Floor Statements

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I ask unanimous consent to speak as in morning business for 5 minutes.

Mr. President, I wish to speak briefly about an article that was in yesterday's Washington Post that I thought raised a very disturbing issue of which the Senate needs to be aware. The article is entitled ``Indian Health Agency Barred New-Voter Drive.'' I will read a couple of paragraphs from the article so that people understand the issues.

It says:

Officials at a federal program that runs hospitals and

clinics serving Native Americans this summer prohibited

employees from using those facilities to sign up new voters,

saying that even nonpartisan voter registration was

prohibited on federal property.

Staff members at several Indian Health Service hospitals

and clinics in New Mexico, a presidential battleground state

where about one-tenth of the population is Native American,

were trying to register employees, patients and family

members who use the facilities.

In a July e-mail, Ronald C. Wood, executive officer of the

program's regional Navajo office, told his hospital and

clinic directors that ``we are in a very sensitive political

season'' and he outlined a policy that he said came from

Indian Health Service headquarters.

``There have been some recent questions about whether we

can do nonpartisan voter registration drives in our IHS

facilities during non-duty hours''. . . .``The guidance from

HQs staff is that we should not allow voter

registration in our facilities or on federal property.''

This is of concern because of the history of Native Americans being denied the right to vote in my State and perhaps in other parts of the country as well.

The history of this issue in New Mexico, very briefly, is that a returning Marine Corps veteran, someone who served in the Second World War in the Marine Corps, named Miguel Trujillo, was denied the right to vote in our State. In 1948, he had to bring suit in Federal court to obtain the right to vote. He was an Isleta Pueblo Indian member, and he was teaching at Laguna Pueblo in my State and was denied the right to vote as a Native American.

I should point out that his son Michael Trujillo went on to become the head of the Indian Health Service. His daughter Josephine Waconda was the first American Indian woman to be a rear admiral in the career Indian Health Service. So they have a tremendous part of our history in that family.

It is absolutely inexcusable that the Indian Health Service would be giving direction saying that it is inappropriate or illegal or prohibited for people to use Federal property or Indian Health Service facilities to register people to vote on a nonpartisan basis.

Yesterday, I sent a letter to Tommy Thompson, Secretary of Health and Human Services, urging that even though it is not going to affect this year's election since voter registration in our State is essentially over this week in New Mexico, even though it does not affect voter registration, it is imperative that he, as head of that Department, issue a policy and clarify that this is not the policy of the Department of Health and Human Services, this is not the policy of the Indian Health Service.

We have a very strong policy that is recognized in the Defense Department that they encourage military personnel and others who are part of the military family to participate in registering others, either on or off base, to vote. That is as it should be. That is on a nonpartisan basis. I think we all support that. We need to have the very same policy with regard to Indian Health Service facilities and Indian Health Service personnel.

I hope very much that Secretary Thompson will respond to my letter positively, will issue a directive so that it is clear from now on that Indian Health Service personnel are not in any way prohibited from participating in voter registration drives on a nonpartisan basis. This is an issue that deserves attention before it is lost in the shuffle of this campaign. I hope we can get a response from the Secretary in the near future.

Mr. President, I ask unanimous consent to print in the Record the letter I sent to Secretary Thompson.

Mr. President, I yield the floor, and I suggest the absence of a quorum.

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

On behalf of Senator Domenici and myself, I send an amendment to the desk. I understand it has been agreed to by both sides.

Mr. President, I ask unanimous consent that further reading be dispensed with.

I urge my colleagues to support this amendment.

I move to reconsider the vote, and I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Mr. President, I certainly have no objection. I thought this had been agreed to by both managers.

Mr. President, the death of one of New Mexico's most beloved and influential residents on Wednesday night has saddened all of us who knew him. Habhajan Sing Khalsa Yogiji was his full name, but his followers and friends worldwide knew him as Yogi Bhajan.

The spiritual teacher of hundreds of thousands of people, Yogi Bhajan was leader of the Sikhs in the Western Hemisphere. He chose New Mexico as one of several centers of business and residence in the United States, and it was at his home in Espanola that he died with family and friends near.

I have the privilege of Yogi Bhajan's friendship and support for more than 20 years. He was a dynamic, powerful person with a strong devotion to human rights, religious freedom, and good health. He was also a masterful businessman with a degree in economics who intimately understood the connection between food and health, and made health food a foundation for several hugely successful companies. ``Yogi Tea,'' for instance, is found in households around the world.

My thoughts and prayers are with his wife Bibiji and their children, his followers and his other friends. He was a teacher of all who came to know him. We have learned much from this man, and with his death we have lost a great and good friend.

Mr. President, I rise today, along with Senators Biden, Specter, and Landrieu, to introduce the Enhanced Second Chance Act of 2004.

I believe this is an important bill that will significantly improve public safety by providing $130 million a year for a competitive grant program to State, local, and tribal governments to reduce recidivism rates and improve the transition of offenders back into society. In addition to the adult and juvenile demonstration projects, the bill would create a Federal reentry task force, reauthorize funding for drug treatment programs in State and Federal correctional facilities, establish a program within the Bureau of Prisons to promote family reunification, bring additional literacy funds to correctional institutions, and establish a mentoring grant program for community- based organizations to assist inmates with their reentry back into the community.

We as a society have an interest in ensuring that when prisoners are released that they be reintegrated back into the community in a manner that reduces the likelihood of them committing additional crimes. Providing assistance to these individuals is not a charity, it is a matter of good public policy. Without employment, without housing, without basic life skills, without help in treating drug addiction or mental illness, offenders are likely to relapse into criminal behavior. It is insufficient to just punish offenders; we also need to look for ways that we can rehabilitate offenders and create an environment that fosters their ability to make a positive contribution to society.

