Floor Statements

I thank the distinguished Senator.

Mr. President, I join my colleagues in commending the distinguished Prime Minister for his eloquent remarks in which I think he captured the essence of what all of us would like to see in the coming weeks and months and years; that is, a joint coalition of peaceful, liberty- loving nations to address the scourge of terrorism. I think he properly described what needs to be done by leaders of this Nation and others around the globe if we are going to succeed in that effort.

It was also wonderful to hear the English language spoken with such eloquence. It was refreshing not to see a teleprompter, I might add, and to hear a political leader with a sense of humor, a sense of commitment and passion, and a deep sense of understanding of the values that our two nations have shared--and, as he properly described, not Western values but human values of freedom-loving peoples everywhere.

I join my colleague from Alaska, and others, in thanking the Prime Minister for his eloquence, for his commitment, for his friendship, and for his loyalty. I look forward to a continuing relationship with this remarkable leader.

Mr. President, I wish to congratulate Goodspeed Musicals of East Haddam, CT, which is celebrating its 40th anniversary on July 16, 2003.

Goodspeed has come a long way in 40 years. It was originally formed in 1959 to save the historic Goodspeed Opera House from destruction. Not only did Goodspeed Musicals succeed in that effort, it restored the 19th century landmark to its former glory, and reopened it in 1963 as a professional theatre.

In the four decades since, Goodspeed Musicals has played a vital role in perpetuating and promoting the art of musical theatre--not only in the State of Connecticut but nationally and even internationally. From its modest beginnings, Goodspeed has gone on to produce over 186 musicals, including 43 world premiere productions and 16 that went on to Broadway.

In addition to performances at the Goodspeed Opera House, Goodspeed Musicals now also stages shows in the Norma Terris Theatre in Chester. Its growth is a testament to the hard work of so many Goodspeed employees, volunteers, members, and supporters, and to the enjoyment and wonder that musical theatre can instill in so many people.

Over the years, Goodspeed has showcased classics by composers such as Gilbert and Sullivan and Cole Porter. But it has also been a palace where emerging artists have been able to develop their work and present it to audiences for the first time. It has produced more than 63 new shows--the largest number of new musicals for any theatre in America.

Productions such as Annie, Man of La Mancha, and Shenandoah had their world premieres at Goodspeed. And countless actors, musicians, choreographers, directors, and other members of the theatre community have had their careers advanced and enriched by working at Goodspeed.

Goodspeed productions that have made it to Broadway have earned over a dozen Tony awards. And for its contributions to American musical theatre, Goodspeed Musicals has earned two Tony awards of its own.

In addition to producing musical theatre, Goodspeed Musicals has also devoted itself to promoting understanding the art form. At Goodspeed's Max Showalter Center for Musical Theatre Education, students--both professional and amateur--gain a greater appreciation of all aspects of musical theatre and also participate in training and development programs that help them put their knowledge into practice.

Goodspeed has become an integral part of a rich and vibrant arts culture in the State of Connecticut. Along with the Shubert and Long Wharf Theatres in New Haven, the Bushnell and the Hartford State in our State's capital, and numerous other theatres, production companies, and musical groups, Goodspeed provides an environment where musical theatre and the performing arts can, and will, continue to thrive and flourish.

On a personal note, as a resident of East Haddam and a member of Goodspeed's Board of Directors, I have enjoyed many a magical evening at the Goodspeed Opera House. And it is my fervent hope that Goodspeed Musicals will continue to inspire and entertain for many years to come.

I offer my warmest congratulations to Michael Price, the remarkably talented Executive Director of Goodspeed Musicals, and to everyone who has been a part of Goodspeed over the past 40 years. I wish them and Goodspeed Musicals nothing but continued success in the future.

Mr. President, I rise to pay tribute to a distinguished public servant and friend, M. Adela Eads, who passed away on July 8 at the age of 83.

For years, Dell Eads was an indispensable member of the Connecticut General Assembly. She served for 4 years in the State House of Representatives, and then for 20 years in the Senate, including 2 years as President Pro Tempore--the first woman ever to be elected to that office for a full term.

If a casual observer walked onto the Senate floor in Hartford while Dell Eads was there, he might have been surprised to learn that the diminutive lady in the smart-looking suit and high heels was one of the chamber's most influential members. But for those 20 years, Dell Eads was indeed an imposing figure in Connecticut. She served her constituents, and her State, with commitment, distinction, and honor.

Dell Eads' life was devoted to working for the public good. Nowhere was that more evident than in her commitment to Connecticut's children. Before becoming a legislator, she chaired the Kent Board of Education for 26 years. She later served on the Connecticut Board of Education as well.

Many of her landmark legislative achievements were also devoted to helping children. Dell Eads was a chief architect of legislation which created our State's Office of the Child Advocate. Today, thanks to her efforts,

there's an office in Connecticut's government where people fight for children who aren't able to fight for themselves.

She also was integral in the passage of the Education Enhancement Act, which raised the pay of Connecticut's public school teachers. Dell Eads recognized that if we want our best and brightest to commit themselves to teaching our children, we need to commit ourselves to paying them fairly.

Dell Eads always seemed to find the right balance of toughness and tact. In the political arena, where it's often hard to figure our exactly what people are saying, Dell Eads wasn't one to mince words. If she had something on her mind, you were going to hear it. But when she spoke, she did so with the courtesy, class, and congeniality that earned her the admiration and friendship of her colleagues.

Though a Republican, she was respected by both Democrats and Republicans alike. She was loyal to her party--yet Dell Eads would never hesitate to reach across the aisle if there was work to be done.

No one could question Dell Eads' commitment to the people of Connecticut. After all, this was a woman who, at the age of 76, slipped and broke her collarbone--and reported to work at the State Capitol the very next day. And she continued to serve in the State Senate until she retired three years ago at the age of 80.

Dell Eads was slight in stature, but she was great in spirit. Her service was an inspiration not only to her colleagues in the Connecticut General Assembly, but to all the people of Connecticut. Our state has truly lost a great citizen, and a remarkable person.

I offer my most heartfelt sympathies to Dell Eads' two sons, Manuel and Gregory Eads, to her brother Manuel Diaz, to her five grandsons, and her entire family.

Mr. President, I send an amendment to the desk.

Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. President, this amendment reflects the language and my discussion with the chairman of the committee which adds the word ``substantial'' to the first paragraph of the first (i) clause--the substantial loss of U.S. jobs. And the rest of the amendment will read as it is presently printed.

Let me, first of all, thank the distinguished chairman and ranking member for allowing me to offer this amendment and for accepting it. This language conforms to existing law with the Overseas Private Investment Corporation, the Export-Import Bank, and other foreign aid programs and takes into consideration job loss on environmental issues.

I think it fits into the Millennium Account category. I am a strong supporter of the Millennium Account. I thank the chairman and others who have been involved. I think it will be a wonderful opportunity for us to provide education and needed assistance to others around the world.

This amendment would add a proviso to Division C of the bill-- Millennium Challenge Assistance--to ensure that Millennium Challenge monies authorized in this legislation do no inadvertently fund projects that result in the loss of American jobs, or the transfer of U.S. production facilities abroad, or pose a threat to public health or the environment.

Why is this amendment necessary? Aren't U.S. foreign assistance laws already on the books that prevent U.S. foreign aid monies from being used in ways that can hurt American families or damage the environment? The answer is yes such laws exist but the bill before us today would exempt the Millennium Challenge Corporation set up in Division C of this bill from this and other restrictions currently in law.

The Millennium Challenge Account has been provided with substantial resources in this bill--more than $8 billion over three years with virtually no legislative strings attached.

Clearly there was a rationale for giving the corporation flexibility to try a new approach to helping countries help themselves climb the development ladder. I am certainly willing to give this ``experiment'' a chance to see if it produces better results than our normal foreign assistance programs.

Having said that, none of us in this body would support the use of American taxpayer dollars being used to displace American jobs or U.S. production or to pose an environmental or health hazard.

There is also ample legislative history to suggest that restrictions of this kind are not unduly burdensome.

USAID programs are already subject to somewhat similar restrictions as are U.S. Export/Import Bank and OPIC programs. None of these organizations have alleged that these restrictions impair their ability to carry out their activities.

Opponents of this amendment suggest that this provision is unnecessarily restrictive and difficult to implement. I find that rather hard to accept. We clearly know that there are a number of sectors in this country that are particularly sensitive to foreign competition--steel, textiles to name a few. Over the last three years more than 2.3 million American manufacturing jobs have been lost. We must not unknowingly make matters worse by providing ill conceived subsidies to foreign competitors.

My colleagues I am sure know that there is a U.S. government entity-- the International Trade Commission--which is charged with monitoring the impact that foreign production is having on U.S. industries and jobs in this country.

Clearly there are enormous U.S. resources and information that will be readily available to the corporation to ensure that U.S. taxpayer dollars aren't being used to, in effective, subsidize the export of American jobs and production. So I don't accept the argument that this amendment is too difficult or draconian for the corporation to implement.

Is this amendment more difficult to implement than a provision already in this bill which requires the corporation to make the judgement that a particular government is ``committed to just and democratic governance'' in order for it to be eligible for assistance from the Millennium Challenge Account? I don't believe it is.

