Floor Statements

I ask unanimous consent that Wendy Miller, who is a fellow with Senator Lieberman's office, be granted the privilege of the floor during the pendency of S. 14.

Mr. President, I ask unanimous consent that the following individuals from my office be allowed floor privileges during the duration of the Energy bill over the next several days and perhaps weeks: Jesse Watson, Fayla Lucero, Evan Cochnar, Kelly-Renae Edwards, Nick Goldberg, Joshua Medina, Chet Roach, Daniel Peters, and Elaine Blest.

Mr. President, I thank my colleague, Senator Domenici. I will just very briefly summarize the views I expressed in much greater detail when we began this bill back in May.

My own view is there is much in this legislation that has come before the Senate which I support. Unfortunately, there are also provisions in here I do not support, and there are provisions left out of the bill that I believe are important to include in any kind of comprehensive energy bill we might pass through the Senate.

On that basis, I did not support the form of the legislation that came out of the Energy Committee. I am hoping during the debate here on the Senate floor we can correct the problems that I believe exist, that we can add some provisions that will improve the bill as regards increased efficiency in the use of energy, that will improve the bill as regards increased diversity in the sources of energy, that will improve the bill as regards a consideration of climate change issues, along with our energy policy. There are a variety of issues that need to be addressed, some that need to be corrected.

I look forward to the chance to debate those issues in detail as we get into the amendments. The chairman's intention, perhaps, is to try to begin dealing with the low-income home energy assistance issue today. I hope we can move ahead on that. It is an extremely important provision of the bill. But I look forward to working with the chairman to try to move this legislation forward. In my view, it is important the Congress act in this area. It is important the country modernize the laws that affect our energy supply and energy usage. It has been many years since we have done that in any comprehensive way. So I hope we can make progress. I know that is the chairman's fondest hope. I certainly join in that and intend to do all I can to cooperate.

With that, I suggest the absence of a quorum.

Mr. President, I strongly support the amendment that Senator Domenici sent to the desk. I think it makes some very much needed improvements in the existing Low-Income Home Energy Assistance Program and also in the Weatherization Assistance Program. It also provides additional funds for development of State energy plans.

I think these are very important provisions. We did not have that severe of a winter in many parts of the country this year. Accordingly, we didn't see as many headlines about the importance of this Low-Income Home Energy Assistance Program as we have in some previous years. But the truth is, this is an extremely important program for a great many of our citizens who are low income and who do need the help. It is important for them in heating their homes in the winter, and it is important for them in keeping their homes reasonably cool in the summer. We are starting the summer.

I went through Dallas on the plane Friday on my way back to Washington. It was 96 degrees. I am sure that is a mild foretaste of what we are going to be seeing in the future as far as the temperature in Dallas and in many parts of the country, particularly in the southern sections of the country.

The Low-Income Home Energy Assistance Program assists people in paying their utility bills for air-conditioning just like it assists them in paying their utility bills for heating.

It is very clear when you look at studies that there are a significant number of people in this country, particularly elderly people in the Southern States, who, in fact, die because of excess heat and the inability to cool their apartments or their homes.

This is a very important program. It is one that we need to deal with. It is one we tried to deal with in the Energy bill last year. We passed it through the Senate in very much this same form. We had general support from the House of Representatives to include it in a final bill to go to the President had we been able to get agreement on a final bill. But there was no disagreement about this part of the program or this part of the legislation.

I believe very strongly this should be agreed to and should be included in this Energy bill.

I notice the House has addressed it already in the Energy bill they have passed. It clearly needs to be part of our Energy bill as well so that when we go to conference we can, in a meaningful way, conference with the House of Representatives on this important issue.

I hope this will be agreed to. I look forward to additional debate on it as necessary.

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

Mr. President, the legislation I am introducing today with Senators Cochran, Lincoln, Collins, Daschle, Jeffords, Clinton, Cantwell, and Johnson is entitled the Children's Dental Health Improvement Act of 2003. This legislation is designed to improve the access and delivery of dental health services to our Nation's children through Medicaid, the State Children's Health Insurance Program, (SCHIP), the Indian Health Services, IHS, and our Nation's safety net of community health centers.

The oral health problems facing children are highlighted in a landmark report issued by the Surgeon General and the Department of Health and Human Services, HHS, in 2000 entitled ``Oral Health in America: A report of the Surgeon General'' in which he observed that our Nation is facing what amounts to ``a `silent epidemic' of dental and oral diseases.''

In fact, dental caries, which refers to both decayed teeth or filled cavities, is the most common childhood disease. According to the Surgeon General,``Among 5- to 17-years olds, dental caries is more than 5 times as common as a reported history of asthma and 7 times as common as hay fever.'' In short, dental care is, as the Surgeon General adds,``the most prevalent unmet health need among American children.''

I was pleased to chair a hearing in the Health, Education, Labor and Pensions Committee on June 25, 2002, entitled ``The Crisis in Children's Dental Health: A Silent Epidemic'' in which the Surgeon General, Dr. David Satcher, testified. Dr. Satcher's testimony was strong and compelling.

In his words, ``Over 108 million children and adults lack dental insurance, which is over 2.5 times the number who lack medical insurance.'' Dr. Satcher also highlight the following information specific to the oral health problems in children:

There are striking disparities in dental disease by income. Poor children suffer twice as much dental cries as their more affluent peers, and their disease is more likely to be untreated. These poor- nonpoor differences continue into adolescence. One out of four children in America is born into poverty, and children living below the poverty line--annual income of $17,000 for a family of four--have more severe and untreated decay.

