Floor Statements

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

I ask unanimous consent for 15 minutes if there is time available. If not, I would appreciate it if the Chair could indicate who has been designated the time.

It is my understanding, through staff, that Senator Lincoln will not be coming to the floor at this time. So if there is no objection, I ask unanimous consent to use the time of the Senator from Arkansas. And if she comes to the floor, I will certainly yield to her.

Mr. President, I rise to speak on the announcement of a dramatic increase in the Medicare Part B premium for seniors and the concern the people of Michigan have about trying to pay a 17.5-percent premium increase for next year. Just a day after President Bush touted his efforts to help our seniors and the disabled cope with increased medical expenses, his administration announced the largest premium increase in Medicare's history, dating back to 1965.

Unfortunately, nothing has been done about record increases in the cost of health care over the last 4 years. Now we see the largest premium increase, a 17.5-percent increase. We have

seen it consistently going up since 2001. It is time to say enough is enough.

Seniors are only going to see about a 3-percent increase in their Social Security cost of living. Yet the Part B premium comes directly out of that track. So instead of getting at least a 3-percent increase to help pay for food and the mortgage and utility bills, prescription drugs and so on, they will actually see a reduction of 14.5 percent in what they receive through Social Security.

This is absolutely unacceptable. Unfortunately, instead of helping, Congress and this administration have pushed through a Medicare plan about which CMS Administrator McClellan has acknowledged that about a sixth of this year's premium increase results from the billions that Medicare is paying private health plans to encourage them to offer private health insurance. So what we see are conscious decisions that we made that have caused this increase to be as high as it is. I believe they were the wrong decisions, the wrong choices.

It doesn't make sense and it is not fair that the millions of seniors who enjoy and want to stay in traditional Medicare--about 89 percent of seniors right now have chosen traditional Medicare over Medicare+Choice or being in an HMO--have to subsidize the big private health insurance companies and HMOs and the 11 percent of the seniors and disabled who have the ability or have the choice, even, to be in an HMO.

Moreover, we have heard time and time again that the private plans are less efficient than traditional Medicare. I have shown charts on the floor as we have debated the Medicare prescription drug bill. We have seen the Congressional Budget Office analysis. In fact, we heard it again last week when the Medicare Payment Advisory Commission reported that CMS pays Medicare private health plans an average of 107 percent of what it costs to care for the same beneficiaries under traditional fee-for-service programs.

At a time when we are looking at great concerns about the long-term solvency of Medicare, looking at these huge increases that have occurred for seniors related to the premiums for Medicare, we are hearing from the Medicare Payment Advisory Commission that CMS is paying private plans an average of 107 percent of what it costs to care for beneficiaries under traditional Medicare.

This makes absolutely no sense, no matter how you look at it. According to the report, Medicare payments to private plans cost 16 percent to 23 percent more than traditional plans. So, basically, we can be spending up to 23 percent more on the approach of privatizing Medicare. That is what it is; this is a strategy to privatize Medicare, which the majority of seniors have not asked for, they have not chosen, and they don't want; and the icing on the cake is it costs up to 23 percent more.

I ask, if HMOs are so much better and more efficient, why do they need the extra dollars? I am certainly not opposed to HMOs. I have participated in the past, as my mother has, when she was on Medicare and when Medicare HMO was available in our community. She got dropped, unfortunately, when they chose to leave. Certainly, this is not a discussion about whether HMOs provide an important service or quality service.

My concern is, within the context of Medicare, why, if they are so much better and more efficient, are we providing them more money? The debate on privatization was that somehow Medicare is going broke, the trust fund is going to run out of money; therefore, we have to privatize Medicare. And exactly the opposite result has occurred as we have begun to privatize Medicare. Premiums for seniors are going up faster than at any other time in our history. We hear from independent reports that it costs anywhere from 16 percent to 23 percent more to privatize Medicare than to keep it the way it is. With higher administrative costs, in fact, private plans are more costly than regular Medicare. So we are told they need subsidies because it costs more to administer them.

Again, the whole point is to be more efficient, stretch the dollars farther, lower costs, so we can provide better prescription drug coverage for seniors and other kinds of preventive care they need, and that Medicare remains solvent and healthy for the future. Older Americans are staggering under the relentless increases in the cost of their health care and prescription drugs. We have all heard the stories. More older Americans will face harsh choices in meeting basic needs of health, food, housing, and paying utility bills. Meeting those challenges will be even more difficult as percentage increases in Medicare premiums greatly outpace the increases for Social Security. The increase will be especially painful because Social Security payments again are expected to rise less than 3 percent. I say ``expected'' because we don't know how much or how little Social Security payments will be yet.

Yet, this year, this administration decided to release the Medicare numbers the Friday right before Labor Day, right before the weekend when the news was focused on a hurricane. That is some holiday for millions of seniors who have labored their whole lives. We learned the OMB moved up the release of this huge increase by 6 weeks. In fact, we hear today in an article that the internal administration memo reveals that the unprecedented 17-percent increase in Medicare premiums seniors will pay in 2005 was scheduled for release October 22. It was scheduled for release on October 22, along with Social Security COLA payments.

Obviously, somebody looked at this and said: This is the largest increase in the history of the program. We want to make sure it is done as quietly as possible. So they chose the Friday before the Labor Day weekend, late in the afternoon, in the middle of a hurricane, to release the numbers.

OMB received the premium notice from HHS on September 1 and cleared it for release only 2 days later. As I said, for the last at least 10 years, they have done it in October along with Social Security.

We are not going to only talk about premium increases here today. We have the ability to do something about it. I am proud to be doing something about this, saying enough is enough; the portion of this that comes from privatizing Medicare needs to be removed and we need to put these premiums back in line with Social Security.

We know health care costs are going up for everyone--every family and every business. In a larger sense, we need to be addressing that as well, which we can do with the cost of prescription drugs. We can bring it to the floor and pass an effort to open the border and lower the costs in half by allowing pharmacists to do business safely with pharmacists in Canada and other places. There are other strategies. There are things we can do to address the broader issue of health care and we need to be doing them.

But while this is happening, we should not be saying to our seniors, saying to someone on Medicare, that instead of addressing these issues, we are going to require you to pay an extra-large increase because of a policy made here to privatize Medicare that, in the face of all evidence, shows the administrative costs are higher and the costs of providing the kinds of care are higher. We now have one more report saying that. In the face of all objective evidence, the Congress and the President have moved forward to want to privatize Medicare, anyway, saying it will lower prices, when in fact it has resulted in the largest premium increase for seniors and the disabled in the history of the Medicare Program.

I believe this is wrong. So I have introduced S. 2780, Keeping the Promise of Medicare Act, with 11 of my colleagues. My bill would cap the Part B premium at the same level as the cost-of-living adjustment so that seniors do not see real cuts in their Social Security benefits. In other words, we would at least keep seniors whole, moving in the right direction while we deal with these other issues, in terms of rising health care costs that need to be and must be addressed.

We need a sense of urgency about this issue. Health care is not optional. This is one of the most urgent issues a family addresses. It is the most urgent cost right now that businesses across the country are facing. Yet we do not see that sense of urgency, even though I know colleagues on both sides of the aisle have concerns, have knowledge about this, and want to see something happen. We can do better than that. We can do better for our seniors through

Medicare. We can do better for businesses that are desperately asking us for help. We can do better for our families, for every worker being asked to pay more for health care, or losing their job because the company cannot keep their health care plan and their jobs. There is more we can do, much more. I urge my colleagues to join with me in one step, S. 2780, Keeping the Promise of Medicare Act. We can, at minimum, start by saying to our seniors we are going to make sure you are not burdened with the costs of paying for these policies to privatize. We will keep you whole by capping this increase at the same level as the cost of living for Social Security. I hope we will vote on this bill before we leave and have the same sense of urgency about it that those paying their bills have every day.

I yield the floor.

Mr. President, I thank my colleagues very much. I thank the Senator from Massachusetts for allowing me to take 2 minutes to follow up on the comments of the distinguished Senator from Illinois concerning what is happening on health care and reimportation.

I just came from a gathering with colleagues on both sides of the aisle and the House of Representatives, speaking out again on why we need to pass that bill immediately. We want to lower prices. We need to allow pharmacists to do business with pharmacists across the border in Canada or other countries where it is safe, and we can drop prices in half.

I also raise one more time this issue of the Medicare premium increase that was announced by the administration over a week ago at the end of the day, on a Friday, in the middle of a hurricane, unfortunately, right after the Republican convention, when the President indicated he was going to lower pricing for seniors for health care, and then we saw an announcement of the largest premium increase in the history of the country--17.5-percent premium increase. Social Security is only going up by approximately 3 percent this year, which means seniors will be moving backward, being put in a real hole as a result of what is happening.

