Medical-Legal Partnership for Health Act

Mr. President, I rise to introduce a critical bill for our economic recovery. As communities across the country continue to recover from the economic downturn and devastating falling property values, commercial real estate properties throughout the nation are confronting a severe equity crisis. Just as the crash in the residential real estate market triggered the most severe economic recession in generations, the looming crisis in the commercial real estate market, if left unchecked, could prove to be devastating for our fragile economic recovery.

Studies have shown that more than $1 trillion of commercial real estate loans will be maturing in just the next few years. In fact, by 2018 more than $2.4 trillion dollars of loans held by insurance companies, thrifts, banks, and in commercial mortgage-backed securities will mature. Just as we saw with home mortgages, if these borrowers can't secure other funding options when these payments come due, commercial properties across the country will go into foreclosure, leaving communities with even more vacant storefronts, less jobs, lower tax revenues, and a deeper economic hole to dig themselves out of.

Simply put, the commercial real estate industry has an equity problem too large for domestic investment alone to solve.

Unfortunately, certain tax rules--most of which were drafted 30 years ago, before the current crisis could be foreseen--impose significant penalties on foreign investments in domestic real estate that do not exist on other types of U.S. investments such as corporate stocks and bonds. As a result, overseas investors are discouraged from investing in U.S. real estate at a time when their capital is sorely needed.

These rules, created by the Foreign Investment in Real Property Tax Act, or FIRPTA as it is come to be known, freeze out foreign investment in our real estate markets by imposing an arbitrary withholding tax on the gains realized by overseas capital invested in domestic properties.

Not only is this different treatment questionable as a policy, it is damaging to the economy. At no point have these rules been more damaging to the economy than today. They continue to keep capital out of the U.S. at a time when commercial real estate in all of our communities desperately needs the equity investment.

If these rules are not reformed, it is a real possibility that hundreds of billions of dollars in debt would go into default, triggering massive foreclosures, significant decreases in property values and a severe constriction of capital available for U.S. consumers and businesses--absolutely the last thing this economy needs right now.

That is why today, Senator Enzi and I are introducing bipartisan, bicameral legislation that would implement efficient and meaningful reform of these tax rules to encourage more equity investment in U.S. real estate.

These reforms would help save communities all across America from the drag of a wave of commercial real estate foreclosures, help to restart the credit markets, and free up capital to create jobs and economic opportunities for families in every region of the country.

These provisions are modest but effective.

We are not tackling the bigger question of whether or not the existing FIRPTA rules are effective in a 21st century economy. This legislation simply creates targeted opportunities for investment in American real estate while preserving the underlying foreign ownership limits imposed by these tax rules.

We may not agree on a whole lot these days, but today we offer a bipartisan, bicameral solution to help the U.S. economy. I hope all of my colleagues can take the time to look at this bill, understand the positive effects it will have for every State, and we can get this done for the American people.

Mr. President, I rise to announce the introduction of the Livable Communities Act of 2011.

The Livable Communities Act presents an opportunity to save taxpayer dollars, reduce household expenditures, improve partnerships, and help local communities create places of lasting value, where businesses want to invest and families want to live.

It will strengthen rural, suburban, and urban communities by supporting local planning efforts to establish a vision for a desired future and chart a realistic course for getting there. The bill promotes local leadership by encouraging communities to partner strategically to develop solutions that are innovative and reflect their unique character, assets, and needs. It also directs public agencies to use taxpayer dollars more efficiently by coordinating investments in infrastructure, facilities, and services to meet multiple economic, environmental, and community objectives.

This bill is the next important step in transforming the Federal Government into a better partner in community efforts to achieve locally-defined goals, support families when they need it most, and keep the U.S. competitive in the global economy.

Dealing with change can be a real challenge--in our professional and personal lives, with our families, and in our communities. But change is an opportunity to move forward, if only we are open to recognizing it. We can accept and manage change or we can be steam-rolled by it.

