjoy. America's veterans are men and women who sacrificed some of their own freedoms to serve and defend our Nation. The connection between these two groups--the defended and the defenders--may not always be visible, but it cannot be denied. Veterans Day gave us the opportunity to recall that connection, to honor those who wore the uniform of our country.

As chairman of the Committee on Veterans' Affairs, it has been my privilege to work alongside other leaders in answering a simple question: How do we best honor veterans? Having so recently celebrated Veterans Day, I am pleased to report on the committee's work in the areas of legislation and oversight to try to answer that question.

The Committee on Veterans' Affairs has worked diligently to fulfill its oversight and legislative responsibilities, demonstrated in part by our hearing and meeting schedule. We have held 40 hearings and meetings, including 7 field hearings, since our organizational meeting in January. The committee has heard from 220 witnesses, and reported 4 nominees to the Senate, each of whom was later confirmed.

At our committee's very first meeting, I discussed my agenda to work with other members to bring the Department of Defense and the Department of Veterans Affairs together to provide a seamless transition for veterans from DOD to VA. We focused on seamless transition and set an agenda to pursue the issue in the coming year.

These actions were taken long before the horrible news reports about conditions at Walter Reed shocked the country into action. Our foresight positioned the committee, in collaboration with the Senate Armed Services Committee, to craft legislation that attacked the flaws within the DOD and VA systems. I am pleased that our legislative responses were incorporated into the National Defense Authorization Act. I look forward to seeing them become law.

Two weeks after the organizational meeting, the committee held its first hearing, which was on VA and DOD cooperation and collaboration. We heard testimony from officials from VA and DOD, as well as the personal stories of veterans who slipped through the cracks during their transition from military service to veterans status. This would be the first of a number of hearings the committee would hold on VA and DOD cooperation and collaboration. Later hearings on this issue focused on specific areas such as health care, education, information technology, and benefits.

In February, I contacted DOD on behalf of VA's Polytrauma Center health care providers so as to ensure that VA providers had easy and appropriate access to DOD's Joint Patient Tracking Application. This medical information sharing application is important to data sharing between VA and DOD. I was pleased when DOD responded shortly thereafter, providing assurance that they would resume their important data sharing practices.

The decision to focus on cooperation and collaboration between DOD and VA was made well before news broke on the deplorable conditions at Walter Reed. As these news stories moved questions about veterans care into the forefront of America's attention, our committee put our focus on the total system of care, involving DOD and VA.

Shortly after the press revelations of problems at Walter Reed Army Medical Center, I visited Walter Reed, along with my good friend and colleague, Senator Carl Levin, chairman of the Senate Armed Services Committee. On the way back to the Capitol from that visit, we agreed to hold an unprecedented joint hearing of the Armed Services and Veterans' Affairs Committee on the issue of DOD-VA cooperation and collaboration. On April 12, we held that hearing, further pursuing answers both about what was happening at Walter Reed and how we could fix it and about the overall state of the relationship between the two Departments.

From that hearing and subsequent work on the problems at Walter Reed and elsewhere in both the DOD and VA systems, and how those problems affected wounded servicemembers, it was clear that a commonsense approach was needed.

One specific focus of that effort was on how to reform the DOD disability system so as to promote greater uniformity among the services and between the services and VA. On April 30, I introduced S. 1252, a bill that would mandate a number of changes to the DOD disability evaluation system, including uniform use of the Veterans Affairs rating schedule across the military services, inclusion of all conditions which render a member unfit when making a disability rating, uniform training of Medical Evaluation Board/Physical Evaluation Board personnel, and accountability by DOD to ensure compliance with disability rating regulations and policies.

Just as veterans and servicemembers benefit when VA and DOD work together, the Committee on Veterans' Affairs and the Senate Committee on Armed Services saw an opportunity to collaborate on legislative solutions. All of the provisions of S. 1252 were included as part of S. 1606, the joint SVAC and SASC proposed Dignified Treatment of Wounded Warriors Act of 2007, which was later included in the 2008 National Defense Authorization Act.

While demands on VA have dramatically increased over recent years, VA funding has not. To allow the hard working men and women of VA to do their jobs without having to worry about whether there will be sufficient funding, we have sought a substantial increase to VA funding. I am pleased that the funding level in VA's fiscal year 2008 appropriations bill amounts to the largest funding increase in the history of the Department.

The appropriations bill also includes significant increases that will enable the Veterans Benefits Administration to pay for up to 3,100 new full-time employees. I hope the VBA will use these funds to attack the current backlog of veterans' claims aggressively. I will continue to work with my colleagues to enact this historic and long overdue increase in funding for veterans.

In working on the legislative front, the committee has taken a collaborative approach with other Members of the Senate and the House of Representatives. Our focus has been on getting good law enacted, whatever the vehicle. I am pleased to report on the committee's progress on many pieces of legislation, some of which have already been enacted into law.

As we continue to pursue adequate funds to pay for the true cost of war, we must also recognize that the nature of the battles our troops are fighting has changed as well. VA health care must be better prepared to address traumatic brain injury, the signature wound of the current war. To improve VA's diagnosis, treatment, and rehabilitation for traumatic brain injuries, I introduced S. 1233, the proposed Traumatic Brain Injury and Health Programs Improvements Act of 2007. This bill, amended to include a number of other health care provisions, was reported by the committee. In addition, many of the provisions of S. 1233 were later incorporated into the Wounded Warriors Act and the National Defense Authorization Act.

S. 1233 would increase access to VA health care for combat veterans, extending the period of eligibility during which recently released or discharged combat veterans have unfettered access to VA care from 2 to 5 years. This provision will help ensure that these newest combat veterans have more time to identify and deal with invisible wounds, such as traumatic brain injury and PTSD. Another key provision of the bill relating to the treatment of invisible wounds is a requirement that VA provide a servicemember with a mental health evaluation within 30 days of making such a request.

S. 1233 also would enhance care for older veterans already in the VA system. It would repeal the 2003 VA regulation which barred Priority 8 veterans, so-called ``higher-income'' veterans, from enrolling in the VA health care system, essentially re-opening the system to these veterans. Many issues have been raised this year with regard to access to VA care for veterans residing in more rural areas, and S. 1233 includes an entire section aimed at looking at ways to increase access for rural veterans.

I am also very proud of the provisions in S. 1233 that seek to expand and enhance services for homeless veterans. We all recognize the sad reality that veterans suffer disproportionately from homelessness. S. 1233 would not only increase the resources available to community-based entities that provide reintegration services to those who are already homeless, it would also provide supportive services to low-income veterans to help prevent homelessness.

This bill also contains a significant increase in the travel reimbursement benefit paid to certain veterans who are forced to commute long distances to access care at VA facilities. The current mileage reimbursement rate is only 11 cents per mile, and this rate has not been increased since 1978. The committee bill would increase the rate to 28 cents per mile--a substantial increase and one that will hopefully help ease the financial burden for those who have to travel sometimes hundreds of miles to get to a VA hospital or clinic.

