Floor Statements

Mr. Speaker, I rise today to honor Mayor David W. Smith for his years of dedicated service to the city of Newark, California. On March 13, 2003, Mayor Smith's colleagues will celebrate his 25 years of service at a reception in Newark.

Mayor Smith was elected to the Newark City Council in 1976, and two years later was elected mayor. He is currently serving his 12th consecutive term, making him the most senior mayor currently serving in California and the 7th most senior mayor in the country.

Mayor Smith's genuine love for the city of Newark shows in the intelligent, common-sense approach he brings to decision making, and colleagues point to his terrific sense of humor as one of his great attributes. Under Mayor Smith's leadership, Newark has evolved into an efficient and responsive government.

When he first came into office in 1978, Newark generated little tax revenue outside of property taxes. Throughout his tenure, Mayor Smith has led Newark's resurgence by working to attract top companies and building state-of-the-art educational and recreational facilities.

Under Mayor Smith's leadership, the NewPark Mall Regional Shopping Center and the Newark Hilton Hotel opened for business in the 1980s. In the last decade, he has worked to accelerate development of the Newark Auto Center, which now houses 13 auto dealerships. He was also instrumental in attracting a large Sun Microsystems complex to the city.

Recently, Mayor Smith provided leadership in planning a new community college and in developing and constructing the George M. Silliman Complex, a world-class recreation center that will include a large indoor aquatic park.

While leading Newark's growth, Mayor Smith has also maintained his position as Vice-President of the Oatey Company's Retail Division. He serves on the U.S. Conference of Mayors, the Alameda County Conference of Mayors, and the Alameda County Transportation Authority, and on many local and national committees and boards. His many awards and honors include a Lifetime Membership in the U.S. Jaycees, and a listing in Who's Who in the West.

I am honored to join the colleagues of Newark Mayor David W. Smith in commending his exemplary leadership, which has enabled Newark to grow into a wonderful place to live and a successful commercial leader.

Mr. Speaker, I join with 34 colleagues to introduce the MediKids Health Insurance Act of 2003, which will provide universal health care for our nation's children through a new Medicare-like national program with benefits tailored toward children.

Sen. Jay Rockefeller is introducing a companion bill in the Senate. I am grateful to Senator Rockefeller for his leadership and commitment to this issue. We are introducing the bill at this time in recognition of the national educational and awareness campaign that has named this week ``Cover the Uninsured Week.''

Despite Medicaid and the implementation of the S-CHIP program, more than 9 million children are still without health insurance in America today. Now, with states facing severe

budget crises, past expansions of Medicaid and S-CHIP are in real danger. In fact, with 35 states currently facing budget shortfalls that must be resolved this year, the number of uninsured children will grow. The outlook for the next fiscal year looks even more fiscally challenging for states. Programs like Medicaid and S-CHIP are the most vulnerable for eligibility and service provision reductions due to fiscal crisis.

The number of uninsured children is more than a statistic. It reflects the harsh reality experienced by many families--80% of whom are working families--who are forced to delay or do without needed medical care for their precious children. And, what does the research tell us about children brought up under these circumstances? Compared to those with health insurance, uninsured children have poorer health and higher mortality; they miss more school and have lower educational achievement; and they are less successful as adults in the workforce.

The MediKids Health Insurance Act is a real solution to the growing problem of children without health insurance. Our bill will guarantee health insurance for all children in the United States regardless of family income. Importantly, it would be a fully-federal program so that children's health care would not change from state to state as it does today.

The program is modeled after Medicare, but the benefits are tailored toward children. MediKids is financed like the Medicare Part B program with families paying a premium of 25% of the value of the program and the rest financed through general revenues. Premiums for MediKids would be collected each year when their parents' file their taxes. There is also a generous low-income subsidy for families phasing out at 300% of poverty.

MediKids would not override other forms of health insurance for children. Parents who have other coverage for their children--employer- sponsored insurance, individual policies, S-CHIP, Medicaid, or other policies--could maintain that coverage. But, if something happens and that coverage is no longer available, their children could always rely on MediKids for coverage. If the family moves, MediKids follows the children across state lines. And, no longer would kids get caught with no health insurance coverage if their parents are climbing out of welfare.

Enrollment in MediKids is simple with no complicated paperwork or re- determination hoops to jump through. When children are born or legally immigrate to this country, the parents are automatically given a MediKids insurance card and information on the benefits. For those children who are already born, the bill authorizes presumptive eligibility and enrollment at out-stationed sites such as Disproportionate Share Hospitals and Federally Qualified Health Centers to simplify outreach efforts. Once the program is fully phased in no outreach will be needed because enrollment into the program will be automatic.

Both children's advocates and the health care professionals who care for children support our legislation. Endorsing organizations include: the American Academy of Pediatrics, the Children's Defense Fund, the American Academy of Child and Adolescent Psychiatry, the American Nursing Association, FamiliesUSA, the March of Dimes, the National Association of Children's Hospitals, the National Association of Community Health Centers, the National Association of Public Hospitals and Health Systems, the National Health Law Program, and NETWORK: a Catholic Social Justice Lobby. These providers and children's advocacy groups are united around the concept that children deserve access to continuous health insurance. MediKids meets that goal.

The successful future of our society rests in our ability to provide our children with the basic conditions to thrive and become healthy, educated and productive adults.

