Floor Statements

Mr. President, on Monday, April 18, 2005, I introduced S. 832, the Taxpayer Protection and Assistance Act of 2005.

I ask unanimous consent to have printed in the Record explanatory language to accompany that legislation.

Mr. President, I rise today to introduce the Save More for Retirement Act of 2005 with my colleagues Senator Snowe, Senator Lieberman and Senator Obama. This legislation is designed to achieve two important savings goals. First, it will encourage workers who are not currently participating in their employer's retirement plan to do so. Second, it will encourage workers who are currently investing in 40l(k) plans to save even more. At a time when national savings is at a near all-time low, Congress needs to look at ways to expand retirement savings, particularly savings garnered through an employer-provided retirement plan. This legislation is a commonsense approach that is based on research undertaken and compiled by a host of retirement policy experts from both academia and business. It is imperative that the Congress continues to look for new and innovative ways to help workers save for their retirement through the existing employer- provided plan system. This legislation accomplishes that goal by creating incentives for employers to modify their existing plans to add features that have been proven to increase savings.

The first step is to encourage employers to add a feature to its 40l(k) or similar plans to enroll its employees in the plan upon being hired unless the employee notifies the employer that he or she does not want to participate in the plan. The decision to participate still rests entirely with the employees, as they can opt out before participation begins or at any time afterward. Although some employers do offer these types of plans now, most maintain a more traditional structure under which the employee must opt into participating. Studies have indicated that such a seemingly minor change in how employees are enrolled can dramatically increase participation rates. It has been reported that one large company experienced an increase in employee participation in their retirement plan of 50 percent once the features were changed to automatically enroll its employees. Clearly the first step towards increasing our national savings rate is to get more people saving.

Obviously the second step is to get those who are saving to set aside even more for their retirement years. For this reason, the legislation would encourage plans to add a feature that increases employees' contributions annually until it reaches at least 10 percent of the employees' compensation. Again, studies have repeatedly demonstrated that people are more likely to agree to save more in the future than they currently do. It has also been demonstrated that people are more likely to agree to save more in the future if they make the decision today and do not wait until future years to make that decision. In our legislation, the employee can stop a future increase or change the contribution rate. The employer has the discretion to tie these automatic increases to either an annual increase or to increases in salary or compensation. This is closely modeled on the Save More Tomorrow, SMarT, plan advocated by Shlomo Benartzi from UCLA and Richard Thaler from the University of Chicago. These behavioral finance experts claim that although participants in this plan may start saving at a lower rate--3.5 percent--than the average, within 4 years increases averaged 13.6 percent--a greater than 10 percent increase. Compared to the control group saving rate of slightly more than 8 percent of their compensation, the end result is quite extraordinary.

To encourage employers to make these two changes to the plan, the legislation creates a new safe harbor that, if all the criteria are met, treats the plan as being nondiscriminatory. In order to qualify for the safe harbor, the employer must provide either a nonelective match of 3 percent of the employee's compensation or an elective match of 50 percent of the first 7 percent of the employee's compensation. These criteria can be met also if the employer contributes a comparable amount to another qualified plan for the same employees. The employer must also allow its contributions to vest in either 2 years, if the employer enrolls the employees in its pension plan before the employees' first paycheck, or in 1 year if the employer enrolls the employees within the first quarter of being hired. It is important to note that both of these vesting periods are shorter than current law allows and are comparable to what employers can do under the existing safe harbor.

Finally, in an effort to help ensure employees are invested wisely, the legislation directs the Department of Labor to provide guidance for employers in selecting ``default'' investments so that employers have options besides money market accounts and investment contracts. A default investment is the investment that is made when

employees fail to indicate how they would like their retirement savings invested. Due to liability concerns, retirement plans tend to invest these funds in either investment contracts or money market accounts. The benefit of compounding interest that would occur with even modest returns in broad-based funds that have an equity component is lost. This guidance will not allow employers to make default investment decisions that are risky or put the employee's retirement at risk. It is important to note that the employee always retains the ability to invest the funds differently in other investment options offered by the plan if they do not like the default investment offered by the employer.

I thank all of those who have done considerable research into the impact of human behavior on savings, which was quite instrumental to the drafting of this legislation. I look forward to continuing to work with them and others interested in this new approach to addressing our Nation's savings problems.

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

Mr. President, I rise today to introduce the Save More for Retirement Act of 2005 with my colleagues Senator Snowe, Senator Lieberman and Senator Obama. This legislation is designed to achieve two important savings goals. First, it will encourage workers who are not currently participating in their employer's retirement plan to do so. Second, it will encourage workers who are currently investing in 40l(k) plans to save even more. At a time when national savings is at a near all-time low, Congress needs to look at ways to expand retirement savings, particularly savings garnered through an employer-provided retirement plan. This legislation is a commonsense approach that is based on research undertaken and compiled by a host of retirement policy experts from both academia and business. It is imperative that the Congress continues to look for new and innovative ways to help workers save for their retirement through the existing employer- provided plan system. This legislation accomplishes that goal by creating incentives for employers to modify their existing plans to add features that have been proven to increase savings.

