Clinical Social Work Medicare Equity Act of 2009

Mr. President, last week Congress was consumed in expressing its justified outrage over the bonuses for AIG executives. The House passed a bill that would tax those bonuses at 90 percent to get the money back. The Senate may consider something similar this week, and I think it is the Senate's job to proceed carefully as we do so. Though I think all of us would support taking back the payments, we need to give due consideration to the means by which we do this. The constitutionality of the House version is certainly questionable at best.

Now, the reason many are seeking expedited consideration of the AIG bonus bill is clear enough--to cover up the past mistakes of the majority party and the Treasury Secretary. We should recall the process that created the stimulus bill: No time to review the final bill before passage, a photo op masquerading as a conference committee, hasty consideration, no bipartisan input, and huge decisions about billions and billions of dollars being made behind closed doors by the majority. It was this process that allowed the provision to give out the AIG bonuses to find its way into law. There was a provision very deep in the Democratic stimulus bill that allowed these bonuses to be paid, and it was inserted at the behest of Treasury Secretary Tim Geithner.

This gets us to the root of the problem: The bailout approach that Secretary Geithner epitomizes. The American people object to the midnight rescue packages, the ad hoc approach, the ``say one thing, do another'' programs. There is a complete lack of any policy framework, explanation of principles or coherent approach in dealing with our financial situation. I believe there is a lack of any transparency whatsoever and a seeming indifference to the taxpayers' interests.

Now, the $700 billion bailout bill last October was congressional ratification of Tim Geithner's approach to big banks: to bail them out. I objected to that at that time and I was in shock that 75 Members of the Senate voted to give an unelected bureaucrat, without any constraints, $700 billion to do with as he wished. Now, that was bad enough. It all started with Bear Stearns a year ago. The initiator of the Bear Stearns deal was not Secretary Paulson, it was not Chairman Bernanke, it was the--they signed off on it, but it was Timothy Geithner. After the deal was announced, Robert Novak reported in his column that an unnamed Federal official confided in him at the time: ``We may have crossed

a line'' in bailing out Bear Stearns. Mr. Novak wrote that was an understatement and that we wouldn't know the ramifications of this decision for a long time.

Well, I think we better understand those ramifications today. We are now trillions of dollars past that line and we are beginning to comprehend the course on which that decision has set us. I, personally, believe that trillions of dollars past that line, we are no better off. That is enough. Tim Geithner's bailout approach has taken us too far. Instead of Congress using the AIG bonus issue to cover up Tim Geithner's mistakes in allowing those bonuses, we should take it as an opportunity to fundamentally reevaluate the bailouts thus far and put an end to any more bailouts. Now, with the revelations of how AIG is being used to funnel money to foreign banks to make them whole on bad investments at the expense of the U.S. taxpayers, we need to put an end to the Geithner approach on bailouts. The taxpayers deserve no less.

The debate over the AIG bonuses, though extremely important, only scratches the surface of some much deeper issues. First, the furor over AIG bonuses obscured some other, perhaps more important, news about the AIG bailout regarding counterparties--or creditors--counterparties, to some of AIG's more exotic transactions. Second, the AIG bonus issue reveals a significant problem with Treasury Secretary Tim Geithner's bailout approach to failing financial institutions.

Under Tim Geithner, the $150 billion in taxpayer money AIG has received is being used to funnel money to AIG's counterparties, mostly big investment banks and foreign banks. Taxpayers are right to be angry about the bonuses, but they should be even angrier about how their taxpayer dollars used to bail out AIG are being distributed by them. Under the contracts AIG entered into with other big banks and foreign banks, AIG needs to come up with billions and billions of dollars when their investments are downgraded. Now, that is where all the AIG bailout money is going. AIG is basically being used as a front to funnel taxpayer moneys into large foreign banks that are taking no loss--no loss--on their investments. It is the taxpayer who is bearing the loss that these banks should have been able to take. Treasury Secretary Geithner needs to explain to the American people why foreign banks are getting 100 percent on their investment while the American people are taking the loss. Why can't any of these banks take a haircut on their AIG investments?