Two other health care bills that I introduced this year are currently moving through the committee process--S. 2160, the proposed Veterans Pain Care Act of 2007, and S. 2162, the proposed Mental Health Improvements Act of 2007. The committee is scheduled to mark up both of these bills, along with two others, tomorrow. I hope to see each of them passed by the end of this year.

For too many veterans, returning home from battle will not bring an end to conflict. They will return home, but the things they have done and seen in combat will follow them. Invisible wounds such as PTSD are complicated and can manifest themselves in many different ways. Studies have estimated that as many as 1 out of every 5 Iraq

war veterans are likely to suffer from readjustment issues. It is clear that action is necessary on the part of Congress to ensure that VA is equipped to deal with these issues.

In April, the committee held a hearing dedicated to veterans' mental health concerns and VA's response. We heard very compelling testimony from witnesses who suffered the consequences of invisible wounds in their families and their own lives. Randall Omvig spoke of his son's suicide upon returning from Iraq. Tony Bailey spoke of his son's struggle with substance abuse, and of his ultimate death from it. Patrick Campbell shared his own experience with PTSD and the experiences of his fellow servicemembers. Their touching and often painful stories put human faces on an issue that is to often reduced to numbers.

The proposed Mental Health Improvements Act is a direct outgrowth of that hearing and the testimony given by those who have suffered with mental health issues and by their family members. The bill addresses the immediate needs of veterans by ensuring high quality mental health services at VA facilities and in their communities. The measure also seeks to address the plight of veterans who suffer both from PTSD and substance abuse.

S. 2160, the proposed Veterans Pain Care Act of 2007, would enhance VA's pain management program. It is estimated that nearly 30 percent of Americans--some 86 million people--suffer from chronic or acute pain every year. A recent study conducted by VA researchers in Connecticut found that nearly 50 percent of veteran patients that are seen at VA facilities reported that they experience pain regularly.

While pain increases in severity with age, it is also a growing problem among younger veterans who have been injured in the wars in Iraq and Afghanistan. Many of these veterans are coming home with severe injuries--often traumatic brain injuries--that require intensive rehabilitation. In some cases, younger veterans will have to live with the long-term effects of their injuries, of which pain is a large and debilitating part.

Pain management is an area of health care that by many accounts is not yet to up to par, in both the private and public sectors. S. 2160 would standardize VA's pain management program on a national, systemwide level, by requiring VA to establish a pain care initiative at every VA health care facility. Every hospital and clinic would be required to employ a professionally recognized pain assessment tool or process, and ensure that every patient who is determined to be in chronic or acute pain is treated appropriately. The bill also calls for comprehensive research on pain management to improve care for chronic pain.

During this session, I introduced S. 1163, the proposed Blinded Veterans Paired Organ Act of 2007, a bill that would offer enhanced benefits to veterans who suffer from service-connected impairment of vision. The bill was amended in committee and the language that was favorably reported to the full Senate was inserted into H.R. 797, the House companion, and passed on November 2. The Senate-passed H.R. 797 would broaden the benefit eligibility requirements for two distinct groups of veterans with impaired vision due to service--those with service-connected blindness in one eye who subsequently suffer loss of vision in the other eye later in life and those who receive special monthly compensation for multiple disabilities, including vision impairment.

The amended bill also includes a series of provisions that would enhance memorial and burial benefits for veterans and private cemeteries, including permanently authorizing VA to provide government headstones or markers for the privately marked graves of veterans interred at private cemeteries; instructing VA to design a medallion or other device to signify a decedent's veteran status, to be placed on a privately purchased headstone or marker, as an alternative to a Government-Furnished headstone or marker; extending the time limit for States to be reimbursed for the unclaimed remains of veterans; and authorizing $5 million for operational and maintenance expenses at State cemeteries. The provisions in the bill are fully paid for through legislative repeal of a Court of Veterans Appeals decision which inappropriately extended a needs-based benefit to a population that Congress did not intend to receive it.

Because inflation erodes the value of the dollar, Congress is responsible for adjusting compensation for service-connected disabilities. This year I sponsored S. 423, the proposed Veterans' Compensation Cost-of-Living Adjustment Act of 2007. The veterans' COLA legislation ensures that the purchasing power of veterans' benefits, including compensation for veterans and assistance for their survivors, is maintained. This annual COLA is done in recognition of the Nation's gratitude towards veterans young and old for their service and sacrifices.

As the sponsor of the Senate version of this bill, I was pleased to support the passage of the House companion, H.R. 1284. I applaud Congress and the President for their work in making it law as of Monday, November 5, 2007. I hope veterans, including the 17,000 recipients of compensation who are served by VA's Honolulu Regional Office, benefit from this demonstration of our appreciation.

Oversight investigations carried out by committee staff uncovered concerns in the veterans' benefits system as well. To improve the benefits system, the committee reported S. 1315, the proposed Veterans' Benefits Enhancement Act of 2007. This bill would improve veterans' life insurance, adaptable housing, education benefits, and provide the committee with more oversight data. It would also address a 60-year wrong that is still being done to Filipino veterans who served under the U.S. Armed Forces during World War II.

In the years since the end of the Second World War, Filipino veterans and their advocates, especially my distinguished colleague, Senator Inouye, have worked tirelessly to secure these veterans the status they were promised when they agreed to fight under U.S. command in defense of their homeland and to protect U.S. interests in the region.

This bill would also more than double the maximum amount of Veterans Mortgage Life Insurance that a service-connected disabled veteran may purchase from $90,000 to $200,000. The VMLI program was established in 1971 and is available to those service-connected disabled veterans who have received specially adapted housing grants from VA. In the event of the veteran's death, the veteran's family is protected because VA will pay the balance of the mortgage owed up to the maximum amount of insurance purchased.

The measure would also establish a new program of insurance for service-connected disabled veterans that would provide up to a maximum of $50,000 in level premium term life insurance coverage. This new program would be available to service-connected disabled veterans who are less than 65 years of age at the time of application. Under the new program, eligible service-connected veterans would be able to purchase, in increments of $10,000, up to a maximum amount of $50,000 in insurance.

S. 1315 would also increase the amount of supplemental life insurance available to totally disabled veterans by 50 percent, from $20,000 to $30,000. This provision stems from S. 643, the proposed Disabled Veterans Insurance Act of 2007, which I introduced in February of this year. Many totally disabled veterans find it difficult to obtain commercial life insurance. This legislation will give totally disabled veterans better life insurance, a small measure of support for veterans who sacrificed so much.