The first step is to encourage employers to add a feature to its 40l(k) or similar plans to enroll its employees in the plan upon being hired unless the employee notifies the employer that he or she does not want to participate in the plan. The decision to participate still rests entirely with the employees, as they can opt out before participation begins or at any time afterward. Although some employers do offer these types of plans now, most maintain a more traditional structure under which the employee must opt into participating. Studies have indicated that such a seemingly minor change in how employees are enrolled can dramatically increase participation rates. It has been reported that one large company experienced an increase in employee participation in their retirement plan of 50 percent once the features were changed to automatically enroll its employees. Clearly the first step towards increasing our national savings rate is to get more people saving.

Obviously the second step is to get those who are saving to set aside even more for their retirement years. For this reason, the legislation would encourage plans to add a feature that increases employees' contributions annually until it reaches at least 10 percent of the employees' compensation. Again, studies have repeatedly demonstrated that people are more likely to agree to save more in the future than they currently do. It has also been demonstrated that people are more likely to agree to save more in the future if they make the decision today and do not wait until future years to make that decision. In our legislation, the employee can stop a future increase or change the contribution rate. The employer has the discretion to tie these automatic increases to either an annual increase or to increases in salary or compensation. This is closely modeled on the Save More Tomorrow, SMarT, plan advocated by Shlomo Benartzi from UCLA and Richard Thaler from the University of Chicago. These behavioral finance experts claim that although participants in this plan may start saving at a lower rate--3.5 percent--than the average, within 4 years increases averaged 13.6 percent--a greater than 10 percent increase. Compared to the control group saving rate of slightly more than 8 percent of their compensation, the end result is quite extraordinary.

To encourage employers to make these two changes to the plan, the legislation creates a new safe harbor that, if all the criteria are met, treats the plan as being nondiscriminatory. In order to qualify for the safe harbor, the employer must provide either a nonelective match of 3 percent of the employee's compensation or an elective match of 50 percent of the first 7 percent of the employee's compensation. These criteria can be met also if the employer contributes a comparable amount to another qualified plan for the same employees. The employer must also allow its contributions to vest in either 2 years, if the employer enrolls the employees in its pension plan before the employees' first paycheck, or in 1 year if the employer enrolls the employees within the first quarter of being hired. It is important to note that both of these vesting periods are shorter than current law allows and are comparable to what employers can do under the existing safe harbor.

Finally, in an effort to help ensure employees are invested wisely, the legislation directs the Department of Labor to provide guidance for employers in selecting ``default'' investments so that employers have options besides money market accounts and investment contracts. A default investment is the investment that is made when

employees fail to indicate how they would like their retirement savings invested. Due to liability concerns, retirement plans tend to invest these funds in either investment contracts or money market accounts. The benefit of compounding interest that would occur with even modest returns in broad-based funds that have an equity component is lost. This guidance will not allow employers to make default investment decisions that are risky or put the employee's retirement at risk. It is important to note that the employee always retains the ability to invest the funds differently in other investment options offered by the plan if they do not like the default investment offered by the employer.

I thank all of those who have done considerable research into the impact of human behavior on savings, which was quite instrumental to the drafting of this legislation. I look forward to continuing to work with them and others interested in this new approach to addressing our Nation's savings problems.

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

Mr. President, I thank my colleague, the Senator from Louisiana.

Amendment No. 483, as modified

Mr. President, I ask unanimous consent that the pending amendments be set aside and that amendment No. 483 be called up.

Mr. President, I send a modification to the amendment to the desk and ask that it be considered.

No. 483.

Mr. President, this modification would provide that instead of the $60 million that is in the bill now for the operation of our Federal courts, there would be $65 million, and that the additional funding could be used for both responding to recent Supreme Court decisions, responding to recently enacted legislation, and responding to the increased immigration-related filings in the Federal court. This is a good amendment. It is one that is important, particularly for the States where these immigration-related filings are happening. I believe this is an acceptable amendment to both sides, and I urge my colleagues to support it. I believe it can be agreed to on a voice vote.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Amendment No. 414, As Modified

Mr. President, I have two amendments to offer, and it will take a total of about 3 minutes. I do not expect votes on them today, of course, but I would like a chance to very briefly offer them, and then have them set aside, if I can do that after the Senator from Oregon concludes his remarks and before the rest of the debate continues.

Mr. President, what is the pending business? Is there an amendment pending?

Mr. President, I ask unanimous consent to set that aside so I can call up an amendment numbered 483.

I ask unanimous consent the reading of the amendment be dispensed with.

Mr. President, this amendment would provide an additional $5 million for the U.S. district courts along our southwest border with Mexico. Due to the increased immigration enforcement efforts along that border, southwest border courts have seen an extraordinary increase in immigration-related filings. This amendment would help border courts cover those expenses as we continue allocating resources to secure our Nation's borders.

Since 1995, immigration cases in the five southwest border districts--that is, the District of Arizona, District of New Mexico, Southern District of California, and the Southern and Western Districts of Texas--have grown approximately 828 percent. In 2003, overall immigration filings in all U.S. district courts surged 22 percent. In 2004, they jumped 11 percent. Of those cases, 69 percent of them came from these five districts I have listed.

In recent years, Congress has appropriated millions of dollars to hire additional Border Patrol officers. Obviously, the more Border Patrol officers you have, the more cases you have coming into the Federal district courts. We need to recognize this. We need to recognize the enormous impact this is having on our courts in this part of the country.