There is no reason to believe that the corporation should find this restriction any more burdensome.

Frankly, I would think that the Administration would welcome this amendment because it will sensitize officials of the corporation that they must always be mindful that nothing that the corporation undertakes or supports should be injurious to American workers--the folks footing the bill for this experimental approach to helping poor countries lift themselves out of poverty.

Some may argue that this provision is unnecessary, that the members of the corporation will be too smart to ever do anything to hurt U.S. workers or production.

I would say to my colleagues that the conditions that currently exist in law with respect to this matter came about because U.S. agencies frankly weren't paying attention to the domestic effects because that wasn't in their ``job descriptions''.

Moreover, the surest way for support to be eroded for the MCA is for it to become known that in its zeal to help MCA eligible countries, it has ignored the negative implications that ill conceived projects could have on American workers and production facilities. With this statutory red flag, it is less likely that such mistakes will be made.

I urge my colleagues to support this amendment.

Let me lastly say, aside from this particular amendment, how deeply proud I am of the chairman and the ranking member. When I was a member of committee, I think I had a full head of black hair the last time we had a State Department authorization bill on the floor of the Senate.

This is not an accident. The last time we were on the floor and it was brought up, the Senator from Indiana was chairing the committee. I am proud to be a member of this committee and proud to be affiliated and associated with the two distinguished Senators, the chairman and the ranking member. They do a fabulous job on this committee.

I hope we get this bill finished. This is important, not only for what it includes but also the statement it makes about how important we consider the role of the State Department, the aid programs which we administer, and the assistance provided to people all over the globe.

My compliments to the chairman and the ranking member for a job tremendously well done.

Mr. President, I think we have to ask unanimous consent that the Dodd amendment be accepted.

I thank the chairman.

Amendment No. 1190 To Amendment No. 1136

Mr. President, I rise to pay tribute to my colleague and dear friend, Senator Strom Thurmond, who passed away last night at the age of 100.

A few months ago, as he was about to retire from the United States Senate, I said on this floor that I could not even begin to imagine the Senate without Senator Thurmond. And since he left this Chamber, I can't tell you how many times, during a vote, when the clerk would reach the lower half of the alphabet, I've looked up from wherever I was on the floor--expecting to see the man who was, for so long, South Carolina's senior Senator.

He was truly an institution within this Chamber--a ranking Member, a committee chairman, a President pro tempore, and the first ever President pro tempore emeritus. He cast over 15,000 votes. His service spanned the terms of 10 U.S. Presidents. And he was directly involved in the confirmation hearings of all nine current Supreme Court Justices.

Strom Thurmond's life was one devoted to public service. He was a teacher, a school superintendent, a State Senator, a judge, a war hero, Governor, and, of course, a Senator for nearly 50 years.

At each step in his life, Strom Thurmond was searching for ways to serve his country. As a circuit judge in South Carolina, he took a leave of absence to volunteer to parachute behind enemy lines during the D-Day invasion at Normandy. For his valor in World War II, he received the Purple Heart, five Battle Stars for Bravery and numerous other decorations. And shortly after the war ended, he was elected Governor of South Carolina, an office he held for 4 years.

But there is no doubt that when his constituents remember Strom Thurmond, their thoughts will immediately turn to his years as their Senator. He served them in this body for over one-fifth of our Nation's history. For many South Carolinians, when he retired earlier this year, he was the only senior Senator they had ever known.

Strom Thurmond did not merely serve in the Senate; he did so, even during his final years, with unparalleled vigor. His commitment to the people of South Carolina was legendary--whether it was helping an elderly constituent get a Social Security check, or ensuring that the widow of a law enforcement officer could keep her husband's badge, Strom Thurmond never forgot the people who sent him to Washington.

And the dozens of schools, buildings, parks, and streets in South Carolina that bear his name today show that they never forgot him either.

I served with Strom Thurmond for 22 years in the Senate, and my father served with him for 12--that's 34 years in which a Dodd served in this body with Senator Thurmond. Both of us certainly had our share of disagreements with him. But those disagreements always came in the spirit of respect, thoughtfulness, and collegiality that are hallmarks of the Senate. And Strom Thurmond truly embodied those qualities.

To the Dodd family, though, Strom Thurmond was more than just a colleague--he was a true and loyal friend. We will never forget the loyalty and friendship he showed us even during some trying and difficult times.

It is impossible to look back at the years of Strom Thurmond's life without being amazed. He lived through the invention of the Model T Ford and the creation of the Internet. As a child, he read newspaper accounts of battles that were fought with bayonets in the trenches of Europe. And in his later years, he watched satellite television reports of conflicts won with smart bombs and laser technology. He experienced the Great Depression of the 1930s and the technology bubble of the 1990s.

And as America matured and changed during his lifetime, Strom Thurmond grew, as well.

Senator Thurmond didn't just live through a century of history. He was intimately involved in it. In each step that America took, Strom Thurmond was there. In that respect, and in so many others, Strom Thurmond was a truly unique and rare individual.

I offer my condolences to the entire family of Strom Thurmond. We will miss him very much.

Mr. President, I rise today to speak in support of S. 1, the Prescription Drug and Medicare Improvement Act of 2003. However, I do so with great trepidation. While I intend to vote for the bill that is presently before the Senate, I believe that drastic changes are still necessary to make the benefit created by this legislation one that meets the needs of our senior citizens.

I am also deeply concerned that Members on the other side of the aisle--as well as those in the House of Representatives, and the administration--will attempt to move this bill in a destructive direction during conference. Let me reiterate what I said in an earlier statement on this issue: we must not approve any Medicare reform measure that would force seniors to join private plans in order to receive a more generous prescription drug benefit. Such a measure would signal an end to the Medicare Program as we know it and should be rejected out of hand. I urge my colleagues to protect the Medicare that our seniors have come to rely on, and I urge the President not to sign any bill that privatizes Medicare. If such changes are made, I will not hesitate to oppose the conference report.

Given these concerns, it is reasonable to ask why I am supporting this bill. The answer is quite simple--seniors in my home State of Connecticut and across the country have been waiting far too long for a prescription drug benefit under Medicare. And it is time that we in Congress heard them.

Over the past month I had the opportunity to convene a series of forums on senior health care in Connecticut in an attempt to frame the scope of this debate. At these forums I heard from my constituents on many matters regarding their health care. But the present lack of coverage for prescription drugs under the Medicare program was by far the issue raised most often.

At these forums I heard from seniors who literally could not afford to fill prescriptions called for by their doctors. I heard from elderly Medicare beneficiaries forced to choose between purchasing groceries or filling their prescriptions. I heard from seniors who were forced to skip dosages of their medicines in an attempt to stretch their limited supplies of needed medicines. I heard from Medicare beneficiaries requiring more than 10 prescribed medicines a day unable to afford even half of these prescriptions. Clearly, what I heard from hundreds of Connecticut's more than 500,000 Medicare beneficiaries is their grave concern over the present lack of a prescription drug benefit under the Medicare Program.

I believe that the legislation about to be approved by this body offers an answer to those concerns. It is not the most complete answer, but it is a start--based on which we can improve in the future. It is a start because it will make so many seniors better off than they are today. And that should be our ultimate goal as legislators--to make people's lives better. Often this must be done incrementally, in steps. This bill is a positive first step.

What do I mean when I say that it will make people better off? In Connecticut, one-third of all Medicare beneficiaries have incomes below 160 percent of poverty. For many of these seniors, drug costs can be crippling. They are forced to choose between putting food on the table, and buying the medicines that they need to live healthy lives. With the passage of this bill, these seniors will no longer have to make this choice. The new Medicare prescription drug benefit will cover most, if not all, of their drug costs. I congratulate Senator Grassley and Senator Baucus, and other members of the Senate Finance Committee for including in this bill such a generous benefit for those low-income seniors.

This legislation is not as clear cut for those seniors who have incomes above 160 percent of poverty. However, I believe that the majority will be helped by passage of this bill. The break even for this benefit--the point where an individual is better off with the benefit rather than just paying for all prescription drugs our of their own pocket--is about $1,100 in total annual drug costs. The average Medicare beneficiary spends approximately $2,300 on prescription medicines today. That number will undoubtedly be higher when this new benefit goes into effect in 2006. With the benefit created by this bill, that average beneficiary will realize nearly $600 in savings. The savings will be even greater for the 11 percent of beneficiaries who spend more than $5,000 per year on prescription drugs. These are the seniors facing the most sever health problems, and most in need of financial assistance. That is what this bill provides--even if it is not to the extent that many of us would have liked.

I am voting for this bill because so many seniors in Connecticut and throughout the country stand to benefit. However, no bill is perfect and S. 1 clearly still leaves much room for improvement even as it moves toward final Senate passage. I am particularly disheartened that, despite numerous attempts over the past 2 weeks, we have failed to address concerns over the present bill's lack of adequate provisions to ensure that those companies presently providing their retirees with prescription drug coverage receive adequate Federal support for their laudable efforts. While the creation of a prescription drug benefit under the Medicare program is laudable, it should not come at the price of displacing the employer-based benefits that so many seniors have come to rely on.