In addition, this bill would expand eligibility for retroactive benefits from traumatic injury protection coverage under Servicemembers' Group Life Insurance. This insurance program went into effect on December 1, 2005. All insured servicemembers under SGLI from that point forward were covered under traumatic injury protection regardless of where their injuries occur. However, individuals sustaining traumatic injuries between October 7, 2001, and November 30, 2005, which were not incurred as a direct result of Operations Enduring or Iraqi Freedom, are not eligible for a retroactive payment under the traumatic injury protection program. S. 1315 would expand eligibility to these individuals.

The reported bill would allow for home improvements for totally disabled servicemembers prior to release from active duty. This provision is very important because many servicemembers return home to finish their rehabilitation and recuperation prior to discharge from the military. Their homes need to be adapted so that they can live comfortably and independently.

S. 1315 also contains a number of provisions derived from S. 1215 which I introduced on April 25 that would make four small but necessary changes in existing laws relating to education and employment. First, it would restore the funding cap on the amount of funding available for State Approving Agencies to the fiscal year 2007 level of $19 million. Without this restoration, these entities that assist VA in approving programs of education would be facing a reduction of more than 30 percent beginning in fiscal year 2008. It is particularly important for SAAs to have adequate resources as more veterans return to civilian life and begin to use their educational benefits.

Second, it would update the special unemployment study required to be submitted by the Secretary of Labor to the Congress by requiring that it cover veterans of Post 9/11 Global Operations. It would also require the report to be submitted on an annual, rather than a biennial, basis. By updating this report, we will have more data available to us on more recent groups of veterans those who served and are serving in the Gulf War and Post 9/11 Global Operations. This should better help us assess the needs of current veterans entering the work force and develop appropriate responses.

Third, the bill would extend for 2 years a temporary increase in the monthly educational assistance allowance for apprenticeship or other on-the-job training. Eliminating the temporary increase would mean a monthly benefit rate cut on veterans enrolled in this type of training and remove marketable incentive to encourage individuals to accept trainee positions they might not otherwise consider.

Finally, the bill would provide for a waiver of the residency requirement for State veterans' employment and training directors. By giving the Secretary of Labor the ability to waive the 2-year residency requirement, this provision would help ensure that the best qualified individuals from any state may be considered for SDVET vacancies.

Both S. 1233 and S. 1315 were reported to the Senate in late August and have been pending floor action ever since. It is most unfortunate that we have been unable to reach agreement to proceed to their consideration, due in part to an abrupt and unexpected change in the minority committee leadership. Late last week, just days before Veterans Day, the other side of the aisle affirmatively blocked consideration of this important legislation that has the support of a majority of the members of the Veterans' Affairs Committee. Let me be clear--I do not expect all Members to support or agree with these bills, only to allow for their consideration by the full Senate. If members have amendments to offer, bring them forward. We can then craft an agreement under which the Senate might do its work and debate these bills.

One final legislative item that I wish to mention--recently, I worked with my colleague Senator Webb on a matter of symbolic and real importance to servicemen and women as well as to veterans. Concerned that the Department of the Army was in a rush to replace the Tomb of the Unknown at Arlington National Cemetery, I introduced an amendment to the National Defense Authorization Act requiring the Army to prepare a comprehensive report for Congress before any further action could be taken. I am hopeful that this provision will be in the final agreement on the NDAA and look forward to the report, and its recommendations on how to best steward this national treasure.

As chairman of the Senate Veterans' Affairs Committee, I am mindful of the employment issues facing veterans, members of the Guard and Reserves, and their families as they seek to move from the military to the civilian workforce. Making this transition is never easy, and for younger veterans it can be particularly difficult. For members of the National Guard and Reserves, returning to a job they previously held may be challenging for a variety of reasons. For family members, the uncertainty of multiple and extended deployments poses different obstacles. Finally, the obstacles facing those who are disabled during their service can sometimes seem overwhelming. The needs of these individuals deserve our utmost attention and resources.

The committee has held two oversight hearings on employment issues this session. The more recent of the two hearings focused specifically on the Uniformed Services Employment and Re-employment Rights Act of 1994, or USERRA. As our troops are returning home from battle, many of them seek to return to the jobs that they held prior to their military service, particularly those serving in Guard and Reserve units. I must admit to being particularly upset at the volume of USERRA claims related to Federal service. It is simply wrong that individuals who were sent to war by their government should, upon their return, be put in the position of having to do battle with that same government in order to regain their jobs and benefits.

It is well known that veterans make good employees. Despite the challenges many face, veterans across the country are working and excelling in the labor force. They know how to work and they bring with them a wealth of expertise and experience. I believe the employment data supports my belief since rates of unemployment for veterans generally are lower than their nonveteran counterpart. However, the rate of unemployment for younger veterans and those recently separated from active duty tends to be higher than their nonveteran peers. I pledge to continue to pursue these issues aggressively in the months ahead.

The issues regarding veterans' educational benefits are especially important to me. Having attended college at the University of Hawaii under the original World War II GI bill, I know the value of this important benefit first hand.

The complexity and the importance of the issues surrounding the various education assistance programs administered by VA have been heard at two hearings this session. I plan to build off of the findings from both hearings for the committee's future work in this area. Educational assistance benefit has an important role in terms of a readjustment benefit for returning veterans and servicemembers. Properly tailored, these same benefits form an important keystone in recruiting and retaining high caliber young men and women in the Armed Forces. The balance between these twin goals is very complex and needs careful examination.

I am concerned that the current structure of benefits has some flaws. It is disturbing to me that servicemembers who are in the line of fire and who place their own safety in jeopardy in service to our country have to pay for their educational benefits. It is also disturbing that members of the Guard and Reserve who complete multiple deployments in combat situations run the risk of having no educational benefits available to them.

I do not expect to see a quick or easy answer for veterans' education benefits reform. I believe we will need to build a foundation for cooperation, compromise and consensus building. That will take some time. But I believe this process has begun, and that by working together, we will be able to develop something that is really meaningful to veterans, their families, and their futures.

As I noted earlier, the committee held seven field hearings over the year. The first, chaired by Senator Brown, was held on May 29, 2007, in New Philadelphia, OH, and focused on the issues facing veterans in the rural areas of Appalachia. Two months later, the committee held its second field hearing, chaired by Senator Testor, again focusing on the needs of rural veterans. This hearing was held on July 21, 2007, in Great Falls, MT. These hearings, along with the insights of our committee members, enabled the committee to develop and mark up legislation to address certain issues facing rural veterans.

On August 17, 2007, Senator Murray chaired a field hearing in Tacoma, WA. The hearing focused on the mental health care services available to veterans and servicemembers in the State of Washington.

In August, I chaired a series of field hearings in my home State of Hawaii, on the islands of Maui, Oahu, and the Big Island. These hearings brought high-ranking VA officials from Washington, DC, to examine the state of VA services for Hawaii's veterans and returning servicemembers.

On August 28, 2007, the committee held a field hearing in Augusta, GA, on cooperation and collaboration between VA and DOD, chaired by Senator Isakson. The specific focus of the hearing was on VA and DOD care for wounded servicemembers returning from Afghanistan and Iraq.

