Preventive Medicine and Public Health Training Act

Mr. President, there is a crisis facing our country, a crisis that directly affects the lives of almost 50 million people in the U.S., and that indirectly affects many more. The crisis is the lack of universal health insurance in America, and its effects are rippling through our families, our communities, and our economy. It is the number one issue that I hear about in Wisconsin, and it is the number one issue for many Americans. Nevertheless, for too long, Congress has been locked in a stalemate when it comes to health reform, refusing to move forward on this life-threatening problem because of party politics and special interests. That is why, for the past few Congresses, I have introduced with the Senator from South Carolina, Lindsey Graham, the State-Based Health Care Reform Act.

Senator Graham and I are from opposite ends of the political spectrum, we are from different areas of the country, and we have different views on health care. But we agree that something needs to be done about health care in our country. Every day, all over our nation, Americans suffer from medical conditions that cause them pain and even change the way they lead their lives. Every one of us has either experienced this personally or through a family member suffering from cancer, Alzheimer's, diabetes, genetic disorders, mental illness or some other condition. The disease takes its toll on both individuals and families, as trips to the hospital for treatments such as chemotherapy test the strength of the person and the family affected. This is an incredibly difficult situation for anyone. But for the uninsured and underinsured, the suffering goes beyond physical discomfort. These Americans bear the additional burden of wondering where the next dollar for their health care bills will come from; worries of going into debt; worries of going bankrupt because of health care needs. When illness strikes families, the last thing they should have to think about is money, but for many in our country, this is a persistent burden that causes additional stress and hopelessness when they are ill.

It is difficult to do justice to the magnitude of the uninsurance problem, but I want to share a few astounding statistics. The need for health care reform has reached crisis proportions in America, with over 46 million Americans uninsured. As a result of our current economic crisis, that number is climbing by the day. In December of 2008 and January of 2009, it is estimated that 14,000 Americans lost their access to health care each day; in Wisconsin, 230 people each day lost access to care during these 2 months. The cost of providing care to the uninsured weighs heavily on the U.S. economy. According to research done by the journal Health Affairs, the uninsured received approximately $56,000,000,000 in uncompensated care in 2008. Government programs finance about 75 percent of uncompensated care. The cost of the uninsured weighs heavily on our collective conscience, as well. In my home State of Wisconsin alone, it is estimated that 250 Wisconsinites, or 5 people each week, died in 2006 because they did not have health insurance.

The U.S. is the only industrialized nation that does not guarantee health care for its citizens. In other countries, if someone is sick, they get proper care regardless of ability to pay. In our country, that is not the case. It is unacceptable for a nation as great as America to not provide good health care for all our citizens. We are failing those in need. We are failing the hard-working family that cannot afford the insurance offered to them. We are failing the uninsured children whose parents do not have any access to insurance. We are failing low-income Americans and middle-income Americans alike. This is not right. We can do better.

Even for those Americans who currently have health insurance through their employer, the risk of becoming uninsured is very real. Large businesses are finding themselves less competitive in the global market because of skyrocketing health care costs. Small businesses are finding it difficult to offer insurance to employees while staying competitive in their own communities. Our health care system has failed to keep costs in check, and there is simply no way we can expect businesses to keep up. More and more, employers are forced to increase employee cost- sharing or to offer sub-par benefits, or no benefits at all. Employers cannot be the sole provider of health care when these costs are rising faster than inflation.

I travel to each of Wisconsin's 72 counties every year to hold townhall meetings. Almost every year, the number one issue raised at these listening sessions is the same--health care. The failure of our health care system brings people to these meetings in droves. These people used to think Government involvement was a terrible idea, but not anymore. Now they come armed with their frustration, their anger, and their desperation, and they tell me that their businesses and their lives are being destroyed by health care costs, and they want the Government to step in.