Additionally, I remain concerned that the gap in coverage in the present bill, the so-called donut hole, will leave many Medicare beneficiaries facing high prescription drug costs with no assistance at the very time when it is most needed. Over the past 2 weeks, I have both offered and supported amendments designed to provide assistance to those with prescription drug costs within the hole, especially those with lower incomes who can least afford any gap in coverage, that have failed to win support by the Senate. Failure to close this gap, in my view, constitutes a glaring failure, one that I hope can be reversed as this bill moves into conference.

I also am concerned that S. 1 fails to adequately protect Medicare beneficiaries form the very understandable confusion and uncertainty that may surround them just as they begin to navigate the intricacies of a brand-new program. Specifically, if enacted the underlying bill will require Medicare beneficiaries choosing a prescription drug plan to stay with that plan for a minimum of 1 year. With the enactment of such broad and weeping changes to the Medicare program, I am fearful that many Medicare beneficiaries will face great uncertainty trying to find the best plan to meet their particular needs. For this reason, I offered an amendment to S. 1 that would have simply granted Medicare beneficiaries navigating this new benefit for the very first time the ability to switch plans as they seek to determine which plan fits their particular health care needs in the first 2 years of the bill's benefit. Unfortunately, this amendment was not agreed to and I remain concerned that without its protections, senior Medicare beneficiaries will be unfairly locked into plans that do not meet their needs.

Mr. President, I am pleased that S. 1 represents a significant departure from

previous plans supported by the administration that would have required Medicare beneficiaries to leave the traditional fee-for-service Medicare Program in order to receive coverage for their prescribed medicines. Such a move would be unconscionable as 89 percent of all Medicare beneficiaries today are in the traditional program. To force these beneficiaries to leave their present system of coverage, and most likely the doctor that they have come to know and trust, would not only create great disruption, it would also for the first time since the program's inception create a tiered benefit system under Medicare that would more greatly reward those who choose to join a private preferred provider organization, PPO, or health maintenance organization, HMO.

And while I am pleased that the bill before us soundly rejects a tiered benefit system, I am deeply concerned that the plan presently taking shape in the House of Representatives appears to rely on such a flawed plan. As I said earlier, such a measure should be soundly rejected.

So it is with great caution that we come to the final moments of debate on this important issue. Medicare's nearly 41 million beneficiaries clearly need assistance in affording their needed medicines. The result of our efforts over the past 2 weeks, and more important, the result of the coming conference committee on this legislation will greatly determine to what extent we assist our Nation's Medicare beneficiaries to afford their needed medicines.

Clearly, a great opportunity is presently before us. As the underlying bill moves to conference committee. I look forward to working with my colleagues to ensure that we seize this opportunity by strengthening the underlying bill. With passage of the bill presently before us, we now face a choice. We can insist on the good start that we have made here with passage of S. 1, and work to strengthen its provisions. Or, conversely, we can accede to the House legislation that in my view unfairly jeopardizes the traditional Medicare Program by tilting the system in favor of risky privatization schemes and against seniors.

I ask my colleagues to join with me in working to ensure that any Medicare prescription drug legislation passed by this Congress is at least as strong as the bill we are about to vote on. A tilt toward the House-drafted language would signify not a strengthening of Medicare, but rather a weakening of this vital program's foundation and must be avoided at all costs.

Nearly 38 years ago on July 9, 1965, this body passed the legislation creating the Federal Medicare Program sending it to a conference committee with the House. On that day, President Lyndon Baines Johnson remarked, ``This is a great day for older Americans. And it is a great day for America. For we have proved, once again, that the vitality of our democracy can shape the oldest of our values to the needs and obligations of today.'' Nearly four decades later, we are on the cusp of a similar challenge. Let us move Medicare toward the future without threatening its proven ability to provide for the health and well being of this Nation's senior citizens.

Mr. President, I ask to be yielded 2 minutes of the 4 minutes on the Rockefeller amendment.

Mr. President, I thank my distinguished friend and colleague from West Virginia.

I hope the body will support this amendment. I have spoken about the bill generally and expressed my optimism about it despite the serious shortcomings I have. It is a major step in the right direction. We can enhance that by adopting what Senator Rockefeller is offering us today: The ability to ensure that employers will continue to offer prescription drug coverage for their retirees.

What we don't want to do, as we move forward with this program, is to supplant existing retiree programs. That would be a great setback for us. The bill, as presently crafted, does not count payments made by the retiree benefit plan that are out-of-pocket expenditures by the individual beneficiary. This will vastly increase the amount of money an employer will have to pay in order to act as an effective supplement to the Medicare drug benefit, a so-called wraparound to Medicare. In other words, this bill would actually discourage employers from playing even that reduced role in terms of prescription drugs.

The Rockefeller amendment will address this problem so that employer contributions are counted toward an individual's out-of-pocket costs. We will offer an amendment ourselves that would add even a bit more. But this is a major amendment and a critical one. It would be a great irony indeed, as we move forward with our plan, that we end up discouraging employers from participating, as they have, in providing their retirees with the kind of protections they need. It would actually cost them more. It is very important we adopt this amendment. This is a critically important question.

Even before we got into this whole business, the benefits being provided by employers, by nonprofits, and others have been important in terms of enhancing a retiree's ability to pay for prescription drugs and not have to make the choice of food on the table or prescription drugs or to self-medicate by reducing the amount of prescription drugs they get. No one in this place wants to be a party to actually encouraging employers to step away from the very important part they already play in providing these benefits for their employees and retirees.

I thank the Senator from West Virginia. It is a very important amendment. I strongly endorse it and hope it will be adopted.

Mr. President, do I need to ask unanimous consent the present amendment be temporarily set aside?

Mr. President, in the 5 minutes I have, let me discuss it very briefly with my colleagues.

This amendment would allow Medicare beneficiaries the freedom to move between plans for the first 2 years that this benefit is in effect, from 2006 to 2007. Under the present bill, you have to make a decision immediately and then you are locked into that decision for a year. Then you would have an open enrollment period for a month after that, and then you would be locked in for another year.

What we are offering with this amendment is initially seniors be given a 2-year window in order to decide which plan works best for them. Then you would go to the 1 year with the 1-month open enrollment. But, initially, given the tremendous amount of potential confusion about which of these various alternatives would work best for people, they ought to be given a bit more time than to have to make an almost instantaneous decision about which of these plans is best suited for them.

One of the hallmarks that has been used to describe this bill is it is to give people choice--flexibility and choice. All we are suggesting is an additional 2 years, if you will, not requiring an immediate decision but a 2-year window in order to make that choice so people are more well informed.

There are a number of areas in the underlying bill that do not go nearly far enough, in my view, to serve Medicare beneficiaries. But I believe this is a good first step, at least as presently proposed. I am inclined to be supportive of this bill. These are some small points I think could help make this a better bill.

If enacted, the underlying bill would require, as I mentioned, Medicare beneficiaries to choose a prescription drug plan and to stay with that plan for a minimum of 1 year. With the enactment of such broad and sweeping changes in the Medicare Program, I am fearful many Medicare beneficiaries will face great uncertainty trying to find the best plan to meet their particular needs. Beneficiaries would be faced with a menu of plans offering varying premiums, copayments or coinsurance, drug formularies, and all the other variables that make up a prescription drug benefit. It may not be immediately clear to people over the age of 65 which of these plans is going to best suit their needs. It is not difficult to imagine a scenario where this could become a significant problem, possibly even affecting the health and well-being of the beneficiary we are trying to assist with this legislation.

A senior on a tight budget might enroll in a plan in an area that offers slightly lower premiums and coinsurance. Perhaps that beneficiary is on blood pressure medication and, after enrolling in the plan, discovers the particular medication--which she has been taking for years and has proven to be effective for a condition, with minimal side effects--is not part of the formulary for the plan she chose immediately.

What I am suggesting is, What are her options? As the bill is currently written, she is stuck with that plan for at least a year. So she can try to navigate the hurdles and obstacles that would allow her to take an off-formulary drug, or switch to another drug that might not be as effective or cause severe side effects. These are not optimal choices.

One of our stated goals is to give seniors as much of a choice as possible, and I am firmly behind that goal, as I mentioned at the outset of these remarks.

I do not want to suggest for a second that we should reduce choice or create simplicity, nor do I question the importance of cost-control mechanisms such as formularies. However, with choice and differentiation comes uncertainty. I believe we can greatly relieve this uncertainty by allowing those initially choosing prescription drug plans for the very first time the opportunity to move from one plan to another to determine which of these plans offers the best plan to fit their needs, and to give them the opportunity of doing that for a 2- year period, and then go to the open enrollment period and a 1-year after that.

I asked people in my own State to take a look at this proposal. In fact, this language comes from them. Their suggestion is this language I have on this chart. I will read from it:

The amendment which you are proposing is essential to

ensure fair and informed access to the health plans which are

planned under the terms of S. 1.

By the way, these people are very much supportive of what Senator Grassley is doing in this bill. They say:

Our experience with Medicare beneficiaries in Connecticut

and nationally has shown that the ability of a Medicare

beneficiary to change from plan to plan, especially during

the period after initially choosing a plan, is of utmost

importance. Making choices about which health plan is best is

often confusing for a Medicare beneficiary, especially for

those who are elderly, frail or having medical problems.

