Hydrographic Services Improvement Act Amendments of 2008

Mr. President, I would like to tell you about Connie Martin from Sycamore, IL. Connie's son decided to go to culinary school in Chicago 5 years ago at the age of 25. To pay for tuition, he borrowed $58,000 in private loans from Sallie Mae at 18 percent interest. His first payment was $1,100 a month--his entire monthly salary at a downtown eatery where he worked after graduation. His loan balance, including government-backed loans, is now $100,000. Connie's son has been working hard, and she and her husband have been trying to help him make the payments. I worry for borrowers like Connie's son who can't start over and will have debt that will likely haunt him for the rest of his life.

The Chicago Sun-Times recently ran a story that described the devastating effect large student loan debt has on the lives of borrowers. Mr. President, I ask unanimous consent that the following article from the Chicago Sun-Times be inserted for the Record.

Private student loans are the fastest growing and most profitable sector of the student loan industry. As college tuition continues to rise, the private loan market flourishes. According to the College Board, tuition, fees, room and board at public 4-year schools have risen by 42 percent over the past 5 years from $9,032 to $12,796. Add books, supplies, transportation and other living expenses, and the total increases to $16,357 for those paying instate tuition and $26,304 for those paying out-of-state tuition. Students rely on private loans to pay for any unmet need that Federal loans and grants fail to cover. According to the College Board, since 2001 the market for private student loans has grown at an annual rate of 27 percent to $17.3 billion in 2006--roughly 20 percent of total student borrowing. Ten years ago, only 5 percent of total education loan volume was in private loans.

Private student loans are more profitable than Federal student loans because lenders can charge whatever interest rate students will pay, barring State usury laws. The interest rates and fees on private loans can be as onerous as credit cards. There are reports of private loans with interest rates of at least 15 percent and often much higher. Unlike Federal student loans, there is no government-imposed loan limit on private loans and no regulation over the terms and cost of these loans.

Today, I am pleased to introduce a bill that will give students, who find themselves in dire financial straits, a chance at a new beginning. My bill takes the bankruptcy law, as it pertains to private student loans, back to where it was before the law was amended in 2005. Under this legislation, privately issued student loans will once again be dischargeable in bankruptcy. My bill also clarifies that existing protections are specific to loans that were issued by or are guaranteed by State and Federal Government.

Federally issued or guaranteed student loans have been protected during personal bankruptcy since 1978. This provision protects Federal investments in higher education. In 2005, a provision was added to law to protect the investments of private lenders participating in the student loan industry. This change in the law creates a couple of problems. First, extending protections to private lenders of student loans but not to other potential creditors who are at risk in a bankruptcy disposition is inherently unfair. Second, such protections are unfair to the debtor. Repayment schedules--with accumulating interest--can extend for decades.

With the 2005 protections in place, there is essentially no risk to lenders making high-cost private loans to people who may not be able to afford them. There is no risk to private lenders extending credit to students at schools with low graduation rates and even lower job placement rates.

Giving private loans such high status in bankruptcy also puts other creditors at a significant disadvantage. No one seems to know how or why private student loans gained this status in 2005. There is nothing in the Congressional Record explaining the reasons behind the change. Why should a private student loan lender be able to jump to the front of the creditor line--in front of the local furniture store or the neighborhood plumber? This bill seeks to restore treatment of privately issued student loans in bankruptcy to the same treatment as any other debt.

There is justification for making Federal loans hard to discharge: they are backed by taxpayer dollars, and they come with some borrower protections in cases of economic hardship, unemployment, death and disability. However, private loans involve only private profit and do not have the protections that government borrowers enjoy, including caps on interest rates, flexible repayment options, and limited

cancellation rights. Why should student borrowers, who are trying to better themselves and our country, be treated in the same manner as people trying to escape child support payments, alimony, overdue taxes, and criminal fines?

The 1950s and 1960s saw the democratization of higher education. The GI Bill provided money for returning WWII veterans to attend college. The National Defense Education Act made college a possibility by making low-interest education loans available for countless students all across the country. Talented kids from working families began realizing the possibility of college, and enrollment at colleges swelled. But since then, college costs have gone through the roof. And students-- heeding the call to obtain a good education--are also earning themselves years of debt. The average student is graduating with nearly $20,000 in debt and in many cases--much, much more--just look at Connie Martin's son. Our country has made great strides in making college a reality for countless students. Let's not reverse the positive trend we started over 50 years ago. That is why I am introducing this bill--to give students a chance at a fresh start.

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

Mr. President, the suffering in Darfur and Sudan on the continent of Africa continues today as it has every day for too many years. I rise again to urge my colleagues that we must do more to end this crisis in Sudan. Two weeks ago, before the Memorial Day recess, I came to the floor to highlight some of the positive steps taken thus far by Congress, the Bush administration, the business community, and nonprofits to pressure the Sudanese regime to end this genocide. I said then and I will repeat today: We must do more.

In that speech I urged the President to follow through on what he promised to do in April at the Holocaust museum just down the street in Washington. To the President's credit, last week he took steps forward. He tightened United States economic sanctions on Sudan. He targeted sanctions against more individuals responsible for the violence, and he vowed to push for a strong new United Nations Security Council resolution that would further pressure the Sudanese regime. I applaud the President for his leadership. But I repeat, we must do more.