There are programs in State and Federal detention facilities that are beginning to address some of these issues, but frankly, I believe we need to be doing more--especially with regard to jails across the country. By neglecting to focus on inmates in local jails we are also losing out on targeting the largest population of offenders that is returning to the community--it is estimated that jails return 10 to 20 times the number of people into the community as do Federal and State prisons,

approximately 10 million releases a year. I am very pleased that my suggestions regarding recognizing the role of local jails in the reentry process were incorporated into this bill.

I also believe we need to pay more attention to the issue of illiteracy among inmates. According to the National Institute of Literacy, 70 percent of all prisoners function at the two lowest literacy levels. Considering that studies have consistently demonstrated that correctional educational programs reduce recidivism rates by up to 30 percent, I strongly believe this is an area which deserves attention, and I am happy that this bill will bring additional resources for literacy programs.

If we are going to reduce the recidivism rate, we can't overlook the importance of getting these offenders the tools necessary to succeed in the community without recourse to crime. With over 2 million people incarcerated in the United States, if punishment is all we do, without any effort to rehabilitate and reintegrate offenders into the community, society will bear a heavy burden. Over 650,000 offenders are released from State and Federal facilities each year, in addition to 100,000 juveniles and the numerous individuals coming in and out of local jails that I previously mentioned. It makes sense to do all we can to ensure that these people are rehabilitated and have the skills necessary to successfully change course.

In recent years, many States and localities have begun to improve ways to transition offenders back into communities, and I believe that this bill provides the resources necessary to continue this effort.

Mr. President, I rise today, along with Senators Biden, Specter, and Landrieu, to introduce the Enhanced Second Chance Act of 2004.

I believe this is an important bill that will significantly improve public safety by providing $130 million a year for a competitive grant program to State, local, and tribal governments to reduce recidivism rates and improve the transition of offenders back into society. In addition to the adult and juvenile demonstration projects, the bill would create a Federal reentry task force, reauthorize funding for drug treatment programs in State and Federal correctional facilities, establish a program within the Bureau of Prisons to promote family reunification, bring additional literacy funds to correctional institutions, and establish a mentoring grant program for community- based organizations to assist inmates with their reentry back into the community.

We as a society have an interest in ensuring that when prisoners are released that they be reintegrated back into the community in a manner that reduces the likelihood of them committing additional crimes. Providing assistance to these individuals is not a charity, it is a matter of good public policy. Without employment, without housing, without basic life skills, without help in treating drug addiction or mental illness, offenders are likely to relapse into criminal behavior. It is insufficient to just punish offenders; we also need to look for ways that we can rehabilitate offenders and create an environment that fosters their ability to make a positive contribution to society.

There are programs in State and Federal detention facilities that are beginning to address some of these issues, but frankly, I believe we need to be doing more--especially with regard to jails across the country. By neglecting to focus on inmates in local jails we are also losing out on targeting the largest population of offenders that is returning to the community--it is estimated that jails return 10 to 20 times the number of people into the community as do Federal and State prisons,

approximately 10 million releases a year. I am very pleased that my suggestions regarding recognizing the role of local jails in the reentry process were incorporated into this bill.

I also believe we need to pay more attention to the issue of illiteracy among inmates. According to the National Institute of Literacy, 70 percent of all prisoners function at the two lowest literacy levels. Considering that studies have consistently demonstrated that correctional educational programs reduce recidivism rates by up to 30 percent, I strongly believe this is an area which deserves attention, and I am happy that this bill will bring additional resources for literacy programs.

If we are going to reduce the recidivism rate, we can't overlook the importance of getting these offenders the tools necessary to succeed in the community without recourse to crime. With over 2 million people incarcerated in the United States, if punishment is all we do, without any effort to rehabilitate and reintegrate offenders into the community, society will bear a heavy burden. Over 650,000 offenders are released from State and Federal facilities each year, in addition to 100,000 juveniles and the numerous individuals coming in and out of local jails that I previously mentioned. It makes sense to do all we can to ensure that these people are rehabilitated and have the skills necessary to successfully change course.

In recent years, many States and localities have begun to improve ways to transition offenders back into communities, and I believe that this bill provides the resources necessary to continue this effort.

Mr. President, on a late Friday afternoon back on September 3, 2004, the Bush Administration announced, just before the Labor Day holiday weekend, that there will be a 17.4 percent increase in the Medicare Part B premium for seniors and people with disabilities. The increase would raise premiums for seniors and people with disabilities from $66.60 per month to $78.20 per month and represents the largest dollar increase in the history of the Medicare program.

In fairness, the premium is set in statute to reflect 25 percent of Medicare Part B spending. However, a large share of the increase is due directly to provisions that were included in the Medicare prescription drug bill that passed last year that did far more to help HMOs, insurance companies, and drug companies than it did for Medicare beneficiaries. In fact, because of this formula, the dramatic increase in payments made to HMOs and insurance companies also has the very unfortunate effect of increasing the Medicare premium, even for seniors and people with disabilities that either do not have access to an HMO or choose not to enroll in an HMO.

As a result, today I am introducing legislation, the ``Affordability in Medicare Premiums Act,'' with Senators Mikulski, Graham of Florida, Corzine, Harkin, Durbin, Feingold, Rockefeller, and Kohl, that would reduce the 17.4 percent premium increase announced by the Administration and instill greater fairness in the Medicare premium in the future. It would do so in three ways.

First, the bill recognizes that one of the contributing factors in the dramatic increase in the Medicare premium was the enactment of provider and managed care plan payment increases in the Medicare drug bill. In the case of payments targeted exclusively to managed care plans, the Congressional Research Service has estimated that payments to HMOs will increase by 17.4 percent between 2004 and 2005. The CMS Office of the Actuary estimates that the vast majority of the increase comes from payments to HMOs over and above that made to traditional Medicare for either preventive services or in the physician payment adjustment.