The committee has also carried out aggressive oversight activity during this session. Since January, the majority staff has conducted 95 days of oversight involving 28 trips to 18 states as well as to Korea, Guam and American Samoa. Oversight investigations have included visits to nine separate VA regional offices.

During these nine visits, oversight staff reviewed a total of 119 individual veteran claim files, including 45 claim files for members of the National Guard and various Reserve units. Claims were selected for review based upon claims for service-connected disability due to traumatic brain injuries, posttraumatic stress disorder, or musculoskeletal conditions. In particular, the reviews were conducted to identify any systemic problems impeding the fair and efficient adjudication of veterans' claims.

On a national level, one of the most critical issues identified by the claims review was a VA regulation which resulted in the denial of a rating higher than 10 percent for almost all traumatic brain injuries, or TBI, claims. As noted earlier, TBI has been described as a signature wound of the current conflicts. Medical evidence supports the view that severe long-term consequences can result from blast injuries involving improvised explosive devices, or IED, such as those used in Iraq and Afghanistan. Despite this, VA adjudicators believed that they could not authorize a rating in excess of 10 percent, or $115 per month, because of a current VA regulation.

Upon learning of this problem, I contacted VA's Under Secretary for Benefits, Daniel Cooper, to ask why veterans with migraine headaches were eligible for higher disability ratings than combat veterans with TBI. I was pleased when Under Secretary Cooper informed me that VA adjudicators have been instructed to stop limiting ratings to 10 percent if not warranted. However, because Under Secretary Cooper's instruction is not binding upon the Board of Veterans Appeals or the United States Court of Appeals for Veterans Claims, I also wrote to the Acting Secretary for Veterans Affairs, Gordon Mansfield, to ask that the ``10 percent and no more'' regulation be rescinded. I understand that VA is now working on new regulations for the adjunction of TBI claims which will hopefully resolve this matter. I will continue to monitor these claims and VA's actions.

In addition to the restrictive instruction in the rating schedule, it appears that neither the military services nor VA are providing comprehensive and thorough evaluations of veterans with mild and moderate TBI. While veterans who are being treated at polytrauma centers appear to be getting appropriate diagnosis and treatment, this is not true for veterans with significant, but less severe injuries. I believe that it is imperative that veterans with silent wounds, such as mild and moderate TBI have a comprehensive evaluation of their signs and symptoms by appropriate medical specialists. New data, such as the recently released information from VA that nearly 6 percent of the veterans from Iraq and Afghanistan screened have sustained traumatic brain injuries, adds to the importance of legislation that improves VA's ability to respond aggressively.

Review of service medical records for claims involving PTSD indicated poor follow-up, assessment and referral of servicemembers who endorsed symptoms of PTSD on postdeployment surveys. This matter has been noted by the GAO and others. In some cases, veterans were discharged for a ``personality disorder'' which was not manifested prior to combat exposure and with no evaluation of classic PTSD symptoms. In other cases, veterans with significant psychiatric symptoms were not considered for a military disability retirement, but were awarded benefits by VA upon discharge.

The committee's oversight investigations indicate that VA generally did a better assessment of claims for service-connected PTSD than the military services. However, for some disorders, VA will not grant service-connection for the small number of veterans who were diagnosed with PTSD during military service without independent verification of the stressor which gave rise to the diagnosis by military doctors. Some veterans who served in Iraq, but did not receive a medal acknowledging their participation in combat, have experienced difficulty establishing their ``personal participation in combat'' in order to validate the existence of a combat stressor.

Under current law, veterans who allege disabilities related to their combat experience may prove their claim without presentation of official military documents. In order to clarify this issue and provide combat veterans with the benefits intended, I recently introduced S. 2309, the proposed Compensation for Combat Veterans Act. This bill would provide that service in a combat zone, recognized as such under the Internal Revenue Code, shall be sufficient proof that the veteran engaged in combat for purposes of the relaxed evidentiary requirement. I hope that we will be able to address this issue in the coming months.

There is no question that the Guard and Reserve have experienced difficulties due to our current combat engagements, in a fashion quite similar to branches such as the Army and Marine Corps. There is some concern that members of the National Guard and Reserve units receive less favorable consideration of their service-connected claims than members of the Armed Forces. While oversight investigations did not substantiate allegations of less favorable treatment for Guard and Reserve claimants, other issues may require further analysis. Many regional office staff reported significant difficulties in obtaining copies of the medical records of members of the Guard and Reserve. As a result, I wrote to the National Guard Bureau to express my deep concern about a policy that I had been told exists in some states that requires National Guard members to sign a release form before their Service Medical Records can be shared with VA for purposes of adjudicating a claim for compensation benefits. Acting upon my request, the National Guard Bureau sent guidance to the field that removes the requirement that servicemembers sign release forms to have their records provided to VA.

VA cannot be expected to end the benefits backlog if it lacks the staff to adjudicate veterans claims. While VA froze hiring in this area, there has been an increase in the number and complexity of claims received. As a consequence, the backlog has ballooned beyond already disconcerting levels. Although the infusion of additional monies for staff should improve the situation, some offices have too few experienced staff compared to the number of new hires. Oversight studies have found that less experienced staff is more likely to make errors on veterans' claims.

In some cases, service medical records are maintained in an electronic format and are not provided to VA adjudicators in any form. In other cases, medical reports are scanned into the Veterans Health Administration electronic records, but are not able to be viewed by VA adjudicators who use a CAPRI system to access VHA records. I have questioned VA about the need to make these records available to VBA and am awaiting a response.

While the committee does much direct oversight, as chairman, I also rely on the VA's inspector general. Indeed, the IG has consistently served as the committee's right hand in the execution of our oversight responsibilities. In the last year alone, the IG has provided us with a number of professional inquests and reports on issues of critical importance to veterans' health care. In the areas of traumatic brain injury, mental health, and substance abuse, among others, the IG has identified the problems and solutions with an insightfulness that few can match. The IG has also responded to my investigation requests in an efficient and collegial manner. The IG is, without question, the central gear in VA's internal

controls and quality assurance mechanism.

All American's have a role to play in honoring veterans. Ordinary citizens give in extraordinary ways, such as volunteering at VA hospitals and VA shelters, and supporting local Veterans Service Organizations. For those of us who serve in Congress, we have a special privilege and responsibility to honor veterans by ensuring that they receive the benefits and care they have earned through service. This Congress has done much for veterans already, but there is more to be done.

The Committee on Veterans' Affairs will continue to do its share throughout this Congress. To name just two items of pending business, we will hold a markup tomorrow on pending legislation, including a bill that is designed to improve significantly VA's programs which address the mental health needs of veterans, especially those recently returned from combat, and second, the Committee is preparing to consider the nomination of Dr. James Peake to become Secretary of Veterans Affairs.