Comparing plans and choosing the right plan can be a

complicated process, and Medicare beneficiaries who discover

they have not made the most informed choice, whose experience

with a plan demonstrates it is not adequate to meet their

needs, or who have changes in their life circumstances, need

to have some ability to change from one plan to another. Only

with this ability to change can they be assured the

opportunity to receive the kind of health care they want, and

the fullest health benefit they need, to meet their

individual circumstances under the Medicare program.

Mr. President, I ask unanimous consent for 30 additional seconds.

All we are asking is, instead of forcing people to make that initial decision, they be given that 2-year window to sort this out. And then you move into the 1 year and the window opens, and so forth. I do not think this has any significant financial implications. It is just allowing people to make intelligent, good choices which all of us want to provide people, particularly older Americans who could be terribly confused by choosing formularies and coinsurance and copayment plans. All that has to be done at the outset once this bill becomes law.

I have used a little more time than I said I would to try to explain the amendment, but I want it to be clear to my colleagues why I think this is a

very reasonable suggestion to make an improvement to this bill.

I thank the Presiding Officer for his indulgence.

Mr. President, I ask unanimous consent that my colleague, Senator Lieberman, be added as a cosponsor of this amendment.

Mr. President, if they don't want to talk, I will be glad to take a little more time to explain this amendment.

Mr. President, I thank the man from Iowa for yielding the 1 minute.

The man from Connecticut appreciates the man from Iowa giving him 1 more minute.

Mr. President, very briefly, the existing underlying bill says you have to make this choice about which plan you want to go into almost immediately once this proposal becomes law. We are suggesting that at the outset you give people a 2-year window to shop wisely. They may make the decision right away. They may make it within a month or two. But knowing how confusing this can be, knowing that different formularies provide for different medications, we ought to provide people at least some opportunity to get this right to the extent they can. So this is merely opening up that window from an immediate choice to a 2-year choice--anytime within that 2 years to make that right choice.

There have been some who wondered, if you move from one plan to the next, what are the cost implications? I will be glad to respond to that. We do not think that is terribly complicated to figure out. If you have reached your deductible levels, obviously, the same would have to apply. You would not start all over in that 1-year period. So whatever costs you have incurred, whatever expenditures you have made or not made would move from one plan to the next, at least as far as the cost goes.

So the additional time should not have any additional financial or fiscal implications but merely the choice of saying to people, who are older Americans: You get a little more time to sort this out. That is all I am suggesting with this amendment.

I would hope the committee might support it. It is not a radical proposal.

I thank the Senator.

I ask unanimous consent for an additional 30 seconds.

Mr. President, this is one time. Unlike Federal employees, who are 30 or 35 years of age, this plan is all new. What we are saying is, for the very first 2 years--that is all, just the first 2 years-- give seniors the flexibility so they do not have to sign up for a plan immediately. You get a couple years within that timeframe to make your choice, then you go into the 1-year cycle as all the rest of us do. But for older Americans, it is very confusing--very confusing--for them to have to make that choice at the get-go, right at the very beginning. So that 2-year window, to have some flexibility to make a choice that best serves your interest, I think is a reasonable request to make for our older Americans. That is the end of it.

Madam President, I ask unanimous consent that the pending amendment be temporarily laid aside.

Madam President, I call up amendment No. 998.

Madam President, I ask unanimous consent that further reading of the amendment be dispensed with.

Madam President, this first amendment is intended to address one of the major problems with this bill, and that is the impact the legislation could have on Medicare beneficiaries who are currently receiving prescription drug coverage under the employer- sponsored retiree benefit plans.

I will quickly point out to my colleagues who may be saying we voted on this with the Rockefeller amendment that this is very different. The Rockefeller amendment was designed to provide encouragement to employers to supplement the existing prescription drug benefit. This amendment is designed to provide that encouragement only to employers who would be picking up the total cost of the prescription drug benefit, not just acting as a supplement. So it is very different. It is not the wraparound. This is an optional choice by the retiree or the employer. If they are the primary provider of the drug benefit, they would be covered by this amendment.

For employers intending to act as a supplement to the coverage, we decided that today; unfortunately, it was voted down. With that in mind, clearly in this bill most of us believe what we ought to be trying to do is support, not supplant, the valuable efforts of employers already providing prescription coverage to retirees.

As presently written, I am concerned the bill would lead many retiree benefit plans to scale back or drop entirely the prescription drug coverage they presently provide. However, this amendment would provide an increased subsidy to employers, because we want to encourage them to provide this benefit to retirees. It seems to me it is in our interest to encourage them to stay involved. They would get a subsidy, as long as they continue to offer prescription drug coverage to retirees only as the primary provider, not as a supplement--not as a wrap around the new Medicare benefit.

The scope of this problem is not small at all. In fact, I was surprised to learn how many seniors would be impacted by the unintended change to retiree benefit coverage. About one-third of all Medicare beneficiaries receive prescription drug coverage through an employer- sponsored health care plan. That is by far the largest source of prescription drug coverage for seniors.

These plans have played a very critical role in providing security to seniors, while Congress has been unable over the last number of years to pass a prescription drug benefit plan under Medicare. Retiree benefit plans should continue, in my view, to play that role even after a drug benefit plan is enacted. In many cases, the drug coverage provided by retiree benefit plans is significantly more generous than the plan we are debating here.

Furthermore, many seniors have become familiar and comfortable with the coverage offered by their former employers.

Understandably, they do not want to give it up for a plan about which they are confused and uncertain or may not be as beneficial to them.

We should be doing, in my view, everything in our power to provide these seniors with a choice, with the option of staying with their employer-sponsored plan. Thus, this amendment.

Unfortunately, the option may not be available for many seniors. That is why I put up this chart. I wish to focus the attention of those who may be following this debate to the left side of this chart. The right side I will talk about briefly, but the most significant numbers are on the left side of the chart. I will get to them in a minute.

While the numbers vary slightly, depending upon which study one consults, they come to the same conclusions, roughly the same numbers, and they are very disheartening. Between 1993 and 2001, the percentage of large employers, those who employ more than 500 people, offering coverage to Medicare-eligible retirees dropped from 40 to 23 percent, almost in half over 7 or 8 years. In the last 2 years, 13 percent of all employers offering future retiree coverage have elected not to do so. Those retaining coverage are experiencing annual cost increases on the order of 14 percent. It has been tremendously expensive. As a result, they are substantially raising the cost-sharing burdens for individuals enrolled in these plans.

The chart on the left-hand side illustrates the crisis that employer- sponsored plans are facing today and are going to continue to face in the future. The numbers are based on a survey conducted by the Kaiser Family Foundation and Hewitt Associates in December of 2002.

The graph shows that the actions large employers have taken over the last 2 years to deal with the rapidly increasing retiree health care cost--these numbers may not be clear to everyone, so I will recite them--a large number of employers have increased individual costs in some way. Forty-four percent have increased retiree contributions to premiums, while 36 percent increased cost sharing. In addition, 14 percent have shifted all costs to the individual retiree, and 13 percent have eliminated the plans altogether. Finally, nearly half of employers surveyed increased cost sharing for prescription drugs, as shown by the bar depicting 49 percent.

The numbers on this chart do not bode well, is the point I am trying to make, for those seniors who currently receive health care benefits from their former employers. Given the enormous financial pressures being felt by employers and the encouragement this bill already provides--in the form of a 64 percent subsidy--to keep employers from dropping coverage, it seems to me that if the employees decide to stay with their existing coverage, we believe that subsidy ought to go from 64 percent to 100 percent of the national average premium. That is what we are trying to do with this amendment.

The Congressional Budget Office has estimated that almost 40 percent of seniors who currently have their prescription drug medicines covered by retiree benefit plans would lose their coverage under the plan before us. So even with the 64 percent subsidy, 37 percent of retirees would be dropped from these plans. We are raising through this amendment that subsidy to 100 percent which we think will do a lot to keep these employer-based plans in place so that retirees would have that option of sticking with those retiree plans.

I supported the Rockefeller amendment. I mentioned that earlier. This is different. This is very different. If you are just supplementing the benefit plan, then you would not be covered by the Dodd amendment. That was the Rockefeller amendment, and the Senate voted it down. My amendment says only if you are the primary provider of the prescription drug benefit would you get the kind of subsidy we are talking about, from 64 to 100 percent. That would mean approximately an additional $400 a year per retiree paid to the employer. This would encourage employers to retain the full prescription drug coverage they presently provide rather than cutting back coverage and simply supplementing a new Medicare benefit.

The underlying bill has a provision that would provide a subsidy to employers for every Medicare-eligible retiree who elects to remain in an employer-sponsored plan as an alternative

to the Medicare prescription drug plan. That subsidy would be approximately, as I mentioned, 64 percent of the national average premium for prescription drug coverage.

This amendment would very simply increase that subsidy to the full national average premium. This would mean an additional $35 a month per beneficiary or roughly $400 a year paid directly to employer-sponsored plans as long as they continue to offer an alternative to Medicare prescription drug coverage, bringing the total subsidies to almost $100 per month when we combine the 64 percent that is in the bill and what we are adding with this amendment.