Guaranteeing continuous health care coverage is a necessary component for us to realize the potential of our future. This is not only a good investment; it is also a noble goal and obligation that we must fulfill. I look forward to working with my colleagues and with the many supporting organizations for the passage of the MediKids Health Insurance Act of 2003.

Below is a short summary of the bill.

Summary of the MediKids Health Insurance Act of 2003

The MediKids Health Insurance Act provides health insurance

for all children in the United States regardless of family

income level by 2009. The program is modeled after Medicare,

but the benefits are targeted toward children. Families below

150 percent of poverty pay no premium or copays, while those

between 150 percent and 300 percent of poverty pay a

graduated premium up to 5 percent of their income and

receive a graduated refundable tax credit for cost sharing

expenses.

The MediKids enrollment process is simple with no re-

determination hoops to jump through because it is not means

tested. MediKids follows children across state lines when

fan-Lilies move, and covers them until their parents can

enroll them in a new insurance program. Moreover, MediKids

fills the gaps when families climbing out of poverty become

ineligible for means-tested programs. It provides security

for children until their parents can obtain reliable health

insurance coverage.

Mr. Speaker I commend to the attention of my colleagues the following letter of resignation written by American diplomat John Brady Kiesling. Mr. Kiesling served in the U.S. State Department as Political Counselor at the American Embassy in Greece before resigning his post on Thursday, February 27--ending twenty years of public service. Mr. Kiesling's letter is an eloquent expression of principal in opposition to war with Iraq and America's heavy-handed approach to foreign policy under the leadership of President Bush.

US Diplomat John Brady Kiesling,

February 27, 2003.

Secretary of State Colin L. Powell,

Letter of Resignation.

Mr. Speaker, I rise with my colleagues, Representatives Patrick Kennedy, Jim Ramstad and many others, to introduce the Paul D. Wellstone Mental Health Parity Act (MHPA) in the House. This bill, well named in memory of a dearly missed Congressional colleague and mental health advocate, ends a major barrier to mental health care by providing full parity in the health insurance coverage of mental illness with physical illness. It is time to heed the call of the 54 million Americans who suffer with the effects of mental illness every day of their lives and change this pernicious form of discrimination.

While the MHPA has received substantial bipartisan support in Congress and is supported in concept by the current administration, there remains a chorus of naysayers; primarily business lobbyists and insurance industry representatives. This chorus chants that this bill removes substantial flexibility by mandating the type of health benefits to offer. Yet examination of the facts refutes their contention. The bill does not require employers to

offer mental health coverage or cover specific mental health services, it excludes parity for substance abuse and out-of-network services, and businesses with less than 50 employees are exempt. Flexibility is not impaired.

The chorus of naysayers chants that this legislation would significantly raise health benefit costs and make these benefits too expensive for employers to offer. Again, examination of the facts refutes their contention. A recent Congressional Budget Office (CBO) projection estimated that passage of this bill would increase group health plan premiums by an average of 0.9 percent. Similarly, a PricewaterhouseCoopers analysis of the bill projected a 1 percent increase in costs or an average of $1.32 per month per plan enrollee. These projections are consistent with the actual findings in states that already provide for full mental health parity by law and the experience of the Federal Employee Health Benefits Program that instituted parity for both mental health and substance abuse benefits in 2001. This approximate 1 percent increase is a small price to pay to increase mental health access and end discriminatory mental health insurance coverage practices. Furthermore, this increase in costs does not take into account the experience of several large employers (e.g. Delta Airlines) that found that increased access to mental health benefits led to decreases in other areas of health care costs and decreased employee absence.

In exasperation, the naysayers then chant that this bill covers an excessively broad range of psychiatric conditions which will open the door to the dubious complaints of the ``worried well'' and lead to over utilization and excessive cost. These contentions deny the reality that the bill requires parity only for those services that are ``medically necessary'' which is defined by the plan or issuer's criteria. In fact, symptoms that do not cause ``clinically significant impairment or distress'' will not be covered.

Thus, in retrospect, the concerns of this chorus are not supported by the data. Then, what can be the origin of this resistance to mental health parity?

A thousand years ago, people displaying symptoms of mental illness were stoned or burned at the stakes. The stigma attached to the mentally ill continues today in a more latent, but no less malicious form. It manifests itself by the employer who finds reasons not to hire or the apartment owner who is less likely to lease to the mentally ill. And, I believe it is manifesting itself in this excessive opposition to the efforts of the mentally ill to obtain treatment.

It is time to overcome the stigma associated with mental illness and put an end to this form of discrimination. It is time for the Administration to take an active role in supporting this bill that facilitates access to mental health services for those in need. It is time for Congress to enact the Paul D. Wellstone Mental Health Parity Act. I am pleased to join with my colleagues to again support this long overdue improvement in our health care system. I urge its speedy passage.

Mr. Speaker, I rise in opposition to H.R. 534, the Human Cloning Prohibition Act of 2003. Like most Americans, I believe reproductive cloning of human beings ought to be criminalized. I support outlawing this practice, which is one of the provisions of this legislation. But, I cannot support this bill because it would also severely limit the ability of scientists to conduct advanced cell research and develop life-saving therapies that could benefit millions of Americans.