Now, I guess it is hard to explain to people because it doesn't sound believable, but what is happening is we have foreign banks--and I will name a few of them in a second--that have put their money into an investment into AIG. They planned to make a profit. If they had made a profit, I dare say they wouldn't have come back to say to our United States of America: We will write you a check for the profit we made. Instead of that, they wait until they take a loss, and then the American taxpayers have to come in.

I think the American people are getting completely fleeced on their $150 billion AIG investment. Secretary Geithner needs to explain to us why relatively healthy firms such as Goldman Sachs aren't taking any loss on a clearly bad investment in AIG. Why are all these foreign banks getting 100 percent of their investment at the expense of the U.S. taxpayer?

Here is a sample of the banks that are getting made whole by U.S. taxpayers--that is our taxpayers--people who elect us to office: The Bank of Montreal, Canada, $1.1 billion; the Societe Generale, France, $11.9 billion; investments made by a French bank. This is a French bank that bought an interest in AIG, they lost their money, they come back to us, and we pay them back for their loss. The BNP Paribas, $4.9 billion; the Deutsche Bank in Germany, $11.8 billion; the ING, Netherlands, $1.5 billion; Barclays, of the UK, $8.5 billion. This is just a sampling of the over $50 billion that foreign banks have gotten from AIG. In other words, $50 billion in taxpayers' money has gone to foreign banks. I don't think many people have caught on to that yet. The taxpayers are picking up the tab. Meanwhile, some U.S. banks are getting the same treatment. Goldman Sachs has received $12.9 billion. These are all investments in AIG. Merrill Lynch, $6.8 billion; Bank of America, $5.2 billion; Citigroup, $2.3 billion. All told, the U.S. banks have gotten around $45 billion through AIG from the U.S. taxpayer. What is interesting, as bad as it is that U.S. banks are getting back $45 billion for bad investments, the foreign banks are actually getting back more than the U.S. banks are. Not one of these banks I have mentioned has taken a dime of loss in their AIG investments--not one. AIG's counterparties have been made whole across the board by the U.S. taxpayer. Why is that? Why can't any of these banks take any of the loss on their AIG investment? Why is the taxpayer being asked to bear the full cost of all these bad investments? The American taxpayers have a right to know and Secretary Geithner needs to explain this.

I say this because I know people are outraged in my State of Oklahoma about the fact that there have been bonuses that have been made, but this is even far worse than that was. The American people are getting completely fleeced on their $150 billion AIG investment, $700 billion bailout of Wall Street, and billions in ad hoc bailouts, of which we have still not seen the end. Only this week, Secretary Geithner has announced that the Government will work with private investors to purchase between $500 billion and $1 trillion of toxic assets.

Now, at this point I would say, remember back when we were being sold a bill of goods, I voted against it, but 75 percent of the Senate voted for it--$700 billion to be given to an unelected bureaucrat to do with as they wished. We all remember that. What was that supposed to be used for? The bad part of the bill was not just the amount of money; there were no guidelines, no accountability. That was supposed to be used to buy toxic assets. I could quote right now things they said at that time: This money has to be spent for toxic assets, and if you don't do that, the whole country is going to go down and we are going to have another depression again. So the President's budget includes a placeholder for billions in additional banking bailouts. The American people have said enough a long time ago. We have to put an end to the Geithner approach on bailouts.

Looking back since last fall, more and more I feel I may have been overly critical of Secretary Paulson, at least when compared to Secretary Geithner. Geithner's handling of the $700 billion Wall Street bailout has been worse than Paulson's. Whether it is Paulson or Geithner, handing $700 billion over to an unelected bureaucrat to do with what he pleases is bad enough when three-fourths of the Senate voted to do it last October, and it is an even worse idea with Tim Geithner at the helm. What has happened with the taxpayers' investment in AIG is clear evidence of that. No matter how you look at it, it has been a bad deal for the U.S. taxpayers.

