Medicare Durable Medical Equipment Access Act of 2007

I rise today, along with Senator Brownback, to introduce the Iran Sanctions Enabling Act of 2007. Before proceeding, I want to commend Chairman Frank for introducing similar legislation on the House side--he is a major force behind this legislation and should be recognized for his work on this issue.

This bill will enable citizens, institutional investors, and State and local governments to ensure that their money is not being used by companies that help develop Iran's oil and gas industry. This would place additional economic pressure on the Iranian regime with the goal of changing Iranian policies.

The Obama-Brownback legislation does this in three ways:

First, this legislation requires the U.S. government, every 6 months, to publish a list of companies that are investing more than $20 million in Iran's energy sector. This sunshine provision accomplishes two important objectives. It provides investors with the knowledge they need to make informed decisions about the consequences of their investments. And, since it is already illegal for U.S. companies to make such investments, it provides a powerful incentive for foreign companies to discontinue investments in Iran.

Second, this legislation authorizes State and local governments to divest the assets of their pension funds and other funds under their control from any company on the list. Several states, such as Florida and Missouri, have already taken actions to achieve these ends. But the States' authority to undertake these measures is unclear, so an explicit authorization from Congress, contained in this bill, will resolve this issue.

Third, this legislation seeks to give fund managers safe harbor and also provide investors with more choices. For fund managers who divest from companies on this list, the Obama-Brownback bill helps protect these managers from lawsuits brought by unhappy investors. The bill also expresses the sense of Congress that the government's own 401(k) fund, the Thrift Savings Plan, should create a ``terror-free'' and ``genocide-free'' investment options for government employees.

We need this bill, as Iranian actions have been well-documented. Iran's pursuit of a nuclear program, and its unwillingness to allow comprehensive international oversight, pose unacceptable risks to the United States and our allies. The international community has voiced its opposition to Iran's nuclear ambitions. For example, the U.N. Security Council passed resolutions last December, and again in March of this year, increasing sanctions on Iran for its failure to suspend uranium enrichment.

The Iranian regime has been actively sowing the seeds of instability and violence in Iraq, with deadly consequences for American soldiers. Beyond Iraq's borders, Iranian leaders are exporting militancy, sectarianism, and rejectionism throughout the Middle East. Fueled by the billions of dollars it earns from oil and gas exports, Iran has been pumping money into radical Islamist terror groups like Hezbollah and Hamas. Every bit as worrying is the rhetoric of President Mahmoud Ahmadinejad publicly calling to ``wipe Israel off the map.''

It is quite a list. But in the midst of all of this, there are signs that some Iranians understand the impact their regime's behavior is having on Iran's national interests. Conservatives in Iran look where the radicals are trying to take the country--more confrontation and more radicalism, and they are worried.

We should send a message that, if Iran wishes to benefit from the international system, it must play by international rules. If it chooses to flout those rules, then the world will turn its back on Iran. Pressuring companies to cut their financial ties with Iran is an important piece of that process, and we should allow pension funds to do so.

For all of its bluster, Iran is not a strong country. Its oil infrastructure is weak and badly in need of investment. The economy lurches under the weight of quasi-state run industries, and billions of dollars in Iranian cash sit offshore because Iranians have so little faith in their government's management of the economy. This is precisely why we need legislation along the lines of what I am introducing here today.

In general, we need to think carefully about allowing divestment, which is a tool that can be misused. However, I believe that Iran is a special case. And, in this case, divestment legislation can dissuade foreign companies from investing in energy operations whose profits will be used to threaten us. It is not a magic bullet--there is none in this situation--but is one of a menu of actions, each of which can help us to deter Iranian aggression.

We are currently involved in one ruinous war, and we need to avoid indiscriminate saber-rattling which could involve us in another. This administration's failure in Iraq has emboldened and empowered Iran, and the forces allied with it, including Hamas and Hezbollah. And while we should take no option, including military action, off the table, sustained and aggressive diplomacy combined with tough sanctions should be our primary means to deal with Iran. It is incumbent upon us to find and implement ways to pressure Iran short of war, ways that demonstrate our deep concern about Iran's behavior, and ways that will help us to exert leadership on this issue. This bill is one of those ways.

I have called for direct engagement with Iran over its efforts to acquire nuclear weapons. But, direct dialogue, as we conducted with the Soviet Union during the Cold War, should be part of a comprehensive diplomatic strategy to head off this unacceptable threat. So should the legislation Senator Brownback and I are introducing today.