I am pleased to be joined by Senator Graham in introducing the State- Based Health Care Reform Act. In short, this bill establishes a pilot project to provide States with the resources needed to implement universal health care reform. The bill does not dictate what kind of reform the States should implement, it just provides an incentive for action, provided States meet certain minimum coverage and low-income requirements.

Even though Senator Graham and I support different methods of health care reform, we both agree that this legislation presents a viable solution to the logjam preventing reform. It may well be that, with a new President and a new Congress, that logjam is already broken. I hope that is the case, as I have long said that a single-payer health care system is what I prefer for our country. I also recognize that there are strong obstacles to enacting real reform, and that we may need the support of members of Congress with different views on this topic. Senator Graham would like to see health care privatized and see a base, catastrophic coverage offered to everyone. Despite our disagreements about the form that health care reform should take, we agree on this legislation.

With the election of Barack Obama, Americans have a real opportunity to reform our health care system. I look forward to consideration of health care reform this Congress, and I do not intend to push this bill as an alternative to broader efforts. But I do think our proposal may help provide ideas about how to bring together Democrats and Republicans on this issue.

Under our proposal, States can be creative in the State resources they use to expand health care coverage. For example, a State can use personal or employer mandates for coverage, use State tax incentives, create a single-payer system or even join with neighboring States to offer a regional health care plan. The proposals are subject only to the approval of the newly created Health Care Coverage Task Force, which will be composed of health care experts, consumers, and representatives from groups affected by health care reform. This Task Force will be responsible for choosing viable State projects and ensuring that the projects are effective. The Task Force will also help the States develop projects, and will continue a dialogue with the States in order to facilitate a good relationship between the State and Federal Governments.

The Task Force is also charged with making sure that the State plans meet certain minimal requirements. First, the State plans must include specific target dates for decreasing the number of uninsured, and must also identify a set of minimum benefits for every covered individual. These benefits must be comparable to health insurance offered to Federal employees. Second, the State plans must include a mechanism to guarantee that the insurance is affordable. Americans should not go broke trying to keep healthy, and health care reform should ensure that individual costs are manageable. The State-Based Health Care Reform Act bases affordability on income.

Another provision in this legislation requires that the States contribute to paying for their new health care programs. The Federal Government will provide matching funds based on enhanced FMAP--the same standard used for SCHIP--and will then provide an additional 5 percent. States that can

afford to provide more are encouraged to, but the matching requirement will ensure the financial viability of the bill and State buy-in. Other than these requirements, the States largely have flexibility to design a plan that works best for their respective residents. The possibilities for reform are wide open.

One of the main criticisms of Federal Government spending on health care is that it is expensive and increases the deficit. My legislation is fully offset, ensuring that it will not increase the deficit. The bill does not avoid making the tough budget choices that need to be made if we are going to pay for health care reform.

We need a solution for a broken system where millions are uninsured, and where businesses and Americans are struggling under the burden of health care costs.

It has been over 10 years since the last serious debate over health care reform was killed by special interests and the soft money contributions they used to corrupt the legislative process. The legislative landscape is now much different. Soft money can no longer be used to set the agenda, and businesses and workers are crying out as never before for Congress to do something about the country's health care crisis.

We are fortunate to live in a country that has been abundantly blessed with democracy and wealth, and yet there are those in our society whose daily health struggles overshadow these blessings. That is an injustice, but it is one we can and must address. Dr. Martin Luther King, Jr., said, ``Of all the forms of inequality, injustice in health care is the most shocking and inhumane.'' It is long past time for Congress to heed these words and end this terrible inequality.

Mr. President, today I introduce the Telework Enhancement Act of 2009 to allow greater workplace flexibility for Federal workers and agencies. I am pleased to be joined in this effort by my good friend, Senator George Voinovich.

Flexible work arrangements referred to generally as ``telework'' have emerged as an important part of Federal agencies' management tools and continuity of operations plans during emergencies, allowing employees to work from home or a remote location. As the Internet and technologies have advanced and become integrated into the modern work environment, opportunities for employees to securely and efficiently perform their official duties from a remote location also have expanded.