Other birth defects such as hereditary ectodermal dysplasias, where all or most teeth are missing or misshapen, cause lifetime problems that can be devastating to children and adults.

Unintentional injuries, many of which include head, mouth, and neck injuries, are common in children.

Intentional injuries commonly affect the craniofacial tissues.

Tobacco-related oral lesions are prevalent in adolescents who currently use smokeless--spit tobacco.

Professional care is necessary for maintaining oral health, yet 25 percent of poor children have not seen a dentist before entering kindergarten.

Medical insurance is a strong predictor of access to dental care. Uninsured children are 2.5 times less likely than insured children to receive dental care. Children from families without dental insurance are three times more likely to have dental needs than children with either public or private insurance. For each child without medical insurance, there are at least 2.6 children without dental insurance.

Medicaid has not been able to fill the gap in providing dental care to poor children. Fewer than one in five Medicaid-covered children received a single dental visit in a recent year-long study period. While recent CMS data indicate progress in this area with 1 million more Medicaid-eligible children now receiving annual dental care than was the case in 1996, there is still a long way to go to ensuring greater access. Although new programs such as the State Children's Health Insurance Program, SCHIP, may increase the number of insured children, many will still be left without effective dental coverage.

The social impact of oral diseases in children is substantial. More than 51 million school hours are lost each year to dental-related illness. Poor children suffer nearly 12 times more restricted-activity days than children from higher income families. Pain and suffering due to untreated diseases can lead to problems in eating, speaking, and attending to learning.

Over 50 percent of 5- to 9-year-old children have at least one cavity or filling, and that proportion increases to 78 percent among 17-year- olds. Nevertheless, these figures represent improvements in the oral health of children compared to a generation ago.

The Senate also heard the testimony of Dr. Burton Edelstein, founding director of the Children's Dental Health Project; Dr. Gregory Chadwick, president of the American Dental Association; Dr. Lynn Douglass Moundon, director of oral health in the Arkansas Department of Health; Ed Martinez, chief executive officer at San Ysidro Health Center in California; and, Dr. Timothy Shriver, president and chief executive officer of Special Olympics, Inc.

Dr. Edelstein underscored the need for more attention to this issue. As he said, ``The too-widespread belief that childhood dental disease has been vanquished states in contrast to the thousands upon thousands of toothaches and acute abscesses experienced daily by America's children--many as young as 2 years of age.''

In endorsing this legislation, Dr. Chadwick added, ``. . . we cannot forget the fact that millions of people in this country--particularly children--aren't getting even basic preventive and restorative dental care. These children are out there suffering.''

The Children's Dental Health Improvement Act of 2003 seeks to end that suffering. One important provision in the bill would grant States flexibility

to provide dental coverage to low-income children through the State Children's Health Insurance Program, or SCHIP, just as States currently are able to do through Medicaid.

Unfortunately, SCHIP law prohibits coverage of children for services unless they are completely uninsured. As authors Ruth Almeida, Ian Hill, and Genevieve Kenney of an Urban Institute report entitled ``Does SCHIP Spell Better Dental Care for Children? An Early Look at New Initiatives write'', ``. . . many low-income children are covered by employer-based or other private health insurance for their medical care, but do not have a comprehensive dental benefit. Because these children are privately insured, they are not eligible for SCHIP and cannot avail themselves of dental coverage under SCHIP. Expanding SCHIP to furnish dental services on a wraparound basis to private covered low-income children without dental coverage could help achieve broader improvements in children's oral health.''

For low-income children with medical coverage but no dental insurance through the private sector, their only option would be to completely dump their private coverage for their children in order to access SCHIP coverage.

Instead, the Children's Dental Health Improvement Act of 2003 creates an option for States to provide low-income families with the ability to receive wraparound dental coverage through SCHIP without having to completely drop their private insurance. This reduces the crowd-out of private insurance, which was a priority of the Congress during passage of SCHIP, and it provides low-income children with dental services that other children in the same economic circumstance are already receiving through SCHIP.

In implementing such a change, I want to make it clear that I am in strong support of providing additional funding to SCHIP to ensure that these services are provided without reducing current levels of SCHIP funding. With those additional funds, I strongly believe that SCHIP, just as Medicaid, should provide services to low-income children who are both uninsured and underinsured. Children need a comprehensive set of child health services, including dental services, to ensure their appropriate health and development.

However, coverage for these services is often not enough. Even when children do have dental coverage, the access to care is often sorely lacking. Medicaid is the largest insurer of dental coverage to children. Yet despite the design of the Medicaid Program to ensure access to comprehensive services for children, including dental care, the inspector general of the Department of Health and Human Services reported in 1996 that only 18 percent of children eligible for Medicaid received even a single preventive dental service. The same report shows that no State provides preventive services to more than 50 percent of eligible children. The factors are complex but the primary one is due to limited dental participation in Medicaid.

According to GAO, in its September 2000 report entitled ``Oral Health: Factors Contributing to Low Use of Dental Services by Low- Income Populations.'' ``Of 39 states that provided information about dentists' participation in Medicaid, 23 reported that fewer than half of the states' dentists saw at least one Medicaid patient during 1999.'' Even worse, a 1998 survey by the National Conference of State Legislatures indicates that fewer than 20 percent of dentists participate in the Medicaid Program nationwide.