I am pleased to have introduced legislation along with my colleague from Massachusetts and other Members. We welcome everyone's support and cosponsorship, and I hope we can get this taken up as quickly as possible. There will be a 17.5-percent increase in Medicare premiums, and a piece of that, as a result of policy changes to privatize Medicare, is not acceptable. As I indicated before, Social Security is going to go up about 3 percent. Yet, we are going to see the highest increase in Medicare's history in premiums.

The majority of seniors have not asked to privatize Medicare. They have not chosen that option. They should not be paying for it. I urge my colleagues to join us to fix that before we leave this fall.

Madam President, I, first, thank my friend and colleague from Connecticut for his eloquence and leadership on this issue. He proposed this amendment last year, and I was very proud to join him in this effort. If we had done this amendment last year, we would be having a very different discussion, I believe, right now. So I thank the very distinguished Senator from Connecticut for his leadership.

I think it is important we recognize the fact that we have been told by the Department of Homeland Security that this is National Preparedness Month, which has just been announced. We are told there are hundreds of activities planned. The Department is encouraging us to encourage families we represent to be prepared individually.

In the spirit of National Preparedness Month, I think we have a responsibility to do exactly the same. That is why I rise to urge my colleagues to support the Dodd-Stabenow amendment that will provide America's first responders with the equipment and the training they need to protect the people of our country.

As the President often says, we are at war. The threat level has been raised to High or Orange six times since it was created. Americans are repeatedly warned the terrorists will strike again, that we should be vigilant and prepared. The experts and our leaders are certain that we remain under the threat of terrorist attack, and certain that we must be ready to prevent, hopefully, and, if not prevent, be able to respond to an attack.

However, what remains uncertain is our ability to prepare for and defend against potential terrorist threats. That is where our Government up until now has failed. We have the opportunity to correct that on this bill.

The experts I speak of, and Senator Dodd spoke of, are a blue-ribbon panel of Nobel laureates, U.S. military leaders, former high-level Government officials, and other senior experts, brought together by the Council on Foreign Relations, led by former Senator Warren B. Rudman, and advised by former White House terrorism and cybersecurity chief, Richard A. Clarke.

During the spring of last year, this Independent Task Force on Emergency Responders conducted meetings across the Nation with first responders and national organizations seeking the answer to one simple question: What do you need to keep us safe? What do you need as first responders to keep us safe? The answer Senator Rudman received was daunting. Unbudgeted needs totaled about $98.4 billion, and these funds would only establish a minimum effective response, according to the report.

I would like to detail some of the deficiencies in our preparedness that the Rudman report outlined.

On average, our fire departments have only half the number of radios needed on a shift and only enough breathing apparatus for one-third of

their firefighters. Now, imagine that. I know in Michigan people assume firefighters and police officers, emergency responders, have communications equipment, that they can talk to each other. I have met with police departments where they have said they cannot talk to the fire department, and they are in the same town or in the next town. This report said, on average, fire departments have only half the number of radios needed on a shift.

They also found police departments across America do not have the protective gear to respond to weapons of mass destruction attacks. They do not have basic protective gear.

Why have we ignored this panel's recommendations?

When the 9/11 Commission recently offered its recommendations--and I commend them for their thoughtfulness--Senators of both parties immediately took action. In fact, there is now a bipartisan bill that incorporates all 41 of the Commission's recommendations, and the majority leader has pledged to take up this legislation in the next month. I support that. In other words, approximately 2 months after we received the recommendations of the 9/11 Commission we are acting.

Unfortunately, the Rudman report is a year and a half old, and I would argue, even though there have been some changes in funding, we have basically done nothing to fundamentally respond to the seriousness of this report. In fact, what we have seen, in some cases, in order to fund homeland security and first responders, other programs have been cut. The COPS Program or other programs have been cut to move dollars over. And the local police department--it does not matter which pot it comes from--what they are looking at is the bottom line: Can they afford to add another police officer? Can they afford protective equipment? And way too many of the law enforcement leaders in Michigan are saying, no, they cannot.

During a series of 11 meetings I held across Michigan, I met face to face with many people I consider to be experts--first responders, community leaders in Michigan. They have told me in no uncertain terms that they are woefully underfunded and underequipped. Month after month they continue to remind me of the fact that they still don't have the dollars they need, even though some dollars have trickled down from Washington.

The situation in Michigan is of particular importance to me, of course, but this is not only about Michigan. This is a problem and a challenge for all of us. This is not a partisan issue. This is about how to keep Americans safe all over the country. We have ignored this report for too long.

I thank the Senators from Mississippi and West Virginia, the distinguished members who have worked hard on this bill. I know they find themselves in a difficult position confronting new threats and correcting countless vulnerabilities that were exposed on September 11. The legislation before us is a step forward. Unfortunately, I believe it is a very small step. We can do better, and we must do better.

The Dodd-Stabenow amendment will provide $690 million for the Federal Law Enforcement Training Center; $11.5 billion for the Office of Domestic Preparedness State and Local Programs; $3 billion for firefighter assistance grants; $660 million for the emergency management performance grants; $3.3 billion for the Emergency Preparedness and Response directorate; and $1 billion for the staffing for adequate firefighter and emergency response grants. In total, the amendment would provide an additional $15 billion in assistance for our Nation's front-line first responders.

Perhaps we should elevate the capabilities of our first responders above the reconstruction of Iraq. Over the past 2 years, Congress has provided $24 billion in American dollars for the reconstruction of Iraq. In late June, the Government Accountability Office told us that only $3 billion had been spent, leaving $21 billion in a fund for reconstruction, substantially more than what we are talking about here. I assure my colleagues that if we had had these funds and they had been given to our first responders, they would have done more and done more quickly, and that would have provided greater safety and the capability to deal with terrorist attacks. Those dollars would have been used here to keep us safe.

I am not suggesting we don't need to be supportive in Iraq, but this truly is a question of urgency and priorities for the American people. I have supported the request by the Department of Defense in support of our Troops. I cannot imagine why we are not giving that same sense of urgency to the total request to keep us safe here at home.

Again, the legislation we are now considering is a good step, but much more needs to be done. Senator Rudman's efforts have made it clear that the safety of the American people requires we do more. We can't be doing this around the edges. We have to do what is necessary, as we need to do what is necessary for defending ourselves abroad in terms of dollars needed for equipment and troops and so on. The very same thing should apply here. We should do what is necessary to keep us safe, period.

This Saturday is the third anniversary of 9/11. We know thousands of Americans lost their lives on that day. We owe it to their families and to all Americans to do everything in our power to defend our country, our families from another terrorist attack.

The Dodd-Stabenow amendment will begin to provide our police officers, firefighters, and emergency medical workers with the equipment and training they need to do one of the hardest jobs in this country--protect their communities and their citizens' lives.

When it comes to providing funding for our military men and women in Iraq and Afghanistan, we have provided money for what they need. I support that and will continue to. The President has requested numerous supplemental appropriations for Iraq and Afghanistan. We have promptly approved those funds. In most cases, Congress provided money in excess of what was actually needed at the time. Unfortunately, we have not done the same when it comes to homeland security. We would never want our troops to fight without the best guns and tanks, but we are willing to let our police and firefighters use outdated and inferior communications and bomb detection equipment. It makes no sense.

God forbid we have another terrorist attack in our country. Despite numerous Code Orange alerts, we have avoided another tragedy. I commend all of those involved in that effort. However, we do know there are likely terrorists already in this country and many trying to gain entry. We know they want to kill innocent citizens. Therefore, we must strengthen our resolve and do whatever it takes to keep us safe. When it comes to protecting our children, we should not be penny wise and pound foolish.

We have seen the pictures of the recent horrific terrorist attacks in Russia. Our hearts and prayers go out to all who are grieving. Who would have thought terrorists would go to such extremes that they would kill innocent children in a school? It demonstrates we can be attacked anywhere at any time.

Again, God forbid such a tragedy would happen in our own country, but if it did, could we look those grieving parents in the eye and tell them we did everything we could to protect their children? Could we tell them we did everything we could at the border to keep the terrorists out? Could we tell them we had the best bomb detection equipment possible? Could we tell them we had the best trained and equipped first responders who could act quickly and communicate with each other to prevent loss of life?

I remind my colleagues, when people call 9-1-1, they don't get somebody in the Homeland Security Department in Washington, DC. They get their local police or fire department. Local police and firefighters are ready and waiting respond to a terrorist attack and save lives, if it happens.

I honestly believe if we don't pass this amendment, based on this report, we are not doing everything we can do to keep Americans safe. That is, frankly, a risk I am not willing to take.