Last Congress, as Chairman of the Subcommittee on Oversight of Government Management, the Federal Workforce, and the District of Columbia, I joined Ranking Member Voinovich in holding a hearing to assess telework policies and initiatives within the Federal Government. Witnesses testified to the benefits of increased telework opportunities within the Federal workforce, including lower vehicle emissions associated with commuting, better work-life balance, reduced overhead costs for agencies, and increased trust and communication between employees and their managers.

Expanding telework options helps the Federal Government attract and retain talented employees. With a large portion of the Federal workforce eligible for retirement in the coming years, it is essential for agencies to develop management tools to enhance recruitment and retention. This bill would provide Federal agencies with an important tool to remain competitive in the modern workplace and would offer a flexible option for human capital management.

Despite these benefits, witnesses also testified that many agencies hesitate to implement broad telework programs. The witnesses cite agency leadership and management resistance as the greatest barriers to the development of robust telework policies. Even the head of the Patent and Trademark Office acknowledged that without his persistent leadership and commitment to telework, the PTO would not have the beneficial program that it does today.

In the past, Congress has approved provisions in appropriations bills to enhance telework opportunities within the Federal Government and encouraged agencies to implement comprehensive telework programs. However, Congress has not approved an authorization bill to make all Federal employees presumptively eligible to telework unless an employing agency expressly determined otherwise. Last Congress I offered an amendment in the nature of a substitute to S. 1000, a telework bill introduced by Senators Stevens and Landrieu. My amendment was adopted by the Committee on Homeland Security and Governmental Affairs and the amended bill was reported on the floor of the Senate.

The Telework Enhancement Act of 2009 builds on those efforts by laying the groundwork for robust telework policies in each executive agency. The Office of Personnel Management, OPM, would work with agencies to provide guidance and consultation on telework policies and goals. A Telework Managing Officer, TMO, would also be created within each agency. The TMO's primary responsibilities would be to monitor and develop agency telework policies, and act as a resource for employees and managers on telework issues.

This bill does more than provide guidelines for the development of robust telework policies; it prohibits discrimination against employees who chose to telework, guaranteeing those employees will not be disadvantaged in performance evaluations, pay, or benefits. This bill also holds agencies accountable by requiring the submission of telework data to OPM. OPM is then responsible for submitting an annual report to Congress, which summarizes the telework data and reports on the progress of each agency in achieving its telework goals.

I am proud to join Senator Voinovich in introducing the Telework Enhancement Act of 2009. We must make sure agencies have the tools necessary to make the Federal Government an employer of choice in the twenty-first century; enhancing telework options will further that goal. I urge my colleagues to support this legislation

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

Mr. President, today I, along with members of the Hawaii Congressional Delegation, introduce a modified version of the Native Hawaiian Government Reorganization Act of 2009. In order to address concerns that have been raised, a new section prohibiting gaming has been included. With the exception of this one section, the resulting Senate bill and House bill preserve the language of S. 381 and H.R. 862, respectively; that were previously introduced on February 4, 2009. The legislation we introduce today is the legislation we will seek to move forward with toward enactment.

I am not a proponent of gaming. Our legislation would not legalize gaming by Native Hawaiians or the Native Hawaiian government in the State of Hawaii, any other state, or the territories. I reiterate to my colleagues, as well as the people of this Nation that all forms of gambling are illegal in Hawaii and the Native Hawaiian government will be subject to all State and Federal laws. The legislation we introduce today with this added gaming prohibition provision simply clarifies our intent.

