Floor Statements

Mr. President, I come to the floor for the purpose of introducing a bill. The bill's title is the Nursing Home Transparency and Improvement Act of 2008.

I introduce this bill along with Senator Kohl of Wisconsin. It is a bipartisan bill. Senator Kohl, because he is in the majority, has the distinguished pleasure of serving as chairman of a special committee on aging which is also a very important responsibility, particularly since our Government spends about more than $50 billion a year on nursing home care for elderly, among other things that are the responsibility tie of that committee.

The bill that we are introducing is an important piece of legislation that aims to bring some overdue transparency to consumers regarding nursing home quality. It also provides long-needed improvements to our enforcement system.

This legislation further strengthens nursing home staff training requirements. In America today, there are over 1.7 million elderly and disabled individuals in roughly 17,000 nursing homes.

As the baby boom generation ages, that number probably will rise, unless we do something about the problems of osteoporosis and Alzheimer's and diabetes. Hopefully, we can do those things so our nursing homes do not fill up more. But those are some of the health problems that are facing 77 million baby boomers. Some of them undoubtedly will end up in nursing homes.

So we have to have not only a tremendous interest in ensuring nursing home quality based upon the number of people who are already there, but we are going to have more in the future.

While many people are using alternatives such as home care or other methods of community-based care, nursing homes are going to remain a critical option for our elderly and our disabled. I always think in terms of nursing homes being at the end of a continuum of care for people who need some help.

People want to stay in their own home. When there is a question, can they do that without endangering them, bring some help to the home, relatives or home health care types.

If that is not the right environment, then assisted living. And then other things that might eventually bring a person to a nursing home. But a nursing home is a last resort. I say that because during my tenure as chairman of the Aging Committee from 1997 to the year 2001, versus the period of time I was chairman of the Senate Finance Committee, dealing with a lot of aging issues, interacting with a lot of older people, I have never once had anybody say to me that: I am just dying to get into a nursing home.

So I think it is important we do whatever we can to keep people out of nursing homes. But there are some people, a lot of people, and a growing number of people who are going to need that type of care.

So we have to be concerned about the quality of care in nursing homes. We surely owe it to them to make sure they receive the safe and quality care they deserve. Unfortunately in many areas, the nursing homes, we have a few bad apples always spoiling the barrel. Too many Americans receive poor care, often in a subset of a nursing home.

Unfortunately, this subset of chronic offenders stays in business, in many ways keeping their poor track records hidden from the public at large and often facing little or no enforcement from the Federal Government.

As ranking member of the Senate Finance Committee, I have a longstanding commitment to ensuring that nursing home residents receive the safe and quality care we expect for our own loved ones. But this effort requires transparency, transparency in the nursing home industry so consumers are armed with information, consumers having information they need to make the best decisions possible for loved ones. This same transparency also provides additional market incentives for bad homes to improve.

This effort also requires a strong mandatory enforcement and monitoring system to ensure safe and quality care at facilities that would not take the steps needed to do so voluntarily.

The Grassley-Kohl legislation seeks to strengthen both areas, transparency and enforcement. It is a bill that is good for consumers, good for nursing home residents, and good even for the nursing home community.

Let's look at transparency. In the market for nursing home care, similar to all markets, consumers must have adequate data to make informed choices. For years people looking at a nursing home for themselves or loved ones had no way of knowing whether that home was-- this is kind of a legal term in the regulations--a ``special focus facility,'' a designation meaning they had been singled out as a consistently poor performer.

Why should consumers not have access to this information? The Government has it and so should consumers. To that end, this bill requires that the ``special focus facilities'' designation be placed on the CMS website. Nursing Home Compare is the name of that website.

By giving consumers this information, we will both give consumers information necessary to make informed choices and poorly performing homes an extra incentive to shape up or consumers then can go elsewhere.

This bill also requires more transparency about ownership information. What is so secretive about who owns a nursing home? Also, it provides transparency in inspection reports and more accountability for large nursing home chains and the development of a standardized resident complaint form so there is a clear and easy way to report problems and have them resolved.

The bill would also bring more transparency on what portion of a nursing home's spending is used for direct care for residents and also bring more uniformity to the reporting of nursing staffing levels so people can make an apples-to-apples comparison between nursing homes.

But even with improved transparency, there are some nursing homes that will not improve on their own. In the nursing home industry, most homes provide quality care on a consistent basis. But as in many sectors, this industry is given a bad name by a few bad apples that spoil the barrel.

So we need to give inspectors better enforcement tools. The current system provides incentives to correct problems only temporarily and allows homes to avoid regulatory sanctions while continuing to deliver substandard care to residents. That system must be fixed.

In ongoing correspondence that I have had with Terry Weems, the Acting Administrator of CMS, that agency has requested the statutory authority to collect civil monetary penalties sooner and hold them in escrow pending appeal. To that end, this bill requires penalties be collected within 90 days following a hearing; after that, they be held in escrow pending appeal.

Penalties should also be meaningful. Too often they are assessed at the lowest possible amount, if at all. Penalties should be more than merely the cost of doing business, they should be collected in a reasonable timeframe and should not be rescinded easily.

These changes would help prod the industry's bad actors to get their act together or get out of business. In addition to increased transparency and improved enforcement, this bill provides commonsense solutions to a number of other problems as well.

This legislation requires the Secretary of Health and Human Services to establish a national independent

monitoring program to tackle problems specific to interstate and large intrastate nursing home chains. This legislation directs the Government Accountability Office to, one, conduct studies on the role, if any, of financial problems in the poor performance of special focus facilities; identify best practices at the State level in temporary management programs; and, three, determine what are the barriers preventing the purchase of nursing homes with a record of poor quality.

Finally, in the case of nursing homes being closed due to prior safety or quality of care, the bill requires that residents and their representatives be given a sufficient notice so they can adequately plan a transfer to a better performing nursing home. I happen to be very sensitive to the fact that nursing home residents are often old and fragile. Moving them into new facilities is often very traumatic. So we have to make sure these residents are transferred appropriately and with the time and care deserved.

This bill would also strengthen training requirements for nursing staff, by including dementia and abuse prevention training as part of the preemployment training.

The Grassley-Kohl bill also requires a study on the appropriateness of increasing training requirements for nurse aids and supervisory staff.

I am proud to introduce this bill today, along with the distinguished Senator from Wisconsin, Mr. Kohl, the chairman of the Aging Committee. He and I have a long history of working on issues together, particularly for the elderly. We will continue to do everything we can to make sure America's nursing home residents receive the safe and quality care they deserve. Increasing transparency, improved enforcement tools, and strengthening training requirements will go a long way toward achieving this goal.

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

I ask unanimous consent to speak as in morning business.

Mr. Leader, I don't know, but we might want to have time.

First, Madam President, following on where Senator Baucus left off, I thank him for his remarks, and I would be glad to associate myself with them and put his words in my mouth so that I would say the same thing about him. It is a pleasure to work with him but, more importantly, a pleasure to have this opportunity to say that a product we have worked on, that was an expression of 59 Members of the Senate, is finally going to go to the President of the United States.

So I say that about Senator Baucus personally, but I also say, for those people who are listening, and who think that nothing in this city ever gets done in a bipartisan way, we are proving to the rest of the Nation that everything in Washington is not partisan and we eventually get things worked out in a bipartisan way. I will add to that: Nothing gets done in the Senate unless it is bipartisan.

I would add a second point, and that second point is that a week before the House of Representatives passed their product, the House of Representatives, Republican and Democratic leaders, reached an agreement with the White House of a so-called perfect package that was going to stimulate the economy. They wanted to get it to the

President immediately, and it was something that the Senate ought to go along with, without question. Then in a speech a week ago, I spoke here about the functions of the Senate--to distill and cool and observe and put in a laboratory the legislation that comes from the other body--and that it wasn't the function of the Senate to rubberstamp the House of Representatives.

I mean, we are not, I guess you would say, like the Senate of France, as an example, or the House of Lords of London, we are the United States Senate representing our constituents and are not a rubberstamp body.

And the Constitution was written with the Senate to give greater deliberation to legislation than what the House of Representatives does. This action right now is a perfect example of what we are set up to do as the Senate, and that perfect piece of legislation that we were told was so perfect, after it went through the process of 21 members of the Senate Finance Committee looking at it, came to the conclusion there were about three things wrong with it: 20 million seniors citizens left out. If you want to stimulate the economy, including low- income seniors as consumers in America who need to spend money as one of the chief stimulants; and then the House of Representatives did not honor the disabled veterans of America the way they should have--I should say the low-income disabled veterans of America the way they should. And then the second one was the possibility, very real possibility, of people who are here illegally maybe being able to qualify for a rebate check. So all of those are shortcomings in that perfect piece of legislation worked out between the White House and the Democratic leadership of the House of Representatives.

