A bill to amend title 38, United States Code, to provide benefits for children with spina bifida of veterans exposed to herbicides while serving in the Armed Forces during the Vietnam era outside Vietnam, and for other purposes.

Mr. President, today I introduce the Graduate Medical Education Reform Act of 2010 along with my colleague Senator Whitehouse.

During my tenure in Congress, I have worked to ensure that medical schools and teaching hospitals have adequate resources to train the next generation of doctors. I have championed legislation to improve the financing of GME payments to teaching hospitals and annually spearhead efforts to increase grant funding for health professions programs through the appropriations process. In addition, the new health insurance reform law contains an entire title of workforce provisions, many of which I helped to write. The consistent goal of these efforts has been to support our future health care workforce and improve the care that patients receive. The GME Reform Act is an extension of those efforts.

The legislation challenges recent statements by some experts that Medicare overpays teaching hospitals to train medical residents by increasing federal oversight of medical residency programs. For most teaching hospitals, which incur higher costs than other hospitals, this funding is essential to support residency programs and provide high- quality patient care. In addition, now is not the time to starve these important programs of the funding necessary to train our future health care workforce since 30 million more Americans will gain access to health insurance in 2014.

First, the legislation would enhance GME payment transparency. New information about the amount of GME funding that teaching hospitals receive respective to the costs to remain operational would demonstrate that more could be done to support these important programs.

The GME Reform Act would also ensure that teaching hospitals and residency programs spend GME funding to train residents in new models of care and updated technology. Some medical residents, including those in my state, are already trained in these areas, but that is not the case in programs throughout the country. This legislation would encourage reform in every program by linking three percent of indirect medical education payments to teaching hospitals to the performance of residency programs. Medical colleges, accrediting bodies, and other stakeholders that are most familiar with how to train residents would set the specific performance measures. This new oversight would help to break down the silos in medicine and ensure that physicians work together to provide patients with comprehensive health care.

These are important and sensible reforms. As I said, many programs throughout the country have already acted in this manner. But, since it is often most effective to have a reasonable balance of oversight and incentives, this legislation would provide a bonus payment to programs that train at least one-third of all residents in primary care.

In addition, this legislation would transform the way that children's hospitals receive payments for training the future health care workforce by

taking those payments out of the discretionary appropriations process and providing mandatory, stable funding every year through a new trust fund.It would also extend residency training funds to children's psychiatric hospitals and women and infants hospitals. There are just a handful of hospitals around the country that fall in these two categories, including two in Rhode Island. Indeed, they should also have access to the resources necessary to support the training of residents.

I am pleased that the GME Reform Act is supported by the only medical school in my state, the Warren Alpert Medical School of Brown University.

My colleagues, Leader Reid, Senator Nelson of Florida, and Senator Schumer have also taken great interest in supporting our future health care workforce by championing legislation to increase the number of physicians trained each year. This effort is vitally important to ending the shortage of primary care providers in many areas, responding to the increased demand of a growing and aging population, and preparing for the implementation of the new health insurance reform law. I look forward to continuing to support their efforts and working with them on the GME Reform Act as well.

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

Mr. President, today I am introducing the Space Available Equity Act.

Members and retirees of the National Guard and Reserve, their families, and surviving military spouses make great sacrifices for our Nation. However, too often these individuals do not receive the benefits they have earned for their service.

For instance, members of the reserve components and ``gray area'' retirees, National Guardsmen or Reservists eligible for retirement but under the age of 60, have limited space-available travel privileges on Department of Defense aircraft under current regulation. Their space- available travel benefits are restricted to the continental United States and are not extended to their dependents, unlike active duty members and retirees.

Surviving spouses of a military member eligible for retired pay retain no space-available travel privileges at all after the death of their spouse, despite having made a lifetime commitment to the military or in many cases, lost their loved one in war.

To correct these inequities, I am introducing the National Guard, Reserve, Gray Area Retiree, and Surviving Spouse Space-available Travel Equity Act. This bill will give these deserving individuals comprehensive and equitable space-available travel privileges on Department of Defense aircraft. The bill is endorsed by the National Guard Association of the United States.

I urge my colleagues to join me in giving parity to our reserve component members and surviving military spouses.