Let me be clear for the record and for my colleagues that this bill is not about gaming. Rather it is about providing Federal recognition to Native Hawaiians so they may have the opportunity to enjoy the same government-to-government relationship with the U.S. provided to Alaska Natives and American Indians. The indigenous people of Hawaii, Native Hawaiians, have not been extended the Federal policy of self-governance and self-determination. The legislation provides parity and authorizes a process to federally recognize Native Hawaiians. The legislation is consistent with Federal law and maintains efforts by the U.S. Government and State of Hawaii to address

the unique needs of Native Hawaiians and empower them to perpetuate their culture, language, and traditions.

The United States has committed itself to a process of reconciliation with the indigenous people of Hawaii. Recognizing and upholding this U.S. responsibility for Native Hawaiians, the legislation allows us to take the next necessary step in the reconciliation process. The legislation does three things. First, it authorizes an Office within the Department of Interior to serve as a liaison between Native Hawaiians and the U.S. Second, it forms an Interagency Task Force cochaired by the Departments of Interior and Justice and comprised of officials from Federal agencies administering programs and services impacting Native Hawaiians. Third, it authorizes the process for the reorganization of a Native Hawaiian government for the purposes of a federally recognized government-to-government relationship. Once the Native Hawaiian government is recognized, the bill establishes an inclusive democratic negotiations process representing both Native Hawaiians and non-Native Hawaiians. There are many checks and balances in this process and any agreements reached during the negotiations process will require implementing legislation at the State and Federal levels.

This legislation will go a long way to address issues present in my home State. It is clear there are longstanding and unresolved issues resulting from the 1893 U.S. overthrow of the kingdom of Hawaii. Progress to address these issues have been limited as there has been no government-to-government relationship to facilitate discussions or implement agreements. However, with the structured process in the bill the people of Hawaii will be empowered to come together, resolve these issues, and move proudly forward together as a State.

The bill remains the product of the dedicated and mindful work of the five working groups that drafted the original bill that passed the U.S. House of Representatives in 2000. Individuals from the Native Hawaiian community, elected officials from the State of Hawaii, representatives from Federal agencies, Members of Congress, as well as leaders from Indian country and experts in constitutional law contributed to this bill. These working groups ensured that all parties that had expertise and would work to implement the bill had an opportunity to participate in the drafting process.

Over the last 9 years there has been significant public input and congressional oversight. This bill benefits from the input received during the nine congressional hearings, including six joint House Natural Resources Committee and Senate Indian Affairs Committee hearings, five of which were held in Hawaii. The bill introduced today provides a constitutionally sound foundation for us to build upon. I encourage my colleagues to join Senator Inouye and me in enacting this legislation.

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

Mr. President, as we move forward with comprehensive health reform we must also not ignore that some of our most vulnerable Medicare beneficiaries are subject to costly, bureaucratic red tape which is delaying

essential, life-saving treatments. Addressing this problem can both increase the quality of life for many patients and ease financial burdens for their medical providers.

Between 6,000 and 10,000 Medicare beneficiaries have primary immunodeficiency diseases, PIDD, that require intravenous immunoglobulin, IVIG, treatment to maintain a healthy immune system.

Primary Immunodeficiency Diseases, PIDD, are disorders in which part of the body's immune system is missing or does not function properly. Untreated PIDDs result in frequent life-threatening infections and debilitating illnesses. Even illnesses such as the common cold or the flu can be deadly for someone with PIDD.

Because of advances in our medical understanding and treatment of primary immune deficiency diseases, individuals who in the past would not have survived childhood are now able to live nearly normal lives. While there is still no cure for PIDD, there are effective treatments available. Nearly 70 percent of primary immune deficient patients use intravenous immunoglobulin, IVIG, to maintain their health.

Immunoglobulin is a naturally occurring collection of highly specialized proteins, known as antibodies, which strengthen the body's immune response. It is derived from human plasma donations and is administered intravenously to the patient every three to four weeks.