As intelligent as those people are, and they are intelligent, it was not so perfect. So the Senate did its work. Here we are. I am pleased we are prepared to finish the job on the economic stimulus package this very day--in fact, within a few minutes.

One week ago today, I spoke at length about the improvement the Finance Committee made in the House bill. The key improvements were on the structure of the rebate. The Finance Committee members added 20 million low-income seniors, and several hundred thousand disabled veterans are now about to be able to participate in the rebate checks.

Illegal immigrants will not benefit from the rebate checks, and they should not. I know that is a no-brainer, but it is something you have to make certain is in law because it will happen.

All these changes are a result of the work, under the leadership of Senator Baucus, of 21 members coming together to do what needed to be done to correct the House bill. Now, this took a while. But my leaders saw the light of the Finance Committee improvements.

My understanding is the House and the White House agree with us as well. Through the process, we will approve a truly bipartisan, bicameral bill. The American people will witness, in this process, a deliberative body, deliberating as we should but doing it in an expeditious way.

The best bill would be the full Finance Committee bill. That bill would have provided more business tax relief, more incentive for investment with probably longer--the certainty of the creation of more jobs. And, of course, we had an energy investment package in it.

Well, those will come up another time. My colleagues who favor those issues are not going to be left out in the cold. The House and the White House did not want these provisions in this bill. So in the interests of compromise, those provisions are dropped but not dropped out of sight.

I wish to thank our leaders for accepting, after some reluctance, the Finance Committee changes. We have a better product because the chairman and the committee process has worked. The committee members made this a better deal, and I thank Chairman Baucus for his leadership.

Madam President, I ask unanimous consent when we come back to this side, Senator Alexander would have 5 minutes.

Madam President, I ask unanimous consent that Senator Snowe be added as an original cosponsor to the amendment.

Mr. President, we have come down to the crucial vote on whether we are going to greatly improve the House stimulus bill. In a few minutes, all Senators will have to undergo that balancing exercise I referred to last week.

On one hand, you have the legitimate concerns on the part of the House, White House, and Senate Republican. Leadership. That concern is that a wide open Senate process would slow down and complicate a straightforward House bill. Those who hold this view correctly point out that the House bill was the product of tough negotiations.

The White House and House Republicans made concessions in that negotiation. Likewise, House Democrats made concessions in that negotiation. Supporters of the House bill emphasize the need for speedy action to send the signal to workers, investors, and business people that the Federal Government is responding to the slowing economy.

On the other hand, are concerns about the substance of the House bill and a truncated process that limits the role of the Senate.

It comes down to this, Mr. President. The leaders' concern with timing must be weighed against the question of the quality of the House bill. In other words, is a take-it or leave-it House bill, which passes quickly, better than a Senate bill which allows the Senate to work its will.

I have laid out the leaders' concerns about timing. Now, we question of the adequacy of the House bill. That is the other side of the balance we need to strike.

Let's examine this side of the question. Asked another way, did the committee process improve the House bill with a Senate amendment?

I think everyone would have to answer yes. That is, the Finance Committee amendment is an improvement over the House bill. Twenty million seniors will get the checks. Over 200,000 disabled veterans will get the checks. Illegal immigrants will not be entitled to checks. These improvements to the rebate structure were the direct result of deliberations in the Finance Committee. They were contributions by members on each side. We improved the business stimulus provisions as well.

Our goal was a bipartisan economic stimulus package. The committee worked its will and improved the bill. The committee bill responded to the needs of Americans and business and, if enacted, would provide a very much needed boost for the economy.

The best proof of this point is the concession by opponents of the Finance Committee bill that the House bill must be changed on the structure of the rebate.

Before you vote, I ask Members to go back to the basic question of balancing quick action on the House bill versus improvements made by the Finance Committee.

The House bill could be passed quickly without improvements. Or we could finish the process here in the Senate and add the improvements made by the Finance Committee.

If cloture is achieved on the Finance Committee amendment, then we will have a different challenge.

We must not load up this stimulus package else further or it is likely to sink. Our leaders are right that we need to act quickly.

Mr. President, today I give tribute to an American hero who was killed in the line of duty while conducting combat operations for Operation Enduring Freedom in Barikowt, Afghanistan. SSG Robert J. Miller was wounded by small arms fire and died from these injuries sustained on January 25, 2008. His bravery and selflessness will be remembered and honored. I extend my thoughts and prayers to his parents, Philip and Maureen Miller, and all his family and friends.

Robert Miller was born in Harrisburg, PA, and eventually found his way to the University of Iowa, where he attended his freshman year. Miller was an avid gymnast who aspired to be on the university's gymnastics team and was an enthusiastic fan of the Hawkeyes. After a year of attending the University of Iowa, he decided to enlist in the U.S. Army in 2003. He earned a green beret from the special forces qualification course in 2005. During his years of service, he has been awarded numerous medals including the Army Commendation Medal with Valor, Army Good Conduct Medal, and Global War on Terrorism Service Medal, among others.

Staff Sergeant Miller was assigned to Company A of the 3rd Battalion, 3rd Special Forces Group out of Fort Bragg, NC. He will be remembered for his courageous sacrifice and excellent work ethic. His mother Maureen said it best: ``We're proud of what he did, and we loved what we did. He died a hero.'' I ask my colleagues here in the Senate and all Americans to remember with gratitude and appreciation a brave soldier, SSG Robert J. Miller.

Mr. President, I think if it is just the two of you ahead of me, I will be glad to wait.

Madam President, I will speak on the stimulus package. Before I give a general overview of it, I want to say something about one of the several mistakes, or oversights, that is in the House bill. I don't mean to imply that these were known as oversights at the time. But one stands out so strongly you wonder whether the House is consistent in its approach to the issue of illegal aliens. I will speak from the standpoint of my experience with the children's health insurance bill.

You may be familiar with this phrase: ``Where you stand depends upon where you sit.'' Nothing better illustrates that point than this debate and the issue of rebates for illegal immigrants. We are told we must pass the House bill and that changes are unnecessary. In other words, somehow you assume the House of Representatives passed the perfect bill and we ought to rubberstamp it. I disagree. I think the House bill makes it too easy in several areas, but especially in the area of illegal immigrants, to get rebate checks. According to Numbers USA, the House bill could allow as many as 3 million illegal immigrants to receive rebate checks. The House minority leader's spokesman was quoted in the press as saying:

There is no language in the measure that would enable

illegal immigrants to receive a tax rebate.

There is no language whatsoever in the House bill that would prevent an illegal immigrant from receiving one of these tax rebate checks. My colleagues on the other side of the Rotunda should be quite familiar with this line of reasoning, because they devoted countless times on the House floor last fall trying to convince people that because the SCHIP bill didn't explicitly prevent States from covering children up to 400 percent of poverty, it must mean States can cover kids up to 400 percent of poverty.

The same folks who want us to believe the House bill is fine said we hadn't done enough to prevent illegal immigrants from receiving benefits in SCHIP, even though the SCHIP bill had this very language:

Nothing in this Act allows Federal payment for individuals

who are not legal residents. Titles 11, 19, and 21 of the

Social Security Act provide for the disallowance of Federal

financial participation for erroneous expenditures under

Medicaid and under SCHIP respectively.

That was in our bill that passed last year. It is amazing how the standard has changed. The same people who said the language I just read wasn't good enough when we took up the children's health insurance program are now saying no language whatsoever is fine.

The simple fact is the House bill allows illegal immigrants to get rebate checks, plain and simple. It is important for us to fix that, and I believe we will before the bill leaves the Senate. We should not give rebate checks to people who have come to this country illegally, and we should give the House of Representatives an opportunity to fix this huge mistake that is in the bill they sent to us. I cannot imagine why anyone on the House side would complain about our doing that after all the uprising we had last fall about the Senate even considering the language I read--didn't do enough to prevent people here illegally-- meaning illegal immigrants--from getting children's health insurance program. My recent experience in negotiating with the House on the issue of illegal immigrants and public benefits taught me that certain folks seem to care quite a lot about that issue, except somehow it was an oversight in this tax rebate bill.