To receive this subsidy, employers would have to offer a prescription drug plan that is competitive with the Medicare benefit because the subsidy would only be paid for beneficiaries who remain in the employer-sponsored plan and do not enroll in Medicare Part C or D.

We simply cannot allow retiree benefit plans to disappear. That would be a great mistake, in my view. This amendment is designed to keep them if we can. It is a modest amendment considering the benefits that could accrue to the retirees, giving them the option of sticking with an employer-based plan.

If CBO is right, under the plan before us, almost 40 percent of these retirees will lose that prescription drug coverage under their employer-based plans. I do not think we want to have that happen. I urge the adoption of this amendment, and I hope my colleagues will be supportive of it.

I see the chairman of the committee who I know wants to respond to my amendment.

That is correct.

Mr. President, if I can finish, I can give the chairman a chance to respond.

I ask unanimous consent that a letter signed by 33 of the labor unions in this country in support of my amendment be printed in the Record.

Mr. President, I will read a pertinent passage because this is really the heart of this issue. I mentioned earlier, one-third of all retirees get coverage under the private employer-based plans. If CBO is right, almost 40 percent of retirees will lose their coverage under this bill, and employers would start dropping them because they do not get the subsidies, then I think we have to understand what the implications mean for a lot of people. I do not believe my colleagues intend this to be the case, but this is what is going to happen if we are not careful.

The letter reads in part:

If the Medicare drug bill before the Senate, S. 1, becomes

law, 37 percent of retirees who now have employer-sponsored

health benefits will lose that coverage.

That is according to CBO.

That's 4.4 million retirees that will be made worse off if

S. 1, as drafted, is enacted into law. Such an act will

represent an enormous and irreversible blow to the employer-

based system that is the backbone of our nation's health care

system.

The letter goes on:

. . . any provision that encourages employers to drop their

retiree benefits will only end up costing the federal

government more--and hurt millions of seniors in the process.

. . .

We urge you to support the [Dodd] amendment aimed at

encouraging both public and private employers to continue

providing retiree health benefits. Congress must enact a drug

benefit that supports, not threatens, our fragile employer-

based system of health coverage.

That is what my amendment is designed to do: to provide that subsidy if the retiree takes the option of continuing in the employer-based plan as the primary provider for health care coverage. If that is the case, then I think we ought to provide that encouragement and inducement. They make a huge difference in people's lives. If CBO is right and we do not adopt this amendment, and 4.5 million people have a worse plan as a result of our action, we have taken a step back rather than a step forward for that many seniors in our country. I don't know of anyone in this Chamber who would like to be a party to that.

For those reasons, I hope my colleagues could support the man from Connecticut on his amendment.

I will take 1 minute on this amendment and move to my second amendment.

This is an optional choice. We are not requiring employers to retain an employer-based plan. We are saying we know already, based on CBO's analysis, that close to 40 percent of people under the employer-based plans will be dropped. We know that.

Our primary responsibility in this bill is to provide a good prescription drug benefit for people. We do not want to be in a situation of actually causing people to have a worse plan than they have.

My point is not to increase spending but to say, if you are going to provide prescription drug coverage as an employer--and I want you to continue doing this; and we are being told 37 percent of the people will be dropped--we will increase the subsidy. To encourage employers to continue doing it seems to me to be in our interest. That is why I offer this amendment and why it is so strongly supported by labor unions who believe this will be a major blow to almost 4.5 million retirees in the country. I urge adoption of this amendment.

Amendment No. 970

The second amendment I call up is amendment No. 970, and I ask for its immediate consideration.

Let me briefly explain this amendment. I commend the committee.

This bill does an awful lot for people who are really hurting. I want the chairman to know I strongly support his efforts. Those who are really hurting get real help with this bill. I commend the committee for focusing on that. I commend him for it.

What this amendment does is a little different. We have all been talking about donut holes. People watching this debate may wonder what we are talking about, but the donut hole is in the plan when you reach a certain level of your costs of prescription drugs. Even though you keep paying the premiums of $35 a month, if your costs run somewhere around $4,500 to $5,800, during that period you are in the eye of the hurricane, and you do not get any help during that period.

That is not true if you are below 160 percent of poverty. If you are below 160 percent of poverty, we will provide help to you even while you are in the donut hole.

My amendment effects those in the donut hole who are between 160 and 250 percent of poverty. That is an individual who makes $22,000 a year or a couple earning $30,000 a year. These are people who are really hurting out there as well. They are not as desperately poor as those at 160 percent of poverty, but they are not much better off. But just in the donut hole, could we say that those people might get a 50/50 deal in the donut hole, between 160 and 250 percent of poverty? In that one set of circumstances where the costs are running from $4,500 to $5,800, you get a 50/50 deal if you are making $22,500, or a couple, $30,000, that is what the amendment does.

I know the chairman is going to say these are great ideas and there is a cost associated, and there is. But we ought to provide some help to people in those earnings groups--$22,000 if you are single or $30,000 as a couple. These are probably cancer patients or patients with serious medical costs. If you are paying somewhere around $4,500 a year, up to $5,800 a year, you have a serious health care problem. If you are making $22,000 or $30,000, as an individual or a married couple, then to provide 50 percent of the cost of those prescription drugs while you are in that donut hole I do not think is asking too much of us.

We should add just a little bit to accommodate these not even middle- income people. It would be an unfair description to say these are middle-income people. There is nothing magic about 250 percent. I just tried to reach out a bit to that constituency here that will continue paying the $35 a month. They have to do that. They do not get anything. If we could just reach a little further to that constituency, beyond the 160 percent, between $4,500 and $5,800 in total spending. We try to provide an additional bit of help for you, 50 percent of that cost. We can't pick up all of it, that would probably be too expensive. I don't know what the CBO numbers would be, but we will put you in the 50/50 bracket up to 250 percent of poverty just while you are in that situation. That is what the amendment does. It is no more complicated than that.

Again, I compliment the chairman. They have done a very good job taking care of the very desperately poor in the country. But for people who are not quite desperately poor--although I suggest some may tell you that living on $22,000 a year as a single person or a couple over the age of 65 with $30,000 worth of income, they are not out partying. These people probably make choices between food and rent and medicines, particularly if you are paying $4,500 a year or up to $5,800 a year for prescription drugs. That comes off the $22,000 or your $30,000. You do not have to do the math to know where you are living, what circumstances you are under.

So this is designed to provide some additional relief for people in that category, moving it up just a little bit, up to that 250 percent from 160 percent while you are in the donut hole, only there, to get a 50/50 break. You still pay 50 percent of the cost. You don't get 100 percent relief, but 50 percent of the cost, and that is what the second amendment is designed to do.

I apologize for racing, but I am trying to get this in in the 5 minutes. This is obviously complicated stuff. I am trying to accommodate my colleagues who I know have other engagements this evening to explain what the amendments do. The time does not justify the context, as to how important this would be to a lot of people in this country. I don't know the numbers of the people in this income category, but I have to believe before we get done with this, to provide some additional help for people in that category ought not to be too much of a stretch when you consider that $22,450 for an individual and $30,000 for a couple is going to put a lot of burden, a lot of pressure on you if you are already paying somewhere between $4,500 and $5,800 in prescription drug costs. This amendment would help those people.

I hope the man from Connecticut might impress the chairman on this one with his support. Hope springs eternal. I keep knocking on the door, seeing if I can't get some help.

I had 5.

I thank the chairman. He has been very gracious. This is my last amendment. I have tried vainly over here in the last couple of days with some amendments--I don't know what the implications are; I appreciate his candor, in terms of not knowing the cost of this amendment--that would fill in the hole, to go from 160 to 250, for people in that category. The reason I offered it is it occurred to me if you are paying that much in prescription drugs, somewhere around $5,000 a year for prescription drugs, and you are making $30,000 as a couple or $22,000 as an individual, you probably have a pretty serious illness if you are paying about $5,000 in prescription drug costs.

It occurs to me that during that hole, we might try to do a little more. We have done that, as the chairman says, very graciously for the desperately poor in this country.

For those reasons, I urge the adoption of the amendment. I will let the chairman proceed. The first amendment, I guess, we will do in that order.

There are two amendments. Amendment No. 998?

Mr. President, I ask unanimous consent that Meghan Taira, a fellow on Senator Daschle's staff, be granted floor privileges during the consideration of S. 1.

Mr. President, I am pleased to join with my colleagues in supporting the conference report on legislation to reauthorize CAPTA, the Child Abuse Prevention and Treatment Act. This measure is very aptly called the Keeping Children and Families Safe Act of 2003.

The conference report we are approving today would strengthen efforts to prevent child abuse and neglect. It would promote increased sharing of information and partnerships between child protective services and education, health, and juvenile justice systems. It would encourage a variety of new training programs to improve child protection, particularly cross-training in recognizing domestic violence and substance abuse in addition to child abuse detection and protection training.

The Keeping Children and Families Safe Act of 2003 renews grants to States to improve child protection systems and increases to $200 million the authorization for child abuse investigations, training of child protection service, CPS, workers, and community child abuse prevention programs.