As a result of these targeted increases in payments just to HMOs, Dr. Brian Biles, with George Washington University and the Commonwealth Fund, has estimated that HMOs will be paid $2.7 billion, or 7.8 percent, in excess of traditional, fee-for-service Medicare in 2005. Moreover, the Medicare Payment Advisory Commission, or MedPAC, has found that in almost one-third of the counties in the United States will have payments to HMOs that will exceed that of traditional Medicare by more than 20 percent.

I voted against the Medicare prescription drug bill, in part due to the overpayments made to HMOs in that legislation. If the rhetoric behind private insurance plans is that they will modernize and save Medicare money, it certainly makes little sense to overpay them by what the CMS Office of the Actuary estimates to be $50 billion over the next 10 years. That is why I have cosponsored legislation to eliminate that overpayment.

In the meantime, for the 89 percent of Medicare enrollees that choose not to enroll or do not even have access to a Medicare HMO, they certainly should not have to pay 25 percent of the Part B costs of the overpayment or excessive subsidies to managed care plans through what is now called the Medicare Advantage program, as they are required to now.

Consequently, our legislation, the ``Affordability in Medicare Premiums Act,'' would eliminate that part of the Medicare premium that is attributable to the costs associated with these overpayments to HMOs. Just as somebody should not have to pay the premium of another for choosing a more costly health plan, our Nation's senior citizens or people with disabilities should not have to pay higher premiums because the Administration and Congress choose to overpay HMOs in the Medicare program.

Unfortunately, as it works now, if more Medicare beneficiaries decided this year to enroll in Medicare HMOs, then Medicare spending increases, on average, by at least 8.4 percent for each new managed care enrollee. With that increased cost, all Medicare beneficiaries, even those that neither have access to nor choose not to enroll in an HMO must pay higher premiums.

Second, the bill recognizes that HMOs are also overpaid by Medicare even further due to the Administration's decision to not appropriately ``risk adjust'' payments to health plans. As MedPAC explained in its March 2004 Report to the Congress, ``From the time plans were first paid based on capitation, the program has adjusted the capitation rates to reflect expected health care spending differences among plans based on the characteristics of their enrollees.'' In 1997, Congress required the Secretary to improve the risk adjustment system. However, in implementation of the new system, which is phased in to cushion the impact on health plans, the Centers for Medicare and Medicaid Services, or CMS, went further by estimating the impact of the new system on aggregate plan payments and has restored the difference.

MedPAC has argued against this and points out that without accurate adjustments it results in even further inequity between traditional Medicaid and private health plans. As MedPAC says, ``If plans in general attract healthier-than-average beneficiaries, the Medicare program pays more than these same beneficiaries would cost in the [fee- for-service] program.''

Dr. Biles estimates that the CMS policy will add another $1.4 billion, or 4.0 percent, to health plan overpayments. The CMS Office of the Actuary estimates that if this policy continues over the next 10 years that it will cost the Medicare program an additional $54 billion in overpayments. HMOs should not reap a significant financial windfall by avoiding serving Medicare beneficiaries who have greater health care needs than average. Moreover, once again, those that do not have access to or choose not to enroll in a Medicare HMO should not be required to pay higher premiums for these overpayments.

Therefore, the legislation requires CMS to risk adjust health plan payments and dictates that these Part B savings be redirected into reducing the Medicare Part B premiums for all Medicare beneficiaries. Furthermore, Part A savings would be applied to reduce the federal deficit and extend the solvency of the Medicare Trust Fund.

And finally, our bill repeals the $10 billion that was established in the Medicare drug bill to allow the Secretary to pay health plans for what is called a ``health plan stabilization fund.'' This fund truly serves no other purpose than to further increase overpayments and subsidies to health plans. Savings in Medicare Part B from the repeal of the provision are also redirected into reducing Medicare premiums for all Medicare beneficiaries. Once again, Part A savings would be applied to reduce the federal deficit and further extend the solvency of the Medicare Trust Fund.

If nothing is done in the next two months, this premium increase will result in a cumulative increase in premiums of 56.4 percent between 2001 and 2005. That is unacceptable to our nation's senior citizens and disabled citizens who often live on fixed incomes. Rather than hiding this fact, as the Administration has sought to do, we urge them to do something about it by supporting this critical and urgent legislation.

The ``Affordability in Medicare Premiums Act'' is all about priorities. For

the 89 percent of Medicare beneficiaries that are not enrolled in an HMO, they should not have to pay added premiums as a result of an estimated $114 billion in overpayments to HMOs over the next 10 years. We have chosen to help senior citizens and people with disabilities living on fixed incomes over HMOs. It is a matter of simple fairness.

Dr. Biles estimates that the average premium would decline for Medicare beneficiaries by at least $5 per month if our legislation is passed.

I would also underscore that by requiring risk adjustment and repealing the $10 billion PPO fund, about half of those savings would be Medicare Trust Fund or Part A dollars. As a result, the legislation has the effect of both extending the solvency of the Medicare Trust Fund and also saving taxpayers over $30 billion in coming years.

And finally, the Medicaid program would also save hundreds of millions of dollars over the next ten years due to the fact that Medicaid pays the cost-sharing and premiums for low-income senior citizens and the disabled who are both enrolled in Medicare and Medicaid. The Federal Funds Information for States, or FFIS, has estimated that the Medicare Part B premium increase will cost the Medicaid program over $800 million in 2005. By reducing the Medicare premium, the Medicaid program--and thereby, both federal and state governments and taxpayers--will see spending decline in this area.

I would like to thank Senators Mikulski, Graham of Florida, Corzine, Harkin, Durbin, Feingold, Rockefeller, and Kohl for working with me on introducing this important legislation on behalf of our nation's seniors and disabled enrolled in Medicare.