Now, in light of all of this, I have introduced legislation to do more than deal with the bonuses. This is S. 680, just introduced. S. 680 gets to the root of this problem. Of the $150 billion we have already given to AIG, it is my understanding that there is $30 billion more for AIG from TARP that has been agreed to by the Treasury Secretary but has not yet been drawn down. My legislation would prevent that from going forward. The taxpayers have given AIG about $150 billion so far. I think it is completely reasonable to say that once a single company gets $150 billion from the taxpayers, it should be cut off from getting more. There has to be a point beyond which Government cannot go, and there has to be an end to the road that is fleecing American taxpayers. This provides that end.

There is no other vehicle out there to do it. I can tell my colleagues right now, if this isn't brought up and voted on, the taxpayers of America are going to put another $30 billion into AIG to be used to pay off foreign banks. This is the only way we can stop it is with this legislation, so I encourage the leadership to help us bring this up for a vote. I can assure my colleagues it would pass with an overwhelming majority. That is S. 680, the only vehicle out there that would keep AIG from using taxpayer money to pay off other foreign banks.

Mr. President, I rise today with Senator Leahy and Senator Specter to introduce the Juvenile Justice and Delinquency Prevention Reauthorization Act. The Juvenile Justice and Delinquency Prevention Act, JJDPA, has played a key role in successful state and local efforts to reduce juvenile crime and get kids back on track after they have had run-ins with the law. This legislation will reauthorize and make significant improvements to these important programs.

A successful strategy to combat juvenile crime consists of a large dose of prevention and intervention programs. Juvenile justice programs have proven time and time again that they help prevent crime, strengthen communities, and rehabilitate juvenile offenders. The JJDPA has always had a dual focus: prevention and rehabilitation.

The JJDPA has successfully focused on intervening in a positive manner to work with those teens that have fallen through the cracks and have had a few scrapes with the law. Many of the juveniles who come into contact with the justice system are not violent offenders or gang members. Rather, they are young people who have made mistakes and deserve a second chance to succeed and lead healthy lives. In fact, seventy percent of youth in detention are held for nonviolent charges. Research has shown that youth who come into contact with the justice system can be rehabilitated, and we have an obligation to support successful programs that do just that.

While putting young people on the right path after they have had run- ins with the law is tremendously important, we would all prefer to keep them from getting into trouble in the first place. Title V, of course, is the only federal program that is dedicated exclusively to juvenile crime prevention. Evidence-based prevention programs are proven to reduce crime. Because each child prevented from engaging in repeat criminal offenses can save the community $1.7 to $3.4 million, reducing crime actually saves money. Research has shown that every dollar spent on effective, evidence based programs can yield up to $13 in cost savings.

Since the last reauthorization in 2002, research and experience have revealed that there is still room for improvement. That is why we are proposing a number of changes to the Act.

Under Title II, the existing JJDPA requires states to comply with certain core requirements that are designed to protect and assist in the rehabilitation of juvenile offenders. This legislation makes improvements to four of the core requirements--removal of juveniles from adult jails, preventing contact between juvenile offenders and adult inmates, the deinstitutionalization of status offenders, and disproportionate minority contact, DMC.

The legislation would amend the jail removal and sight and sound requirements to ensure that juveniles charged as adults are not placed in an adult facility or allowed to have contact with adult inmates unless a court finds that it is in the interest of justice to do so. Research has shown that juveniles who spend time in adult jails are more likely to reoffend. Therefore, it is critical that we get judges more involved in this process to ensure that it is in everyone's best interest, but particularly the juvenile's best interest, to place that young person in an adult facility.

This measure would also place important limitations on the valid court order exception to the deinstitutionalization of status offenders. Under the current JJDPA, courts can order status offenders to be placed in secure detention with minimal process and no limit on duration. We seek to change both of these. This bill would place a 7 day limit on the amount of time a status offender can spend in a secure facility, and ensure that juvenile status offenders have significant procedural protections.