H.R. 534's overly broad language would needlessly outlaw an important form of advanced cell research, known as somatic cell nuclear transfer. This research holds great promise to radically improve the health of Americans. This laboratory procedure allows for the development and harvesting of embryonic stem cells that can potentially repair damaged organs and tissues. If the donor material of this procedure is from the patient, the stem cells would be genetically identical to the patient and thus avoid the problem of immune system rejection that is present with conventional treatments. According to the National Institutes of Health, this technology has ``enormous'' medical potential to treat conditions as varied as Parkinson's disease, chronic heart disease, Alzheimer's disease, diabetes and spinal injuries.

Unfortunately, this bill's broad language also makes illegal the importation of any therapies developed in other countries that employ this advanced cell research technology. This ban against importation will further deprive our Nation's patients of treatments that could save their lives.

Support for the continuation of advanced cell research has been expressed by countless teaching and research institutions, scientists, and patient advocate groups. Opponents of this research are quick to offer scenarios of doom and gloom if we allow this research to continue. Yet, this same group of religious zealots and hapless naysayers made similar predictions with the development of such biological advances as in-vitro fertilization and recombinant DNA. The only ``horrors'' that have occurred from fostering that biological research has been allowing more than 16,000 otherwise infertile couples to experience the joys of childbirth and parenthood and the development of an improved form of insulin for the treatment of diabetes.

While I strongly urge my colleagues to oppose H.R. 534, I also encourage support of the Greenwood/Deutsch substitute bill that prohibits the cloning of a human life, but allows for the continuation of advanced cell research and the unfettered availability of health- improving products and procedures derived from this research.

Mr. Speaker, I rise today to honor Don Pickinpaugh's years of service to the Board of Directors of the Washington Township Health Care District. Mr. Pickinpaugh passed away on February 6, 2003 of heart failure at Washington Hospital.

The longest serving member of the hospital's Board of Directors, Mr. Pickinpaugh was first elected to the Board in 1976. He was elected Board president five times during his 27-year tenure, most recently in 2002.

During his time on the Board, Mr. Pickinpaugh provided leadership on many projects, but most notable are his work on the acquisition of Washington West in 1997 and the renovation of the hospital's sixth floor in 2002. This renovation added more than 29 beds to the hospital's capacity.

Mr. Pickinpaugh's interest in health care developed when he served as a Navy chief hospital corpsman. While in the Navy, he supervised the operations of an emergency room at a major Naval hospital and served as a chief laboratory and blood bank technician.

Deeply involved in the community, Mr. Pickinpaugh was a long-time real estate broker in the Fremont area, and was actively involved in the Boy Scouts, Alameda County's Highland Hospital Citizen's Committee, and the Alameda County Tax Assessment Appeals Board. He was also a reading mentor at a Fremont Elementary School.

I send heartfelt sympathies to Don Pickinpaugh's family, and I join his colleagues in mourning the loss of this true community activist.

Mr. Speaker, I rise to introduce the Safe Nursing and Patient Act of 2003 with Rep. Steven LaTourette and more than 40 of our colleagues. Assuring quality medical care and addressing our nursing shortage should not divide us on partisan lines. That's why I'm especially pleased that the bill we're introducing today has support from Democrats and Republicans alike. Senator Kennedy is introducing the companion legislation in the Senate.

There are some 500,000 trained nurses in this country who are not working in their profession. Of course, their reasons for leaving nursing are many. But nurses consistently cite their concerns about the quality of care they feel they are able to provide in many health care settings today. Nurses are also greatly concerned about being forced to work mandatory overtime.

Listen to these words of a nurse in the state of Washington:

I have been a nurse for six years and most of the time I

have worked in the hospital environment. It is difficult to

tell you how terrible it is to ``work scared'' all the time.

A mistake that I might make could easily cost someone their

life and ruin mine. Every night at work we routinely ``face

the clock.'' All of us do without lunch and breaks and work

overtime, often without pay, to ensure continuity of care for

our patients. Yet, we are constantly asked to do more. It has

become the norm for us to have patient assignments two and a

half times greater than the staffing guidelines established

by the hospital itself. I cannot continue to participate in

this unsafe and irresponsible practice. So I am leaving, not

because I don't love being a nurse, but because hospitals are

not safe places: not for patients and not for nurses.

While stories like this are telling, we also have research to back up the concern. A recent study published in JAMA (October 23/30, 2002) proves what nurses have been telling us--that working too many hours while caring for too many patients leads to increased patient deaths and increased job dissatisfaction. The study found that the risk of death to a patient who has undergone surgery increases by 7 percent for each patient over four in a nurse's workload. It also found that patients in hospitals with the lowest nurse staffing levels (eight patients per nurse) have a 31% greater chance of dying than those patients in hospitals with four patients per nurse.

Studies also point to overtime issues as reasons for the nursing shortage. For example, a 2001 report by the General Accounting Office, Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors, concluded: [T]he current high levels of job dissatisfaction among nurses may also play a crucial role in determining the extent of current and future nurse shortages. Efforts undertaken to improve the workplace environment may both reduce the likelihood of nurses leaving the field and encourage more young people to enter the nursing profession. . . .

We have the voices of nurses and the research evidence to prove that the practice of requiring nurses to work beyond the point they believe is safe is jeopardizing the quality of care patients receive. It is also contributing to the growing nurse shortage. Current projections are that the nurse workforce in 2020 will have fallen 20 percent below the level necessary to meet demand.