The GAO concludes poor participation rates by dentists is due in large part to poor reimbursement rates in Medicaid. As the GAO points out, ``Our analysis showed that Medicaid payment rates are often well below dentists' normal fees. Only 13 states had Medicaid rates that exceeded two-thirds of the average regional fees dentists charged. . . .''

Clearly, Medicaid is chronically underfunded with respect to dental care. The Surgeon General's report notes, ``On average, state Medicaid agencies contribute only 2.3 percent of their child health expenditures to dental care, whereas nationally, the percentage of all child health expenditures dedicated to dental care is more than 10 times that rate, almost 30 percent.''

The good news is that many States, including New Mexico, have taken recent actions to improve the participation of dentists in the Medicaid Program by raising low payment rates and reducing administrative requirements. These efforts were highlighted by the GAO in its September 2000 report. To further encourage such efforts, the ``Children's Dental Health Improvement Act of 2003'' provides $50 million annually as financial incentives and planning grants to States to undertake additional improvements in their Medicaid Programs delivery of dental health services to children.

In addition to Medicaid and SCHIP, the Federal Government administers other health care programs providing dental services or providers for low-income children and their families, including services administered by community health centers and the Indian Health Service, or IHS. Unfortunately, both of these programs are underfunded and, as the GAO found, ``report difficulty in meeting the dental needs of their target populations.''

For example, the GAO found that ``HHS and health center officials report that the demand for dental services significantly exceeds the [urban and rural health] centers' capacity to deliver it. In 1998 . . ., a little more than half of the nearly 700 health center grantees funded under this program had active dental programs.'' This is also true for public health departments across the country.

To assist the health centers and public health departments with this need, the Children's Dental Health Improvement Act of 2003 provides $40 million to community health centers and public health departments to expand dental health services through the hiring of additional dental health professionals to serve low-income populations.

This is particularly a problem that needs to be addressed in areas with severe dental health professional shortages, such as New Mexico. For example, New Mexico ranked next to last in the Nation with just 32.1 dentists per 100,000 population in 1998, according to HHS. This compares to the national average of 48.4 per 100,000. Moreover, the number of dentists in New Mexico declined by 7 percent between 1991 and 1998 while the State's population grew 12 percent. The result was a 17 percent decline in dentists per capita during the period.

With regard to American Indian and Alaska Native populations, the need is so great and the funding so little that a comprehensive solution is requiring throughout the IHS system. With respect to the unmet need, the GAO notes that ``American Indian and Alaska Native children aged 2 to 4 years old have five times the rate of decay that all children have.''

Unfortunately, the GAO adds, ``. . . about one-fourth of IHS' dentist positions at 269 IHS and tribal facilities were vacant in April 2000. Vacancies have been chronic at IHS facilities--in the past 5 years, at least 67 facilities have had one or more dentist positions vacant for at least a year. According to IHS officials, the primary reason for these vacancies is that IHS is unable to provide a competitive salary for new dentists . . .''

The GAO continues, ``The IHS' dental personnel shortages translate into a large unmet need for dental services among American Indians and Alaska Natives. IHS reports that only 24 percent of the eligible population had a dental visit in 1998. The personnel shortages have also reduced the scope of services that facilities are able to provide. According to IHS officials, available services have concentrated more on acute and emergency care, while routine and restorative care have dropped as a percentage of workload. Emergency services increased from one-fifth of the workload in 1990 to more than one-third of the workload in 1999.''

To help alleviate this workforce shortage, the Children's Dental Health Improvement Act of 2003 provides IHS with the authority to offer multiyear retention bonuses to dental providers offering services through the IHS and tribal programs.

The bill also provides for some technical amendments to ensure that tribal organizations and community health centers are allowed to apply for school-based dental sealant funding from the Centers for Disease Control and Prevention, or CDC.

The legislation also has a new provision that addresses a technical and unintended problem with the implementation of provisions changing the way Medicare graduate medical education, or GME, is funded. As background in the Balanced Budget Act of 1997, or BBA, Congress recognized the unfairness of subjecting dentistry to GME policies based on the oversupply of physician specialists by exempting dental residency positions from caps placed on the number of residents supported by Medicare GME.

However, the two provisions in that law--both enacted primarily to alleviate the impact on hospitals that decrease physician slots--have had the opposite impact on hospitals that increase their dental residency positions. While successful in achieving the purpose of reducing the number of physicians being trained, these provisions have hurt dentistry and access to oral health care in the United States and are contrary to the congressional goal in 1997 to increase the number of postgraduate dental residency slots. As a result, the legislation would exempt dental residency training positions from the 3-year rolling average provision used to calculate the number of residents for Medicare GME payments.

The bipartisan legislation I am introducing today would improve the access and delivery of dental health services to our Nation's children through Medicaid, SCHIP, IHS, and our Nation's safety net of community health centers. These problems are well documented and call out for congressional action as soon as possible.

I would like to thank the American Dental Association, the American Dental Education Association, the American Academy of Pediatric Dentistry, the National Association of Community Health Centers, Inc., the National Association of Children's Hospitals, the American Dental Hygienists' Association, and the Children's Dental Health Project for their outstanding support and/or their technical advice on this legislation. This bill is a result of their outstanding work.

