Floor Statements

I ask for 20 minutes.

Mr. President, let me express my sincere thanks to my good friend from the Dakotas, and thank him for the work he has done on the Budget Committee as the ranking member. I thank my friend from Oklahoma, the chairman of the Budget Committee, as we are seeing that being on the Budget Committee is one of the most thankless jobs around. You have to read economic analysis, tons and tons of pages, and 50-year economic analyses. Then you come out with a bill that is a series of numbers. It is all supposed to work out. Then people like me come along and try to change it. It is with some experience on the Budget Committee that I express my appreciation for the work that has been done.

Today, along with a number of my colleagues, I want to address an amendment which is at the desk, amendment No. 358 to the Senate budget resolution. I am very pleased to be joined in this by Senator Reid of Nevada, Senator Inhofe, Senator Jeffords--all three from the EPW committee--as well as Senators Shelby, Sarbanes, Warner, Murray, Murkowski, Byrd, Chafee, Feinstein, Collins, Specter, Levin, Lott, Reed of Rhode Island, and Brownback.

This amendment would increase the budget allocations to $255 billion for highway infrastructure, and $56.5 billion for mass transit needs over the 6-year period fiscal year 2004 to fiscal year 2009.

Before these numbers startle some of my colleagues and good friends, like my friends on the Budget Committee, let me remind my colleagues we are not abandoning the ``user pays'' concept of the Highway Trust Fund. In fact, over the past several years, a great deal of money has been stolen or diverted out of the Highway Trust Fund, paid in by highway users, that rightfully should have gone for road improvements.

For example, highway users started paying a 2.5 cent tax in 1990 with the Omnibus Budget Reconciliation Act of 1990 that never went to road improvements. It went to the general fund instead. The tax even grew to as high as 6.8 cents in 1994 and 1995, and over the years, highway users have paid well over $40 billion--that is a conservative estimate--$40 billion which never went into the highway trust fund.

In addition, the highway trust fund lost revenues as a result of alternative fuel vehicles. I support alternative fuel vehicles, whether they run on hydrogen or electricity or some other form of energy. But we also must remember that

these alternatively fueled vehicles travel on the roads. They use the roads. They crowd the roads. They are, in fact, burdens on the roads. And they must somehow pay some share, just as those vehicles fueled by gas or diesel pay for a share.

Some very significant constituents have spoken out about the needs for the highway trust fund. I have letters of support, that I will offer later, from affiliated labor unions engaged in transportation, construction, and the broader Transportation Construction Coalition, the Highway Users Alliance, the U.S. Chamber of Commerce, the National Governors Association, and others.

I daresay we have all heard from our respective State transportation officials, our metropolitan planning organizations, from our labor unions, our friends in the transportation industries, and others about the needs. But perhaps more importantly, we have all seen the congestion, the potholes covered with steel plates, the bridges down to one lane.

If any of you who have done what I have done, and had an open meeting in a townhall forum in the last several months as we came up on the reauthorization of TEA-21, you have heard that our citizens are concerned about inadequate transportation. They are really chafing at the bit because in too many areas our country is strangling.

Now, we have all waited in traffic, hoped our car's alignment would not be permanently damaged, and looked down through a bridge to see the water below.

We have also comforted far too many friends and families who have lost loved ones because of unsafe roads or bridges. I still correspond with families who have made getting decent highways their cause to remember a loved one who was killed because of an inadequate highway system with too much traffic on it.

Our Nation has some needs. This little chart shows in red what the President proposed in his budget. What the Budget Committee has come out with is shown in green. And what this Bond-Reid amendment would do is shown in blue. As you can see, these start going up a little bit.

You may ask, what is this big yellow line way up here above all of them, even well above the blue line? Well, it is simply this administration's own estimate of the cost simply to maintain the current system; that is, not to get it any better. Just to keep it as it is, we should be spending this much, as shown in yellow. Right now, this budget has us spending what is shown in the green. We really need to get up at least to this high, as shown in the blue, so we can begin to try to keep up with the needs.

We know our Nation's transportation needs are staggering and our constrained transportation system is costing our country a whole lot of time and money. We know it is time to do something about it.

The transportation system is a lifeline of our country and our economy. I was a student of American history. The economic history of America really began when railroads tied together this Nation and brought it as a whole economic unit. Railroads were the tie that bound us together in the 19th century. In the 20th century, it became the highway system. The highway system provides mobility. It provides transportation for economic activities. It, in essence, brings jobs.

I can tell you, in the years I spent as Governor of Missouri, I spent an awful lot of time working on economic development. It was one of my top priorities. And I could see, economic development was going by where the roads went. If you build a good four-lane road, jobs will go there.

Jobs and economic opportunity require good transportation. Not all jobs. We have e-mail and telecommunications. But distribution requires a good transportation system.

I can tell you, for the 21st century, it is not only good railroads, it is not only good roads and highways, it is good transportation systems, it is good air transportation, it is good water transportation, and it is good mass transportation that is going to be essential for our growth.

Looking at the road side of it, in my home State of Missouri the problems are diverse and complex. To highlight just a few of the glaring examples: Commercial truck traffic is expected to increase 89 percent by the year 2020. The cities of St. Louis and Kansas City spend over $1 billion each year on costs associated with traffic congestion. Fatalities on Missouri highways are considerably higher than the national average--nearly 7,000 people were killed between 1995 and 2000 on our highways.

How will this broad range of problems be adequately and appropriately addressed? The answer simply is investment--investment in the future of our Nation's surface transportation to promote safety, to increase employment, to decrease congestion, and to enhance security.

In order to meet these needs, Federal, State, and local government investment will have to be significantly increased. Our amendment we offer today will allow it to do so at a very modest rate compared to the true needs, but without raising gas taxes and diesel taxes at this time.

I want to emphasize to my colleagues, this transportation responsibility is a duty of the Federal Government. Road building is one activity that the Government should administer but in coordination with the private sector and other levels of government. If we do not want the responsibility at the national level, or if we are unwilling to fund it, then let's quit calling our I-70s, our I-80s, our I-5s, our I-95s, and our other interstates by those names.

When President Dwight Eisenhower first proposed the interstate highways, if I remember correctly--I was a youngster at the time--our Nation's defense was the primary focus, the national defense highway system.