I will quote from the debate on the SCHIP bill in the House of Representatives of October 25 of last year. I will not actually quote the Members by name. You can find it in the Congressional Record if you want to know who said it, but it doesn't matter who said it. It was an overwhelming opinion of people in that body--particularly Republicans. One Member alleged that the SCHIP bill tried ``to give benefits to illegal immigrants while we still have Americans unserved.'' He went on to say, ``that is not right. This is not fair. This is not democratic.''

Suppose I put ``tax rebates'' in there in place of ``benefits,'' and paraphrase it this way, with the same quote: ``To give [tax rebates] to illegal immigrants while we still have Americans unserved. That is not right. This is not fair. This is not democratic.''

Well, let's go on. If it weren't right there in the SCHIP bill, it is surely not right here in this tax bill. It is also not fair. We should not leave some Americans unserved when it comes to rebates, such as seniors and disabled veterans, as they did in the House of Representatives, while we are going to let illegal immigrants get rebate checks.

I want to give you another quote. This is also from the same day, October 25:

I don't think our constituents want us to vote for a bill

that makes it easier for illegal immigrants to get tax-paid

health care.

That is the SCHIP bill.

I think this bill does that.

So if that were the case, then I would think that Member of the House would not want to make it easier for illegal immigrants to get tax-paid rebate checks.

Finally, here is a quote from September 25, 1 month before that, in debate on the SCHIP program in the other body, from a Member who used to chair one of the committees of jurisdiction over there:

What that means is that they want illegal residents of the

United States of America to get these benefits. This is what

the objection means. So for that reason alone, I would ask

that we vote against this bill.

``For that reason alone,'' he said--regardless of what else is good about the bill, including the language the Senate put in, which was meant not to give the SCHIP program money to illegal aliens. It still wasn't enough. Yet now that tax rebate bill comes over from that very same body and would let illegal immigrants get rebate checks.

So I say, for that reason alone, it is a reason for this body to defy people in that body who said we should not have changed the Senate bill one iota. To my colleagues on the House side, the shoe is now on the other foot. The same principle that applied then should apply now. If you felt strongly enough to stop the SCHIP bill over your concerns about illegal immigrants receiving public benefits, then you certainly should not object to the Senate repairing a bill you sent us that would allow illegal immigrants to get a rebate check. You cared about it then; you should care about it now. You said it wasn't right then. Well, it is not right now. You said it wasn't fair then. Well, it is not fair now. The Senate will fix it. It was a mistake that the Senate will fix.

Let's get back to some history about the purpose of the Senate. For anybody to think a bill would come over here from the other body without fair consideration by this body, I have used this example before, and I don't know whether George Washington actually said this, but it has been in the history books so long that it is fact as far as I am concerned. He was trying to demonstrate to people then about the new Constitution and the purpose of the House and the Senate. He had a cup of coffee on a saucer. The cup with the coffee in it was the House and the saucer was the Senate. The hot coffee in the cup was a piece of legislation, I assume. So what he did to explain the

difference between the House and Senate is say this is the House of Representatives writing a bill. Then he poured out the hot coffee into the saucer. I don't know whether we do it anymore or not--I don't do it, but I have seen it demonstrated that you can pour it out to cool so you don't burn your tongue. He explained that the Senate's role was to give deep consideration, to let the pressure that comes upon a body that is elected for a 2-year period of time--a body that might be more responsible to the transient will of the majority, that that transient will of the majority needed to have a body to kind of rethink things, maybe verify that what the House did was absolutely right, or maybe verify that everything they did was absolutely wrong, or that a few changes might be made. And then, after that, the Senate passes the bill and it goes on its merry way to the President of the United States.

But I believe that people I have heard from lately, including, I guess, even our own President of the United States, have said that somehow the Senate ought to automatically take what the House did and forget all about the historical purpose of the Senate, and be on our way, with these mistakes in it--that a person who is illegally in this country could get a rebate check, when I doubt, if we are taking the needs of all of the people, that can help us revitalize this economy, through rebate checks and through enhanced investment.

Madam President, I also came to the floor to discuss this bill generally. I will start by thanking Chairman Baucus for his courtesy, hard work, and patience in this legislative effort. As we have in the past, we wanted to process the economic stimulus issue through the committee. That process started shortly after this session of Congress opened. We talked substance and process. We had discussions with the administration, especially Secretary Paulson. We had discussions with our leaders. We had two private meetings and took input from our committee members. We had two hearings on an economic stimulus.

Our goal in the Finance Committee was a bipartisan economic stimulus package. We both wanted a bipartisan economic stimulus package that responded to the needs of Americans and business and would provide a much needed boost for the economy. During this same period, the President sent a strong message that Congress must act, and Congress ought to act quickly to design a fiscal stimulus package aimed at boosting the economy. The President said such a plan would provide a ``shot in the arm'' to keep the economy healthy.

Last week, the bipartisan, bicameral congressional leadership met with the President. At that meeting, the Senate leaders more or less yielded the legislative process and the substance of this important question to the House and the Senate. In other words, Senate leaders agreed that whatever package the House leadership and White House agreed on would be treated as a fait accompli in the Senate. The Senate leadership's sudden shift in direction caught Chairman Baucus and me by surprise and, as I noted above, we had already engaged in the committee process for several weeks.

We were fully engaged on a member and staff level. Many of our members and staff brought to the table the experience from three stimulus bills earlier this decade.

I respect the role of leaders here. My guess is Chairman Baucus and two-thirds of the committee members who supported the bill yesterday also respect the role of our leaders. Many in the leadership on my side of the aisle worried about the problem that might arise if the Senate had no role other than to rubberstamp the House bill. They are rightly concerned about the Senate processing a bill, dragging it out, and loading up the bill. Certainly, that is a reasonable concern. Certainly, that is something we find happening often in the Senate. But is that concern in itself so great that the Senate should abdicate all of its legislative responsibility? Is that concern so great that the Finance Committee members should have no say over legislation falling within its jurisdiction?

In my almost quarter century of service on the Finance Committee, I am not aware of any precedent such as this. I am also not aware of any precedent on the House side. At the end of last session, some in the House side might have complained about the outcome of legislation favoring the Senate position. I am not, however, aware of a situation where House leaders on either side virtually ceded their role in legislating on a tax bill this important. As I said, I respect the concerns of leaders about timing.

It comes down to this: The leaders' concerns with timing might weigh against the question of the quality of the House bill. In other words, is a ``take it or leave it'' House bill which passes quickly better than a Senate bill which allows the Senate to work its will?

I have laid out the leaders' concern about timing. Now we question the adequacy of the House bill. That is the other side of the balance we need to strike. I know other members on both sides have asked themselves the same questions, including Chairman Baucus. Chairman Baucus makes the ultimate call. Even if I had decided the importance of quick action outweighed the benefits of going through the committee process, the chairman would have made the ultimate call to go ahead. That was the call the chairman made back in 2002, and it was the call he made this time.

In 2002, I disagreed on the substance, and we had a party line markup, but the committee did process the stimulus bill. So to anyone on my side who says my opposition would have stopped the chairman from going forward, check the history books. It did not stop the committee in 2002, and it will not stop it now.

The same outcome occurred in 2003, when I was chairman of the committee and Senator Baucus was the ranking member. We went forward in 2003. This time we were able to proceed in a bipartisan manner, and what did the committee process yield? Let's examine this side of the question. Asked another way: Did the committee process improve the House bill with Senate amendments?

One thing I heard loudly and clearly from Republicans was concerns about suffocating income limits. The chairman heard me out and agreed to eliminate them. Unfortunately, the support from the Republican side of the aisle did not line up with the principle I heard from them that they wanted included in the bill as a correction to the House bill.

On the chairman's side of the aisle, meaning the Democratic side of the aisle, there was great controversy over taking those limits off. We heard the uncapped proposal over and over defined as something specifically benefiting Bill and Melinda Gates.

To those on the left, let me tell you there must be a lot of Bill and Melinda Gateses out there. The reason I say that is $12 billion of rebate checks is involved in going back to the House income caps. With the amount of checks capped, it means there are millions of families, not a few millionaires, who are being affected.

As I said, those facts did not move many on my side away from the House bill that contains those caps, so I revisited the issue with the chairman. The caps are back, but at a much higher level. They begin to phase out at $150,000 for single taxpayers and $300,000 for married taxpayers.

So we include a few more middle-income people. That is double the House income limits, helping more middle-income people.