In particular, I want to thank Dr. Burt Edelstein, Libby Mullin, and Ann De Biasi of the Children's Dental Health Project for their vast knowledge and technical assistance on this issue. I want to thank Judy Sherman of the American Dental Association, Myla Moss and Jack Bresch of the American Dental Education Association, Dr. Herber Simmons and Scott Litch of the American Academy of Pediatric Dentistry, Karen Sealander of the American Dental Hygienists' Association, Dr. Jim Richeson and Judy Kloss Bynum of the Academy of General Dentistry, Dr. Stephen Corbin of Special Olympics, Inc., and Dan Hawkins, Chris Koppen, and Roger Schwartz of the National Association of Community Health Centers, Inc., for their valuable insight, technical advice, and continued support for this legislation. I look forward to working with them all to ensure that we achieve increased access to oral health care for our children.

In addition to those organizations, I would like to thank the following groups for their support of the bill, whether in the past session of Congress or this year. They include: the Academy of General Dentistry, American Academy of Child and Adolescent Psychiatry, American Academy of Oral and Maxillofacial Pathology, American Academy of Periodontology, American Association of Dental Examiners, American Association of Dental Research, American Association of Endodontists, American Association of Public Health Dentistry, American Association of Oral and Maxillofacial Surgeons, American Association of Orthodontists, American Association of Women Dentists, American College of Dentists, American College of Preventive Medicine, American Dental Trade Association, American Public Health Association, American Society of Dentistry for Children, American Student Dental Association, Association of Clinicians for the Underserved, Association of Maternal and Child Health Programs, Association of State and Territorial Dental Directors, Dental Dealers of America, Dental Manufacturers of America, Inc., Family Voices, Hispanic Dental Association, International College of Dentists--USA, March of Dimes, National Association of City and County Health Officers, National Association of Local Boards of Health, National Dental Association, National Health Law Program, New Mexico Department of Health, Partnership for Prevention, Society of American Indian Dentists, Special Care Dentistry, and United Cerebral Palsy Associations.

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

Mr. President, today, I am introducing a bill with Senators Daschle, Boxer, and Lincoln that will be jointly introduced by Representatives Ciro Rodriguez, Hilda Solis, and others in the House of Representatives entitled the ``Hispanic Health Improvement Act of 2003.'' This bill addresses the tremendous health disparities that confront the Hispanic community in our Nation.

Even if you know the statistics, they remain shocking. Over one- third, a 35 percent of Hispanic adults lack health insurance. Despite that passage of the Children's Health Insurance Program, 27 percent of Latino children remain uninsured, which is sharp comparison to 9 percent of white, 18 percent of black and 17 percent of Asian/Pacific Islander children.

In testimony before the Senate Health, Education, Labor and Pensions Committee on September 23, 2002, on Hispanic health issues, Dr. Glenn Flores, chair of the Latin Consortium of the American Academy of Pediatrics Center for Child Health Research, added: ``Among uninsured poor children in the U.S., Latinos outnumber all other racial/ethnic groups, including whites: there are 1 million poor, uninsured Latino children, compared with 766,000 white, and 533,000 African-American poor, uninsured children. Although 1999 marked the first time in many years that the proportion of uninsured Latino children actually decreased (from 30 percent to 27 percent), recent national data suggest that outreach efforts to enroll Latino children have largely been unsuccessful. A Kaiser Commission report found that only 26 percent of parents of eligible uninsured children said that they had ever talked to someone or received information about Medicaid enrollment, and 46 percent of Spanish-speaking parents were unsuccessful at enrolling their uninsured children in Medicaid because materials were unavailable in Spanish.''

In order to address the lack of health care coverage, the legislation would expand CHIP to cover pregnant women and parents of children enrolled in CHIP. The legislation provides $50 million in grants to community-based groups to improve outreach and enrollment of children in Medicaid and CHIP with the grants targeted to Hispanic communities.

In addition, the bill eliminates a number of enrollment barriers within Medicaid.

And finally, it provides States the option to enroll legal immigrant pregnant women and children in Medicaid or CHIP. This comes from legislation introduced by Senator Graham earlier in this Congress.

In addition to poor coverage rates, according to the Centers for Disease Control and Prevention, or CDC, the Hispanic population has morbidity and mortality rates that more often than not exceed that of any other ethnic groups. For example, age-adjusted mortality rates for diabetes are over 50 percent higher among Hispanic persons than non- Hispanic whites. HIV infection rates are over 3 times those of non- Hispanic whites. Tuberculosis rates among Latino children are 13 times that of whites.

The legislation addresses these problems in a number of ways. In the area

of access and affordability, our bill requires an annual report to Congress on how federal programs are responding to improve the health status of Hispanic individuals with respect to diabetes, cancer, asthma, HIV infection, AIDS, substance abuse, and mental health. The bill provides $100 million for targeted diabetes prevention, education, school-based programs, and screening activities in the Hispanic community.

In addition, the legislation specifically addresses the problems facing communities along the U.S.-Mexico border, a 2,000-mile stretch of land that contains 11 million people, 5 of the 7 poorest metropolitan statistical areas in the country, and disease rates in some areas that are extraordinary. If the region were a state, the border would rank 1st in the number of uninsured, last in terms of per capita income, and 1st in a number of diseases.

As Dr. Francisco Cigarroa, president of the University of Texas Health Sciences Center at San Antonio, noted in testimony at the hearing last year on Hispanic health, ``Germs respect no INS regulations. We truly must work with our neighbors to the South if we are to avoid a major influx of new conditions and diseases. It can be seen so clearly on a map. Just as there are `rivers of commerce' there are `rivers of infectious disease' and though they may start at the Border, they are eventually seen all the way to the northern Border that we share with Canada.''

In response, the bill provides $200 million to border communities to improve health services and infrastructure along the U.S.-Mexico border.