I ask for unanimous consent that the Fact Sheet supporting the legislation and the text of the bill be printed in the Record.

Mr. President, on a late Friday afternoon back on September 3, 2004, the Bush Administration announced, just before the Labor Day holiday weekend, that there will be a 17.4 percent increase in the Medicare Part B premium for seniors and people with disabilities. The increase would raise premiums for seniors and people with disabilities from $66.60 per month to $78.20 per month and represents the largest dollar increase in the history of the Medicare program.

In fairness, the premium is set in statute to reflect 25 percent of Medicare Part B spending. However, a large share of the increase is due directly to provisions that were included in the Medicare prescription drug bill that passed last year that did far more to help HMOs, insurance companies, and drug companies than it did for Medicare beneficiaries. In fact, because of this formula, the dramatic increase in payments made to HMOs and insurance companies also has the very unfortunate effect of increasing the Medicare premium, even for seniors and people with disabilities that either do not have access to an HMO or choose not to enroll in an HMO.

As a result, today I am introducing legislation, the ``Affordability in Medicare Premiums Act,'' with Senators Mikulski, Graham of Florida, Corzine, Harkin, Durbin, Feingold, Rockefeller, and Kohl, that would reduce the 17.4 percent premium increase announced by the Administration and instill greater fairness in the Medicare premium in the future. It would do so in three ways.

First, the bill recognizes that one of the contributing factors in the dramatic increase in the Medicare premium was the enactment of provider and managed care plan payment increases in the Medicare drug bill. In the case of payments targeted exclusively to managed care plans, the Congressional Research Service has estimated that payments to HMOs will increase by 17.4 percent between 2004 and 2005. The CMS Office of the Actuary estimates that the vast majority of the increase comes from payments to HMOs over and above that made to traditional Medicare for either preventive services or in the physician payment adjustment.

As a result of these targeted increases in payments just to HMOs, Dr. Brian Biles, with George Washington University and the Commonwealth Fund, has estimated that HMOs will be paid $2.7 billion, or 7.8 percent, in excess of traditional, fee-for-service Medicare in 2005. Moreover, the Medicare Payment Advisory Commission, or MedPAC, has found that in almost one-third of the counties in the United States will have payments to HMOs that will exceed that of traditional Medicare by more than 20 percent.

I voted against the Medicare prescription drug bill, in part due to the overpayments made to HMOs in that legislation. If the rhetoric behind private insurance plans is that they will modernize and save Medicare money, it certainly makes little sense to overpay them by what the CMS Office of the Actuary estimates to be $50 billion over the next 10 years. That is why I have cosponsored legislation to eliminate that overpayment.

In the meantime, for the 89 percent of Medicare enrollees that choose not to enroll or do not even have access to a Medicare HMO, they certainly should not have to pay 25 percent of the Part B costs of the overpayment or excessive subsidies to managed care plans through what is now called the Medicare Advantage program, as they are required to now.

Consequently, our legislation, the ``Affordability in Medicare Premiums Act,'' would eliminate that part of the Medicare premium that is attributable to the costs associated with these overpayments to HMOs. Just as somebody should not have to pay the premium of another for choosing a more costly health plan, our Nation's senior citizens or people with disabilities should not have to pay higher premiums because the Administration and Congress choose to overpay HMOs in the Medicare program.

Unfortunately, as it works now, if more Medicare beneficiaries decided this year to enroll in Medicare HMOs, then Medicare spending increases, on average, by at least 8.4 percent for each new managed care enrollee. With that increased cost, all Medicare beneficiaries, even those that neither have access to nor choose not to enroll in an HMO must pay higher premiums.

Second, the bill recognizes that HMOs are also overpaid by Medicare even further due to the Administration's decision to not appropriately ``risk adjust'' payments to health plans. As MedPAC explained in its March 2004 Report to the Congress, ``From the time plans were first paid based on capitation, the program has adjusted the capitation rates to reflect expected health care spending differences among plans based on the characteristics of their enrollees.'' In 1997, Congress required the Secretary to improve the risk adjustment system. However, in implementation of the new system, which is phased in to cushion the impact on health plans, the Centers for Medicare and Medicaid Services, or CMS, went further by estimating the impact of the new system on aggregate plan payments and has restored the difference.

MedPAC has argued against this and points out that without accurate adjustments it results in even further inequity between traditional Medicaid and private health plans. As MedPAC says, ``If plans in general attract healthier-than-average beneficiaries, the Medicare program pays more than these same beneficiaries would cost in the [fee- for-service] program.''

Dr. Biles estimates that the CMS policy will add another $1.4 billion, or 4.0 percent, to health plan overpayments. The CMS Office of the Actuary estimates that if this policy continues over the next 10 years that it will cost the Medicare program an additional $54 billion in overpayments. HMOs should not reap a significant financial windfall by avoiding serving Medicare beneficiaries who have greater health care needs than average. Moreover, once again, those that do not have access to or choose not to enroll in a Medicare HMO should not be required to pay higher premiums for these overpayments.

Therefore, the legislation requires CMS to risk adjust health plan payments and dictates that these Part B savings be redirected into reducing the Medicare Part B premiums for all Medicare beneficiaries. Furthermore, Part A savings would be applied to reduce the federal deficit and extend the solvency of the Medicare Trust Fund.

And finally, our bill repeals the $10 billion that was established in the Medicare drug bill to allow the Secretary to pay health plans for what is called a ``health plan stabilization fund.'' This fund truly serves no other purpose than to further increase overpayments and subsidies to health plans. Savings in Medicare Part B from the repeal of the provision are also redirected into reducing Medicare premiums for all Medicare beneficiaries. Once again, Part A savings would be applied to reduce the federal deficit and further extend the solvency of the Medicare Trust Fund.

