A bill to permit pass-through payment for reasonable costs of certified registered nurse anesthetist services in critical access hospitals notwithstanding the reclassification of such hospitals as urban hospitals, including hospitals located in "Lugar counties", and for on-call and standby costs for such services.

Mr. President, today I am pleased to introduce the Protecting America's Workers Act. Almost 40 years ago, Congress set out to guarantee a safe workplace for all Americans. The Occupational Safety and Health Act of 1970 was landmark legislation that has dramatically improved the well-being of working men and women.

Since then, the annual job fatality rate has dropped from 18 deaths per 100,000 workers to less than four. Thousands of lives have been saved each year. These are not abstract numbers--they represent thousands of families who have been spared the pain and heartache of losing a loved one on the job.

We are enormously proud of the progress we have made, but we also know that too many workers continue to face needless dangers in the workplace. In 2007, almost 5,500 workers were killed on the job and 4 million other workers became ill or were injured. Fifteen workers still die on the job every day, and nearly 11,000 who are injured or become ill because of dangerous conditions.

We now have strong partners in the White House and at the Department of Labor who are committed to making our workplaces safer. But they need action by Congress as well. That is why today we are reintroducing the Protecting America's Workers Act, to take concrete steps to address many of the failures of the existing law.

First, this legislation expands the coverage of the current job safety laws to protect the millions of public employees and transportation workers who are not covered by these laws. In Massachusetts alone, 350,000 public sector workers lack the protections granted by the federal workplace safety law.

Our bill also protects workers who speak up about unsafe conditions on the job, by updating OSHA's whistleblower provisions. OSHA inspectors can't be in every workplace, every day. We must rely on workers who have the courage to come forward when they know their employer is cutting corners on safety. This legislation makes good on the promise to stand by those workers and guarantee they don't have to sacrifice their jobs in order to do the right thing.

In addition, the legislation gives workers and their families and representatives a seat at the table on safety issues. It includes sensible reforms to ensure that victims and their families have a right to talk to OSHA before a citation issues, to obtain copies of important documents, to be informed about their rights, and to have their voices heard before OSHA accepts a settlement that lets an employer off the hook for endangering workers.

Finally, a critical element of this bill is the increase in penalties on employers who turn their backs on the safety of their workers. Too many employers in our country blatantly ignore the law, and too often they are not held accountable. They pay only minimal fines, which they treat as just another cost of doing business.

Last year, my office issued a report that showed that the median penalty for a workplace fatality was only $3,675. In other words, in cases investigated by OSHA where workers were killed on the job, half of all employers were fined $3,675 or less. Workers' lives are obviously worth far more than that. We know this administration will do better, but it needs our help.

The bill makes reasonable increases in civil penalties--especially in the most serious cases. It also creates a strong criminal penalty, including the possibility of felony charges and significant prison terms. These changes will create the deterrence we need so that employers will think twice before they gamble with workers' lives to save a few dollars. We need to send a strong message that it is unacceptable to treat workers as expendable or disposable.

Earlier this year a brave young woman, Tammy Miser, testified before our Labor Committee about her brother Shawn, who was killed in an explosion at the Hayes Lemmerz manufacturing plant in Huntington, Indiana in 2003. We can't bring Shawn back and we can't ease Tammy's pain at the loss of her beloved brother. But we can stand with her as she pursues her life's work since then of speaking out for the right of every worker to come home safely at the end of the day. I urge my colleagues to join me in honoring the millions of hardworking Americans who deserve real protection by supporting the Protecting America's Workers Act.

Mr. President, the promise of America will never be fulfilled as long as justice is denied to any of our fellow citizens. We have made remarkable progress in the long march towards equal opportunity and equal justice for all Americans, but this is no time for complacency. Civil rights remains the unfinished business of America. Millions of our people are still shut out of the American dream solely because of their sexual orientation or gender identity. The Employment Non-Discrimination Act brings us closer to fulfilling the promise of America for gay, lesbian, bisexual, and transgender citizens, and I am proud to join Senators Merkley, Collins, and Snowe today in introducing this important legislation.

ENDA reflects the bedrock American principle that employees should be judged on the basis of job performance, not prejudice. It prohibits employers from making decisions about hiring, firing, promotions, or compensation based on sexual orientation or gender identity. It makes clear that there is no right to preferential treatment, and that quotas are prohibited.