The numbers I have cited thus far indicate what we do know. Almost as much of a concern is what we do not know with respect to the status of Hispanic health in this Nation. According to one study, only 22 percent of all articles published in major medical journals included non- English-speaking patients.

The bill provides funding to do additional research and work on reducing health disparities in this Nation. The various provisions include efforts to improve the recruitment and retention of Hispanic health professionals and programs that support training health professionals who can provide culturally competent and linguistically appropriate care. With respect to training more minority health professionals, Dr. Cigarroa said at last year's hearing, ``We should do this because it is the smart thing to do. If we fail to take steps to address the gap between the health of the majority population and the health of the Nation's rapidly growing minority populations, we are on a court leading to a collision. We are far too great a nation to allow this to happen.''

Representative Ciro Rodriguez, chairman of the Congressional Hispanic Caucus, and I, have worked together on this legislation to respond to the challenge before us with regard to coverage, access, and health disparities in the last Congress and have reintroduced the bill with the hope to move it forward this year.

Before closing, it should be noted that while the legislation puts forth a number of initiatives to address what are disproportionately Hispanic problems, each section of the bill, including those to reduce the number of uninsured and to improve access to care, would improve the overall health of our entire Nation regardless of race or ethnicity.

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

Mr. President, the legislation I am introducing today with Senators Cochran, Lincoln, Collins, Daschle, Jeffords, Clinton, Cantwell, and Johnson is entitled the Children's Dental Health Improvement Act of 2003. This legislation is designed to improve the access and delivery of dental health services to our Nation's children through Medicaid, the State Children's Health Insurance Program, (SCHIP), the Indian Health Services, IHS, and our Nation's safety net of community health centers.

The oral health problems facing children are highlighted in a landmark report issued by the Surgeon General and the Department of Health and Human Services, HHS, in 2000 entitled ``Oral Health in America: A report of the Surgeon General'' in which he observed that our Nation is facing what amounts to ``a `silent epidemic' of dental and oral diseases.''

In fact, dental caries, which refers to both decayed teeth or filled cavities, is the most common childhood disease. According to the Surgeon General,``Among 5- to 17-years olds, dental caries is more than 5 times as common as a reported history of asthma and 7 times as common as hay fever.'' In short, dental care is, as the Surgeon General adds,``the most prevalent unmet health need among American children.''

I was pleased to chair a hearing in the Health, Education, Labor and Pensions Committee on June 25, 2002, entitled ``The Crisis in Children's Dental Health: A Silent Epidemic'' in which the Surgeon General, Dr. David Satcher, testified. Dr. Satcher's testimony was strong and compelling.

In his words, ``Over 108 million children and adults lack dental insurance, which is over 2.5 times the number who lack medical insurance.'' Dr. Satcher also highlight the following information specific to the oral health problems in children:

There are striking disparities in dental disease by income. Poor children suffer twice as much dental cries as their more affluent peers, and their disease is more likely to be untreated. These poor- nonpoor differences continue into adolescence. One out of four children in America is born into poverty, and children living below the poverty line--annual income of $17,000 for a family of four--have more severe and untreated decay.

Other birth defects such as hereditary ectodermal dysplasias, where all or most teeth are missing or misshapen, cause lifetime problems that can be devastating to children and adults.

Unintentional injuries, many of which include head, mouth, and neck injuries, are common in children.

Intentional injuries commonly affect the craniofacial tissues.

Tobacco-related oral lesions are prevalent in adolescents who currently use smokeless--spit tobacco.

Professional care is necessary for maintaining oral health, yet 25 percent of poor children have not seen a dentist before entering kindergarten.

Medical insurance is a strong predictor of access to dental care. Uninsured children are 2.5 times less likely than insured children to receive dental care. Children from families without dental insurance are three times more likely to have dental needs than children with either public or private insurance. For each child without medical insurance, there are at least 2.6 children without dental insurance.

Medicaid has not been able to fill the gap in providing dental care to poor children. Fewer than one in five Medicaid-covered children received a single dental visit in a recent year-long study period. While recent CMS data indicate progress in this area with 1 million more Medicaid-eligible children now receiving annual dental care than was the case in 1996, there is still a long way to go to ensuring greater access. Although new programs such as the State Children's Health Insurance Program, SCHIP, may increase the number of insured children, many will still be left without effective dental coverage.

The social impact of oral diseases in children is substantial. More than 51 million school hours are lost each year to dental-related illness. Poor children suffer nearly 12 times more restricted-activity days than children from higher income families. Pain and suffering due to untreated diseases can lead to problems in eating, speaking, and attending to learning.

Over 50 percent of 5- to 9-year-old children have at least one cavity or filling, and that proportion increases to 78 percent among 17-year- olds. Nevertheless, these figures represent improvements in the oral health of children compared to a generation ago.

The Senate also heard the testimony of Dr. Burton Edelstein, founding director of the Children's Dental Health Project; Dr. Gregory Chadwick, president of the American Dental Association; Dr. Lynn Douglass Moundon, director of oral health in the Arkansas Department of Health; Ed Martinez, chief executive officer at San Ysidro Health Center in California; and, Dr. Timothy Shriver, president and chief executive officer of Special Olympics, Inc.

Dr. Edelstein underscored the need for more attention to this issue. As he said, ``The too-widespread belief that childhood dental disease has been vanquished states in contrast to the thousands upon thousands of toothaches and acute abscesses experienced daily by America's children--many as young as 2 years of age.''