I close with this thought: On the battlefield, one never leaves behind a fallen comrade. Similarly, veterans should never be left behind by a system designed to care for and honor them. We cannot stand by while veterans who have fought for our country have to fight to get the care and benefits they have earned through their service. The Committee on Veterans' Affairs will respond to whatever challenges may arise in our work on behalf of those who rose up to defend and serve our Nation. To our veterans: Our thoughts, prayers, gratitude, honor and pride are with you, not only on Veterans Day, but always.

Mr. President in February, a series of articles in the Washington Post highlighted shortfalls in the care and treatment of our wounded warriors at the Walter Reed Army Hospital. These articles described deplorable living conditions for some service members in an outpatient status; a bungled, bureaucratic process for assigning disability ratings that determine whether a service member will be medically retired with health and other benefits for himself and for his family; and a clumsy handoff between the Department of Defense and the Department of Veterans Affairs as the military member transitions from one department to the other. The Nation's shock and dismay reflected the American people's support, respect, and gratitude for the men and women who put on our Nation's uniform. They deserve the best, not shoddy medical care and bureaucratic snafus.

The Armed Services Committee and the Veterans' Affairs Committee held a rare joint hearing to identify the problems our wounded soldiers are facing. These committees continue to work together to address these issues, culminating in the bill we introduce today, the Dignified Treatment for Wounded Warriors Act. Our bill addresses the issues of substandard facilities, inconsistent disability ratings, lack of seamless transition from DOD to the VA, inadequacy of severance pay, care and treatment for traumatic brain injury and post-traumatic stress disorder, medical care for caregivers not eligible for TRICARE, and the sharing of medical records between the Department of Defense and the Department of Veterans Affairs.

The Dignified Treatment for Wounded Warriors Act requires the Secretary of Defense to establish standards for the treatment of and housing for military outpatients. These standards will require compliance with Federal and other standards for hospital facilities and operations and will be uniform and consistent throughout the Department of Defense.

Another shortfall identified in the aftermath of the Washington Post articles is the inconsistency in disability ratings for the same and similar disabilities. In many instances, disability ratings assigned by the Veterans' Administration are higher than the disability ratings assigned by the military services for the same injuries. The military services are not even consistent among themselves in assigning disabilities. The Dignified Treatment for Wounded Warriors Act addresses the issue of disparate disability ratings in several ways.

First, it requires the military departments to use VA standards for rating disabilities, allowing the military to deviate from these standards only when the deviation will result in a higher disability rating for the service member. In our view, requiring all of the military departments and the VA to use the same standards should result in identical disability ratings for the same or similar disabilities.

Second, the act will change the statutory presumption used by the military departments for determining whether a disability is incurred incident to military service or existed prior to military service to mirror the statutory presumption used by the VA. Currently, the military rule is that a disability is presumed to be incident to service if a member has been in the military for 8 or more years. That leaves out a high percentage of our troops. Under the revised rule, a disability will be presumed to be incident to service when the member has 6 months or more of active military service and the disability was not noted at the time the member entered active duty, unless compelling evidence or medical judgement warrant a finding that the disability existed before the member entered active duty. This should avoid the situation where the military assigns a disability rating of zero percent on the basis that a disability existed prior to service and the VA later awards a higher disability rating and disability compensation by using the VA presumption to conclude that the very same disability is service connected.

Third, the act will require two pilot programs to test the viability of using the VA to assess disability ratings for the Department of Defense. One pilot program will require the Veterans' Administration to assign the disability ratings for the Department of Defense, based on all medical conditions that render the service member medically unfit for military service. The other pilot program will require the military department and the VA to jointly assign the disability rating, also based on all medical conditions that render the service member medically unfit for military service.

Fourth, the act will require the Secretary of Defense to establish a board to review and, where appropriate, correct disability determinations of 20 percent or less for those service members separated from service because they were medically unfit for duty after September 11, 2001. This will give our service members an opportunity to correct unwarranted low disability ratings and ensure that disability ratings are uniform and equitable.

The Institute of Medicine has just completed a study for the Veterans' Disability Benefits Commission, concluding that current VA standards are out of step with modern medical advances in conditions such as traumatic brain injury and modern concepts of disability. The Disability Commission is due to report to Congress on its findings and recommendations in October. The Dignified Treatment for Wounded Warriors Act will require the Department of Defense to use any updated standards as soon as the Veterans' Administration adopts them.

Our bill addresses the lack of a seamless transition from the military to the Veterans' Administration by requiring the Secretary of Defense and the Secretary of Veterans Affairs to jointly develop a comprehensive policy on the care and management of service members who will transition from DOD to the VA. This policy will address the care and management of service members in a medical hold or medical holdover status, the medical evaluation and disability evaluation of disabled service members, the return of disabled service members to active duty when appropriate, and the transition of disabled service members from receipt of care and services from the Department of Defense to receipt of care and services from the VA.

Another problem identified by the committees is the inadequacy of separation pay for junior service members. Those separated with a disability rating of 30 percent or higher are medically retired with health care and additional benefits for the service members and their families. Those separated with a disability rating of less than 30 percent are discharged and given a severance pay that is based on how long they were in the military. For example, a service member with 2 years of service will receive the equivalent of only 4 months basic pay as severance pay. This bill increases the minimum severance pay to 1 year's basic pay for those separated for disabilities incurred in a combat zone and 6 months' basic pay for all others. Furthermore, under current law, severance pay is deducted from any VA disability compensation these service members receive. Our bill changes that by eliminating the requirement that severance

pay be deducted from disability compensation for disabilities incurred in a combat zone.

The signature injuries of the current conflicts are post-traumatic stress disorder, commonly referred to as PTSD, and traumatic brain injury, referred to as TBI. We still have a lot to do to adequately respond to these injuries. To address this, the Dignified Treatment of Wounded Warriors Act authorizes $50 million for improved diagnosis, treatment, and rehabilitation of members with TBI or PTSD. The act also requires the Secretary of Defense to establish Centers of Excellence for PTSD and for TBI. These centers will conduct research, train health care professionals, and provide guidance throughout the Department of Defense in the prevention, diagnosis, mitigation, treatment, and rehabilitation of these injuries. Finally, the act requires the Secretary of Defense, in consultation with the Secretary of Veterans Affairs, to report to Congress with comprehensive plans to prevent, diagnose, mitigate, treat, and otherwise respond to TBI and PTSD. These plans will address improvements of personnel protective equipment in addition to addressing the medical aspects of diagnosing and treating TBI and PTSD.

We are also addressing the problem that exists because medically retired service members, who are eligible for TRICARE as retirees, do not have access to some of the cutting-edge treatments that are available to members still on active duty. To address this shortfall, the act authorizes medically retired service members with disability ratings of 50 percent or higher to receive the active duty medical benefit for 3 years after the member leaves active duty.