In addition, the legislation will push states to take concrete steps to identify the causes of disproportionate minority contact and take meaningful steps to achieve concrete reductions.

The bill also focuses a great deal of attention on improving cooperation between the states and the Federal Government in the area of juvenile justice. It directs the Administrator of the Office of Juvenile Justice to conduct additional research. It seeks to strengthen the amount of training and technical assistance provided by the Federal Government, particularly workforce training for those people who work directly with juveniles at every stage of the juvenile justice system.

The Juvenile Justice and Delinquency Prevention Reauthorization Act would improve treatment of juveniles in two important respects. It seeks to end the use of improper isolation and dangerous practices, and it encourages the use of best practices and alternatives to detention.

This measure also places a greater focus on mental health and substance abuse treatment for juveniles who come into contact, or are at risk of coming into contact, with the juvenile justice system. Research has shown that the prevalence of mental disorders among youth in juvenile justice systems is two to three times higher than among youth who have not had run-ins with the law. Taking meaningful steps to provide adequate mental health screening and treatment for these juveniles is a critical part of getting them on the right track, and needs to be a part of federal, state and local efforts to rehabilitate juvenile offenders.

Finally, and possibly most importantly, the key to success is adequate support. Funding for juvenile justice programs has been on a downward spiral for the last 8 years. Just 6 years ago, these programs received approximately $556 million, with more than $94 million for the Title V Local Delinquency Prevention Program and nearly $250 million for the Juvenile Accountability Block Grant program. Last year, the Bush administration requested just $250 million for all juvenile justice programs, which represents more than a 50 percent cut from fiscal year 2002. Local communities do a great job of leveraging this funding to accomplish great things, but we cannot say with a straight face that this level is sufficient. We look forward to working with President Obama to ensure that these vital programs once again receive the adequate funding they deserve.

Therefore, we are seeking to authorize increased funding for the Juvenile Justice and Delinquency Prevention Act. The bill will authorize more than $272 million for Title V and nearly $200 million for Title II in fiscal year 2009. Then, funding for each title will increase by $50 million each subsequent fiscal year. These programs are in desperate need of adequate funding. It is money well spent, and this increase in authorized funding will demonstrate Congressional support for these critical programs.

In addition to increased funding for traditional JJDPA programs, we have created a new incentive grant program under the Act. This program authorizes another $60 million per year to help local communities to supplement efforts under the Act, and in some cases go above and beyond what is required of them. Specifically, this funding will support evidence based and promising prevention and intervention programs. It will enhance workforce training, which will improve the treatment and rehabilitation of juveniles who come into contact with the system. Lastly, a significant portion of this funding will be dedicated to mental health screening and treatment of juveniles who have come into contact, or are at risk of coming into contact, with the justice system.

The Juvenile Justice and Delinquency Prevention Act is an incredibly successful program. The fact that it is cost efficient is important. But the most important thing is that it is effective. It is effective in reaching the kids it is designed to help. The evidence based prevention programs it funds are able to touch the lives of at-risk youth and steer them away from a life of crime. For those who have unfortunately already had run-ins with law enforcement, its intervention and treatment programs have successfully helped countless kids get their lives back on the right track and become productive members of society.

It is beyond dispute that these proven programs improve and strengthen young people, as well as their families and their communities. For that reason, we urge our colleagues to support this important measure to reauthorize and improve these programs.

President, I rise today to introduce two important social work bills; the Dorothy I. Height and Whitney M. Young, Jr. Social Work Reinvestment Act and the Clinical Social Work Medicare Equity Act of 2009. I am proud to sponsor these pieces of legislation that will improve the shortage of social workers and properly reimburse social workers for the services they provide.