On March 28, as Treasury Secretary Paulson testified in front of the Appropriations subcommittee I chair, I asked the Secretary: What resources does the Treasury Department need to put more pressure on the Sudanese Government to end the genocide? His answer:

. . . We'd like the flexibility to charge a larger fine,

because $50,000 may not be enough.

He was talking about civil and criminal penalties that violators of American sanctions on Sudan should face and the fact that the current penalties are not much of a deterrent. It was a concrete suggestion from the administration, and I agreed to accept his challenge. Based on that testimony, more discussions with the Treasury Department, the Securities and Exchange Commission, the State Department, and other agencies, we created the Sudan Disclosure and Enforcement Act which I introduce today. This act provides the administration and all Americans with more resources and tools and information so we can each do our part to end the genocide and bring peace to Darfur. It creates real consequences for those who support the Sudanese regime and, perhaps most importantly, it requires the administration and Congress to meet in 90 days to reassess the steps that need to be taken to help to end the crisis.

For my colleagues who are considering supporting this legislation, here is what the bill will do in specifics: first, express the sense of Congress that the international community should continue to bring pressure against the Government of Sudan to convince that regime that the world would not allow this crisis to continue; second, authorize greater resources for the Office of

Foreign Assets Control within the Department of the Treasury to strengthen its capabilities in tracking Sudanese economic activity and pursuing sanctions violators; third, require more detailed SEC disclosures by United States listed companies that operate in the Sudanese petroleum sector so investors can make informed decisions regarding divestment from these companies; fourth, dramatically increase civil and criminal penalties for violating American economic sanctions to create a true deterrent against transacting with barred Sudanese companies; fifth, require the administration to report on the effectiveness of the current sanctions regime and recommend other steps Congress could take to help end the crisis.

I am proud to introduce this legislation with bipartisan support. I particularly thank the ranking member of the Financial Services and General Government Appropriations Subcommittee, my friend and colleague Senator Sam Brownback of Kansas, for all of his great work on this issue. I am pleased to be joined by all of the other original cosponsors as well: Senators Dodd, who also chairs the Banking Committee and is a great ally; Senators Klobuchar, Mikulski, Bill Nelson, Obama, and Wyden.

I urge all my colleagues on both sides of the aisle to join this effort. As we move around our States and visit parts of the country, occasionally a person will come up after a meeting and say to me: Senator, what are you doing about Darfur? Didn't your country, America, declare a genocide? What are you doing?

Frankly, aside from speeches on the floor and an occasional resolution, bills of very little consequence, there hasn't been much to point to. I hope my colleagues who face that same question and worry that the response is so inadequate will take a good look at this legislation. I hope they will join me in cosponsoring this effort. We should pass this measure, work with our House colleagues and do the same, send this bill to the President. The President said in April:

You who have survived evil know that the only way to defeat

it is to look it in the face and not back down. It is evil

that we are now seeing in Sudan, and we're not going to back

down.

The President went on to say:

No one who sees these pictures can doubt that genocide is

the only word for what is happening in Darfur and that we

have a moral obligation to stop it.

I completely agree with the President. It has been more than 2\1/2\ years since the President called what is taking place in Darfur, Sudan by its rightful name--genocide. Yet even as an estimated 200,000 to 400,000 people have been killed, even as over 2 million men, women, and tiny children have been forced from their homes by violence and killing, even as the violence continues as we meet in the safety and comfort of this great Nation, America and the entire international community have not done enough to help. We must do more. This bill moves in the right direction. It gives our Government the tools and the encouragement to act and act quickly.

I urge my colleagues to support it.

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

Mr. President, Abraham Lincoln once said, ``The declaration that `all men are created equal' is the great fundamental principle upon which our free institutions rest.''

As a Senator representing the distinguished land of Lincoln, I take seriously our Nation's promise for equality, particularly when it comes to health care.

I rise today as a strong and proud cosponsor of the Minority Health Improvement and Health Disparity Elimination Act of 2007--an important piece of legislation, long in the making, and long overdue.

Not since 2000 has our Congress made a concerted effort to address the health of some of our most at-risk populations--people of color.

In these 7 years, we have not seen a substantial improvement in the health status of people of color.

Cervical cancer, a disease that can be greatly reduced by effective health care, is five times more common among Vietnamese women in the United States than it is among Caucasian women.

African Americans with diabetes are seven times more likely to have amputations and develop kidney failure than are Caucasians with diabetes.

In Chicago's Latino community, you will likely find one in two Latino children who are obese, a condition that often leads to the onset of diabetes.

In the hospitals of East St. Louis, it's likely that African-American babies die at more than double the rate of White infants.

In the small town of Cairo, families have to travel hours to other parts of the State and sometimes even to other States to obtain the right care.

In general, we are making progress in prolonging life. Death rates for Whites, African Americans, and Latinos from many of our most debilitating diseases have declined during the last decade. But what progress are we making on quality of life during those extra years? Is the answer different depending on the racial or ethnic minority groups? Simply speaking, yes.

Even when controlling for insurance coverage and economic status, racial and ethnic minorities tend to have less access to health care and a lower quality of health care than their Caucasian counterparts.

The Centers for Disease Control and Prevention has reported that, among a wide range of health indicators, ``relatively little progress has been made toward the goal of eliminating racial/ethnic disparities.''

In general, yes, Americans are healthier, but the shameful gaps between minority groups and Caucasians remain nearly the same as a decade ago.