It is safe to say the higher income limits will aid a lot of alternative minimum tax-paying families we hear about. From my perspective, this is a big improvement over the House bill. So if you support the Finance Committee bill, you are recognizing the burden these taxpayers' families bear through the AMT. I don't want to hear any more demagoguery about Bill and Melinda Gates getting checks because there is not going to be any more billionaires getting checks, no millionaires getting checks, no ``half millionaires'' getting checks. But a lot of upper middle-income families who will not get a check under the House bill will get a check under the Finance Committee amendments.

Most on my side would consider these higher income caps an improvement of the House bill. I particularly credit Senators Crapo and Kyl for bringing up this point in our Finance Committee meetings.

Some on the other side, especially those from high-income, high-tax blue States, will quietly support this change as well but not echo it because they don't want to face the chagrin of Members who think that nobody on the Democratic side ought to be concerned about anybody who has a little higher income.

At the other end of the income scale are 20 million low-income seniors. I underscore that point, 20 million low-income seniors. The House bill leaves them out entirely. The chairman's mark in the Senate corrects that situation.

In the House bill, you will not find seniors with Social Security income covered in this bill. You will find them covered in the Senate bill.

Since we do not have the bill text yet--I am holding up the chairman's mark--we made this happen by including Social Security benefits as a qualifying income in the chairman's mark, and here is what that mark says on page 3:

All eligible individuals are entitled . . . if they satisfy

at least two of the following criteria: The sum of an

individual's: earned income . . . and (2) Social Security

benefits must be at least $3,000.

That language is not in the House bill. Because that language is not in the House bill, 20 million seniors would not have gotten checks--if that House bill had been rubberstamped by the Senate.

During our committee process, many members discussed this defect in the House bill. As a result of careful Finance Committee member deliberations, we were able to improve the House bill.

Many disabled veterans do not get checks under the House bill. Here again, the House bill does not cover disabled veterans. Under the Senate bill, disabled veterans will be covered.

On page 2, the Finance Committee document says these words:

The provision modifies the chairman's mark to expand the

rebate benefit to disabled veterans.

During careful Finance Committee deliberations, Senators Lincoln and Snowe filed an amendment to ensure that disabled veterans would be covered. The chairman incorporated that amendment into his modified mark. Does anyone think this is an inappropriate improvement in the House bill? I ask that of those who insist we rubberstamp this House bill, if they do not have guts enough to tell Chuck Grassley that be included, at least in their own mind, I hope they know they are wrong by not including the disabled veterans by saying we ought to rubberstamp the House bill. So the House bill, which some are insisting cannot be improved by the Finance Committee, excludes 20 million seniors and disabled veterans.

The House bill could also send checks to illegal aliens. That is right. As I said before, I spent a great deal of time on this point, for those who maybe missed the beginning. The House bill, which some are saying is the best bill we can get and ought to be rubberstamped in the Senate, is going to allow illegal aliens to get checks before we take care of all the people.

Do my colleagues understand the House of Representatives passed a bill to give rebate checks to stimulate the economy, making it possible for illegal aliens to get checks but not 20 million seniors and disabled people in this country who are here legally?

I wish to be specific on the modifications in the chairman's mark, and here is again the document to which I am referring. On page 2, this is what the document says:

The provision denies the basic credit and the qualifying

child credit to individuals if they do not include on their

tax return a valid taxpayer identification number for: (1)

themselves (and if they are married, their spouse) and (2)

any children for whom the qualifying child tax credit is

claimed. For these purposes, a valid taxpayer identification

number is defined as a Social Security number.

Continuing the quote:

If an individual fails to provide a correct taxpayer

identification number, such omission will be treated as a

mathematical or clerical error. As under present law, the

Internal Revenue Service may summarily assess additional tax

dues as a result of a mathematical or clerical error without

sending the taxpayer a notice of deficiency and giving the

taxpayer an opportunity to petition the Tax Court. Where the

IRS uses the summary assessment procedure for mathematical

and clerical errors, the taxpayer must be given an

explanation of the asserted error and given 60 days to

request that the IRS abate the assessment.

This provision uses current IRS verification techniques. It ensures that the taxpayer getting the check is identified by the tax system.

During Finance Committee deliberations, Senator Ensign and his staff raised this important issue. Senator Ensign filed an amendment that was addressed in the modified chairman's mark.

The House bill has no such provision. Again--I am not going to keep holding up these bills--we have the House bill without this provision; the Senate bill with that provision. There is no language in the House bill to address a problem Senator Ensign properly raised in the committee. The committee bill improves the House bill by making sure illegal aliens do not get a check.

The Finance Committee amendment also beefs up the business stimulus package by adding additional years to the current law net operating loss carryback rules. The Finance Committee bill adds extension of unemployment insurance benefits. I know this was a big sticking point in the negotiations between the House and the White House. In this respect, I favor the House bill. My personal preference would be to eliminate this provision. It, however, was a key issue for all the Democrats. So in compromise--and we do not get anything done in the Senate if we do not have some compromise; nothing is strictly Democratic or strictly Republican, nothing can pass here except under a process of reconciliation. So in compromise, the chairman has it worked out, and it was essential that it be worked out.

I pushed hard for investment energy incentives, and the chairman agreed with me in that respect. So the last piece of this compromise is an expansion of investment incentives to seamlessly extend investment incentives for wind, biomass, and other renewable energy projects. In committee, these provisions caught some criticism, and I expect we will hear more of the same during this debate. I will respond in detail when those criticisms are given.

I compliment committee members on finding a bipartisan middle ground. The committee stimulus package raises the caps on rebate checks, expanding the benefits to more middle-class Americans, Social Security recipients, and disabled veterans. It makes sure illegal immigrants do not get checks. It also expands some of the business relief, and it addresses unemployment. The energy investment incentives round out the package.

I ask Members to go back to the basic question of balancing quick action on a House bill--and that House bill being imperfect as I pointed out in this debate--versus improvements that were made by the Finance Committee. The House bill could be passed quickly without improvement or we could finish the process in the Senate and add improvements made by the Finance Committee. I would challenge anyone to argue that none of the improvements made by the committee process are important enough to finish the job in the Senate. I hope nobody comes over and tells us that, for instance, it is OK to give rebate checks to people who are here illegally.

Having made that point, Madam President, we could prove our leaders right if we load up the bill in the Senate. So we ought to keep our eye on the ball and not load it up because we want to get a stimulus package passed. We don't want that to sink. Christmas is over, so let's not make this the traditional Christmas tree that sometimes legislation becomes.

Madam President, I yield the floor.

Mr. President, last May, Senator Baucus and I began investigating GlaxoSmithKline regarding their diabetes drug, Avandia.

We began this investigation when Dr. Steve Nissen at the Cleveland Clinic published a study in the New England Journal of Medicine. That study found a link between Avandia and heart attacks.

Shortly after we began our investigation, Dr. Scott Gottlieb, a former Deputy Commissioner at the Food and Drug Administration, wrote an op-ed in the Wall Street Journal. In that article, he insinuated that congressional investigators had obtained a copy of the Nissen study before it was published. Dr. Gottlieb suggested that this action called into question the integrity of both congressional investigators and Dr. Nissen.

Well, congressional investigators did not get a copy of the Nissen study until it became public. But you can imagine my surprise when I learned that one of GlaxoSmithKline's own consultants leaked a copy of the study to GlaxoSmithKline weeks before it was published. The man who did this is Dr. Steven Haffner. He confirmed to my investigators that he faxed a draft of the study to GlaxoSmithKline weeks before it was published.

The New England Journal of Medicine picked Dr. Haffner to peer review the study submitted by Dr. Nissen. That means that Dr. Haffner was supposed to check the study for quality. He was not supposed to pass it back to GlaxoSmithKline.

Not only did Dr. Haffner breach his agreement with the New England Journal of Medicine to properly peer review the Nissen study, but he violated practically every tenet of independence and integrity held sacred by the major medical journals.

Dr. Haffner told my investigators that GlaxoSmithKline did not ask for an early copy of the Avandia study. But the question still remains about what the company did once they had the study. Maybe GlaxoSmithKline's executives returned the study to Dr. Haffner or maybe they contacted the New England Journal of Medicine to report this violation of publishing ethics. I don't know, but I have sent GlaxoSmithKline a letter asking how they behaved after Dr. Haffner leaked the study to them.

But the most troubling aspect of this situation is that the integrity of another aspect of the scientific process is called into question-- scientific peer review.

This process ensures that other scientists will judge a study's quality before it is made public and becomes used as a marketing tool.

It is only good quality science that separates modern pharmaceuticals from old-fashioned snake oil.

