Floor Statements

Mr. President, I put a footnote on this. I recommend the Lewis and Clark exhibit. It is wonderful history. Of course, the Louisiana Purchase is of great interest to all of us in the West. I recommend a book I am about two-thirds of the way through. It is called ``The Wilderness So Immense.'' It is the history of how we purchased all that land from France when Jefferson was ambassador to France. It goes back to 1785 and 1786, and also the politics involved with Spain. It involves the navigation of the Mississippi River, the control of New Orleans and, of course, Spain's influence in the great American southwest that led to the Louisiana Purchase. I recommend that book. It is written by Jon Kukla, and it gives a great insight on what happened.

I thank the Senator for mentioning this great 200th anniversary of the Louisiana Purchase.

Mr. President, this morning we have been through a series of briefings with regard to Iraq. It amazes me, as we hear some of the rhetoric that is coming out of this town and, of course, across the waves, and I wish to bring to the attention of those who missed it, it was a very good briefing put on by Ambassador Bremer of what is happening in Iraq after the armed conflict is over, but which continues today on a guerrilla basis, and report to the American people that all the press we get is sort of on the negative side, but there are some very positive signs.

I hasten back to the start of our country. The path to democracy is a very rocky path. Sometimes it is very slow and sometimes it is very dangerous, but there are things being done now, and the best ambassadors I have found on the ground in Iraq are our uniformed troops.

If one can imagine a people who have been under the tyranny of Saddam Hussein for the last 25 years being told how evil this great army could be, that they would either cut out their tongues or they would kill them, and then have one of our soldiers or marines in combat gear and helmet, dirty, sandy, and grimy, walk up to a young Iraqi person with a smile and offer a hand of friendship in the form of water or some food, but mostly the hand of friendship, they are making great strides in winning the hearts of the Iraqi people and helping them to establish a free and open government for their own freedom and prosperity.

Right now, we are not hearing these kinds of figures: 85 percent of the cities and towns in Iraq now have elected councils in place and working. There was a strategy after the conflict was over, but No. 1 was security. We cannot do a thing in Iraq, and neither can the Iraqi people do for themselves, until it is secure so they will feel safe.

The building of central services, electrical power, water, sewer, all of these amenities that make life easy for us, are not in place. Saddam Hussein never paid a lot of attention to that. He rationed electrical power, water, all the services we take for granted in America. He limited them in order to suppress, and he got to pick and choose who were afforded those kinds of amenities or those central services we find so necessary in our own towns, villages, counties, and States.

We are making progress. We are now reconfiguring our military presence there. We are also doing something about the economy. How does one move state-owned enterprises into the private sector to provide some economic thrust for job and economic opportunity for the Iraqi people? That framework is in place, and it is being carried out.

How do we train a militia or a police force for the Iraqi people, headed by Iraqi people, and an armed forces for Iraq who answer not to a military tyrant but to a civilian government patterned somewhat like our own? That, too, is being put in place, and they are being trained by our forces.

We have around 30 to 40 coalition forces from different countries represented in Iraq right now. There are 12 top contributors, of which the U.S., the U.K., Spain, Norway, and others are all participating in this endeavor.

I advise the American people to look at the positive side of establishing a civil and free government in Iraq. We are building a new irrigation system and repairing old systems because the infrastructure has dwindled away. It has almost been destroyed--not by war but by use and wear. These folks need to be able to feed themselves.

We have agriculturists in the field, nongovernmental organizations in the field working in health care and agriculture and services vital to the Iraqi people to put this country back together and make it a democracy that will be the shining example of the Middle East.

We cannot lose our resolve. The Founders of this country did not lose

their resolve. They committed to an idea of freedom and self- government. Our path to democracy was not easy either. We have had 200 years of democracy. They have had less than 200 days to establish what they have dreamed of--freedom and the dignity of the individual. That is what this is all about. If they do not lose their resolve, we cannot lose our resolve.

Our President has provided that leadership under heavy criticism. He has established a goal and idea that will change the Middle East and how they do business in the Middle East.

Peace and freedom can be accomplished. The American people have made a commitment to do that goal. Now we have to maintain our resolve to the completion of that mission.

I thank our military forces this morning. They are men and women of great courage who know what the mission is and know how to complete the mission. Congratulations to our leadership, our leadership in Washington, President Bush and his staff. They have provided the resolve it takes to complete the mission.