When will we as a nation demand more and work harder to reach that ideal of equality that is a pillar of our Nation's moral strength?

This legislation is a critical step toward achieving that notion of equality: the belief that we are all created equal and as such should have equal access to quality care.

Why is it that this country spends so much more than any other industrialized country on its health care, but has consistently lagged behind other countries in delivering better health outcomes? Why is it that one in six Americans, almost one in three African Americans, almost one in two Latino Americans, are uninsured? Why do our health outcomes not reflect the $2 trillion investment we make in health care each year? There is a disconnect between the rhetoric around our Nation's health crisis and where our resources are placed. It is a shame, and we can do better.

Our health workforce should reflect, understand, and respect the backgrounds, experiences, and perspectives of the people it serves. We need to recruit, train and retain health care professionals from underrepresented groups and underserved areas.

In areas like downstate Illinois, small communities rely heavily on Federal incentives, such as loan repayment, the Health Careers Opportunity Program, and Centers of Excellence to create a critical pipeline of professionals.

Graduates of title VII programs are more likely to serve in underserved areas. That is the outcome we want, so we need to support successful programs like these.

In addition to improving the diversity of our workforce, we need to redouble efforts to fight diseases that disproportionately affect racial and ethnic minorities--diseases like diabetes, heart disease, breast cancer and so many others.

To accurately respond to the presence of health care disparities and try to address them, we need better data on health care access and utilization that includes race, ethnicity, primary language, and socio- economic status. To develop accurate solutions, we need accurate information on prevalence, contributing factors, and effects of health care disparities.

The Minority Health Improvement and Health Disparity Elimination Act of 2007 is a critically important step toward improving the access, workforce, research and information that will close the color gap that exists in health care today. I look forward to working with my colleagues to improve the health of all Americans and, specifically, to eliminate health disparities that hurt our communities of color, and all of us.

I did not always agree with the former majority leader, Senator William H. Frist, but I couldn't agree more with his statement that, ``Inequity is a cancer that can no longer be allowed to fester in health care.''

I urge my colleagues to support the health disparity legislation introduced today.

Mr. President, we will soon begin consideration of legislation to educate America's students, with Head Start, the Elementary and Secondary Education Act, and the Higher Education Act all slated for reauthorization. One of the most important aspects of No Child Left Behind is its provision for a highly qualified teacher for every child, in every classroom in America.

Expert teachers are the most important educational resource in our schools, and also the most inequitably distributed. In the United States, too many students in high-need schools are taught by inadequately prepared teachers, who are often not ready for the challenges they face, and thus leave the classroom too soon. High- poverty schools lose one-fifth of their teaching staff each year. This constant turnover of inexperienced, inadequately prepared teachers undermines efforts to create stable learning cultures and to sustain school improvement, especially in schools with greatest need.

Many schools are being identified as in need of improvement, and many students are asked to be successful in schools where success is a rare commodity. Rather than being a leader in a competitive world where educational attainment is precious, America has one of the lowest high school graduation rates in the industrialized world. Three out of every 10 ninth-grade students will not graduate on time, and about half of all African American and Hispanic ninth graders will not earn a diploma in four years. Less than 2 out of every 10 students who begin high school will receive a postsecondary degree within a reasonable time. Students of color, new immigrants, and children living in poverty are all being left behind. A good education is granted to some, but denied to others, denied not only to children of color in our cities, but also to children living in poverty in our rural areas. We must end this.

We must recruit the best and the brightest Americans to become teachers and we must transform teaching, restoring its luster as a profession, so that when new teachers join it, they are successful, and want to stay. As teachers and principals are increasingly being held individually responsible for student success, it is increasingly important that we adequately prepare teachers to become successful.

Research shows that inexperienced teachers are less effective than teachers with several years of experience, but good preparation programs can make novice teachers effective more rapidly. We must help novice teachers get the training and coaching they need. Teacher preparation seldom provides the opportunity to learn under the supervision of expert teachers working in schools that effectively serve high-need students. Most new teachers lack such support, and so leave the profession before achieving success.

Today I am proud to introduce the Teaching Residency Act, which builds on a successful model of teacher preparation similar to medical residencies. Teaching Residency Programs are school-based teacher preparation programs in which prospective teachers teach alongside a mentor teacher for one academic year, receive master's level coursework in teaching the content area in which they will become certified, and attain certification prior to completion of the program. Once certified, graduates of the program are placed in high-needs schools, and continue to receive strong mentoring and coaching for their first years of teaching. This bill proposes establishing Teaching Residency Programs as a provision of Title II of the Higher Education Act.

I am particularly proud to introduce this legislation today, because it is a model of effective teacher preparation that I have supported since before I was elected to the Senate in 2004. I have seen the power of teacher residencies through the very successful Academy for Urban School Leadership in my home State of Illinois. And I am pleased to be supported in this effort by the introduction of legislation in the House by my good friend, Congressman Rahm Emanuel.

It is critical to develop programs that increase the probability that recruits will succeed and stay in those classrooms where they are most needed. Teaching Residency Programs are based on what we know works best to improve teacher preparation. We know that mentoring is critical to help young teachers develop in the early years of their career and to retain many of new teachers who would otherwise leave the profession in their first years. We cannot afford to lose any more high quality teachers because they do not feel supported or do not feel that they are progressing professionally.