We have existing government standards that limit the hours that pilots, flight attendants, truck drivers, railroad engineers and other professions can safely work before consumer safety is endangered. However, no similar limitation currently exists for our nation's nurses who are caring for us at often the most vulnerable times in our lives.

The Safe Nursing and Patient Care Act would change that. It would set strict, new federal limits on the ability of health facilities to require mandatory overtime from nurses. Nurses would be allowed to continue to volunteer for overtime if and when they feel they can continue to provide safe, quality care. But, forced mandatory overtime would only be allowed when an official state of emergency was declared by federal, state or local government. These limits would be part of Medicare's provider agreements. They would not apply to nursing homes since alternative staffing and quality measures are already moving forward for those facilities.

To assure compliance, the bill provides HHS with the authority to investigate complaints from nurses about violations. It also grants HHS the power to issue civil monetary penalties of up to $10,000 for violations of the act and to increase those fines for patterns of violations.

Providers would be required to post notices explaining these new rights and to post nurse schedules in prominent workplace locations. Nurses would also obtain anti-discrimination protections against employers who continued to force work hours for nurses beyond what a nurse believes is safe for quality care. Providers found to have violated the law would be posted on Medicare's website.

This legislation is not the final solution. I believe that standards must be developed to define timeframes for safe nursing care within the wide variety of health settings (whether such overtime is mandatory or voluntary). That is why the legislation also requires the Agency on Healthcare Research and Quality to report back to Congress with recommendations for developing overall standards to protect patient safety in nursing care.

I know that our nation's hospital trade associations will claim that my solution misses the mark because it is precisely the lack of nurses in the profession today that is necessitating their need to require mandatory overtime. Let me respond directly. Mandatory overtime is dangerous for patients plain and simple. It is also a driving force for nurses leaving the profession. These twin realities make mandatory overtime a dangerous short-term gamble at best. We should join together to end the practice.

This bill takes the first step to address the problem by strictly limiting the ability of providers to force nurses to work beyond their professional opinion of what is safe for fear of losing their jobs. This is a very real problem facing the nursing profession and that is why my bill is endorsed by the American Nurses Association, AFSCME, AFT, SEIU, AFGE, UAW, and the AFL-CIO--organizations that speak for America's nearly 3 million nurses.

Again, my bill is not the sole solution. I supported the Nurse Reinvestment Act, which was passed by Congress and signed into law last year. That legislation authorizes new federal investment and initiatives to increase the number of people pursuing a nursing education. Such efforts will help in the future, but it will be years before that law's impact is felt in our medical system. And, it will take even longer if the President and Republicans in Congress continue to withhold the funding necessary for the act to be implemented.

We need to help now. We must take steps to improve the nursing profession immediately so that today's nurses will remain in the field to care for those of us who need such care before new nurses can be trained. We also need today's nurses to be there as mentors for the nurses of tomorrow.

Mandatory nurse overtime is a very real quality of care issue for our health system and I look forward to working with my colleagues to enact the Safe Nursing and Patient Care Act. It will start us down the right path toward protecting patients and encouraging people to remain in-- and enter--the nursing profession.

Mr. Chairman, I rise in strong opposition to this so- called Personal Responsibility, Work and Family Promotion Act. It is sort of an anti-Christian, egalitarian, rich-folks welfare bill. They are going to pay for the tax cut by impacting the least powerful people in our community.

In 1964, Lyndon Johnson declared a war against poverty. Well, today my Republican colleagues and the President have declared a war against the poor and against all successful social programs in this country. My Republican colleagues in the House, led by President Bush, want to gut the poverty programs. The Republicans propose to privatize Medicaid, destroy Head Start, eliminate housing subsidies for the poor and make it impossible for low-income families to get the earned income tax credit.

But the real hotshots in the Republican Party have dreamed this one up. Not only will they make it difficult for adults. You know, Ronald Reagan created their welfare cheat years ago in his mind, when it was still working, and he had an African American woman in a white ermine cape in an El Dorado Cadillac. And my friend from California has heard this story time and time again. Now the Republicans have come up with a new welfare cheat. It is a little kid in second grade. I have one. Let me show you a picture. Here is one. It is my son. He is in second grade.

Now, he does not get subsidized lunches at school, Mr. Chairman, but you know what the Republicans will do, they will wait until these kids get in the cafeteria line for their subsidized lunch, and they will say, Sonny, go home and get a tax return from your parents, because we are kicking you out of the school lunch program.

That is how they will save money to do away with the inheritance tax. They will beat up on little children and call them welfare cheats.

It is that kind of arrogant, obscene statement in programs that will impact the poor and the helpless in our country. And this TANF legislation is the first legislation in the program to reduce the impoverished in our country to begging.

For example, there is no job training after the first 24 hours out of 40 hours of work. There is a requirement that traps poor people in welfare or in poverty. In Alabama, Oregon, Louisiana, Mississippi, Wyoming and Texas, anyone who works 24 hours a week at minimum wage would be ineligible for any welfare programs at all.

Right now, three out of four families in our country are eligible for child care under State rules, but they cannot get it. That is why both of our Democratic alternatives provide substantial increase in child care funding over the next 5 years.