There are many positive things. When the President said: We will hunt down these killers and deal with them--he meant it. The credibility around the world continues to be high with our leader. When he says it, he means it, he does it. It has bolstered Americans and shows what it is like to be the champion of freedom and human dignity around the world.

Is it costly? Yes, it is costly. Was it costly back in 1776 and the following years until 1800? Yes, it was costly. But we survived. We never lost our resolve. We cannot lose it now.

I thank the Senator from Texas for allowing me this little time. There are a lot of facts and figures we could throw out, but the message today is stand fast. If we believe in the fire of freedom, it is our responsibility to maintain that resolve.

I yield the floor.

Mr. President, today I recognize and honor a special friend, Mr. Brad Bean. Brad has been involved in the development and planning of the Burns' Telecommunications Center since its inception and has been dedicated to the continued expansion and advancement of the Burns' Center. Brad played an integral role in capturing my vision of using technology to connect all sectors of our rural State to the ``new world'' of electronic transmission and communication which has developed since the late 1980s. My goal to develop a technology training center dedicated to distance learning, telemedicine, classrooms, students and teachers and the business community has been advanced by Brad's belief in that vision.

His proven leadership has drawn individuals and companies from around the world to invest in the Burns' Telecommunications Center. Brad and his wife, Jacqueline, have helped to promote the opportunities available at the Burns' Center to people from many places in Montana and beyond its borders. Brad has served on the Burns' Telecommunications National Advisory Board and is retiring this year to my regret. I personally thank Brad and acknowledge and praise his passion for excellence, program development and his loyalty to my mission for the Burns' Center. Brad has gone above and beyond the call of duty and I salute him for his generous support and help.

We are fortunate in Montana to have people like Brad and Jacqueline, who are willing to give of themselves to help their community and their State.

Mr. President, I rise today to express my support of S. 1406, which is pesticide harmonization legislation. I join my colleague, Senator Dorgan, as an original cosponsor of this legislation. I would like to commend Senator Dorgan and his staff, the Montana Grain Growers, the National Association of Wheat Growers, and our Montana Department of Agriculture for their willingness to work out the gritty details of this bill. It has been a long and laborious negotiation process, but I believe we have come up with legislation that is better for the farmers of this country.

In my home State of Montana and many other Western and Midwestern States, we have faced a number of trade disputes between Canada and the United States. One of the most glaring discrepancies deals with pesticides. Chemicals that are sold for one price just across the border in Canada are sold at a considerably higher cost to American producers. Why does this happen you may ask? The EPA places strong regulations on chemicals used in the United States and therefore, the chemical companies believe they should hike up the prices to pay for their trouble.

The chemicals sold in Canada and the United States, in most cases, have the exact same chemical makeup. The same company manufactures them but often gives them a different name and nearly always prices the American chemicals higher. The crops harvested at a lower production cost in Canada are now competing with American products. I am a strong believer in fair trade, but for free trade to actually occur, this problem must be addressed.

Currently, American farmers are facing a serious economic recession. Grain prices are the lowest they have been in a number of years and there does not appear to be a light at the end of the tunnel. Additionally, much of the West is looking at yet another year of drought. Also, fertilizer costs are skyrocketing with the ever-rising cost of natural gas. To top it all off, they are also being forced to pay twice as much for nearly the same chemicals as their foreign neighbors.

This bill would eliminate current obstacles and even the playing field for our farmers. The bill operates under a similar concept as the previous bills introduced, but many of the details have changed. The pesticide harmonization bill that is currently introduced, S. 332, had the States, not EPA, in charge of pesticide registrations. This new version has EPA in charge of the process. This eliminated some of the concerns of States, whose budgets would not allow these much-needed registrations to be completed. It also protects confidentiality of ingredients in the chemicals.

Our farmers and ranchers have been paying too much for their pesticides and chemicals for too long. From my years as a football referee, I learned everyone needs to follow the same rules to play the game. We need to make sure Canadian farmers and U.S. farmers are playing under the same rules. I believe this bill makes that happen. I look forward to working with my colleagues on this crucial issue to America's farmers and ranchers.

Mr. President, I would like to congratulate Ruth Abbey of Malta, MT on her 99th birthday. Ruth is a pillar of her community and an inspiration to many, including her children, grandchildren, great-grandchildren, and great-great-grandchildren. Ruth was a teacher for many years and subsequently served as County Superintendent of Schools.