If nothing is done in the next two months, this premium increase will result in a cumulative increase in premiums of 56.4 percent between 2001 and 2005. That is unacceptable to our nation's senior citizens and disabled citizens who often live on fixed incomes. Rather than hiding this fact, as the Administration has sought to do, we urge them to do something about it by supporting this critical and urgent legislation.

The ``Affordability in Medicare Premiums Act'' is all about priorities. For

the 89 percent of Medicare beneficiaries that are not enrolled in an HMO, they should not have to pay added premiums as a result of an estimated $114 billion in overpayments to HMOs over the next 10 years. We have chosen to help senior citizens and people with disabilities living on fixed incomes over HMOs. It is a matter of simple fairness.

Dr. Biles estimates that the average premium would decline for Medicare beneficiaries by at least $5 per month if our legislation is passed.

I would also underscore that by requiring risk adjustment and repealing the $10 billion PPO fund, about half of those savings would be Medicare Trust Fund or Part A dollars. As a result, the legislation has the effect of both extending the solvency of the Medicare Trust Fund and also saving taxpayers over $30 billion in coming years.

And finally, the Medicaid program would also save hundreds of millions of dollars over the next ten years due to the fact that Medicaid pays the cost-sharing and premiums for low-income senior citizens and the disabled who are both enrolled in Medicare and Medicaid. The Federal Funds Information for States, or FFIS, has estimated that the Medicare Part B premium increase will cost the Medicaid program over $800 million in 2005. By reducing the Medicare premium, the Medicaid program--and thereby, both federal and state governments and taxpayers--will see spending decline in this area.

I would like to thank Senators Mikulski, Graham of Florida, Corzine, Harkin, Durbin, Feingold, Rockefeller, and Kohl for working with me on introducing this important legislation on behalf of our nation's seniors and disabled enrolled in Medicare.

I ask for unanimous consent that the Fact Sheet supporting the legislation and the text of the bill be printed in the Record.

Mr. President, I rise to speak briefly about an important bill that I hope we can pass before the Congress leaves town and adjourns this year. That is the IMPACT bill, of which Senator Frist is the prime sponsor. I have cosponsored it and various other Senators have also cosponsored it.

This is a bill that passed the Senate. It is awaiting action by the House. I wanted today to come to the floor and urge the House to bring up that bill and pass it so it can be sent to the President for his signature.

Just last week, the Institute of Medicine released a report on childhood obesity. It is a report that I requested in 2001. The report indicates that the prevention of obesity in children and youth needs to be a national public health priority.

Obesity-associated annual hospital costs for children and youth have more than tripled in two decades to $127 billion. In adults, national expenditures associated with overweight and obesity in adults ranges from $98 billion to $129 billion annually. The report calls on the government, industry, media, health care professionals, the nonprofit organizations, State and local educational authorities, schools, parents, and families to take immediate steps to confront this epidemic. And the IMPACT bill I have referred to will address many of those issues.

The bill is of critical importance. It tries to focus attention on these issues. There are a variety of provisions in the bill that I think are extremely important. It will direct us toward finding solutions, first, by preparing the health care community to deal with obesity in terms of prevention, diagnosis, and intervention by adding obesity, overweight, and eating disorders to the list of priority conditions to be addressed in the health professions title VII training grants.

Second, IMPACT supports community-based solutions to increase physical activity and improve nutrition on a number of levels. It provides funding for demonstration projects in communities and schools and health care organizations and other qualified entities that promote fitness or healthy nutrition.

It authorizes the Centers for Disease Control to collect fitness and energy fitness expenditure information from children.

It directs the Agency for Health Care Research and Quality to review any new information related to obesity trends among various subpopulations, and includes such information in its health disparities report.

It allows States to use their preventive services block grant funds for community education on nutrition and increased physical activity. And it instructs the Secretary to report on what research has been done in this area of obesity.

There are a variety of other provisions in the bill. The legislation is an excellent first step in the fight to improve health. It is not the only step we need to take, but it is a first step.

We also need to assist our schools in providing healthy nutrition options and expanding physical activity programs. We need to grow the workforce such that people have access to the health care professions they need to prevent, diagnose, and treat obesity, and we need to ensure that Medicare and Medicaid provide the services necessary to help people prevent obesity and its complications.

These are not small goals, but they are critical to our Nation's health, both today and in the future.

I want to continue working with Senator Frist and other colleagues in the Senate to find new ways to address

these goals, but before Congress adjourns this year we need to go ahead and call on the House to pass the legislation we have passed in the Senate. This is an important step and one that should not be delayed until the convening of a new Congress. I hope the House of Representatives will bring this legislation up quickly, will pass it, will send it to the President, and we can begin down the road of dealing with this serious problem that afflicts so many of our children.

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

Mr. President, I ask unanimous consent that Nancy Faulk, who is a fellow in my office, be given the privilege of the floor today.

I thank the Chair. I thank my colleague from Nevada, Senator Reid, for yielding me time.

Mr. President, last week the Russian Federation began the process of ratifying the Kyoto Protocol on global warming. Russia's ratification is the crucial step that will bring the Kyoto Protocol into force as an international agreement.

In the initial stages of the negotiations, the Senate made clear that we would not be willing to sign any agreement on global warming that did not include scheduled commitments for the developing world in addition to the commitments that were being asked of ourselves. This was not a refusal to participate in the Kyoto negotiations, but it was a guide for what we would find acceptable if we were to actually enter into a treaty.

The Bush administration misrepresented that guide and decided to completely walk away from international negotiations on the issue. Now it looks as though a majority of the world will begin to move forward on the issue of global climate change without U.S. participation.

President Bush's decision was a profound and strategic mistake for our country. The protocol is moving forward now and the United States has very little to say about the direction that it will take. The administration has compounded the error of dropping out of the world climate discussion by failing to come up with a viable climate change policy of its own.