Currently, Medicare beneficiaries needing IVIG treatments are experiencing access problems. This is an unintended result of the way Medicare has determined the payment for IVIG. In January 2005, the Medicare Modernization Act changed the way physicians and hospital outpatient departments were paid under Medicare. The law reduced IVIG reimbursement rates so most physicians in outpatient settings could no longer afford to treat Medicare patients requiring IVIG. Access to home based infusion therapy is limited since Medicare currently pays for the cost of IVIG, but not for the nursing services or supplies required for infusion.

As a result, patients are experiencing delays in receiving critically-needed treatment and are being shifted to more expensive care settings such as inpatient hospitals. In April 2007, the U.S. Department of Health and Human Services Office of the Inspector General, OIG, reported that Medicare reimbursement for IVIG was inadequate to cover the cost many providers must pay for the product. In fact, the OIG found that 44 percent of hospitals and 41 percent of physicians were unable to purchase IVIG at the Medicare reimbursement rate during the 3rd quarter of 2006. The previous quarter was even worse--77.2 percent of hospitals and 96.5 percent of physicians were unable to purchase IVIG at the Medicare reimbursement rate.

We have an opportunity to fix this very real problem with a compassionate and common sense solution. I believe we can improve the quality of life for PIDD patients and cut inpatient expenses by improving reimbursement procedures for IVIG treatments for physicians and outpatient facilities and allowing for home treatments and coverage for related services.

That is why, today, I am introducing the Medicare IVIG Access Act, with Senators Alexander, Wyden, Whitehouse, and Brownback, to authorize the Secretary of Health and Human Services to update the payment for IVIG, based on new or existing data, and to provide coverage for related items and services currently excluded from the existing Medicare home infusion therapy benefit. This bill is endorsed by several national organizations from the patient and physician communities, including the Immune Deficiency Foundation, GBS/CIDP Foundation International, the Jeffrey Modell Foundation, the Clinical Immunology Society, and the National Patient Advocate Foundation.

I hope all my colleagues can support this legislation to help patients, physicians, caretakers, researchers, and plasma donors.

Mr. President, I rise to support the Overseas Private Investment Corporation Reauthorization Act of 2009. Along with Senators Lugar, Kaufman and Menendez, I ask for approval of the Overseas Private Investment Corporation Reauthorization Act of 2009, a bill to reauthorize a vital U.S. Government agency that has assisted U.S. businesses and promoted projects in support of our foreign policy interests since 1971. This legislation reauthorizes the Overseas Private Investment Corporation, OPIC, for 4 years.

OPIC is an independent U.S. agency whose mission is to mobilize U.S. private sector investment in poorer countries to facilitate their economic and social development. It provides U.S. companies with financing--from large structured finance to small business loans, political risk insurance, and investment funds.

OPIC operates at no net cost to taxpayers: OPIC charges market-based fees for its products and operates on a self-sustaining basis. Over its 38-year history, OPIC projects have generated more than $72 billion in U.S. exports and supported more than 273,000 American jobs while supporting over $188 billion worth of investments that have helped developing countries generate almost $15 billion in host-government revenues leading to over 821,000 host-country jobs.

OPIC's financing and political risk insurance help U.S. businesses, particularly small- and medium-sized enterprises, to compete in emerging markets and meet the challenges of investing overseas when private sector support is not available. OPIC promotes U.S. best practices by requiring that projects adhere to international labor standards.

OPIC also engages in critical foreign policy areas. It is implementing major projects in the Middle East, including Jordan, the West Bank, and Lebanon. In Africa, OPIC has established a new investment fund that will mobilize $1.6 billion of private investment in Africa towards health care, housing, telecommunications and small businesses. The agency also gives preferential consideration to projects supported by small businesses. It has even established a separate department to focus on small business financing. An overwhelming majority of projects supported by OPIC involved small business--87 percent in fiscal year 2006. This is up from 24 percent in fiscal year 1997.

The bill incorporates several important aspects, including: strengthening the rights of workers overseas, and strengthening transparency requirements to ensure NGOs and other interested groups have sufficient notice and

information about potential OPIC-supported projects.