Ruth is exemplary of our Montana way of life, and I am honored to offer my congratulations on this special occasion.

Mr. President, today I am introducing legislation that will protect an existing exemption for farmers and agribusinesses from the Department of Transportation's, DOT, limitations on maximum driving time in transporting agricultural commodities or farm supplies during peak planting and growing seasons.

In 1995, Public Law 104-59 passed by Congress granted farmers and retail farm suppliers a limited exemption from DOT limitations on maximum driving time in transporting agricultural commodies or farm supplies within a 100-mile radius of a final distribution point. This legislation recognized the special needs of rural America, understanding that drivers employed by farm retailers generally operate in local areas to farmers' fields delivering and applying crop inputs. Much of their time is spent waiting at the field or the farm store loading and unloading their trucks. In short, farm retail drivers stay in a local area and return to their homes each night to sleep. The work of these crop input suppliers is essential to the Nation's farmers, who often have short windows of time to plant and harvest their crop around changing weather patterns.

The agricultural exemption is seasonal, applying only during designated months throughout the year as determined by each State. Every State has now taken this action, and to my knowledge this exemption has not had any impact on public safety.

It is important to note that under my clarifying legislation, the farm supply/farm commodity exemption would remain limited in scope.

My legislation reiterates original Congressional support for the agricultural exemption. The DOT has no expertise in this area nor, in my opinion, does the definition of agricultural commodity come under the jurisdiction of this agency. In addition, the term ``agricultural commodity'' is already defined by Section 102 of the Agricultural Trade Act of 1978 (7 U.S.C. 5602). Therefore, in my legislation, Section 345 (e) of the National Highway System Designation Act of 1995 is amended to reflect the definition in the Agricultural Trade Act.

A bipartisan group of House Members are also seeking clarifying legislation in this regard with Representative Bereuter of Nebraska taking the lead.

I urge all my colleagues to join me in passing this legislation to protect the agricultural exemption to hours of service rules and prevent DOT from diminishing or revoking the exemption.

Mr. President, today I am introducing legislation that will protect an existing exemption for farmers and agribusinesses from the Department of Transportation's, DOT, limitations on maximum driving time in transporting agricultural commodities or farm supplies during peak planting and growing seasons.

In 1995, Public Law 104-59 passed by Congress granted farmers and retail farm suppliers a limited exemption from DOT limitations on maximum driving time in transporting agricultural commodies or farm supplies within a 100-mile radius of a final distribution point. This legislation recognized the special needs of rural America, understanding that drivers employed by farm retailers generally operate in local areas to farmers' fields delivering and applying crop inputs. Much of their time is spent waiting at the field or the farm store loading and unloading their trucks. In short, farm retail drivers stay in a local area and return to their homes each night to sleep. The work of these crop input suppliers is essential to the Nation's farmers, who often have short windows of time to plant and harvest their crop around changing weather patterns.

The agricultural exemption is seasonal, applying only during designated months throughout the year as determined by each State. Every State has now taken this action, and to my knowledge this exemption has not had any impact on public safety.

It is important to note that under my clarifying legislation, the farm supply/farm commodity exemption would remain limited in scope.

My legislation reiterates original Congressional support for the agricultural exemption. The DOT has no expertise in this area nor, in my opinion, does the definition of agricultural commodity come under the jurisdiction of this agency. In addition, the term ``agricultural commodity'' is already defined by Section 102 of the Agricultural Trade Act of 1978 (7 U.S.C. 5602). Therefore, in my legislation, Section 345 (e) of the National Highway System Designation Act of 1995 is amended to reflect the definition in the Agricultural Trade Act.

A bipartisan group of House Members are also seeking clarifying legislation in this regard with Representative Bereuter of Nebraska taking the lead.

I urge all my colleagues to join me in passing this legislation to protect the agricultural exemption to hours of service rules and prevent DOT from diminishing or revoking the exemption.