We are also beginning to address the problem created when parents, siblings, and others who are not normally authorized to receive military health care leave their homes to serve as caregivers to military personnel with severe injuries while the members are undergoing extensive medical treatment. In many cases, these family members leave their jobs and lose their job-related health care. Even though these family members are in a military hospital, they are not authorized to receive medical care from the doctors at that facility when they need it. To address this, the act authorizes military and VA health care providers to provide urgent and emergency medical care and counseling to family members on invitational travel orders.

One of the significant shortfalls in the smooth transition from military health care to VA health care is the inability to share health records between the two Departments. Our bill will establish a Department of Defense and Department of Veterans Affairs Interagency Program Office to develop and implement a joint electronic health record.

The Dignified Treatment of Wounded Warriors Act is a comprehensive bill that lays out a path for the Department of Defense and the Department of Veterans Affairs to address shortfalls in the care and management of our wounded warriors. They deserve the best care and support we can muster. The American people rightly insist on no less.

Mr. AKAKA Mr. President, as chairman of the Veterans' Affairs Committee and as a member of the Armed Services Committee, I was delighted to work with Senator Levin, chairman of the Armed Services Committee, and others on this important legislation, the Dignified Treatment of Wounded Warriors Act of 2007. I really appreciated the willingness of the Armed Services Committee staff to work in close cooperation with the Veterans' Affairs Committee staff on its drafting. This legislation would improve the policies which govern the care and management of all servicemembers with a serious illness or injury that might render them unfit for duty in order to facilitate and enhance their care, rehabilitation, and physical evaluation, as well as improve their transition from the Department of Defense to the Department of Veterans Affairs.

This measure is a direct outcome of an unprecedented joint hearing held on April 12, 2007, by the Senate Armed Services and Veterans' Affairs Committees during which we heard testimony on the transition of servicemembers from DoD to VA. This measure will go a long way toward addressing the problems that first gained public attention with the stories about Walter Reed Army Medical Center and will help achieve the goal of providing optimal care and a truly seamless transition for the nation's wounded warriors.

I view issues relating to those servicemembers who may be rendered unfit as a result of an illness or injury from two different perspectives, both as chairman of the Veterans' Affairs Committee and as a member of the Armed Services Committee. As I said at the joint hearing, this is not solely a DoD or a VA problem. While DoD and VA are separate organizations, they both deal with the same servicemembers. A key element of this proposed legislation is the requirement that DoD and VA develop a comprehensive policy for transitioning those with serious illnesses or injuries from Active Duty military status to veteran status. As part of this effort, the two Departments will be required to conduct a comprehensive review of all regulations, policies, and procedures that impact these servicemembers and to identify best practices when developing joint policy. If we are going to fix the problems identified at Walter Reed, there must be uniform standards for the transition process that are understood by all parties and that are consistently applied by the military services.

I am delighted that the Dignified Treatment of Wounded Warriors Act embraces the reforms to the DoD Disability Evaluation System contained in S. 1252, legislation I introduced on April 30, 2007. For the Disability Evaluation System to work fairly and consistently, there must be uniform use by the military services of VA's disability rating schedule. The services must take into account all conditions which render a servicemember unfit when making a disability rating, as well as develop a program for the uniform training of Medical Evaluation Board and Physical Evaluation Board personnel. It is also essential that DoD develop a system of accountability to ensure that the military services comply with disability rating regulations and policies.

I am pleased to note that on June 27 the Veterans' Affairs Committee will conduct a markup of legislation that will complement the efforts of the Armed Services Committee to make sure that VA appropriately addresses problems confronting seriously wounded and injured servicemembers once they become veterans.

I commend Chairman Levin and the staff of the Armed Services Committee for crafting this comprehensive legislation. It will go a long way toward providing DoD and VA with a roadmap for improving the transition processes and ensuring that seriously ill and injured servicemembers and veterans get the benefits and services they need and deserve, the benefits and services these courageous men and women have earned by their service.

I urge all of our colleagues to support this proposed legislation.

Mr. President, I rise today to introduce legislation to close the U.S. detention facilities at Guantanamo Bay, Cuba.

Guantanamo has become a lightning rod for international condemnation. Both allies and enemies have decried the stories of detainee abuse and the U.S. refusal to acknowledge that the individuals held at Guantanamo are legally entitled to be treated in accord with the Geneva Conventions. In short, the continued use of Guantanamo is causing more damage than benefit in our war on terrorism.

The Supreme Court determined last summer that the Geneva Conventions applies to Guantanamo detainees, and Congress passed the Military Commissions Act in response. There remain court challenges and policy questions as to whether the proceedings at Guantanamo are now legal. What is clear, however, is that, whether legal or not, Guantanamo is harming our national interests.

This is not solely my view.

Secretary of Defense Gates testified recently before the House Defense Appropriations Subcommittee. He said, ``I came to this position believing that Guantanamo should be closed. I know that people have expressed that as a wish. The president has expressed it as a wish.'' The Secretary remarked that Guantanamo has ``a taint about it.''

According to media accounts, the current and former Secretaries of State, Condoleezza Rice and Colin Powell, share this view.

Unfortunately, these expressions will not necessarily lead to concrete action. On March 23, White House Press Secretary Tony Snow stated that it was unlikely that the Guantanamo detention facility would close during the Bush Presidency.

That is unfortunate, but I think the way forward is now clear. It is time to close the detention facilities at Guantanamo, and it is time for the Congress to act. And so today I am proud to offer legislation to end detention operations at Guantanamo within a year.

Approximately 750 enemy combatants--including individuals believed to be Taliban fighters or al-Qaida irregulars have been sent to Guantanamo since January 11, 2002. Roughly 385 are there today, and it is estimated that only 60 to 80 of them will ever be charged. According to a Pentagon spokesman last month, another 80 detainees remain at Guantanamo despite having been cleared for transfer or release.

This is an untenable situation.

Let me be clear. I have no room in my heart for al-Qaida members or affiliates. I know full well that they would kill innocent Americans given half the chance. But the people in this administration who have made these decisions have never recognized that it is not just for the detainees' sake that we comply with U.S. and international law, it is to our benefit as well.

As Senator McCain and GEN Colin Powell have forcefully argued, we treat individuals in accordance with international law to ensure that Americans captured in battle are treated likewise.

Unfortunately, due to the administration's decision not to apply Article 3 of the Geneva Conventions and to allow new interrogation techniques, there have been abuses. These have been documented, among other places, in the official report by Air Force LTG Randall Schmidt on June 9, 2005.

Ironically, use of these techniques not only turned the tide of world opinion and shocked our consciences, but they are inconsistent with producing accurate intelligence.

The second major result from mistaken administration policies has been our fall from the world's leader in the realm of ideals, not just in power.

The detentions at Guantanamo have been decried, from moral leaders such as Archbishop Desmond Tutu to political leaders like Tony Blair.