In endorsing this legislation, Dr. Chadwick added, ``. . . we cannot forget the fact that millions of people in this country--particularly children--aren't getting even basic preventive and restorative dental care. These children are out there suffering.''

The Children's Dental Health Improvement Act of 2003 seeks to end that suffering. One important provision in the bill would grant States flexibility

to provide dental coverage to low-income children through the State Children's Health Insurance Program, or SCHIP, just as States currently are able to do through Medicaid.

Unfortunately, SCHIP law prohibits coverage of children for services unless they are completely uninsured. As authors Ruth Almeida, Ian Hill, and Genevieve Kenney of an Urban Institute report entitled ``Does SCHIP Spell Better Dental Care for Children? An Early Look at New Initiatives write'', ``. . . many low-income children are covered by employer-based or other private health insurance for their medical care, but do not have a comprehensive dental benefit. Because these children are privately insured, they are not eligible for SCHIP and cannot avail themselves of dental coverage under SCHIP. Expanding SCHIP to furnish dental services on a wraparound basis to private covered low-income children without dental coverage could help achieve broader improvements in children's oral health.''

For low-income children with medical coverage but no dental insurance through the private sector, their only option would be to completely dump their private coverage for their children in order to access SCHIP coverage.

Instead, the Children's Dental Health Improvement Act of 2003 creates an option for States to provide low-income families with the ability to receive wraparound dental coverage through SCHIP without having to completely drop their private insurance. This reduces the crowd-out of private insurance, which was a priority of the Congress during passage of SCHIP, and it provides low-income children with dental services that other children in the same economic circumstance are already receiving through SCHIP.

In implementing such a change, I want to make it clear that I am in strong support of providing additional funding to SCHIP to ensure that these services are provided without reducing current levels of SCHIP funding. With those additional funds, I strongly believe that SCHIP, just as Medicaid, should provide services to low-income children who are both uninsured and underinsured. Children need a comprehensive set of child health services, including dental services, to ensure their appropriate health and development.

However, coverage for these services is often not enough. Even when children do have dental coverage, the access to care is often sorely lacking. Medicaid is the largest insurer of dental coverage to children. Yet despite the design of the Medicaid Program to ensure access to comprehensive services for children, including dental care, the inspector general of the Department of Health and Human Services reported in 1996 that only 18 percent of children eligible for Medicaid received even a single preventive dental service. The same report shows that no State provides preventive services to more than 50 percent of eligible children. The factors are complex but the primary one is due to limited dental participation in Medicaid.

According to GAO, in its September 2000 report entitled ``Oral Health: Factors Contributing to Low Use of Dental Services by Low- Income Populations.'' ``Of 39 states that provided information about dentists' participation in Medicaid, 23 reported that fewer than half of the states' dentists saw at least one Medicaid patient during 1999.'' Even worse, a 1998 survey by the National Conference of State Legislatures indicates that fewer than 20 percent of dentists participate in the Medicaid Program nationwide.

The GAO concludes poor participation rates by dentists is due in large part to poor reimbursement rates in Medicaid. As the GAO points out, ``Our analysis showed that Medicaid payment rates are often well below dentists' normal fees. Only 13 states had Medicaid rates that exceeded two-thirds of the average regional fees dentists charged. . . .''

Clearly, Medicaid is chronically underfunded with respect to dental care. The Surgeon General's report notes, ``On average, state Medicaid agencies contribute only 2.3 percent of their child health expenditures to dental care, whereas nationally, the percentage of all child health expenditures dedicated to dental care is more than 10 times that rate, almost 30 percent.''

The good news is that many States, including New Mexico, have taken recent actions to improve the participation of dentists in the Medicaid Program by raising low payment rates and reducing administrative requirements. These efforts were highlighted by the GAO in its September 2000 report. To further encourage such efforts, the ``Children's Dental Health Improvement Act of 2003'' provides $50 million annually as financial incentives and planning grants to States to undertake additional improvements in their Medicaid Programs delivery of dental health services to children.

In addition to Medicaid and SCHIP, the Federal Government administers other health care programs providing dental services or providers for low-income children and their families, including services administered by community health centers and the Indian Health Service, or IHS. Unfortunately, both of these programs are underfunded and, as the GAO found, ``report difficulty in meeting the dental needs of their target populations.''

For example, the GAO found that ``HHS and health center officials report that the demand for dental services significantly exceeds the [urban and rural health] centers' capacity to deliver it. In 1998 . . ., a little more than half of the nearly 700 health center grantees funded under this program had active dental programs.'' This is also true for public health departments across the country.

To assist the health centers and public health departments with this need, the Children's Dental Health Improvement Act of 2003 provides $40 million to community health centers and public health departments to expand dental health services through the hiring of additional dental health professionals to serve low-income populations.

This is particularly a problem that needs to be addressed in areas with severe dental health professional shortages, such as New Mexico. For example, New Mexico ranked next to last in the Nation with just 32.1 dentists per 100,000 population in 1998, according to HHS. This compares to the national average of 48.4 per 100,000. Moreover, the number of dentists in New Mexico declined by 7 percent between 1991 and 1998 while the State's population grew 12 percent. The result was a 17 percent decline in dentists per capita during the period.

With regard to American Indian and Alaska Native populations, the need is so great and the funding so little that a comprehensive solution is requiring throughout the IHS system. With respect to the unmet need, the GAO notes that ``American Indian and Alaska Native children aged 2 to 4 years old have five times the rate of decay that all children have.''