Over the last few years, my investigations have found that the Food and Drug Administration has a very cozy relationship with drug companies. I have also discovered that drug companies spend big bucks to influence which drugs doctors prescribe.

Finally, I have shown that some drug companies intimidate scientists who speak up about bad drugs. Now it appears that even peer-reviewed science is not completely without its own problems.

Before I close, I would like to ask unanimous consent to have printed in the Record my letter to GlaxoSmithKline.

Mr. President, I am pleased to join my colleague, Senator Biden, in cosponsoring a resolution to designate the week of February 10-16, 2008, as National Drug Prevention and Education Month. Although recent survey data compiled by the Substance Abuse and Mental Health Services Administration shows illegal drug use among youth has declined by 24 percent since 2001, the number of teens abusing prescription and over-the-counter medicines has rapidly increased. Kids are turning to these dangerous drugs because they are easily accessible and widely used. Many of us do not realize that our left-over prescriptions and cold medicines are just as addictive and dangerous as meth or heroin when not properly used. This is why we must continue our efforts to inform the public about the dangers of these and other drugs. We must continue to do all we can to prevent our kids from falling into a vicious cycle of drug abuse and dependence.

Research has shown that if you can keep a child drug free until they turn 20, chances are very slim that they will ever try or become addicted to drugs. This is why it is essential to maintain a coherent antidrug message that begins early in adolescence and continues throughout the growing years. Such an effort must engage professionals, parents, communities, and young people. While the Federal Government has a role to play in supporting these activities, local, community- based initiatives are better able to target specific concerns and respond to them flexibly.

Local community antidrug coalitions are our first line of defense against the scourge of drug abuse. Each community is different from the other, and each community antidrug coalition is tailored to meet the specific antidrug needs of its community. For example, I formed the Face It Together, FIT, Coalition in an effort to combat drug use in Iowa. My goal with FIT is to bring to the same table parents, educators, businesses, religious leaders, law enforcement officials, health care providers, youth groups, and members of the media to promote new ways of thinking about how to reach and educate Iowans about the dangers of drug abuse. With everyone working together, we will make a difference in our communities. Moreover, together we can build healthy children, healthy families, healthy communities, and a healthy future for society at large.

Community antidrug coalitions would not be able to succeed in fighting drug abuse without the support of the Community Anti-Drug Coalitions of America, CADCA. CADCA works to strengthen the ability of new and existing community coalitions to build safe, healthy, and drug- free communities and helps provide vital funding to local coalitions through the Drug Free Communities grant program.

Since the inception of the Drug Free Communities grant program over 1,300 community coalitions have received grants nationwide. There have been 43 coalitions in my State of Iowa that have received grants to provide crucial assistance to combat the abuse of alcohol, tobacco, and illegal drugs. These coalitions have been successful in tracking the use of illegal drugs in their communities, starting afterschool and summer programs for kids, holding community events and townhall meetings, and uniting all sectors of the community to fight drug abuse.

I believe that we have a moral obligation to ensure that our young people have a chance to grow up without being accosted by drug dealers at every turn, whether on TV, in the movies, or on the way to school. We need, as a country, to create a strong moral context to help our kids know how to make the right choices. They need to know how to say ``no.'' They need to know that saying ``no'' is OK. They need to know that saying ``no'' to drugs is the right thing to do, not just the safe thing or the healthier thing

but the right thing. I urge my colleagues to join us in passing this resolution to show our ongoing support for community antidrug coalitions that work to eliminate drug abuse throughout the Nation.

Mr. President, today I salute a great American hero who has fallen in service to his country in support of Operation Iraqi Freedom. Army SSG Sean M. Gaul gave his life on January 9, 2008, after sustaining wounds when an improvised explosive device detonated while he was on patrol in Sinsil, Iraq, in the Diyala Province. He was serving his fifth deployment in Iraq and Afghanistan. His loyalty and bravery will be remembered. My thoughts and prayers go out to Sean's family and friends, especially to his wife Jessica and their young daughter, his mother Christine, and his father Michael.

Sean Gaul lived in Cresco, IA, with his parents until the age of 7. He then moved to Reno, NV, with his mother. He attended Reed High School, where he was a member of the Junior Reserve Officers' Training Corps. In 1997, he passed the GED exam. He was first deployed to Afghanistan shortly after the Sept. 11, 2001, terrorist attacks. Before deploying for the final time, he completed the Army's sniper school.

Staff Sergeant Gaul's wife Jessica called him a ``very good man and loving husband.'' She said, ``He did not waiver from his responsibility. He always trained hard as he led the way by example. He was focused and determined as he sought out more special forces training.'' Again, my sincerest condolences go to his family and friends. I ask my colleagues here in the Senate and all Americans to remember with gratitude and appreciation a fine man and an exemplary solider, Army SSG Sean M. Gaul.

I agree. I have supported the enactment of the TREE Act for several years, and will work to see it enacted early in 2008.

Madam President, I had an opportunity to hear the first half hour of this tribute to Senator Lott, and then I had to go on to another piece of business, and I have just returned. But in all of this conversation about Senator Lott, there has been some levity. I am not going to be able to add to that because my wife always tells me every time I try to be funny, I kind of screw up. So I want to add to the business aspect of Senator Lott and the Senate.

I think most of the tribute I heard praised Senator Lott for making the Senate work, the process of the Senate, moving things through the Senate, making the Senate a great part of our institution of self- government, and he does that. But I would like to talk about the substance of policy I have seen Trent Lott bring to the Senate and bring to the people, and whatever I talk about is part of the laws of the United States to which I think he has contributed.

Like all of my colleagues, it is hard for me to imagine the Congress, and especially the Senate, without Trent Lott being a part of it.

I met my friend Trent Lott when I was elected to the House of Representatives in 1974. He had already been in the House of Representatives at that time for 2 years. As has been said so many times, he went on to become a very competent House Republican whip, first showing what a successful national leader he would prove to be again and again, as he is now in that position in the Senate.

I also remember talking with Congressman Lott 8 years after I came to the Senate, as he was imagining whether he should run for the Senate. But it has really only been in the last 12 years that I have had the opportunity to work most closely with Senator Lott. He has been a very strong ally, particularly for me as a leader on the Finance Committee, but he has also, on occasion, been a worthy opponent.

Senator Lott has fought tirelessly for legislation that respects the principle of less government and more freedom, particularly economic freedom. His support for tax relief, expanded market opportunities for U.S. manufacturers and for job creation, and for consumer-driven health care has been essential to the many successful legislative initiatives that have come from the Committee on Finance in recent years.

Back in 1997, as a new member of the Finance Committee, Senator Lott worked for passage of the Tax Relief Act of 1997. This legislation included a $500-per-child tax credit, a 20-percent capital gains tax rate, the Roth IRA, and estate tax relief for small businesses. In fact, Senator Lott was a leading proponent of capital gains tax relief, and he remains unfailing today in his commitment to this vitally important progrowth tax policy.

In 1998, Senator Lott was a key player on the Finance Committee in putting together a final agreement on the highway bill.

In 2001, when I became chairman of the Finance Committee and we had the opportunity to pass the largest tax relief bill in a generation, Senator Lott was Republican leader at that time, but he continued as a member of the Finance Committee and in turn an essential supporter and contributor to what has become known as the Economic Growth and Tax Relief Reconciliation Act of 2001. This legislation lowered rates for all taxpayers, made the Tax Code more progressive, and created the first ever 10-percent marginal tax rate.

Two years later, after September 11, we were at work on the Finance Committee to pass legislation to stimulate the economy. Again, Senator Lott was in the forefront as an advocate for reducing the capital gains tax rate to 15 percent, where it is today. Senator Lott weighed in heavily to get it done. Also, with lowering taxes on income from dividends and capital gains, the Job Growth Tax Relief Reconciliation Act of 2003 accelerated some of the tax changes passed in 2001 and increased the exemption amount for the alternative minimum tax. These initiatives encouraged economic growth and were vital to mitigating the economic shock of the terrorist attacks of September 11, 2001. By spurring economic activity, those tax policies altogether resulted in recordbreaking revenues collected by the Federal Treasury.

Senator Lott has brought tremendous energy to policy and tremendous energy to getting the work of the Senate done. But I am going to remember his contribution to the policy this Senate has made--very good policy--and he has been there working very hard as a member of the Senate Finance Committee to do that. The drive to get the work done has helped me get my work done in the Senate.