This amendment would add an additional $5 million to southwest border courts to the existing $60 million that is currently allocated under the supplemental to cover expenses related to recent Supreme Court decisions and the class action bill. The Administrative Office of the Courts should be free to allocate the funds as it deems necessary among the various courts. I hope my colleagues will support that amendment.

Amendment No. 417

At this point I ask that amendment be set aside, and I call up amendment

No. 417, the Grassley-Baucus amendment.

I ask unanimous consent the reading of the amendment be dispensed with.

Mr. President, this is an amendment I am offering on behalf of Senator Grassley and Senator Baucus and myself. It would provide an additional $2 million in funding to the Office of the U.S. Trade Representative for the balance of the current fiscal year. The reasons for the amendment are straightforward. As many of us have heard, because of the lack of funding, the Office of the Trade Representative has been forced to eliminate a substantial portion of its foreign travel. It has placed a freeze on all its hiring. It is essentially no longer able to do the job we are requiring it to do.

In my opinion, the U.S. Trade Representative's Office is chronically underfunded and understaffed as it is. It is the principal agency in charge of negotiating and enforcing our trade agreements, and it certainly deserves our support, particularly in this time of unprecedented trade imbalances.

We talk a lot about holding our partners to their obligations in trade agreements. We talk about protecting U.S. jobs. Unfortunately, we have not dedicated a proper amount of resources to this effort.

This fiscal year, the Trade Representative's Office has faced unexpected additional constraints as a result of the WTO Ministerial, travel related to enforcement, the need for more staff to pursue congressionally mandated enforcement actions, and substantial fluctuations in the exchange rate, almost all of which fluctuations, I would point out, have been adverse to the dollar.

This amendment will provide the Trade Representative's Office with the emergency funding needed to get through this fiscal year. It is an investment well worth making. It will add to U.S. competitiveness and economic security. I hope my colleagues will support the amendment.

I ask that amendment be set aside and the earlier amendment by Senator Chambliss be brought up again.

I yield the floor.

Mr. President, I rise today to introduce legislation that will help address the devastating health workforce shortages we will be facing in this country. Health care expenditures represent 15.3 percent of U.S. gross domestic product. These expenditures are expected to rise to l8.7 percent by 2014. As health care needs grow, society faces increasing challenges related to the health care workforce. By 2020, 29 percent nursing positions are projected to be vacant. From 2000-2010, an additional 1.2 million aides will be needed to cover projected growth in long-term care positions and replacement of departing workers. An aging health care workforce means that by 2008, almost half of the workforce will be 45 years of age and older. Currently, U.S. providers rely on international medical graduate and foreign trained nurses to fill some critical roles, while continuing to face a shortage of providers in health professional shortage areas. Health workforce challenges need to analyzed, understood, and alleviated, to ensure better access and better quality of care.

The Health Workforce Advisory Commission Act of 2005 will help to create a national vision to serve as a roadmap for investing in the health workforce. Through analysis and recommendation, an 18 member commission of national workforce and health experts will provide insight regarding the solutions necessary to enhance our health workforce. Key areas for commission focus will include forecasting of supply and distribution of physicians, nurses and other health professionals, studying the national and global impact of workforce policies related to the utilization of internationally trained practitioners, and developing appropriate measures to ensure diversity of the U.S. health workforce. The commission will make recommendations to Congress on health workforce policy.

It is vital that the U.S. take new measures to ensure that workforce challenges are met and overcome for current and future generations. By undertaking and overcoming the challenges before us, we will enhance both the quality of healthcare and the quality of life, provide access nationwide, and build a health care system that is consistent with our current and future health and economic needs. The Health Workforce Advisory Commission can serve a new and integral role for our health care system and our society, now and in the future.

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

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

Mr. President, I rise today to introduce legislation that will help address the devastating health workforce shortages we will be facing in this country. Health care expenditures represent 15.3 percent of U.S. gross domestic product. These expenditures are expected to rise to l8.7 percent by 2014. As health care needs grow, society faces increasing challenges related to the health care workforce. By 2020, 29 percent nursing positions are projected to be vacant. From 2000-2010, an additional 1.2 million aides will be needed to cover projected growth in long-term care positions and replacement of departing workers. An aging health care workforce means that by 2008, almost half of the workforce will be 45 years of age and older. Currently, U.S. providers rely on international medical graduate and foreign trained nurses to fill some critical roles, while continuing to face a shortage of providers in health professional shortage areas. Health workforce challenges need to analyzed, understood, and alleviated, to ensure better access and better quality of care.

The Health Workforce Advisory Commission Act of 2005 will help to create a national vision to serve as a roadmap for investing in the health workforce. Through analysis and recommendation, an 18 member commission of national workforce and health experts will provide insight regarding the solutions necessary to enhance our health workforce. Key areas for commission focus will include forecasting of supply and distribution of physicians, nurses and other health professionals, studying the national and global impact of workforce policies related to the utilization of internationally trained practitioners, and developing appropriate measures to ensure diversity of the U.S. health workforce. The commission will make recommendations to Congress on health workforce policy.

It is vital that the U.S. take new measures to ensure that workforce challenges are met and overcome for current and future generations. By undertaking and overcoming the challenges before us, we will enhance both the quality of healthcare and the quality of life, provide access nationwide, and build a health care system that is consistent with our current and future health and economic needs. The Health Workforce Advisory Commission can serve a new and integral role for our health care system and our society, now and in the future.