I hope my colleagues will support this important legislation.

Mr. President, this Nation has witnessed dramatic improvements in public health and health care technology and practice over the last century. Diseases that were once life-threatening are now curable; conditions that once devastated are now treatable. Our Federal investment in

medical research has paid off handsomely, with new and more effective tests and treatments and near daily reports of new scientific breakthroughs. Yet still today too many Americans have not and will not derive full benefit from these advances.

We know that minority Americans and other vulnerable populations needlessly continue to experience higher rates of disease and lower rates of survival, and this is simply unacceptable. As we in the Congress work to combat the serious health issues that threaten the well-being of all Americans, we must also remain vigilant and committed in our fight to address the persistent and pervasive health disparities that affect millions of minorities, low-income individuals and other at-risk populations.

Congress has passed legislation before to address the health of minority populations and eliminate health disparities--the Minority Health and Health Disparities Research and Education Act of 2000. That bill created the National Center for Minority Health and Health Disparities, supported the landmark IOM report Unequal Treatment, required annual reporting on health care disparities by AHRQ, and strengthened the research base for many HBCU's, among many other provisions.

Since that bill passed, our knowledge and understanding about the root causes of these disparities has dramatically increased. Efforts to strengthen the research infrastructure needed to investigate health concerns among people of color have been quite effective. Momentum has also accelerated in the medical and public health communities as advocates' voices are heard more and more, with new interventions being implemented and evaluated. All of these positive steps and advances have helped to raise minority health as a national priority. However, despite this activity, much work remains to be done in order to close the gap and eliminate health and health care disparities.

Study after study reveals the stark line of health disparity drawn between minorities and whites. In cancer alone, the numbers are hard to overlook. In 2004, African American men were 2.4 times as likely to die from prostate cancer, as compared to white men. For heart disease, the statistics are equally compelling: 2004 data show that when compared to white men, African American men were 30 percent more likely to die from heart disease, and American Indian adults were 30 percent more likely to have high blood pressure.

The underlying factors for health disparities are multi-factorial. Our individual genetic makeup certainly contributes to differences in rates of disease and mortality in diverse populations. However, other factors play an equal if not greater role. We know that minority and low-income Americans are disproportionately less likely to live in communities that promote healthy behaviors and choices through access to wholesome foods and opportunities for physical activity, and that protect from exposure to environmental toxins and violence. In addition, minority Americans are less likely to have health coverage and thus more likely to experience difficulties accessing the health care system, which leads to delayed diagnoses and foregone care. And last but not least, we know that minority Americans are less likely to receive medical care that meets recommended or accepted standards of practice, when compared to White Americans. As an example, the American Journal of Public Health has reported that more than 886,000 deaths could have been prevented from 1991 to 2000 if African Americans had received the same level of health care as Whites.

For all of these reasons, I am joining my colleagues Senator Kennedy and Senator Cochran in introducing the Minority Health Improvement and Health Disparity Elimination Act of 2007. This critical legislation has a number of important provisions to help us achieve our goal to improve the health status of minority and other underserved populations. First, this bill strengthens education and training in cultural competence and communication, which is the cornerstone of quality health care for all patients. It also reauthorizes the pipeline programs in title VII of the Public Health Service Act, which seek to increase diversity in the health professions. We all know that the door to opportunity is only half open for minority students in the health professions. The percentage of minority health professionals is shockingly low--African Americans, Hispanics and American Indians account for one-third of the Nation's population but less than 10 percent of the Nation's doctors, less than 5 percent of dentists and only 12 percent of nurses. We can-- and must--do better.

Lack of workforce diversity has serious implications for both access and quality of health care. Minority physicians are significantly more likely to treat low-income patients, and their patients are disproportionately minority. Studies have also shown that minority physicians provide higher quality of care to minority patients, who are more satisfied with their care and more likely to follow the doctor's recommendations.

Second, this bill expands and supports a number of initiatives to increase access to quality care. Specifically, the legislation authorizes demonstration grants to improve access to healthcare, patient navigators, and health literacy education services. Additionally, partnerships modeled after the Health Disparity Collaboratives at the Bureau of Primary Health Care are supported through established grants. The REACH program at Centers for Disease Control and Prevention--designed to assist communities in mobilizing and organizing resources to support effective and sustainable programs to reduce health disparities--is established under this bill. And I am pleased that the Health Action Zone Initiative has also been authorized. This new environmental public health program was introduced as part of the Healthy Communities Act of 2007 that I introduced earlier this year, and guides and strengthens community efforts to improve health in comprehensive and sustained fashion.

A third area of focus is expansion and acceleration of data collection and research across the agencies, including the Agency for Healthcare Research and Quality and the National Institute of Health, with special emphasis on translational research. The tremendous advances in medical science and health technology, which have benefited millions of Americans, have remained out of reach for too many minorities, and translational research will help to remedy this problem. The National Center on Minority Health and Health Disparities, which has a leadership role in establishing the disparities research strategic plan at the National Institutes of Health, is reauthorized. And a new advisory committee has been established at the Food and Drug Administration to focus on pharmacogenomics and its safe and appropriate use in minority populations, another issue area that I championed as part of my Genomics and Personalized Medicine Act of 2006.