Social workers play a critical role combating the social problems facing our nation and are an integral part of our healthcare system. As we move into an era of unprecedented healthcare and social service needs, we must have the workforce in place to make sure that our returning soldiers have access to mental health services, our elderly maintain their independence in the communities they live in, and abused children are placed in safe homes. Social workers support physical, psychological and social needs. They provide mental health therapy, caregiver and family counseling, health education, program coordination, and case management. In these tough economic times social workers play a more important role than ever to keep communities together and help individuals and families cope with the new stresses they are facing.

The Dorothy I. Height and Whitney M. Young, Jr. Social Work Reinvestment Act reinvests in social workers by providing grants to social workers, reviewing the current social workforce challenges, and determining how this shortage will affect the communities social workers serve. I am honored to introduce this bill named after two social visionaries, Dorothy I. Height and Whitney M. Young. Dorothy Height, a pioneer of the civil rights movement, like me began her career as a case worker and continued to fight for social justice. I am particularly honored to introduce this bill today, on Dorothy Height's birthday. Whitney Young, another trailblazer of the civil rights movement, also began his career transforming our social landscape as a social worker. He helped create President Johnson's War on Poverty and has served as President of the National Association of Social Workers.

This bill is about reinvesting in social work. It provides grants that invest in social work education, research, and training. These grants will fund community based programs of excellence and provide scholarships to train the next generation of social workers. The bill also addresses how to recruit and retain new social workers, research the impact of social services, and foster ways to improve social workplace safety. This bill establishes a national coordination center that will allow social work education, advocacy and research institutions to collaborate and work together. It will facilitate gathering and distributing social work research to make the most effective use of the information we have on how social work service can improve our social fabric. This bill also gives social work the attention it deserves. It creates a media campaign that will promote social work, and recognizes March as Social Work Awareness Month.

Today 30,000 social workers specialize in gerontology, but we will need 70,000 of these social workers by 2010. I want to make sure that when the aging tsunami hits us, we have the workforce in place to care for our aging family members, the Alzheimer patients, and the disabled.

The Clinical Social Work Medicare Equity Act of 2009 ensures that clinical social workers receive Medicare reimbursements for the mental health services they provide in skilled nursing facilities. Under the current system, social workers are not paid for the services they provide. Psychologists and psychiatrists, who provide similar counseling, are able to separately bill Medicare for their services.

Since my first days in Congress, I have been fighting to protect and strengthen the safety of our nation's seniors. Making sure that seniors have access to quality, affordable mental health care is an important part of this fight. I know that millions of seniors do not have access to, or are not receiving, the mental health services they urgently need. Nearly 6 million seniors are affected by depression, but only one-tenth ever receive treatment. According to the American Psychiatric Association, up to 25 percent of the elderly population in the United States suffers from significant symptoms of mental illness and among nursing home residents the prevalence is as high as 80 percent. These mental disorders, which include severe depression and debilitating anxiety, interfere with the person's ability to carry out activities of daily living and adversely affect their quality of life. Furthermore, older people have a 20 percent suicide rate, the highest of any age group. Every year nearly 6,000 older Americans kill themselves. This is unacceptable and must be addressed.

This bill protects patients across the country and ensures that seniors living in underserved urban and rural areas, where clinical social workers are often the only available option for mental health care, continue to receive the treatment they need. Clinical social workers, much like psychologists and psychiatrists, treat and diagnose mental illnesses. In fact, clinical social workers are the primary mental health providers for nursing home residents and seniors residing in rural environments. Unlike other mental health providers, clinical social workers cannot bill Medicare directly for the important services they provide to their patients. Protecting seniors' access to clinical social workers ensures that our most vulnerable citizens get the quality, affordable mental health care they need. This bill will correct this inequity and make sure clinical social workers get the payments and respect they deserve.

Before the Balanced Budget Act of 1997, clinical social workers billed Medicare Part B directly for mental health services they provided in nursing facilities for each patient they served. Under the Prospective Payment System, services provided by clinical social workers are lumped, or ``bundled,'' along with the services of other health care providers for the purposes of billing and payments. Psychologists and psychiatrists, who provide similar counseling, were exempted from this system and continue to bill Medicare directly. This bill would exempt clinical social workers, like their mental health colleagues, from the Prospective Payment System, and would make sure that clinical social workers are paid for the services they provide to patients in skilled nursing facilities.