I hope my colleagues will cosponsor the Obama-Brownback legislation. On the House side, I hope my colleagues in that Chamber sign on to the Frank bill. I look forward to working with others to get this bill signed into law.

In closing, I want to thank Daniel McGlinchey and James Segel of Chairman Frank's staff for their work on this bill. They were extraordinarily helpful in putting together this legislation, and I would be remiss I did not recognize their efforts.

Mr. President, I rise today to introduce, on behalf of myself and good friend, Senator Gordon Smith, the United States Commitment to Global Child Survival Act of 2007.

This bill seeks to drastically reduce child and maternal mortality rates abroad. It is a goal entirely within our reach, relying on tools that are already within our grasp. We have the power to save millions of innocent lives; and there is no better measure for the success of our foreign aid.

The legislation would perform three simple yet vital functions. First, it would require the administration to develop and implement a strategy to improve the health of, and reduce mortality rates among, newborns, children, and mothers in developing countries.

Second, it would establish a task force to monitor and evaluate the progress of the relevant departments and agencies of our Government in meeting by 2015 the U.N. Millennium Development Goals related to reducing mortality rates for mothers and for children under 5.

Third, it would authorize appropriations for programs that improve the health of newborns, children, and mothers in developing countries. Specifically, it would increase funding for child survival programs from the current level of around $350 million to $600 million in fiscal year 2008, $900 million in fiscal year 2009, $1.2 billion in fiscal year 2010, and up to $1.6 billion in fiscal year 2011-2012.

I know that some of my colleagues will dispute the wisdom of such a large investment. None of them would deny this issue's importance; but some may question its priority. How can we answer them?

In a world of seemingly intractable problems, we have here an opportunity for quick and uncomplicated success. Each dollar we spend in this cause helps to save a vulnerable life.

And what is more, we have already given our word. As part of the Millennium Development Goals, the United States made an explicit commitment, along with 188 other countries, to reducing child and maternal mortality. But at current funding levels, we are set to renege on that promise by a wide margin.

On September 14, 2005, President Bush stated that the United States is ``committed to the Millennium Development Goals.'' I commend the President for his words, but they have not been matched with action.

As we reach the goals' halfway mark, the world's progress is distressingly slow. The leading medical journal The Lancet reports that, of the 60 countries accounting for 90 percent of child

deaths, ``only 7 are on track to meet the goal for reducing child mortality, 39 are making some progress, and 14 are cause for serious concern.''

Now what does that mean in real, human terms? It means each year over 10 million children under the age of 5 die in the developing world, that's approximately 30,000 each day. About 4 million of those children die in their first 4 weeks of life. In many cases, they aren't even provided with a fighting chance. Preventable or treatable diseases such as measles, tetanus, diarrhea, pneumonia, and malaria are the most common causes of death.

Similarly, more than 525,000 women die from causes related to pregnancy and childbirth, more than 1,400 each day. Some of the most common risk factors for maternal death include early pregnancy and childbirth, closely spaced births, infectious diseases, malnutrition, and complications during childbirth.

Nearly every one of those deaths is entirely preventable. And that fact makes a poor American commitment inexcusable.

That commitment will not require new medicine. It will not require sophisticated technology. The tools we need are already at hand. Even now, simple measures are saving lives in the developing world.

Studies in the Lancet tell us that, for just over $5 billion, the world could prevent two-thirds of under-5 child deaths with proven, low-cost, high-impact interventions. For 6 million lives, that is a bargain.

How cheap are these lifesaving measures? Oral rehydration therapy for diarrhea costs 6 cents per treatment. Antibiotics to treat respiratory infections cost a quarter per treatment. Encouraging breastfeeding, providing vitamin supplements and immunizations, and expanding basic clinical care are just as cost effective.

This bill incrementally scales up U.S. funding for child and maternal health programs up to $1.6 billion by 2011. That is a third of the money the world needs to save those 6 million children's lives, and it is proportionate to our efforts against HIV/AIDS, TB, and malaria. And it is less money than we spend in Iraq in just 1 week. Yes, 1 week.

To be clear, America is not new to this battle. We've had some significant successes: Between 1960 and 1990, U.S. investment in reducing child mortality in the developing world contributed to a 50 percent reduction in under-5 deaths. Over the past 20 years, we have devoted over $6 billion to child survival programs.