Last but not least, I want to highlight that the bill strengthens and clarifies the duties of the Office of Minority Health. This office has been critical in providing the leadership, expertise and guidance for health improvement activities across the agencies of the Department of Health and Human Services, and has helped to ensure coordination, collaboration and integration of such efforts as well.

In conclusion, I want emphasize that it is past time to expand and accelerate our work in a of minority health beyond the initial bipartisan effort Congress achieved in 2000. We have got to translate the knowledge we have gained into practical and effective interventions that will improve minority health and eliminate disparities, and this bill will help us do just that.

I urge my colleagues to join me in cosponsoring and passing this critical legislation. Regardless of how you measure it, whether by needless suffering, lost productivity, financial costs, or lives lost, disparities in health and health care are a tremendous problem and a moral imperative for our Nation, and one that is within our power to address right now.

Mr. President, I rise today to introduce the Patient Safety and Abuse Prevention Act with Senators Domenici, McCaskill, Stabenow, Lincoln, Levin and Clinton.

This bill is supported by the Elder Justice Coalition, the National Citizens' Coalition for Nursing Home Reform, the American Association of Homes and Services for the Aging, AARP and many other organizations dedicated to protecting our Nation's vulnerable citizens. If enacted, this legislation could help to prevent many of the tragic tales of physical and financial elder abuse that we hear about from our constituents and read about in our local newspapers. I strongly urge this Congress to do what the States cannot: create a nationwide system of background checks for workers who care for our Nation's frail elders and those who are living with disabilities.

The vast majority of long-term care workers are selfless and dedicated. Yet there are a few with violent criminal histories who pose a clear threat to the defenseless individuals needing long-term care services. Under the disorganized, patchwork system of background checks that exists today, employers trying to hire caregivers do not always know which applicants have records of abuse or a history of committing violent crimes. As a result, predators are sometimes hired to take care of our most vulnerable citizens, allowing them to work in situations where they can cause enormous harm. For example, in just the last 6 weeks, three stories of such elder abuse created headlines across the country:

Last year, Pat Torano, at the age of 89, was partially

paralyzed by a stroke. He realized he no longer could care

for his 95-year-old wife, who by then was blind and suffering

from dementia. Intent on staying at home, the Toranos

contracted with Visiting Angels, a network of private home-

care agencies that matches clients with caretakers. They

expected to find an honest professional to help them with

household chores and other non-medical needs. Instead they

got convicted felon Gina Treveno, who stole their house just

five months later by tricking the couple into placing the

deed in her name.

Attorney General Andrew M. Cuomo today announced the

sentencing of William Morrison, a former aide at the Rome

Memorial Hospital Residential Health Care Facility, who was

convicted last month of raping and sexually assaulting a 90-

year-old resident of the nursing home. . . . The background

check would have revealed that Morrison was previously

convicted for one felony drug offense in 1992 and several

misdemeanors in the 1990s.

An 84-year-old man allegedly assaulted at a nursing home

last month is suing the facility, claiming it failed to

protect him from the employee accused of punching him in his

bed. Earl Gates of Bozeman claims Evergreen Bozeman Health

and Rehabilitation center didn't do a background check on his

accused attacker, Joshua Fowler, 23, who has a prior assault

conviction.

The bill that I am introducing today with Senators Domenici, Stabenow, McCaskill, Lincoln, Levin, and Clinton proposes to take action to stop predators from working in all long-term care settings. It would close gaping loopholes in our current system of background checks through a nationwide expansion of a pilot program that Congress enacted as part of the Medicare Modernization Act of 2003.

Under the MMA, the Centers for Medicare and Medicaid Services has been conducting a pilot program in seven states to implement efficient, equitable systems that cost-effectively screen out certain applicants for employment in long-term care facilities. Applicants excluded are those whose backgrounds include findings of substantiated abuse and/or a serious criminal history.

The seven pilot States are Alaska, Idaho, Illinois, Michigan, Nevada, New Mexico and Wisconsin. These States have significant flexibility in several key areas under the grant. For example, each State establishes parameters for the definition of a ``direct patient access employee'' for workers who must be checked, and defines specific criteria for ``disqualifying'' crimes that prohibit a long-term care employer from hiring workers with such histories.

In other areas, the pilot States must meet Federal standards. They must cover a broad range of long-term care providers, including nursing homes, home health agencies and intermediate care facilities for the mentally retarded. States must require each applicant to submit a written statement disclosing any disqualifying information, and to authorize a State and national criminal record check.

As is currently required under Federal law, providers must search any available registry that is likely to contain disqualifying information about an applicant. Forty-one States already require a criminal background check of some variety, mostly at the State level. The pilot States have integrated their systems to coordinate these checks in a single streamlined process and added a Federal background check through the FBI's Integrated Automated Fingerprint Identification System. Applicants who are subsequently found to have a record of substantiated abuse or a serious criminal history cannot be hired. But individuals who are denied employment can appeal the background check results. Finally, facilities can use the results of the background checks only for the purpose of determining suitability of employment.

That is the basic structure of the pilot program that Congress enacted 4 years ago. Since then, we have learned important lessons from the pilot States' experiences. For example, federal funds have been used for a variety of purposes. States have used pilot funds to hire new staff to administer background checks; to purchase mobile digital scanners; to pay for the cost of fingerprint checks; to provide technical assistance to facilities; and to build online systems that applicants and providers can readily access, and which serve to integrate information from various registries and entities, and as storage and retrieval systems.