Archbishop Tutu said, ``I never imagined I would live to see the day when the United States and its satellites would use precisely the same arguments that the apartheid government used for detention without trial. It is disgraceful.''

Prime Minister Blair commented that Guantanamo Bay is an ``anomaly that at some point has to be brought to an end.''

While world leaders and various offices of the United Nations have criticized Guantanamo, terrorists around the world have used it to rally new recruits. Just like the horrible scenes from Abu Ghraib, we have found evidence that the disrespect for Islam and the Koran at Guantanamo has helped breed a new generation of terrorists.

The legislation that I introduce today would close the Guantanamo detention facilities within a year of enactment.

Everyone being held at that time would have to be transitioned to an alternative legal status. There are five major options. Detainees could be transferred to a civilian or military facility in the United States and charged with a violation of U.S. or international law for prosecution in a civilian or military proceeding; transferred to a facility in the United States for continued detention, for individuals judged to be enemy combatants; transferred to any international legal tribunal that may be authorized for this purpose; transferred to their home nation or a third-party government for further processing. This would require that the Government obtain the required assurances that the detainee will not be tortured or otherwise handled in a matter against international law; or for detainees judged to pose no continuing security threat to the United States or our allies, released.

What would this accomplish?

First, and most importantly, it would end the stain on America's reputation and reiterate that we are a nation of laws and justice.

Second, moving trials to the United States, whether under the military commission process or otherwise, would enhance the credibility of those proceedings. As Secretary Gates testified, ``no matter how transparent, no matter how open the trials, if they took place at Guantanamo in the international community, they would lack credibility.''

Finally, moving detainees to the mainland would ease the logistics of trials and oversight. It would obviate the need for the government to run its own airline business shuttling Members of Congress, lawyers, reporters, and military police to Guantanamo.

Some will argue that closing Guantanamo will damage our security. Let me make clear: I am not for releasing any terrorist, any Taliban fighter, or anyone that we will have to face again on the battlefield.

We have high-security prisons and military brigs around the nation and know how to keep prisoners from harming the local population. In fact, the Justice Department has successfully convicted Sheikh Omar Abdel-Rahman and Ramzi Yousef for their roles in the first World Trade Center bombing. Jose Padilla was held in a naval brig, and is currently awaiting a trial in the United States. Our military and criminal justice systems are up to this task.

Nor is it the case that moving detainees from Guantanamo will hinder our ability to gain intelligence from them. In fact, the majority of detainees are not being interrogated at Guantanamo, and almost none of them have any actionable intelligence left after imprisonment for years.

Finally, I am aware that legislation has been introduced to amend the Military Commissions Act, especially with regard to its habeas corpus provisions. I support these efforts. But legal experts have testified that moving detainees to the United States would have little impact on the Government's ability to prosecute them. The procedures of the Military Commissions Act, or any other court martial or criminal proceeding, do not depend on the location of the trial. Indeed, the Supreme Court has already held that legal process at Guantanamo is subject to U.S. law.

As I said at the beginning of my remarks, it is our responsibility to ensure that the war on terror is being fought in a way that maximizes our ability to prevail. The situation at Guantanamo has impeded our success. It has strained our relations with key allies. It has provided fodder to our detractors. And it has dampened the national support we need to keep fighting our enemies.

After more than 5 years, it is time to close this prison. I urge my colleagues to support this legislation.

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

Mr. President, as ranking member of the Senate Armed Services Committee I am pleased to co-sponsor the Dignified Treatment of Wounded Warriors Act, which would ensure that wounded and injured members of the Armed Forces receive the care and benefits that they deserve.

We were all surprised and deeply disappointed by the conditions at Walter Reed and the problems that our wounded warriors faced after their inpatient care was complete, living in substandard conditions at Building 18, being treated poorly, battling a Cold War-era disability evaluation process, and for some, simply falling through the cracks.

Since February of 2007, many encouraging changes have been initiated by the Department of Defense. First and foremost, Secretary Gates established and enforced a culture of accountability for the leadership failures that lead to the tragedy at Walter Reed. Medical facilities have now been inspected by all three military departments, and improvements are underway. Additional counselors and support has been provided to families. On April 25, 2007, a new Warrior Transition Brigade stood up at Walter Reed to manage all the needs of wounded and ill soldiers, both Active and Reserve. DOD has begun to exert greater management responsibility for the disability

evaluation systems of the military departments. We are on the right track to address the problems at Walter Reed and at other hospitals. We need to ensure that the effort is sustained. This legislation will ensure that these efforts continue.

The legislation requires that the Secretaries of Defense and Veterans Affairs work together to develop new policy to better manage the care and transition of our wounded soldiers. This policy would address many of the concerns that have been raised by wounded soldiers and their families, conditions while in a medical hold status, the need to streamline and make more transparent the medical and physical evaluation board processes, policies that facilitate the return to duty for soldiers who are able, and a policy governing the smooth transition of separating service members from the Department of Defense to the Department of Veterans Affairs which focuses on the needs of patients.

This legislation would improve health care benefits to severely wounded soldiers by extending their health care benefits as if the member were on active duty for a period of up to 5 years. This approach ensures that our most severely wounded have as many health care options as possible, especially for treatment of traumatic brain injury and other long term serious conditions.

This legislation authorizes additional funding for traumatic brain injury and post-traumatic stress disorder and requires the establishment of two centers of excellence for the prevention, research and treatment on these consequences of war. This legislation would also require DOD to develop a comprehensive plan for research, prevention and treatment of traumatic brain injury, which is long overdue in addressing the so-called signature injury of this war.

The administration requested, and this bill would provide, additional authorities to the Department of Defense to hire health care professionals to care for our service members and their families. It would also require the Department of Defense and Department of Veterans Affairs to jointly develop an electronic health record that can easily be shared between the two departments.

With respect to disability determinations for wounded warriors who leave military service, this legislation would require the Secretary of Defense to establish a special review board to independently review the findings and decisions of the Physical Evaluation Boards of the military departments since 2001, in cases in which the disability rates of 20 percent or less were awarded and members were not medically retired. We must act, in light of data showing that some members, particularly junior enlisted soldiers, may have unfairly been denied medical retirement. This legislation empowers the special board to correct military records and, if appropriate, restore to a wounded soldier a higher disability rating or retired status.

The bill would also end the requirement that disabled service members pay back severance pay if they obtain a higher disability rating from the VA, and increase the amount of severance pay that separating members receive.

To address the need for fundamental change in the way that the DOD and VA disability evaluation systems are structured, a belief shared by many of my colleagues, this legislation would require the Secretary of Defense to immediately implement pilot projects to test new improvements to the disability evaluation system. Such pilot programs will help expedite implementation of needed changes to the disability evaluation system.