Finally, and here is perhaps the most arrogant of all, the Republicans, who consider themselves experts in family law and marriage, waste $300 million to promote a marriage program inspired by their blind allegiance to the Holy Rollers of the Christian right. These arrogant Republicans are suggesting we take this money and train people to get married. Now with 60 percent of the women on welfare having at one point been victims of domestic violence, the Republican agenda that coerced poor people into marriage virtually guarantees tragic consequences across our country.

Marriage programs completely ignore the real barriers that prevent many from pulling themselves out of poverty. If you want to truly motivate healthy marriages, then they would support both Democratic bills, because we address the underlying causes of

marital instability, which in most cases is poverty.

The Democratic bills make poverty reduction an explicit goal of welfare. It gives States the tools to help families move from welfare to work and it provides State financial incentive to reduce child poverty, not kick children off the school lunch program and let them starve. It lets them live in stable families, have families that have the income and the support for decent healthy, progressive lives in this country.

I urge Members to oppose H.R. 4 and support both Democratic alternatives.

Mr. Chairman, I rise today to insert into the Congressional Record this letter from the Consortium for Citizens with Disabilities.

I urge my colleagues to read this letter, which provides important reasons why they should vote against H.R. 4, the Personal Responsibility, Work, and Family Promotion Act of 2003.

This letter suggests needed changes to the TANF law that would help many welfare recipients with barriers to work to get and maintain employment.

I urge my colleagues to vote for the Democratic alternative welfare reauthorization that includes many of these important changes.

Consortium for Citizens

with Disabilities,

February 11, 2003.

Dear Representative: The Consortium for Citizens with

Disabilities (CCD) is a coalition of national consumer,

advocacy, provider and professional organizations

headquartered in Washington, DC. We work together to advocate

for national public policy that ensures the self

determination, independence, empowerment, integration and

inclusion of children and adults with disabilities in all

aspects of society. The CCD TANF Task Force seeks to ensure

that families that include persons with disabilities are

afforded equal opportunities and appropriate accommodations

under the Temporary Assistance for Needy Families block

grant. We are very concerned that the provisions in H.R. 4

will greatly harm, rather than help, families in which there

is an adult or a child with disabilities. We are writing to

urge you to vote ``no'' on H.R. 4, the ``Personal

Responsibility, Work, and Family Promotion Act of 2003.''

Some argue that those who are concerned about the needs of

people with disabilities should welcome the emphasis in H.R.

4 upon higher work participation rates and increased hours of

work, because then states will be required to work with

parents with disabilities. Unfortunately, the exact opposite

is true. It is important to understand that, without some

flexibility, higher work requirements for states and for

families will prevent states from helping move families with

disabilities from welfare to work--at a pace that works best

for the individual family and will have long-term benefits.

If states face more rigid rules on rates and hours of

participation, sanction rates will climb and people with

disabilities and their families will continue to be heavily

represented in their numbers.

Over 40 percent of TANF recipients have a disability, yet

this important fact is largely unknown. In July 2002, GAO

reported that overall, 44 percent of TANF recipients have

impairments or are caring for a child with impairments,

compared with 15 percent of the non-TANF population. Many

face multiple barriers. GAO also reported that, in eight

percent of TANF families, there is both a parent and a child

with disabilities, compared to only one percent in non-TANF

families. Also in July 2002, the HHS Office of the Inspector

General agreed with GAO's findings.

What should this mean for TANF reauthorization? The

problems facing TANF parents with disabilities are

significant. But, just because a person has a disability

which may be a barrier to work, this does not mean that she

cannot work. With appropriate services and supports,

including accommodations in state policies and procedures and

in the work place, most parents with disabilities should be

able to work and would very much like the opportunity to so.

While their policies vary, many states have taken some steps

to help families with disabilities. Comgress must encourage

states to continue to develop their programs to serve people

with disabilities--both adults and children--on TANF. We are

very concerned that H.R. 4 does not do this.

Listed below are the key components that people with

disabilities need in TANF reauthorization.

1. Permit states to determine how long a family will need

rehab services and allow participation in rehab services to

meet the full weekly work requirement for as long as the

state determines the family needs. HR 4 provides that only

three months of rehabilitative services can be counted as

work activity. After three months, a person with a disability

must climb a steep mountain of 24 hours of work before the

state will get credit for providing her with any additional

rehabilitative services. This is a formula for failure. To

suggest that this will work because 16 hours of

rehabilitative services can still be provided misses the

point: people with disabilities and other barriers often are

going to need intensive help--including mental health

treatment, training that accommodates their learning

disabilities, substance abuse treatment, services that

address other

barriers--before any other work activity will be appropriate.

Many times, this help will take in excess of a year to result

in good, long-lasting outcomes. This will not be possible

under HR 4.

2. Protect families with barriers from unnecessary and

inappropriate sanctioning. The 1996 law requires states to

impose sanctions where a parent ``refuses'' to comply with a

state work requirement. Unfortunately, many of those who are

being sanctioned cannot comply--they are not refusing to

comply, they simply cannot because of a disability or other

barrier, or may not even understand what is being required of

them. Efforts to increase the number of hours of required

work activity and states' overall work participation rates

are likely to harm these same families. Without strong

protections against inappropriate sanctioning, it is likely

that the number of inappropriate sanctions will increase.

States should be required to have procedures that review a

family's circumstances prior to the imposition of a sanction

and determine whether modifications are needed to the

requirements so that the family is better able to comply.

Fairness dictates that all states have such basic policies.

HR 4 does not include this protection.