While some states have taken this important step to guarantee fair treatment in the workplace, ENDA is necessary to guarantee these rights for all. It is unacceptable that in our country in 2009, it is legal anywhere to judge people on who they are, not what they can accomplish. This legislation will right this historic wrong.

ENDA has broad, bipartisan support. It reflects non-discrimination principles already in place at some our country's largest employers. In the past, this legislation has been endorsed by a broad religious coalition, civil rights leaders, and distinguished Americans from both parties.

I am proud to join my colleagues today in bringing us one step closer to our ideal of a nation free from prejudice and injustice. I look forward to doing all I can to pass this important legislation, and I urge my colleagues to support us.

Mr. President, today I am introducing legislation to clarify the application of the Federal Tort Claims Act and how it applies to free medical clinics. In my home State of Vermont, free clinics provide important health care, and in these tough economic times they provide an essential safety net for many people. Free clinics in Vermont and around the country are struggling to pay medical malpractice insurance premiums, due to an ambiguity in the Federal law. Current law provides for physicians who volunteer in free clinics to receive medical malpractice coverage under the Federal Torts Claims Act, FTCA, but it is unclear whether other professionals serving the community in free clinics are also covered. Existing Federal law explicitly provides more comprehensive FTCA coverage to community health centers, including coverage for their boards, employees, contractors and officers. But free clinics currently must purchase malpractice insurance for their board members, employees, contractors and officers. Purchasing this coverage diverts thousands of dollars annually from each of the free clinics in the country. These are funds that could be directed to providing necessary healthcare to the uninsured. This is especially true in States like Vermont, where free clinics make a significant impact serving those in rural areas. Additionally, by removing this financial burden for free clinics, the impact of organizations like Volunteers in Medicine, which assists in setting up and staffing free clinics, will be that much greater. In clarifying current law, and at minimal expense to the Federal Government, we can increase the effectiveness of free clinics that serve and care for so many Americans.

This legislation would make it clear that FTCA coverage should be the same for community health centers and free clinics. Both of these institutions deserve our help and play a fundamental role in our communities. It is my understanding that this clarification would not dramatically raise medical malpractice defense costs of the Federal Government because free clinics do not perform high risk procedures like surgeries or births. I urge my fellow Senators to join me in supporting the important work that free clinics provide our communities.

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

Mr. President, our Nation has a proud history of diversity and a commitment to justice and equal rights for all Americans. The promise of equal rights is a foundational freedom of our democracy. Today we re-introduce important legislation to protect Americans from discrimination in the workplace. I am proud to again cosponsor the bipartisan Employment Non-Discrimination Act, and I thank Senators Kennedy, Collins, and Merkley for their leadership and commitment to an issue that has practical significance in the daily lives of millions of our fellow Americans.

American workers should be evaluated on the basis of how they perform, not on irrelevant considerations, such as their race, gender, gender identity or sexual orientation. It is a question of fundamental fairness. In these difficult economic times, I can think of nothing more fundamental than equality in the workplace.

The Employment Non-Discrimination Act would prohibit workplace discrimination by making it illegal to fire, refuse to hire, or refuse to promote employees simply based on a person's sexual orientation or gender identity. Currently, Federal law protects against employment discrimination on the basis of race, gender, religion, national origin or disability, but not sexual orientation or gender identity. It is long overdue for Congress to extend these protections to American workers.

Senator Kennedy introduced the Employment Non-Discrimination Act in previous sessions of Congress, and with his leadership, it has consistently maintained strong bipartisan support. Unfortunately, partisan politics have prevented passage of the measure. It goes against our country's basic values to fire someone based on who they are or what they look like, and we should not tolerate discrimination in the workplace. I hope that this year Congress will have the ability to finally

pass this straightforward civil rights measure.

My home State of Vermont has played a constructive role in America's journey to build a more just society. Vermont added sexual orientation to the list of protected categories in its antidiscrimination in employment law in 1992, and added gender identity protection in 2007. Twenty-one other States have also taken the lead to ban discrimination on the basis of sexual orientation, with 13 of those States also banning discrimination on the basis of gender identity. But it is clear that more still deeds to be done. In 30 States, it remains legal to fire someone based on their sexual orientation and in 38 States, to do so based on gender identity. Americans' civil rights should be protected no matter where they live, which is why I am proud to once again cosponsor this bill, as I have every time it has been introduced in the Senate. I believe the passage of this legislation is long overdue and it is a step in the right direction toward creating equality in the workplace.