Now, there is no doubt he served his constituents of Mississippi very effectively. After nearly three decades in the Senate, he showed his loyalty by staying in the Senate after a planned retirement just last election. He decided to run for reelection in order to do what he has done for an entire life as a public servant--to help the people of Mississippi, and in this specific instance to help the people of Mississippi recover from Hurricane Katrina. Mississippians didn't quit, and neither did Senator Lott quit. He used his influence and power in the Senate to help his State recover.

As a Republican leader in the Senate, Trent Lott's experience and knowledge of the Senate and the Senate's procedures have proven to be invaluable. It will be a long time, if ever, that we see anyone work the whip process better than Senator Lott has.

Senator Lott leaves the Senate with a great legacy of accomplishments. Woven throughout everything, though, is Senator Lott's ability to lead. He demonstrated repeatedly his talents and abilities for building winning coalitions. He led with commitment to getting things done. He understood that there are different points of view but that they can be brought together for the right approach that brings results and, as a result, good policy.

I salute Senator Lott's tremendous success as a leader in the Senate, and I am truly sorry to see Senator Lott leave the Senate. I will miss him as a colleague and as a friend. Trent Lott has made the Senate, he has made his home State, and, for sure, the Nation a better place.

Thank you for your service, Trent Lott.

Mr. President, as we approach the end of 2007, one cannot help but look ahead and see that there are many challenges that await us in the second session of the 110th Congress, specially in addressing issues relating to health care. In 2008, we will need to take a serious look at many issues in the Medicare Program. Among them will be continuing to work on developing a solution for Medicare's flawed physician reimbursement system. As usual, I look forward to working with my partner on the Senate Finance Committee, chairman, Senator Max Baucus, in our usual bipartisan way to address this and many other issues.

However, before we could adjourn this first session and go home to enjoy the holidays with our families, there was still urgent work to finish. That was the purpose of this exercise. In the legislation we considered today, there were several provisions that rise to the level of ``must do's.'' These included ensuring that physicians do not receive a drastic cut in their Medicare reimbursement and extending a number of expiring provisions including the State Children's Health Insurance Program.

Ensuring health care access to my constituents is a top priority of mine and the possibility of a negative update for physicians was of great concern to me as well as to doctors and patients in Iowa and elsewhere. When discussions began to solve this problem I was in favor of a 2-year update. I know that several of my colleagues were as well. But in continuing negotiations with the House and Senate colleagues it became apparent that a 2-year fix was not possible.

I wanted to do more. I know Senator Baucus wanted to do more. We were unable to reach consensus even on the Republican side either and, therefore, the Finance Committee was unable to move ahead with the legislation that Senator Baucus and I had been developing. Unfortunately, for a variety of complex reasons, we are now here with a much more limited package. This is a disappointment for many of us. So the purpose of moving forward with a 6-month package now is to provide the opportunity for the Finance Committee to address these priorities next year.

One of my first priorities has been to ensure access to rural hospital services. Since hospitals are often not only the sole provider of health care in rural areas, but also significant employers and purchasers in the community, it is especially important that they are able to keep their doors open. One group of hospitals that I am especially concerned about are ``tweener'' hospitals, which are too large to be critical access hospitals, but too small to be financially viable under the Medicare hospital prospective payment systems. The struggles these facilities face in Iowa are real and serious. I am very disappointed we were not able to help these hospitals in this package. I look forward to working with Senator Baucus and other Members to include ``tweener'' hospital improvements in next year's package.

Second, we must address the problem of specialty hospitals. I have been an outspoken advocate against these facilities for several years now. My primary concern with these facilities is the inherent conflict of interest that exists when physicians have an ownership interest in the facilities to which they refer patients. The best interest of the patient should always be the deciding factor when a referral for treatment is made, not the financial self-interest of the doctor who is treating the patient. I strongly support a competitive marketplace and free market forces, but not at the expense of decreasing access to health care for the poor and uninsured or decreasing the quality of care for and safety of patients. I have been and remain concerned about the ability of community hospitals to provide care to all patients. I also look forward to working with Senator Baucus on addressing this issue in our package next year.

There are a number of other important issues that need to be addressed as well. We need to take on the reforms of the Medicare Quality Improvement Organization Program, we need to inject some sunshine into the payments that drug companies make to doctors, and we also need to make sure that Medicare is part of the solution when it comes to greater use of electronic prescribing and electronic health records.

In the meantime, we have this package with the following provisions that extend a number of Medicare, Medicaid and SCHIP provisions.

This legislation prevents the 10.1 percent cut to physician payment that would have occurred as of January 1, 2008, and instead gives a 6- month 0.5 percent update for physicians through June 30, 2008. In effect, this provides a 10.5 percent increase in physician fees from what they would otherwise have received beginning in January under current law. While this is not what many of us had in mind when we began this process, providing an update through next June will allow more time and the opportunity for a bill to fully go through the legislative process beginning with a committee markup next year.

This legislation also continues to provide additional payment incentives for physicians and other health care practitioners who report quality measures in the Physician Quality Reporting System. We must ensure that health care providers can afford to continue to practice medicine. We must also ensure that beneficiaries have access to physicians and other health care providers. And we must provide incentives for quality improvement.

We also accommodate physicians ordered to active duty in the Armed Services by extending for 6-months a provision that permits them to engage in substitute billing arrangements for longer than the 60 days allowed under current law when they are ordered to active duty.

Our legislation also revises the Physician Assistance and Quality Initiative Fund, which is intended to help stabilize physician payments and promote physician quality initiatives.

This new fund will be available in 2008 to help minimize fluctuations in physician payments and promote physician quality initiatives.

The physician payment changes will be offset, in part, by an adjustment to the Medicare Advantage stabilization fund. Our legislation does not repeal the stabilization fund but rather preserves the fund for future years. We use the $1.5 billion available in 2012, while preserving the fund in 2013. Given the continued strong participation by plans in the program right now, the legislation preserves the fund so that Congress can add more funds in future years if they are needed.

The legislation extends Medicare private plan cost contracts through 2009, which, without this legislation, are due to expire at the end of 2008. These are longstanding plans that provide health care to Medicare beneficiaries in many communities but have been unable to convert to Medicare Advantage plans. In addition, the legislation includes a 1- year extension to Medicare Advantage special needs plans through 2009. At the same time, the legislation puts a moratorium on new special needs plans. When Congress enacted the Medicare Modernization Act in 2003, it created a category of plans intended to provide specialized care models for certain populations, including Medicare beneficiaries who are also eligible for Medicaid, those who are chronically and severely ill or disabled, and those who are institutionalized (for example, in nursing homes). While these plans have proliferated, it is unclear how well they are meeting their mission of specialized care. The legislation freezes the program at the plans currently approved so that Congress and CMS can monitor the plans' performance and determine if any changes are needed.

In addition to reforming the manner in which Medicare pays for physician services, this legislation will extend several expiring provisions enacted in the Medicare Modernization Act to help ensure that beneficiaries will continue to have access to needed medical services. This includes provisions applicable to rural payments to physicians, extending the 1.0 floor on the work geographic adjustment, continuing direct payments to independent laboratories for physician pathology services, and continuing Medicare reasonable cost payments for lab tests in small rural hospitals.

Our legislation also provides a 6-month extension of the therapy cap exceptions process that was included in the Tax Relief and Health Care Act last year to ensure that beneficiaries receive the physical, occupational, and speech language therapy services they need. It also extends the existing payment methodology for brachytherapy services and extends it to therapeutic radiopharmaceuticals through June 30, 2008.

As in previous legislation that Congress has passed, this legislation will continue to improve accountability in the Medicare Program. There are situations when Medicare is not the primary payer for a beneficiary's health care, but it is currently difficult to identify these situations. This legislation will improve the Secretary's ability to identify beneficiaries for whom Medicare is the secondary payer by requiring group health plans and liability insurers to submit data to the Secretary.

The legislation will ensure beneficiary access to long-term care hospitals. These facilities will receive regulatory relief for 3-years. In order to ensure patients are receiving appropriate levels of care at long-term care hospitals, facility and medical review requirements will be established, and the Secretary will be required to conduct a study on long-term care hospital facility and patient criteria. Also, there will be a limited moratorium on the development of new long-term care facilities and a freeze to the annual long-term care hospital payment update for one quarter in rate year 2008.