But as I have noted, at current funding levels in the U.S. and abroad, the world will not meet the Millennium Development Goals. Certainly, America cannot meet them alone. But with a strong effort, we can galvanize other nations to do their part and come forward with the funds we need to save lives.

So I am proud to offer the Global Child Survival Act of 2007, a bill with widespread, bipartisan, bicameral support. It has been endorsed by Save the Children, the US Fund for UNICEF, and the One Campaign; is being jointly introduced with my good friend Senator Gordon Smith from across the aisle; and was introduced last week in the House in a bipartisan manner by Congresswoman Betty McCollum and Congressman Chris Shays.

For me it's simple. As the world's only superpower and largest economy, the United States is in a unique position to tackle the toughest challenges of our times. Where we can make a concrete difference, we must not fail to act. Where we have the tools to alleviate death and suffering, we must deliver them.

So I urge my colleagues to support this bill. Millions of lives are in the balance.

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

Mr. President, I rise today with my colleagues Senator Collins from Maine and Senator Warner from Virginia to introduce legislation to strengthen the Department of Defense nanotechnology initiative. I greatly appreciate their strong leadership on this issue and their understanding of the importance of how the development of nanotechnology will impact our armed forces in the future.

This bill, the Defense Nanotechnology Research and Development Act of 2007, sustains the Department's nanotechnology research and development program while at the same time transitioning the technologies developed into products that can enhance the United States military capability.

The Department of Defense has done a tremendous job conducting nanotechnology research and development. Examples of this nanotechnology research include improved energy absorbing body armor, lightweight batteries, and novel chemical and biological sensor. I believe now is the time to start the transition of this research into new technologies and products to protect our military personnel and enhance our war fighting capability.

The Department of Defense has a long history of successfully supporting innovative nanotechnology research efforts for the future advancement of the war fighter and battle systems. Congress established the defense nanotechnology research program Section 246 of the Bob Stump National Defense Authorization Act for fiscal year 2003, Public Law 107-314, which this bill updates and enhances. Section 246 requires the Secretary of Defense to carry out a defense nanotechnology research and development program in coordination with other Federal agencies performing nanotechnology research and development activities established by the 21st Century Nanotechnology Research and Development Act, Public Law 108-153. The investment strategy described in the National Nanotechnology Initiative, or NNI, Strategic Plan identifies and defines 7 major subject categories, or program component areas, relating to areas of investment that are critical to accomplishing the overall goals of the NNI. The Department of Defense has organized its nanotechnology research to align with these 7 program component areas and each year since 2004 has submitted to Congress an annual report on the nanotechnology programs within the Department of Defense.

This bill requires the Secretary of Defense to act through the Under Secretary for Acquisition, Technology and Logistics, who shall supervise the planning, management, and coordination of the program. We believe this office can best achieve the goals of maintaining a state- of-the-art research and development program while simultaneously accomplishing technology transition. The bill directs the Department to coordinate all nanoscale research and development within the Department of Defense with other departments and agencies of the United States that are involved in the NNI and with the National Nanotechnology Coordination Office, NNCO, including providing appropriate funds to support the NNCO. The bill also directs the Department to develop a strategic plan for defense nanotechnology research and development that integrates with the NNI strategic plan, issue policy guidance each year to the defense agencies and services that prioritizes the Program's research initiatives, state a clear strategy for transitioning the research into products needed by the Department of Defense, and develop a plan to transition nanoscale research and development within the Department of Defense, including the Small Business Innovative Research and Small Business Technology Transfer Research programs, to the Department of Defense Manufacturing Technology program.

Finally, the bill requires the Department to submit a biennial report to the congressional defense committees describing the Department's coordination with the other departments and agencies participating in the NNI, a review of the findings relating to the Department by the NNI triennial external review, an assessment of the Department's technology transition from research to enhanced war fighting capability, an evaluation of nanotechnology used in foreign defense systems, and an appraisal of the defense nanotechnology manufacturing and industrial base. Because there is a need for metrics and goals to ensure that the Department's nanotechnology program is well structured and successfully developing needed defense technologies, the bill requires a review by the Government Accountability Office of the overall Department nanotechnology program.