I urge my fellow Senators to come together to support this important, bipartisan bill without further delay.

Mr. President, I rise today to discuss the Employment Non-Discrimination Act, a bill I introduced with Senators Susan Collins, Ted Kennedy, Olympia Snowe, and more than 30 others. This historic bill will prohibit employers from discriminating against those employed or seeking employment, on the basis of their perceived or actual sexual orientation or gender identity.

Senator Kennedy has long been a champion for civil rights, and without his decades of leadership and determination, we would not have the strong coalition of support we exhibit today with the introduction of ENDA.

I would also like to thank the Human Rights Campaign and the Leadership Conference on Civil Rights for their strong commitment to this legislation.

Our country was founded on the principle of equal justice for all. It is that philosophy which has guided us through decades of progress. It is that philosophy which led to passage of the Civil Rights Act of l964. It was that act which paved the way for countless groundbreaking moments, and I am certain this is one of them.

Passage of the Civil Rights Act was a defining time in our history, the result of generations of people willing to march and struggle for equality. Although we have made progress, we continue that fight today. We continue that fight for those who have, for too long, been left out.

Let me be clear, discrimination on the basis of personal characteristics has no place in any workplace or in any State, and it is long overdue for Congress to extend American employees these protections. Under ENDA, employment decisions will be based upon merit and performance, not prejudice.

This is not a new idea. In fact, many states have already confronted this challenge. I am proud that Oregon has long been a leader on equality issues, and already offers protections to those discriminated against based on both sexual orientation and gender identity. But it was not easy. It is never easy.

Martin Luther King, Jr. said, ``Human progress is neither automatic nor inevitable. Every step toward the goal of justice requires sacrifice, suffering, and struggle; the tireless exertions and passionate concern of dedicated individuals.''

For the first time in history, the Senate has before it a fully inclusive bill, extending employment protections to members of communities that have historically been left out. I am proud to be a part of this historic effort to ensure that no matter who you are, you have the right to earn a living.

Corporate America is light years ahead. More than 85 percent of Fortune 500 companies have implemented non-discrimination policies that include sexual orientation, and another third have policies that include gender identity.

Unfortunately, we are still faced with cases of employment discrimination that are entirely legal--a fact I find offensive and contradictory to the founding principles of this great nation.

In 2000, Linda, an attorney, relocated to Virginia where her partner had accepted a faculty position at a university. During her job search, Linda was invited for a second interview with a local law firm. During the interview, Linda was asked why she was moving to Virginia, and she replied that her spouse had taken a position at a local university.

The firm asked Linda to come back for a third interview, which included dinner with all the partners and their spouses to ``make sure they all got along.'' At that point, Linda told one of the partners at the firm that her spouse was a woman. It was not long before Linda was told that the firm would not hire a lesbian and the invitation to the final interview was rescinded.

Thankfully, Linda spoke out, but there are still countless instances where victims of this type of discrimination remain silent.

By extending the protection of Title VII to those victimized purely because of who they are, we move one step closer to that fundamental principle of equal justice for every American.

I am proud that we are again taking a step toward progress. I hope my colleagues will move swiftly to pass the Employment Non-Discrimination Act, which will ensure that every American receives equality under the law.

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

Mr. President, today I'm introducing the Rural Access to Nurse Anesthesia Services Act to ensure patients in rural communities can access the health care services they need. The bill would restore rural healthcare by making improvements to the Medicare Part A reasonable cost-based, pass-through program for nurse anesthesia services in rural and critical access hospitals.

Throughout the Nation, 1,300 critical access hospitals provide essential health care services to the elderly and medically underserved communities in rural areas. In my State of Illinois, 51 Critical Access Hospitals provide emergency, primary care, and surgery services directly to rural communities, covering over 60 percent of the counties in the State and reaching over 1 million rural residents.

For the majority of Critical Access Hospitals, Certified Registered Nurse Anesthetists are the sole providers of anesthesia services. The nurse anesthetists make it possible for these hospitals to offer surgical, obstetrical, trauma stabilization, interventional diagnostic and pain management capabilities.

Critical Access Hospitals depend on the work of nurse anesthetists to deliver quality care, even while the hospitals are pressed for resources. Because of the limited availability of nurse anesthetists and fewer patients in their rural communities, Critical Access Hospitals do not have anesthesia in the hospital 24/7. They rely on anesthesia and other surgery staff to be on call and available to the hospital within 15 minutes to cover emergency surgery procedures and obstetric services.