Mr. President, I would like to take a few moments to comment on H.R. 2312, which allows for some technical corrections to the ORBIT Act. Although neither Inmarsat nor Intelsat has yet conducted the IPO that the ORBIT Act provided for, there is one satellite provider that has fulfilled the ORBIT Act's original requirements in this regard. That provider is New Skies Satellites, which has separated itself from its one-time parent Intelsat, conducted an IPO under challenging market conditions, substantially diluted its shareholder base through both the IPO and a recent 10 percent share buyback, and become a full-fledged competitor in the satellite marketplace. New Skies has asked that we consider some amendments to the Act that would acknowledge and recognize its fully independent status. While the abbreviated process leading to the Senate's consideration of this bill today did not permit full consideration of those issues, I am open to listening to the arguments for such changes in the context of a broader review of the ORBIT Act and its implementation.

Mr. President, I thank the chairman of the committee and the chairman of the subcommittee and the ranking member. I submitted two amendments. One has to do with general aviation and reimbursement to organizations that suffered losses due to September 11. We took care of the airlines and a lot of service industries in and around airports, but we forgot and left out one very important part of the American aviation scene, very important to my State of Montana, those people involved in general aviation, in other words, the charter business, as they were impacted, too, and received no reimbursement in any way to recover the damages or the losses they may have incurred.

We have talked about this. I ask the amendment which is at the desk to be considered. It has been amended and worked on by both sides of the aisle. There is agreement on this amendment.

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

It has been worked on by both sides and I ask for its adoption.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Amendment No. 899

The second amendment I have has to do with recommendations concerning air travel agents who have been part of a report requested of the Transportation Department. This is only language that requires the Department of Transportation to recommend the changes they see as a result of this report. I ask it be considered at this time.

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

I ask the amendment be agreed to.

By the way, it has been cleared by both sides.

I move to reconsider the vote.

I appreciate the leadership on both sides of the aisle for consideration of the amendments.

I yield the floor.

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

Mr. President, I rise today to honor our military personnel on the occasion of Armed Forces Day.

As a veteran of the Marine Corps, I believe one of the most important things a person can do is serve this great country through the military. Our nation must honor those who take up the call to defend our freedoms and never take for granted those freedoms that all of us enjoy. These freedoms are only because of our veterans and military personnel.

Our active military forces have seen a lot of action as of late. The Guard and Reserve components have seen an increase in their operations as well. The performance of our military men and women has been outstanding. In my home State of Montana, as many as 750 men and women, Active Duty, Reservists and National Guard Personnel are supporting our ongoing operations, both in the United States and overseas. I am especially proud of these folks that have stepped up to the plate and have gone above and beyond the call to duty during these trying times.

Our military has performed honorably in the latest missions with which they have been tasked--the Global War on Terrorism, Operation Enduring Freedom and Operation Iraqi Freedom. We have seen Americans coming together to support these men and women and their families at home.

The men and women who wear our country's uniform are the keepers of the flame that has been passed down through generations. They are the bearers of our national memory. Each and every veteran and military member understands that the cost of freedom is steep. They were willing to accept that cost, so that we may live in peace. Arlington National Cemetery and veterans' cemeteries across this great land are full of those who understand that ``freedom is not free.'' My thoughts and prayers go out to their loved ones for their loss.

I will continue to do my best to ensure that the United States military has the tools, skills and support needed to maintain its position as the finest fighting force in the world. I will also work to ensure that our veterans receive the benefits that they so richly deserve. It is because of their sacrifices each and every one of us are able to be here today.

God Bless our Military Personnel and God Bless America.

Mr. President, I ask unanimous consent that the amendment offered by Senator Bunning be laid aside.

Mr. President, I rise today to offer an amendment to this bill, and I ask for its immediate consideration.

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

Mr. President, I come to the floor today with an amendment that is offered by Senator Rockefeller and myself that provides some incentives to accelerate the deployment of broadband high-speed Internet access across the country. There are other cosponsors of the amendment. My colleague from Montana, Senator Baucus, is a cosponsor. Senators Clinton, Kennedy, and Johnson of South Dakota also are cosponsors.

Broadband has always been of interest to both Senator Rockefeller and myself. Both of us serve on the Commerce Committee. We have worked on this a lot. We both represent States that have quite a lot of rural outdoors. What this amendment does is affords tax incentives for the buildout of broadband. Although many urban and suburban areas now have access to broadband connections, many rural areas across the country and, of course, in Montana do not. That places rural areas at a disadvantage in a number of ways.