For States to receive funding, they must meet several new requirements: have triage procedures to provide appropriate referrals of a child ``not at risk of imminent harm'' to a community organization or for voluntary preventive services; have policies and procedures for the referral of abused children under the age of three to early intervention services funded under Part C of the Individuals with Disabilities Education Act; have policies in place to address the needs of infants who are born and identified as having been physically affected by prenatal exposure to illegal drugs, which must include a safe plan of care for the child; have policies of improved training, retention, and supervision of caseworkers; and require criminal background record checks for prospective foster and adoptive parents and all other adults living in the household, not later than 2 years after the law's enactment.

Child abuse and neglect continue to be significant problems in the United States.

Nearly 3 million referrals concerning the welfare of about 5 million children were made to Child Protection Services, CPS, agencies throughout the Nation in 2001. Of these referrals, about two-thirds, 67.3 percent, were ``screened-in'' for further assessment and investigation. Professionals, including teachers, law enforcement officers, social service workers, and physicians made more than half, 56.5 percent, of the screened-in reports. About 903,000 children were found to be victims of child maltreatment. Over half, 59 percent, suffered neglect, including medical neglect; 19 percent were physically abused; 10 percent were sexually abused; 6.8 percent were emotionally maltreated; and 19.5 percent were associated with ``other'' forms of maltreatment such as abandonment, threats of harm to the child, and drug addiction. About 275,000, or 20 percent, of abused children were placed in foster care as a result of CPS investigation or assessment.

Many of these children fail to receive adequate protection and services.

The most tragic consequence of child maltreatment is death. In 2001, about 1,300 children died of abuse and/or neglect. Children younger than six years of age accounted for 85 percent of child fatalities and children younger than one year of age accounted for 41 percent of child fatalities.

Child abuse is not a new phenomenon. For more than a decade, numerous reports have called attention to the tragic abuse and neglect of children and the inadequacy of our Child Protection Service systems to protect our children.

In 1990, the U.S. Advisory Board on Child Abuse and Neglect concluded that ``child abuse and neglect is a national emergency.'' In 1995, the U.S. Advisory Board on Child Abuse and Neglect reported that ``State and local CPS caseworkers are often overextended and cannot adequately function under their current caseloads.'' The report also stated that, ``in many jurisdictions, caseloads are so high that CPS response is limited to taking the complaint call, making a single visit to the home, and deciding whether or not the complaint is valid, often without any subsequent monitoring of the family.''

A 1997 General Accounting Office, GAO, report found that, ``the CPS system is in crisis, plagued by difficult problems, such as growing caseloads, increasingly complex social problems and underlying child maltreatment, and ongoing systemic weakness in day-to-day operations.'' According to GAO, CPS weaknesses include ``difficulty in maintaining a skilled workforce; the inability to consistently follow key policies and procedures designed to protect children; developing useful case data and record-keeping systems, such as automated case management; and establishing good working relationships with the courts.''

According to a May 2001 report conducted by the American Public Human Services Association, APHSA, the Child Welfare League of America, CWLA, and the Alliance for Children and Families, annual staff turnover is high and morale is low among CPS workers. The report found that CPS workers had an annual turnover rate of 22 percent, 76 percent higher than the turnover rate for total agency staff. The ``preventable'' turnover rate was 67 percent, or two-thirds higher than the rate for all other direct service workers and total agency staff. In some States, 75 percent or more of staff turnovers were preventable.

States rated a number of retention issues as highly problematic. In descending order they are: workloads that are too high and/or demanding; caseloads that are too high; too much worker time spent on travel, paperwork, courts, and meetings; workers not feeling valued by the agency; low salaries; supervision problems; and insufficient resources for families and children.

To prevent turnover and retain quality CPS staff, some States have begun to increase in-service training, increase education opportunities, increase supervisory training, increase or improve orientation, increase worker safety, and offer flex-time or changes in office hours. Most States, however, continue to grapple with staff turnover and training issues.

Continued public criticism of CPS efforts, continued frustration by CPS staff and child welfare workers, and continued abuse and neglect, and death, of our Nation's children, served as the backdrop as we composed the Child Abuse Prevention and Treatment Act CAPTA, reauthorization bill this year.

The Child Protection System mission must focus on the safety of children. To ensure that the system works as intended, CPS needs to be appropriately staffed. The staff need to receive appropriate training and cross-training to better recognize substance abuse and domestic violence problems.

The conference agreement we are passing today encourages triage approaches and differential response systems so that those reports where children are most at risk of imminent harm can be prioritized.

The bill specifically emphasizes collaborations in communities between CPS, health agencies, including mental health agencies, schools, and community-based groups to help strengthen families and provide better protection for children.

The bill provides grants for prevention programs and activities to prevent child abuse and neglect. By focusing this assistance on at-risk families, we can help improve the likelihood that a

child will grow up on a home without violence, abuse, or neglect.

Beyond the CAPTA title of this legislation, the bill reauthorize the Family Violence Prevention and Services Act, including new efforts to address the needs of children who witness domestic violence, and a new highly secure web site to increase the likelihood that when an abused spouse calls for help, such calls will be handled as efficiently as possible with on-line links to shelters immediately letting the caller know of open shelters and the services these shelters offer. The measure also reauthorizes the Adoption Opportunities Act, and the Abandoned Infants Assistance Act.

Child protection ought not be a partisan issue. This bill will help ensure that it is not. I want to commend and thanks my colleagues on the conference committee--Chairman Gregg, Senator Kennedy, Senator Alexander, and Senator DeWine as well as my colleagues in the House for their efforts to craft a bipartisan initiative that can help to prevent and alleviate suffering among our Nation's children.

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, what is the business before the Senate?

I thank the Presiding Officer.

Mr. President, yesterday we began what can truly be expected to be an historic effort to transform the Medicare Program in this country, an effort, if it is successful in these coming days, that would provide for the most sweeping changes to that program since its inception in 1965.

We began debate this week on the need for coverage of prescription medicines under the Federal Medicare Program. While it is a debate that is sure to be spirited in the coming days, it is my hope the debate will, in the end, result in a significant move forward that will strengthen the Medicare Program for its 41 million beneficiaries and for the millions of future beneficiaries who will depend on this critically important program for their health and their well-being.

Over the past month, I have had the opportunity to convene a series of forums on senior health care in my home State of Connecticut in an attempt to frame the scope of this debate. At these forums, I heard from many constituents on many matters regarding their health care, but the present lack of coverage for prescription drugs under the Medicare Program was far and away--without even a close second--the most important question that was raised to me by literally dozens and dozens of seniors in my State.

I would guess in similar forums being held in other States around the country by our colleagues they have encountered virtually the same reaction as did I with my seniors in Connecticut: When are we going to get a prescription drug benefit? When are we going to get it under Medicare? And will it be meaningful enough to make a difference in our lives? Over and over and over again, in all parts of my State, this was the call that I received from my constituents.

At these forums, I heard from seniors who literally could not afford to fill prescriptions called for by their doctors. I heard from elderly Medicare beneficiaries forced to choose between purchasing groceries or filling their drug prescriptions. I heard from seniors who were forced to skip dosages of their medicines in an attempt to stretch their limited supplies of needed medicines. And I heard from Medicare beneficiaries requiring more than 10 prescribed medicines a day unable to afford to fill even half of those needed prescriptions.

Clearly, what I heard from hundreds of Connecticut's more than 500,000 Medicare beneficiaries--in a State, I might add, that has 3\1/ 2\ million people--is their grave concern over the present lack of a prescription drug benefit under the Medicare Program.

Our goal over the next 2 weeks is very clear: to ensure that all Medicare beneficiaries have access to their needed prescribed medicines. To achieve anything less in this debate would be an abdication of our responsibility to ensure that Federal programs correspond with the times in which we live.

The simple fact is that pharmaceuticals have and will continue to better the lives of millions of Americans. When the Medicare Program was first enacted in 1965, few could even begin to imagine the great strides we have realized in health care as a result of the development and widespread dissemination of pharmaceutical medicines. However, the present lack of a prescription drug benefit under the Medicare Program fails to reflect these great gains that have been made, leaving more than half of all Medicare beneficiaries without any coverage for their needed medicines. This is unacceptable, and it must be remedied.

For this reason, I am heartened that it appears that today, for the very first time--for the very first time since we began discussion of this subject matter--we are on the cusp of passing in the Senate comprehensive Medicare reforms that will, at long last, add a prescription drug benefit to the Medicare Program.

I am particularly pleased the measure reported by the Senate Finance Committee last week, and that is before us this afternoon, represents a very significant departure from previous plans supported by the administration that would have required Medicare beneficiaries to leave the traditional fee-for-service Medicare Program in order to receive coverage for their prescribed medicines. Such a move would have been unconscionable, as 89 percent of all Medicare beneficiaries today are in the traditional program.

To force those beneficiaries to have to leave their present system of coverage, and most likely the doctor they have come to know and trust, would not only create great disruption, but it would also, for the first time since the program's inception, create a tiered benefit system under Medicare that would more greatly reward those who choose to join a private preferred provider organization or health maintenance organization over those who wanted to stay in the traditional Medicare Program.

That is what the administration was originally advocating. That is what many, unfortunately, in the other body, the House of Representatives, are still pursuing and still advocating. So I hope, as a result of the change we have seen in the last week, this breakthrough will make a huge difference in the lives of Medicare beneficiaries who want to retain the ability to stay under the traditional Medicare Program if they so choose.