I urge my colleagues, before they vote on the amendment, to ask themselves: Are we doing enough at home to keep us safe? Are we doing everything we need to do as quickly as we can? Currently the answer is no, with any objective analysis. With the adoption of this amendment, the answer can be yes.

I urge my colleagues to come together with a sense of urgency, as they would if their own families were immediately threatened, because I believe they are.

I urge adoption of the Dodd-Stabenow amendment.

Madam President, I thank the distinguished Senator from Connecticut one more time for his eloquence on this point. I was thinking, as my colleague was speaking in terms of the choices we have to make and whether someone with great means in this country would be willing to defer a small portion of a tax cut in order to keep us safe, that it does not matter how much your income, you are still vulnerable to terrorist attack in this country. And I cannot imagine anybody who would not say: Do what you need to do to keep my family safe. Do what you need to do to keep my children safe on the way to school or at school or after school or at their college or my husband and wife at work or me driving down the street. These are serious choices.

I am constantly amazed at the times we use bureaucracy and budget arguments versus the times we ignore them. I very much understand the constraints of the appropriations process and the difficulty the subcommittee chairman has in operating within the amounts that have been allocated. I understand that and appreciate the hard work that takes. But I remember also, as a member of the Budget Committee, raising questions about why we could be appropriating $87 billion and before that $150 billion--over $200 billion--to Iraq that has never been in the budget at all, has never been anywhere in the budget. Instead of offsetting that in some way, we added it to the deficit, the largest deficit in the history of the country.

We could eliminate everything except the Department of Defense in terms of annual spending and equal what this debt is this year. It is huge. But when we were focused on Iraq, somehow it was ``whatever it takes,'' not only for the troops but in addition to whatever folks felt was necessary to rebuild Iraq--to rebuild their roads, their schools, and give them a health care system, and all these other items. It did not matter whether there was any money appropriated or if there was any way to pay for it.

Monday night, we responded quickly--and I supported so responding--to Florida with $2 billion. That was not in the budget. We responded because of an emergency.

We are talking about, in relative terms to the huge allocation in defense and the hundreds of billions of dollars now in Iraq, a relatively small amount. It is less than 3 months' spending in Iraq to keep us safe at home.

I cannot imagine anybody from any part of this country, any political persuasion would not look at this and say: This should pass overwhelmingly with a voice vote. Why are we struggling with the question of doing everything possible as quickly as possible?

I know there have been improvements made, but we are not doing everything that needs to be done as quickly as possible.

I also know that when I talk at home to folks who are on the front lines and they tell me, You are taking money out of this pocket and putting it in this one, it is not new money. Or that they received small amounts, but they are not large increases that have been coming to local communities. When we take an officer whose salary is paid by the COPS Program and we cut it and then we restore the funding through homeland security, it is still only one officer. That is what is happening in too many places.

Again, I agree with my friend from Connecticut that there needs to be a sense of urgency about this matter. I understand budget constraints, and I understand the limits that have been placed on this particular budget. But I suggest it is our responsibility to challenge that and together stand up and say the rules do not fit for this situation. That is what we are expected to do. We make the rules.

It is pretty hard for us to say we cannot change them when they do not make sense, and particularly when we change them all the time. We change them. Depending on whatever the majority folks want to do, we change them. Why in the world would we not want to make sure we are doing everything possible?

I remember a week before we left for the August recess and we were sitting in 407, all of us together hearing about the new sense of urgency and the very specific threats that were present. We watched at both conventions the armed fortresses around not only the conventions but our hotel. It was amazing. Certainly there were resources those communities needed to have to deal with that, but we were told in no uncertain terms that it is very likely something could happen between now and November 2.

Then I go home and speak with the sheriffs, the police chiefs, the firefighters, the emergency preparedness folks, the folks at the emergency rooms at the hospital, and they look at me and say, what are you doing? We do not have the resources to do this ourselves.

I know there are those who believe local communities should bear the brunt of this funding. I would argue that when New York and Washington, DC, were attacked, they were attacking the country. Regardless of where we are attacked in the country, it is our responsibility, the Federal Government, to be a serious partner with local communities to make sure the resources are there.

Again, if we are saying we are conducting military actions abroad because of the threat and we are being told that there are the threats here and they are real, why would we not provide the same approach in saying we will do whatever is necessary? That does not mean indiscriminately throwing dollars at a situation. It means in a thoughtful way using the complete report the Senator from Connecticut has spelled out as a basis for why would we not respond. That is all this amendment does. It allows us to respond to a thoughtful report, just as we are responding to the 9/11 report. I argue very strongly we should think long and hard, while this budget is in front of us, about whether we can honestly say to the people we represent, as well as our own families, that we are doing everything possible, as quickly as possible, to keep us safe.

Mr. President, first I commend our Democratic leader for an outstanding vision of what we should be doing to do right by America. His eloquence this morning certainly speaks to every single person in Michigan and what we care about, the priorities and values that we have, and certainly it speaks to the sense of urgency that I believe we need to get something done for the people we represent in this wonderful country. We need to do right by America.

There is something wrong when we have provided funding for health care in Iraq for a broad, universal health care system, yet we cannot focus on health care at home for over 44 million people and focus on the costs of prescription drugs or make sure there is a real Medicare bill that works. There is something wrong with this picture. It is truly time for us to do right by America. That is our job.

I speak today specifically about a topic that I frequently think about on the floor of the Senate that needs to have a sense of urgency about it as we come to the end of this week. We will not be in session in August. We will come back only for a few weeks in the fall. There is a sense of urgency at home about the need to lower the cost of medicine, the access to prescription drugs in this country.

I rise to express great concern today because at this very moment the Senate HELP Committee was supposed to be marking up a bill that hopefully would lead to the safe importation of FDA-approved prescription drugs from Canada and other countries where it can be done safely. But, once again, the markup has been delayed. I am deeply concerned that with the number of legislative days winding down, we will not see a bill coming from committee to the floor of the Senate any time this year.

We know the prices of prescription drugs continue to rise and continue to place a tremendous burden not only on our seniors but on everyone who uses medicine on a regular basis.

We have a strong bipartisan bill that we put together to allow the reimportation of prescription drugs. It has been carefully discussed and deliberated. There is no reason that Americans should not benefit from the passage of this new law so we can have access to safe, FDA- approved drugs that come from FDA-inspected facilities in other countries. In fact, Sav-Rx, one of the companies that is offering a Medicare drug card now, is even promoting reimportation as part of their marketing.

As reported in Tuesday's Washington Post, the company's Web site reads:

Sav-Rx is giving you the opportunity to save an additional

20%-30% on your mail order prescriptions through the use of

our Canadian Mail Order Pharmacy.

This is one of our Medicare cards that is using a Canadian mail order pharmacy.

I have to say I am more concerned about mail order or Internet sales--particularly Internet sales--where we do not have the safeguards, or may not know where the prescriptions are coming from, rather than what our bill does, which is allow the local pharmacist in Michigan or the pharmacist in any other State to do business with the pharmacist across the border in a safe, FDA-approved way, with a closed supply chain that brings the medicine from one place to another so we know where it comes from and we can assure its safety.

But here we have one of those providing a Medicare card to seniors who are using right now a Canadian mail order pharmacy as part of this process. Yet we can't get the support to pass a bill that would guarantee this process is available for everyone through the local pharmacy--one pharmacy to another--and which is done in the safest possible way. We don't have regulations right now that mirror what we have in our bill in terms of promoting the safety of reimportation of prescription drugs.

If we are going to continue to see mail order and Internet sales, we certainly need to address the issues that we have addressed in our bill to make sure this process is safe.

This is all about numbers, as usual. The opposition is all about numbers. It is about the $17 billion annually that the drug companies stand to profit from the new Medicare law versus the $5 billion cost that American consumers can save per month from reimporting prescription drugs from Canada or allowing the local pharmacists in America to do business with the pharmacists in Canada.

It is about requiring our seniors to go through this complicated process under Medicare to attempt to get a discount through a Medicare card that would set up much more to profit the drug companies than to profit the seniors. It is about a process that we are forcing people to go through to try to get help. It is complicated. There are multiple cards. The prices can change every 7 days. The discounted drugs can change every 7 days.

We heard testimony on Monday from Dr. McClellan in charge of the Center for Medicare. What we are hearing is this massive effort of spending money to market and try to explain to people this complicated process. Why do we have this complicated process? Because it benefits the pharmaceutical companies. It doesn't allow Medicare to negotiate group prices to get the best deal for people. So we have this complicated, costly process going on to guarantee that the profits of the industry are protected.