Now terrorism threatening our homeland requires an adequate defense network to get the people, the law enforcement, the military, to prevent actions, to bring in responders where there is an action, to give people a means away from an area of danger. These all require good roads and highways.

To demonstrate the enormity of this crucial task of relieving congestion and building highway infrastructure, we have to examine the costs involved. A report by the Nation's State transportation officials found that $92 billion will be needed on an annual basis just to maintain the current conditions of highways and to keep traffic from getting worse.

However, if our goal were to be as I think it should be--to improve significantly the overall condition of U.S. highways, enhancing safety standards, reducing traffic congestion; a goal that I think is critical to the protection of American lives as well as our economy, the study showed that more would be needed, a total of $125 billion annually.

Now, those figures do not even include the additional $19 billion in capital investments required each year to maintain existing road conditions and service levels. Clearly, this will be a massive and expensive effort.

Increased funding for transportation will also have other beneficial effects. It creates jobs at a time when many businesses around the country are heading in the reverse and are contracting. The added investment for transportation will serve to directly stimulate the economy. Every billion dollars of investment is 47,000 jobs.

Naturally, this will contribute to the prosperity of American communities by bringing a wide variety of benefits to people in every State and every location across the country. The increased investments in roads will help satisfy many of our needs currently and for the future.

Unfortunately, the administration's 2004 budget provides allocations that remain wholly inadequate for conquering the ever-growing needs of the people who use our Nation's transportation infrastructure. It is the status quo funding.

Again, our amendment will increase spending authority on highways to $255 billion and on mass transit to $56.5 billion over the 6-year life of the TEA-21 reauthorization bill. As my colleagues know, a budget resolution amendment is all about numbers and not about specific requirements. However, I will offer some ideas and thoughts because there is a menu of sources and options, so you can understand where that money comes from.

Let me go over a few of the aspects. The $255 billion increase over the budget, where does that come from: 5.2 cents on the ethanol tax incentive fix,

something the Finance Committee is going to work on; spending down the trust fund balances. This was proposed by the President in his budget, and it is proposed in the Budget Committee's markup that we extend that. We provide interest credit on the balances, and we restore a lost $8 billion in TEA-21; $8 billion just disappeared from the trust fund. We put that back. We maintain the historic relationship between contract authority and obligation limitations. I will forgo a description of the contract authority and obligation limits. I don't think it is necessary to add further confusion at this point. But let me say we straighten out the problem that the underlying budget amendment has.

Then we ought to have fair share funding for alternative fuel vehicles--electric hybrids, natural gas, recognizing the loss to the fund for these vehicles which pay little or nothing into the trust fund but cause the same damage to roadways. This is vitally important, as is cracking down on tax evasion and compliance initiatives, dealing with those who avoid the taxes or otherwise have been excluded from paying for their use of our roads and highways.

This increased investment authorized by our amendment will decrease congestion, enhance security, help to create jobs, stimulate the economy, and, most importantly, will save American lives by improving safety on the highways.

These are the highway-related fatalities in thousands, beginning with 39.3 thousand in 1992, reaching as high as 42.1 thousand in 1996, and again in 2001, over 40,000 people killed in each of these years, too many of them because of inadequate highways. It is not an option to stand idle in the wake of these conditions.

I urge my colleagues to support our amendment. I ask unanimous consent to print letters of endorsement for this proposal.

Mr. President, I rise today to introduce an important piece of new legislation to help an essential part of our health care safety net--our Nation's health centers--serve the uninsured and medically- underserved.

The Building Better Health Centers Act will promote health centers' mission of providing care to anyone who needs it by getting rid of an artificial distinction existing in current law. Right now, federal grant dollars to health centers can be used for most things a health center needs to do--including salaries, supplies, and basic upkeep. But federal grants to health centers cannot be used for one of the most critical and expensive needs a health center, or any business or nonprofit organizations, will ever face--capital improvements.

Unless we correct this silly distinction, many of our health centers are destined to be shackled to slowly deteriorating facilities. Over time, this will sap their ability to provide care. If we are serious about maximizing health centers' ability to deal with our health care access needs, we must allow Federal grant dollars to be used to meet our health centers' capital needs.

I've been down here on the Senate floor many times to talk about health centers, but let me cover the basics once again. Health centers--which include community health centers, migrant health centers, homeless health centers, and public housing health centers-- address the health care access problem by providing primary care service in thousands of rural and urban medically-underserved communities throughout the United States.

And as we all know, the health care access problem remains a serious issue in our country. Many health care experts believe that Americans' lack of access to basic health services is our single most pressing health care problem. Nearly 50 million Americans do not have access to a primary care provider, whether they are insured or not. In addition, over 41 million Americans lack health insurance and have difficulty accessing care due to the inability to pay.

Health centers help fill part of this void. More than 3,400 health center clinics nationwide provide basic health care services to more than 12 million Americans, almost 8 million minorities, nearly 850,000 farmworkers, and almost 750,000 homeless individuals each year. The care they provide has been repeatedly shown by studies to be high- quality and cost-effective. In fact, health centers are one of the best health care bargains around--the average yearly cost for a health center patient is just over one dollar per day.

I believe that one of the most effective ways to address our health care access problem is by dramatically expanding access to health centers. And I am pleased to report a strong consensus is developing to do exactly that. The Senate has voted in support of a proposal I have made with Sen. Hollings to double access to health centers by doubling funding over a five-year period. In addition, President Bush has proposed that we double the number of people that health centers care in the years ahead.

But over the next few years, as we hopefully see additional resources flow to health centers, we will increasingly encounter problems that stem from an artificial distinction we see in current law. As I mentioned, Federal health center grants are currently allowed to be used for most purposes--including salaries for health professionals and administrators, medical supplies, basic upkeep of clinic facilities, even lease payments if the health center rents. But they simply cannot be used for capital improvements.

This means that unless health centers can find some other way to finance their capital needs--and I will talk in a moment about the significant barriers they face in doing this--major projects that could provide substantial benefit to patients will never happen.

It means that an urban community health center that has been slowly expanding staff and services over many years until it's bursting at the seams of its modest two-story building will have to continue to find ways to cope, even if that prevents additionally-needed expansion or even if upkeep costs on the old building begin to spiral out-of- control.

It means that a rural community health center in an area desperately in need of dental services may not be able to expand the facility and purchase dental chairs, X-ray machines and other major dental equipment needed for the desired expansion into dental services.