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

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

Mr. President, I rise today to introduce bipartisan legislation with Senators Lugar, Lincoln, Murray, Kerry, Cantwell, Kohl, Lautenberg, Boxer and Corzine. This legislation, entitled the ``Start Healthy, Stay Healthy Act of 2005,'' would significantly reduce the number of uninsured pregnant women and newborns by expanding coverage to pregnant women through Medicaid and the Children's Health Insurance Program, or CHIP, and to newborns through the first full year of life.

Today is World Health Day 2005 and the message this year is ``Make Every Mother and Child Count''. I can think of no better way to honor our Nation's mothers and children than to increase their access to health care services and improve their overall health.

According to a recent report by Save the Children entitled ``The State of the World's Mothers,'' the United States fares no better than 11th in the world. Why is this? According to the report, ``The United States earned its 11th place rank this year based on several factors: One of the key indicators used to calculate the well-being for mothers is lifetime risk of maternal mortality. . . . Canada, Australia, and all the Western and Northern European countries in the study performed better than the United States in this indicator.''

The study adds, ``Similarly, the United States did not do as well as the top 10 countries with regard to infant mortality rates.''

In fact, the United States ranks 21st in maternal mortality and 28th in infant mortality, the worst among developed nations. We should and must do

better by our Nation's mothers and infants.

There has been long-standing policy in this country linking programs for pregnant women to programs for infants, including Medicaid, WIC, and the Maternal and Child Health Block Grant. Yet the CHIP program, unfortunately, fails to provide coverage to pregnant women beyond the age of 18. As a result, it is more likely that newborns eligible for CHIP are not covered from the moment of birth, and therefore, often miss having comprehensive prenatal care and care during those first critical months of life until their CHIP application is processed.

By expanding coverage to pregnant women through CHIP, the ``Start Healthy, Stay Healthy Act'' recognizes the importance of prenatal care to the health and development of a child. As Dr. Alan Waxman of the University of New Mexico School of Medicine has written, ``Prenatal care is an important factor in the prevention of birth defects and the prevention of prematurity, the most common causes of infant death and disability. Babies born to women with no prenatal care or late prenatal care are nearly twice as likely to [be] low birthweight or very low birthweight as infants born to women who received early prenatal care.''

Unfortunately, according to the Centers for Disease Control and Prevention, New Mexico ranked worst in the nation in the percentage of mothers receiving late or no prenatal care in 2003. The result is often quite costly--both in terms of the health of the mother and newborn but also in terms of the long-term expenses for society since the result can be chronic, lifelong health problems.

In fact, according to the Agency for Healthcare Research and Quality, ``four of the top 10 most expensive conditions in the hospital are related to care of infants with complications (respiratory distress, prematurity, heart defects, and lack of oxygen).'' In addition to reduced infant mortality and morbidity, the provision to expand coverage to pregnant women is cost effective.

The ``Start Healthy, Stay Healthy Act'' also eliminates the unintended federal policy through CHIP that covers pregnant women only through the age of 18 and cuts off that coverage once the women turn 19 years of age. Certainly, everybody can agree that the government should not be telling women that they are more likely to receive prenatal care coverage only if they become pregnant as a teenager.

This bipartisan legislation has been supported in the past by: the March of Dimes, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the What to Expect Foundation, the American Academy of Family Physicians, the American Academy of Pediatric Dentistry, the American Academy of Child and Adolescent Psychiatry, the National Association of Community Health Centers, the American Hospital Association, the National Association of Children's Hospitals, the Federation of American Health Systems, the National Association of Public Hospitals and Health Systems, Premier, Catholic Health Association, Catholic Charities USA, Family Voices, the Association of Maternal and Child Health Programs, the National Health Law Program, the National Association of Social Workers, Every Child By Two, the United Cerebral Palsy Associations, the Society for Maternal- Fetal Medicine, and Families USA.

This legislation is a reintroduction of a bill that was introduced in 2001 and 2003. Throughout 2001, the Administration made numerous statements in support of the passage of this type of legislation, but unfortunately, reversed course in October 2002 after publishing a regulation allowing states to redefine a ``child'' as an ``unborn child'' only and to provide prenatal care, but not postnatal care through CHIP in that manner. In a letter to Senator Nickles dated October 8, 2002, Secretary Thompson argued, ``I believe the regulation is a more effective and comprehensive solution to this issue.''

While a number of senators strongly disagreed with Secretary Thompson's assertion and sent him letters to that effect on October 10, 2002, and on October 23, 2002, we felt it was important to get the testimony of our nation's medical experts on the health and well-being of both pregnant women and newborns. We called for a hearing in the Senate Health, Education, Labor and Pensions Committee on October 24, 2002. Witnesses included representatives from the March of Dimes, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the What to Expect Foundation. They were asked to compare the regulation to the legislation and I will let their testimony speak for itself.

Dr. Nancy Green testified on behalf of the March of Dimes Birth Defects Foundation. She said:

We support giving states the flexibility they need to cover

income-eligible pregnant women age 19 and older, and to

automatically enroll infants born to SCHIP-eligible mothers.

By establishing a uniform eligibility threshold for coverage

for pregnant women and infants, states will be able to

improve maternal health, eliminate waiting periods for

infants and streamline administration of publicly supported

health programs. Currently, according to the Department of

Health and Human Services' Centers for Medicare and Medicaid

Services and the National Governors' Association, 36 states

and the District of Columbia have income eligibility

thresholds that are more restrictive for women than for their

newborns. Encouraging states to eliminate this disparity by

allowing them to establish a uniform eligibility threshold

for pregnant women and their infants should be a national

policy priority.