On the other hand, all we need to do is bring to the floor this bipartisan bill that would allow our local pharmacists to do business safely with pharmacists in Canada and other countries. We could drop prices in half immediately for consumers. We would save over $5 billion a month for consumers. We would truly begin to address the stories we hear all the time--it is happening; they are not just stories--of people who are choosing between food and medicine, paying their electric bill or paying their rent. We don't make up those stories. It is happening every day, and I am sure it is happening right now as I am speaking. We can fix that, too.

If the HELP Committee brought up a bill, had a meeting and voted this bill out today, we would have on the floor a means for us to be able to work together to adopt a bill that works, is safe, and lowers prices. But instead one more time this is delayed--delayed, delayed. Unfortunately, folks can't delay their bills. When they go to the pharmacy to get their medicine, they can't say: I would be happy to pay you but nothing is happening in Congress yet. The President won't support lowering prices. So I can't afford to pay this right now. Can you wait? Can I pay it next year when they finally get around to fixing this, maybe? People can't do that when they go into the pharmacy. They have to pay for their medicine.

There is a sense of urgency which they feel that, unfortunately, is not felt in this body, or by the leadership. Those of us who have been working

across the aisle to get something done certainly feel it, but leadership does not. Unfortunately, the White House does not.

What we see is a continual unwillingness to schedule a bill, to bring it out, to give us an opportunity to vote and to get this done in the Senate.

We have legislation, S. 2328, the Pharmaceutical Market Access and Drug Safety Act, that is widely supported. It has been crafted carefully by Senate leaders on both sides of the aisle. It will work. It will guarantee that we put in place the safe precautions we need and that will allow us to finally be able to address the issue of lowering prices.

There are many concerns that I and my colleagues have about the bill before the HELP Committee. I will not go into all the specifics at this time, except to say we feel confident that the legislation we have introduced would fix the concerns and the problems, and that we can work together to get this done in the right way.

I am deeply concerned that right now seniors of this country are being asked to wade through Medicare card after Medicare card trying to find out whether there is anything that can be done for them in terms of lowering prices. They are wading through all the other complexities of the Medicare bill. We are not taking action as we could on something that would immediately make a difference.

I go back to what our Democratic leader spoke about so eloquently this morning. Senator Daschle spoke about doing right by America.

How is it that there is a sense of urgency here to be providing funds to make sure those in Iraq have access to health care? Certainly we want them to have access to health care. But what about us? What about doing right by America as well? What about taking just a portion of the funds we are spending abroad to build roads and schools and create health care systems and use that here at home to help Americans who are desperate about being able to afford the medicine they need?

I might also say that this is directly related to the health insurance premiums our small businesses and large businesses are paying in America. We know that about half the cost increases on health care premiums comes from the explosion of prescription drug prices.

When we pass the reimportation bill that we are coming forward with in a bipartisan way, we not only help our seniors who need our help and the disabled and their families and workers, we are helping businesses be able to lower prices. We are helping universities that have medical schools to be able to allow their pharmacies to do business with those across the border in a safe way. We are helping the local hospitals be able to lower their costs which in turn helps them lower the cost of health care and health insurance premiums.

Just one proposal has very broad implications to bring down prices and make sure we are addressing one of the fastest rising components of health insurance for businesses in our country.

We have a bipartisan bill before the Senate that is endorsed by the AARP, Families USA, the Alliance for Retired Americans, numerous senior, consumer groups, and health groups. I am deeply troubled by the fact it will be very difficult to bring this bill before the Senate and pass it before we break on Friday. This debate has gone on far too long.

As I have indicated, this can help business and individuals with the high cost of health care. It is time to get it done. We have the greatest country in the world. Give us a chance to make this change and we can help every American have access to the medicine they need. We can take an important step forward in doing right by America.

Mr. President, I rise today to express deep disappointment about what is taking place on the Senate floor in the cloture vote scheduled for tomorrow. For the past 3\1/2\ years, Senator Levin and I have been urging the Bush administration to work with us to develop a bipartisan solution regarding the Michigan nominees to the Sixth Circuit Court. We have met on several occasions with Judge Gonzales, the current White House counsel, and other White House staff, but the White House has rejected all of our efforts at a compromise. We also had numerous meetings with Chairman Hatch and testified before the Senate Judiciary Committee several times on the need for a bipartisan solution.

Chairman Hatch had expressed a willingness to work with us and to work with Senator Leahy on a bipartisan solution to this impasse, but it seems these efforts have been abandoned by Republican leadership in

favor of scoring political points before the party conventions.

I still believe the best way to end this impasse is to forge a compromise. I hope the Bush administration and the Republican leadership will not continue down this road of what appears to be politically motivated and partisan cloture votes instead of working with us to develop a fair solution. A ``nay'' vote on cloture will preserve potential negotiations toward the bipartisan compromise we have been seeking. A ``yea'' vote will destroy these efforts and, unfortunately, be a vote for preconvention politics.

Let me start by saying a few words about Judge Saad's nomination. Judge Saad is before us now. After listening to people in Michigan who have shared serious concerns with both Senator Levin and I, and having had an opportunity to review the FBI background materials, I have to say that I have serious concerns about Judge Saad's temperament and appropriateness for serving on this important bench. While I cannot go into specifics, I urge my colleagues to review the Judiciary Committee's FBI background materials for themselves.

Judge Saad's lack of fitness for this appointment is also evidenced in the record he has put together as it relates to his work on the Michigan Court of Appeals. Most troubling, perhaps, are his decisions and reversals in cases involving the application of the law in civil rights cases--particularly in sexual harassment cases.

His decisions also demonstrate hostility to the rights of whistleblowers. We know in this day and age, as we have learned through those who were courageous and came forward in the Enron and Halliburton cases, and others where employees have come forward, how important it is to be able to protect the rights of employees who see that something is wrong and they step forward. They are what we call whistleblowers.

His decisions also have been hostile to the rights of people who are injured. For example, in Coleman v. State, Judge Saad joined in deciding against the plaintiff in a sexual harassment case, which was later reversed by the Michigan Supreme Court. Coleman, a State prison employee, was subjected to comments by her supervisor about her allegedly provocative dress and to daily inspections of her clothing, after she was the victim of an attempted assault and rape by an armed prison inmate. She was the one who was questioned, as too often we hear as it relates to women who are told it was their fault, because of the way they dress, and that is why they were assaulted. The Michigan Supreme Court reversed the decision, holding that there was sufficient evidence for the victim to go to trial.

In Haberl v. Rose, Judge Saad dissented from the court of appeals' reinstatement of a jury verdict for the plaintiff who was injured by a Government worker who was doing Government work but driving her own automobile.

In the complicated case, the majority found that Michigan's sovereign immunity statute was not applicable, since a more specific civil liability statute said that car owners are not immune from liability. Car owners have liability in these kinds of cases.

The dissenting Judge Saad stated that the sovereign immunity statute applied but the civil liability statute did not and, thus, the injured plaintiff could not recover.

Judge Saad was harshly criticized for his dissent by the majority of the judges, who essentially called him a judicial activist:

Indeed, it is the dissent that urges ``rewriting'' the

statutes in question and advocates overstepping the bounds of

proper judicial authority.

Based on these concerns, I do not believe Judge Saad has the necessary judicial temperament to serve a lifetime appointment--a lifetime appointment--on the Sixth Circuit Court of Appeals.

Mr. President, I wish to speak more broadly now about the process of bringing the Sixth Circuit nominees to the floor of the Senate. Senator Levin has spoken eloquently about the history of the Sixth Circuit nominees prior to my serving in the Senate. He has explained how two extremely well-qualified women--Judge Helene White and Kathleen McCree Lewis--failed to get a hearing before the Judiciary Committee for more than 4 years and 1\1/2\ years, respectively, during the previous administration.

In fact, if she had been confirmed, Kathleen McCree Lewis would have been the first African-American woman on the Sixth Circuit Court of Appeals.

Senator Levin and I are not alone in the view we hold that what occurred with respect to these nominees was fundamentally unfair.

On more than one occasion, Judge Gonzales, the current White House counsel, has acknowledged that it was wrong for the Republican-led Senate to delay action on judicial nominees for partisan reasons, at one point even calling the treatment of some nominees during the Clinton administration ``inexcusable.''

Senator Levin and I have repeatedly proposed to settle this longstanding conflict by appointing a bipartisan commission to make recommendations to the White House on judicial nominations.

Our proposal would be based on the commission that is set up and working just across Lake Michigan in Wisconsin. The State of Wisconsin commission has produced bipartisan nominees for both district and circuit courts since its inception under the Carter administration.

In fact, just recently, the Senate confirmed Judge Diane Sykes for a vacancy on the Seventh Circuit Court of Appeals. Judge Sykes, a Bush administration nominee, was recommended by the bipartisan Wisconsin commission and had the support of both of her Democratic home State Senators.