It means that even if Federal Government is willing to commit grant funds to open a new health center in one of the hundreds of underserved communities nationwide which lacks any health care professionals for miles around, the new center may never come to be due to lack of funding for a facility in which to house it.

This is more than theory--the evidence shows that many existing health centers operate in facilities that desperately need renovation or modernization. Approximately one of every three health centers reside in a building more than 30 years old, and one of every eight operate out of a facility more than half a century old.

Moreover, a recent survey of health centers in 12 states showed that more than two-thirds of health centers had a specifically-identified need to renovate, expand, or replace their current facility. The average cost of a needed capital project was $1.8 million, and the needs ranged from ``small'' projects of $400,000 to major $5 million efforts. The survey demonstrates that there may be as much as $1.2 billion in unmet capital needs in our nation's health centers.

And that is just for existing health centers. As I mentioned, hundreds of

medically-underserved areas lack--and could desperately use--the services of a health center. This further shows the need for new facilities--and more capital--as we expand access to new communities.

So what about possible sources of capital? There are plenty of ways-- in theory--that health centers might be able to get money for capital improvements. Businesses--large and small--do it all the time. So do other nonprofit organizations like universities and hospitals. They use built-up equity. They take out loans. They float bonds. They raise money through private donations as part of a capital campaign.

But unfortunately, health centers just aren't quite like most other businesses or nonprofits, and many times these options are unrealistic as a way to provide the entire cost of a major project.

Health centers simply don't have loads of cash in the bank. The revenue these clinics are able to cobble together from federal grants, low-income patients, Medicaid, private donations, and other health insurers is typically all put back into to patient care.

Health centers already work hard to maximize the money they can raise through private donations and non-Federal grant sources. In fact, an average of 9 percent of health center revenue comes from these sources. Most of this private and public funding is used to meet operating expenses, and it is difficult to go back to the same sources to request further donations for capital needs. In fundraising, health centers also face a huge disadvantage compared to nonprofit organizations like universities and hospitals because health centers lack a natural middle- and upper-class donor base. And raising private funds is particularly hard in isolated rural areas that are often quite poor and which can have the most dire health care access problems.

Finally, health centers have difficulties obtaining private loans for capital needs for a variety of reasons. The high number of uninsured patients health centers treat and the poor reimbursement rates received from most Medicaid programs mean health centers rarely have significant operating margins. Without these margins, banks are leery about loans because they don't feel assured that a health center will have sufficient cash flow to successfully manage loan payments. Banks are made even more nervous by the high proportion of health center revenue that comes from sometimes-unreliable government sources--such as the health centers' grant funding and Medicine and Medicaid reimbursements.

So what should we do? This isn't exactly rocket science. We have a need--many health centers require significant help to build or maintain adequate facilities because they can't raise the money or obtain the loans themselves. And we have an existing law that prevents the federal government from using health center funding to do exactly that.

We simply need to get rid of the artificial distinction we have right now and allow our health center grant dollars to go to further the health center mission in the best way possible--and that is going to mean at times that we should support some new construction or major renovation projects. If a crumbling building is constantly in need of repair, is soaking up money, and is reducing the number of patients a health center can reach out to, the Federal Government should help with the major renovation or the new construction needed.

The Building Better Health Centers Act authorizes the Federal Government to make grants to health centers for facility construction, modernization, replacement, and major equipment purchases. If our goal is to help health centers provide high-quality care to as many uninsured and medically-underserved people as possible, we need to get rid of barriers to doing that, including capital barriers.

Behond just the possibility of grant funding, the bill goes further and permits the Federal Government to guarantee loans made by a bank or another private lender to a health center to construct, replace, modernize, or expand a health center facility. This loan guarantee is an additional tool that will help allay the fears of banks and other private lenders by limiting their exposure if a health center defaults on a loan. An additional advantage of loan guarantees is that you can stretch funds farther. When guaranteeing a $1 million loan, the Federal Government need only set aside a much smaller amount of appropriated money--perhaps only a twelfth to a tenth of the loan total--to insure against that loan's possible default. This multiplier factor means that for every dollar appropriated for this purpose, many dollars worth of loans can be guaranteed.

There is actually tremendous potential for these two new options--the facility grants and the facility loan guarantees--to work together. Sharing in up-front costs through grant funding, and helping further by guaranteeing a loan that covers the remainder of a project's cost may well be the best approach. This will balance the need to make sure specific projects get enough grant funding to make them realistic and the need to spread capital assistance among as many projects as possible.

Let my try to respond in advance to a few potential criticism of this legislation. First, to those who simply think on principle that the government should stay out of private-sector bricks and mortar projects, I would say we're already at least halfway pregnant. In just about every appropriations bill, we have dozens if not hundreds of specific projects earmarked for major building or renovation projects.

Some might worry that the potential large costs of construction projects could get out of hand and squeeze out funding actually used for patient care. But let me point out that we limit capital assistance to five percent of all health center funding. Based on this year's funding level, this would mean up to $75 million for facility grants and loan guarantees. Because the loan guarantee program would allow some of this money to be stretched, this level of support could easily mean help for more than $200 million in health center capital projects. But the main point is that capital projects are absolutely limited to five-percent of health center funding, which prevents any possible runaway spending.

Finally, we should ask ourselves whether or not Federal assistance is going to give a free pass to communities, which really should be expected to help out with public-minded projects like the construction or renovation of a health center. In my bill, local communities are expected to help. No more than 90 percent of the total costs of a major project can come from Federal sources--and this is the absolute upper limit. Much more likely are evenly-shared costs or situations in which federal support represents a minority of the capital investment. This bill does not give local areas a free ride.

The quick rationale for this bill is simple. Many health centers are hampered in their efforts to provide health care to the medically- underserved by inadequate facilities. It doesn't make sense to help these vital community clinics only with day-to-day expenses if their building is literally crumbling around them.

I urge my colleagues to join me in supporting this legislation. I look forward to working with my colleagues in the Senate and on the Health, Education, Labor, and Pensions Committee to aggressively help our nation's health centers meet their dire capital needs by making this bill law.

Mr. President, I rise today to introduce an important piece of new legislation to help an essential part of our health care safety net--our Nation's health centers--serve the uninsured and medically- underserved.