3. Permit states to exempt parents caring for a child with

a disability from the work requirement and time limit. States

should have the option to exempt from the work requirement

and time limit parents caring for a child with a disability

if caring for the child prevents the parent from meeting the

state's work requirement. Some states already do this.

Appropriate, safe child care for children with disabilities

is very difficult to find. In many areas, it is non-existent.

The medical needs of some children require frequent medical

visits and care. If the need for such care becomes

unnecessary, parents then can be brought more fully into the

program with their allotted time for receipt of benefits

still intact.

4. For the previous provisions to be effective in helping

families move from welfare to work and avoid inappropriate

sanctioning, states must have screening and assessment

policies and procedures that identify a family's barriers and

the steps needed to assist the family to move to greater

independence. Assessments should be done by qualified

personnel. Because all later decisions hinge on the quality

of the assessments, it is important that they be done by

qualified personnel. Family self-sufficiency plans developed

without meaningful assessments are all too likely to be

ineffective, wasting state and federal resources and

preventing families from receiving the assistance needed to

move successfully from welfare to work.

As a result of all of the concerns raised above, we urge

you to vote ``NO'' on H.R. 4. We also urge you to raise

concerns about how families with disabilities will fare under

this bill and to suggest that changes be made before the bill

leaves conference.

For further information, please contact members of the

Consortium for Citizens with Disabilities (CCD) TANF Task

Force, including any of the co-chairs: Laurel Stine, Bazelon

Center for Mental Health Law, 202-467-5730,

[email protected]; Donna Meltzer, Association of University

Centers on Disability, 301-593-8549, [email protected]; and

Sharon McDonald, National Alliance to End Homelessness, 202-

638-1526, ext. 109, [email protected].

Thank you for considering our concerns.

Sincerely,

Adapted Physical Activity Council.

American Association on Mental Retardation.

American Association of People with Disabilities.

American Network of Community Options and Resources.

Association of Maternal and Child Health Programs.

Association for Persons in Supported Employment.

Association of University Centers on Disabilities.

Bazelon Center for Mental Health Law.

Brain Injury Association of America.

Council for Exceptional Children.

Council of State Administrators of Vocational

Rehabilitation.

Learning Disabilities Association of America.

National Alliance to End Homelessness.

National Association of Developmental Disabilities

Councils.

National Association of Protection and Advocacy Systems.

National Association of School Psychologists.

National Association of Social Workers.

National Mental Health Association.

National Respite Coalition.

NISH--creating employment opportunities for people with

severe disabilities.

Research Institute for Independent Living.

Spina Bifida Association of America.

The Arc of the United States.

United Cerebral Palsy.

Mr. Speaker, I rise today to honor the accomplishments of Richard Cowan, Executive Director of Legal Assistance for Seniors (LAS) and its well-known Health Insurance Counseling and Advocacy Program (HICAP). HICAP's health insurance counseling program provides the local assistance seniors need to make sure Medicare works for them.

With a leadership style of humor and compassion, Richard Cowan has steered LAS and HICAP through a major growth in services, outreach, and budget during his nine-year tenure as Executive Director. The agency's size has quadrupled under Cowan's leadership, and the legal staff has increased from six attorneys to thirteen.

Richard Cowan worked to develop Healthy Seniors, a program that unites the work of LAS and HICAP, and he led the Senior Immigrant Legal Services Project. He advocated for the Elder Abuse Prevention and Grandparent/Kin Caregiver programs and strengthened the agency's ties throughout Alameda County's senior, social services, health, and legal networks.

He spearheaded development of several LAS newsletters, and expanded LAS's funding resources to include over 30 major individual donors and firm contributors. Also, Cowan oversaw the hiring of a diverse LAS staff, which has the capability to assist clients in eight languages. He was a founding member of Alameda County Senior Services Coalition and Save Oakland Seniors, two groups dedicated to advocating for increased senior services.

Prior to joining LAS, Richard Cowan was Executive Director of the Conciliation Forums of Oakland, a citywide dispute resolution center, for six years, and interim Executive Director of the Volunteer Centers of Alameda County for one year. He earned his Bachelor of Arts, Master of Arts, and Masters of Public Health degrees from the University of California, Berkeley.

I am honored to join the colleagues of Richard Cowan in commending him for his years of exemplary leadership at Legal Assistance for Seniors. I have great respect for the work of Mr. Cowan and this organization. Under his direction, Legal Assistance for Seniors has become a program that should be modeled nationwide.

Mr. Speaker, I rise today in opposition to this omnibus appropriations bill. It is unfortunate that Republicans felt it necessary to use this legislation as a vehicle to peddle their anti- environment agenda while forcing cuts in basic priorities. I would have liked to support many provisions included in this bill.

This bill contains funding I have worked for to fund two Army Corps of Engineers flood control studies that will help communities in my district to evaluate flood problems. It will also provide money for a pilot program in Alameda County to protect children at risk from entering the long-term foster care system. I strongly support these vital programs. However, I have no choice but to oppose the legislation before us today.

I cannot in good conscience support this Republican bill because it will open the door to an unprecedented assault on our environment. It grants logging companies unfettered access to public lands to devastate and degrade our national forests. It specifically invites the timber industry to invade Alaska's Tongass Rainforest and reduce the splendor of this wilderness to a patchwork of clear cuts. It opens the pristine landscape of the Arctic National Wildlife Refuge for the gas industry to make another oil field. An it leaves little money for the unkeep of our national parks and conservation efforts.