This process works. The Wisconsin commission includes representatives from the Wisconsin Bar Association, the deans of the State's law schools, as well as members appointed by both Republicans and Democrats. They only recommend qualified candidates who have the support of the majority of the commission. The President then looks to the recommendations of the commission when making his nominations.

The Wisconsin commission's recommendations have always been followed by the President, regardless of political party. Again, this system has worked.

This type of commission preserves the constitutional prerogatives of both the President and the Senate. It allows the President to pick one of the recommended nominees and protects the Senate's advise and consent role.

Wisconsin is not the only State where this type of bipartisan commission works. In a similar form, it has worked in several other States, including Washington, California, and Vermont.

Unfortunately, the White House continues to reject this proposal from Michigan, despite having agreed to similar commissions in other States with other Democratic Senators.

Senator Levin and I are interested in finding a real bipartisan solution to this problem. We have stated on numerous occasions that we are willing to accept the commission's recommended nominees, even if they do not include Helene White and Kathleen Lewis, or any other person we would choose if it were up to us.

Instead of divisive cloture votes, let's look to the future and restore civility to this process. It is time to do that with the Sixth Circuit.

I hope we can still accomplish this and that the Bush administration and Chairman Hatch will work with us to develop a fair compromise to this longstanding problem.

Let me take a moment to reiterate this is not about being unwilling to fill vacancies. As other colleagues have indicated, we have, in fact, confirmed 198 judicial nominees of this President, and I have voted for the overwhelming majority of those nominees. This is more judicial nominees than were confirmed for President Reagan in all 4 years of his first term, more nominees than were confirmed for first President Bush during his 4-year Presidency, and for President Clinton in all 4 years of his second term. Mr. President, 100 judges were confirmed in the 17 months of the Democratic Senate majority.

So under Democratic control, we confirmed 100 judges, and we were only in the majority for 17 months of the last almost 4 years. Now, 98 more judges have been confirmed in the 25 months of Republican leadership. In other words, the Democrats were in the majority less time and confirmed more

judges for this President during the last 3\1/2\ years. So this is not about being unwilling to support filling judgeships, but it is about a very specific concern about what has been happening in Michigan and the lack of willingness of the administration to work with both Senators to fulfill our equal responsibilities of being able to pick the best people to serve our great State for a lifetime appointment.

These are not Cabinet appointments of this President. They are lifetime appointments. The reason the Framers of the Constitution divided the responsibility--half with the President and half with the Senate, as we know--is because this is a third branch of Government with lifetime appointments, and it is very important there be the maximum amount of input, balance, and thoughtfulness brought to this process.

Unfortunately, regarding the Sixth Circuit, until we have a fair solution, I believe I have no other option than to oppose this cloture vote and to urge my colleagues to do the same.

I thank the Chair. I yield the floor.

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

Mr. President, today I rise to discuss yet another revision by the administration to the new Medicare law. We all know the administration refused to give Congress an estimate on how much the Medicare bill would cost. We later found OMB estimated that the Medicare law would cost $534 billion over the next 10 years, $134 billion more than was estimated by the Congressional Budget Office.

We also know the CMS actuary, Richard Foster, said the high cost projection was actually known before the final House and Senate votes on the legislation last November. But Mr. Scully told him, ``We can't let that get out.''

In an e-mail to colleagues at CMS, Foster indicated he believed he might lose his job if he revealed the administration's cost estimates for the Medicare legislation.

Now we are getting another round of revised numbers. In last year's debate, Republicans repeatedly claimed the new drug benefits would be completely voluntary, that seniors happy with the current Medicare system should be able to keep their coverage the way it is. In fact, we have heard President Bush say that over and over again. He said that in the State of the Union Message in 2003.

But many of us warned at the time that because of the way the benefit was structured, employees with good retiree coverage would lose it. People who currently have coverage, currently have prescription drug assistance, actually could lose it. At the time the Congressional Budget Office estimated 2.7 million seniors and disabled could potentially lose--they indicated would lose--their retiree drug coverage because of the way this was written, in terms of the interface with the private sector retiree coverage. But once again the numbers are coming back even worse than was thought.

In today's New York Times, Health and Human Services now has estimated that not 2.7 but 3.8 million retirees will lose their prescription drug benefits when Medicare offers the coverage in 2006. HHS admitted this represents one-third of all retirees with employer- sponsored drug coverage.

I know CMS Administrator McClellan has released a press statement disputing the article.

I hope we get to the bottom of what is going on with this revision. But certainly what has happened up to date does not give us confidence in the information they have given to us. The administration certainly can't possibly think seniors will be happy to hear that up to one-third of those who have current coverage will lose it when this new Medicare law takes effect.

When you think about folks who have worked all their lives, and probably paid attention to the fact they had health insurance and retirement benefits, planned for that possibly over the life of their worktime, they took pay cuts in order to guarantee they had that retirement benefit, or wage freezes as people are being asked today, make sure in their retirement they had that coverage, and now this law is estimated to actually lose the private retiree coverage up to one- third of those who have it today.

My mother is one of those folks, a retired nurse. She followed the debate we had in great detail. One of the questions she had for me after the passage of this law was whether she would lose her benefits. I had to honestly say: Mom, I don't know.

One of the things we heard was those who may be in a situation most likely to lose may, in fact, be those who are nurses or police officers or retired firefighters or others who are in local or State government with all of the cutbacks where State and local governments are being forced to cut back.

It is amazing to me that in light of what we are seeing, point after point--information that wasn't given, information that wasn't accurate, the inability to negotiate group discounts under Medicare, the confusion on the prescription drug card--I hate to even call them discount cards because we know from AARP and from Families U.S.A. and from all of the groups that watched this that, in fact, the drug companies increased their prices very rapidly knowing they were going to be asked to give a discount through a discount card--we have seen prices go up 10, 20, 30 percent since we passed the law back in November, so they could then provide a card with a 15-percent discount or a 20-percent or a 25-percent discount. Seniors know after they watched this happen that it was not really a discount.

We have seen the confusion about how to even wade through the 40, 50, 60, or 70 different cards you may be able to choose from as a Medicare beneficiary to see if you can even begin to get a discount. We have seen the confusion of low-income seniors who actually have the most to gain because there is a $600 credit to buy prescription drugs attached to the card, and yet there is such confusion about how to even sign up and qualify, and that those who probably need it the most will be the ones least likely to receive it.

We have seen confusion and misinformation and threats to people about losing jobs if they tell us the truth and bad policies that over and over again have been put into place to help the industry instead of helping seniors and helping the disabled.

While all of this is going on, prices just keep going up. People need their medicine every day. Whether it is confusing or not, whether people are going to lose their coverage or not, today folks walk into the pharmacy trying to get their medicine, or maybe they didn't go in because they couldn't afford it, or maybe they went into the pharmacy but not the grocery store because they couldn't afford to do both, or maybe, as the couple I talked to not too long ago who were on the same medicine, the husband takes it one day and the wife takes it another day.

We can do better than that. This is the greatest country in the world. Shame on us for not being able to get this right and not being able to do it now.

The good news is we can do it now. We have a proposal in front of us that will allow the competition necessary in the pharmaceutical industry to bring prices down immediately. It is called reimportation of prescription drugs. We have talked about it so many times. I have been talking about it since being a House Member, and talking about taking bus trips to Canada. Now in my fourth year in the Senate, we are still talking about what ought to be done to bring down prices. But the good news is that things are beginning to move.

I was pleased to join with the AARP and with colleagues on both sides of the aisle, Senator Snowe, Senator McCain, Senator Dorgan, and I today to talk about the fact that we believe we have the votes now in the Senate to be able to pass meaningful, safe, reimportation of prescription drugs. All we need is the opportunity to vote on it. All we need is the opportunity to make the case to our colleagues.

There was a Senate Judiciary Committee hearing today. We understand that the HELP Committee will be meeting hopefully to report out a bill later this week. That bill has been introduced and hearings are scheduled, and rescheduled. Hopefully, that will happen this week.

While we are talking about it, while ineffective Medicare legislation passed with all this confusion and information, there is a sense of urgency on the part of every single person using medicine today because they are paying too much. It is not just our seniors, who certainly use the most medicine, or the disabled; it is also the family who has a child with a chronic disease, or it is a person of any age who is using medicine, or it is the businesses that have seen their premiums skyrocket in large part because of the skyrocketing prices of prescription drugs.

I come from a great State that makes automobiles. We are very proud of that. When I sit down with the Big Three automakers which are desperately concerned about the cost of

health care and what needs to be done, they show me numbers. One-half the increase in their health care costs is because of prescription drugs. I know this is also true with small businesses which, on overage, have seen their premiums double at least in the last 5 years. In fact, it is more likely to be doubling every 3 years.