The Building Better Health Centers Act will promote health centers' mission of providing care to anyone who needs it by getting rid of an artificial distinction existing in current law. Right now, federal grant dollars to health centers can be used for most things a health center needs to do--including salaries, supplies, and basic upkeep. But federal grants to health centers cannot be used for one of the most critical and expensive needs a health center, or any business or nonprofit organizations, will ever face--capital improvements.

Unless we correct this silly distinction, many of our health centers are destined to be shackled to slowly deteriorating facilities. Over time, this will sap their ability to provide care. If we are serious about maximizing health centers' ability to deal with our health care access needs, we must allow Federal grant dollars to be used to meet our health centers' capital needs.

I've been down here on the Senate floor many times to talk about health centers, but let me cover the basics once again. Health centers--which include community health centers, migrant health centers, homeless health centers, and public housing health centers-- address the health care access problem by providing primary care service in thousands of rural and urban medically-underserved communities throughout the United States.

And as we all know, the health care access problem remains a serious issue in our country. Many health care experts believe that Americans' lack of access to basic health services is our single most pressing health care problem. Nearly 50 million Americans do not have access to a primary care provider, whether they are insured or not. In addition, over 41 million Americans lack health insurance and have difficulty accessing care due to the inability to pay.

Health centers help fill part of this void. More than 3,400 health center clinics nationwide provide basic health care services to more than 12 million Americans, almost 8 million minorities, nearly 850,000 farmworkers, and almost 750,000 homeless individuals each year. The care they provide has been repeatedly shown by studies to be high- quality and cost-effective. In fact, health centers are one of the best health care bargains around--the average yearly cost for a health center patient is just over one dollar per day.

I believe that one of the most effective ways to address our health care access problem is by dramatically expanding access to health centers. And I am pleased to report a strong consensus is developing to do exactly that. The Senate has voted in support of a proposal I have made with Sen. Hollings to double access to health centers by doubling funding over a five-year period. In addition, President Bush has proposed that we double the number of people that health centers care in the years ahead.

But over the next few years, as we hopefully see additional resources flow to health centers, we will increasingly encounter problems that stem from an artificial distinction we see in current law. As I mentioned, Federal health center grants are currently allowed to be used for most purposes--including salaries for health professionals and administrators, medical supplies, basic upkeep of clinic facilities, even lease payments if the health center rents. But they simply cannot be used for capital improvements.

This means that unless health centers can find some other way to finance their capital needs--and I will talk in a moment about the significant barriers they face in doing this--major projects that could provide substantial benefit to patients will never happen.

It means that an urban community health center that has been slowly expanding staff and services over many years until it's bursting at the seams of its modest two-story building will have to continue to find ways to cope, even if that prevents additionally-needed expansion or even if upkeep costs on the old building begin to spiral out-of- control.

It means that a rural community health center in an area desperately in need of dental services may not be able to expand the facility and purchase dental chairs, X-ray machines and other major dental equipment needed for the desired expansion into dental services.

It means that even if Federal Government is willing to commit grant funds to open a new health center in one of the hundreds of underserved communities nationwide which lacks any health care professionals for miles around, the new center may never come to be due to lack of funding for a facility in which to house it.

This is more than theory--the evidence shows that many existing health centers operate in facilities that desperately need renovation or modernization. Approximately one of every three health centers reside in a building more than 30 years old, and one of every eight operate out of a facility more than half a century old.

Moreover, a recent survey of health centers in 12 states showed that more than two-thirds of health centers had a specifically-identified need to renovate, expand, or replace their current facility. The average cost of a needed capital project was $1.8 million, and the needs ranged from ``small'' projects of $400,000 to major $5 million efforts. The survey demonstrates that there may be as much as $1.2 billion in unmet capital needs in our nation's health centers.

And that is just for existing health centers. As I mentioned, hundreds of

medically-underserved areas lack--and could desperately use--the services of a health center. This further shows the need for new facilities--and more capital--as we expand access to new communities.

So what about possible sources of capital? There are plenty of ways-- in theory--that health centers might be able to get money for capital improvements. Businesses--large and small--do it all the time. So do other nonprofit organizations like universities and hospitals. They use built-up equity. They take out loans. They float bonds. They raise money through private donations as part of a capital campaign.

But unfortunately, health centers just aren't quite like most other businesses or nonprofits, and many times these options are unrealistic as a way to provide the entire cost of a major project.

Health centers simply don't have loads of cash in the bank. The revenue these clinics are able to cobble together from federal grants, low-income patients, Medicaid, private donations, and other health insurers is typically all put back into to patient care.

Health centers already work hard to maximize the money they can raise through private donations and non-Federal grant sources. In fact, an average of 9 percent of health center revenue comes from these sources. Most of this private and public funding is used to meet operating expenses, and it is difficult to go back to the same sources to request further donations for capital needs. In fundraising, health centers also face a huge disadvantage compared to nonprofit organizations like universities and hospitals because health centers lack a natural middle- and upper-class donor base. And raising private funds is particularly hard in isolated rural areas that are often quite poor and which can have the most dire health care access problems.

Finally, health centers have difficulties obtaining private loans for capital needs for a variety of reasons. The high number of uninsured patients health centers treat and the poor reimbursement rates received from most Medicaid programs mean health centers rarely have significant operating margins. Without these margins, banks are leery about loans because they don't feel assured that a health center will have sufficient cash flow to successfully manage loan payments. Banks are made even more nervous by the high proportion of health center revenue that comes from sometimes-unreliable government sources--such as the health centers' grant funding and Medicine and Medicaid reimbursements.

So what should we do? This isn't exactly rocket science. We have a need--many health centers require significant help to build or maintain adequate facilities because they can't raise the money or obtain the loans themselves. And we have an existing law that prevents the federal government from using health center funding to do exactly that.

We simply need to get rid of the artificial distinction we have right now and allow our health center grant dollars to go to further the health center mission in the best way possible--and that is going to mean at times that we should support some new construction or major renovation projects. If a crumbling building is constantly in need of repair, is soaking up money, and is reducing the number of patients a health center can reach out to, the Federal Government should help with the major renovation or the new construction needed.

The Building Better Health Centers Act authorizes the Federal Government to make grants to health centers for facility construction, modernization, replacement, and major equipment purchases. If our goal is to help health centers provide high-quality care to as many uninsured and medically-underserved people as possible, we need to get rid of barriers to doing that, including capital barriers.