Dr. Green adds:

Specifically, we are deeply concerned that final regulation

fails to provide to the mother the standard scope of

maternity care services recommended by the American College

of Obstetricians and Gynecologists (ACOG) and the American

Academy of Pediatrics (AAP). Of particular concern, the

regulation explicitly states that postpartum care is not

covered and, therefore, federal reimbursement will not be

available for these services. In addition, because of the

contentious collateral issues raised by this regulation

groups like the March of Dimes will find it even more

difficult to work in the states to generate support for

legislation to extend coverage to uninsured pregnant women.

Dr. Laura Riley testified on behalf of ACOG. In her testimony, she stated:

ACOG is very concerned that mothers will not have access to

postpartum services under the regulation. The rule clearly

states that ``. . . care after delivery, such as postpartum

services could not be covered as part of the Title XXI State

Plan . . . because they are not services for an eligible

child.

On the importance of postpartum care, Dr. Riley adds:

When new mothers develop postpartum complications, quick

access to their physicians is absolutely critical. Postpartum

care is especially important for women who have preexisting

medical conditions, and for those whose medical conditions

were induced by their pregnancies, such as gestational

diabetes or hypertension, and for whom it is necessary to

ensure that their conditions are stabilized and treated.

As a result, Dr. Riley concludes:

Limiting coverage to the fetus instead of the mother omits

a critical component of postpartum care that physicians

regard as essential for the health of the mother and the

child. Covering the fetus as opposed to the mother also

raises questions of whether certain services will be

available during pregnancy and labor if the condition is one

that directly affects the woman. The best way to address this

coverage issue is to pass S. 724, supported by Senators

Bond, Bingaman and Lincoln and many others, and which

provides a full range of medical services during and after

pregnancy directly to the pregnant woman.

Dr. Richard Bucciarelli testified on behalf of the American Academy of Pediatrics. He said:

Recently, the Administration published a final rule

expanding SCHIP to cover unborn children. The Academy is

concerned that, as written, this regulation falls dangerously

short of the clinical standards of care outlined in our

guidelines, which describe the importance of covering all

stages of a birth--pregnancy, delivery, and postpartum care.

It is important to note that the regulation subtracts the time that an ``unborn child'' is covered from the period of continuously eligibility after birth. Consequently, children would be denied insurance coverage at very critical points during the first full year of life. As such, Dr. Bucciarelli expressed support for the legislation over the regulation because it, in his words:

. . . takes an important step to decrease the number of

uninsured children by providing 12 months of continuous

eligibility for those children born . . . This legislation

ensures that children born to women enrolled in Medicaid or

SCHIP are immediately enrolled in the program for which they

are eligible. Additionally, this provision prevents newborns

eligible for SCHIP from being subject to enrollment waiting

periods, ensuring that infants receive appropriate health

care in their first year of life.

And finally, Lisa Bernstein testified as Executive Director of The What to Expect Foundation, which takes its name from the bestselling What to Expect pregnancy and parenting series that has helped over 20 million families from pregnancy through their child's toddler years. Ms. Bernstein also supported the legislation as a far superior option over the regulation and make this simple but eloquent point:

. . . only a healthy parent can provide a healthy future for a healthy child.

The testimony of these experts speaks for itself and I urge my colleagues to pass this legislation as soon as possible.

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

Mr. President, I rise today to introduce bipartisan legislation with Senators Lugar, Lincoln, Murray, Kerry, Cantwell, Kohl, Lautenberg, Boxer and Corzine. This legislation, entitled the ``Start Healthy, Stay Healthy Act of 2005,'' would significantly reduce the number of uninsured pregnant women and newborns by expanding coverage to pregnant women through Medicaid and the Children's Health Insurance Program, or CHIP, and to newborns through the first full year of life.

Today is World Health Day 2005 and the message this year is ``Make Every Mother and Child Count''. I can think of no better way to honor our Nation's mothers and children than to increase their access to health care services and improve their overall health.

According to a recent report by Save the Children entitled ``The State of the World's Mothers,'' the United States fares no better than 11th in the world. Why is this? According to the report, ``The United States earned its 11th place rank this year based on several factors: One of the key indicators used to calculate the well-being for mothers is lifetime risk of maternal mortality. . . . Canada, Australia, and all the Western and Northern European countries in the study performed better than the United States in this indicator.''

The study adds, ``Similarly, the United States did not do as well as the top 10 countries with regard to infant mortality rates.''

In fact, the United States ranks 21st in maternal mortality and 28th in infant mortality, the worst among developed nations. We should and must do

better by our Nation's mothers and infants.

There has been long-standing policy in this country linking programs for pregnant women to programs for infants, including Medicaid, WIC, and the Maternal and Child Health Block Grant. Yet the CHIP program, unfortunately, fails to provide coverage to pregnant women beyond the age of 18. As a result, it is more likely that newborns eligible for CHIP are not covered from the moment of birth, and therefore, often miss having comprehensive prenatal care and care during those first critical months of life until their CHIP application is processed.