This bill is about more than paperwork and payment procedures. This bill is about equal access to Medicare payments for the equal and important work done by clinical social workers. It is about making sure our nation's most vulnerable citizens have access to quality, affordable mental health care. The overarching goal we should be striving to achieve for our seniors is an overall improved quality of life. Without clinical social workers, many nursing home residents may never get the counseling they need when faced with a life-threatening illness or the loss of a loved one. I think we can do better by our nation's seniors. I am fighting to make sure we do.

As a social worker, I have been on the frontlines of helping people cope with issues in their everyday lives. I started off fighting for abused children, making sure they were placed in safe homes. Today I am a social worker with power. I am proud to continue to fight every day for the long range needs of the nation on the floor of the U.S. Senate and as Chairwoman of the Aging Subcommittee of the Health, Education, Labor and Pensions Committee.

The Clinical Social Work Medicare Equity Act of 2009 and the Dorothy I. Height and Whitney M. Young, Jr. Social Work Reinvestment Act is strongly supported by the National Association of Social Workers. I also want to thank Senator Stabenow and Senator Murray for their cosponsorship of the Clinical Social Work Medicare Equity Act of 2009. I look forward to working with my colleagues to enact these two important pieces of legislation.

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

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

Mr. President, I am introducing today important legislation designed to protect our communities and particularly our most precious asset, our children. I am pleased to be joined by Senator Specter and Senator Kohl, who have been leaders in this area of the law for decades, and Senator Durbin, who is the new Chairman of the Crime and Drugs Subcommittee. Our legislation is intended to keep children safe and out of trouble and also to help ensure they have the opportunity to become productive adult members of society.

The Senate Judiciary Committee reported this important bill last July. I was disappointed that Republican objections prevented this vital bipartisan legislation from passing the Senate in the last Congress, but we will redouble our efforts to pass this bill this year.

The Juvenile Justice and Delinquency Prevention Act sets out Federal policy and standards for the administration of juvenile justice. It authorizes key Federal resources for states to improve their juvenile justice systems and for communities to develop programs to prevent young people from getting into trouble. We are recommitting ourselves to these important goals with this proposed reauthorization. We also push the law forward in key ways to better serve our communities and our children.

The basic goals of the Juvenile Justice and Delinquency Prevention Act remain the same: keeping our communities safe by reducing juvenile crime, advancing programs and policies that keep children out of the criminal justice system, and encouraging states to implement policies designed to steer those children who do enter the juvenile justice system back onto a track to become contributing members of society.

The reauthorization that we introduce today augments these goals in several ways. First, this bill encourages states to move away from keeping young people in adult jails. The Centers for Disease Control and Prevention has concluded that children who are held in adult prisons commit more crimes, and more serious crimes, when they are released, than children with similar histories who are kept in juvenile facilities. After years of pressure to send more and more young people to adult prisons, it is time to seriously consider the strong evidence that this policy is not working.

We must do this with ample consideration for the fiscal constraints on states, particularly in these lean budget times, and with deference to the traditional role of states in setting their own criminal justice policy. We have done so here. But we also must work to ensure that unless strong and considered reasons dictate otherwise, the presumption must be that children will be kept with other children, particularly before they have been convicted of any wrongdoing.

As a former prosecutor, I know well the importance of holding criminals accountable for their crimes with strong sentences. But when we are talking about children, we must also think about how best to help them become responsible, contributing members of society as adults. That keeps us all safer.

I am disturbed that children from minority communities continue to be overrepresented in the juvenile justice system. This bill encourages states to take new steps to identify the reasons for this serious and continuing problem and to work together with the Federal Government and with local communities to find ways to start solving it.