This legislation would also require the Secretary of Defense to establish uniform standards for medical treatment facilities and medical residential housing facilities, and a DOD investment strategy to remedy all medical facility deficiencies. It would also require the Secretary of Defense to study the feasibility of accelerated construction of state-of-the art facilities and consolidation of patient care services at the new National Medical Center at Bethesda. As a condition for the closure of Walter Reed Army Medical Center, it would require the Secretary of Defense to certify that health care services would remain available in their totality until the new facility and staff are in place to effect a seamless transfer of care. The current facilities at Walter Reed have served the Nation well, but we can and must do better.

This legislation is a start on the journey to restore trust for America's wounded and her veterans, but it is not our final destination. It will take time to understand fully the complexities of the DOD and VA disability systems and to reconcile them in the best interests of our wounded veterans.

We must also look to the Department of Veterans Affairs to improve access to care for wounded veterans and improvements in its handling of veterans claims for disabilities. We must ensure that the VA maintains a robust medical infrastructure for quality health care, teaching and research, but one that also supports veterans beyond the limits of bricks and mortar in communities throughout the nation. I am developing legislation which would require the Secretary of Veterans Affairs to establish health care access standards for veterans with a service- connected disability throughout the VA health care delivery system, and, similar to DOD's TRICARE system, when services cannot be provided by the VA, authorize that care to be purchased from civilian providers. Civilian health care specialists are eager to do their part for America's veterans. Given the strain on the veterans health system, and the limits to our resources, we should give them that chance, and make certain that our Nation's veterans get the care that they need, when they need it.

There is no more important responsibility than to act on our moral obligation as a Nation to those who are willing to give their blood for its freedom. Let us continue to be guided by the words of President George Washington in 1789, who said, ``the willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional as to how they perceive the Veterans of earlier wars were treated and appreciated by their country.''

I hope that my colleagues will join Senator Levin and me in a bipartisan effort to make a difference in the lives of our service members who have given so much in support of our Nation.

Mr. President, it is with mixed emotions that I rise today to introduce the Rural Hospital and Provider Equity Act of 2007, or R-HoPE. This proposal is the result of months of work with my friend and colleague, Senator Craig Thomas, who just passed away. In fact, Senator Thomas and I were getting ready to introduce this bill the week we lost him.

This particular legislation is the product of work that Senator Thomas and I have done over many years as cochair of the rural health caucus. So it is a poignant moment for me to come to the floor to introduce this bill. I am asking my colleagues that we name this bill the Craig Thomas Rural Hospital and Provider Equity Act of 2007, as we pay tribute to the service of our colleague, Senator Thomas.

I can think of no better champion of rural health than Senator Craig Thomas, and there is not a more appropriate way to honor his Senate career than by enacting this legislation that will carry his name.

As Senator Thomas and I continually argued in this Chamber, Medicare shortchanges many rural hospitals and providers. Before the Medicare Modernization Act, rural providers received one-half the payments that urban areas received--one-half to provide exactly the same treatment for exactly the same illness. That was unfair.

Senator Thomas and I teamed up at the time to make changes that were in the Medicare prescription drug bill that began to level the playing field, but those provisions are about to run out.

I would be the first to admit that health care can be more expensive in urban areas than rural areas, but it is not twice as much. When I ask the doctors and hospital administrators of my State if they get a rural discount when they buy technology for hospitals, they laugh, they chuckle, they say, no, they don't get any rural discount. We know now it actually costs more to recruit doctors to rural parts of the country than it does more urban settings, and we know while there is some cost differential, it is not a 100-percent cost differential.

The Medicare bill, the prescription drug bill recognized this disparity in reimbursement and took steps to close the gap. Even with the additional funding, many rural hospitals and providers continue to experience negative margins.

If we are to maintain access to health care in rural areas, we cannot allow providers to lose 3 percent on nearly every patient they see. But that is what is occurring in rural America today.

Congress needs to take steps to fairly reimburse rural providers for the care they provide. The Craig Thomas R-HoPE bill will build on the progress made in the medicare Prescription Drug Act and add new provisions that would protect access to rural health care.

First, the bill will fulfill the promise made to those living and traveling in rural areas that they don't have to travel far for hospital care. The bill would also provide more reflective reimbursement for the cost of labor in rural areas. I should say reimbursement that more fairly reflects the costs in rural areas since they are often competing with more urban areas in the global health care marketplace.

In addition, our proposal would provide the resources currently lacking in rural hospitals to repair crumbling buildings. It also includes two changes to the Critical Access Hospital Program and will put these facilities on a sounder financial footing.

Second, R-HoPE will promise that rural Americans can see a doctor when they are sick. As is the case with most rural States, much of North Dakota is designated as a health professional shortage area. Recruiting doctors is extremely difficult. Our bill would extend the provision in current law that provides incentive payments for doctors who practice in rural areas.

Third, our bill would guarantee that when there is an emergency, there is an ambulance there to respond. Many rural ambulance services are closing because of lower Medicare reimbursement, resulting in response times far above the national average. R-HOPE would protect rural ambulance services and those living and traveling in these parts of the country by providing a 5-percent bonus payment for 2008 and 2009.

Finally, our bill takes a number of steps to help protect the availability of other health care providers, such as rural health clinics, home health agencies, and mental health professionals. This bill achieves the goal Senator Thomas and I have had for a number of years, that rural America enjoy the same level of health care access and affordability more urban areas enjoy. Rural America is the heart of our country. We cannot turn our backs on these areas and their health care needs.

Before I close, I also want to recognize Senator Thomas's staff member, Erin Tuggle, who has worked tirelessly on this legislation on behalf of rural health care and served Senator Craig Thomas so very well. She played a key role in developing this legislation, along with my staff, and I thank her for her efforts.

It is my hope this legislation, which will carry Senator Craig Thomas's name, will help strengthen our rural health care system. I can't think of a better tribute to my friend and our colleague, Senator Craig Thomas.

At this point, I wish to indicate that Senator Roberts is my leading cosponsor, Senator Roberts of Kansas, and we are joined by Senator Harkin, Senator Salazar, Senator Domenici, Senator Bingaman, Senator Smith, Senator Nelson of Nebraska, Senator Snowe, Senator Murray, Senator Thune, Senator Dorgan, Senator Collins, Senator Johnson, and Senator Enzi. I ask unanimous consent that they all appear as cosponsors of this legislation.

I should also indicate before I close that this bill has now been endorsed by the National Rural Health Association, the American Hospital Association, the American Ambulance Association, the American Telemedicine Association, the National Association for Home Care & Hospice, the American Association for Marriage and Family Therapy, the National Association of Rural Health Clinics, the North Dakota Hospital Association, and the Federation of American Hospitals, all of them joining together to send a message that this legislation is needed and it is needed now.

This is one way we can pay a tangible tribute to the service of Senator Craig Thomas. I think all of us who knew him and worked with him knew him as

a quintessential gentleman, and I hope very much that others of our colleagues will join us in cosponsoring this legislation in this tribute to Senator Thomas.