By expanding coverage to pregnant women through CHIP, the ``Start Healthy, Stay Healthy Act'' recognizes the importance of prenatal care to the health and development of a child. As Dr. Alan Waxman of the University of New Mexico School of Medicine has written, ``Prenatal care is an important factor in the prevention of birth defects and the prevention of prematurity, the most common causes of infant death and disability. Babies born to women with no prenatal care or late prenatal care are nearly twice as likely to [be] low birthweight or very low birthweight as infants born to women who received early prenatal care.''

Unfortunately, according to the Centers for Disease Control and Prevention, New Mexico ranked worst in the nation in the percentage of mothers receiving late or no prenatal care in 2003. The result is often quite costly--both in terms of the health of the mother and newborn but also in terms of the long-term expenses for society since the result can be chronic, lifelong health problems.

In fact, according to the Agency for Healthcare Research and Quality, ``four of the top 10 most expensive conditions in the hospital are related to care of infants with complications (respiratory distress, prematurity, heart defects, and lack of oxygen).'' In addition to reduced infant mortality and morbidity, the provision to expand coverage to pregnant women is cost effective.

The ``Start Healthy, Stay Healthy Act'' also eliminates the unintended federal policy through CHIP that covers pregnant women only through the age of 18 and cuts off that coverage once the women turn 19 years of age. Certainly, everybody can agree that the government should not be telling women that they are more likely to receive prenatal care coverage only if they become pregnant as a teenager.

This bipartisan legislation has been supported in the past by: the March of Dimes, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the What to Expect Foundation, the American Academy of Family Physicians, the American Academy of Pediatric Dentistry, the American Academy of Child and Adolescent Psychiatry, the National Association of Community Health Centers, the American Hospital Association, the National Association of Children's Hospitals, the Federation of American Health Systems, the National Association of Public Hospitals and Health Systems, Premier, Catholic Health Association, Catholic Charities USA, Family Voices, the Association of Maternal and Child Health Programs, the National Health Law Program, the National Association of Social Workers, Every Child By Two, the United Cerebral Palsy Associations, the Society for Maternal- Fetal Medicine, and Families USA.

This legislation is a reintroduction of a bill that was introduced in 2001 and 2003. Throughout 2001, the Administration made numerous statements in support of the passage of this type of legislation, but unfortunately, reversed course in October 2002 after publishing a regulation allowing states to redefine a ``child'' as an ``unborn child'' only and to provide prenatal care, but not postnatal care through CHIP in that manner. In a letter to Senator Nickles dated October 8, 2002, Secretary Thompson argued, ``I believe the regulation is a more effective and comprehensive solution to this issue.''

While a number of senators strongly disagreed with Secretary Thompson's assertion and sent him letters to that effect on October 10, 2002, and on October 23, 2002, we felt it was important to get the testimony of our nation's medical experts on the health and well-being of both pregnant women and newborns. We called for a hearing in the Senate Health, Education, Labor and Pensions Committee on October 24, 2002. Witnesses included representatives from the March of Dimes, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the What to Expect Foundation. They were asked to compare the regulation to the legislation and I will let their testimony speak for itself.

Dr. Nancy Green testified on behalf of the March of Dimes Birth Defects Foundation. She said:

We support giving states the flexibility they need to cover

income-eligible pregnant women age 19 and older, and to

automatically enroll infants born to SCHIP-eligible mothers.

By establishing a uniform eligibility threshold for coverage

for pregnant women and infants, states will be able to

improve maternal health, eliminate waiting periods for

infants and streamline administration of publicly supported

health programs. Currently, according to the Department of

Health and Human Services' Centers for Medicare and Medicaid

Services and the National Governors' Association, 36 states

and the District of Columbia have income eligibility

thresholds that are more restrictive for women than for their

newborns. Encouraging states to eliminate this disparity by

allowing them to establish a uniform eligibility threshold

for pregnant women and their infants should be a national

policy priority.

Dr. Green adds:

Specifically, we are deeply concerned that final regulation

fails to provide to the mother the standard scope of

maternity care services recommended by the American College

of Obstetricians and Gynecologists (ACOG) and the American

Academy of Pediatrics (AAP). Of particular concern, the

regulation explicitly states that postpartum care is not

covered and, therefore, federal reimbursement will not be

available for these services. In addition, because of the

contentious collateral issues raised by this regulation

groups like the March of Dimes will find it even more

difficult to work in the states to generate support for

legislation to extend coverage to uninsured pregnant women.

Dr. Laura Riley testified on behalf of ACOG. In her testimony, she stated:

ACOG is very concerned that mothers will not have access to

postpartum services under the regulation. The rule clearly

states that ``. . . care after delivery, such as postpartum

services could not be covered as part of the Title XXI State

Plan . . . because they are not services for an eligible

child.

On the importance of postpartum care, Dr. Riley adds:

When new mothers develop postpartum complications, quick

access to their physicians is absolutely critical. Postpartum

care is especially important for women who have preexisting

medical conditions, and for those whose medical conditions

were induced by their pregnancies, such as gestational

diabetes or hypertension, and for whom it is necessary to

ensure that their conditions are stabilized and treated.

As a result, Dr. Riley concludes:

Limiting coverage to the fetus instead of the mother omits

a critical component of postpartum care that physicians

regard as essential for the health of the mother and the

child. Covering the fetus as opposed to the mother also

raises questions of whether certain services will be

available during pregnancy and labor if the condition is one

that directly affects the woman. The best way to address this

coverage issue is to pass S. 724, supported by Senators

Bond, Bingaman and Lincoln and many others, and which

provides a full range of medical services during and after

pregnancy directly to the pregnant woman.