Relying solely on voluntary measures as the basis for our climate change strategy has proven to be ineffective in slowing the growth of our own greenhouse gas emissions. These voluntary actions have been in place since the previous Bush administration, the administration of George Herbert Walker Bush. And now they have been repackaged by the current Bush administration. The current administration and Republican leadership in the House have been so stalwart on this issue that they have opposed efforts in the Senate to even develop modest measures on climate protection, such as a national registry on greenhouse gas emissions and a national registry on climate change.

The science of climate change is clear. The potential losses to our economy through climate-related disruptions such as the increased frequency of hurricanes and other severe storms is starkly apparent. We are putting our own economic security and our competitive edge at risk every day that we delay addressing this issue. The fact that the Kyoto Protocol will officially be entered into force is a signal that the rest of the world is headed toward a marketplace for more efficient and cleaner ways to produce and use energy. But because we in the United States have absented ourselves from

the international discussions, we will have a limited role in setting the terms for the development of that marketplace.

The costs to our economic competitiveness could be substantial. A 1999 report by the President's committee of advisers on science and technology shows that between now and 2050 investments in new energy technologies in developing nations will likely be between $15 and $20 trillion, accounting for more than half of the global investments in energy supply.

Let me restate that. Between $15 and $20 trillion, 90 percent of the markets for coal and nuclear and renewable energy technologies that are expected to be developed, 90 percent of those markets are outside the United States. And the question arises: Who will supply those technologies? Given the right incentives, the United States has the technical capability and the human resources to lead in this area.

A recent edition of Newsweek demonstrated that a large number of U.S. companies, maybe even a majority, are ready to move forward. These companies want to take climate change seriously because they are fearful of losing a huge part of the growing market for clean energy technology. Clean energy technology is the future cornerstone of a world market, and we should be vying to capture that market. Instead, we are on a track for a future where we will be buying the technology from overseas rather than selling the technology to others.

In contrast to our weak policy on climate change, the Europeans and the Japanese have already made serious commitments to reducing emissions with or without Kyoto. They are poised to corner the market in the developing world while our discussions on climate are being held hostage by those who would like to avoid an honest discussion of the issue. The longer we play politics, the wider this gap will grow as the Europeans and the Japanese and others develop more efficient vehicles and cleaner and superior ways to produce energy.

Mr. President, I recently visited China, and the Chinese are developing at a rapid pace. My impression from that visit was of the enormous number of coal-fired powerplants that are scheduled to be built in that country over the next two decades.

This development illustrates why it is important to engage the developing world in climate negotiations. But by walking away from the table over 3 years ago, the administration did not improve its ability to cause that engagement to occur. Our misguided refusal to engage in the issue lets everyone else off the hook.

The news of Russia's willingness to go forward with the Kyoto Protocol should be a wake-up call to this administration. We should seize it as an opportunity for the United States to start showing leadership on the issue. Only then can we credibly engage China and the developing world. One way of taking that leadership is for the United States to propel itself forward in the development of cleaner and more efficient technology. If we do not and if Kyoto goes into force, then the United States will run the risk of falling behind in participating in important new markets for energy technology.

There are flexibility mechanisms within the Kyoto structure to allow the United States to participate in a global regime, but we need to take our own first steps.

Two credible first steps could be, first, for us to strengthen our own capabilities for energy technology R&D, and, second, for us to develop a robust and verified national registry for greenhouse gas emissions.

With respect to the registry, if the United States is to develop a strategy for helping to achieve a stable climate in the future, knowing where our emissions are coming from is a necessary first step. The Senate has gone on record in favor of such a registry in the last Congress and again in this Congress.

With time so short in this Congress, frankly, I am not optimistic that we will be able to revisit the issue, but I hope the developments in Russia will drive home the need to start a real debate on a proactive climate policy, and we need to start taking even modest steps to address this extremely important issue.

Mr. President, I yield the floor.

Mr. President, I come to the floor today to express my dismay that the administration and the Congress have failed to prevent almost $1.1 billion in money that has been previous allocated to the State Children's Health Insurance Program, or SCHIP, from expiring. Families USA points out that the loss of these funds approximate the annual cost of providing health coverage to almost 750,000 children. That failure is unacceptable for a nation such as ours.

However, I am pleased to report that both Finance Committee Chairman Grassley and Senator Baucus are moving quickly to pull together a bipartisan group together to resolve this problem as soon as possible. Considering that the chairman is the author of important pieces of legislation, such as the Family Opportunity Act, to improve the health of our Nation's children with special health care needs, it should come as no surprise that he is working to bridge the gap between legislation introduced by Senators Rockefeller and Chafee that would preserve and reallocate the $1.1 billion in SCHIP funds and the administration's stated position to preserve the funding but take those dollars currently dedicated to health insurance coverage and use them instead ``to enroll more children who remain uninsured despite being eligible for coverage.''

In light of the chairman's dedication to the issue and commitment to a bipartisan solution, I am hopeful that we will get this resolved, and I urge all parties to work toward a compromise as soon as possible.

What is at stake here? According to data from a Kaiser Commission on Medicaid and the Uninsured report that was released on Monday, there were over 9.1 million children who were uninsured in our country in 2003. There have been important strides made in reducing the number of uninsured children since the passage of SCHIP, as the number of uninsured has dropped from 9.4 million uninsured in 2000 to the 9.1 million in 2003. The uninsured rate would have increased dramatically if not for SCHIP. In fact, the uninsured rate for adults during this same time-period increased from 30.2 million to 35.5 million.

Regardless of the improvement in children's health, the fact that over 9 million children remain uninsured is absolutely unacceptable for a nation such as ours.