Beyond assaulting our environment, this bill continues to shortchange education and will leave our children behind regardless of the President's rhetoric to the contrary. It calls for an across-the-board cut in federal investment in our schools, a cut of over $300 million this school year. This bill also makes it more difficult for parents and students to pay for college. The meager increase for Pell grants doesn't even keep pace with the rising cost of inflation.

The bill makes a drastic cut in housing subsidies for poor families. In this tough economy, there is little reason to make times harder for those who have already been hardest hit by this tough economy.

Finally, this bill makes a mockery of homeland security and public safety. While the President continues to raise fears about impending terrorist attacks, his Republican cronies aren't funding the first responders who will be on the front lines if such an attack occurs. This bill also contains cuts in security at our ports, dams, and nuclear facilities that if breached could have a catastrophic impact.

I urge President Bush and Congressional Republicans to end their assault on our basic priorities. I ask my colleagues to support Representative Obey's motion to recommit, which would remove the disastrous anti-environmental riders from this bill. And, if that motion does not pass--which it won't--I urge my colleagues to vote against the entire bill.

Mr. Speaker, I rise today to introduce the ``Building Secure and Healthy Families Act of 2003.'' This legislation amends existing welfare law to provide alternative programs to the Republican marriage proposals. It would also improve provisions concerning family violence, childcare, care-giving, and teen pregnancy prevention.

I'm thankful to Senator Murray for working to pass companion legislation in the Senate. I am also grateful to the more than 80 poverty, domestic violence, and children's groups that have endorsed this legislation.

As the current Republican marriage proposal demonstrates, even when Republicans correctly identify a societal problem, they administer the wrong remedy due to their blind allegiance to their Christian right wing ideology. Of course families with one income are likely to be poorer than families with two incomes. However, simply getting poor people married does not address any of the underlying causes of poverty such as domestic violence, substance abuse or mental illness. In fact, encouraging marriage may exacerbate those very problems. Thus, the Republican solution is at best naive and simplistic and at worst dangerously harmful and intolerant.

In contrast, the Building Secure and Healthy Families Act of 2003 provides evidence-based solutions to help families overcome problems such as: lacking sufficient income, suffering from family violence, facing teenage pregnancy, being without child care or care-giving skills themselves, or suffering from physical and mental disabilities.

My bill provides an alternative to the marriage promotion provisions of the Republican plan by creating a $100 million per year competitive grant to states to be used for one of the following programs:

Income enhancement programs (like the Minnesota Family Investment Program);

Programs that provide education, opportunity and support to teens to reduce first and subsequent births; and

Programs that provide services to build family stability by securing employment and child care, and providing other services such as mental health and substance abuse counseling.

One of the key programs encouraged in my bill is the Minnesota Family Investment Program or MFIP. This innovative program allows welfare recipients to keep more of their welfare check while they work. It is structured to raise incomes, MFIP is the only welfare program in the country that has created more stable marriages and improved outcomes for child well-being.

In fact, Wade Horn, the Assistant Secretary for Administration for Children and Families at the Department of Health and Human Services, agrees that MFIP works. In a November 2000 Washington Times editorial Horn wrote, ``These results [of MFIP] provide dramatic new evidence that changes in welfare incentives can increase the likelihood that single parents will get married and that married parents will stay married.''

Unfortunately, the Republican marriage plan in their welfare bill does nothing to encourage MFIP-type programs. Instead, it narrowly focuses on providing education programs that deal with inadequate relationship skills, unrealistic expectations about marriage, and the inadequate meaning of marital commitment. It ignores other economic, social and cultural issues relating to marriage instability.

Unlike MFIP, there is no evidence that the Republican-backed marriage programs work. But, maybe they don't care. Their proposal fails to require grantees to meet any criteria of experience, competence or fiscal soundness to get these grants. Also, there are no evaluation standards in their grants. Therefore, it is apparent that the Republican program is more an effort to appease its political base--the religious right--than it is to stabilize and make poor families secure and healthy.

Besides its competitive grant program, my bill encourages parental care-giving and seeks to protect children from the dangers of poverty. Specifically, the bill:

Prohibits states from kicking children off welfare for parents failure to meet TANF requirements;

Disallows states from sanctioning parents on welfare who cannot meet their work requirements because they have no available child care for their children age 13 and under;

Requires states to count care-giving as work for parents who have children that are age I and under;

Gives states the option to count as work care-giving for a child up to age 3;

Deems care-giving for one's sick or disabled child or other family member as a work activity and stops the welfare work clock for care- giving for one's sick or disabled family member

Finally, this bill extends the current Family Violence Option by requiring that states:

Coordinate with domestic or sexual violence coalitions in the development of policies and procedures to have trained caseworkers identify survivors of domestic and sexual violence, refer them for services, and modify or waive welfare work requirements as necessary.

Provide notice, confidentiality, and pre-sanction review to ensure that individuals are not being sanctioned under the welfare law when domestic or sexual violence is a significant contributing factor in noncompliance.

Unfortunately, studies show that even local welfare offices of states that have domestic violence provisions may not fully inform individuals who disclose domestic violence of all their rights. Approximately 75 percent of welfare recipients who identified themselves as victims of violence were not informed about available services, including counseling, housing, or the possibility of using work time to seek help.