We all are aware of the unfortunate history associated with extractive industry projects and developing countries. Our bill ensures that OPIC projects will conform to principles and standards developed by the Extractive Industry Transparency Initiative. The transparency for extraction investments is a new subsection created by the bill to ensure that countries with extractive industry projects will put in place functioning systems to allow accurate accounting, regular independent audits and broader accountability. Ultimately, this will be an important tool for preventing fraud, bribery and corruption in host countries with extractive projects.

This legislation will also ensure greater transparency for how the Corporation operates. It directs OPIC to provide more detailed information in advance about potential projects so NGOs and other groups can determine their impact. The bill ensures that NGOs and other interested groups will have adequate notice and information about potential OPIC-supported projects, prior to Board meeting votes on OPIC assistance.

I would like to reiterate that OPIC is an important foreign policy tool that encourages U.S. private sector companies to invest in poorer countries and improve their economic and social development. I want to make sure OPIC can continue to do its good work, but I also want to ensure that OPIC adheres to the highest labor and environmental standards, incorporates stringent accountability measures towards extractive industry projects, and promotes a green investment agenda.

In conclusion, I urge my colleagues to approve the Overseas Private Investment Corporation Reauthorization Act of 2009 and join in this effort.

Mr. President, I rise today along with my colleagues, Senators Brown and Collins, to introduce bipartisan legislation entitled Ending the Medicare Disability Waiting Period Act of 2009. This legislation would phase out the current 2-year waiting period that people with disabilities must endure after qualifying for Social Security Disability Insurance, SSDI. In the interim or as the waiting period is being phased out, the bill would also create a process by which the Secretary can immediately waive the waiting period for people with life-threatening illnesses.

When Medicare was expanded in 1972 to include people with significant disabilities, lawmakers created the 24-month waiting period. According to an April 2007 report from the Commonwealth Fund, it is estimated that over 1.5 million SSDI beneficiaries are in the Medicare waiting period at any given time, ``all of whom are unable to work because of their disability and most of whom have serious health problems, low incomes, and limited access to health insurance.'' Nearly 39 percent of these individuals do not have health insurance coverage for some point during the waiting period and 26 percent have no health insurance during this period.

The stated reason at the time was to limit the fiscal cost of the provision. However, I would assert that there is no reason, be it fiscal or moral, to tell people that they must wait longer than 2 years after becoming severely disabled before we provide them access to much needed health care.

In fact, it is important to note that there really are actually three waiting periods that are imposed upon people seeking to qualify for SSDI. First, there is the disability determination process through the Social Security Administration, which often takes many months or even longer than a year in some cases. Second, once a worker has been certified as having a severe or permanent disability, they must wait an additional five months before receiving their first SSDI check. And third, after receiving that first SSDI check, there is the 2-year period that people must wait before their Medicare coverage begins.

What happens to the health and well-being of people waiting more than 2\1/2\ years before they finally receive critically needed Medicare coverage? According to Karen Davis, president of the Commonwealth Fund, which has conducted several important studies on the issue, ``Individuals in the waiting period for Medicare suffer from a broad range of debilitating diseases and are in urgent need of appropriate medical care to manage their conditions. Eliminating the 2-year wait would ensure access to care for those already on the way to Medicare.''

Again, we are talking about individuals that have been determined to be unable to engage in any ``substantial, gainful activity'' because of either a physical or mental impairment that is expected to result in death or to continue for at least 12 months. These are people that, by definition, are in more need of health coverage than anybody else in our society. The consequences are unacceptable and are, in fact, dire.

The majority of people who become disabled were, before their disability, working full-time jobs and paying into Medicare like all other employed Americans. At the moment these men and women need coverage the most, just when they have lost their health, their jobs, their income, and their health insurance, Federal law requires them to wait 2 full years to become eligible for Medicare. Many of these individuals are needlessly forced to accumulate tens-of-thousands of dollars in healthcare debt or compromise their health due to forgone medical treatment. Many individuals are forced to sell their homes or go bankrupt. Even more tragically, more than 16,000 disabled beneficiaries annually, about 4 percent of beneficiaries, do not make it through the waiting period. They die before their Medicare coverage ever begins.