I am also concerned that too many runaway and homeless young people are locked up for status offenses, like truancy, without having committed any crime. In a Judiciary Committee hearing last year on the reauthorization of the Runaway and Homeless Youth Act, we were reminded of the plight of this vulnerable population, even in the wealthiest country in the world, and inspired by the ability of so many children in this desperate situation to rise above that adversity.

This reauthorization of the Juvenile Justice Act takes strong and significant steps to move away from detaining children from at-risk populations for status offenses, and requires states to phase out the practice entirely in three years, but with a safety valve for those states that are unable to move quite so quickly due to limited resources.

As I have worked with experts on this legislation, it has become abundantly clear that mental health and drug treatment are fundamental to making real progress toward keeping juvenile offenders from reoffending. Mental disorders are two to three times more common among children in the juvenile justice system than in the general population, and 80 percent of young people in the juvenile justice system have been found by some studies to have a connection to substance abuse. This bill takes new and important steps to prioritize and fund mental health and drug treatment.

The bill tackles several other key facets of juvenile justice reform. It emphasizes effective training of personnel who work with young people in the juvenile justice system, both to encourage the use of approaches that have been proven effective and to eliminate cruel and unnecessary treatment of juveniles. The bill also creates incentives for the use of programs that research and testing have shown work best.

Finally, the bill refocuses attention on prevention programs intended to keep children from ever entering the criminal justice system. I was struck when Chief Richard Miranda of Tucson, AZ, said during our December 2007 hearing on this bill that we cannot arrest our way out of the problem. I heard the same sentiment from Chief Anthony Bossi and others at the Judiciary Committee's field hearing last year on young people and violent crime in Rutland, Vermont. When seasoned police officers from Rutland, Vermont, to Tucson, Arizona, tell us that prevention programs are pivotal, I pay attention.

Just as the last administration gutted programs that support state and local law enforcement, so they consistently cut and narrowed effective prevention programs. It would have been even worse had it not been for Senator Kohl's efforts. We must work with the

Obama administration to reverse this trend and help our communities implement programs proven to help kids turn their lives around.

I thank the many prominent Vermont representatives of law enforcement, the juvenile justice system, and prevention-oriented non- profits who have spoken to me in support of reauthorizing this important Act, and who have helped inform my understanding of these issues. They include Ken Schatz of the Burlington City Attorney's Office, Vermont Juvenile Justice Specialist Theresa Lay-Sleeper, and Chief Steve McQueen of the Winooski Police Department. I know that many Judiciary Committee members have heard from passionate leaders on this issue in their own states.

I have long supported a strong Federal commitment to preventing youth violence, with full respect for the discretion due to law enforcement and judges, with deference to states, and with a regard for difficult fiscal realities. I have worked hard on past reauthorizations of this legislation, as have Senators Specter and Kohl and others on the Judiciary Committee. We have learned the importance of balancing strong law enforcement with effective prevention programs. This reauthorization pushes forward new ways to help children move out of the criminal justice system, return to school, and become responsible, hard-working members of our communities. I hope all Senators will join us in supporting this important legislation.

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

Mr. President, today, I am joining with Senator Specter and others to introduce the Community Choice Act. This legislation is needed to truly bring people with disabilities into the mainstream of society and provide equal opportunity for employment and full involvement in community activities.

The individuals affected by the Community Choice Act are those persons who require an institutional level of care to manage their disabilities. The question is whether they will receive these services only in an institutional setting--typically, a nursing home--or whether they will also have the choice to receive these services in their communities, where they can be part of community life and close to family and friends.

Under the U.S. Supreme Court's decision in Olmstead v. L.C., 1999, individuals with disabilities have the right to choose to receive their long-term services and supports in the community, rather than in an institutional setting. This year marks the 10-year anniversary of the Olmstead decision.

Unfortunately, under current Medicaid policy, and despite much effort to ``rebalance'' the system, the deck is still stacked in favor of living in an institutional setting. The reason for this is simple. Despite the Olmstead decision, Federal law only requires that States cover nursing home care in their Medicaid programs. There is no similar requirement for providing individuals the choice of receiving their services and supports in a community-based setting.