Behond just the possibility of grant funding, the bill goes further and permits the Federal Government to guarantee loans made by a bank or another private lender to a health center to construct, replace, modernize, or expand a health center facility. This loan guarantee is an additional tool that will help allay the fears of banks and other private lenders by limiting their exposure if a health center defaults on a loan. An additional advantage of loan guarantees is that you can stretch funds farther. When guaranteeing a $1 million loan, the Federal Government need only set aside a much smaller amount of appropriated money--perhaps only a twelfth to a tenth of the loan total--to insure against that loan's possible default. This multiplier factor means that for every dollar appropriated for this purpose, many dollars worth of loans can be guaranteed.

There is actually tremendous potential for these two new options--the facility grants and the facility loan guarantees--to work together. Sharing in up-front costs through grant funding, and helping further by guaranteeing a loan that covers the remainder of a project's cost may well be the best approach. This will balance the need to make sure specific projects get enough grant funding to make them realistic and the need to spread capital assistance among as many projects as possible.

Let my try to respond in advance to a few potential criticism of this legislation. First, to those who simply think on principle that the government should stay out of private-sector bricks and mortar projects, I would say we're already at least halfway pregnant. In just about every appropriations bill, we have dozens if not hundreds of specific projects earmarked for major building or renovation projects.

Some might worry that the potential large costs of construction projects could get out of hand and squeeze out funding actually used for patient care. But let me point out that we limit capital assistance to five percent of all health center funding. Based on this year's funding level, this would mean up to $75 million for facility grants and loan guarantees. Because the loan guarantee program would allow some of this money to be stretched, this level of support could easily mean help for more than $200 million in health center capital projects. But the main point is that capital projects are absolutely limited to five-percent of health center funding, which prevents any possible runaway spending.

Finally, we should ask ourselves whether or not Federal assistance is going to give a free pass to communities, which really should be expected to help out with public-minded projects like the construction or renovation of a health center. In my bill, local communities are expected to help. No more than 90 percent of the total costs of a major project can come from Federal sources--and this is the absolute upper limit. Much more likely are evenly-shared costs or situations in which federal support represents a minority of the capital investment. This bill does not give local areas a free ride.

The quick rationale for this bill is simple. Many health centers are hampered in their efforts to provide health care to the medically- underserved by inadequate facilities. It doesn't make sense to help these vital community clinics only with day-to-day expenses if their building is literally crumbling around them.

I urge my colleagues to join me in supporting this legislation. I look forward to working with my colleagues in the Senate and on the Health, Education, Labor, and Pensions Committee to aggressively help our nation's health centers meet their dire capital needs by making this bill law.

Mr. President, I rise today to introduce important legislation, the Resolution to Expand Access to Community Health Centers, or the REACH Initiative. This resolution will continue to expand access to health care for the medically underserved by doubling funding for our nation's community health centers. I am joined in this effort by my good friend from South Carolina, Sen. Hollings.

The goal of the REACH Initiative is simple--to make sure more people have access to health care. During the last session of Congress we set out an ambitious plan to double the federal funding for community health centers by 2006. Congress responded by increasing the funding for the program and now we are calling on Congress to continue this effort and complete the doubling plan.

Health centers are already helping millions of Americans get health care. But they can still help millions more--pregnant women, children, and anyone else who desperately needs care. The REACH Initiative will allow another 10 million women, children, and others in need to receive care at health centers by 2006. And since we began this effort, we've already increased the number of health center patients by nearly 3 million, and increased federal funding by nearly 30 percent. We're on track, we just need to stay there; and that's just what this resolution will do--keep us on track to double this important program.

Simply put, we must achieve the goal of the REACH initiative--and we can and should make it happen.

Let me close with what this initiative means in human terms.

The REACH initiative will help make sure that a young woman who has just found out she is pregnant but does not have health insurance has a place to get prenatal care so she does not risk her health and the baby's health by waiting until late in the pregnancy.

The REACH initiative will help make sure that a 6-year-old boy who is living in a deep rural Missouri community, a community that otherwise would not have any health care providers at all, has a place to get regular checkups so he can stay healthy at home and in school.

The REACH initiative will help make sure a young couple without any place to go will be able to get their infant daughter immunized to protect her from a variety of dreaded disease.

These Americans, and millions like them, are the reasons why we must make the REACH Initiative a reality. I invite my colleagues to join me as a cosponsor of this resolution. If we work together, we can make a difference and deliver care to those who are in the greatest need.

Mr. President, I ask unanimous consent that a congressional fellow in my office, David Napoliello, be granted the privilege of the floor for the remainder of the consideration of S. Con. 23.

Mr. President, I rise to pay tribute to Fire Chief Steve Paulsell who for the past 25 years has been Chief of the Fire District in Boone County, MO. When Mr. Paulsell became Fire Chief in 1997, the fire department was volunteer and consisted of six stations and 50 firefighters. Under Chief Paulsell's supervision, the fire district has become a national leader in fire and emergency service. Chief Paulsell's departmental accomplishments include: growth from six to fourteen fire stations in 2003, over 300 volunteer personnel, creation of one of 28 Federal Emergency Management Agency urban search and rescue task forces, an FBI accredited bomb squad, award-winning elementary school education life safety program, creation of fire and building codes in Boone County, and original creator of the Joint Communications 911 Center. Chief Paulsell's personal accomplishments include: International Association of Fire Chief's Fire Chief of the Year in 1996, chair of the Missouri Fire Service Alliance, National Fire Academy course developer, and developer of Missouri State Fire Mutual Aid system. In addition to these accomplishments, Mr. Paulsell has testified on behalf of the Nation's fire service to the Senate.

Boone County Fire District Board President Willis Smith praises Chief Paulsell and states, ``He was the right man to lead our fire department in 1977 and he is still the right man to lead. He has the vision, insight and leadership abilities to continue to grow this department.'' I commend Boone County Fire Chief Steve Paulsell for his dedicated service to protecting and improving the quality of fire and emergency services for Missourians, and for making the Boone County Fire District a model for our country.

Madam President, I rise today to congratulate three outstanding eighth grade students from Nipher Middle School in Kirkwood, MO: Rebecca Peterson, Roger Alessi, and Cait Hafer. These three students won National Engineers Week Regional Future City Competition.