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

Mr. President, I am introducing a bill to provide medically separated servicemembers and their family continued access to commissaries and exchanges. Unfortunately, these individuals lose many benefits upon their honorable discharge from the military for disabilities and injuries which prevent them continuing service.

These servicemembers have served their country dutifully. They have earned the right to retain commissary and exchange privileges after being honorably discharged for disabilities that prevent further service and may preclude certain types of employment thus hindering their ability to provide for their families.

My legislation will give commissary and exchange privileges to individuals medically separated from the military to ease economic hardships faced after their discharge. Additionally, by granting commissary and exchange privileges to these Soldiers, Sailors, Airmen, and Marines they will be able to stay connected to their military communities.

This legislation is supported by the National Guard Association of the United States. I hope my colleagues will join me in this effort to honor and recognize the sacrifices of our disabled servicemembers.

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

Mr. President, the Centers for Medicare and Medicaid Services, CMS, recently announced that nearly three-quarters of Medicare enrollees will see no increase in their Medicare Part B premium in 2011.

This group of beneficiaries is protected by a ``hold harmless'' provision in the law for years when there is no increase in Social Security checks. As a result, these beneficiaries will continue to pay the same monthly premium of $96.40 that they have paid since 2008.

Unfortunately, 27 percent of Medicare beneficiaries do not receive this ``hold-harmless'' protection and will see their monthly premiums disproportionately increase to $115.40 to shoulder the full load for those beneficiaries who are held harmless. This represents an increase of nearly 19 percent over the past two years with no cost of living adjustment to their retirement pensions or annuities.

This inequity in the law negatively affects new Medicare enrollees, low-income beneficiaries who receive Medicare and Medicaid, higher income enrollees who already pay higher premiums, and seniors who do not receive Social Security, such as federal, state, and local government retirees.

I believe we have a responsibility to protect all Medicare beneficiaries from premium increase, especially during these tough economic times when every penny counts. A premium increase for many seniors would mean choosing between food and medicine and that's a choice they should not have to make.

That is why today I am introducing the Medicare Premium Fairness Act. This legislation would restore fairness to our Medicare system and put money in the pockets of 12 million seniors and individuals with disabilities who desperately need it. It would correct this inequity in the law by applying the ``hold harmless'' provision to all Medicare beneficiaries, so that no enrollee will pay a monthly premium more than $96.40 in 2011.

The Medicare Premium Fairness Act is cosponsored by Senator Dodd and Senator Casey, both of whom have been integral to the development of this legislation. Our legislation is supported by twenty four organizations that represent retirees and senior citizens across the country. I would like to thank all of the number of organizations who have endorsed our legislation today, including the American Federation of State, County and Municipal Employees, AFSCME, the National Active and Retired Federal Employees Association, NARFE, and the National Committee to Preserve Social Security and Medicare, NCPSSM.

Now is the time to protect all Medicare beneficiaries from substantial and unfair Part B premium increases next year. I look forward to working with my colleagues in the Senate to pass the Medicare Premium Fairness Act before the end of the year.

Mr. President, as chairman of the Senate Committee on Veterans' Affairs, today, I am introducing legislation that would expand an existing VA benefit program for certain children with spina bifida. These benefits are currently provided under chapter 18 of title 38, United States Code, to the natural children of veterans who were exposed to herbicides such as Agent Orange, in Vietnam or near the Demilitarized Zone, DMZ, in Korea during the Vietnam era.

Current law provides benefits for the natural children of veterans exposed to herbicides only if the veteran served in a specific location, during a specific time frame. VA reports that 1,222 childen currently receive these benefits and that only 10 of these receive them based on the service of a parent who served in outside of Vietnam.

However, VA has conceded that certain veterans who worked on the perimeter of Air Force bases in Thailand outside of the locations provided in current law during the Vietnam era were exposed to herbicides. As a result, children of those veterans suffering from spina bifida are excluded from the benefits provided based solely on where the exposure occurred.

The legislation I am introducing today would correct this inequity. Because only a very small number of children whose veteran parent served outside of Vietnam currently receive benefits, I expect only a small number of children would qualify for benefits under this bill. However, it is an inequity that should be remedied.

I urge our colleagues to support this bill and provide the exact same benefit to all children who have spina bifida related to the veteran parent's exposure to herbicides regardless of the location of their parent's exposure.

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