States have passed legislation under the pilot program that treat disqualifying crimes somewhat differently. For example, Michigan has created a tiered system, under which certain disqualifying crimes carry time-limited prohibitions on working in long-term care facilities. By comparison, Wisconsin has chosen to enact legislation defining disqualifying crimes as those that carry a lifetime ban only. Alaska has established a ``variance'' process to permit certain individuals to work who have committed crimes but who have subsequently shown evidence of recovery. Similarly, in Idaho, some disqualifying crimes result in an ``unconditional'' denial that carries a lifetime ban on working in long-term care settings, while others result in ``conditional'' denials that apply to less serious crimes that may be waived under certain circumstances, following an ``exemption review'' by the Department of Health and Welfare.

The data on results from the pilot programs are impressive. Among the seven States, Michigan's information is the most complete. In the first year of operation, Michigan excluded more than 3,000 people with records of abuse or a disqualifying criminal history. As of April 30, 2007, 625 of these were excluded through a fingerprint check. Twenty- five percent of these exclusions were identified through an FBI check only, a fact that State officials believe indicates that these individuals committed crimes in other States, or have been avoiding prosecution within the State. Information for Nevada, while less complete, suggests similar results. As of last December, Nevada was identifying an even higher percentage of individuals with criminal histories on the basis of an FBI check only.

The director of Michigan's workforce background check program, Orlene Christie, recently testified before the Special Committee on Aging about the State's program. ``The applicants that have been excluded from employment are not the types of people Michigan could ever allow to work with our most vulnerable citizens,'' she said. ``We have prevented hardened criminals that otherwise would have access to our vulnerable population from employment.''

Ms. Christie also noted that ``of the criminal history reports examined, fraudulent activity and controlled substance violations account for 25 percent of all disqualifying crimes. Fraudulent activity includes such things as embezzlement, identity theft, and credit card fraud. This is particularly alarming giving the projected increase in financial abuse of the elderly.''

Importantly, Michigan has implemented a ``rap back'' system where the Michigan State Police notifies the health agency of any subsequent arrest, which in turn notifies the employer. This is a key component of the bill we are introducing today. It will allow the States, as well as the FBI, to ensure that an employer will be automatically notified as soon as a worker's criminal history record is updated.

To find out what providers think of the pilot program, Idaho conducted a survey of participating facilities, which found 87 percent believed the background checks were successfully screening out workers who shouldn't be hired. Additionally, 63 percent said that the quality of employees hired has improved since the pilot began.

The pilot program demonstrates that participating States are successfully excluding individuals who have a history of abuse or a disqualifying criminal background. If this model is expanded, the resulting nationwide system would greatly enhance the probability of identifying individuals with criminal backgrounds who can now easily escape detection. If all States had parallel, multi-level, comprehensive systems in place, very few potentially abusive workers would be hired into positions of caring for the extremely vulnerable residents of our Nation's long-term care facilities.

The MMA pilot program is scheduled to end this September. I urge the Senate not to let this initiative simply expire. Rather, I hope that we will take the logical step of expanding on the success of this program, and provide limited federal funding for all other States to create similar programs. The Patient Safety and Abuse Prevention Act also lays out sensible standards for creating a nationwide system that will prevent predators, who now go undetected, from being hired into positions where they can harm society's most vulnerable people. I sincerely hope that all of my colleagues will join me in this effort.

I ask unanimous consent that the bill and supporting material be printed in the Record.

Mr. President, today I am introducing the Veterans Advocacy Act of 2007. This bill would create a grant program for organizations providing pro bono legal representation to servicemembers and veterans to ensure that they receive the health care and benefits to which they are entitled.

The men and women of the Armed Services have served this Nation honorably and deserve the best health care and benefits available. However, as recent revelations about the extent of bureaucratic delays at the Walter Reed Army Medical Center demonstrate, these brave individuals face a series of hurdles as they navigate the health care and disability compensation processes. Many of them are forced to turn to their representatives in Congress for help cutting through the red tape. I have heard from many military personnel and veterans who are frustrated with the system or unaware of Federal health care and other benefits for which they may be eligible. I regret that the system too often makes the burden of proving that a condition is related to military service nearly insurmountable. Our men and women in uniform deserve the benefit of the doubt, and should not have to fight the Department of Defense or the Department of Veterans Affairs for benefits that they have earned through their service to our Nation.

Numerous reports have detailed the range of administrative and legal hurdles injured servicemembers will face when they return home. Service members returning with unprecedented rates of post traumatic stress disorder, PTSD, and traumatic brain injury, TBI, will struggle to get the medical records they need to file benefits claims. Those with severe TBI that does not show up on brain scans will have an even harder time establishing that they need compensation. Those with profound TBI may be prematurely relegated to care in a nursing home when, with proper assistance, they may be fully capable of living independent lives in the community. The Government Accountability Office reported

that over 75 percent of servicemembers who screen positive for PTSD will not be referred to a mental health professional. Members of the Guard and Reserves face additional hurdles to gain access to military doctors. This is unacceptable.