The opportunity we have to create more competition and to open the borders is something that not only would help our seniors, many of whom are incredibly disillusioned and, frankly, angry that a Medicare bill was passed that may not be of much help at all to them. But we can also be helping every single American from the youngest to the oldest as well as businesses if we do this and do this now.

We have 1 more week before we break for the summer. We know there are precious few weeks when we come back in the fall. This needs to get done now.

There are 31 in the Senate on both sides of the aisle from all different political beliefs who are cosponsoring this reimportation bill. Our bill provides substantial safeguards and assures quality and affordability. Our bill ensures that licensed pharmacists in the United States can do business with licensed pharmacists in Canada and in other countries with strong safety standards.

Our bill provides for inspections for anticounterfeiting technologies and chain of custody. Our bill is a well-thought-out, well-designed piece of legislation that meets and addresses every legitimate concern that has been raised.

There is no reason Americans should not have access to safe, FDA- approved drugs that come from FDA-inspected facilities in our country or other countries. We have been debating this issue far too long. I am extremely hopeful we will be able to see a debate in the Senate and a vote before we leave this summer.

Researchers at Boston University have told me that in the 1-month delay for the markup of the HELP Committee--the bill was on the agenda a month ago; now it will be on this next week--we could have saved over $5 billion by simply allowing citizens to do business with Canadian pharmacies.

That means $5 billion has been spent, coming out of the pockets of people choosing between food and medicine, caring for their children, worried about being able to have medicine for their disability, or a small business struggling to make it through insurance premium increases, or a large business. That is $5 billion just by not acting this last month. I assume that means $5 billion next month and $5 billion the month after.

The legislation we have put together on a bipartisan basis will make a real difference. It is something we can do now.

I commend my House colleagues on both sides of the aisle who have not only passed legislation similar to the legislation we now have worked on and developed on a bipartisan basis, but they have, once again, placed language in the Agriculture appropriations bill that would stop any enforcement against reimportation and allow it to continue. This passed the House of Representatives just yesterday.

It is time for the Senate to step up and to make this happen. In the past, there has been an effort to require certification by Health and Human Services regarding safety. That, unfortunately, has been a barrier by those who simply do not want to do this. So we have taken a different route this time. We have decided to sit down and go through all the safety standards and regulations and put it in the statute. That is what we have done.

We have also included in the bill an effort that Senator Feinstein has worked on regarding Internet drug efforts and safety requirements.

There is no reason substantively not to pass our drug reimportation bill if the goal is to help lower the costs of prescription drugs through competition and to lower prices for our seniors and for our families and for our businesses. We have the tool. Let's not wait another month and another $5 billion, or another 2 months, $10 billion, or $15 billion or $20 billion, when we have the ability to join with the majority of our House colleagues and get this done now.

I yield the floor and suggest the absence of a quorum.

Mr. President, I rise today to pay tribute to the only person from the State of Michigan to have served as President of the United States. On behalf of the people of the State of Michigan, I want to extend my best wishes to President Gerald R. Ford and his family on the occasion of his 91st birthday.

President Ford took office during an extraordinarily trying time for America. He was the first Vice President chosen under the terms of the Twenty-Fifth Amendment and, in the aftermath of Watergate, succeeded the first American President ever to resign. In his inaugural address on August 9, 1974, President Ford noted, ``This is an hour of history that troubles our minds and hurts our hearts.'' Gerald Ford took on the challenge of healing our national faith in the presidency with courage, wisdom and integrity.

Indeed, it was President Ford's reputation for openness and integrity that propelled him into the White House. He was appointed Vice President after serving twelve terms in the U.S. House of Representatives, having secured each term with more than 60 percent of the vote. The confidence of his colleagues fueled his ascent to Ranking Member on the Defense Appropriations Subcommittee and, eventually, to Minority Leader. It also won him an appointment to the Warren Commission investigating the assassination of President John F. Kennedy.

As President, Gerald Ford led our Nation on the path toward healing a wounded faith in that office. He also labored to improve relationships among nations. In his own words ``a dyed-in-the-wool internationalist,'' President Ford presided over the signing of the Helsinki Agreement, which ratified post-World War II European borders and codified international human rights standards. He also worked for improved relations among the nations of the Middle East and, together with Soviet leader Leonid Brezhnev, set new limitations on nuclear proliferation.

Since leaving the White House in 1977, President Ford has remained actively engaged in the political process and has continued to speak out on important issues. He has lectured at hundreds of colleges and universities, hosted numerous forums on public affairs, and served as an adjunct professor of Government at the University of Michigan. In 1999, President Bill Clinton awarded Ford the Presidential Medal of Freedom, the Nation's highest civilian honor.

Gerald Ford has also made an important mark in his home State of Michigan. In 1977, he announced the establishment of the Gerald R. Ford Institute for Public Policy and Service at Albion College, which administers an interdisciplinary program for undergraduate students preparing for careers in public service. In 1981, the Gerald R. Ford Library in Ann Arbor and the Gerald R. Ford Museum in Grand Rapids were dedicated. Through these institutions, the people of Michigan and many visitors from around the country and the world continue to benefit from President Ford's legacy of internationalism, scholarship and humor.

President Ford, on the occasion of your 91st birthday, the American people salute you, and express our profound gratitude for your leadership and service.

Mr. President. I yield the floor.

Mr. President, I rise today to introduce the Ensuring Quality and Access to Cancer Care Act of 2004. I want to thank my colleague, Senator Hutchison, for working with me on this critical issue. Regardless of how we feel about the new Medicare law, I believe we all agree that there are legitimate concerns about changes in cancer care reimbursement. Critical services that help patients and their families may be in jeopardy because Medicare reimbursement is scheduled to be drastically cut in 2005.

I believe that these changes will be disruptive to patients' care. It is especially urgent in Michigan, which is ranked fourth in the Nation in number of residents with cancer.

Doctors administer more than 70 percent of all cancer chemotherapy in their offices, but the new Medicare law drastically cuts doctors' reimbursement for drug administration. Changes in the reimbursement system will

mean that doctors will likely be paid dramatically less for chemotherapy. Preliminary estimates indicate that roughly $4.2 billion will be taken out of cancer care in the United States over the next 10 years.

Many critical services are paid for through drug administration reimbursement because they are not covered by Medicare. These include specially-trained oncology nurses and related staff; the handling, storage, and preparation of the toxic chemotherapy agents; and cognitive, nutrition, and support care services that are important indices of quality cancer care.

The result could be fewer and fewer doctors will treat cancer patients, leaving them without access to the best care possible. Furthermore, patients may lose access to vital support services.

Congress clearly recognized that questions related to the impact of the Medicare law on patient access needed to be answered. That's why the Medicare law included a temporary one-year increase in physicians' practice expenses. But access problems will likely emerge in 2005 when the temporary aid and drug reimbursement decrease significantly. And several programs to help oncologists and patients will not begin until 2006.

The ``Ensuring Quality and Access to Cancer Care Act of 2004'' would merely extend the 1-year transitional period built into the law for an additional year. It's a fair compromise so that we have time to answer important questions regarding the impact of the payment reductions. And it will ensure that policy changes do not disrupt patient access to quality cancer care.

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

Mr. President, I rise today to introduce the Ensuring Quality and Access to Cancer Care Act of 2004. I want to thank my colleague, Senator Hutchison, for working with me on this critical issue. Regardless of how we feel about the new Medicare law, I believe we all agree that there are legitimate concerns about changes in cancer care reimbursement. Critical services that help patients and their families may be in jeopardy because Medicare reimbursement is scheduled to be drastically cut in 2005.

I believe that these changes will be disruptive to patients' care. It is especially urgent in Michigan, which is ranked fourth in the Nation in number of residents with cancer.

Doctors administer more than 70 percent of all cancer chemotherapy in their offices, but the new Medicare law drastically cuts doctors' reimbursement for drug administration. Changes in the reimbursement system will

mean that doctors will likely be paid dramatically less for chemotherapy. Preliminary estimates indicate that roughly $4.2 billion will be taken out of cancer care in the United States over the next 10 years.

Many critical services are paid for through drug administration reimbursement because they are not covered by Medicare. These include specially-trained oncology nurses and related staff; the handling, storage, and preparation of the toxic chemotherapy agents; and cognitive, nutrition, and support care services that are important indices of quality cancer care.

The result could be fewer and fewer doctors will treat cancer patients, leaving them without access to the best care possible. Furthermore, patients may lose access to vital support services.

Congress clearly recognized that questions related to the impact of the Medicare law on patient access needed to be answered. That's why the Medicare law included a temporary one-year increase in physicians' practice expenses. But access problems will likely emerge in 2005 when the temporary aid and drug reimbursement decrease significantly. And several programs to help oncologists and patients will not begin until 2006.