To have a secure and healthy America requires having secure and healthy American families. This bill helps develop those healthy American families by broadening the use of the Republican marriage promotion funds to fund proven programs we know that have accomplished this goal. Please join me in enacting the ``Building Secure and Healthy Families Act of 2003.''

Mr. Speaker, today I join with Representative Leach and 18 other colleagues to introduce the Clinical Social Work Medicare Equity Act of 2003. Senator Mikulski is introducing the companion bill in the Senate. This legislation changes a provision in the Balanced Budget Act of 1997 that omits Certified Social Workers, CSWS, from a list of clinical professionals allowed to directly bill through Medicare, Part B for mental health services provided to Medicare beneficiaries in skilled nursing facilities, SNFs. As a result of this omission, CSWs are the only Medicare-authorized mental health providers without this direct billing capability within the SNF setting.

Approximately 20 percent of seniors suffer from mental illness and the prevalence is higher in nursing home residents. These mental disorders interfere with the person's ability to carry out activities of daily living. They include major depression, anxiety, and severe cognitive impairment resulting from Alzheimer's disease. Furthermore, older people have the highest rate of suicide of any age group. Thus, access to mental health services for seniors in nursing homes is very important.

Unfortunately, the inability for CSWs to bill Medicare Part B in SNFs has the effect of excluding these highly skilled professionals from providing mental health services to this population. This is particularly problematic in rural and other medically underserved areas where other Medicare-authorized mental health providers such as psychiatrists and psychologists are often unavailable. The National Association of Social Workers, NASW, strongly supports this access enhancing legislation.

Clinical social workers are highly trained mental health professionals who have participated in the Medicare program since 1987. They constitute the single largest group of mental health providers in the nation. Until BBA'97, clinical social workers were able to bill Medicare directly for providing mental health services to SNF residents, just like clinical psychologists and psychiatrists. Their current exclusion from this provider list is not defensible.

The ultimate victims of the current regulations are the vulnerable seniors who need mental health care. Mental health treatment works. Alzheimer's patients and their families can benefit enormously from psycho-education and counseling around how to cope and manage behavior problems. Research trials have repeatedly demonstrated that psychotherapy, either alone or in combination with medication, can be effective in treating depression and debilitating anxiety. Clinical social workers provide these important services and do so at a fraction of the cost of clinical psychologists and psychiatrists.

In summary, our legislation changes a billing mechanism that again makes it viable for CSWs to provide mental health services in skilled nursing facilities. As a result, our legislation helps to ensure ease of access to needed mental health services to the many Medicare beneficiaries who reside in skilled nursing facilities. The Clinical Social Work Medicare Equity Act is a small technical change to existing law, but it would have the effect of improving the lives of Medicare beneficiaries in nursing homes who are suffering from mental illness. We urge our colleagues to work with us to enact this important legislation this year.

Mr. Speaker, today, I rise to express my grave concerns with the content of the resolution condemning the election of Libya to chair the United Nations Commission on Human Rights.

I abhor Libya's human rights record. I don't agree with Libya's selection to head the Commission. But, the members of the United Nations have held a legitimate, democratic vote. Despite our serious reservations we have a responsible obligation to abide by the U.N.'s decision. We should not, as this resolution calls for, hold nations accountable for their votes.

In a straight up or down vote, the U.N. Commission on Human Rights voted to elect Libya as its chair. Many people don't agree with that decision--Members of Congress, human rights advocates and many others. There is clear evidence of Libya's state sponsorship of terrorism and it's human rights record. Yet, regardless of our distaste with the outcome, this was a fair election in which the member nations elected Libya to this post. Everyone involved had an opportunity to vote and a majority decided who they wanted to lead them. Democracy has prevailed. Now, the U.S. Congress is asked to vote to condemn that practice of democracy?

The United States should practice what it preaches. We cannot in one breath say democracy is good and in the next say democracy is bad, simply because we disagree with the result.

Mr. Speaker, I rise to express my grave concerns with the content of the resolution congratulating Israel on their recent elections.

What could--and should--have been a nice innocuous resolution congratulating a key ally for running their recent election more fairly than we can, was instead hijacked by anti-Palestinian groups in Congress and turned into another diatribe against the Palestinians.

Rather than simply congratulating Israel, the resolution includes language accusing Palestinian leaders of supporting terrorism in Israel and the occupied territories. It further suggest that leaders of the Palestinian Authority, chosen by the Palestinian people, should be thrown out of office. If our role as a nation is to play peace broker in the Middle East, we must stop choosing sides in this ongoing conflict in which neither side is fully in the right.

I do commend Israel for conducting a free and fair election and I wish I could say the same for our most recent Presidential election. But, the commendation should have ended there.

Mr. Speaker, I gladly recognize and congratulate President Ronald Reagan on his 92nd birthday. However, I voted present because I could not in good conscience support a resolution that goes beyond simply offering personal well wishes and endorses President Reagan's economic policies.

I do not believe President Reagan's legacy of monumental budget deficits and excessive tax cuts for the rich was good economic policy. I don't believe his policies renewed America's economic prosperity. Instead they left too many Americans behind and left a giant bill we are still paying today.

I am sorry that the authors of this resolution felt it necessary to insert such partisan language. It would have otherwise been a completely non-controversial resolution that I would gladly support it.