Unfortunately, the GAO adds, ``. . . about one-fourth of IHS' dentist positions at 269 IHS and tribal facilities were vacant in April 2000. Vacancies have been chronic at IHS facilities--in the past 5 years, at least 67 facilities have had one or more dentist positions vacant for at least a year. According to IHS officials, the primary reason for these vacancies is that IHS is unable to provide a competitive salary for new dentists . . .''

The GAO continues, ``The IHS' dental personnel shortages translate into a large unmet need for dental services among American Indians and Alaska Natives. IHS reports that only 24 percent of the eligible population had a dental visit in 1998. The personnel shortages have also reduced the scope of services that facilities are able to provide. According to IHS officials, available services have concentrated more on acute and emergency care, while routine and restorative care have dropped as a percentage of workload. Emergency services increased from one-fifth of the workload in 1990 to more than one-third of the workload in 1999.''

To help alleviate this workforce shortage, the Children's Dental Health Improvement Act of 2003 provides IHS with the authority to offer multiyear retention bonuses to dental providers offering services through the IHS and tribal programs.

The bill also provides for some technical amendments to ensure that tribal organizations and community health centers are allowed to apply for school-based dental sealant funding from the Centers for Disease Control and Prevention, or CDC.

The legislation also has a new provision that addresses a technical and unintended problem with the implementation of provisions changing the way Medicare graduate medical education, or GME, is funded. As background in the Balanced Budget Act of 1997, or BBA, Congress recognized the unfairness of subjecting dentistry to GME policies based on the oversupply of physician specialists by exempting dental residency positions from caps placed on the number of residents supported by Medicare GME.

However, the two provisions in that law--both enacted primarily to alleviate the impact on hospitals that decrease physician slots--have had the opposite impact on hospitals that increase their dental residency positions. While successful in achieving the purpose of reducing the number of physicians being trained, these provisions have hurt dentistry and access to oral health care in the United States and are contrary to the congressional goal in 1997 to increase the number of postgraduate dental residency slots. As a result, the legislation would exempt dental residency training positions from the 3-year rolling average provision used to calculate the number of residents for Medicare GME payments.

The bipartisan legislation I am introducing today would improve the access and delivery of dental health services to our Nation's children through Medicaid, SCHIP, IHS, and our Nation's safety net of community health centers. These problems are well documented and call out for congressional action as soon as possible.

I would like to thank the American Dental Association, the American Dental Education Association, the American Academy of Pediatric Dentistry, the National Association of Community Health Centers, Inc., the National Association of Children's Hospitals, the American Dental Hygienists' Association, and the Children's Dental Health Project for their outstanding support and/or their technical advice on this legislation. This bill is a result of their outstanding work.

In particular, I want to thank Dr. Burt Edelstein, Libby Mullin, and Ann De Biasi of the Children's Dental Health Project for their vast knowledge and technical assistance on this issue. I want to thank Judy Sherman of the American Dental Association, Myla Moss and Jack Bresch of the American Dental Education Association, Dr. Herber Simmons and Scott Litch of the American Academy of Pediatric Dentistry, Karen Sealander of the American Dental Hygienists' Association, Dr. Jim Richeson and Judy Kloss Bynum of the Academy of General Dentistry, Dr. Stephen Corbin of Special Olympics, Inc., and Dan Hawkins, Chris Koppen, and Roger Schwartz of the National Association of Community Health Centers, Inc., for their valuable insight, technical advice, and continued support for this legislation. I look forward to working with them all to ensure that we achieve increased access to oral health care for our children.

In addition to those organizations, I would like to thank the following groups for their support of the bill, whether in the past session of Congress or this year. They include: the Academy of General Dentistry, American Academy of Child and Adolescent Psychiatry, American Academy of Oral and Maxillofacial Pathology, American Academy of Periodontology, American Association of Dental Examiners, American Association of Dental Research, American Association of Endodontists, American Association of Public Health Dentistry, American Association of Oral and Maxillofacial Surgeons, American Association of Orthodontists, American Association of Women Dentists, American College of Dentists, American College of Preventive Medicine, American Dental Trade Association, American Public Health Association, American Society of Dentistry for Children, American Student Dental Association, Association of Clinicians for the Underserved, Association of Maternal and Child Health Programs, Association of State and Territorial Dental Directors, Dental Dealers of America, Dental Manufacturers of America, Inc., Family Voices, Hispanic Dental Association, International College of Dentists--USA, March of Dimes, National Association of City and County Health Officers, National Association of Local Boards of Health, National Dental Association, National Health Law Program, New Mexico Department of Health, Partnership for Prevention, Society of American Indian Dentists, Special Care Dentistry, and United Cerebral Palsy Associations.

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

Mr. President, today, I am introducing a bill with Senators Daschle, Boxer, and Lincoln that will be jointly introduced by Representatives Ciro Rodriguez, Hilda Solis, and others in the House of Representatives entitled the ``Hispanic Health Improvement Act of 2003.'' This bill addresses the tremendous health disparities that confront the Hispanic community in our Nation.

Even if you know the statistics, they remain shocking. Over one- third, a 35 percent of Hispanic adults lack health insurance. Despite that passage of the Children's Health Insurance Program, 27 percent of Latino children remain uninsured, which is sharp comparison to 9 percent of white, 18 percent of black and 17 percent of Asian/Pacific Islander children.