The National Engineers Week Future City Competition provides a fun and exciting educational engineering program for seventh and eighth- grade students that combines a stimulating engineering challenge with a hands-on application to present their vision of a city of the future. As a part of the competition these students designed a city of the future which included decisions on population, waste management and how the city would be run. After they designed the city, they constructed a model of the city from recycled materials, completed an essay, and presented an oral presentation.

These students have not only shown great leadership and team work, but they have also exemplified excellence in problem solving and creativity. They have demonstrated merit in math, science, and computer knowledge and I commend these exemplary students on their hard work and this well deserved honor.

Madam President, it is a great pleasure today to be able to welcome my new colleague from Missouri to this body. I think he will find, since we are not limited to 1 minute on this side of the Capitol, that remarks are not nearly as concise as they would be in the other body. But certainly his experience there will be of great value.

I have been proud and pleased to know Jim Talent and his wonderful family for many years in the State of Missouri. I knew him when he served as the Republican leader in the legislature. I worked with him closely when he was the chairman of the Small Business Committee in the House. There was a time when the State of Missouri had double duty in small business and it was a pleasure to work with him then.

I also know his children and his wonderful wife, Brenda. They are a great family. They make a great team. This fall I got to see a lot of them. They give him the courage and the support he needs to do an excellent job.

We also were very saddened that his father, who meant so much to him, did not live to see him achieve this victory in the end of the campaign. He lost his father and, while it was quite a blow to him, he persevered. It was a mark of the man that he came through these very difficult times.

I know this body will benefit from Jim Talent's contributions. He has been a champion for association health plans, which I think are essential for enabling small businesses to participate in the competitive marketplace, to secure health insurance for employees and their families. Jim has championed this idea on the House side. I know it is a top priority of the President and the Secretary of Labor, and it is good to have him leading this charge in the Senate now, along with Chairman Snowe and the other members of the Small Business Committee and people who are supportive of small business in the Senate.

Obviously, as has been said, the benefit of an AHP, or association health plan, is by allowing small businesses with similar interests across State lines, across the country, to come together in one pool; they can gain the efficiencies of purchasing in volume; They can gain the advantages of administering overhead, which can be spread across many businesses. For the same reason that you pay less for soda in cans if you buy it by the case, or multiple cases, than if you buy it one at a time, buying health care is much the same. No. 1, you get efficiencies of scale. You also have an opportunity to spread the risks. Those who have taken time to study health care know that the broader the pool, the broader the actuarial component is, the more reasonable the limits will be.

I see my colleague from Massachusetts is ready to take the floor.

I thank my colleague. I appreciate the indulgence of the Members on the floor.

I yield the floor.

Will the Senator yield?

Mr. President, I ask the Senator from Utah, who has experience with the entire judicial process. As one who has served as a law clerk, I ask is it not commonplace for law clerks, for assistants, to write memoranda that do not necessarily reflect their views, but are designed to explain the rulings made by the judge or other lawyer or solicitor who may serve?

Is it the experience and knowledge of the distinguished chairman of the committee that the legal scholarship may be shown by these rulings, by these drafts, but they do not in any way reflect, necessarily, the views of the clerk or the assistant?

Is it not true, then, that perhaps the best judge of the legal capabilities of a law clerk, Assistant Solicitor General, or assistant attorney would be those for whom that clerk or assistant worked?

Mr. President, there is something very troubling that I wish to pursue and that is whether a nominee----

Mr. President, I will ask the question of the Senator from Utah, who happens to be in the line of sight of the Chair, both of whom I respect. I will focus the question to the Senator from Utah. Do you share the concern that should a clerk, assistant counsel to a U.S. Senator, or perhaps a Member of the other body, be nominated for a judicial position, under this principle enunciated by our friends on the other side of the aisle the nominee would have to turn over all of the papers prepared for that Senator, or that House Member, or the committee for which that nominee may have worked?

That is the question I am asking, the same principle. Would the same principle apply, that someone who had served you or me as a counsel, if nominated, would have to provide all of the memoranda, drafts, and opinions prepared, or memoranda prepared for you or me, were they to be nominated?

Mr. Chairman, would you ever----

I simply ask the question, as a Senator, would you ever consent to have confidential memoranda prepared for you by a lawyer who happened to be in your employ, who is subsequently nominated for a judicial position--would you ever consent to a wholesale turnover of all that work product prepared for you as a U.S. Senator?

Mr. President, I rise today with a heavy heart, which was lifted with the inspiring and thoughtful words of our guest Chaplain. I thank him for helping us see the greater design, the hope for the future, and the good news that we have been given by the Lord.

As did millions of Americans, I spent Saturday watching the dreams of seven brave astronauts streak back to Earth in sadness. The sadness we still feel today, and we will feel for many days, is because those seven astronauts carried our dreams with them.

That is the wonder and the magic of our space program. Our astronauts go into space in large part for those of us who cannot go. Our hearts and our spirits are their cargo. We soar and ride with them into a realm that is beyond the grasp of most men but not beyond the grasp of mankind.

Even while we engage in the somber work of recovering from this terrible accident, in recovering the crew and the Columbia itself, our thoughts have already returned to the work of ensuring the safety of the U.S. manned space flight program and of the remaining shuttles. That is one of the responsibilities entrusted to us with the funding and oversight of the space agency.

Shuttle safety is not a new issue to those of us on the Appropriations Committee--or the authorizing committee--which funds the space agency and its operations. It is our job--my wonderful friend, the Senator from Maryland, Ms. Mikulski, and me--to ensure we know and understand each crucial element of the budget that safeguards the lives of our brave astronauts.

Whether during my service as chairman or under the leadership of my able colleague from Maryland, the direction of the VA-HUD and Independent Agencies Appropriations Subcommittee has been consistent throughout. Space shuttle safety is paramount.

I am proud the subcommittee I currently chair has consistently fully funded NASA's request for manned space flight program safety. Nevertheless, nothing about manned exploration of space is or will ever be free of risk. Manned space flight is, by its very nature, life threatening. Flying a space shuttle is nothing less than hurtling across the heavens where a slightest mistake guarantees instantaneous death.

No matter how successful we are, and no matter how many safe shuttle launches we have under our belts, we can never forget the dangers inherent in space travel. We can and should never be complacent.

We have an ironclad social and moral contract with our astronauts: In return for their willingness to place themselves in jeopardy on behalf of all mankind, we in return have an obligation to provide them with all the resources required for a safe flight.