I commend my colleagues for their support of increased funding for the military and veterans' health care systems in the 2007 emergency supplemental. However, I am concerned that unless veterans have independent advocates to ensure that they are receiving top notch care and that they are aware of the benefits to which they are entitled, these additional funds may be mismanaged. Last November, the Government Accountability Office reported that for the last two years the Department of Veterans Affairs has not expended all the funds allocated for mental health initiatives. My bill would ensure that service members and veterans who have trouble accessing the care to which they are entitled will have an advocate outside the chain of command who can negotiate with the Departments to ensure proper care.

In addition to helping ensure that service members and veterans receive top notch care, my bill would help service members and veterans overcome legal barriers to obtaining benefits. During the Veterans' Affairs Committee's hearing on benefits legislation, Meredith Beck of the Wounded Warrior Project summarized the problem as follows: ``In many of the cases we have seen, the creation of new benefits wasn't needed to aid the service member, rather, the wounded warrior just needed to have the existing benefits systems better explained and untangled in order to understand what was available to them.''

Fortunately, service members and veterans benefit from the services of a nationwide system of veterans and military service organizations. However, the system is simply overwhelmed. It will be further inundated when the over 170,000 servicemembers deployed in Iraq and Afghanistan return home. I want to be clear that the purpose of this legislation is to supplement the existing network of advocates to ease the caseload of overburdened service officers and allow them to spend more time per case helping veterans and service members.

Congress has a responsibility to simplify the system and ensure that it gives service members and veterans the benefit of the doubt when they seek assistance for service-connected disabilities. It is my hope that the majority of veterans will not need legal representation. But the reality is that many veterans face unnecessary delays and appeals of legitimate compensation claims that could be avoided if there were enough advocates to ensure that every veteran's case is carefully developed from the beginning. Several judges of the Court of Appeals for Veterans Claims have described the importance of ensuring that veterans have legal representation throughout the claim process. Judge Holdaway summarized the need as follows:

If you get lawyers involved at the beginning, you can focus

in on what is this case about. I think you would get better

records, you would narrow the issue, there would be screening

. . . I think if we had lawyers involved at the beginning of

these cases, it would be the single most fundamental change

for the better that this system could have.

While the need for legal representation in complicated cases is clear, I do not believe that veterans should have to pay for legal representation just to get the benefits they earned through their service. I have been troubled when I have heard that service members are seeking expensive legal assistance to help them overcome daunting administrative and legal hurdles. Fortunately, there are legal service organizations and attorneys who are willing to provide assistance to these service members and veterans free of charge. The purpose of this bill is to help these organizations get the training they need to help veterans and service members.

The bill would establish a pilot program of one-year grants to organizations that have experience serving veterans or persons with disabilities. The Veterans Administration will be charged with appointing a committee to disburse the grants. The committee shall be composed of veterans and military service officers, veterans and disability legal service attorneys, and representatives of the Department of Veterans Affairs employees and the Department of Defense. The Secretary of Veterans Affairs will be required to submit a report to Congress on the number of individuals served and the kinds of assistance they received as a result of the pilot program.

In order to avoid adding to our country's sizable debt, the $1 million cost of this program is taken from the $3 billion appropriated to the defense health program by the 2008 supplemental spending bill. The grant program will help ensure that these funds are spent wisely.

Veterans and military service organizations that currently employ attorneys will be eligible to receive the grants either to provide legal services at no charge or to provide training to other pro bono attorneys. The bill will also help servicemembers and veterans access the services of the federally funded and mandated protection and advocacy system for persons with disabilities. This system has lawyers in every state who are trained to help people with disabilities obtain the benefits, health care and services they need to live independent lives. These attorneys are uniquely qualified to, for example, ensure that veterans with PTSD are properly diagnosed and treated and to prevent those with TBI from being placed in nursing homes when they are capable of living in the community. Many veterans have been seeking out their assistance but the system is currently overwhelmed. I have included a description of the assistance that the protection and advocacy systems have been providing veterans. This bill would help foster collaboration between lawyers with expertise in veterans' law and those with expertise in disability law.

I commend my colleagues who have offered bills to increase funding for the care of service members and veterans, to expand necessary benefits and to ensure that our military and veterans health care systems offer the best care available. In order to ensure that service members and veterans are able to capitalize on these important reforms, they need independent advocates who can help them cut through the red tape. My bill would help expand the cadre of experienced advocates who will do just that. The bill has been endorsed by the National Organization of Veterans Advocates, the Vietnam Veterans of America and the Protection and Advocacy System's National Disability Rights Network.

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

Mr. President, I wish today to join with my colleague, Senator Snowe to introduce the bipartisan Rural Aviation Improvement Act. Senator Snowe has been a longtime champion of commercial air service in rural areas, and I applaud her continued leadership on this important legislation.

One of the goals of our bill is to preserve and improve the Essential Air Service Program. Congress established the Essential Air Service Program in 1978 to ensure that communities that had commercial air service before airline deregulation would continue to receive scheduled service. The Essential Air Service Program currently ensures commercial air service to over 100 communities in 35 States. EAS supports an additional 39 communities in Alaska. Without EAS, many rural communities would have no commercial air service at all. I believe our bill makes a number of important improvements to EAS to ensure rural communities continue to have the commercial air service that is so vital to their futures.

Our bill also extends through 2011 the Department of Transportation's authority to provide grants to cities under the Small Community Air Service Development Program, which was first established in 2000. The program helps rural communities establish new air service or to promote and improve their existing air service. Since it was first enacted, a number of New Mexico communities have won grants, including most recently Gallup in 2006.