Overall about 60 percent of Medicaid long-term care dollars are still spent on institutional services, with about 40 percent going to home and community-based services. In 2007, only 11 States spent 50 percent or more of their Medicaid long-term care funds on home and community- based care.

The statistics are even more disproportionate for adults with physical disabilities. In 2007, 69 percent of Medicaid long-term care spending for older people and adults with physical disabilities paid for institutional services. Only 6 States spent 50 percent or more of their Medicaid long-term care dollars on home and community-based services for older people and adults with physical disabilities, while half of the States spent less than 25 percent. This disparity continues even though, on average, it is estimated that Medicaid dollars can support nearly three older people and adults with physical disabilities in home and community-based services for every person in a nursing home.

Although 30 States have already recognized the benefits of community- based services, and are providing the personal care optional benefit through their Medicaid program, these programs are unevenly distributed and only reach a small percentage of eligible individuals. Many of these programs serve only persons with certain disabilities. They have long waiting lists. They have financial caps. None of them allow the recipients to retain their benefits if they move to other States. Individuals with the most significant disabilities are usually afforded the least amount of choice, despite advances in medical and assistive technologies and related areas.

This current imbalance means that individuals with disabilities do not have equal access to community-based care throughout this country. An individual with a disability should not have to move to another State in order to avoid needless segregation. Nor should that individual have to move away from family and friends because the only choice is an institution.

The right to live in the community is too important a right to be left to State discretion. Instead, it should be left to the individual to decide, as the Supreme Court has recognized.

The majority of individuals who use Medicaid long-term services and supports prefer to live in the community, rather than in institutional settings.

I think of my nephew Kelly, who became a paraplegic after an accident while serving in the U.S. Navy. The Veterans Administration pays for his attendant services. This allows Kelly to get up in the morning, go to work, operate his own small business, pay taxes, and be a fully contributing member of our economy and society. This country is rich enough to provide these same opportunities to every American who needs attendant services.

We in Congress have a responsibility to help States meet their obligations under Olmstead, to level the playing field, and to give eligible individuals equal access to the community-based services and supports they need.

The Community Choice Act is designed to do just that, and to make the promise of the Americans with Disabilities Act a reality. It will help rebalance the current Medicaid long-term care system, which spends a disproportionate amount on institutional services.

Federal Medicaid policy should reflect the goals of the Americans with Disabilities Act that Americans with disabilities should have equal opportunity, and the right to fully participate in their communities. No one should have to sacrifice their ability to participate because they need help getting out of the house in the morning or assistance with personal care or some other basic service.

The Community Choice Act can substantially reform long-term services in this country, consistent with the Olmstead decision, by allowing people with disabilities who need an institutional level of care the choice of receiving their services and supports in their

own communities, rather than in an institution. With appropriate community-based services and supports, we can transform the lives of people with disabilities. They can live with family and friends, not strangers. They can be the neighbor down the street, not the person warehoused down the hall. This is not asking too much. This is the bare minimum that we should demand for every human being.

Community-based services and supports allow people with disabilities to lead independent lives, have jobs, and participate in their communities. Some will become taxpayers, some will get an education, and some will participate in recreational and civic activities. But all will be given a chance to make their own choices and to govern their own lives.

The Community Choice Act will open the door to full participation by people with disabilities in our workplaces and economy. It will give them better access to the American Dream.

As has been true with all major disability-rights legislation going back to the ADA, this is a strictly bipartisan bill. I urge all my colleagues to come together on this important measure. I especially want to thank Senator Specter for his leadership on this issue and his commitment to improving access to home and community-based services for people with disabilities. I also thank Senators Kennedy, Durbin, Kerry, Schumer, Stabenow, Dodd, Brown, Sanders, Casey, Tester, Bennet, and Gillibrand for joining me in this important initiative.

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