The legislation will also ensure beneficiary access to inpatient rehabilitation facility services by addressing the 75-percent rule. This rule has been criticized as too blunt an instrument for ensuring that appropriate patients receive care at these facilities. Under current law, a percentage of Medicare patients must have at least 1 of 13 listed medical conditions in order to be classified as an inpatient rehabilitation facility. This percentage or compliance threshold is currently at 65 percent. This legislation would permanently freeze the compliance threshold at 60 percent and allow comorbid conditions to count permanently toward this threshold. The Secretary will be required to study beneficiary access to inpatient rehabilitation services and care at inpatient rehabilitation facilities and to make recommendations for alternatives to the 75-percent rule. In addition, there will be a freeze to the annual inpatient rehabilitation facility payment update from April 1, 2008 through fiscal year 2009.

This legislation will also continue to promote more accurate hospital payments. One aspect of Medicare hospital payments that has been subject to much criticism is the area wage index. Many say that the current method of calculating the wage index does not reflect a hospital's actual labor costs and is instead arbitrary in nature so that similarly situated hospitals can receive significantly different wage index values. Since the enactment of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, hospitals have been able to obtain relief from this unfair situation temporarily.

The legislation also provides more accurate payment for Part B drugs. It implements recommendations of HHS Office of Inspector General and requires CMS to adjust its average sales price, ASP, calculation to use volume-weighted ASPs based on actual sales volume. It also establishes appropriate reimbursement rates for generic albuterol and for glycated hemoglobin diabetes laboratory tests.

In the Medicaid arena, the legislation extends the provision of disproportionate share hospital payments to Tennessee and Hawaii for the first three-quarters of the current fiscal year. These payments were authorized for these States for the first time in last year's Tax Relief and Health Care Act and this is an extension of that policy.

The legislation also delays implementation of recently released regulations on school-based services and rehabilitation services in Medicaid so that the Finance Committee can appropriately review those regulations.

And finally, the legislation also includes an extension of the State Children's Health Insurance Program, SCHIP, through March 31, 2009. This provision makes additional funding available so that States do not have to scale back SCHIP. This SCHIP extension will ensure that no State has to cut back their program due to insufficient Federal funding.

I remain hopeful that when the 110th Congress reconvenes next year, there will be a renewed effort to reauthorize and improve SCHIP.

The bill we considered today addressed the things Congress needed to do before going home for the holidays. I am pleased we were able to act quickly and unanimously to pass the bill. I know many of my colleagues wanted to do more. I know some of my colleagues are disappointed because their individual priorities could not be included. It is unfortunate. I do hope we can do more when we come back next year.

Next year is an election year. The caucuses in my home state of Iowa are but days away. We have important business to conclude in Medicare and Medicaid and SCHIP. We have a Democratic Congress that has to work with a slim majority in the Senate and a Republican President. At times this year, I am not sure my colleagues on the other side of the aisle fully grasped the consequences of that reality. It certainly shows when you consider what we could have done this year and what was ultimately accomplished. I sincerely hope we do a better job of being bipartisan albeit in a political year.

Let me be clear that I stand ready to roll up my sleeves and get back to work come January. I am committed to moving ahead with the broader Medicare package when we return here next year. To make law, that package

will have to be one that the President will sign. It will require bipartisan cooperation and hard work. I am ready to get the job done. There are many problems that need to be addressed, and we can address the myriad issues that we left on the table. We can review and act on the proposed Medicaid regulations that have so many people vexed. We can pass a SCHIP reauthorization that can become law. We have learned the pathway to failure this year. I stand ready to join any of my colleagues who want to join me on the path not taken in 2007 to a more productive 2008.

As we move to the end of the first session of the 110th Congress, I want to extend my grateful appreciation to my health staff and others for the work they have done in 2007. My staff director on the Finance Committee, Kolan Davis, has been with me for many, many years and provides me invaluable counsel. My chief health policy counsel, Mark Hayes, accomplishes more every day than any other hundred people on the Hill combined and for his tireless work ethic, I am truly thankful. My Medicare Part A counsel, Mike Park, labored through the last several weeks though he was sick as a dog because it is that important. My Medicare Part B counsel, Sue Walden, ably deciphered the multiple variations we considered for providing an update to the physicians. The newest member of my team, Kristin Bass, who handles Medicare Parts C and D, helped us reach thoughtful compromises on numerous challenging issues. My Medicaid staffer, Rodney Whitlock, deftly handles the most controversial of issues day in and day out. I particularly want to pay tribute to my SCHIP staffer, Becky Shipp. We may have not accomplished what we hoped to do with SCHIP this year, but we wouldn't have been remotely close without Becky's expertise and effort. My team benefits from the able assistance of Sean McGuire and Shaun Freiman going above and beyond the call of duty to make sure the little things get done. I also want to thank Senator McConnell's point person on health care, Meg Hauck, for working with us throughout the year. The Finance Committee benefits from that strong working relationship.

We work as hard as we possibly can to achieve bipartisan consensus in the Finance Committee and so I also want to pay tribute to Senator Baucus' staff: staff director Russ Sullivan, Michelle Easton, Neleen Eisinger, Billy Wynne, Shawn Bishop, David Schwartz, and Catherine Dratz.

We benefit greatly from the Congressional support staff as well. Tom Bradley, Tim Gronniger, Shinobu Suzuki, Jeanne De Sa, Eric Rollins and all of the hard-working scoring gurus at CBO. Jim Fransen, John Goetcheus, Kelly Malone, and Ruth Ernst at Senate Legislative Counsel. Jennifer O'Sullivan, Rich Rimkunas, Chris Peterson, April Grady, Elicia Herz, Sybil Tyson, Mark Hamelburg, Erin Taylor and all the folks at CRS. Mark Miller and all of his staff at MedPAC. They make us look a lot more intelligent and effective than we actually are some days.

Finally, I want to thank some folks at CMS. Liz Hall, Erin Clapton, Ira Burney, Richard Strauss are people who help make sure we get things right even when we aren't in complete agreement.

In closing, I want to thank all those folks for their hard work in 2007 in service to the people of Iowa, Montana, and all of America. Thank you.

Mr. President, I yield myself such time as I may consume. I haven't had a request on this side for many people to speak. I think I will speak for 9 or 10 minutes on my side. If people want time, I will be glad to yield time.

When we were debating the Tax Relief Act of 2005, the other side forced a series of debates on the same subject matter. We had the same debate three times, and it culminated on Groundhog Day, February 2, 2006. Despite numerous votes and debates in each round, we went through essentially the same debate and vote not once or twice but three times.

I have two charts that will remind folks of that exercise.

My first chart depicts a groundhog. For those of you who see the groundhog, you will recall that the centerpiece of that debate involved the alternative minimum tax patch. During the first groundhog debate, the bipartisan majority had to prove that we meant business on the cornerstone of that bill, which was the last AMT patch that was enacted. I am referring to the AMT patch that protected then about 15 million families, and now we are talking about protecting about 23 million families.

The bipartisan majority, I am pleased to remind everybody, stuck to our guns in conference on that bill. We made sure the AMT patch was one of the cornerstones of the conference agreement. So despite the extended debate, what we said would happen did happen.

Now, the next Groundhog Day is February 2, 2008. That is just 45 days from now. That may seem like a long time, but given recent history, I am worried. Here is why.

About 47 days ago, the two tax-writing committee chairmen, Congressman Rangel and Senator Baucus, and the ranking members, Congressman McCrery, and this Senator, wrote Secretary Paulson and acting IRS Commissioner Stiff and pledged to get an AMT patch bill to the President before the end of the year. We wrote the letter for a couple of reasons. The first reason is to spare 23 million middle- income families from an average tax increase of $2,000 per family. As everyone now agrees, this monster tax was not meant to hit 23 million middle-income families. The second reason was to assure the Secretary of the Treasury and the IRS Commissioner that we would do everything possible to minimize delays in refunds for another 27 million families and individuals, on top of the 23 million who would be hit for the first time.

After pledging to get mutually agreeable AMT patch legislation to the President in a form he could sign--that is what the letter was about-- we are instead now engaged in this Groundhog Day type of exercise. We are essentially having the same debate, and we will go through the same votes the Senate went through just a couple of weeks ago. In other words, the floor debate tonight illustrates my worry that we are repeating the Groundhog Day exercise.

I ask unanimous consent to have printed in the Record a copy of that letter by the two chairmen and ranking members.

So we are not quite there yet, but the way we are going, we

might not get this year's AMT patch done until the next Groundhog Day.

Let me bring up another chart to expand on this point. I have next to me the portrait of Punxsutawney Phil, that famous groundhog. In thinking of Phil and the weather report he will provide in 45 days, I also thought about the popular film entitled ``Groundhog Day.'' That movie stars Bill Murray, in which a man relives the same day--Groundhog Day--over and over and over. This film has taken on greater significance for me as I seem to be in a very similar situation. More than just a sense of the deja vu, I feel I am reliving a past experience.