Removing the waiting period is well worth the expense. According to the Commonwealth Fund, analyses have shown providing men and women with Medicare at the time that Social Security certifies them as disabled would cost $8.7 billion annually. This cost would be partially offset by $4.3 billion in reduced Medicaid spending, which many individuals require during the waiting period. In addition, untold expenses borne by the individuals involved could be avoided, as well as the costs of charity care on which many depend. Moreover, there may be additional savings to the Medicare program itself, which often has to bear the expense of addressing the damage done during the waiting period. During this time, deferred health care can worsen conditions, creating additional health problems and higher costs.

Further exacerbating the situation, some beneficiaries have had the unfortunate fate of having received SSI and Medicaid coverage, applied for SSDI, and then lost their Medicaid coverage because they were not aware the change in income when they received SSDI would push them over the financial limits for Medicaid. In such a case, and let me emphasize this point, the Government is effectively taking their health care coverage away because they are so severely disabled.

Therefore, for some in the waiting period, their battle is often as much with the Government as it is with their medical condition, disease, or disability.

Nobody could possibly think this makes any sense.

As the Medicare Rights Center has said, ``By forcing Americans with disabilities to wait 24 months for Medicare coverage, the current law effectively sentences these people to inadequate health care, poverty, or death. . . . Since disability can strike anyone, at any point in life, the 24-month waiting period should be of concern to everyone, not just the millions of Americans with disabilities today.''

Although elimination of the Medicare waiting period will certainly increase Medicare costs, it is important to note that there will be some decrease in Medicaid costs. Medicaid, which is financed by both Federal and State governments, often provides coverage for a subset of disabled Americans in the waiting period, as long as they meet certain income and asset limits. Income limits are typically at or below the poverty level, including at just 74 percent of the poverty line in New Mexico, with assets generally limited to just $2,000 for individuals and $3,000 for couples.

Furthermore, from a continuity of care point of view, it makes little sense that somebody with disabilities must leave their job and their health providers associated with that plan, move on to Medicaid, often have a different set of providers, then switch to Medicare and yet another set of providers. The cost, both financial and personal, of not providing access to care or poorly coordinated care services for these seriously ill people during the waiting period may be greater in many cases than providing health coverage.

Finally, private-sector employers and employees in those risk-pools would also benefit from the passage of the bill. As the Commonwealth Fund has noted, ``. . . to the extent that disabled adults rely on coverage through their prior employer or their spouse's employer, eliminating the waiting period would also produce savings to employers who provide this coverage.''

To address concerns about costs and immediate impact on the Medicare program, the legislation phases out the waiting period over a 10-year period. In the interim, the legislation would create a process by which others with life-threatening illnesses could also get an exception to the waiting period. Congress has previously extended such an exception to the waiting period to individuals with amyotrophic lateral sclerosis, ALS, also known as Lou Gehrig's disease, and for hospice services. The ALS exception passed the Congress in December 2000 and went into effect July 1, 2001. Thus, the legislation would extend the exception to all people with life-threatening illnesses in the waiting period.

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

Mr. President, today I am introducing the Neotropical Migratory Bird Conservation Act with the support of my colleagues, Mr. Crapo, Mr. Leahy, Mr. Lieberman, Mr. Menendez, and Mr. Nelson. This bill supports habitat protection, education, research, monitoring, and capacity building to provide for the long-term protection of neotropical migratory birds. It does this by providing grants to countries in Latin America and the Caribbean for the conservation of these birds, through a U.S. Fish and Wildlife Service competitive matching grants program. Up to one-quarter of the annual grants can also be used for projects in the United States. Projects include activities that benefit bird populations, such as habitat restoration, research and monitoring, law enforcement, and outreach and education.