Just for economics, why should folks in rural areas be denied access to the Internet, or the Internet economy as some would say, just because they live where they do to merchandise and to exchange ideas in this economy and find some way to supplement their primary income? We have people who market their grain and livestock every day through the commodity markets around the world. In terms of educational opportunities in rural areas, why should a young person, just because he is born in Garfield County, MT, be denied the same educational opportunities as those who were born and raised in the more urban areas where their curriculum is broadly taught.

These young folks deserve the same opportunity. Distance learning is an important part of the education system in rural areas. Broadband is the technology that takes them those distances.

In the area of health care, I have 14 counties in Montana that do not have a doctor. People receive their health care from physician assistants and in other ways. We know from rural demographics that the folks are getting older, so our health care for the elderly is very important, and part of that is supplied by broadband technologies.

Our amendment would create a temporary tax incentive for providers in the form of expensing, allowing an immediate deduction of a capital expenditure in the first year of service rather than depreciating that investment over time. In the case of the current generation broadband investments in rural and underserved areas, the bill would allow a 50 percent expensing on the investment, with the rest to be depreciated according to the normal depreciation schedules. And where the providers build out next generation broadband networks, which are typically more expensive, the bill would provide for 100 percent expensing in that year.

Our amendment would have a tremendous impact on the economy. In fact, we know it would. For instance, Robert Crandall, an economist at the Brookings Institute, has estimated that accelerated deployment of broadband would generate $500 billion in economic growth annually. I think we would all be delighted to have that happen. I believe we should take the steps to allow it to do so. This amendment is a very important step in that direction.

This is an opportune time to take advantage of such a provision. Currently South Korea and Japan are ahead of the United States in broadband deployment. I believe it is extremely important that the United States avoid falling behind in telecom and Internet technology, and the financial incentive of the type provided by this legislation will help us ensure that we will not.

As we take a look at this issue, this means new technologies on the wired system but also on the wireless system. It says technology neutral, which means it allows the new technologies that are being offered and the R&D work going on with new technologies, it allows those technologies to be deployed and taken advantage of. Just remember, 50 percent expensing for investments in rural and underserved areas of current generation broadband technologies. It provides 100 percent expensing for the investments in the next generation of broadband technologies in rural areas.

It is technology neutral. It makes no difference if you are using a medium copper wire, coaxial cable, optical fiber terrestrial wireless, satellite or something else. If you deliver the threshold speeds, you are eligible for the benefit. And it sunsets after 1 year. The intent is not to provide a permanent benefit to the telecom sector but, rather, an incentive to build out new infrastructure within a short period of time.

Think of the generation of business and our economic setup and the jobs and the job climate in that area in the first year of deployment. It is a very important amendment. Not only do we deliver better and quicker services to rural America, but we put a lot of people to work.

I hope more of our colleagues will join with Senator Rockefeller and me in supporting it, and I hope we can work with Senator Grassley to include this in the jobs and growth package.

Mr. President, I ask unanimous consent to add as cosponsors of the amendment Senators Baucus, Clinton, Kennedy, and Johnson.

Mr. President, I rise today in recognition of the dedication and service that the American Legion Auxiliary Unit No. 70 has provided to Montana's veterans and their communities. The American Legion Auxiliary was formally founded in 1919 by a group of concerned women who stepped in to fill the role of the men who left home for the battlefields of World War I. These women were driven to service by their compassion, by their sense of civic duty, but, most of all, they were driven by their love of country.

In the more than eight decades since its founding, the American Legion Auxiliary has expanded to include hundreds of chapters in every state and territory. Likewise, their original mission expanded as well to include helping many others in need.

The women of American Legion Auxiliary Unit No. 70 have been particularly active in their community. They have donated funds to veteran's facilities and programs in Fort Harrison, Miles City, Glendive and Columbia Falls, MT. They are distributing more than 900 poppies in recognition of the service and sacrifice our veterans have given their country. During Operation Iraqi Freedom, they tied hundreds of yellow ribbons across Judith Gap to show their support for our troops and their family members.

Mr. President, I thank the women of American Legion Auxiliary Unit No. 70 and all the American Legion Auxiliaries for their service to our Nation's veterans and communities. These women have not only given their time and money in service to our Nation, they have given their hearts as well, and that is the best thing anyone can give.

Mr. President, I rise to introduce The Rural Health Care Fairness and Medicare Equity Act with my good friend and colleague, Senator Dorgan, from North Dakota.