I have heard horror stories from across the country about veterans hospitals being built in places that are not accessible by public transportation. I have heard of homebuyers who ``drive to qualify'' for mortgage financing only to rack up transportation costs that break their budgets when gas prices go up. Many of these families are paying 50 percent of their household income on housing and transportation costs alone. It may seem cheaper and easier in the short term to build on a corn field outside of town than it is to re-use land located close to existing transportation, power, and water infrastructure, but it often does not make sense in the long run.

This is why I welcomed the opportunity to work with Chairman Dodd on the Livable Communities Act in 2009 and why I am honored to be the leading sponsor of the updated legislation today. It is the most comprehensive piece of planning legislation that has been proposed in decades. If passed, it will have a transformative impact on the way the federal government supports locally-driven planning processes.

Unfortunately, when many on the other side of the aisle hear the word ``livable,'' they cringe. They think of top-down mandates from the Federal Government. What they fail to understand is that the beauty of what is ``livable'' is defined by the communities themselves to reflect the unique character, assets, and needs of that community.

The fact is the private sector wants to be located in communities that have dependable transportation systems to get their goods to market and their workers to their jobs. Businesses want to attract and retain workers and ensure that their enterprise will be viable in the long run. Private enterprise has spearheaded some of the most notable past and current planning efforts and the Federal Government should be a supportive, versatile partner in this work.

I invited bipartisan cooperation on the bill numerous times and although some offices quietly praise the good work going on in their communities, political pressure prevents them from doing so publicly. We remain optimistic that supporting community efforts to proactively plan for the future and save money by coordinating capital investment strategies are values we all support, regardless of the terminology we use to describe them.

The Livable Communities Act of 2011 is a streamlined approach that would keep the good work at the U.S. Department of Housing and Urban Development going. Its intent is to find better ways to coordinate interconnected but often silo-ed programs and policies that impact housing, transportation, and the environment and affect the way we live our daily lives.

The bill would formally authorize the existing HUD Office of Sustainable Housing and Communities, to work with the Department of Transportation and Environmental Protection Agency, to provide technical assistance and capacity support to communities working on integrated planning for housing, transportation, water and sewer infrastructure needs. These tools help communities develop projects that support job creation, leverage significant private sector investment, and bolster long-term economic resilience by creating places where businesses want to invest. Increased coordination at the regional and Federal level will cut red tape and save communities money as they plan for their future needs. The bill also directs the Office of Sustainable Housing and Communities to provide best practices and technical assistance to ensure that communities of all sizes learn from each other's success.

The Livable Communities Act of 2011 also directs HUD to coordinate with DOT and EPA to identify and eliminate Federal barriers to sustainable development. The Office of Sustainable Housing and Communities will coordinate Federal sustainable development policies and research agendas to facilitate Federal collaboration by streamlining and reconciling program requirements and policies. It will also administer grant programs to support local planning for long-term housing and infrastructure needs. This will enable communities to foster economic development in an efficient and inclusive way. Selection criteria and eligible activities would be flexible to allow all sizes and types of communities to plan for a more sustainable future, including job creation; revitalizing existing small town Main Streets; reducing traffic congestion and pollution; protecting farmland, working landscapes, and green space; addressing vacant, abandoned, and foreclosed properties; and building more affordable and healthy housing.

The bill would also spur private investment in transit-oriented development, TOD, by helping communities overcome initial financing hurdles that so often lock up private investment and prevent desired transit-oriented, mixed-use development. Locally directed TOD provides numerous economic benefits, including increased property values and business activity as well as congestion reduction. TOD also promotes economic competitiveness by efficiently connecting our work force to educational and employment opportunities. This creates avenues for business growth in communities across the country and keeps America competitive in the global economy.

I know how important planning is to our communities. My home State of New Jersey is the most densely populated in the country, so we know the value of good community planning. Over the years we have learned some important lessons about how vital it is to make sure that our development projects are functional, serviceable, and livable at the human scale, places where people feel safe, where they want to spend time, relax as well as work--places where they can live, shop, and be connected to their surroundings. If this economic crisis is teaching us anything, it is to live within our means,

think creatively about opportunities to leverage resources, and to invest now for future prosperity.

Good planning means saving $122 billion on water, sewer, and roads over the next 25 years. It means protecting housing values by putting housing near transit. As President Obama remarked over two years ago, our days of building mindless sprawl are over. We simply cannot afford it. Now is the time to reinvest in our communities and infrastructure. The HUD-DOT-EPA Partnership for Sustainable Communities is doing this in a very active way. There are many members of Congress who support this important work, but we need to convince more of them that we are right, and that--for the good of their communities--they should be on our side.

The fact is, we all have a role to play. The environment is substantially different today than it was ten years ago--twenty years ago when I was trying to get people on board with the idea reactivating an existing right of way to serve as the Hudson Bergen Light Rail when I was Mayor of Union City.

Today, communities are catching on. Innovation is happening. The Federal Government can be an important partner in helping communities achieve their goals. I can tell you that in Jersey City, ``livable'' means the transforming 111 acres of under-utilized industrial land into a mixed use, walkable community along the Hudson Bergen Light Rail. A quiet revolution is underway and communities like Jersey City are leading by example. It's time for the Federal Government to catch up.

It is our job--together--all of us--to provide the information, tools, and encouragement these communities need, that Federal, State, and local agencies and elected officials need--to achieve the aspirations that they set for themselves.

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

Mr. President, today I join Senators Leahy and Inouye to introduce the Medical-Legal Partnership for Health Act. This legislation will reduce our Nation's health care costs and improve the health of vulnerable patients by building upon the great work that medical-legal partnerships are doing every day, all across the United States.

Medical-legal partnerships bring legal aid services into medical settings, such as hospitals and community health centers, to help patients overcome problems that create and perpetuate poor health. In today's difficult economy, many Americans are struggling to meet the basic health needs of themselves and their children. This may mean struggling to pay the high costs of medical care or prescription drugs, or putting off an annual check-up until next year.

But some health care needs are non-medical in nature, like making sure your home is properly heated in the winter; that it is not infested by insects or rodents; and that it is free of domestic violence. These needs may require more than just medical care; they may require legal assistance.

Unfortunately, most health care providers are not equipped to deal with the non-medical issues that lead some patients to seek medical care repeatedly or on an ongoing basis. Despite the perception that legal issues frequently affect their patients, a survey of physicians at Boston Medical Center revealed that fewer than 20 percent of doctors knew how to refer patients to legal resources. As a result, many patients never address the root cause of their health problems, leading to costly visits to the emergency room and lengthy hospital stays.

Medical-legal partnerships connect patients with the legal assistance they need to address these root causes. Rather than just applying a temporary fix to a health issue, they help patients get healthy and stay healthy.

In the process, medical-legal partnerships generate substantial cost savings for families and the entire health care system. One study found a 50 percent reduction in emergency room visits following the intervention of medical-legal partnerships, saving families hundreds of dollars per visit. Another study showed that medical-legal partnerships reduced the cost per pediatric asthma patient from $735 to $181 through fewer emergency room visits, while also resulting in decreased frequency and duration of asthma attacks following an intervention. These cost savings not only help keep families out of potentially crippling debt, but they also help reduce emergency room overcrowding and decrease health care expenditures on preventable health conditions.

Unfortunately, many patients are unlikely to seek legal services on their own. Eighty-five percent of patients who sought legal assistance from one medical-legal partnership in California had not used legal resources before and more than 78 percent were not previously aware of legal services at all. By embedding legal services in health care settings, medical-legal partnerships raise awareness of legal services so that patients are more likely to address problems before they turn into crises.

In an article about medical-legal partnerships last year, the Los Angeles Times told the story of Maria Perez. Maria had a fever of 103, her body ached and she had trouble breathing. After being told in the emergency room that she had pneumonia, she went to a clinic in South Los Angeles for a follow-up appointment. The doctor asked Perez about her housing situation. Her apartment had cockroaches and mice, and rain fell through a broken window and filled the walls with mold. The doctor wrote prescriptions to treat the pneumonia and an asthma flare-up and then sent her down the hall to talk to a lawyer.

After the attorney contacted both the landlord and the Los Angeles Housing Department, Maria's living conditions improved, and so did her health. She told the Times: ``The medicine wasn't what cured me. It was [my lawyer] and what he did.''

Medical-legal partnerships also offer a critical lifeline to victims of domestic violence. In my home state of Iowa, a young woman named Brenda sought help to escape an abusive marriage. Her husband was a gang member and threatened to kill her or have members of his gang kill her. One night, while attempting to flee an attack, Brenda's husband pulled her back into the house and beat and choked her until she lost consciousness. When Brenda sought medical care the next day, her care providers referred her to Iowa Legal Aid's Health and Law Project for help.

Iowa Legal Aid helped Brenda obtain a protective order, which included custody of the couple's daughter. Iowa Legal Aid is currently helping Brenda with a divorce so that she and her daughter will have protection and long-term autonomy from her abuser; thereby reducing the need for ongoing health care.

The success of these programs is catching on. The first medical-legal partnership was created nearly two decades ago at Boston Medical Center. By 2009, there were 60 such partnerships across the country. Today there are 90 medical-legal partnerships working with more than 240 health services providers.

Medical-legal partnerships have attracted the attention of corporate America, too. In July, Walmart became the first corporation to take a lead role in a medical-legal partnership, and I commend them for recognizing the valuable role these programs can play in our communities.

After graduating from law school, I served as a Legal Services attorney in Iowa. I learned first-hand how crucial this assistance is to struggling families and individuals who have no place else to turn when they are taken advantage of or abused. I know the invaluable legal help provided to battered women trying to leave abusive relationships while fearing for their safety and the safety of their children. I know that, without access to the legal system, the poor are often powerless against the injustices they suffer.

I am particularly proud of the success of a medical-legal partnership in my home state of Iowa. The Iowa Legal Aid Health and Law Project harnesses the talents of Iowa physicians and attorneys to improve the lives of vulnerable Iowans. By partnering with 17 hospitals and health centers across my state, the Iowa Legal Aid Health and Law Project is able to extend services from Sioux City to Dubuque, and from Council Bluffs to Fort Dodge. In 2009, the program served 880 Iowans, and 94 percent of their cases had a positive outcome. The Iowa Legal Aid Health and Law Project does a remarkable job. They are just one example of the great work going on across the country.

You may be surprised to learn that when it comes to medical-legal partnerships, a little money can go a long way. Iowa's program was started with a federal investment of less than $300,000. The program prevents hospital admissions and emergency room visits that cost hospitals and patients many thousands of dollars in health care costs and insurance premiums. A modest investment in these community programs can help people achieve healthier, safer lives and prevent future hospitalizations and health care costs. That sounds like common sense to me. And that's why, today, I am proud to introduce the Medical-Legal Partnership for Health Act: to give health care providers and lawyers across the country the opportunity to start such programs.

The Act creates a federal demonstration program to help create, strengthen, and evaluate medical-legal partnerships. Overall, this legislation will support 60 partnership sites in community health centers, the Veterans Administration, hospitals, and other health care settings.

I was proud to have the support of former Senator Kit Bond of Missouri when I introduced this legislation during the previous Congress. I know there are many Americans who think that the two political parties in Washington can't agree on anything these days, but this is an issue that has attracted bipartisan support in the past and it is my strong hope that it will do so again. In the spirit of compromise and bipartisanship, I have taken contentious issues off the table: the bill excludes federal money from being used toward class action law suits, medical malpractice cases, representation of undocumented individuals, and abortion or abortion-counseling services.

Medical-legal partnerships also have broad support from prominent organizations representing physicians and attorneys. They've received the endorsement of the American Medical Association, the American Bar Association, the American Academy of Pediatrics, the American Hospital Association, and the Accreditation Council of Graduate Medical Education, to name just a few.

Through this community-based, common-sense investment, we will be able to help some of our most vulnerable citizens avoid illness and hospitalization, while reducing costs across the entire health care system.

I urge my colleagues to join me in supporting this investment in medical-legal partnerships.

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

Mr. President, today I join Senators Leahy and Inouye to introduce the Medical-Legal Partnership for Health Act. This legislation will reduce our Nation's health care costs and improve the health of vulnerable patients by building upon the great work that medical-legal partnerships are doing every day, all across the United States.

Medical-legal partnerships bring legal aid services into medical settings, such as hospitals and community health centers, to help patients overcome problems that create and perpetuate poor health. In today's difficult economy, many Americans are struggling to meet the basic health needs of themselves and their children. This may mean struggling to pay the high costs of medical care or prescription drugs, or putting off an annual check-up until next year.

But some health care needs are non-medical in nature, like making sure your home is properly heated in the winter; that it is not infested by insects or rodents; and that it is free of domestic violence. These needs may require more than just medical care; they may require legal assistance.

Unfortunately, most health care providers are not equipped to deal with the non-medical issues that lead some patients to seek medical care repeatedly or on an ongoing basis. Despite the perception that legal issues frequently affect their patients, a survey of physicians at Boston Medical Center revealed that fewer than 20 percent of doctors knew how to refer patients to legal resources. As a result, many patients never address the root cause of their health problems, leading to costly visits to the emergency room and lengthy hospital stays.

Medical-legal partnerships connect patients with the legal assistance they need to address these root causes. Rather than just applying a temporary fix to a health issue, they help patients get healthy and stay healthy.

In the process, medical-legal partnerships generate substantial cost savings for families and the entire health care system. One study found a 50 percent reduction in emergency room visits following the intervention of medical-legal partnerships, saving families hundreds of dollars per visit. Another study showed that medical-legal partnerships reduced the cost per pediatric asthma patient from $735 to $181 through fewer emergency room visits, while also resulting in decreased frequency and duration of asthma attacks following an intervention. These cost savings not only help keep families out of potentially crippling debt, but they also help reduce emergency room overcrowding and decrease health care expenditures on preventable health conditions.

Unfortunately, many patients are unlikely to seek legal services on their own. Eighty-five percent of patients who sought legal assistance from one medical-legal partnership in California had not used legal resources before and more than 78 percent were not previously aware of legal services at all. By embedding legal services in health care settings, medical-legal partnerships raise awareness of legal services so that patients are more likely to address problems before they turn into crises.

In an article about medical-legal partnerships last year, the Los Angeles Times told the story of Maria Perez. Maria had a fever of 103, her body ached and she had trouble breathing. After being told in the emergency room that she had pneumonia, she went to a clinic in South Los Angeles for a follow-up appointment. The doctor asked Perez about her housing situation. Her apartment had cockroaches and mice, and rain fell through a broken window and filled the walls with mold. The doctor wrote prescriptions to treat the pneumonia and an asthma flare-up and then sent her down the hall to talk to a lawyer.

After the attorney contacted both the landlord and the Los Angeles Housing Department, Maria's living conditions improved, and so did her health. She told the Times: ``The medicine wasn't what cured me. It was [my lawyer] and what he did.''

Medical-legal partnerships also offer a critical lifeline to victims of domestic violence. In my home state of Iowa, a young woman named Brenda sought help to escape an abusive marriage. Her husband was a gang member and threatened to kill her or have members of his gang kill her. One night, while attempting to flee an attack, Brenda's husband pulled her back into the house and beat and choked her until she lost consciousness. When Brenda sought medical care the next day, her care providers referred her to Iowa Legal Aid's Health and Law Project for help.

Iowa Legal Aid helped Brenda obtain a protective order, which included custody of the couple's daughter. Iowa Legal Aid is currently helping Brenda with a divorce so that she and her daughter will have protection and long-term autonomy from her abuser; thereby reducing the need for ongoing health care.

The success of these programs is catching on. The first medical-legal partnership was created nearly two decades ago at Boston Medical Center. By 2009, there were 60 such partnerships across the country. Today there are 90 medical-legal partnerships working with more than 240 health services providers.

Medical-legal partnerships have attracted the attention of corporate America, too. In July, Walmart became the first corporation to take a lead role in a medical-legal partnership, and I commend them for recognizing the valuable role these programs can play in our communities.

After graduating from law school, I served as a Legal Services attorney in Iowa. I learned first-hand how crucial this assistance is to struggling families and individuals who have no place else to turn when they are taken advantage of or abused. I know the invaluable legal help provided to battered women trying to leave abusive relationships while fearing for their safety and the safety of their children. I know that, without access to the legal system, the poor are often powerless against the injustices they suffer.

I am particularly proud of the success of a medical-legal partnership in my home state of Iowa. The Iowa Legal Aid Health and Law Project harnesses the talents of Iowa physicians and attorneys to improve the lives of vulnerable Iowans. By partnering with 17 hospitals and health centers across my state, the Iowa Legal Aid Health and Law Project is able to extend services from Sioux City to Dubuque, and from Council Bluffs to Fort Dodge. In 2009, the program served 880 Iowans, and 94 percent of their cases had a positive outcome. The Iowa Legal Aid Health and Law Project does a remarkable job. They are just one example of the great work going on across the country.

You may be surprised to learn that when it comes to medical-legal partnerships, a little money can go a long way. Iowa's program was started with a federal investment of less than $300,000. The program prevents hospital admissions and emergency room visits that cost hospitals and patients many thousands of dollars in health care costs and insurance premiums. A modest investment in these community programs can help people achieve healthier, safer lives and prevent future hospitalizations and health care costs. That sounds like common sense to me. And that's why, today, I am proud to introduce the Medical-Legal Partnership for Health Act: to give health care providers and lawyers across the country the opportunity to start such programs.

The Act creates a federal demonstration program to help create, strengthen, and evaluate medical-legal partnerships. Overall, this legislation will support 60 partnership sites in community health centers, the Veterans Administration, hospitals, and other health care settings.

I was proud to have the support of former Senator Kit Bond of Missouri when I introduced this legislation during the previous Congress. I know there are many Americans who think that the two political parties in Washington can't agree on anything these days, but this is an issue that has attracted bipartisan support in the past and it is my strong hope that it will do so again. In the spirit of compromise and bipartisanship, I have taken contentious issues off the table: the bill excludes federal money from being used toward class action law suits, medical malpractice cases, representation of undocumented individuals, and abortion or abortion-counseling services.

Medical-legal partnerships also have broad support from prominent organizations representing physicians and attorneys. They've received the endorsement of the American Medical Association, the American Bar Association, the American Academy of Pediatrics, the American Hospital Association, and the Accreditation Council of Graduate Medical Education, to name just a few.

Through this community-based, common-sense investment, we will be able to help some of our most vulnerable citizens avoid illness and hospitalization, while reducing costs across the entire health care system.

I urge my colleagues to join me in supporting this investment in medical-legal partnerships.

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

Mr. President, I have heard from many Arkansans and businesses, particularly small businesses, which are struggling to meet an increasing regulatory burden. Each year, Federal agencies issue more than 3,000 final rules, many of which have significant economic impact. In Executive Order 13563, President Obama emphasized that our regulatory system should promote ``economic growth, innovation, competitiveness, and job creation.'' I agree. We need a 21st-century regulatory system that promotes future prosperity. However, there are some rules where that goal appears to have been ignored and as a result our economy suffers.

Experience suggests that improvements in the regulatory process are necessary to ensure that all agencies pay close attention to the impact their regulatory actions have on jobs and on the economy.

For example, the EPA is currently considering more stringent regulations of dust as part of the national ambient air quality. From county roads to farm fields, dust is an unavoidable reality in rural areas. Imposing strict dust regulations on these communities would hurt family farmers and rural economies across Arkansas and our Nation.

Another example comes from a county judge in Arkansas. He was rightly concerned about a regulation stemming from the Bush administration that would have cost municipalities and counties and States across the country tens of millions of dollars to replace their street signs. The burden of paying for hundreds of thousands of new signs at costs ranging anywhere from $30 to $110 would have fallen to State and local governments, and that means State and local taxpayers. Fortunately, as part of the administration's review of regulations, Transportation Secretary Ray LaHood has decided that a specific deadline for replacing street signs makes no sense and that local and State transportation agencies are best equipped to determine when they need to replace these signs in the course of their daily work.

In his Executive order, President Obama remarked that the regulatory system ``must identify and use the best, most innovative, and least burdensome tools for achieving regulatory ends.'' Last month, Cass Sunstein, the Administrator of the Office of Information and Regulatory Affairs, wrote in the Wall Street Journal that Cabinet Secretaries were instructed to minimize regulatory costs, avoid imposing excessive regulatory burdens, and prioritize regulatory actions that promote economic growth and job creation. I applaud the administration's new directive.