While it is our goal to eliminate risk, to be quite frank, we cannot. We can only minimize risk. That is the cruel reality of manned space flight. Some element of risk haunts every mission. And in the face of such risks, we still have Americans and international partners willing--yes, anxious--to go. They know the risks. Their families understand they are in harm's way and still they dare to live a dream that very few of us can fully appreciate. It is precisely that element of human nature that inspires us to seek challenges greater than ourselves.

To those who question the value of our space program, I ask them: How can you quantify the dreams of millions of children here and across the world? How can you quantify the spirit of discovery? What value should we place on our quest to understand our place in the universe?

Those are the questions we must ask ourselves during this period of recovery. The weeks and months ahead will be filled with questions. So far, we have too few answers.

Our questions did not begin with Saturday's terrible loss of Columbia. The subcommittee has had continuing concerns about whether the budget requests from NASA accurately reflect the full safety needs of the space agency and the shuttle program. It is reflected in our reports. It is all in the public record. I know NASA has always placed the safety of our astronauts as its highest priority, we have an obligation to ensure that the analysis of safety, no matter what the cost, is fully disclosed, understood, and addressed. We have labored to do so in the past and will continue to do so in the future.

We recognize that Congress, NASA, and the administration have to live within a budget. At the same time, we cannot allow a budget to force our hand on safety decisions. We have not done so, nor will we. I do not believe NASA has done so, nor this, nor the previous administration. Nevertheless, our concerns on VA-HUD appropriations were heightened by the March 2002 NASA Aerospace Safety Advisory Panel Report which stated that the current budget projections for the space shuttle were insufficient to accommodate significant safety upgrades, infrastructure needs, and the maintenance of critical workforce skills over the long term.

Our most recent report to the appropriations bill endorsed these concerns as well as the need for additional funding for shuttle safety upgrades. Our concerns were sufficient to request that NASA conduct an assessment of future safety needs in light of the shuttle's longer than expected operational life and use. We need to know more and we need to know more now.

NASA has already responded with a request for additional shuttle upgrades and safety funding over the next few years. This was the right response, but we need to know how much more we need to do to ensure that every funding decision continues to make the lives of our astronauts the paramount priority at NASA.

Clearly, we had concerns, and those concerns remain. We must work together to gain greater confidence in NASA's budget.

I applaud and have the highest admiration for NASA Administrator Sean O'Keefe, who is already working hard on this and many more issues at NASA. He took over a troubled agency drowning in cost overruns and out- of-control spending on the International Space Station program. He stopped the bleeding of huge cost overruns and has righted NASA's ship through responsible program management. I look forward, as do, I am sure, the rest of the Members of this body, to continuing to work with Administrator O'Keefe in our efforts to ensure the safety of our shuttle program and the well-being of our astronauts. This will, as always, remain our top priority.

Of course, we must find out what happened to the Columbia, fix the problem, and move our space program forward, as the deputy administrator for space so eloquently stated on Saturday. But this is not a simple issue. We have three international astronauts on the International Space Station, two Americans and one Russian. We need to be able to bring them home in complete safety.

The administration is moving forward with two commissions to understand what happened, and to make sure it does not happen again. In addition, I believe it is appropriate to hold a hearing in the appropriations subcommittee on shuttle funding upgrades and safety needs. This is too important an issue not to receive the full attention of the Senate. I assure my colleagues that we will work to provide whatever funding is necessary to meet the immediate needs of the space agency through the remaining months of the fiscal year.

We are currently waiting to hear back from NASA at this moment, and clearly we will provide whatever additional funds are necessary for NASA in the 2003 supplemental, as appropriate, or even if we receive a request in time in the conference report on the 2003 measure that is pending. I will convene a hearing on safety needs as soon as practicable, as soon as NASA has information for us, understanding full well that the immediate needs focus on recovery of the Columbia, the crew, and the twin investigations now underway.

At a time of such tragedy, we all function as part of a team with a single mission, to find out what went wrong, and then to take steps to make sure it never happens again. We must and we will leave no stone unturned. There are astronauts who have not yet flown but who will perhaps this year and in 10 years. They dream of carrying our hopes beyond this planet we call home. We must always keep faith with them and their families. We must honor the contract that binds us in this great endeavor.

That dream has not died with Columbia and her proud crew. Her dream lives on in the hearts of all of us who look to the heavens on a quiet night in awe and wonder, and we see the Columbia still. We mourn for the astronauts and we pray for their families. We shall always remember them, along with the Challenger and the Apollo crews. The courage of all of the astronauts shall forever inspire our dreams and brighten our hopes for the future.

Manned space exploration is a great challenge, a great opportunity. Yes, there are dangers with it, but fulfilling the hopes and the dreams of those who have gone before is our great opportunity and our obligation.

I yield the floor.

Mr. President, if I may, I wish to extend sincere thanks to the Senator from Nevada for his remarks. Senator Mikulski is and has been one of the foremost champions of NASA and its mission. She is in Houston today. I am sure we will hear from her. It is her ongoing and strong commitment to space shuttle safety that inspires and leads all of us, and I thank the distinguished assistant minority leader for his words.

Mr. President, on behalf of the majority leader, I announce that today the Senate will be in a period for morning business from now until 6 p.m., with the time equally divided. Senators have requested time to memorialize and reflect upon the Space Shuttle Columbia disaster.

There will be no rollcall votes today because many of the Senators are in Houston for the memorial service for the space shuttle crewmembers. An early adjournment this evening is expected.

I yield to the distinguished assistant minority leader.

Mr. President, I join with my good friend from Nevada in expressing our good wishes to the distinguished Senator from Kentucky, as well as our good friend, the distinguished Senator from Florida, who also has undergone a very serious operation. We are a family and our thoughts and concerns of those in this body who have had illnesses are with them. We wish them a very speedy recovery. The Senate will be a bit duller and quieter until they return, but I am confident they will do so soon.

Mr. President, I rise today to introduce the Birth Defects and Developmental Disabilities Prevention Act. It is a pleasure to work, once again, on this important issue with Senators Dodd, Frist and Kennedy.

My interest in birth defects prevention began while I was Governor. As Governor I had secured dollars to fund the neonate care units at our hospitals in Missouri. These remarkable institutions and the dedicated men and women who serve there do a tremendous job of saving low birth weight babies and babies with severe birth defects.