Many predominately rural States, such as my home State of Montana, face difficult challenges in the health care arena. Funding, staffing shortages, and inadequate reimbursement levels have plagued many hospitals and health care providers in the most rural areas of our country since the passage of the Balanced Budget Act of 1997. I have been a strong supporter of improving access to health care in these areas through education and telemedicine, but many rural communities in particular still face dangerous health care-related shortages.

The Rural Health Care Fairness and Medicare Equity Act seeks to make Medicare reimbursement more fair and equitable for rural and small urban hospitals and physicians by correcting the unintended inequities in the Medicare system put in place by the Balanced Budget Act of 1997 with five components. First, this act would provide a single standardized amount under the Medicare inpatient Provider Payment System, PPS, by permanently raising the standardized amount for rural and other hospitals to the same standardized amount level as large urban area hospitals. My colleagues in the Senate and I recognized the importance of doing this in the fiscal year 2003 Omnibus Appropriations package, which made this change for the remaining months of fiscal year 2003. We should now standardize hospital levels by making this change permanent, and this bill does just that.

Second, this bill would change the hospital labor market share from its current level of 71.1 percent, to 62 percent, based on a study done by the University of North Carolina Rural Health Research and Policy Analysis Center demonstrating that the current hospital labor market share is too high. Hospitals that would be harmed by this change would be held harmless. Third, this legislation would create a wage index floor of 0.85 for hospitals that would otherwise have a wage index less than the floor. Thirty of my colleagues and I cosponsored legislation in the 107th Congress that included a 0.925 floor, and I am hopeful that by setting the floor at 0.85, this provision will be better targeted toward rural hospitals with negative Medicare inpatient margins, helping our rural health centers to not only keep their doors open, but to continue providing quality, affordable health services to the rural communities they serve.

Fourth, this bill would create new, alternative criteria for hospital reclassification. This bill would require the Secretary of Health and Human Services to develop a new category of reclassiciation of hospitals for area wage index and standardized amount purposes. I am greatly concerned that the current reclassification process, particularly the proximity and adjacency criteria, has not been helpful to hospitals in States like Montana, with large land bases and lots of distance between communities, even though these hospitals must still compete with one another for nurses and other health care staff.

Two-thirds of all hospital reclassification take place in California and in the Northeast, largely because of these proximity and adjacency criteria. This bill would allow hospitals located in sparsely populated States that do not meet these prohibitive criteria to re-classify if they otherwise need reclassification criteria. This bill defines a sparsely populated state to be one in which there are fewer than 20 people per square mile of land, under which eight States, including Montana, qualify. Finally, the Rural Health Care Fairness and Medicare Equity Act would create a physician geographic adjustment floor of 1.0 for the physician work component of the Medicare physician payment system, beginning in 2004. This provision would lessen the geographic disparities in Medicare payment so gravely affecting physicians in the field today.

Patients in both rural and urban areas depend on the availability of quality health care providers to offer superior, affordable health services to people across the Nation. Medicare physician payments are intended to correspond to the costs that efficient providers incur. Instead, research has shown that the sustainable growth rate, SGR, under which reimbursement rates are supposed to be adjusted annually fails to account for all the relevant factors that affect the cost of physician payments, and maintains further inequities, such as Medicare paying different amounts for the same service, depending on where the service is provided.

Cuts in Medicare reimbursement to health care providers have forced health providers to make difficult choices, including becoming a nonparticipating Medicare provider, moving to areas with better reimbursement rates or less Medicare patients, retiring from practice early, limiting or discontinuing charitble care, reducing staff, or leaving Medicare entirely. The impact on these cuts has taken a serious toll on rural communities, such as those in Montana. The most recent cut in physician payment levels was the largest in Medicare history, immediately affecting 1 million health care professionals and the countless millions of elderly and disabled patients they, in turn, serve. Not only does this create a negative health care environment so adverse to the principles of the Medicare system, but the inequities in physician reimbursement rates have created a crisis situation for many patients in rural areas who do not have the luxury of choosing to see a different health care provider who can still afford to take Medicare patients.

This bill is extremely important to ensure that America's seniors and low-income have access to high quality physician services. It is imperative that Congress continue it commitment to rural health care quality, accessibility, and affordability, and the Rural Health Care Fairness and Medicare Equity Act is an important step toward this goal.

Mr. President, I rise to introduce The Rural Health Care Fairness and Medicare Equity Act with my good friend and colleague, Senator Dorgan, from North Dakota.