In testimony before the Senate Health, Education, Labor and Pensions Committee on September 23, 2002, on Hispanic health issues, Dr. Glenn Flores, chair of the Latin Consortium of the American Academy of Pediatrics Center for Child Health Research, added: ``Among uninsured poor children in the U.S., Latinos outnumber all other racial/ethnic groups, including whites: there are 1 million poor, uninsured Latino children, compared with 766,000 white, and 533,000 African-American poor, uninsured children. Although 1999 marked the first time in many years that the proportion of uninsured Latino children actually decreased (from 30 percent to 27 percent), recent national data suggest that outreach efforts to enroll Latino children have largely been unsuccessful. A Kaiser Commission report found that only 26 percent of parents of eligible uninsured children said that they had ever talked to someone or received information about Medicaid enrollment, and 46 percent of Spanish-speaking parents were unsuccessful at enrolling their uninsured children in Medicaid because materials were unavailable in Spanish.''

In order to address the lack of health care coverage, the legislation would expand CHIP to cover pregnant women and parents of children enrolled in CHIP. The legislation provides $50 million in grants to community-based groups to improve outreach and enrollment of children in Medicaid and CHIP with the grants targeted to Hispanic communities.

In addition, the bill eliminates a number of enrollment barriers within Medicaid.

And finally, it provides States the option to enroll legal immigrant pregnant women and children in Medicaid or CHIP. This comes from legislation introduced by Senator Graham earlier in this Congress.

In addition to poor coverage rates, according to the Centers for Disease Control and Prevention, or CDC, the Hispanic population has morbidity and mortality rates that more often than not exceed that of any other ethnic groups. For example, age-adjusted mortality rates for diabetes are over 50 percent higher among Hispanic persons than non- Hispanic whites. HIV infection rates are over 3 times those of non- Hispanic whites. Tuberculosis rates among Latino children are 13 times that of whites.

The legislation addresses these problems in a number of ways. In the area

of access and affordability, our bill requires an annual report to Congress on how federal programs are responding to improve the health status of Hispanic individuals with respect to diabetes, cancer, asthma, HIV infection, AIDS, substance abuse, and mental health. The bill provides $100 million for targeted diabetes prevention, education, school-based programs, and screening activities in the Hispanic community.

In addition, the legislation specifically addresses the problems facing communities along the U.S.-Mexico border, a 2,000-mile stretch of land that contains 11 million people, 5 of the 7 poorest metropolitan statistical areas in the country, and disease rates in some areas that are extraordinary. If the region were a state, the border would rank 1st in the number of uninsured, last in terms of per capita income, and 1st in a number of diseases.

As Dr. Francisco Cigarroa, president of the University of Texas Health Sciences Center at San Antonio, noted in testimony at the hearing last year on Hispanic health, ``Germs respect no INS regulations. We truly must work with our neighbors to the South if we are to avoid a major influx of new conditions and diseases. It can be seen so clearly on a map. Just as there are `rivers of commerce' there are `rivers of infectious disease' and though they may start at the Border, they are eventually seen all the way to the northern Border that we share with Canada.''

In response, the bill provides $200 million to border communities to improve health services and infrastructure along the U.S.-Mexico border.

The numbers I have cited thus far indicate what we do know. Almost as much of a concern is what we do not know with respect to the status of Hispanic health in this Nation. According to one study, only 22 percent of all articles published in major medical journals included non- English-speaking patients.

The bill provides funding to do additional research and work on reducing health disparities in this Nation. The various provisions include efforts to improve the recruitment and retention of Hispanic health professionals and programs that support training health professionals who can provide culturally competent and linguistically appropriate care. With respect to training more minority health professionals, Dr. Cigarroa said at last year's hearing, ``We should do this because it is the smart thing to do. If we fail to take steps to address the gap between the health of the majority population and the health of the Nation's rapidly growing minority populations, we are on a court leading to a collision. We are far too great a nation to allow this to happen.''

Representative Ciro Rodriguez, chairman of the Congressional Hispanic Caucus, and I, have worked together on this legislation to respond to the challenge before us with regard to coverage, access, and health disparities in the last Congress and have reintroduced the bill with the hope to move it forward this year.

Before closing, it should be noted that while the legislation puts forth a number of initiatives to address what are disproportionately Hispanic problems, each section of the bill, including those to reduce the number of uninsured and to improve access to care, would improve the overall health of our entire Nation regardless of race or ethnicity.

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

Mr. President, we have in the Senate repealed the ban on low-yield nuclear weapons, specifically, section 3136 of the National Defense Authorization Act for fiscal year 1994, Public Law 103-160.

I have submitted an amendment which has been accepted, that requires the Secretaries of the Departments of Defense, Energy, and State, to provide Congress by March 1, 2004, an assessment of the effects, if any, that such a repeal will have on the ability of the United States to achieve its nonproliferation objectives, and whether or not, changes in programs or activities would be required to achieve these objectives. I have asked that this report be submitted in an unclassified form with a classified annex, if needed.

The Senator is correct. There is concern on the signal that this repeal could send to other nations, especially those we are working with to stem the proliferation of nuclear weapons. In particular, my intent in submitting this amendment was the effect that the repeal would have on the Cooperative Threat Reduction Program, which was started by Senators Nunn, Lugar, and Domenici. I want to be assured that we do not send any bad-faith signals to Russia, and other countries, that participate in the program. The United States spends over a billion dollars a year in this effort; the repeal of the low- yield ban must not negatively affect this investment of the taxpayers' money.

I appreciate the committee's help in this important matter.

Mr. President, I rise today to introduce the Trade Adjustment Assistance for Communities Act of 2003. This legislation is co-sponsored by Senators Baucus, Rockefeller, Daschle, Murray, