Floor Statements

Mr. President, I am going to send a copy of this bill to the desk to be printed in the Record. It is not going to be referred to any committees in the waning minutes of this 108th Congress, but I will submit it for the Record. My plans are to reintroduce this legislation in January when we reconvene for the 109th Congress.

I thought it might be helpful to have this legislation in the Record for my colleagues to review. It is called the Free Speech Protection Act of 2004.

This bill is designed to ensure that the free speech guarantees enshrined in the First to the Constitution will be strong and effective for many generations to come. After all, it is the free flow of news and information to the public on a wide variety of concerns which makes our democracy vibrant and alive.

Indeed, the very design of our democratic institutions is premised in large part upon an informed citizenry that could exercise informed judgments.

As James Madison once observed:

Knowledge will forever govern ignorance: And apeople who

mean to be their own Governor, must arm themselves with the

power that knowledge gives.

Madison and the other Founders of our great Republic understood full well that the best guarantee of a knowledgeable citizenry is a free press and a public free to speak to the press. The press must be free to report on the human condition, the conduct of public officials, matters of business and corporate governance, as well as the strengths and weaknesses of our society and its institutions.

A free press must also be able to access a broad spectrum of views from a wide variety of sources. Once individuals deliberate over such information, they are able to make more educated decisions. In addition, they can also more effectively and intelligently participate in matters of public concern. To quote Madison once again:

Popular government without popular information or the means

of acquiring it is but a prologue to a farce, or a tragedy,

or perhaps both.

In fact, one of the hallmarks of a totalitarian government is that the state controls the press and similar sources of public information. Such regimes are characterized by extreme levels of secrecy and a total lack of transparency. The free flow of information to the public is greatly restricted. Criticism of the government could result in imprisonment or even death.

In recent memory, such regimes existed in Nazi Germany, the Soviet Union, and Saddam Hussein's Iraq, where the press was often used as a tool for propaganda. Unfortunately, there are still a number of governments around the globe today that greatly restrict the flow of news and information to their citizens.

The United States, in its formative years, never chose that path. The Founding Fathers of this great Nation of ours knew the value of a free press because they had often been denied it by their colonial rulers. Repressive measures had long been part of English history in this regard, such as the censorship of published materials and a licensing system whereby nothing could get published without the government's consent.

Our Founding Fathers recognized then that for a society to remain free, it must also allow for divergent views and opinions to be expressed, and for ideas to be openly exchanged. In many respects, the rights of free speech and a free press protect the government from trampling on the other political and personal liberties all Americans hold so dear.

Freedom of speech and freedom of the press are like the government watchdog that shines a spotlight when other rights are being threatened. Without this, the press becomes an extension of the government and the people know only what the government wants them to know. As Jefferson once commented:

When the press is free and everyone is able to read, all is

safe.

Congress cannot afford to stand idly by and allow our sacred First Amendment freedoms to be threatened. Let me be clear. The legislation I submitted to the desk, the Free Speech Protection Act of 2004, is not merely about protecting the press. Instead, this legislation is about consumer protection. It is about openness, debate, the free flow of information and deliberation--the very ideals that the Senate holds so dear.

It is also about ensuring that our constituents, the American citizenry, have access to the knowledge and information they need to make educated decisions and fully participate in our democracy.

Yet these freedoms which we hold so dear are not as safe as they have been in other times in the life of our Nation. They have come under attack by the heavy hand of Government in a manner not seen since the height of the Watergate scandal 30 years ago.

The press today is frequently being subpoenaed to appear in Federal court and threatened with fines and/or imprisonment if they refuse to reveal a confidential source to the prosecutor or attorneys involved in the lawsuit. In some instances, the prosecutor or attorneys might also request the reporter's notes, video outtakes, or other unpublished information.

In recent months, the press has come under intense pressure to reveal the identity of their confidential sources, threatening the public's right to know.

In Providence, RI, WJAR-TV reporter Jim Taricani aired an FBI surveillance tape in 2001 that showed an aide to Mayor Vincent ``Buddy'' Cianci accepting a bribe from a local businessman. Taricani broke no law in airing the tape, but a special prosecutor was subsequently brought in to investigate who leaked the information. He refused to identify the source and was convicted of criminal contempt yesterday in Federal court. Taricani now faces 6 months in prison when he is sentenced in December.

Perhaps the most alarming instance in recent months of the growing threat to the sacred right to freedom of speech in America is the case of Judith Miller of the New York Times. Last month, a Federal judge held Miller in contempt of court for refusing to name her sources to prosecutors investigating the disclosure to syndicated columnist Robert Novak and to other journalists of Valerie Plame's identity as a covert CIA agent. Plame's husband, former Ambassador Joseph Wilson, IV, had in a New York Times editorial criticized the Bush administration for claiming that Iraq had tried to buy uranium from Niger.

Unidentified senior administration officials revealed Plame's identity to Robert Novak and other Washington area journalists, allegedly as an act of revenge for Wilson speaking out against President Bush's rationale for invading Iraq.

Mr. Novak then published Plame's identity in a July 2003 column, which prompted an investigation by the Justice Department and the subpoenaing of several journalists before a Federal grand jury, including Judith Miller, Tim Russert of NBC's ``Meet the Press,'' Walter Pincus and Glen Kessler of the Washington Post, and Time magazine reporter Matthew Cooper.

Some of these reporters have talked to the prosecutors after the alleged Government sources signed waivers releasing the journalists from any pledge of confidentiality. New York Times reporter Judith Miller, however, has refused to testify, even under the limited terms of the waiver. As a result, she is being held in contempt of court and could face up to 18 months in jail unless she agrees to testify.

What is so surprising about this case is that Judith Miller never even published an article in the New York Times, or any other newspaper or magazine for that matter, about Valerie Plame. The mere fact that Miller contemplated writing such an article and had conducted interviews for it was enough for the judge to hold her in contempt of court for refusing to name sources.

Currently, 31 States and the District of Columbia have enacted protections for gatherers and disseminators of news and information. They include red States, blue States, Alabama, North Carolina, and Montana, for example.

Why then is there a need for a Federal statute in this area? A strong and uniformed Federal law on shielding would provide uniformity and consistency to the patchwork of inconsistent court decisions and State statutes currently in place.

In many instances, whether the disclosure will be compelled and how much information will be disclosed depends upon the particular State in which the journalist is pursuing a story when he or she is subpoenaed. The different potential outcomes affect reporters' practices, the flow of information, the articles written or not written, in various news media. It ultimately impacts the public's ability to learn about matters of interest and importance as well.

The protections that these laws and court rulings provide vary widely in detail and in scope. For example, some States grant nearly complete protection for sources and information, while

others provide little or none. In addition, the protections may differ in their applicability to criminal and/or civil proceedings.

In the Federal court system, for instance, most have interpreted Branzburg, a 1972 United States Supreme Court decision, to provide at least qualified news gathering protection--that is, a protection that can be overcome in certain circumstances. A few Federal courts, however, such as the Seventh Circuit, have rejected such protection, or have limited it only to when the subpoenas are being used to harass the press.

For those reasons, I think it is quite clear that a national standard would protect gatherers and disseminators of information from the varying State statutes and their interpretations by State courts. This goal is exactly what the Free Speech Protection Act of 2004 would achieve.

Under the legislation, the protection against compelled disclosure for sources would be absolute. The protection against compelled disclosure of news and information, however, is qualified. That is, an individual involved in gathering news would be required to reveal their unpublished material only under certain circumstances. The legislation requires three criteria to be met before such news or information can be disclosed.

First, the person seeking the news or information must prove by clear and convincing evidence that the news or information is critical or necessary to significant legal issues before a judicial, legislative, or administrative body that has the power to issue a subpoena.

Secondly, the news or information could not be obtained by alternative means. Finally, there is an overriding public interest in the disclosure that must exist.

The legislation I am introducing this evening is a work in progress. Obviously, in the coming weeks I intend to further refine it, and in the 109th Congress to seek out my colleagues' advice and counsel on how we might proceed. I am nevertheless introducing this bill in the closing hours of this Congress because I believe the Senate discussion of this matter is urgent. The public's right to know is under attack. When that happens, all Americans suffer since they are deprived of knowledge and information which affects their lives.

There are countless examples of information that we have received because there have been confidential sources who have come forward. Certainly, we can go back to Watergate, Whitewater, or Iran-Contra, Abu Ghirab--the prison scandal in Iraq--Enron, WorldCom, corporate governance issues, the list is almost endless. Had it not been for confidential sources coming forward and sharing information with a free press that would then share that with the public, if we had to rely exclusively on government press releases or press conferences, then we might never have learned anything about some of these issues which have been so vitally important to make our Government and our Nation stronger.

I urge my colleagues to take a look at this proposal and urge them to consider it when we return in January. I will reintroduce it again and urge them to support it.

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

Mr. President, I draw attention to the growing problem of premature birth. As a sponsor of the PREEMIE Act, with my colleague Senator Alexander, I have heard the stories about the strain a premature birth places on families, as well as the lifelong health problems many preterm children face.

Nationwide, 1 out of every 8 babies is born too early. In my own State of Connecticut, 1 of every 10 babies born in 2002 was preterm and the rate of preterm births in Connecticut has risen more than 11% since 1992.

Senator Alexander and I are introducing a resolution to raise awareness of this public health crisis. As part of their 5-year campaign designed to use the combined power of awareness, education, and research to significantly decrease the number of premature births in the United States, the March of Dimes has designated November as Prematurity Awareness Month. I am pleased to be supporting this campaign.

I urge my colleagues to find out about the toll of premature births in their states and to work together to solve this problem. I hope we can move the PREEMIE Act quickly in the 109th Congress in order to expand the Government's efforts to reduce the rates of preterm birth.

Mr. President, I support a bipartisan, bicameral reauthorization of the Individual with Disabilities Education Act, IDEA. I want to start by thanking my fellow conferees and their staff for all of their hard work in putting together the bipartisan, bicameral legislation we are considering today. While we may still have some disagreements about the substance of the bill, getting to this point in a bipartisan way is no small achievement, and I know we are all better for it.

Nothing pleases me more than to move forward with a reauthorization that the education, the disability, and the parent and student community have been eagerly waiting for: a bill that will ensure that students with disabilities get the services they are entitled to while providing school systems with a greater degree of flexibility in implementing the law.

The Individuals with Disabilities Education Improvement Act of 2004 emphasizes accountability and improved results, improves monitoring and enforcement of the law, and works to reduce litigation by providing new opportunities for parents and schools to address concerns and disputes.

The bill reduces paperwork by streamlining State and local paperwork requirements, provides earlier access to services and supports for infants, toddlers and preschoolers with disabilities, and properly puts added emphasis on transition services so that special education students leave the system ready to be full productive citizens, whether they choose to go on to college or a job. Like No Child Left Behind, this bill also increases and improves opportunities for parental involvement and supports special education teachers in becoming ``highly qualified'' to do their jobs.

I am particularly pleased that the IDEA conference agreement contains provisions that I, along with Senators Cochran, Harkin and Bunning, originally introduced as the Instructional Materials Accessibility Act, IMAA. These important provisions will greatly aid blind and print- disabled students by ensuring that they receive their textbooks and other instructional materials in the formats that they require, such as Braille, at the same time as their sighted peers.

Far too often, blind, visually-impaired and print-disabled students wait months for their State or local school districts to convert their textbooks into Braille or another alternative format. At the same time, school districts face exorbitant costs for these conversions. The Instructional Material Accessibility Act provisions included in this reauthorization will mandate the adoption of one uniform electronic file format that will greatly ease the process of converting learning materials into alternative formats, such as Braille.

Secondly, the IMAA provisions will create a repository for these formats so that they can be disseminated to local school districts quickly and cost effectively.

We often hear today the pledge that we will leave no child behind. May I suggest that we also make every effort to ensure that we leave no blind child behind. The adoption of these important provisions will go a long way toward ensuring that blind, visually-impaired and print- disabled students are not left behind in the classroom.

And while I am disappointed that the bill does not contain a provision to provide mandatory full-funding of IDEA, I believe that the monetary targets that have been provided, are at least pointing us in the right direction. Still, I think it is important to remind everyone, yet again, that thirty years ago when we passed IDEA, we made a commitment to, over time, cover 40 percent of the State cost of servicing students with special needs.

We have yet to make good on this commitment. Today the Federal Government supports less than 20 percent of the cost of the program. That is not even half of the 40 percent we promised 29 years ago. States and municipalities are bearing more than their share of responsibility for meeting disabled students' needs. States and municipalities need our help. As I have said before, I cannot accept the argument that because our economy is faltering, or we are a Nation at war, we cannot provide our children and their families with the critical educational resources they need. Investment in education is no less important in a weak economy or while our Nation is at war.

Almost 30 years ago, Congress passed the Individuals with Disabilities Education Act to help States provide all children with disabilities with a free, appropriate public education in the least restrictive environment possible. Since that time, this law has made an incredible difference in the lives of millions of American children and their families.

Fundamentally, this is a good bill--one that will help guarantee the full potential of all our children while assisting school districts in their efforts to deliver special education services in an efficient manner. That is why I will support it.

Mr. President, I speak about the vote that took place yesterday to raise the statutory limit of our

Nation's indebtedness. It is terribly unfortunate that for the third time in three years this administration has run up against the Federal debt limit, thereby forcing once again an increase in the National debt from $7.384 trillion to $8.184 trillion.

I think it is a mistake for this body to give the administration what is essentially an $800 billion check to continue its irresponsible fiscal policies.

For quite some time now, the Treasury Department has been forced to halt payments owed to federal retirement accounts and take other extraordinary measures in order to keep the government from defaulting. And now we are in a position where the Treasury Department has said that Congress must increase the debt ceiling by the end of this week or the government will default on its obligations. What this says is that the government is living far beyond its means.

Just several years ago, when President Clinton was President, the National debt was shrinking, not growing. In 1997, the debt held by the public was $3.745 trillion. By FY2001, it decreased by more than $400 billion to $3.296 trillion. Former President Clinton made it a goal to pay off the debt by 2013, so that America would be debt free for the first time since 1835. He recognized that eliminating the debt would strengthen our economy, allow investments in education and other critical priorities, and ensure that Social Security could meet the challenges to come when the baby boomers retire.

By contrast, under the Bush administration, the debt limit was raised by $450 billion in 2002 and $984 billion in 2003. And now, this year, in 2004 it will increase by $800 billion. I find it astounding that just four years ago we were having compelling conversations in the Senate Banking Committee with Federal Reserve Chairman Alan Greenspan about what would happen if we paid off the debt too quickly. And now, here we are about to pass another increase of $800 billion to the National debt.

This new increase will bring the grand total to more than $2 trillion under President Bush--the largest total debt limit increase recorded under any President. Now instead of being eliminated, we are expecting the debt held by the public to reach $6.5 trillion by 2011.

When President Bush first came to office he assured the nation that if we adopted his tax cuts, we would not only see job growth, but we would still be able to eliminate the publicly held debt by 2008. Instead, we have seen 1.5 million private-sector jobs lost, making this the first Administration since Herbert Hoover to actually lose jobs. In just 4 years, we have gone from a projected 10-year surplus of $5.6 trillion to a 10-year deficit of over $3 trillion. And now we are about to once again, for the third year in a row, increase the debt.

If additional debt is going to be accumulated, the administration and the majority could at the minimum ensure that we are adequately investing in our children's education, the country's infrastructure, health care, the solvency of Social Security, and other vital national priorities. But that does not appear to be the case considering that we are seeing across the board cuts in the upcoming omnibus bill, and this Administration continues to push for policies that push us further in the red without any real results.

The administration's reckless policies will pass the burden of paying for them onto future generations, and unfortunately, the administration has shown absolutely no regard for the hardship this will cause. We often discuss the so-called ``death tax'', this administration's reckless fiscal policies are forcing a ``birth tax'' on every child born today.

What do I mean by the term ``birth tax''? Simply this: a child born today is born owing his or her country $25,000. That is that child's share of the national debt. This is unconscionable. We have a responsibility as lawmakers to leave our country better off tomorrow than it is today. With policies like this, I am afraid that this administration and its supporters are failing to meet this fundamental moral responsibility to our country and to future generations.

Also deeply troubling is that in order to cover increased borrowing, the U.S. is going deeper into debt to foreign countries. Japan, China, the United Kingdom, and Caribbean Banking Centers are now the largest foreign holders of U.S. Treasury Debt.

We have borrowed over $720 billion from Japan, over $174 billion from China, and even tens of billions of dollars from South Korea. During the term of the President's first four years, we have seen our foreign debt holdings increase 83 percent from just over $1 trillion to over $1.8 trillion. This is especially dangerous because these countries can collect their debt when it suits them, which could potentially puts our nation in a very difficult economic situation.

I find it astounding that the administration and the majority of this Congress have not put forward any plan to reduce the alarming increase in our nation's debt--an increase largely caused by their reckless tax and budget policies. Indeed, their only known plans to permanently extend tax breaks for the affluent and drain at least $1 trillion from Social Security--would only make our current problems worse.

I strongly believe that increasing the debt limit once again without a plan is a big mistake. We owe it to future generations to do more to ensure that their future is economically sound. I hope that this Administration, and the majority of the Congress begin to enact more responsible fiscal policies before it truly is too late.

Mr. President, there are a few of us who would like to be heard on different subject matters. Maybe we could work out some arrangement so we don't have to wait around. I have about 20 minutes to speak on the bill that was just agreed to. I know other colleagues will also request time on various matters.

I will ask unanimous consent that once matters of business are finished, I be recognized for 15 minutes in morning business.

Mr. President, I would like to express my deep sorrow that many of my colleagues and many millions of Americans share over the loss of Christopher Reeve a remarkable individual who, as a result of a tragic paralyzing injury that he suffered while horseback riding, dedicated his last 10 years to making a positive difference. Rather than wallowing in his own misery and sorrow, he used those 10 years to inspire and change America in terms of our attitudes and perceptions about people with such serious injuries and disabilities. I know that we will miss him very much. We have admired him immensely for his courage and dedication.

I express my condolences to his family. I wish to express the deep sorrow I feel over the loss of someone I knew not terribly well, yet someone I had the pleasure of meeting on a number of occasions.

Some of my colleagues, particularly Senators Harkin and Kennedy, knew him better than I and may express their own views on the subject. It was a sad day for America to lose this courageous individual. I hope his message on a number of subject matters, not

the least of which was stem cell research, will be heard and that his memory and the work he was engaged in will be our work in the coming years.

Mr. President, I rise this afternoon to speak about the most recently passed piece of legislation; that is, the FSC/ETI tax bill that consumed a great deal of time over the last several days. I begin by congratulating Senators Grassley and Baucus who wrote a very good bill in the Senate.

When that bill left the Senate, I thought that it was a very sound piece of legislation, one that not only addressed the immediate problem dealing with trade issues, but also incorporated some other good ideas that all of us believed were important to be a part of that legislation. All of them were in one way or another bipartisan amendments offered on the floor of the Senate.

The legislation provided tax deductions for American manufacturers to stimulate job growth in our economy. It protected American workers' overtime provisions that had been adopted by this body and the other body on several occasions over the last year.

The legislation limited the outsourcing of American jobs with the use of American taxpayer money. Senator Specter and I and 68 of our colleagues endorsed that amendment which was before the Senate.

In addition, the Senate-passed bill contained an extremely important and delicate compromise worked out between the Senator from Massachusetts and the Senator from Kentucky that would have provided financial relief to hard-pressed tobacco farmers, while at the same time establishing critical new protections for the health and safety of our children, 2,000 of whom start smoking each and every day in the United States.

The Senate bill was a very good piece of legislation. It was a sensible bill and a well-crafted bill. Senators Baucus and Grassley did an outstanding job.

Unfortunately, that bill is at best dimly reflected in the conference report that we voted on today. The Senate bill essentially has been mugged, if I might say, by the other body and by the administration. In its place, the Senate was asked to consider a conference report that lacks many of the provisions most important to America's small businesses and to workers. In their place, the conference report has added a number of provisions that amount to little more than sops to a variety of special interests from NASCAR to makers of ceiling fans.

In the process the bill neuters the ability of Congress to make meaningful contributions to economic growth. At the same time it creates new threats to fiscal discipline, which is at an all-time low.

Allow me to discuss several of these shortcomings in more detail, and to discuss other provisions that were either left out of this conference report or changed dramatically from the legislation that left this body only a few weeks ago.

First, I am concerned that this bill may not achieve its central goal: lifting the European Union duties, which currently are at 12 percent and could reach as high as 17 percent. Instead of simply repealing the Foreign Sales Corporation and Extraterritorial Income Exclusion (FSC/ETI), the conference report uses House language which phases the subsidy out over two years and allows companies to receive a percentage of the subsidy based on what they export each year. We were told early on that the European Union would find the Senate language acceptable for the removal of sanctions. We were also told that the language from the other body raises serious reservations within the European Union.

In last week's Washington Post, the European Union spokesman Anthony Gooch was quoted as saying:

``The export subsidy phases out of existence slowly when it should be lifted immediately.''

So here we are, about to pass a massive tax bill that is supposed to fix our FSC/ETI problem, and yet we are not even sure if it will do that job. In other words, we might have to do this all over again. The E.U. had said that the Senate-passed language would be acceptable, but had expressed concern over the House language. And here we are with a conference report with the House language. I find this baffling and deeply troubling. And while some would welcome another opportunity to pass even more special interest tax cuts in another FSC/ETI bill, this Senator would certainly not.

Second, instead of meaningful, broad-based, and fiscally responsible tax relief for manufacturing here in the United States, the conference report includes a smorgasbord of special provisions. Even the administration's Treasury Secretary just last week highly criticized this legislation as including a ``myriad of special interest tax provisions that benefit few taxpayers and increase the complexity of the tax code.'' I am quoting the Secretary of the Treasury about this bill we just overwhelmingly adopted.

Let me mention some of these provisions, and then ask your own constituents whether they think this is a wise use of their tax dollars. We are going to provide a $101 million tax break that would allow NASCAR racetracks to recover costs over 7 years; a $445 billion Alaska energy tax break; $42 million for film and television production; $27 million to the horse and dog racing industries. Ask your constituents whether they think these provisions are critically important at a time when we have massive deficits, whether these interests are the kinds of interests we should be including in a bill primarily designed to increase manufacturing, to limit the kinds of export problems we have as a result of trade agreements.

It seems to me we have gone far afield of what we should have been doing, far afield of what the Senate did only a few weeks ago.

I might point out as well that in this legislation we are not doing what we ought to be doing, and that is, of course, trying to provide some real relief for the manufacturing sector in our economy. It is a well-known fact that our manufacturing sector is hurting. The erosion of our manufacturing base is of great concern. Under the present Administration we have lost nearly 2.7 million manufacturing jobs. Just last Friday, the September unemployment numbers showed that we only added 96,000 new jobs. This is one-third the job growth of 300,000 per month that would have been achieved if job growth had occurred at the rate this average for a recovery. The September unemployment numbers also showed that we actually saw manufacturing jobs fall by 18,000--the largest drop since December, 2003. Despite this fact, this conference report weakens language that would have rewarded domestic manufacturing by giving an even bigger tax cut to companies that manufacture more of their goods in the U.S. It expands the definition of what constitutes manufacturing to include industries that hardly fall within the category of manufacturing. By diluting the definition of manufacturing and expanding this out by some 9 or 10 percent, we are going to make it harder for the very industries which are critically important to our long-term economic growth to create jobs. By expanding that definition, we have set ourselves back.

According to the Joint Committee on Taxation's complex analysis of the manufacturing deduction in this bill, which they are required to do by law and which was tucked away at the end of the conference report, only slightly more than 10 percent of small businesses will be affected by these provisions. Only 10 percent of small businesses will be able to enjoy the benefits of this legislation. Since the title of this bill is a jobs bill, I would have expected more help for our smaller companies which are the biggest source of job growth in our Nation.

The Joint Tax report also notes that ``the provision will result in an increase in disputes between small businesses and the IRS.'' Reasons for such a dispute ``include the complexity of the provision and the inherent incentive for small businesses and other taxpayers to characterize the activities as qualified production activities to claim the deduction under the provision.'' Just what a small business needs, a more complex Tax Code and problems with the IRS.

Third, this legislation changes a major provision which was adopted in the bill as it left the Senate--a provision that stopped the use of federal tax dollars to subsidize the outsourcing of American jobs. As the author of this provision dealing with outsourcing, I

am terribly disappointed that, despite the fact that an overwhelming majority of our colleagues on a bipartisan basis approved language that prohibited the use of American taxpayer money to outsource jobs outside of the United States, this provision was stripped out in the conference report.

We ought to be exporting our products and our services, not jobs in this country. At a time when as many as 14 million white-collar jobs could be lost over the next 10 years from outsourcing and with 2.7 manufacturing jobs already lost in the last four years, the American people deserve a majority in Congress to stand up against the surge of outsourcing afflicting this country.

The unanimous vote of the 12 conferees on the Republican side to take the outsourcing provisions out of this bill, I think, is a slap in the face of American workers. The fact we would be using Federal taxpayer money to hire someone offshore to do a job that ought to be done in the United States I think is wrong. I am for fair trade and free trade. We ought to stand up for the American worker. They are worried and concerned about their future. They are bothered about whether they are going to have enough to take care of their families' needs.

Yet we found nothing wrong with continuing to have provisions in our policies that allow tax money to be used to hire people outside of this country, when jobs are needed in the U.S. We have the worst job production in almost 70 years in the U.S. We ought not to be stepping back. This bill stripped out a provision that was adopted here by a vote of 70 to 26. I think that was a great mistake. I regret that my colleagues on the conference committee sought to do that.

It is no secret how much this Administration supports outsourcing. They believe, it is, in their words ``a good thing.'' They said so in the President's Economic Report to Congress this year, and they so again in this conference agreement.

Fourth, the conference report does nothing to protect overtime pay. Six million citizens rely on overtime pay to provide for their families' needs. So many families are struggling to make ends meet. The cutback in overtime is an unfair burden that American workers should not have to bear.

Overtime pay amounts to about 25 percent of the income of workers who work overtime. These include police officers, firefighters, nurses, and many others. Workers stripped of overtime protections will end up working longer hours for less pay.

The Bush administration's overtime regulation would deny overtime protections to as many as 6 million hard-working men and women, including registered nurses, cooks, clerical workers, nursery schoolteachers, and others. Even veterans, who have served in Iraq and Afghanistan, would be hurt. If they received some training as soldiers that would give the administration an excuse to classify them as ``managers'' in the civilian workforce, they could be denied overtime-- even if they resume the same job. That is an outrage.

The Senate has voted against the Bush rule three times and said you should not impose that rule. The House voted twice to say don't impose that rule. Yet the conference committee sought to drop it entirely.

So the Bush administration's rule on overtime will affect 6 million Americans adversely. Fifty-five categories of jobs that qualify for overtime pay are gone. That is now out, despite the fact we insisted it be part of this legislation.

Fifth, the conference report breaks an agreement we made not only to protect tobacco farmers but also children. It was a bipartisan agreement that simply said that if we were to help out tobacco farmers, we were going to have FDA regulations to protect children from the life-threatening dangers of tobacco. These dangers--and the costs they pose to our nation--are enormous.

By regulating tobacco products and taxing them higher, tobacco farmers are going to be adversely affected. Some tobacco--specifically tobacco made into cigar wrappers--is grown in my State. I see my colleague from North Carolina here and I know how important that issue is to her and her constituents, just as it is in Kentucky. I think they deserve help as a result of this legislation, but I also believe part of the deal here was that we were going to allow this industry to be regulated by the FDA. To strip the FDA provision out, I think, was a great mistake. I think that we will regret it.

It costs us $75 billion a year in health care costs to deal with tobacco-related illnesses in America. According to the Centers for Disease Control and Prevention, tobacco use by pregnant women alone causes between $400 million and $500 million per year due to complications of low birth weight, premature births, and sudden infant death syndrome.

Every day, another 2,000 kids start smoking in America, one third of whom will die prematurely. That is not speculation. That is a fact. Yet this bill stripped it out and said we would provide relief to tobacco farmers but forget about doing a better job of regulating an industry that is causing so much harm and sadness in our country because of the related illnesses and death caused by people who smoke.

Sixth, the conference report is missing a provision included in the Senate bill I cosponsored, which is the Landrieu amendment. We are going to have a separate vote on that later. It is not a likely amendment that will be offered and voted on in the House. We will vote on it, but it is still not going to be included in legislation that goes to the President for signature. That was the provision that would have honored patriotic employers who continue to pay the salaries of their employees, who are members of the National Guard and Reserve and are deployed in the war on terrorism--whether it be in Afghanistan or Iraq. Employers would have been eligible for a 50-percent tax benefit for wages they paid to members of the National Guard and Reserve while on Active-Duty status. The credit would have been good up to 12 months, about the length of a standard deployment in Afghanistan or Iraq.

Forty-one percent of activated Guard and Reserve take a reduction in pay when called to duty. This places a tremendous burden on their loved ones back home. Yet conferees stripped the provision out of the conference report.

As my friend and colleague from Louisiana pointed out earlier, the $44 million tax credit for ceiling fans included in the conference report would have paid for 1 year of Guard and Reserve tax credits. Yet the conferees chose ceiling fans over businesses, or saving jobs for our National Guard and Reserve people.

Finally, this conference report is fiscally reckless. While the offsets are likely to expire, the tax breaks are likely to be extended--if past history under this leadership is any guide. That will only add tens of billions of dollars to the deficit. We have the highest deficit in the history of our country. This is a birth tax on young children being born because we already know they bear an obligation to pay back in interest to the Federal Government a staggering amount of money. The idea we are going to have higher mortgage rates, higher car payments, and tuition costs because of mounting deficits, because $1.8 trillion of America's debt is held by nations outside of the United States--principally Japan and China. That is dangerous, in my view. This bill adds tremendously to the national debt. We are not paying for it.

For all of those reasons, I think we would have been wise to wait when cooler heads prevail, and deal with what we should have been dealing with, or at least draft legislation that was the rationale for bringing it up in the first place, and deal with the trade issue. We didn't do that well in this bill.

I was in a small minority to vote against this, but I believe strongly that if you think something is as wrong as this is, you have to speak out against it. For the reasons outlined here, and because we so emasculated what we did in the Senate a few weeks ago and brought back a piece of legislation that hardly resembled what we did in the Senate, I could not vote for this legislation.

I hope we come back in January and reconsider some of the provisions included in this bill and do a better job on behalf of the American taxpayer and future generations of Americans.

I yield the floor.

For his last 5 years, Jesse's right hand on tobacco issues was David Rouzer, and David has been my senior

adviser as we have worked through this buyout.

At a young age, David began working on his family's tobacco farm in Johnston County, NC. He understands the stress that tobacco farmers have been under, and he has labored tirelessly to get us to this day.

I made the buyout a top priority when I arrived in the Senate because our tobacco-producing communities have suffered terribly--terribly--in recent years. The rigid Government program created in the 1930s was not designed for the intense world competition of today. It was not designed to withstand the consequences of the master settlement agreement.

In past years, our farmers led the world in tobacco production. Now they account for only 7 percent of flue-cured tobacco sold worldwide. The time has come to end the last of the Depression-era farm programs. Our farmers want to operate in a free market.

As the U.S. market share of tobacco has slipped, the quota system, with its price supports, kept U.S. producer costs artificially high. These high prices led to tobacco imports from lower cost countries, such as Brazil and China. Under the current tobacco program formula, the decline in demand for American tobacco produced a cut in quota, the amount of tobacco a farmer can grow and sell.

In just the last 5 years, the tobacco quota has been cut almost 60 percent. That is the equivalent of cutting your paycheck by 60 percent. There is not a business in America that would not take a serious hit with a 60-percent cut in revenue. And according to agricultural economists, these farm families were about to get an additional 33- percent cut in quota for the 2005 crop-year. These cuts have had profound impacts on North Carolina's tobacco communities. For almost 70 years, the U.S. Government-issued tobacco quota was something you could take to the bank, literally.

Under permanent law, they could expect a yearly return on investment. Farmers used it as collateral for loans in order to put the next year's crop in the field. Families handed quota down from generation to generation. That paid the death tax as part of keeping family farms alive. Widows have counted on quota as an investment to supplement their Social Security.

By buying out these quota holders, we give families the option of retiring with dignity. We give them the ability to pay off the banks for loans made against an ever-shrinking collateral. By getting the buyout done before the next quota cut, literally thousands of families in rural North Carolina will be saved from bankruptcy.

Rather than having to quit the farm, this buyout gives our farmers the ability to compete in the free market, and if farmers want to continue to grow leaf, they can compete worldwide without the artificial cost increase.

Many will also use this opportunity to invest in new equipment and transition to other crops. This tobacco buyout will help not only the farmers and their families, but their hard-pressed communities. It is the retailers, equipment dealers, chemical and fertilizer dealers, and a whole array of small local businesses that will also benefit from the tobacco buyout. These are the very small businesses that create the majority of new jobs in tobacco-producing States--jobs that are much needed.

With our action today, we come to the end of an era in tobacco policy. We stop conceding tobacco production to countries such as China and Brazil. We stop foreclosures to thousands of farmers, and we stop the negative economic ripple effect throughout rural communities in the Southeastern States. For that, we can all be extremely proud.

To those who have worked so hard on the tobacco quota buyout, on behalf of the thousands of farm families in North Carolina and throughout the Southeast, a heartfelt thank you. What has been accomplished is a legislative miracle and a monumental achievement. It has been a great privilege to work with you.

Mr. President, I yield the floor.

Mr. President, I rise today to remind my colleagues that October is National Spina Bifida Awareness Month and to pay tribute to the more than 70,000 Americans and their family members who are currently affected by Spina bifida--the Nation's most common, permanently disabling birth defect.

Spina bifida is a neural tube defect that occurs when the central nervous system does not properly close during the early stages of pregnancy. Spina bifida affects more than 4,000 pregnancies each year, with 1,500 babies born with Spina bifida each year. There are three different forms of Spina bifida--the most severe being myelomeningocele Spina bifida, which causes nerve damage and severe disabilities. Myelomeningocele Spina bifida is diagnosed in 96 percent of children born with this condition. Additionally, 70 to 90 percent of the children born with Spina bifida are at risk of mental retardation, a condition caused when spinal fluid collects around the brain.

The exact cause of Spina bifida is not known, but researchers have concluded that women of childbearing age who take daily folic acid supplements can reduce their chances of having a Spina Bifida pregnancy by up to 75 percent. Progress has been made with regard to the importance of consuming folic acid supplements and maintaining diets rich in folic acid. The September 17, 2004, edition of the Centers for Disease Control and Prevention publication, Morbidity and Mortality Weekly Report, finds that 40 percent of women of childbearing age reported taking a vitamin containing folic acid every day, an increase of eight percentage points from 2003. This increase suggests a substantial positive change in behavior. Since the Food and Drug Administration decision to fortify enriched grains with folic acid, the CDC has documented a 26 percent decline in these birth defects. Despite this success, thousands of pregnancies each year continue to be affected by these preventable birth defects. Thus, increasing use of vitamins containing folic acid remains an important strategy for preventing these birth defects.

Although folic acid consumption reduces the risk and incidence of Spina bifida pregnancies, we will still have babies born with Spina Bifida who need intensive care and families that need guidance and support in caring for and raising these children. As a result of this neural tube defect, most babies suffer from a host of physical, psychological, and educational challenges, including paralysis, developmental delay, numerous surgeries, and living with a shunt in their skulls in an attempt to ameliorate their condition. Today, approximately 90 percent of all babies diagnosed with this birth defect live into adulthood, approximately 80 percent have normal IQs, and approximately 75 percent participate in sports and other recreational activities. With proper medical care, people who suffer from Spina Bifida can lead full and productive lives. However, they must learn how to move around using braces, crutches or wheelchairs, and how to function independently. They are also at risk of a host of secondary health problems ranging from depression and learning disabilities to skin problems and severe latex allergies.

Lifesaving breakthroughs in research, combined with improvements in health care and treatment of children with Spina Bifida, now fortunately lead many with Spina bifida to live into adulthood. However, adults with Spina bifida face many new challenges in the fields of education, job training, independent living, health care for secondary conditions, and concerns related to aging.

I am grateful for my colleague from Missouri, Senator Bond who, along with myself, has been working to improve the quality of life for individuals with Spina bifida with the passage of the Birth Defects and Developmental Disabilities Prevention Act of 2003 and supporting increased funding for the National Spina Bifida Program at the Centers for Disease Control and Prevention. In fiscal year 2004, Congress provided a much needed $3 million in funding for the National Spina Bifida Program. I strongly urge my colleagues to support increased funding in fiscal year 2005 to ensure that the CDC has the resources necessary to prevent Spina bifida, improve quality-of-life for those living with the condition, and to deliver important public health messages to those communities most at-risk for a Spina bifida pregnancy.

I want also to recognize the special work of the Spina Bifida Association of America, an organization that has helped people with Spina bifida and their families for nearly 30 years, working every day to prevent and reduce suffering from this devastating birth defect. The SBAA was founded in 1973 to address the needs of the individuals and families affected by Spina bifida and is currently the only national organization solely dedicated to advocating on behalf of the Spina bifida community. As part of its service through approximately 60 chapters in more than 125 communities across the country, the SBAA puts expecting parents in touch with families who have a child with Spina bifida. These families answer questions and concerns and help guide expecting parents. The SBAA then works to provide lifelong support and assistance for affected children and their families.

Together, the SBAA and the Spina Bifida Association of Connecticut work tirelessly to help families meet the challenges and enjoy the rewards of raising their child. I would like to acknowledge and thank SBAA and the SBAC for all that they have done for the families affected by this birth defect, especially those living in my State. The Spina bifida community and our nation owe a tremendous debt to the SBAA for its work over the past three decades. I am honored to be an honorary co-chair along with Majority Leader Frist of the 16th Annual Roast for Spina Bifida to benefit the Association and its work in local communities around the country.

As a nation, we have accomplished a great deal in our battle against birth defects. However, much more work remains to be done. I urge all of my colleagues and all Americans to endorse the important efforts to prevent Spina Bifida but also to support those already living with this often debilitating birth defect. Those living with Spina bifida and their loved ones deserve our utmost support. It is my hope that by recognizing National Spina bifida Awareness Month we can move closer to the laudable goal of eventually eliminating the suffering caused by this terrible birth defect.

Mr. President. today I join my friend and colleague from New Mexico, Senator Domenici, in support of a resolution declaring next week National Character Counts Week. Senator Demenici and I have worked together for many years on the issue of character education and hope that by designating a special week to this cause, students and teachers will come together to participate in character building activities in their schools. In 1994, Senator Domenici and I established the Partnerships in Character Education Pilot Project and have worked regularly since then to commemorate National Character Counts Week. I am pleased that we are continuing our efforts today to help expand States' and schools' abilities to make character education a central part of every child's education.

Our schools may be built with the bricks of English, math and science, but character education certainly is the mortar. Character education means teaching students about such qualities as caring, citizenship, fairness, respect, responsibility, trustworthiness, and other qualities that their community values.

Character education provides students a context within which to learn. If we view education simply as the imparting of knowledge to our children, then we will not only miss an opportunity, but will jeopardize our future. Character education is not a separate subject, but part of a seamless garment of learning. Taking this to heart, teachers and administrators at the Ivy Drive Elementary School in Bristol, CT, incorporate the fundamentals of character education into a school wide program. In its eighth year, the Character, Assets & Resiliency Education, C.A.R.E, program integrates several pillars of character into daily lessons and special events. This year Ivy Drive chose ``swimming to success'' as their theme to build on the previous year's ``lets go fishing'' giving each child the opportunity to focus on the fundamentals of character education.

Two Hartford, CT Elementary Schools, Burr Elementary and Kennelly Elementary, recently demonstrated outstanding community service through their character education program. Supervised by their teachers, students raised close to $1000 in financial support for the family of a fifth grade student who died of leukemia. In doing so, they implemented the character pillars of caring, citizenship, and diligence.

The New Haven Public Schools recently implemented a 4-year character education curriculum within a pre-existing social development program. Grades K-3 experience the ``incredible

years'' curriculum, focusing on social skills and peer relations through service learning, community outreach, and teacher and parent training. A total of 700 character related lessons were taught in 2003- 2004. Community service projects included visits to the central firehouse, local animal shelter and elderly care home.

Character education programs work. Schools across the country that have adopted strong character education programs report better student performance, fewer discipline problems, and increased student involvement within the community. Children want direction, they want to be taught right from wrong. The American public wants character education in our schools, too. Studies show that about 90 percent of Americans support schools teaching character education.

As all education policy should be, character education is bi- partisan. This year we have 31 cosponsors to our resolution, cosponsors on both sides of the aisle. Character education is also actively supported by a number of national education and youth organizations including 4-H and the Boys and Girls Clubs of America. Character education can and is being incorporated into children's lives in and outside of the classroom.

This measure provides a helping hand to our schools and communities to ensure those children's future are bright and filled with opportunities and success. Character education not only cultivates minds, it nurtures hearts. While our children may be one quarter of our population, they are 100 percent of our future.

s. res. 462

Mr. President, I would like to commend Senator Gregg for taking what I hope is one of many steps in closing what most, if not all of us agree, is an egregious loophole in current law relating to student loans.

In the 1980's, the Higher Education Act sought to attract more lenders to the student loan program by offering nonprofits a 9.5 percent rate on return on student loans in exchange for their participation in the program. At a time of high interest rates, it provided an assurance to nonprofits that they could make student loans and stay afloat economically. The 9.5 percent subsidy was an incentive to bring the nonprofit sector into the lending business, to offer students more options in choosing a lender. The subsidy made sense at the time.

In 1993, a time when interest rates were coming down, 9.5 percent amounted to a windfall for lenders. Congress rescinded the policy but grandfathered loans already made, assuming that the volume of these loans would decline as borrowers paid them off. That assumption turned out to be wrong.

Exploiting a loophole in current law, some lenders, including for- profits that have acquired nonprofits, have been rolling new loans into old accounts, sometimes for as little as a day, to qualify for the subsidy. That means that in today's market, some guaranteed a 9.5 percent profit on 3.4 percent student loans. The Federal Government is making up the 6.1 percent difference.

How egregious is this practice? From January 2004 to June 2004, one bank alone amassed over $3.2 billion in 9.5 percent loans by exploiting this loophole. The General Accounting Office GAO, has found that the overall volume of loans receiving a 9.5 percent return has increased to more than $17 billion this year from $11 billion in 1995. This is money that should be going to the student loan program and the Pell grant program, not bank profits.

In response to this discovery, the Department of Education has been asked to issue new rules clarifying that the practice in question is, in fact, not within the intent of current law. They have refused to do so. They claim that their hands are tied, that only Congress can close the current loophole. The GAO disagrees.

In a report issued September 21, the GAO states that the Department could use less formal guidance to clarify or alter its position on the practice, or publish an interim rule that would close the loophole until a formal rulemaking process is complete. The GAO also suggests that the Department publish an emergency rule. This type of rule allows Federal agencies to skip the formal process if they believe it would be ``impracticable, unnecessary or contrary to public interest.'' The Department does not believe the current situation rises to that level. Clearly, it is against the public interest, and against the interest of the U.S. Treasury, to allow this practice to continue.

According to some, the payments in question could cost the U.S. Treasury nearly $1 billion by the end of this calendar year and at least $5 billion over the next 10 years. This is money that could be used to send kids to college.

Mr. President, in response to this crisis, Senator Gregg has proposed a bill to close the 9.5 percent loophole. There is just one problem with his bill. It does not close the loophole completely and it does not close the loophole permanently. The loophole should be completely and permanently closed.

I applaud Senator Gregg for taking this first step. Between enactment of the change and the time that it expires next year, his bill will achieve a $285 million savings for the student loan program. If we were to shut down the loophole completely, we would achieve a $400 million savings within the same time frame. That would amount to an additional $115 million for student financial aid.

In response to Senator Gregg's bill, Senator Kennedy offered an amendment to close the loophole completely and permanently. This is something that my Democratic colleagues and I have been fighting to do since last October. Unfortunately, the amendment was not accepted.

Mr. President, the Pell grant maximum has remained flat for 3 years. Tuition is up. And all the while, the Federal government is giving away a $1 billion annual subsidy through 9.5 percent loans. The Federal Government is paying hundreds of million of dollars in unnecessary subsidies to student loan companies. The bill before us allows this practice to continue, even if it is to a lesser extent. I hope we will have an opportunity in the near future to take definitive action to correct this egregious short-coming in the law.

Mr. President, I rise today to introduce the Fair Access to Clinical Trials (FACT) Act. I want to begin by thanking Senator Kennedy, Senator Johnson, and Senator Wyden for joining me in introducing this legislation. Our bill will create a clinical trials registry--an electronic database--for drugs, biological products, and medical devices. Such a registry will ensure that physicians, the general public, and patients seeking to enroll in clinical trials have access to basic information about those trials. It will require manufacturers and other researchers to reveal the results of clinical trials so that clinically important information will be available to all Americans, and physicians will have all the necessary information to make appropriate treatment decisions for their patients.

Events of the past several months have made it clear that such a registry is needed. Serious questions have been raised about the effectiveness and safety of antidepressants when used in children and youth. It has now become clear that the existing data indicates that these drugs may very well put children at risk. However, because the data from antidepressant clinical trials was not publicly available, it took years for this risk to be realized. In the meantime, millions of children have been prescribed antidepressants by well-meaning physicians. While these drugs undoubtedly helped many of these children, they also led to greater suffering for others.

Unfortunately, antidepressants are just one example of a story that has become all too common. In the case of antidepressants, negative data might actually have been suppressed, and if this is discovered to be the case, those responsible should be dealt with harshly. However, because of what is known as ``publication bias,'' the information available to the public and physicians can be misleading even without nefarious motives. The simple fact is that a study with a positive result is far more likely to be published, and thus publicly available, than a study with a negative result. Physicians and patients hear the good news, but rarely the bad news. In the end, the imbalance of available information hurts patients.

Our bill would correct the imbalance of information, and prevent manufacturers from suppressing negative data. It would do so by expanding clinicaltrials.gov, an existing registry that is operated by the National Library of Medicine (NLM). Currently, clinicaltrials.gov includes information for patients seeking to enroll in clinical trials for drugs to treat serious or life-threatening conditions. The FACT Act would expand the registry to include all trials (except for preliminary safety trials), and would also require the submission of results data. At the same time, the bill would ensure that clinicaltrials.gov continues to operate as a resource for patients seeking to enroll in trials.

Our legislation would enforce the requirement to register trials in two ways. First, by requiring registration as a condition of Institutional Review Board (IRB) approval, no trial could begin without submitting preliminary information to the registry. This information would include the purpose of the trial, the estimated date of trial completion, as well as all of the information necessary to help patients to enroll in the trial.

Once the trial is completed, the researcher or manufacturer is required to submit the results to the registry. If they refuse to do so, they are subject to monetary penalties or, in the case of federally funded research, a restriction on future funding. It is my belief that these enforcement mechanisms will ensure broad compliance. However, in the rare case where a manufacturer does not comply, this legislation also gives the Food and Drug Administration (FDA) the authority to publicize the required information.

Let me also say that any time you are collecting large amounts of data and making it public, protecting patient privacy and confidentiality must be paramount. Our legislation would in no way threaten that privacy. The simple fact is that under this bill, no individually identifiable information would be available to the public.

I believe that the establishment of a clinical trials registry is absolutely necessary for the health and well-being of the American public. But I would also like to highlight two other benefits that such a registry will have. First, it has the potential to reduce health care costs. Studies have shown that publication bias also leads to a bias towards new and more expensive treatment options. A registry could help make it clear that, in some cases, less expensive treatments are just as effective for patients.

In addition, a registry will ensure that the sacrifice made by patients who enroll in clinical trials is not squandered. Many patients would be less willing to participate in trials if they understood that the data are unlikely to be made public if the results of the trial are negative. We owe it to patients to make sure that their participation in a trial will benefit other individuals suffering from the same illness or condition.

The problems associated with publication bias have recently drawn more attention from the medical community, and there is broad consensus that a clinical trials registry is one of the best ways to address the issue. Accordingly, the American Medical Association (AMA) has recommended the creation of such a registry, and the major medical journals have established a policy that they will only publish the results of trials that were registered in a public database before the trial began. Our legislation meets all of the minimum criteria for a trial registry set out by the International Committee of Medical Journal Editors.

To its credit, the pharmaceutical industry has also acknowledged the problem, and has created a registry to which manufacturers can voluntarily submit clinical trials data. I applaud this step. However, if our objective is to provide the public with a complete and consistent supply of information, a voluntary registry is unlikely to achieve that goal. Some companies will provide information, but others may decide not to participate. We need a clinical trials framework that is not just fair to all companies, but provides patients with peace of mind that they will receive complete information about the medicines they rely on.

The American drug industry is an extraordinary success story. As a result of the innovations that this industry has spawned, millions of lives have been improved and saved in our country and around the globe. Because of the importance of these medicines to our health and well- being, I have consistently supported sound public policies to help the industry to succeed. This legislation aims to build upon the successes of this industry, and help ensure that the positive changes to our health care system that prescription drugs have brought are not undermined by controversies such as the one now surrounding antidepressants, which is at least in part based on a lack of public information. This bill will help ensure that new and innovative medicines will be used by well-informed patients.

I look forward to working with industry, physicians, the medical journals, patient groups, and my colleagues to

move this legislation forward. This bill has already been endorsed by the National Organization for Rare Disorders, Consumers Union, the Elizabeth Glaser Pediatric AIDS Foundation, and the American Academy of Child and Adolescent Psychiatry. I thank these organizations for lending their expertise as we crafted this legislation, and I ask that a copy of their letters of endorsement be included in the Record after this statement.

Clinical trials are critical to protecting the safety and health of the American public, and for this reason, trial results must not be treated as information that can be hidden from scrutiny. Recent events have made it clear that a clinical trials registry is needed. Patients and physicians agree that such a registry is in the interest of the public health. I urge my colleagues to support this legislation, and I am hopeful that it will become law as soon as possible.

Mr. President, I rise today to introduce the Fair Access to Clinical Trials (FACT) Act. I want to begin by thanking Senator Kennedy, Senator Johnson, and Senator Wyden for joining me in introducing this legislation. Our bill will create a clinical trials registry--an electronic database--for drugs, biological products, and medical devices. Such a registry will ensure that physicians, the general public, and patients seeking to enroll in clinical trials have access to basic information about those trials. It will require manufacturers and other researchers to reveal the results of clinical trials so that clinically important information will be available to all Americans, and physicians will have all the necessary information to make appropriate treatment decisions for their patients.

Events of the past several months have made it clear that such a registry is needed. Serious questions have been raised about the effectiveness and safety of antidepressants when used in children and youth. It has now become clear that the existing data indicates that these drugs may very well put children at risk. However, because the data from antidepressant clinical trials was not publicly available, it took years for this risk to be realized. In the meantime, millions of children have been prescribed antidepressants by well-meaning physicians. While these drugs undoubtedly helped many of these children, they also led to greater suffering for others.

Unfortunately, antidepressants are just one example of a story that has become all too common. In the case of antidepressants, negative data might actually have been suppressed, and if this is discovered to be the case, those responsible should be dealt with harshly. However, because of what is known as ``publication bias,'' the information available to the public and physicians can be misleading even without nefarious motives. The simple fact is that a study with a positive result is far more likely to be published, and thus publicly available, than a study with a negative result. Physicians and patients hear the good news, but rarely the bad news. In the end, the imbalance of available information hurts patients.

Our bill would correct the imbalance of information, and prevent manufacturers from suppressing negative data. It would do so by expanding clinicaltrials.gov, an existing registry that is operated by the National Library of Medicine (NLM). Currently, clinicaltrials.gov includes information for patients seeking to enroll in clinical trials for drugs to treat serious or life-threatening conditions. The FACT Act would expand the registry to include all trials (except for preliminary safety trials), and would also require the submission of results data. At the same time, the bill would ensure that clinicaltrials.gov continues to operate as a resource for patients seeking to enroll in trials.

Our legislation would enforce the requirement to register trials in two ways. First, by requiring registration as a condition of Institutional Review Board (IRB) approval, no trial could begin without submitting preliminary information to the registry. This information would include the purpose of the trial, the estimated date of trial completion, as well as all of the information necessary to help patients to enroll in the trial.

Once the trial is completed, the researcher or manufacturer is required to submit the results to the registry. If they refuse to do so, they are subject to monetary penalties or, in the case of federally funded research, a restriction on future funding. It is my belief that these enforcement mechanisms will ensure broad compliance. However, in the rare case where a manufacturer does not comply, this legislation also gives the Food and Drug Administration (FDA) the authority to publicize the required information.

Let me also say that any time you are collecting large amounts of data and making it public, protecting patient privacy and confidentiality must be paramount. Our legislation would in no way threaten that privacy. The simple fact is that under this bill, no individually identifiable information would be available to the public.

I believe that the establishment of a clinical trials registry is absolutely necessary for the health and well-being of the American public. But I would also like to highlight two other benefits that such a registry will have. First, it has the potential to reduce health care costs. Studies have shown that publication bias also leads to a bias towards new and more expensive treatment options. A registry could help make it clear that, in some cases, less expensive treatments are just as effective for patients.

In addition, a registry will ensure that the sacrifice made by patients who enroll in clinical trials is not squandered. Many patients would be less willing to participate in trials if they understood that the data are unlikely to be made public if the results of the trial are negative. We owe it to patients to make sure that their participation in a trial will benefit other individuals suffering from the same illness or condition.

The problems associated with publication bias have recently drawn more attention from the medical community, and there is broad consensus that a clinical trials registry is one of the best ways to address the issue. Accordingly, the American Medical Association (AMA) has recommended the creation of such a registry, and the major medical journals have established a policy that they will only publish the results of trials that were registered in a public database before the trial began. Our legislation meets all of the minimum criteria for a trial registry set out by the International Committee of Medical Journal Editors.

To its credit, the pharmaceutical industry has also acknowledged the problem, and has created a registry to which manufacturers can voluntarily submit clinical trials data. I applaud this step. However, if our objective is to provide the public with a complete and consistent supply of information, a voluntary registry is unlikely to achieve that goal. Some companies will provide information, but others may decide not to participate. We need a clinical trials framework that is not just fair to all companies, but provides patients with peace of mind that they will receive complete information about the medicines they rely on.

The American drug industry is an extraordinary success story. As a result of the innovations that this industry has spawned, millions of lives have been improved and saved in our country and around the globe. Because of the importance of these medicines to our health and well- being, I have consistently supported sound public policies to help the industry to succeed. This legislation aims to build upon the successes of this industry, and help ensure that the positive changes to our health care system that prescription drugs have brought are not undermined by controversies such as the one now surrounding antidepressants, which is at least in part based on a lack of public information. This bill will help ensure that new and innovative medicines will be used by well-informed patients.

I look forward to working with industry, physicians, the medical journals, patient groups, and my colleagues to

move this legislation forward. This bill has already been endorsed by the National Organization for Rare Disorders, Consumers Union, the Elizabeth Glaser Pediatric AIDS Foundation, and the American Academy of Child and Adolescent Psychiatry. I thank these organizations for lending their expertise as we crafted this legislation, and I ask that a copy of their letters of endorsement be included in the Record after this statement.

Clinical trials are critical to protecting the safety and health of the American public, and for this reason, trial results must not be treated as information that can be hidden from scrutiny. Recent events have made it clear that a clinical trials registry is needed. Patients and physicians agree that such a registry is in the interest of the public health. I urge my colleagues to support this legislation, and I am hopeful that it will become law as soon as possible.

Mr. President, today I am pleased to announce the introduction of the Information Technology for Health Care Quality Act. Let me thank Senator Kennedy for joining me in introducing this bill. By encouraging health care providers to invest in information technology (IT), this legislation has the potential to bring skyrocketing health care costs under control and improve the overall quality of care in our nation.

We are facing a health care crisis in our country. The Census Bureau recently released a report showing that 45 million Americans were without health insurance in 2003--an increase of 1.4 million over 2002. In many respects, we have the greatest health system in the world, but far too many Americans are unable to take advantage of this system.

The number of uninsured continues to rise because the cost of health care continues to soar. Year after year, health care costs increase by double-digit percentages. The cost of employer-sponsored coverage increased by 11 percent this year, after a 14 percent increase in 2003. Employers are dropping health care coverage because they can no longer afford to foot the bill.

One of the ways to provide health care coverage to every American is to reign in health care costs. And expanding the use of IT in health care is the best tool we have to control costs. Studies have shown that as much as one-third of health care spending is for redundant or inappropriate care. Estimates suggest that up to 14 percent of laboratory tests and 11 percent of medication usage are unnecessary. Finally, and perhaps most disturbingly,

we know that it takes, on average, 17 years for evidence to be incorporated into clinical practice. Along these same lines, a recent study showed that patients receive the best evidence-based treatment only about half the time.

Significant cost-savings will undoubtedly be realized simply by moving away from a paper-based system, where patient charts and test results are easily lost or misplaced, to an electronic system where data is easily stored, transferred from location to location, and retrieved at any time. With health IT, physicians will have their patients' medical information, at their fingertips. A physician will no longer have to take another set of X-Rays because the first set was misplaced, or order a test that the patient had six months ago in another hospital because she is unaware that the test ever took place. The potential for cost-savings from simply eliminating redundancies and unnecessary tests, and reducing administrative and transaction costs, is substantial.

Of course, when we consider the improved quality of care and patient safety that will result from wider adoption of health IT, the impact on cost is even greater. For example, IT can provide decision support to ensure that physicians are aware of the most up-to-date, evidence- based best practices regarding a specific disease or condition, which will reduce expensive hospitalizations. Given all of these benefits, estimates suggest that Electronic Health Records (EHRs) alone could save more than $100 billion each year. The full benefits of IT could be multiple hundreds of billions annually. Such a significant reduction in health care costs would allow us to provide coverage to millions of uninsured Americans.

The benefits of IT go beyond economics. I am sure that all of my colleagues are familiar with the Institute of Medicine (IOM) estimate that up to 98,000 Americans die each year as a result of medical errors. A RAND Corporation study from last year showed that, on average, patients receive the recommended care for certain widespread chronic conditions only half of the time. That is an astonishing figure. To put it in a slightly different way, for many of the health conditions with which physicians should be most familiar, half of all patients are essentially being treated incorrectly.

Most experts in the field of patient safety and health care quality, including the IOM, agree that improving IT is one of the crucial steps towards safer and better health care. By providing physicians with access to patients' complete medical history, as well as electronic cues to help them make the correct treatment decisions, IT has the potential to significantly impact the care that Americans receive. It is impossible to put a value on the potential savings in human lives that would undoubtedly result from a nationwide investment in health care information technology.

It might seem counterintuitive that we can realize tremendous cost savings while, at the same time improving care for patients. But in fact, improving patient care is essential to reducing costs. IT is the key to unlocking the door--it has the potential to lead to improvements in care and efficiency that will save patients' lives, reduce costs, and reduce the number of uninsured.

Unfortunately, despite the impact that IT can have on cost, efficiency, patient safety, and health care quality, most health care providers have not yet begun to invest in new technologies. The use of IT in most hospitals and doctors' offices lags far behind almost every other sphere of society. The vast majority of written work, such as patient charts and prescriptions, is still done using pen and paper. This leads to mistakes, higher costs, reduced quality of care, and in the most tragic cases, death.

There is no question in my mind that the Federal government has a significant role to play in expanding investment in health IT. The legislation that I am introducing today defines that role. First, this bill would establish Federal leadership in defining a National Health Information Infrastructure (NHII) and adopting health IT standards. While I am pleased that the administration has already appointed a National Coordinator for Health Information Technology, I believe that the authority given to the Coordinator and the resources at his disposal are not equal to the enormity of his task. That is why my legislation creates an office in the White House, the Office of Health Information Technology, to oversee all of the Federal Government's activities in the area of health IT, and to create and implement a national strategy to expand the adoption of IT in health care.

This office would also be responsible for leading a collaborative effort between the public and private sectors to develop technical standards for health IT. These standards will ensure that health care information can be shared between providers, so that a family moving from Connecticut to California will not have to leave their medical history behind. At the same time, this bill would ensure that the adopted standards protect the privacy of patient records. While the creation of portable electronic health records is an important goal, privacy and confidentiality must not be sacrificed.

This legislation would also provide financial assistance to individual health care providers to stimulate investment in IT, and to communities to help them set up interoperable IT infrastructures at the local level, often referred to as Local Health Information Infrastructures--LHIIs. IT requires a huge capital investment. Many providers, especially small doctors offices, and safety-net and rural hospitals and health centers, simply cannot afford to make the type of investment that is needed.

Finally, this legislation would provide for the development of a standard set of health care quality measures. The creation of these measures is critical to better understanding how our health care system is performing, and where we need to focus our efforts to improve the quality of care. IT has the potential to drastically improve our ability to capture these quality measures. All recipients of Federal funding under this bill would be required to regularly report on these measures, as well as the impact that IT is having on health care quality, efficiency, and cost savings.

The establishment of standard quality measures is also the first step in moving our nation towards a system where payment for health care is more appropriately aligned--a system in which health care providers are paid not simply for the volume of patients that they treat, but for the quality of care that they deliver. To this end, my legislation would require the Secretary of Health and Human Services to report to Congress on possible changes to Federal reimbursement and payment structures that would encourage the adoption of IT to improve health care quality and patient safety.

It is time for our country to make a concerted effort to bring the health care sector into the 21st century. We must invest in health IT systems, and we must begin to do so immediately. The number of uninsured, the skyrocketing cost of care, and the number of medical errors should all serve as a wake-up call. We have a tool at our disposal to address all of these problems, and there is no more time to waste. I urge my colleagues to support this legislation.

Mr. President, today I am pleased to announce the introduction of the Information Technology for Health Care Quality Act. Let me thank Senator Kennedy for joining me in introducing this bill. By encouraging health care providers to invest in information technology (IT), this legislation has the potential to bring skyrocketing health care costs under control and improve the overall quality of care in our nation.

We are facing a health care crisis in our country. The Census Bureau recently released a report showing that 45 million Americans were without health insurance in 2003--an increase of 1.4 million over 2002. In many respects, we have the greatest health system in the world, but far too many Americans are unable to take advantage of this system.

The number of uninsured continues to rise because the cost of health care continues to soar. Year after year, health care costs increase by double-digit percentages. The cost of employer-sponsored coverage increased by 11 percent this year, after a 14 percent increase in 2003. Employers are dropping health care coverage because they can no longer afford to foot the bill.

One of the ways to provide health care coverage to every American is to reign in health care costs. And expanding the use of IT in health care is the best tool we have to control costs. Studies have shown that as much as one-third of health care spending is for redundant or inappropriate care. Estimates suggest that up to 14 percent of laboratory tests and 11 percent of medication usage are unnecessary. Finally, and perhaps most disturbingly,

we know that it takes, on average, 17 years for evidence to be incorporated into clinical practice. Along these same lines, a recent study showed that patients receive the best evidence-based treatment only about half the time.

Significant cost-savings will undoubtedly be realized simply by moving away from a paper-based system, where patient charts and test results are easily lost or misplaced, to an electronic system where data is easily stored, transferred from location to location, and retrieved at any time. With health IT, physicians will have their patients' medical information, at their fingertips. A physician will no longer have to take another set of X-Rays because the first set was misplaced, or order a test that the patient had six months ago in another hospital because she is unaware that the test ever took place. The potential for cost-savings from simply eliminating redundancies and unnecessary tests, and reducing administrative and transaction costs, is substantial.

Of course, when we consider the improved quality of care and patient safety that will result from wider adoption of health IT, the impact on cost is even greater. For example, IT can provide decision support to ensure that physicians are aware of the most up-to-date, evidence- based best practices regarding a specific disease or condition, which will reduce expensive hospitalizations. Given all of these benefits, estimates suggest that Electronic Health Records (EHRs) alone could save more than $100 billion each year. The full benefits of IT could be multiple hundreds of billions annually. Such a significant reduction in health care costs would allow us to provide coverage to millions of uninsured Americans.

The benefits of IT go beyond economics. I am sure that all of my colleagues are familiar with the Institute of Medicine (IOM) estimate that up to 98,000 Americans die each year as a result of medical errors. A RAND Corporation study from last year showed that, on average, patients receive the recommended care for certain widespread chronic conditions only half of the time. That is an astonishing figure. To put it in a slightly different way, for many of the health conditions with which physicians should be most familiar, half of all patients are essentially being treated incorrectly.

Most experts in the field of patient safety and health care quality, including the IOM, agree that improving IT is one of the crucial steps towards safer and better health care. By providing physicians with access to patients' complete medical history, as well as electronic cues to help them make the correct treatment decisions, IT has the potential to significantly impact the care that Americans receive. It is impossible to put a value on the potential savings in human lives that would undoubtedly result from a nationwide investment in health care information technology.

It might seem counterintuitive that we can realize tremendous cost savings while, at the same time improving care for patients. But in fact, improving patient care is essential to reducing costs. IT is the key to unlocking the door--it has the potential to lead to improvements in care and efficiency that will save patients' lives, reduce costs, and reduce the number of uninsured.

Unfortunately, despite the impact that IT can have on cost, efficiency, patient safety, and health care quality, most health care providers have not yet begun to invest in new technologies. The use of IT in most hospitals and doctors' offices lags far behind almost every other sphere of society. The vast majority of written work, such as patient charts and prescriptions, is still done using pen and paper. This leads to mistakes, higher costs, reduced quality of care, and in the most tragic cases, death.

There is no question in my mind that the Federal government has a significant role to play in expanding investment in health IT. The legislation that I am introducing today defines that role. First, this bill would establish Federal leadership in defining a National Health Information Infrastructure (NHII) and adopting health IT standards. While I am pleased that the administration has already appointed a National Coordinator for Health Information Technology, I believe that the authority given to the Coordinator and the resources at his disposal are not equal to the enormity of his task. That is why my legislation creates an office in the White House, the Office of Health Information Technology, to oversee all of the Federal Government's activities in the area of health IT, and to create and implement a national strategy to expand the adoption of IT in health care.

This office would also be responsible for leading a collaborative effort between the public and private sectors to develop technical standards for health IT. These standards will ensure that health care information can be shared between providers, so that a family moving from Connecticut to California will not have to leave their medical history behind. At the same time, this bill would ensure that the adopted standards protect the privacy of patient records. While the creation of portable electronic health records is an important goal, privacy and confidentiality must not be sacrificed.

This legislation would also provide financial assistance to individual health care providers to stimulate investment in IT, and to communities to help them set up interoperable IT infrastructures at the local level, often referred to as Local Health Information Infrastructures--LHIIs. IT requires a huge capital investment. Many providers, especially small doctors offices, and safety-net and rural hospitals and health centers, simply cannot afford to make the type of investment that is needed.

Finally, this legislation would provide for the development of a standard set of health care quality measures. The creation of these measures is critical to better understanding how our health care system is performing, and where we need to focus our efforts to improve the quality of care. IT has the potential to drastically improve our ability to capture these quality measures. All recipients of Federal funding under this bill would be required to regularly report on these measures, as well as the impact that IT is having on health care quality, efficiency, and cost savings.

The establishment of standard quality measures is also the first step in moving our nation towards a system where payment for health care is more appropriately aligned--a system in which health care providers are paid not simply for the volume of patients that they treat, but for the quality of care that they deliver. To this end, my legislation would require the Secretary of Health and Human Services to report to Congress on possible changes to Federal reimbursement and payment structures that would encourage the adoption of IT to improve health care quality and patient safety.

It is time for our country to make a concerted effort to bring the health care sector into the 21st century. We must invest in health IT systems, and we must begin to do so immediately. The number of uninsured, the skyrocketing cost of care, and the number of medical errors should all serve as a wake-up call. We have a tool at our disposal to address all of these problems, and there is no more time to waste. I urge my colleagues to support this legislation.

Mr. President, I am pleased to rise today with Senators Snowe, Kennedy, Collins, Murray, Durbin, Lautenberg, Clinton and Johnson to introduce legislation which would supply greatly needed support to

college students struggling to balance their roles as parents with their roles as students. The Child Care Access Means Parents in School Act, CCAMPIS, would increase access to, support for, and retention of low-income, nontraditional students who are struggling to complete college degrees while caring for their children.

The typical college student is no longer an 18 year old recent high school graduate. According to a 2002 study by the National Center for Education Statistics, only 27 percent of undergraduates meet the ``traditional'' undergraduate criteria of earning a high school diploma, enrolling full-time, depending on parents for financial support and not working or working part-time. This means that 73 percent of today's students are considered nontraditional in some way. Clearly, nontraditional students--older students with children and various job and life experiences--are filling the ranks of college classes. Why? Because they recognize the importance of college to future success. It is currently estimated that a full-time worker with a bachelor's degree earns about 60 percent more than a full-time worker with only a high school diploma. This amounts to a lifetime gap in earnings of more than $1 million.