The ``Ensuring Quality and Access to Cancer Care Act of 2004'' would merely extend the 1-year transitional period built into the law for an additional year. It's a fair compromise so that we have time to answer important questions regarding the impact of the payment reductions. And it will ensure that policy changes do not disrupt patient access to quality cancer care.

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

Mr. President I rise to clarify an important issue with the distinguished chairman of the Agriculture Committee.

First, I thank the chairman for his leadership in getting this child nutrition bill to the floor. He has worked hard and has produced a good, bipartisan bill which I supported in the Committee.

For over 2 years, a bipartisan group of Senators and I have been concerned about USDA disregarding language included in the 2002 farm bill. The 2002 farm bill, section 10603, states that at least $200 million must be spent annually on the purchase of specialty crops. However additional language included in the 2002 farm bill conference report states:

[t]he Managers intend that the funds made available under

this section are to be used for additional purchases of

fruits and vegetables, over and above the purchases made

under current law or that might otherwise be made without

this authority. The Managers expect the $200 million to be a

minimum amount for fruit and vegetable purchases under

section 32 funds; it is not intended to interfere with or

decrease from Agricultural Marketing Service's historical

purchases of fruit and vegetables [e.g. $243 million in 2001;

$232 million in 2000] or to decrease or displace other

commodity purchases.

Does the chairman agree that this language is clear and that the intent of Congress is $200 million in new purchases on top of existing commodity purchases?

This was a great victory for our children because they need more and more fruits and vegetables in their school lunches. We all know about the problem we have with kids eating too much junk food for lunch and this program would have put more nutritious foods on our children's lunch trays. Instead of eating candy, they could be eating nutritious foods like apples, pears and carrots.

Unfortunately, the USDA is not complying with this provision. Instead of adding the $200 million on top of baseline spending, USDA has eliminated the baseline spending, so there is no guarantee that there will be any new spending on fruits and vegetables for our children. In fact in 2002, USDA did not even meet the minimum purchase requirement. In 2002, only $181 million in fresh fruits and vegetables were purchased under section 32.

Does the chairman agree that the USDA is misinterpreting the farm bill with regards to section 32, fresh fruit and vegetable purchases?

Mr. President, today I rise to introduce the Health Care Access for Small Businesses Act of 2004. I am pleased to be joined in this endeavor by my colleagues, Senator Lincoln and Michigan's senior Senator Levin. My bill would help small businesses provide health coverage for their employees, an important first step in providing access to health care for all Americans.

Last month, thousands of Americans participated in the annual Cover the Uninsured week, a discussion about the urgent need to cover the uninsured. The sheer breadth of the groups that participated in the unprecedented effort demonstrates the urgency of this issue. Labor unions were united with business groups, doctors with nurses, and charity health care providers with for-profit hospitals and insurance companies.

And yesterday, the consumer group Families USA and the governors of Iowa, Kansas, and Maine released even more disturbing news. Using Census Bureau data, they found that approximately 81.8 million Americans--one out of three people under 65 years of age--were uninsured at some point of time for the past two years. Almost two- thirds were uninsured for six months or more; and over half were uninsured for at least nine months.

We need to stop having discussions and start finding solutions. Too many hard working Americans are going without health insurance. There is a great misconception that uninsured Americans are largely unemployed or on welfare. That is simply not the case. More than 80 percent of uninsured Americans are part of working families, and almost half work for small businesses. If we can help small businesses cover their employees, we will have made great progress in covering the uninsured.

The bill I am introducing today is aimed at making coverage more affordable for employees of small businesses through what is called a ``three-share'' program. It would not impose any new funding mandates on state or local governments nor would it create new bureaucracy. It is an innovative community-based approach that could work throughout the country.

And it's aimed at ensuring primary care services are more available. We know that the primary care model through federally qualified health centers has been a tremendous success. This would build on this success by empowering communities--health care providers, small businesses, churches, civic groups--to form their own health care programs.

The three-share model is an innovative community-based idea that has been working across the U.S. from California to Arkansas to Maryland and, of course, Michigan. The name ``three-share'' stems from the program's payment structure. Premiums are shared between the employer who pays 30 percent, the employee who pays 30 percent, and the community which covers the remaining 40 percent of the cost.

In a three share model, a non-profit or local government entity serves as the manager of the plan. They design a benefit package by negotiating directly with providers or contracting through an insurance company. Then, they recruit small businesses that have not offered insurance coverage to their employees for the past year. The average cost for coverage is about $1,800 per year, much lower than the national average for commercial insurance, which on average costs about $3,400 for a single person and $9,000 for a family, according to the 2003 Kaiser survey of

employer benefits. Of the $1,800, the employer and employee would each pay approximately $540 and the community would pay about $720.

And they have been successful. For example, in Muskegon, Michigan, the three-share program Access Health has been working with about 400 small businesses to cover some 1,500 uninsured full and part-time employees. Wayne County has operated Health Choice for a decade. Although it is undergoing some changes, it has nearly 1,300 businesses enrolled and covers everyone from cab drivers, nail salon technicians, and nursing aides. Kent County, where Grand Rapids is located, began enrolling small businesses and employees in their program in 2002 and hope to grow to cover 2,500 individuals this year.

Different three share plans have received funds for the community portion from various places. In Michigan, most of the money has come from Medicaid funds. A plan in California uses money from the tobacco settlement, while a plan in Arkansas raises funds through church events and other community initiatives.

Unfortunately, despite the nuances that distinguish three share plans from one another, they all share a common challenge: they all lack a stable and sustainable funding source for the community share. This bill will help provide a steady stream of funding and analyze what three shares do right and how communities can develop their own three share model programs.

Insuring more working families will also take the pressure off state Medicaid budgets. Adequate care for those presently uninsured will also help slash the billions that is spent on uncompensated care.

Providing health care for these families fulfills a moral commitment. No one in America who gets up in the morning and goes to work should go to sleep at night fearful that an illness or injury in the family could wipe out everything they have worked hard for. This is a great nation, and together we can ensure that no American has to go without health care again.

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

Mr. President, today I rise to introduce the Health Care Access for Small Businesses Act of 2004. I am pleased to be joined in this endeavor by my colleagues, Senator Lincoln and Michigan's senior Senator Levin. My bill would help small businesses provide health coverage for their employees, an important first step in providing access to health care for all Americans.

Last month, thousands of Americans participated in the annual Cover the Uninsured week, a discussion about the urgent need to cover the uninsured. The sheer breadth of the groups that participated in the unprecedented effort demonstrates the urgency of this issue. Labor unions were united with business groups, doctors with nurses, and charity health care providers with for-profit hospitals and insurance companies.

And yesterday, the consumer group Families USA and the governors of Iowa, Kansas, and Maine released even more disturbing news. Using Census Bureau data, they found that approximately 81.8 million Americans--one out of three people under 65 years of age--were uninsured at some point of time for the past two years. Almost two- thirds were uninsured for six months or more; and over half were uninsured for at least nine months.

We need to stop having discussions and start finding solutions. Too many hard working Americans are going without health insurance. There is a great misconception that uninsured Americans are largely unemployed or on welfare. That is simply not the case. More than 80 percent of uninsured Americans are part of working families, and almost half work for small businesses. If we can help small businesses cover their employees, we will have made great progress in covering the uninsured.

The bill I am introducing today is aimed at making coverage more affordable for employees of small businesses through what is called a ``three-share'' program. It would not impose any new funding mandates on state or local governments nor would it create new bureaucracy. It is an innovative community-based approach that could work throughout the country.

And it's aimed at ensuring primary care services are more available. We know that the primary care model through federally qualified health centers has been a tremendous success. This would build on this success by empowering communities--health care providers, small businesses, churches, civic groups--to form their own health care programs.

The three-share model is an innovative community-based idea that has been working across the U.S. from California to Arkansas to Maryland and, of course, Michigan. The name ``three-share'' stems from the program's payment structure. Premiums are shared between the employer who pays 30 percent, the employee who pays 30 percent, and the community which covers the remaining 40 percent of the cost.

In a three share model, a non-profit or local government entity serves as the manager of the plan. They design a benefit package by negotiating directly with providers or contracting through an insurance company. Then, they recruit small businesses that have not offered insurance coverage to their employees for the past year. The average cost for coverage is about $1,800 per year, much lower than the national average for commercial insurance, which on average costs about $3,400 for a single person and $9,000 for a family, according to the 2003 Kaiser survey of

employer benefits. Of the $1,800, the employer and employee would each pay approximately $540 and the community would pay about $720.