Dr. Richard Bucciarelli testified on behalf of the American Academy of Pediatrics. He said:

Recently, the Administration published a final rule

expanding SCHIP to cover unborn children. The Academy is

concerned that, as written, this regulation falls dangerously

short of the clinical standards of care outlined in our

guidelines, which describe the importance of covering all

stages of a birth--pregnancy, delivery, and postpartum care.

It is important to note that the regulation subtracts the time that an ``unborn child'' is covered from the period of continuously eligibility after birth. Consequently, children would be denied insurance coverage at very critical points during the first full year of life. As such, Dr. Bucciarelli expressed support for the legislation over the regulation because it, in his words:

. . . takes an important step to decrease the number of

uninsured children by providing 12 months of continuous

eligibility for those children born . . . This legislation

ensures that children born to women enrolled in Medicaid or

SCHIP are immediately enrolled in the program for which they

are eligible. Additionally, this provision prevents newborns

eligible for SCHIP from being subject to enrollment waiting

periods, ensuring that infants receive appropriate health

care in their first year of life.

And finally, Lisa Bernstein testified as Executive Director of The What to Expect Foundation, which takes its name from the bestselling What to Expect pregnancy and parenting series that has helped over 20 million families from pregnancy through their child's toddler years. Ms. Bernstein also supported the legislation as a far superior option over the regulation and make this simple but eloquent point:

. . . only a healthy parent can provide a healthy future for a healthy child.

The testimony of these experts speaks for itself and I urge my colleagues to pass this legislation as soon as possible.

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

I yield myself 4 minutes.

Mr. President, let me once again do what I did last evening, and that is commend Senator Smith for his leadership on this important issue. This is a very important test of what our priorities are and also whether we are essentially going to try to take advantage of those we think are less organized to resist.

There are a lot of ways we can save money in health care costs that the Federal Government underwrites. In fact, I have an amendment I am going to be offering later on today where I will propose some significant cuts, substantially more than we are talking about here, that can be saved in Medicare because I believe we should look at health care as an area where we need to constrain the growth in costs. But the problem is this budget does not do anything about Medicare. This budget particularly does not do anything about the enormous growth in the cost of Medicare as a result of last year's prescription drug bill. There are a lot of provisions in that bill which clearly overfund health maintenance organizations, HMOs, provide a slush fund to be used by the Secretary of Health and Human Resources. There is an enormous amount of money sloshing around in that legislation, but there is no effort in the budget to get at any of that. Instead, we have said, let's go after $15 billion of cuts in the areas that affect these less organized lobbies, these less organized groups, these groups that are not going to speak up so strongly and resist the cuts.

That is why Senator Smith's initiative is so important. That is why it is so important that we have a national commission to give us recommendations as to how we can intelligently save money in health care costs in future years.

There are ways that we can better coordinate health care delivery under Medicare and health care delivery under Medicaid. Forty-two percent of the cost of Medicaid is spent on people who are covered by Medicare. Now, we need to do a better job of coordinating those programs, and there are opportunities for saving money. Of course, none of that has been studied, and none of that has been given to us in the way of recommendations. All we are presented with in this budget is a recommendation that we cut $15 billion and somehow or another essentially shift that cost to the States.

I know there is some discussion up and down the halls that maybe Secretary Leavitt has made some arrangement with the Governors and they are agreeable to this $15 billion cut. I have spoken with our Governor, Governor Richardson of New Mexico, who is head of the western Democratic Governors--maybe all the Governors; I am not exactly sure of the title he holds these days. He is a leader on this issue, and he has assured me there is no deal and that these cuts that are proposed in this budget will adversely affect us in New Mexico.

We are struggling to continue the services we have traditionally provided under Medicaid. We are struggling to deal with the fact that more and more people are insisting on services in Medicaid because they are losing their private health insurance. That is why the cost of Medicaid overall has been going up, because more and more people are dependent on Medicaid.

This is an important amendment. Senator Smith deserves the support of all of our colleagues on this amendment. I urge all our colleagues to support it. I yield the floor.

I want to thank the Senator from Oklahoma for raising this issue, and I will ask the Budget Committee staff to look into the scoring of the ESPC program with an eye towards accounting for the mandatory savings and thus resolving the matter.

it/p4p reserve fund

Mr. President, I am pleased to come to the floor today to express my gratitude to J. Paul Taylor--a man of great passion for his wife and children, art and culture, education, border health, progressive politics, and last but definitely not least, improving the economic, social, and spiritual well-being of the people in the Mesilla Valley in southern New Mexico.

J. Paul Taylor has touched the lives of so many of the people throughout our great State of New Mexico, but what is most remarkable is that he has done so in so many different facets of life. News articles about him have never really captured but one small piece of his life, as they focus on: J. Paul Taylor: The Artist; J. Paul Taylor: The Historian; J. Paul Taylor: The Educator; J. Paul Taylor: The Politician; J. Paul Taylor: The Father of Border Health; J. Paul Taylor: The Advocate for the Poor; J. Paul Taylor: Children's Advocate.