In fact, if every single child living in the 21 States of Alaska, Arkansas, Delaware, Hawaii, Idaho, Iowa, Kansas, Maine, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Rhode Island, South Dakota, Utah, Vermont, West Virginia, Wyoming, and the District of Columbia were uninsured, that would still be less than 9 million children. In other words, the number of children without health insurance in our nation exceeds the number of all children living in 21 states and the District of Columbia combined.

That is not something anybody in the administration or this chamber should find acceptable. We should be doing everything in our power to, at the very least, preclude the loss of over $1 billion that could be used to reduce that uninsured rate.

In New Mexico, the loss of this money is coupled with the loss of an expiring provision that is very important to our State and 10 others. The Center on Budget and Policy Priorities estimates that New Mexico will lose at least $20 million over the next few years in money for children's health if the administration and Congress fails to act.

Moreover, there was a very important provision that was included in the last redistribution effort that allows the 11 States, including New Mexico, Connecticut, Hawaii, Maryland, Minnesota, New Hampshire, Rhode Island, Tennessee, Vermont, Washington, and

Wisconsin, to use up to 20 percent of allotted and retained funds by our States on children who are enrolled in Medicaid with income above 150 percent of poverty. This provision was included to recognize that our 11 States had enacted health care expansions for children prior to the enactment of SCHIP and were being effectively penalized financially for having done the right thing for children prior to 1997. The reason is that children in the other 39 States are able to receive an enhanced matching rate for children as low as 100 percent of poverty while children in states such as Washington cannot receive an enhanced matching rate until a child lives in a family with income above 200 percent of poverty.

This important compromise, which significantly reduces the inequity among the States, was achieved in large part due to the hard and dedicated work of Senators Murray, Cantwell, Jeffords, Leahy, Chafee, Reed of Rhode Island, Domenici, and Frist.

Unfortunately, that critically important provision will also effectively expire tonight. This will have a detrimental impact on the health and well-being of the children in these States, as this has been funding that our states have counted on for the delivery of children's health services in both Medicaid and SCHIP for fiscal year 2005.

In Secretary Thompson's letter to Senator Grassley on Tuesday and the majority Leader's letter to Senator Chafee on September 24, 2004, they both failed to recognize this issue. It is for that reason I raise it here again in the Senate to remind my colleagues and the administration that it is an important issue to our 11 States, including that of the Majority Leader, and that, just as we must find a solution to restoring the $1.1 billion in expiring funding for SCHIP, we must also get this other issue resolved as soon as possible.

I strongly urge the administration to reconsider its position that the $1.1 billion should be completely diverted from health coverage to outreach and enrollment. If implemented as proposed, it would result in over 20 percent of SCHIP dollars in 2005 going to outreach and enrollment. While I am a strong supporter of outreach and enrollment in SCHIP, this proposal is both extreme and excessive. In fact, it should be noted that beginning in fiscal year 2002 that expenditures of federal SCHIP funds have begun to exceed federal SCHIP allotments. Therefore, keeping as much funding in actual health coverage is critically important to continue to reduce the number of uninsured children in our nation.

On the other hand, as the sponsor of legislation with the Congressional Hispanic Caucus that authorizes the use of $50 million of SCHIP funding for outreach and enrollment that was subsequently picked up by the majority leader in legislation he introduced, I firmly believe setting aside a limited portion of the $1.1 billion for outreach and enrollment is both necessary to reach a compromise and would also result in better health coverage for children.

In fact, of the 9.1 million uninsured, according to data from the Kaiser Commission on Medicaid and the Uninsured, 6.8 million live in households that have incomes below 200 percent of poverty, which is the level at which most States provide a combination of coverage for children through either their Medicaid or State Children's Health Insurance Programs. While some of these children would not be eligible for either Medicaid or SCHIP due to their immigration status, it is clear from a variety of studies that somewhere between 60 to 85 percent of uninsured children are eligible for but not enrolled in either Medicaid or SCHIP.

Princeton University's publication entitled The Future of Children dedicated much of one issue to looking at successful efforts to improve outreach and enrollment. As one of its articles notes, ``Most important to reducing the uninsurance problem facing children is raising participation in Medicaid and SCHIP, as 76 percent of uninsured children are already eligible for coverage under SCHIP and Medicaid, but are not enrolled. A continued focus on simple and convenient enrollment and renewal systems, as well as proactive outreach and educational efforts, will be key to reaching these children. Special efforts will be needed to enroll Latino and other minority children, children in immigrant families (families in which at least one member is an immigrant), and adolescents. Children in these groups are all over-represented in the ranks of the eligible, but uninsured.''

In New Mexico, we have our own special program along the U.S.-Mexico border that has been funded by the Bureau of Primary Health Care called Border VISION Fornteriza. The program funds the recruitment and training of community health workers or promotoras that have over the years successfully assisted in the enrollment of thousands of children into health coverage through Medicaid and SCHIP. The program was honored as a model program by the U.S.-Mexico Border Commission and it is precisely this type of program that should be encouraged in whatever agreement is reached.

As a point of comparison, when Congress passed the Medicare prescription drug bill last year, hundreds of millions of dollars was dedicated to doing outreach and enrollment to senior citizens and people with disabilities about the prescription drug cards and the pending drug coverage. In contrast, while States can spend some of their administrative dollars in SCHIP on outreach and enrollment, there are no federal funds exclusively dedicated to conduct outreach and enrollment efforts in either Medicaid or SCHIP.

That should change, and I hope my colleagues will closely review the language introduced by me as part of S. 1159 and in S. 2091 introduced by the majority leader on providing outreach and enrollment funding for children's health.

And finally, I am also hopeful that the Senate will consider legislation by Senator Lugar and me that would streamline enrollment of children in either Medicaid or SCHIP. Just as we know that low-income senior citizens and the disabled enrolled in Medicare Savings Programs are clearly income eligible for the new Medicare prescription drug card and its $600 annual subsidy, I had introduced legislation with Senator Lincoln to auto-enroll those Medicare beneficiaries into the drug card to get the $600 subsidy.

Dr. Mark McClellan, Administrator of the Centers for Medicare and Medicaid Services, or CMS, worked hard and has agreed that those beneficiaries should be presumed income-eligible and sent the card for them to activate. Over 1 million low-income senior citizens and people with disabilities will now be getting access to the drug card subsidy that would not have otherwise received those funds.

The same type of mechanism should be applied to children' health. The Children's Partnership and the Kaiser Family Foundation recently released a report on what they call ``Express Lane Eligibility.'' This concept is encompassed in Senator Lugar's legislation by employing ``two common-sense strategies to find and enroll these nearly seven million `eligible but uninsured' children in health insurance coverage. . . .''

Those common-sense strategies are: No. 1, it targets large numbers of eligible children where they can be found: in other public benefit programs like school lunch and food stamps. More than 70 percent of low-income uninsured children are already receiving other public assistance benefits of some kind; and No. 2 it expedites children's enrollment in health coverage by using information already submitted by parents when they enrolled their children in other benefit programs.

Again, I urge the Congress to also closely look at this successful model to improve enrollment of children into health insurance coverage.

I am terribly disappointed that the expiring SCHIP funds were not retained in a timely manner, but am hopeful that under the leadership of both Senators Grassley and Baucus that we will quickly come to a resolution of this issue in which all the $1.1 billion in restored and retained for children's health. Furthermore, I am hopeful that a portion of that funding will be allocated to outreach and enrollment of children and for streamlining enrollment mechanisms into the program.

Mr. President, since the Manhattan project, national laboratory scientists have performed an inherently unique governmental function of not only designing and producing nuclear weapons, but analyzing intelligence on foreign nuclear weapons and nuclear technology.

In performing this governmental function, the national laboratory scientists have staffed the Joint Atomic Intelligence Committee, which produces strategic assessments on foreign nuclear weapons programs, helped produce technical assessments of foreign nuclear weapons, and provided critical technical support in disabling improvised nuclear devices, which in today's post-9/11 environment is one of our greatest fears. In many cases these functions are performed through rotational assignments to the intelligence community staff.

The amendment I have offered today, and cosponsored by my colleague Senator Domenici, preserves this rotational capability in the intelligence reforms proposed by Senators Collins and Lieberman.

Typically, national laboratory personnel can be detailed to the intelligence community, or any Federal agency, through the Intergovernmental Personnel Act. This act permits employees of federally funded research and development centers, FFRDCs, to act for set periods of time, as staff of a Government agency.

This amendment does not alter the authorities under the act. What this amendment does is reinforce the congressional intent, that in addition to the authorities granted to the National Intelligence Authority to staff its centers with personnel from other branches of the Government, that it continue to be able to utilize the unique capabilities of Department of Energy staff and other FFRDCs.

Mr. President, I would like to express my support for passage of H.R. 4259, the Department of Homeland Security Financial Accountability Act. This Act will apply the Chief Financial Officers Act of 1990 to the Department of Homeland Security, and will codify the existence of an Office of Program Analysis and Evaluation within the Department. This latter provision, which was not part of the Senate- passed companion bill, S. 1567, is an important one, and I would like to engage in a colloquy with the chair and ranking member of the Committee on Governmental Affairs to clarify what is and is not intended by this provision.

The Department of Homeland Security is charged with carrying out a wide range of activities related to our domestic security. In my view, it is probably the executive department with the broadest range of activities that need to be coordinated and reconciled from a programmatic standpoint. It is crucial that the Department have a robust programmatic coordination function at the highest level, and that this function have, at its base, a strong analytical capability for purposes of setting priorities among the disparate parts of the Department for purposes of budget formulation and execution. For this reason, the statutory creation of an Office of Program Analysis and Evaluation, and the mandate that it report no lower in the organization than directly to the new chief financial officer, is very sound.

There is another related function in the Department of Homeland Security that has been given a different placement by statute. That is the function of test and evaluation for developing homeland security priorities and for assessing specific technologies. Under section 302 of the Homeland Security Act of 2002, the Under Secretary for Science and Technology within the Department of Homeland Security was given statutory missions for, among other things, ``assessing and testing homeland security vulnerabilities and possible threats,'' ``testing and evaluation activities that are relevant to any or all elements of the Department'' and ``coordinating and integrating all research, development, testing, and evaluation activities of the Department.'' It is crucial that these testing and evaluation functions remain under the management of the Under Secretary for Science and Technology, because they need strong scientific management and focus. We cannot afford to spend constrained Federal funds for homeland security on approaches or technologies that are not technically sound, or that are not cost- effective compared to other technologies.

I do not believe that there is an inherent conflict between the new statutory office created by this bill and the existing statutory assignments in the Homeland Security Act. Offices like the proposed Office of Program Analysis and Evaluation exist in several executive departments, and are generally more focused on assessing programmatic directions, outcomes, resources, and priorities. The test and evaluation function, in contrast, focuses more specifically on technical issues and relative technical merits. In the Department of Defense, for example, both functions are in distinct organizations that work together where appropriate to complement the different strengths and missions that each brings to the table. It would be my assumption that this is the outcome that Congress wants to see in the case of the Department of Homeland Security.

With this as background, I would like to ascertain from my colleagues, the chair and ranking member of the Committee on Governmental Affairs, if they agree with my understanding that the statutory creation of the new Office of Program Analysis and Evaluation is not meant to supersede or alter the testing and evaluation function that Congress has previously assigned to the Under Secretary of Homeland Security for Science and Technology.

I thank my colleagues.

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