And they have been successful. For example, in Muskegon, Michigan, the three-share program Access Health has been working with about 400 small businesses to cover some 1,500 uninsured full and part-time employees. Wayne County has operated Health Choice for a decade. Although it is undergoing some changes, it has nearly 1,300 businesses enrolled and covers everyone from cab drivers, nail salon technicians, and nursing aides. Kent County, where Grand Rapids is located, began enrolling small businesses and employees in their program in 2002 and hope to grow to cover 2,500 individuals this year.

Different three share plans have received funds for the community portion from various places. In Michigan, most of the money has come from Medicaid funds. A plan in California uses money from the tobacco settlement, while a plan in Arkansas raises funds through church events and other community initiatives.

Unfortunately, despite the nuances that distinguish three share plans from one another, they all share a common challenge: they all lack a stable and sustainable funding source for the community share. This bill will help provide a steady stream of funding and analyze what three shares do right and how communities can develop their own three share model programs.

Insuring more working families will also take the pressure off state Medicaid budgets. Adequate care for those presently uninsured will also help slash the billions that is spent on uncompensated care.

Providing health care for these families fulfills a moral commitment. No one in America who gets up in the morning and goes to work should go to sleep at night fearful that an illness or injury in the family could wipe out everything they have worked hard for. This is a great nation, and together we can ensure that no American has to go without health care again.

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

Mr. President, I thank my friend and colleague from Michigan.

Mr. President, I rise today with my friend from Michigan to offer this resolution congratulating the Detroit Pistons for winning the National Basketball Association Championship.

What a game, and what a win.

In a remarkable display of toughness, talent, tenacity, and old- fashioned hard work, the Pistons made history yesterday by winning their third consecutive home game at the Palace of Auburn Hills to clinch their third NBA title.

It was the first time in NBA Finals history that the home team won the third, the fourth, and the fifth game at home.

The Pistons embody all that I love about the people of Michigan. They are a determined, hard-working team that has shown relentless determination to achieve their goal. The Pistons are a complete team. They sacrifice personal gains for the good of their teammates. And we saw that over and over again last night. They dove for loose balls, and they played great defense.

Like the people of Michigan, the Pistons do not seek the limelight but, rather, let their performance on and off the court speak for itself.

Off the court, the Pistons launched their Read to Achieve Program in October 2001. I was very pleased to participate in one of their reading events. To date, they have opened four reading and learning centers, the most recent last Monday at the Cornerstone Elementary Linwood Campus Library. And they have donated their time to read with over 4,500 students throughout Michigan.

On the court, the Pistons faced many hurdles to win this title. First, they overcame a grueling regular season schedule to win 54 games. Next, they outlasted three of the toughest teams in the Eastern Conference playoffs: the Milwaukee Bucks, the New Jersey Nets, and the Indiana Pacers to make it to the NBA Finals.

In the end, the Pistons prevailed against the storied Los Angeles Lakers, a franchise with 14 titles to its credit, four future Hall of Famers, and a future Hall of Fame coach, Phil Jackson, who has coached nine NBA championship teams.

Our Pistons beat them all and showed they are the best.

I would like to take a moment to recognize members of the Pistons organization who made this remarkable season possible.

Congratulations, first, to Bill Davidson, the Pistons owner, a man who has had a wonderful year. Mr. Davidson, a generous philanthropist for the last 25 years, adds the Pistons' NBA title to the Detroit Shock's 2003 WNBA championship.

I also congratulate the Pistons President of Basketball Operations, Joe Dumars. As an NBA player, Joe was one of the driving forces on the 1989 and 1990 Pistons championship teams, and proved to be equally valuable in the Pistons front office by assembling this terrific team.

Next, of course, big congratulations are in order to Larry Brown, the first coach to win an NBA championship and an NCAA title. The much traveled Hall of Fame coach made his nest in Detroit this year and won this championship by asking his players to play basketball the ``right way,'' emphasizing defense, rebounding, and team play. This kind of old-fashioned philosophy is the kind of workman-like philosophy we value in Michigan.

Finally, and most importantly, cheers to the guys doing the hard work on the hardwood. The Pistons starting backcourt of Richard Hamilton and Finals MVP Chauncey Billups provided the leadership, scoring, and defense when the team needed it most. Each game, the tandem of Ben Wallace and Rasheed Wallace erected a virtual wall around the Pistons basket and blocked shots and collected rebounds that were critical to the Pistons' success--and great fun to watch.

Joining the Wallaces in the front court was Tayshaun Prince, the long-armed forward who made the highlight-reel block of a layup during game 2 of the Eastern Conference Finals that turned that series around and propelled the Pistons to the NBA Finals.

Finally, the contributions of the Pistons reserves, known collectively as the ``Alternatorz,'' proved invaluable, as they always provided a spark whenever they were called upon.

Mr. President, I attended game 3 of the NBA Finals last Thursday evening with my son. It was very exciting, and I can tell you that Pistons basketball is a beautiful thing to watch. And though this Detroit Pistons team is not known for its physical play, as the ``Bad Boys'' teams of 1989 and 1990 were, it is known for the intimidating presence of the Pistons center and spiritual leader, Ben Wallace.

Aside from the Pistons' victory, there was nothing more entertaining and fun to watch than seeing the countless Detroit fans at the Palace wearing wigs resembling Ben Wallace's hair. Looking forward to next year, I want to pass on a message to the NBA I saw on one fan's sign: ``Fear the Fro.''

Again, congratulations to all the Pistons players, coaches, and staff who made this championship possible. This was truly a magnificent accomplishment for fans in Detroit and across the State of Michigan.

Mr. President, I ask unanimous consent that the names of the Pistons players and coaches be printed in the Record following my remarks.

Mr. President, I might also say, I look forward to collecting, with my colleague, on the bet that Senator Levin and I won from our colleagues and friends from California.

Mr. President, I yield the floor.

Exhibit 1

Detroit Pistons--2004 NBA World Champions

Players: Chauncey Billups, Elden Campbell, Tremaine

Fowlkes, Darvin Ham, Richard Hamilton, Lindsey Hunter, Mike

James, Darko Milicic, Mehmet Okur, Tayshaun Prince, Ben

Wallace, Rasheed Wallace, Corliss Williamson,

Head Coach: Larry Brown

Assistant Coach: Herb Brown, Dave Hanners, Igor Kokoskov,

John Kuester, Mike Woodson

Athletic Trainer: Mike Abdenour

Mr. President, I rise today to pay tribute to Ronald Reagan, our Nation's 40th President. First, my condolences and prayers go out to Nancy Reagan, the Reagan family, and all of those who are mourning his passing.

Ronald Reagan was an optimist. He was the best kind of optimist--a living example of the fulfillment of the American dream. From a small Midwestern town, he rose to become leader of the free world and was respected around the world by both our allies and our Soviet bloc opponents alike.

President Reagan was called the Great Communicator for a reason. Many of his speeches touched the heartstrings of all Americans. Whether it was his speech at the Berlin Wall or his 1984 tribute to those who died on D-Day, President Reagan always conveyed a positive, optimistic sense of our shared destiny. His words will long be remembered.

President Reagan loved America, and this love for our country shaded every word he spoke to the Nation as President. He always wanted our country to be the ``shining city'' on a hill.

I also pay tribute and convey my genuine respect to our former First Lady Nancy Reagan, a woman whose unwavering commitment to her husband not only provided a testament to their love but also extended hope and empathy to countless Americans who share in the role of caregiver.

As we begin now to consider ways to pay proper tribute to our admired former President, let us go beyond the erecting of a monument or the etching of a portrait. Instead let us act to help the many Americans who needlessly suffer from the debilitating effects of Alzheimer's disease.

We should increase research funding for Alzheimer's and expand stem cell research, which Nancy Reagan supports.

I am pleased to be a cosponsor of a Mikulski-Bond bill that will double our investment in Alzheimer's research and refocus our efforts to find a cure. This bipartisan measure, if passed, would leave a lasting legacy to President Reagan.

Earlier this month, I joined with 57 other Members of this body, both Republican and Democrat alike, to urge President Bush to broaden the current Federal policy regarding stem cell research. By expanding stem cell research beyond those stem cells derived by August 9, 2001, we will take the necessary first step of helping millions of Americans who are plagued by Alzheimer's--Americans, who like President Reagan, live out their daily lives traveling an unknowable journey of solitude.

If we allow the medical experts to do stem cell research, we can begin the work Mrs. Reagan so steadfastly promotes: finding a cure to this devastating disease.

To find a cure of Alzheimer's would indeed be the greatest tribute we could ever give to President Reagan.

In this time of grief, let us evoke President Reagan's gentlemanly service, swift wit, jovial candor, and unconditional patriotism. With differences in philosophy and politics aside, let's all praise a man whose decorum and distinguished character exemplified the office for which he held.