One difference in what the administration is doing versus what we are doing in the Portman-Pryor legislation is that the President is looking retrospectively. He is doing a review of regulations that are on the books now, which is good. I welcome that. But the Portman-Pryor legislation will be prospective; it will go forward. We will talk about that more as we go.

I think it is time that Congress reviewed several of the laws that form the basis of our Federal regulatory system. We need to find ways to make these laws more fair, reasonable, and effective in meeting the dual challenges of protecting the public while making our economy stronger and more competitive. That is why I have teamed up with Senator Portman on this important legislation.

Done right, I believe regulatory reform can lead to better, cheaper, and faster rulemaking. Specifically, agencies should, one, propose or adopt regulations only when the benefits justify the costs; two, write regulations so that they impose the least burden on society; and three, in choosing among alternative regulatory approaches, select those that strike the right balance between minimizing costs and maximizing benefits.

Portman-Pryor amends the Administrative Procedures Act to place greater

emphasis on early engagement between agencies and parties subject to high-impact rules costing $1 billion or more per year and major rules costing $100 million or more. These expensive rules are where our focus should be. In fact, as a historical footnote, the Administrative Procedures Act was written in 1946 and has not really been revised and updated since that time. So now that it is 65 years old, I think it is time to look at it and update it.

Portman-Pryor makes better use of two existing regulatory tools. It requires an advanced notice of proposed rulemaking for high-impact and major rules to enable agencies to solicit written data, views, or arguments from interested parties. Second, although the Administrative Procedures Act already allows for formal hearings, agencies rarely use this option. Portman-Pryor requires an agency to conduct a formal rulemaking hearing for high-impact rules and, in some cases, major rules so that data and information can be debated on the record--here again, on the record. We are trying to make this process more transparent.

Portman-Pryor strikes a balance between minimizing costs and maximizing benefits. The bill makes clear that the agencies are encouraged to choose the least costly alternative that would achieve the objectives of the statute authorizing the rule. However, the bill also makes clear that the agency may choose--may choose--a more costly rule so long as it does two things: one, explains why it has done so based on policy concerns addressed by the statute authorizing the rule and, two, shows that the added benefits are greater than the added costs, which is by definition a push toward ``maximizing benefits.''

Today, the length of rulemaking varies widely from a few months to several years. After this reform, times will still vary in about that same amount, but the final rules should be more stable and more credible. A principal goal of Portman-Pryor is that the bill may shorten the rulemaking process because the final rule will be based on more sound, thorough information and that fewer high-impact and major rules will be vacated by courts and sent back to the agency.

Finally, the bill reinforces that agencies must assess both the costs and benefits of their rules. However, the bill requires the Administrator of OIRA to establish guidelines so that costs-benefit analysis can be commensurate with the economic impact of the rule.

Regulatory reform is not an exciting subject, I know, but it is vitally important to our Nation's economic recovery. I look forward to working with Senator Portman on this important legislation. I also look forward to working with other colleagues to try to get them interested and possibly cosponsoring and helping us get this bill through the process.

My final point is that this is a piece of legislation which not only is bipartisan but is bicameral. We have two Members of the U.S. House of Representatives who have announced this legislation with us today: Lamar Smith, who is chairman of the Judiciary Committee, and Collin Peterson, who is the ranking member on the Agriculture Committee in the House. So it is rare when we get bipartisan, bicameral legislation coming in this Congress.

I hope--I sincerely hope--I will have colleagues on both sides of the aisle who will look at this legislation. I hope we will get broad bipartisan support and we will be able to move it through the committees and get it to the floor in a timely fashion.

Mr. President, I am pleased to be joined today by Senator Hutchison in the introduction of the Pediatric, Adolescent, and Young Adult Cancer Survivorship Research and Quality of Life Act of 2011.