Nanotechnology is one of the next great scientific frontiers with the potential to enable novel applications that can enhance war fighting and battle system capabilities. I am proud to say that in Arkansas several universities including the University of Arkansas, the University of Arkansas at Little Rock, and Arkansas State University are performing research and technology development in support of the Department of Defense nanotechnology program. One example of particular note is the Center for Ferroelectric Electronic-Photonic Nanodevices that is developing new nanomagnetic devices for high performance information and communication technology. Our Arkansas small businesses are also contributing to the defense nanotechnology industrial base by developing novel nanoscale materials, devices, and products.

I am very excited by the future nanotechnology holds for Arkansas and the United States. As a member of the Senate Armed Services Committee I look forward to working to strengthen the Department of Defense nanotechnology program.

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

Mr. President, I am pleased to join Senators Conrad and Roberts in introducing the Medicare Durable Medical Equipment Access Act of 2007.

Some background on why this bill is necessary might be useful.

Among the provisions of the Medicare Modernization Act, MMA, was a provision that instituted a bidding process for durable medical equipment. It was a good concept--we have all seen the advantages to Medicare beneficiaries and to the Federal Government of competitive bidding in Medicare Part D. The government and beneficiaries are paying lower prices for prescription drugs as a result of fair competition.

At the time of the passage of the MMA, it was known that Medicare was overpaying substantially for certain durable medical equipment. The MMA instituted a bidding process for durable medical equipment in order to bring market discipline to the purchasing process. It also directed the Secretary of Health and Human Services, HHS, to establish badly needed quality standards for Medicare's suppliers of durable medical equipment and related services.

The purpose of S. 1428, the Medicare Durable Equipment Access Act, is to correct problems arising from provisions in the MMA that apply to rural areas and urban areas of low population density. The bill seeks to protect the access of Medicare beneficiaries in these areas to homecare equipment and services. It also will allow small businesses to participate in the program, but only if they meet the quality standards established in this legislation and can meet the competitively bid price.

The bill protects Medicare beneficiaries in three ways.

First, the MMA permits the HHS Secretary to exempt from the bidding process rural areas and areas with low population density that are not competitive unless there is a significant national market through mail order for a particular item or service. The law also permits suppliers in rural areas to be exempted from the program's quality standards. Medicare patients must be assured that they are dealing with qualified suppliers and our bill assures them that they will be.

Second, the MMA allows the Secretary of HHS to exempt rural areas and sparsely populated urban areas from the bidding process if they lack health care infrastructure, a vague and subjective judgment. This bill defines areas eligible for exemption as metropolitan service areas with fewer than 500,000 people.

Finally, the MMA established a Program Advisory and Oversight Committee to advise the Secretary on implementation of the program. The MMA exempted the Program Advisory and Oversight Committee from The Federal Advisory Committee Act, FACA. FACA was enacted by Congress in 1972. Its purpose is to ensure that committees that advise the executive branch be accessible to the public and objective in their judgments. This bill places this program under FACA.

This legislation also provides important protection to small businesses. The MMA provides that there shall be no administrative or judicial review for businesses participating in competitive bidding. Our bill provides for judicial appeal rights, giving legal recourse to businesses that participate in the competitive bidding process.

The MMA also directs the HHS Secretary to take appropriate steps to ensure that small suppliers have an opportunity to participate. Our bill specifies that such appropriate steps shall include permitting suppliers that are classified as small businesses under the Small Business Act to continue to participate at the single payment amount, so long as they submit bids at less than the fee schedule amount.

In addition, the MMA permits the HHS Secretary to use competitive acquisition bid rates from one region to determine payment rates in another noncompetitive acquisition area. Our bill requires the HHS Secretary to complete a comparability analysis to ensure that payments in non-competitive areas are fair. It requires the Secretary to publish the analysis in the Federal Register.

Finally, the purpose of the competitive bidding process is to save the Medicare program and its beneficiaries' money from the purchase of durable medical equipment, but a new bureaucracy must be created to implement the program. Our bill requires the HHS Secretary to exempt from competitive acquisition requirements any items and services not likely to result in savings of at least 10 percent.

Twenty-five small suppliers of durable medical equipment in Utah have banded together to support this legislation and I believe they speak for hundreds of small suppliers around the United States. They support the establishment of quality standards for all suppliers of durable medical equipment to Medicare. They are willing to price their products competitively. They are used to providing personal services to their customers in small Utah towns. Their customers are also their neighbors. They all fear that their businesses, which are built on personal service, may be sacrificed to large suppliers from distant cities who cannot educate Medicare beneficiaries. A flyer in the mail may not be enough to teach a disabled diabetic how to use a walker.

I urge my colleagues to support this legislation which permits the potential savings from competitive bidding, mandates quality standards for all of Medicare's durable medical equipment suppliers, and protects small businesses and Medicare beneficiaries in rural areas and in low density urban areas.

Mr. President, I am pleased to join Senators Conrad and Roberts in introducing the Medicare Durable Medical Equipment Access Act of 2007.

Some background on why this bill is necessary might be useful.

Among the provisions of the Medicare Modernization Act, MMA, was a provision that instituted a bidding process for durable medical equipment. It was a good concept--we have all seen the advantages to Medicare beneficiaries and to the Federal Government of competitive bidding in Medicare Part D. The government and beneficiaries are paying lower prices for prescription drugs as a result of fair competition.

At the time of the passage of the MMA, it was known that Medicare was overpaying substantially for certain durable medical equipment. The MMA instituted a bidding process for durable medical equipment in order to bring market discipline to the purchasing process. It also directed the Secretary of Health and Human Services, HHS, to establish badly needed quality standards for Medicare's suppliers of durable medical equipment and related services.

The purpose of S. 1428, the Medicare Durable Equipment Access Act, is to correct problems arising from provisions in the MMA that apply to rural areas and urban areas of low population density. The bill seeks to protect the access of Medicare beneficiaries in these areas to homecare equipment and services. It also will allow small businesses to participate in the program, but only if they meet the quality standards established in this legislation and can meet the competitively bid price.

The bill protects Medicare beneficiaries in three ways.

First, the MMA permits the HHS Secretary to exempt from the bidding process rural areas and areas with low population density that are not competitive unless there is a significant national market through mail order for a particular item or service. The law also permits suppliers in rural areas to be exempted from the program's quality standards. Medicare patients must be assured that they are dealing with qualified suppliers and our bill assures them that they will be.

Second, the MMA allows the Secretary of HHS to exempt rural areas and sparsely populated urban areas from the bidding process if they lack health care infrastructure, a vague and subjective judgment. This bill defines areas eligible for exemption as metropolitan service areas with fewer than 500,000 people.

Finally, the MMA established a Program Advisory and Oversight Committee to advise the Secretary on implementation of the program. The MMA exempted the Program Advisory and Oversight Committee from The Federal Advisory Committee Act, FACA. FACA was enacted by Congress in 1972. Its purpose is to ensure that committees that advise the executive branch be accessible to the public and objective in their judgments. This bill places this program under FACA.

This legislation also provides important protection to small businesses. The MMA provides that there shall be no administrative or judicial review for businesses participating in competitive bidding. Our bill provides for judicial appeal rights, giving legal recourse to businesses that participate in the competitive bidding process.

The MMA also directs the HHS Secretary to take appropriate steps to ensure that small suppliers have an opportunity to participate. Our bill specifies that such appropriate steps shall include permitting suppliers that are classified as small businesses under the Small Business Act to continue to participate at the single payment amount, so long as they submit bids at less than the fee schedule amount.

In addition, the MMA permits the HHS Secretary to use competitive acquisition bid rates from one region to determine payment rates in another noncompetitive acquisition area. Our bill requires the HHS Secretary to complete a comparability analysis to ensure that payments in non-competitive areas are fair. It requires the Secretary to publish the analysis in the Federal Register.

Finally, the purpose of the competitive bidding process is to save the Medicare program and its beneficiaries' money from the purchase of durable medical equipment, but a new bureaucracy must be created to implement the program. Our bill requires the HHS Secretary to exempt from competitive acquisition requirements any items and services not likely to result in savings of at least 10 percent.

Twenty-five small suppliers of durable medical equipment in Utah have banded together to support this legislation and I believe they speak for hundreds of small suppliers around the United States. They support the establishment of quality standards for all suppliers of durable medical equipment to Medicare. They are willing to price their products competitively. They are used to providing personal services to their customers in small Utah towns. Their customers are also their neighbors. They all fear that their businesses, which are built on personal service, may be sacrificed to large suppliers from distant cities who cannot educate Medicare beneficiaries. A flyer in the mail may not be enough to teach a disabled diabetic how to use a walker.

I urge my colleagues to support this legislation which permits the potential savings from competitive bidding, mandates quality standards for all of Medicare's durable medical equipment suppliers, and protects small businesses and Medicare beneficiaries in rural areas and in low density urban areas.