We are going through the same debate we had a couple of weeks ago. We are on a different bill and the amendment has different offsets. Yet I seem to remember already having this debate.

So, Mr. President, instead of taking the next steps and focusing on what we said we would do in the letter and finding a mutually agreeable--those are words from the letter--resolution to the AMT patch, the House Democratic leadership is insisting that the Senate repeat the same debate and vote of just last week.

At 5:01 p.m., on Tuesday, December 4, 2007, we took up H.R. 3996, with the title ``Temporary Tax Relief Act of 2007.'' For several hours on Tuesday, Wednesday, and into Thursday, we debated the bill. The final vote on final passage came at 7:25 p.m., Thursday evening, December 6.

According to the Secretary of the Senate, 93 of us were here for that vote. So I must not be the only one reliving this experience.

I ask unanimous consent to have printed in the Record the results of that final vote.

Mr. President, as we consider the Senate amendment to the omnibus bill, I have to ask: Why are we still here? I have to ask: Didn't we already go through this exercise? I have to ask: Aren't we finished with the Senate debate?

In the face of the urgent need to enact an AMT patch, does the House Democratic leadership want the Senate to reenact recent debates and resuscitate old talking points? Our un-offset AMT patch already passed with the support of 88 Senators.

While I believe this legislation is extremely important and we will debate it for as long as is necessary, I question the necessity of going through a process that resulted in overwhelming bipartisan passage of the same bill 2 weeks ago.

That is my first point. This is, in fact, a curious exercise. It is an exercise with no apparent purpose other than delay. Is the delay on the part of the House Democratic leadership important? Why doesn't the House send the amended House bill which cleared this Chamber by a vote of 88 to 5 to the President of the United States for signature? Because President Bush will sign it. That bill does meet--again the words from the letter of the chairman of the committee--that bill does meet the mutually agreeable criteria of the tax writers' letter. The amendment before us, just as the prior House vote, does not meet the mutually agreeable criteria that was in that letter.

Nearly all House and Senate Republicans have a problem with this amendment and its predecessor that failed in the Senate. The problem is not necessarily with the offsets themselves. Some of them might be acceptable tax policy to this Senator and others on our side. The debate and resistance on our side rests with a bigger principle. It is about accepting the notion that the unintended reach of the AMT should be permitted unless we find offsetting revenue from other taxpayers; in other words, other taxpayers being taxed to offset revenue from middle- income taxpayers who were never supposed to pay this tax in the first place. It is the use of the AMT then as an open-ended revenue- generating machine that creates problems on the Republican side of the aisle.

I am going to point to another chart to illustrate this debate. This is a chart of a very fine horse, a horse named Trigger and his rider Roy Rogers. Trigger is a fine horse, but he is dead. He is very dead. Trigger is so dead that he is stuffed and resides in a museum. This debate is the practice of beating a dead horse. It would be like tourists taking swipes at Trigger as they go through the museum. Everyone knows beating a dead horse is a waste of time, but that is what we are doing. We need to stop beating a dead horse. We need to show our good friends in the House Democratic leadership that they need to stop reviving a dead horse of an offset AMT patch. It is a dead horse. Let's stop beating it. Vote against this amendment.

After this exercise is done, then I urge my friends in the House leadership to pass the un-offset AMT patch bill we sent them several days ago, that very same bill that passed this body 88 to 5.

Think, will you, on the other side of the Capitol, think of the 23 million families that will face a tax increase of $2,000 per family if we don't get this bill to the President. Think of the 27 million families and individuals that will face even longer delays in getting their refunds next year if we don't get this bill passed, or even if we do get this bill passed, it is going to be delayed. Think of these hard-working taxpayers. Stop beating a dead horse and let's get the people's business done.

I reserve the remainder of my time.

Mr. President, if the other side is ready to yield back their time, I will yield back our time, but I want to find out if they are interested in doing that.

I yield back our time.

I want to thank my distinguished colleague for raising this issue, which has also been a concern of mine. I agree with him that these rural hospitals--the so-called ``tweener'' hospitals--should be given some assistance. These hospitals play a critical role in the medical care of our seniors throughout Iowa, and I remain committed to working with Senator Baucus to include ``tweener'' hospital improvements in next year's Medicare legislation.

Mr. President, I want to speak about an issue that may come up during the negotiations between the House and the Senate to reconcile the farm bill.

The bill we passed last week in the Senate included a sense-of-the- Senate resolution addressing trade in sweeteners between parties to the North American Free Trade Agreement, also known as NAFTA.

Apparently, some view this language as just a placeholder for new language that will be inserted in conference.

Even more troubling, the new language that is being contemplated would call for managed trade in sweeteners between the United States and Mexico.

The issue of trade in sweeteners between the United States and Mexico has a long history.

For years, Mexico put up barrier after barrier to our exports of high fructose corn syrup.

It started in 1998. That year, Mexico imposed an antidumping duty order on imports of high fructose corn syrup from the United States.

We challenged that order, and we won. In 2001, a dispute resolution panel determined that Mexico was out of compliance with its obligations under NAFTA.

The appellate body of the World Trade Organization reached a similar conclusion.

The antidumping duty order on our high fructose corn syrup was inconsistent with Mexico's obligations under the WTO.

Mexico finally lifted its antidumping duties in 2002. But that same year, Mexico imposed a 20 percent tax on soft drinks flavored with high fructose corn syrup.

This soda tax was designed specifically to discriminate against high fructose corn syrup imported from the United States.

As a result of this unfair discrimination, our exports of high fructose corn syrup to Mexico fell dramatically.

We challenged Mexico's discriminatory tax at the World Trade Organization.

In 2006, the appellate body determined that this tax was inconsistent with Mexico's obligations under the WTO.

Mexico complied with the WTO decision earlier this year by repealing its discriminatory soda tax.

Now, after years of pressuring Mexico to drop its unfair barriers to our exports of high fructose syrup, we're finally at a good spot.

Mexico has eliminated both its antidumping duty order and its discriminatory tax.

We are on the verge of seeing high fructose corn syrup start to flow freely across our border.

Starting January 1, 2008, Mexico is obligated to provide duty-free access to our exports of high fructose corn syrup under NAFTA.

That is why I am so concerned. This new language being contemplated for the farm bill could disrupt our legitimate expectations of free trade in high fructose corn syrup next year.

If instead of free trade we end up with managed trade, it could significantly impede our exports of high fructose corn syrup to Mexico.

Under a managed trade regime, we would presumably limit the amount of sugar that we import from Mexico.

And in response, Mexico would presumably limit imports of high fructose corn syrup from the United States.

Simply put, managed trade could reverse all the gains we have made over the years to get Mexico to take our high fructose corn syrup.

Corn farmers and high fructose corn syrup producers in Iowa and other States would, of course, be harmed by any import restrictions imposed by Mexico as a result of managed trade.

And managed trade could well result in Mexico further violating its obligations under NAFTA.

Many of my colleagues complain, legitimately, when our trading partners fail to comply with their international trade obligations.

The last thing we should do is give Mexico an excuse to violate its NAFTA obligations, particularly when it would harm U.S. agricultural producers.

The current language in the Senate-passed bill does not call for managed trade.

The current language would not likely induce Mexico to impose further restrictions on our exports of high fructose corn syrup.

As a Senator from Iowa, as well as the ranking member of the Senate Finance Committee and a member of the Committee on Agriculture, I have worked hard over the years to get a fair deal for agriculture when it comes to international trade.

In particular, I have put considerable effort into opening foreign markets to our exports of agricultural products.

Too often our trading partners have imposed barriers to U.S. farm exports. And too often those barriers are in violation of international trade obligations.

Those barriers harm American farmers and agricultural producers.

Whether it is unfair restrictions on U.S. beef exports to Japan and Korea, or under restrictions on U.S. corn exports to Europe, it is imperative that we focus our efforts to remove barriers to trade.

With effort, we have been successful in getting our trading partners to remove such barriers.

That is the case with Mexico's treatment of high fructose corn syrup, as I have described.

We can't go backwards.

Our corn farmers and our producers of high fructose corn syrup are counting on us.

I will be working hard to see that the current language on trade in sweeteners is retained without change in the conference report to the farm bill.

Free trade in high fructose corn syrup with Mexico is long overdue.

I yield the floor.