As an incentive to continue serving Medicare beneficiaries in rural areas, critical access hospitals were given permission to use reasonable, cost-based funding for anesthesia services performed by nurse anesthetists. However, recent changes in CMS policy have denied Critical Access Hospitals' claims for tens of thousands of dollars each in annual Medicare funding that they had come to rely on. In Illinois, Critical Access Hospitals lost $50,000-$100,000 per hospital.

These hospitals aren't just looking for a handout. Without being able to pay nurse anesthetists, the rural hospitals have to turn away patients whose procedures call for anesthesia. Patients have to travel to the next nearest hospital, which is a terrible option when dealing with trauma stabilization, obstetrical care, or even pain management, particularly for elderly patients.

In addition, despite previously reimbursing Critical Access Hospitals for the costs of having a nurse anesthetist available or on call for emergency services, CMS recently began to deny payments for this service. How is a hospital able to retain the few nurse anesthetists who are available if they can't at least keep them on call?

The Rural Access to Nurse Anesthesia Services Act will enable hospitals to offer the highest quality of care and availability of services to patients of Critical Access Hospitals. For decades, the Medicare Part A reasonable cost based pass-through program has successfully and safely ensured the availability of anesthesia services for Medicare patients in rural areas. Because of the program's success and impact, the Rural Access to Nurse Anesthesia Services Act is supported by the American Association of Nurse Anesthetists and the American Hospital Association. I hope my colleagues will join me in supporting this bill and work to protect anesthesia services for patients in rural communities.

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

Mr. President, today I'm introducing the Rural Access to Nurse Anesthesia Services Act to ensure patients in rural communities can access the health care services they need. The bill would restore rural healthcare by making improvements to the Medicare Part A reasonable cost-based, pass-through program for nurse anesthesia services in rural and critical access hospitals.

Throughout the Nation, 1,300 critical access hospitals provide essential health care services to the elderly and medically underserved communities in rural areas. In my State of Illinois, 51 Critical Access Hospitals provide emergency, primary care, and surgery services directly to rural communities, covering over 60 percent of the counties in the State and reaching over 1 million rural residents.

For the majority of Critical Access Hospitals, Certified Registered Nurse Anesthetists are the sole providers of anesthesia services. The nurse anesthetists make it possible for these hospitals to offer surgical, obstetrical, trauma stabilization, interventional diagnostic and pain management capabilities.

Critical Access Hospitals depend on the work of nurse anesthetists to deliver quality care, even while the hospitals are pressed for resources. Because of the limited availability of nurse anesthetists and fewer patients in their rural communities, Critical Access Hospitals do not have anesthesia in the hospital 24/7. They rely on anesthesia and other surgery staff to be on call and available to the hospital within 15 minutes to cover emergency surgery procedures and obstetric services.

As an incentive to continue serving Medicare beneficiaries in rural areas, critical access hospitals were given permission to use reasonable, cost-based funding for anesthesia services performed by nurse anesthetists. However, recent changes in CMS policy have denied Critical Access Hospitals' claims for tens of thousands of dollars each in annual Medicare funding that they had come to rely on. In Illinois, Critical Access Hospitals lost $50,000-$100,000 per hospital.

These hospitals aren't just looking for a handout. Without being able to pay nurse anesthetists, the rural hospitals have to turn away patients whose procedures call for anesthesia. Patients have to travel to the next nearest hospital, which is a terrible option when dealing with trauma stabilization, obstetrical care, or even pain management, particularly for elderly patients.

In addition, despite previously reimbursing Critical Access Hospitals for the costs of having a nurse anesthetist available or on call for emergency services, CMS recently began to deny payments for this service. How is a hospital able to retain the few nurse anesthetists who are available if they can't at least keep them on call?

The Rural Access to Nurse Anesthesia Services Act will enable hospitals to offer the highest quality of care and availability of services to patients of Critical Access Hospitals. For decades, the Medicare Part A reasonable cost based pass-through program has successfully and safely ensured the availability of anesthesia services for Medicare patients in rural areas. Because of the program's success and impact, the Rural Access to Nurse Anesthesia Services Act is supported by the American Association of Nurse Anesthetists and the American Hospital Association. I hope my colleagues will join me in supporting this bill and work to protect anesthesia services for patients in rural communities.

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