Neotropical migratory birds breed in Canada and the U.S. during our summer and spend our winters in Latin America and the Caribbean. There are nearly 500 species of these birds, and they face a range of threats, including development pressures, invasive species, climate change, and avian diseases. Protecting these birds requires international cooperation.

The NMBCA program has a proven track record of reversing habitat loss and advancing conservation strategies for the broad range of neotropical birds that populate the United States and the rest of the Western hemisphere. The public-private partnerships and international collaboration provided by this program are integral to preserving vulnerable bird populations. Just as importantly, this Federal program is a good value for taxpayers, leveraging over four dollars in partner contributions for every one that we spend.

Migratory birds are not only beautiful creatures eagerly welcomed by millions of Americans into their backyards every year; they help generate $2.7 billion annually for the U.S. economy through wildlife watching activities, and they help our farmers by consuming billions of harmful insect pests. Bird watchers include over 48 million Americans, 20 million of whom take annual trips to watch birds. In 2006, 20 million American wildlife watchers spent $12.8 billion on trip-related expenditures. Americans spend $3.3 billion each year on bird food. 16 million Americans spend $790 million each year on bird houses, nest boxes, feeders, and baths.

The Baltimore Oriole, the state bird of my state of Maryland, migrates in flocks to southern Mexico, Central America, and northern South America. The Oriole has recently been threatened by destruction of breeding habitat and tropical winter habitat, and by toxic pesticides ingested by the insects which constitute the Oriole's main diet. This legislation will help ensure that the broad range of migratory birds, from the Cerulean Warbler to the Baltimore Oriole, will have the healthy habitat they need on both ends of their annual migration routes so they can continue to play their vital biological, recreational, and economic roles.

Congress passed the Neotropical Migratory Bird Conservation Act of 2000 and it became public law 106-527. It authorized an annual $5 million for each of the fiscal years 2001 through 2005. Since 2002, the U.S. has invested more than $25 million in 262 projects in 44 U.S. states, Canada, and 33 Latin American and Caribbean countries, and leveraged an additional $112 million in partner funds to support these projects. The reauthorization legislation would authorize $8 million for fiscal year 2010, gradually escalating to $20 million for fiscal year 2015, in order to meet expanding funding needs.

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

Mr. President, today the Obama administration is taking an important first step in ending mountaintop mining, one of the most environmentally destructive practices currently in use in this country. More than 1 million acres of Appalachia have already been destroyed. An estimated 1,200 miles of headwater streams have been buried under tons of mining wastes. Over 500 mountains have been permanently scarred. Homes have been ruined and drinking water supplies contaminated. It is time to end this especially destructive method of coal mining.

By stopping the issuance of some of the most destructive permits, today the administration is sending the right signals that the days of mountaintop mining are being relegated to the dust bin of the past, where they belong.

Today, Senator Lamar Alexander and I are introducing bipartisan legislation that will go one step further. Our bill, the Appalachia Restoration Act, will make clear that mining wastes cannot be dumped into our streams, smothering them and sending plumes of toxic run-off into groundwater systems. This Cardin-Alexander legislation amends the Clean Water Act, specifically preventing the so-called ``excess spoil'' of mining wastes from entering our streams and rivers. This simple legislation will restore the Clean Water Act to its original purpose. In doing so, it will stop the wholesale destruction of some of America's most beautiful and ecologically significant regions.

Mountaintop mining produces less than five percent of the coal mined in the United States. This bill does not ban other methods of coal mining. Instead, it is narrowly tailored to stop a practice that has earned the condemnation of communities across Appalachia as well as citizens across the rest of the country.

I applaud the Obama administration for the steps it is taking today, and Senator Alexander and I look forward to working with the Administration to pass the Cardin-Alexander Appalachia Restoration Act later this year.