Only J. Paul Taylor could be honored in the wide array of ways he has, including having New Mexico State University establish the J. Paul Taylor Endowment in the College of Education, the New Mexico Human Needs Coordinating Council establishing the J. Paul Taylor Legislative Champion Award to honor other legislators, the New Mexico Library Association naming him a ``New Mexico Library Treasure,'' getting the Lifetime Achievement Award with his wife from the New Mexico Historic Preservation Division, receiving the Voice for Children Award from the New Mexico Voices for Children, and the awards go on and on.

Representative Taylor was recently honored by his legislative colleagues in the New Mexico Roundhouse, both Democrats and Republicans. As the Las Cruces Sun-News reported, ``Taylor was described as `the great gentleman of New Mexico politics,' and `a populist advocate for the poor and disenfranchised.' He was also lauded for his effort to create the Office of Childhood Development and for the donation

of his home in Mesilla, to be converted into a museum following the death of Taylor and his wife, Mary.''

Earlier this month, J. Paul Taylor was unanimously confirmed as a member of the New Mexico National Hispanic Cultural Center and the awards and recognitions just keep on coming.

I am so pleased to have worked closely with J. Paul Taylor for the good of New Mexico and the people of the Mesilla Valley throughout my career and think words are impossible to express my gratitude to him for all that he has done for the people of New Mexico. He embodies the very best of our State--its culture and its heart and soul.

Mr. President, today my colleague, Senator Thomas, and I along with Senator Isakson are re-introducing the ``Equity for Our Nation's Self-Employed Act of 2005.'' This important legislation corrects an inequity that currently exists in our tax code that forces self-employed workers to pay payroll taxes on the funds used to pay for their health insurance while larger businesses do not. Because of this inequity, health insurance is more expensive for the self-employed. At a time when the uninsured are growing at an alarming rate, we need to find ways to reduce the cost of health insurance. This legislation is a first logical step.

Under current law, the self-employed are allowed an income tax deduction for the amount they pay for health insurance, but must still calculate their payroll taxes as if they were not allowed this income tax deduction. The result is that the self-employed are paying payroll taxes on the amount they pay for health insurance. As previously stated, larger businesses do not include pay payroll taxes on the amount they pay for health insurance. The legislation we are introducing today would stop this inequitable tax treatment and allow the self-employed to deduct the amount they pay for health insurance from their calculation of payroll taxes.

This problem affects all self-employed who provide health insurance to their families. According to the Census Bureau, there are almost 74,000 self-employed workers in New Mexico. While we have no idea how many of these people in New Mexico have health insurance, we do know that roughly 3.6 million working families in the United States paid self-employment tax on their health insurance premiums. Estimates indicate that roughly 60 percent of our Nation's uninsured are either self-employed or work for a small business. According to the Kaiser Family Foundation, self-employed workers spend more than $9,000 per year to provide health insurance for their family. Because they cannot deduct this as an ordinary business expense, those that spend this amount will pay a 15.3 percent tax on their premiums resulting in almost $1,400 of taxes annually.

This problem was identified by the National Taxpayer Advocate in several of her annual reports to Congress and our legislation to correct it is supported by a variety of groups including the National Association for the Self-Employed, the National Small Business Association, the National Federation of Independent Businesses, the U.S. Chamber of Commerce, the U.S. Hispanic Chamber of Commerce, and the Small Business Legislative Council.

I look forward to working with my colleagues to get this important legislation passed.

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

Mr. President, today my colleague, Senator Thomas, and I along with Senator Isakson are re-introducing the ``Equity for Our Nation's Self-Employed Act of 2005.'' This important legislation corrects an inequity that currently exists in our tax code that forces self-employed workers to pay payroll taxes on the funds used to pay for their health insurance while larger businesses do not. Because of this inequity, health insurance is more expensive for the self-employed. At a time when the uninsured are growing at an alarming rate, we need to find ways to reduce the cost of health insurance. This legislation is a first logical step.

Under current law, the self-employed are allowed an income tax deduction for the amount they pay for health insurance, but must still calculate their payroll taxes as if they were not allowed this income tax deduction. The result is that the self-employed are paying payroll taxes on the amount they pay for health insurance. As previously stated, larger businesses do not include pay payroll taxes on the amount they pay for health insurance. The legislation we are introducing today would stop this inequitable tax treatment and allow the self-employed to deduct the amount they pay for health insurance from their calculation of payroll taxes.

This problem affects all self-employed who provide health insurance to their families. According to the Census Bureau, there are almost 74,000 self-employed workers in New Mexico. While we have no idea how many of these people in New Mexico have health insurance, we do know that roughly 3.6 million working families in the United States paid self-employment tax on their health insurance premiums. Estimates indicate that roughly 60 percent of our Nation's uninsured are either self-employed or work for a small business. According to the Kaiser Family Foundation, self-employed workers spend more than $9,000 per year to provide health insurance for their family. Because they cannot deduct this as an ordinary business expense, those that spend this amount will pay a 15.3 percent tax on their premiums resulting in almost $1,400 of taxes annually.

This problem was identified by the National Taxpayer Advocate in several of her annual reports to Congress and our legislation to correct it is supported by a variety of groups including the National Association for the Self-Employed, the National Small Business Association, the National Federation of Independent Businesses, the U.S. Chamber of Commerce, the U.S. Hispanic Chamber of Commerce, and the Small Business Legislative Council.

I look forward to working with my colleagues to get this important legislation passed.

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