Many predominately rural States, such as my home State of Montana, face difficult challenges in the health care arena. Funding, staffing shortages, and inadequate reimbursement levels have plagued many hospitals and health care providers in the most rural areas of our country since the passage of the Balanced Budget Act of 1997. I have been a strong supporter of improving access to health care in these areas through education and telemedicine, but many rural communities in particular still face dangerous health care-related shortages.

The Rural Health Care Fairness and Medicare Equity Act seeks to make Medicare reimbursement more fair and equitable for rural and small urban hospitals and physicians by correcting the unintended inequities in the Medicare system put in place by the Balanced Budget Act of 1997 with five components. First, this act would provide a single standardized amount under the Medicare inpatient Provider Payment System, PPS, by permanently raising the standardized amount for rural and other hospitals to the same standardized amount level as large urban area hospitals. My colleagues in the Senate and I recognized the importance of doing this in the fiscal year 2003 Omnibus Appropriations package, which made this change for the remaining months of fiscal year 2003. We should now standardize hospital levels by making this change permanent, and this bill does just that.

Second, this bill would change the hospital labor market share from its current level of 71.1 percent, to 62 percent, based on a study done by the University of North Carolina Rural Health Research and Policy Analysis Center demonstrating that the current hospital labor market share is too high. Hospitals that would be harmed by this change would be held harmless. Third, this legislation would create a wage index floor of 0.85 for hospitals that would otherwise have a wage index less than the floor. Thirty of my colleagues and I cosponsored legislation in the 107th Congress that included a 0.925 floor, and I am hopeful that by setting the floor at 0.85, this provision will be better targeted toward rural hospitals with negative Medicare inpatient margins, helping our rural health centers to not only keep their doors open, but to continue providing quality, affordable health services to the rural communities they serve.

Fourth, this bill would create new, alternative criteria for hospital reclassification. This bill would require the Secretary of Health and Human Services to develop a new category of reclassiciation of hospitals for area wage index and standardized amount purposes. I am greatly concerned that the current reclassification process, particularly the proximity and adjacency criteria, has not been helpful to hospitals in States like Montana, with large land bases and lots of distance between communities, even though these hospitals must still compete with one another for nurses and other health care staff.

Two-thirds of all hospital reclassification take place in California and in the Northeast, largely because of these proximity and adjacency criteria. This bill would allow hospitals located in sparsely populated States that do not meet these prohibitive criteria to re-classify if they otherwise need reclassification criteria. This bill defines a sparsely populated state to be one in which there are fewer than 20 people per square mile of land, under which eight States, including Montana, qualify. Finally, the Rural Health Care Fairness and Medicare Equity Act would create a physician geographic adjustment floor of 1.0 for the physician work component of the Medicare physician payment system, beginning in 2004. This provision would lessen the geographic disparities in Medicare payment so gravely affecting physicians in the field today.

Patients in both rural and urban areas depend on the availability of quality health care providers to offer superior, affordable health services to people across the Nation. Medicare physician payments are intended to correspond to the costs that efficient providers incur. Instead, research has shown that the sustainable growth rate, SGR, under which reimbursement rates are supposed to be adjusted annually fails to account for all the relevant factors that affect the cost of physician payments, and maintains further inequities, such as Medicare paying different amounts for the same service, depending on where the service is provided.

Cuts in Medicare reimbursement to health care providers have forced health providers to make difficult choices, including becoming a nonparticipating Medicare provider, moving to areas with better reimbursement rates or less Medicare patients, retiring from practice early, limiting or discontinuing charitble care, reducing staff, or leaving Medicare entirely. The impact on these cuts has taken a serious toll on rural communities, such as those in Montana. The most recent cut in physician payment levels was the largest in Medicare history, immediately affecting 1 million health care professionals and the countless millions of elderly and disabled patients they, in turn, serve. Not only does this create a negative health care environment so adverse to the principles of the Medicare system, but the inequities in physician reimbursement rates have created a crisis situation for many patients in rural areas who do not have the luxury of choosing to see a different health care provider who can still afford to take Medicare patients.

This bill is extremely important to ensure that America's seniors and low-income have access to high quality physician services. It is imperative that Congress continue it commitment to rural health care quality, accessibility, and affordability, and the Rural Health Care Fairness and Medicare Equity Act is an important step toward this goal.