As I visited those hospitals and held those tiny babies, the doctors and nurses who staffed these units asked me, ``Why don't we do something to reduce the incidents of birth defects and the problems that bring the tiniest of infants to these very high-tech, specialized care units.''

Since I became a Senator I have been working with colleagues on both sides of the aisle and with the March of Dimes to deal with this serious and compelling health problem facing America.

Many people are not aware that birth defects affect over 3 percent of all births in America, and they are the leading cause of infant death. This year alone, an estimated 150,000 babies will be born with a birth defect. Among the babies who survive, birth defects often result in lifelong disability. Medical care, special education, and may other services are often required into adulthood, costing families thousands of dollars each year.

In 1998, Congress finally passed a bill I had sponsored for 3 previous sessions, the Birth Defects Prevention Act, which created a federal birth defects prevention and surveillance strategy. That was followed by the Children's Health Act of 2000, which established the National Center on Birth Defects and Developmental Disabilities at CDC. With these two important pieces of legislation Congress recognized that birth defects and developmental disabilities are major threats to children's health.

The Birth Defects and Developmental Disabilities Prevention Act revises and extends the Birth Defects Prevention Act of 1998. This bill is straightforward and has the support of the March of Dimes, Spina Bifida Association of America, the Autism Society of America, and the Coalition for Children's health among others. It: (1) Reauthorizes the National Center on Birth Defects and Developmental Disabilities for 5 years; (2) makes several technical amendments to ensure that the full scope of activities conducted by the center are included in statute; (3) authorizes CDC to collect data from educational records that are necessary to conduct surveillance on developmental disabilities-- including autism--while

protecting the privacy of individuals and their families; (4) authorizes CDC to support a National Spina Bifida Program to promote prevention and enhance the quality of life of those living with Spina Bifida; (5) authorizes CDC to conduct research and programs on the prevention of secondary conditions and the promotion of health and wellness in individuals living with disabilities; and (6) finally, the bill transfers certain members of the Advisory Committee to the Director of the National Center for Environmental Health who have expertise in birth defects, developmental disabilities and disabilities and health to the National Center on Birth Defects and Developmental Disabilities.

We have come a long way in the past 5 years toward preventing certain birth defects and developmental disabilities, but we face many challenges ahead. There is still much work to be done to improve the health of all Americans by preventing birth defects and developmental disabilities in children, promoting optimal child development and ensuring health and wellness among children and adults living with disabilities.

Today, with the introduction of this bill we have the opportunity to renew our commitment to birth defects prevention and to improve the quality of life of those living with disabilities. I look forward to working with my colleagues to ensure and enhance the well-being of our Nation's children.

Mr. President, I rise today to introduce the Birth Defects and Developmental Disabilities Prevention Act. It is a pleasure to work, once again, on this important issue with Senators Dodd, Frist and Kennedy.

My interest in birth defects prevention began while I was Governor. As Governor I had secured dollars to fund the neonate care units at our hospitals in Missouri. These remarkable institutions and the dedicated men and women who serve there do a tremendous job of saving low birth weight babies and babies with severe birth defects.

As I visited those hospitals and held those tiny babies, the doctors and nurses who staffed these units asked me, ``Why don't we do something to reduce the incidents of birth defects and the problems that bring the tiniest of infants to these very high-tech, specialized care units.''

Since I became a Senator I have been working with colleagues on both sides of the aisle and with the March of Dimes to deal with this serious and compelling health problem facing America.

Many people are not aware that birth defects affect over 3 percent of all births in America, and they are the leading cause of infant death. This year alone, an estimated 150,000 babies will be born with a birth defect. Among the babies who survive, birth defects often result in lifelong disability. Medical care, special education, and may other services are often required into adulthood, costing families thousands of dollars each year.

In 1998, Congress finally passed a bill I had sponsored for 3 previous sessions, the Birth Defects Prevention Act, which created a federal birth defects prevention and surveillance strategy. That was followed by the Children's Health Act of 2000, which established the National Center on Birth Defects and Developmental Disabilities at CDC. With these two important pieces of legislation Congress recognized that birth defects and developmental disabilities are major threats to children's health.

The Birth Defects and Developmental Disabilities Prevention Act revises and extends the Birth Defects Prevention Act of 1998. This bill is straightforward and has the support of the March of Dimes, Spina Bifida Association of America, the Autism Society of America, and the Coalition for Children's health among others. It: (1) Reauthorizes the National Center on Birth Defects and Developmental Disabilities for 5 years; (2) makes several technical amendments to ensure that the full scope of activities conducted by the center are included in statute; (3) authorizes CDC to collect data from educational records that are necessary to conduct surveillance on developmental disabilities-- including autism--while

protecting the privacy of individuals and their families; (4) authorizes CDC to support a National Spina Bifida Program to promote prevention and enhance the quality of life of those living with Spina Bifida; (5) authorizes CDC to conduct research and programs on the prevention of secondary conditions and the promotion of health and wellness in individuals living with disabilities; and (6) finally, the bill transfers certain members of the Advisory Committee to the Director of the National Center for Environmental Health who have expertise in birth defects, developmental disabilities and disabilities and health to the National Center on Birth Defects and Developmental Disabilities.

We have come a long way in the past 5 years toward preventing certain birth defects and developmental disabilities, but we face many challenges ahead. There is still much work to be done to improve the health of all Americans by preventing birth defects and developmental disabilities in children, promoting optimal child development and ensuring health and wellness among children and adults living with disabilities.

Today, with the introduction of this bill we have the opportunity to renew our commitment to birth defects prevention and to improve the quality of life of those living with disabilities. I look forward to working with my colleagues to ensure and enhance the well-being of our Nation's children.

Mr. President, I appreciate the thoughtful discussion our majority leader has given on health issues, on combating AIDS, and on the need to prepare vaccines and protection against the biological weapons that terrorists may use. It was a very important part of the President's speech last night, and certainly there is no one more qualified in this body, or elsewhere, than the distinguished majority leader, the Senator from Tennessee, to speak about these matters.

Following on the State of the Union Message, some commentators were saying today they wish the President had spoken more about the economy. He did speak about the economy. He made it clear that his goal is to see that every American who wants a job and needs a job can find one, and he proposed tax relief to make sure that the money is there for small businesses to expand and grow and hire more people.

Money for working families, for child care and health deductions on their tax returns, and putting a thousand dollars in the pocket of every American family is going to make the economy move.