The population of survivors of childhood cancer has grown exponentially over the years. In 1960, only 4 percent of children with cancer survived more than 5 years. Today, nearly 80 percent of children with cancer survive more than five years. While this is heartening news, as a result of their cancer and treatment, many of these children unfortunately have health complications, often life-threatening, for years to come. Indeed, after beating cancer, as many as \2/3\ of these children suffer from late effects of their disease or treatment, including second cancers and heart and lung damage. There are also serious psychosocial impacts that these survivors face.

With so many facing the risk of these late effects, it is critical that resources are made available to help these survivors, especially those in underserved communities. Our legislation would enhance research on the late effects of childhood cancers and improve collaboration among providers so that doctors are better able to care for this population as they age. It would also establish a new pilot program to begin to explore models of care for childhood cancer survivors. Creating standard protocols and procedures will help providers, patients, and families know what to expect after beating cancer, including when to get certain check-ups and tests that guard against late effects.

This bill is part of a continuing effort to focus greater attention on childhood cancers. In 2008, I worked on a bipartisan basis to enact, the Caroline Pryce Walker Conquer Childhood Cancer Act. This law has increased support for research on childhood cancers and improved treatment for patients. But we must not stop there.

The legislation Senator Hutchison and I are introducing today to address the late effects of childhood cancer, will do more to help childhood cancer patients. I look forward to working with my colleagues to pass this legislation and help ensure that children who survive cancer live a long and healthy life.

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

Mr. President, I introduce with my colleague Senator Johanns, the Healthy Housing Council Act. I thank Senators Boxer, Merkley, and Franken for joining us as original cosponsors of this bill.

Many factors impact health and wellness. Typically, doctors and other health professionals are able to counsel patients on the importance of exercise and healthy eating, for example, to prevent diseases and conditions. Too frequently, however, these providers overlook the possibility of housing-related health hazards that patients knowingly or unknowingly come into contact with, which can also cause a variety of preventable diseases and conditions like cancer, lead poisoning, and asthma.

While there are many programs in place to address these hazards, these programs are fragmented and spread across many agencies. Our legislation, the Healthy Housing Council Act, would establish an independent interagency Council on Healthy Housing in the executive branch in order to improve the coordination of existing but fragmented programs, bringing these various efforts out of their respective silos and reducing duplication to improve the efficiency and efficacy of these efforts.

Through periodic meetings, Federal, State, and local government representatives, along with industry and nonprofit representatives will meet to discuss ways to educate individuals and families on how to recognize housing-related health hazards and access the necessary services and preventive measures to combat these hazards. This collaboration is particularly critical as every member of the council

will bring a different perspective to the table on how to review, monitor, and evaluate existing housing, health, energy, and environmental programs and work together to collectively improve these programs for the future. Then, in order to ensure that members of the public are informed of and benefit from the council's activities, the council would hold biannual stakeholder meetings, maintain an updated website, and work to unify healthy housing data collection and maintenance.

It is our goal for this council to help reduce the more than 5.7 million households living in conditions with moderate or severe health hazards, 23 million additional homes with lead-based paint hazards, 14,000 unintentional injury and fire deaths every year that result from housing-related hazards, and 21,000 radon-associated lung cancer deaths every year. Indeed, the council will help us embark on a path to assure that affordable and decent homes are also healthy.

This council could also be critical in helping to curb overall health care expenditures. For example, the annual cost of environmentally attributable childhood diseases, including cancer, lead poisoning, and cancer was $76 billion in 2008 dollars, 3.5 percent of total health costs. Low-income and minority individuals and families who are disproportionately affected by housing-related health hazards are the same individuals and families who are typically enrolled in Medicaid or forgo insurance altogether, which costs Federal and States governments. Helping to improve housing conditions can help prevent an estimated 250,000 children under the age of 6 from having elevated blood levels each year, nearly 10,000 emergency department visits for carbon monoxide exposure, and 12.3 million asthma attacks. Keeping children out of the doctor's office and emergency rooms will save families and the government money.

As Congress continues to explore methods to reduce spending and reign in our deficit and improve the health of individuals, children, and families, promoting low-cost measures to eliminate subpar housing can make a dramatic and meaningful difference, and I urge my colleagues to join me and Senators Johanns, Boxer, Merkley, and Franken in supporting this bipartisan bill and other healthy housing efforts.

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