And so while I am pleased the bill before us soundly rejects a tiered benefit system--and I commend the distinguished Senator from Iowa, the chairman of the committee, and the distinguished Senator from Montana, for rejecting the idea of a tiered benefit system, I am deeply concerned that the plan presently taking shape, as I mentioned, in the other body, the House, appears to rely on such a flawed plan. And until we have resolved the matters between these two bodies, this fundamental difference will still be out there and need to be addressed.

President Bush, just last week, visited my home State of Connecticut and called on Congress to pass a prescription drug benefit before July 4th. For my part, I call on the President not to sign any Medicare reform measure that would force seniors to join private plans in order to receive a more generous prescription drug benefit. Such a measure would signal an end to the Medicare Program as we know it and should be rejected out of hand. In fact, I would hope the President would say, categorically, that while he wants Congress to pass a bill before July 4th--he must say, with equal strength, that he will not sign a bill that denies people under traditional Medicare the opportunity to have an adequate prescription drug benefit or forces them to have to make a choice between staying in traditional Medicare and getting no prescription drug benefit or going to a private plan where they can get that prescription drug benefit but having to give up traditional Medicare as the price. The President needs to state that he will reject any proposal on his desk that incorporates that idea.

The bill before us, S. 1, the Prescription Drug and Medicare Improvement Act of 2003, represents a strong step forward on this issue. However, no bill is perfect, and S. 1 clearly leaves much room for improvement. In the coming weeks, I plan to work with my colleagues to specifically address concerns over the present bill's lack of adequate provisions to ensure that those companies presently providing their retirees prescription drug coverage receive adequate Federal support for their laudable efforts. Any measure that we enact should be crafted so as to support, not supplant, the valuable efforts of employers already providing prescription drug coverage for their retirees.

Additionally, I remain concerned that the gap in coverage in the present

bill--the so-called donut hole--will leave many Medicare beneficiaries facing high prescription drug costs with no assistance at the very time when it may be needed most. These may be the people who are the most sick, under the most dire medical circumstances. And if they were to reach that threshold of approximately $4,500 in prescription drug costs, they will have to maintain paying the premiums without receiving any benefit until they reach the upper limit of the gap, approximately $5,800 in drug costs. This gap in coverage could provide a huge hardship on literally hundreds of thousands of Medicare beneficiaries. I hope we are going to be able to close the so-called donut hole, especially for those in the lower income category who can least afford any gap in their coverage.

I am also concerned that S. 1 fails to adequately protect Medicare beneficiaries from the very understandable confusion and uncertainty that may surround these beneficiaries just as they begin to navigate the intricacies of a brand new program. Specifically, I am worried that, if enacted, the underlying bill would require Medicare beneficiaries choosing a prescription drug plan to stay with that plan for a minimum of 1 year. With the enactment of such broad and sweeping changes to Medicare as S. 1 would provide, I am fearful that many Medicare beneficiaries will face great uncertainty trying to find the best plan to meet their particular medical needs.

I believe we can greatly relieve this uncertainty by allowing those initially choosing prescription drug plans for the first time the opportunity to move from one plan to another as they determine what each plan will specifically offer and which plan best fits their own needs. We ought to give our senior citizens that opportunity. All Medicare beneficiaries are not the same merely because they have reached the same age. They are under very different circumstances with very different medical needs. We ought to show them the dignity and respect they deserve as an older generation to give them the ability to choose the plan that serves their needs best and not force them to have to make decisions that may do them great harm.

In the coming weeks I will offer several amendments to the legislation that will address these very specific issues and possibly other ones as well.

On July 30, 1965, President Lyndon Baines Johnson traveled to the Truman Library in Independence, MO, to sign the Medicare Program into law. In attendance on that day was the former President of the United States, Harry S. Truman, 81 years of age at the time. On that day, President Johnson remarked:

No longer will older Americans be denied the healing

miracle of modern medicine. No longer will illness crush and

destroy the savings that they so carefully put away over a

lifetime so that they might enjoy dignity in their latter

years.

Almost 38 years later, we face a similar struggle of ensuring seniors access to modern medicine, this time in the form of prescribed medicines.

So it is with a great sense of hope that I join the debate this afternoon. Medicare's nearly 41 million beneficiaries clearly need assistance in affording their needed medicines. Our effort over the next 2 weeks will greatly determine to what extent we assist in that effort.

Clearly, a great opportunity is presently before us. I look forward to working with all of my colleagues on both sides of the aisle, Republicans and Democrats, to ensure that we seize this opportunity. It may not come again. While the bill before us may be less than perfect and the resources we are limited to may not be as adequate as we would like, we have an opportunity over the next couple of weeks to take the legislation presented to us by the Finance Committee, to work on that legislation and hopefully improve it in several of the areas I have mentioned.

What greater gift could we give, 38 years after Medicare's creation, to retirees and future generations of retirees than to grant them access to this wave of new medicines and prescription drugs, that cannot only extend life but can substantially improve the quality of life for people, which will give them the opportunity to enjoy years of retirement with their children and grandchildren and friends. Surely these wonderful miracle drugs ought not to become the exclusive domain of only those who can afford to buy them.

Mr. President, I do not want to have to face constituents in my State ever again who will report that they had to make a choice between putting food in their mouths or medicines that they need; that they had to choose between the medicines they need because they can't afford all of them that the doctors have prescribed, or that they reject altogether the medicines that they have been prescribed because they can't afford them. We can't do everything for everyone, but it seems to me providing a meaningful prescription drug benefit that will really serve the underprivileged in our society, particularly those age 65 and above, is something this Congress ought not to fail to do in its responsibilities.

I look forward to the debate. I look forward, more than anything else, to voting for a package in the end that will do that which most of us would like to see accomplished and seeing to it that the elderly will receive the full promise given to them back in 1965 that a Medicare Program is going to be there for them, and this time we are going to include in the program coverage for needed prescribed medicines.

I commend those who have moved so diligently and worked so hard to bring us to this very optimistic moment. I am hopeful in the coming days we can complete the job by adding some improvements here and presenting a bill to the American public which they will applaud if we correctly do our job.

I suggest the absence of a quorum and ask unanimous consent that time thereunder be equally divided.

Madam President, I thank Senator Leahy and Senator Hatch for moving the nomination of Mark Kravitz. This is a first-rate nomination. I commend the President and others who recommended Mark Kravitz. He is a first-class nominee to sit on the Federal bench. My colleague Senator Lieberman and I strongly support this nomination. He has been a wonderful lawyer in Connecticut, a graduate of Wellesley University, Georgetown Law School, a clerk for then-Justice Rehnquist, has written extensively and taught at the University of Connecticut Law School. He is going to be a wonderful addition to the district court bench.

We wanted our colleagues to know how strongly Senator Lieberman and I felt about this nomination. We urge our colleagues to give their unanimous support.

I yield back my remaining time.

Mr. President, I thank Chairman Hatch, Senator Leahy and all the members of the Judiciary Committee for acting on this judicial nomination in a thorough and expeditious manner. I am pleased to recommend Mr. Kravitz to my colleagues to serve as Federal District Judge for the District of Connecticut.

Mark Kravitz is a graduate of Wesleyan University in Middletown, Connecticut and Georgetown Law School. After graduating from law school, Mr. Kravitz clerked for Judge James Hunter of the U.S. Court of Appeals for the Third Circuit. Mr. Kravitz also served as a clerk for then-Justice William H. Rehnquist of the United States Supreme Court.

In 1976, Mr. Kravitz joined the respected law firm of Wiggin & Dana in New Haven, CT, where he is now a partner and heads their appellate practice. Mr. Kravitz's law practice has been devoted to civil litigation in State and Federal courts. He has been lead counsel on more than 60 appeals in State and Federal courts. In addition to his appellate and litigation practice, Mr. Kravitz has been an Adjunct Professor of Law at the University of Connecticut School of Law.

Over the course of the last quarter of a century, Mr. Kravitz has built an excellent reputation. He has become a respected and admired member of the Connecticut bar and he has contributed to the larger community, giving his time and talents to such causes as the Guilford Land Conservation Trust, the Connecticut Foundation for Open Government, and the Connecticut Council on Environmental Quality. Mr. Kravitz has been listed as one of the Best Lawyers in America since 1991. He has been elected as a fellow to the American Academy of Appellate Lawyers and as a member of the American Law Institute. In 1995, Mr. Kravitz received the Deane C. Avery Award for ``advancing the cause of freedom of information and freedom of speech in Connecticut.''

Recently, there has been a great deal of debate in the Senate about judicial nominations. I don't believe there should be any debate about this nomination. Mark Kravitz is the kind of nominee whom I believe the Framers of the Constitution had in mind when they envisioned an independent judiciary composed of jurists whose experience, intellect, and commitment to justice are unquestionable.

I believe that Mark Kravitz possesses the intellect, the experience, and the disposition to be an impartial finder of fact, a faithful legal analyst, and a fair and just jurist. He is an outstanding lawyer, and given everything I know about him, I am certain that he has the capacity to be an outstanding judge, as well. The State of Connecticut is proud to have him as one of our own. I'm certain that he will serve his country with honor and distinction, and I look forward to his confirmation. Again, I commend Mark Kravitz without reservation and I urge my colleagues to vote to confirm his nomination.