All across America, small communities face ever-increasing hurdles to promoting their economic growth and development. Today, many rural areas lack access to interstate or even four-lane highways, railroads, or broadband

telecommunications. Business development in rural areas frequently hinges on the availability of scheduled air service. For small communities, commercial air service provides a critical link to the national and international transportation system. I do believe Congress must help ensure that affordable, reliable, and safe air service remains available in rural America.

The Senate Commerce Committee and its Aviation Subcommittee are well along in developing a reauthorization of aviation programs this year. I look forward to working with my colleagues Chairmen Inouye and Rockefeller and Ranking Members Stevens and Lott to improve commercial air service programs for rural areas. I believe our bill is one important step in that process.

Mr. President, the landmark 1999 Surgeon General's report on mental health brought a hidden mental health crisis to the attention of the U.S. public. According to that report, 13.7 million children in our country--about one in five--suffer from a diagnosable emotional or behavioral disorder. Such disorders as Anxiety Disorders, Attention-Deficit/Hyperactivity Disorder, and Depression are among the most common in this age group. Yet more than two-thirds of these children do not receive any treatment. Long waiting lists for children seeking services, including those in crisis, are not uncommon. The primary reason is that severe shortages exist in qualified mental health professionals, including child psychiatrists, psychologists, social workers, and counselors. The President's New Freedom Commission on Mental Health also found that ``the supply of well-trained mental health professionals is inadequate in most areas of the country . . . particular shortages exist for mental health providers who serve children, adolescents, and older Americans.'' The situation is no better in our public schools, where children's mental health needs are often first identified. According to the National Center for Education Statistics within the Department of Education, there are approximately 479 students for each school counselor in U.S. schools, nearly twice the recommended ratio of 250 students for each counselor.

The situation in my home State of New Mexico is a case in point. Estimates suggest that 56,000 children and adolescents in New Mexico have an emotional or behavioral disorder. Of these, roughly 20,000 have serious disturbances that impair their ability to fulfill the demands of everyday life. In 2001, there were a total of 44 child and adolescent psychiatrists in the entire State of New Mexico. The impact of this shortage on the affected children and their communities is disconcerting. Research shows that children with untreated emotional and behavioral disorders are at higher risk for school failure and dropping out of school, violence, drug abuse, suicide, and criminal activity. For New Mexico youth, the suicide rate is twice the national average, the fourth highest in the nation, and the third leading cause of death. By one estimate, roughly one in seven youth in New Mexico detention centers are in need of mental health treatment that is just not available.

New Mexico is not alone in its struggle to address the needs of these children. Nationwide, over 1600 urban, suburban, and rural communities have been designated Mental Health Professional Shortage Areas by the Federal Government due to their severe lack of psychiatrists, psychologists, social workers, and other professionals to serve children and adults. Rural areas are especially hard hit. For example, in New Mexico there is one psychiatrist per 20,000 residents in rural areas, whereas in urban areas there is one per 3000 residents. In rural and frontier counties, it is not unusual for the parents of a child in need of services to travel 60 to 90 miles to reach the nearest psychiatrist, psychologist, or other mental health provider. In States like Alaska and Wyoming, the distance may be even farther.

Finally, graduate programs providing the vital pipeline for the child mental health workforce have not sufficiently increased their funding, class sizes, and training programs to meet the ever growing need for these specialists. In the U.S., only 300 new child and adolescent psychiatrists are trained each year, despite projections by the Bureau of Health Professions that the shortage of child and adolescent psychiatrist will grow to 4,000 by the year 2020. Federal grant funding for graduate psychology education has also been significantly reduced in the past two years, which could reduce the numbers of child and adolescent psychologists entering the profession.

Clearly something needs to be done to address this serious shortage in mental health professionals to meet the growing needs of our Nation's youth. It is for this reason that I rise today with my colleagues Senator Collins of Maine, Senator Leahy of Vermont, Senator Durbin of Illinois, Senator Reed of Rhode Island, Senator Harkin of Iowa, Senator Stabenow of Michigan, Senator Dodd of Connecticut, and Senator Sanders of Vermont to offer The Child Health Care Crisis Relief Act of 2007. This bill creates incentives to help recruit and retain mental health professionals providing direct clinical care, and to help create, expand, and improve programs to train child mental health professionals. It provides loan repayments and scholarships for child mental health and school-based service professionals as well as internships and field placements in child mental health services and training for paraprofessionals who work in children's mental health clinical settings. The bill also provides grants to graduate schools to help develop and expand child and adolescent mental health programs. It restores the Medicare Graduate Medical Education Program for child and adolescent psychiatrists and extends the board eligibility period for residents and fellows from 4 years to 6 years. Across all mental health professions, priority for loan repayments, scholarships, and grants is given to individuals and programs serving children and adolescents in high-need areas.

Finally, The Child Health Care Crisis Relief Act of 2007 requires the Secretary to prepare a report on the distribution and need for child mental health and school-based professionals, including disparities in the availability of services, on a State-by-State basis. This report will help Congress more clearly ascertain the mental health workforce needs that are facing our Nation.

I ask unanimous consent that the text of the bill and my statement be printed in the Record. I also ask unanimous consent that the appended letter from the Mental Health Liaison Group, representing 40 national professional and mental health advocacy organizations in support of The Child Health Care Crisis Relief Act of 2007, be printed in the Record.