Today's nontraditional students face barriers unheard of by traditional college students of earlier years. Many are parents and must provide for their children while in school. Access to affordable, quality and convenient child care is a necessity for these students. But obtaining the child care that they need is often difficult because of their limited income and nontraditional schedules, compounded by declining assistance for child care through other supports. Campus based child care can fill the gap. It is conveniently located, available during the right hours, and of high quality and lower cost. Unfortunately, it is unavailable at many campuses. Even when programs do exist, they are often available to only a fraction of the eligible students. That is where the Dodd-Snowe CCAMPIS Act comes in.

The Dodd-Snowe CCAMPIS Act increases and expands the availability of campus based child care in three ways. First, it raises the minimum grant amount from $10,000 to $30,000. For most institutions of higher education, $10,000 has proven too small relative to the effort to complete a Federal application. Grant offices on campuses often pass small grants over in favor of those that appear more cost effective.

Second, the Dodd-Snowe CCAMPIS Act ensures that a wider range of students are able to access services. Present language defines low- income students as students eligible to receive a Federal Pell Grant. This language excludes graduate students, international students, and students who may be low-income but make slightly more than is allowed to qualify for Pell grants. CCAMPIS will open eligibility for these additional populations.

Third, the CCAMPIS Act raises the program's current authorization level from $45 million to $75 million so that we not only expand existing programs, we create new ones.

Research demonstrates that campus based child care is of high quality and that it increases the educational success of both parents and students. Furthermore, recipients of campus based child care assistance who are on public assistance are more likely to never return to welfare and to obtain jobs paying good wages.

Currently, there are approximately 1,850 campus based child care programs but over 4,000 colleges and universities eligible to participate in the CCAMPIS program. Currently, CCAMPIS funds only 343 programs in 25 states and the District of Columbia. Meanwhile, the number of nontraditional students across America is increasing. As these numbers increase, the need for campus based child care will be increasingly unmet.

This is a modest measure that will make a major difference to students. It will offer them new hope for starting and staying in school. I am hopeful that it can be considered and enacted as part of the Higher Education Act. I look forward to working with my colleagues to move this important measure forward.

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

Mr. President, I rise to introduce, along with Senators Edwards, Levin and Kennedy, the Youth Service Scholarship Act. This Act would authorize the Secretary of Education to award college scholarships of up to $5,000 a year to high school students and undergraduates who perform community service.

A recent study titled Community Service and Service Learning in U.S. Public Schools reveals that 66 percent of public schools involve students in community service. This means that approximately 54,000 public schools in America currently engage about 13.7 million students in community service each year. Other studies have shown that nearly 84 percent of high school students participate in volunteer activities either in or out of school, and two-thirds of college students have recently participated in volunteer activities.

The Youth Service Scholarship Act is dedicated to assist low-income students who dedicate a significant portion of their time to volunteer service with money for college. This Act would authorize the Secretary of Education to award college scholarships of up to $5,000 to high school students who perform over 600 hours of community service in two years. In order to be considered, high school applicants must maintain a 2.0 grade point average, submit character recommendations, and write an essay on the nature of their community service. Additional money is available if the student continues to participate in a significant amount of community service once they are in college.

Volunteerism not only brings support and services to communities in need, it provides significant benefits to the students who participate. Research has shown that students who volunteer are 50 percent less likely to use drugs and alcohol, or engage in destructive behavior. Additionally, students who volunteer are more likely to receive good grades, be philanthropic, graduate, and be interested in going to college.

In the 21st Century, higher education is not a luxury, it is a necessity. For many of our low-income youth, finding money to pay for college is an obstacle to enrollment. This scholarship program provides aid to motivated and inspirational youth.

I urge my colleagues to join me in supporting the Youth Service Scholarship Act. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I rise today to introduce the Children and Family HIV/AIDS Research and Care Act of 2004. This bipartisan legislation will address the special needs of children and youth with HIV/AIDS--needs that are too often overlooked, both domestically and internationally. This legislation recognizes the simple fact that when it comes to HIV prevention, research, care, and treatment, children and youth are not just small adults. To give them a chance for a healthy future, we must ensure that their unique needs are met.

I want to begin by thanking my good friend Senator Bond of Missouri for joining me in introducing this important legislation. Senator Bond has provided crucial support for children and for children's health. Over the years, he has been a leader in the fight to protect children from birth defects and developmental disabilities. He has also done a great deal to ensure that our nation's children's hospitals and community health centers have the resources they need to continue to provide essential care to children and families. I am very pleased to work with him to move this legislation forward.

Children's growing bodies are especially susceptible to the rapid advancement of HIV infection. Because their immune systems are still immature, the disease typically progresses more rapidly and differently in children than in adults. For example, children with HIV infection are more prone to neurological abnormalities and certain opportunistic infections than adults. In addition, because children's bodies are growing and developing, HIV/AIDS can have profound effects on children's physical growth and ability to reach developmental milestones such as crawling, walking and learning to talk.

While research has definitively shown that initiating drug treatment in children in a timely manner promotes normal growth and development, and prolongs life, treating children with HIV/AIDS presents particular challenges. Appropriately formulated and dosed HIV/AIDS drugs are urgently needed to ensure that children receive optimal care. Currently, liquid formulations that young children can swallow are not always readily available. In addition, pediatric dosing and safety information for these powerful drugs is often lacking, particularly for younger children. This lack of information puts children at risk; too much medication can be toxic and too little will not effectively suppress the virus. Over time, under-dosing can lead to drug resistance, a particularly serious concern for children who will need to use these medications for years, if not decades.

Appropriate HIV/AIDS care and treatment for children and youth also requires that special attention be paid to their social development needs. Children and youth have unique concerns regarding disclosure and stigma that may be exacerbated by frequent absences from school and social activities, and the onset of sexual maturity. Working with schools and other social and community institutions is imperative to promoting a sense of normalcy. Because children are not typically medical decision-makers, developing long-term care partnerships with parents and other caregivers is also crucial to successful care and treatment. At the same time, maximizing each child's own ability to take active participation in different aspects of his or her own care can increase a child's sense of ownership over treatment, improving adherence and overall health.

By reauthorizing and expanding Title IV of the Ryan White CARE Act this legislation will help to ensure that the unique care and treatment needs of children are addressed. This program is a lifeline for more than 53,000 women, children, and youth affected by HIV/AIDS served annually by Title IV-funded projects. Through 91 grants in 35 states, the District of Columbia, Puerto Rico and the Virgin Islands, Title IV projects provide medical care, case management, support services, mental health, transportation, child care, and other crucial services to families affected by HIV/AIDS. Title IV is the smallest of the four main titles of the Ryan White CARE Act, yet reaches the highest proportion of minorities.

Key to the success of Title IV projects is the model of ``family- centered care.'' This model of care treats the whole family as the client, whether several family members are infected by HIV, or just a parent or child. The family-centered care model is crucial to developing strong partnerships between consumers and providers, leading to better health outcomes for women,

children, and youth. By allowing affected family members to receive services, as well as the infected individuals, Title IV projects promote health at the family level, thereby prolonging life, improving quality of life, and saving money by keeping people out of the hospital.

I would like to take a moment to recognize the work done by the Children, Youth and Family AIDS Network of Connecticut, which provides Title IV services to more than 500 children, youth, women, and families affected by HIV/AIDS in my home state. I have heard from many of these individuals about just how important these services are to their quality of life.

While recommitting the Health Resources and Services Administration (HRSA) to family-centered care and the unique work of Title IV, this legislation will also expand the innovative strategies Title IV projects have used to prevent mother-to-child HIV transmission. Since 1994, when the administration of preventive drug interventions was shown to significantly reduce perinatal HIV transmission, the number of newborns infected with HIV has decreased dramatically. Yet mother-to- children transmission does continue to occur, largely due to missed opportunities for identifying HIV-positive pregnant women and providing the supportive services needed to ensure adherence to recommended treatment regimens. We propose to fund demonstration grants to assess the effectiveness of two strategies in reducing mother-to-children transmission: (1) Increasing routine, voluntary HIV testing of pregnant women and (2) increasing access to prenatal care, intensive case management, and supportive services for HIV-positive pregnant women.

In addition, this bill will encourage research into key care and treatment questions affecting the pediatric populations. These include: the long-term health effects of preventive drug regimens on HIV-exposed children; the long-term health, psycho-social, and prevention needs for children and adolescents perinatally HIV-infected; the transition to adulthood for HIV-infected children; and safer and more effective treatment options for infants, children, and adolescents with HIV disease.

Since history suggests that a vaccine may prove to be the most effective, affordable, long-term approach to stopping the spread of HIV, this legislation will also ensure that children are not an afterthought when it comes to the development of an HIV vaccine. Currently, some of the populations hardest hit by the pandemic--infants and youth--are at risk of being left behind in the search for an effective vaccine. Because we cannot assume that a vaccine tested in adults will also be safe and effective when used in pediatric populations, it will be important to ensure that promising vaccines are tested in infants and youth as early as is medically and ethically appropriate. Failure to begin planning for the inclusion of these groups in clinical trials could mean significant delays in the availability of a pediatric HIV vaccine, at the cost of countless thousands of lives. This legislation will ensure that we begin now to address the logistical, regulatory, medical, and ethical issues presented by pediatric testing of HIV vaccines so that children can share in the benefits of any advances in vaccines research.

I want to thank several organizations for lending their expertise to the development of this legislation, in particular the Elizabeth Glaser Pediatric AIDS Foundation, the AIDS Alliance for Children, Youth and Families, and the American Academy of Pediatrics, all of whom support this bill. I would also like to note that the AMS Vaccine Advocacy Coalition is endorsing this legislation. I would ask unanimous consent that three letters of endorsement be printed in the Record.

HIV/AIDS is the single greatest health care catastrophe facing the world today. We need to do much more to seek effective treatments and, eventually, a cure for this horrible illness. This legislation is by no means sufficient to reach that goal, but it is a step towards ensuring that children are not left behind as we make progress, and then when we do finally eradicate HIV/AIDS once and for all, children and youth are able to benefit immediately. I urge all of my colleagues to join us in support of this legislation.