Mr. President, I rise today to introduce the Focus on Committed and Underpaid Staff for Children's Sake Act. I am pleased that Senators Kennedy, Murray, and Bingaman are joining me as original cosponsors and that companion legislation is being introduced in the House today by Representatives George Miller and Patrick Kennedy.

The need for child care has become a daily fact of life for millions of parents nationwide. Sixty-five percent of mothers with children under age six and 78 percent of mothers with children ages 6 to 13 are in the labor force. Each day, 13 million preschool children, including 6 million infants and toddlers, spend some part of their day in child care.

The quality of that care has a tremendous impact on the critical early years of children's development. And, the most powerful determinant of the quality of child care is the training, education, and pay of those who spend 8-10 hours a day caring for our children.

Yet, what we know about the child care field is alarming. Despite the fact that continuity of care is critical for the emotional development of children, staff turnover at child care centers averages 30 percent per year--four times greater than the turnover rate for elementary school teachers.

We as a society say there is no more important task than helping to raise a child. Yet, according to the Bureau of Labor Statistics, we pay the average child care worker about $16,500 a year--barely above the poverty level for a family of three. Few child care providers have basic benefits like health coverage or paid leave. Only a small fraction of child care workers have graduated from college.

We pay people millions of dollars a year to throw baseballs, to shoot basketballs and to swing golf clubs. What does that say about our priorities when at the same time we pay those who care for our most precious resource--our children--poverty-level wages?

A report by the University of California, Berkeley and the Center for Child Care Workforce on child care providers' pay, training and education highlighted the current crisis in the child care field. In a survey of child care centers in three California communities, the study found that three-quarters of all child care staff employed in 1996 were no longer on the job in 2000. Some centers reported 100 percent turnover. Additionally, nearly half of the child care providers who had left had a Bachelor's degree, compared to only one-third of the new teachers. Some 49 percent, nearly half, of those who had left their job, left the child care field entirely.

It's clear that if we want to attract quality teachers to the child care field, the pay has to better reflect the value we place on their work. We can't attract them and we can't keep them if we don't pay them a living wage.

The legislation I am introducing today will provide states with funds to increase child care worker pay based on the level of education--the greater the level of education, the greater the increase in pay. In addition, the legislation will provide scholarships of up to $1,500 for child care workers who want to further their early childhood education training by getting a college degree, an Associate's degree, or a child development associate credential.

The legislation also includes a separate allotment to states to address access to health care coverage by child care workers. States would be free to develop their own creative methods to improve access to health care, but the intent is to ensure that an industry that works with children--who as many parents know, often come down with a variety of illnesses, particularly preschool age children--would have greater access to comprehensive and affordable health care coverage.

We will never make significant strides in improving the quality of child care in this Nation if we fail to address one of the leading problems--attracting and retaining a quality child care workforce. It is time to invest in our children by investing in those who dedicate their lives to caring for our children.

I ask unanimous consent to print a short summary of the bill following my remarks.

Mr. President, I rise today to introduce the Focus on Committed and Underpaid Staff for Children's Sake Act. I am pleased that Senators Kennedy, Murray, and Bingaman are joining me as original cosponsors and that companion legislation is being introduced in the House today by Representatives George Miller and Patrick Kennedy.

The need for child care has become a daily fact of life for millions of parents nationwide. Sixty-five percent of mothers with children under age six and 78 percent of mothers with children ages 6 to 13 are in the labor force. Each day, 13 million preschool children, including 6 million infants and toddlers, spend some part of their day in child care.

The quality of that care has a tremendous impact on the critical early years of children's development. And, the most powerful determinant of the quality of child care is the training, education, and pay of those who spend 8-10 hours a day caring for our children.

Yet, what we know about the child care field is alarming. Despite the fact that continuity of care is critical for the emotional development of children, staff turnover at child care centers averages 30 percent per year--four times greater than the turnover rate for elementary school teachers.

We as a society say there is no more important task than helping to raise a child. Yet, according to the Bureau of Labor Statistics, we pay the average child care worker about $16,500 a year--barely above the poverty level for a family of three. Few child care providers have basic benefits like health coverage or paid leave. Only a small fraction of child care workers have graduated from college.

We pay people millions of dollars a year to throw baseballs, to shoot basketballs and to swing golf clubs. What does that say about our priorities when at the same time we pay those who care for our most precious resource--our children--poverty-level wages?

A report by the University of California, Berkeley and the Center for Child Care Workforce on child care providers' pay, training and education highlighted the current crisis in the child care field. In a survey of child care centers in three California communities, the study found that three-quarters of all child care staff employed in 1996 were no longer on the job in 2000. Some centers reported 100 percent turnover. Additionally, nearly half of the child care providers who had left had a Bachelor's degree, compared to only one-third of the new teachers. Some 49 percent, nearly half, of those who had left their job, left the child care field entirely.

It's clear that if we want to attract quality teachers to the child care field, the pay has to better reflect the value we place on their work. We can't attract them and we can't keep them if we don't pay them a living wage.

The legislation I am introducing today will provide states with funds to increase child care worker pay based on the level of education--the greater the level of education, the greater the increase in pay. In addition, the legislation will provide scholarships of up to $1,500 for child care workers who want to further their early childhood education training by getting a college degree, an Associate's degree, or a child development associate credential.

The legislation also includes a separate allotment to states to address access to health care coverage by child care workers. States would be free to develop their own creative methods to improve access to health care, but the intent is to ensure that an industry that works with children--who as many parents know, often come down with a variety of illnesses, particularly preschool age children--would have greater access to comprehensive and affordable health care coverage.

We will never make significant strides in improving the quality of child care in this Nation if we fail to address one of the leading problems--attracting and retaining a quality child care workforce. It is time to invest in our children by investing in those who dedicate their lives to caring for our children.

I ask unanimous consent to print a short summary of the bill following my remarks.

Mr. President, just before the Memorial Day recess, the distinguished Presiding Officer and I had the great honor of introducing bipartisan legislation, S. 1157, to create a National Museum of African American History and Culture within the Smithsonian Institution.

We were joined in that effort by 44 of our colleagues, and I might point out that another four have joined since that time, bringing the total number of cosponsors to this legislation to 48. I presume before the day is out we will have a clear majority of our colleagues who endorse the legislation introduced by the distinguished Senator from Kansas.

Senator Brownback and I introduced similar legislation in the last Congress and I am pleased that we have such strong continuing interest from our colleagues, ensuring this important museum be created.

This long overdue legislation will guarantee that the compelling stories and invaluable contributions of African Americans to our Nation will finally be shared with all Americans, indeed all peoples of the world.

This legislation also allows us to publicly display the contributions of African Americans to the founding of our Nation and educate students of all ages about the importance of their experience. This museum is not intended to replace the numerous museums and institutions of African American culture and history that already exist in our country. Instead, it will bring a national focus and prominence to the contributions and experiences of African Americans.

In New Haven, CT, for example, we are fortunate to be the home port of the 19th century freedom schooner, Amistad. The recreated Amistad is a floating classroom and reminder of the devastating effects of the transatlantic slave trade. Amistad America is dedicated to promoting the legacies of the Amistad incident of 1839 and to celebrating and teaching the historic lessons of perseverance, leadership, justice, and freedom experienced by African Americans during that incident, and similar ones like it during the centuries before 1839.

It is my hope, of course, that organizations such as Amistad America and numerous others will be able to work with the Smithsonian to ensure that these important stories may be told. I am pleased that we have been able to provide support for these numerous organizations and associations, such as Amistad, in this bill as well.

During my tenure as chairman of the Senate Rules Committee, I was pleased to work with colleagues to pass legislation to establish the Presidential Commission on the National Museum of African American History and Culture action plan.

In April, the Presidential commission issued its report in which it documented the voices of African Americans across the Nation, calling for a national place to tell their individually collective stories. This long overdue

legislation will provide such a place, and I commend the distinguished Presiding Officer for his leadership on this issue.

The mission statement contained in that report sums up the purpose of this legislation:

This museum will give voice to the centrality of the

African American experience and will make it possible for all

people to understand the depth, complexity, and promise of

the American experience.

It is that very goal, of completing the American story of our quest for freedom and truth by publicly incorporating the experience and contribution of African Americans, that is the essence of this legislation. This museum offers the promise and the hope that all Americans can come to understand the full story of how this Nation was formed. It is past time that we publicly acknowledge and incorporate the African Americans' experience into our collective identity and this museum will provide the appropriate means for accomplishing that very goal.

Again, I congratulate my colleague, Senator Brownback, and I want to specifically highlight the tremendous contribution of Representative John Lewis of Georgia, who is the lead sponsor in the House of Representatives for this bill, on their perseverance in this matter. I am honored today to join them as their lead sponsor on this side of the aisle.

I see my colleague from Mississippi, who I know has some comments he wants to make on this as well. I thank him for his leadership. As the chairman of the Rules Committee, he will have a lot to say about how this bill moves through the committee and comes to the floor.

My congratulations to the Presiding Officer from Kansas and all others who have joined with us in this collective effort this morning.

I yield the floor.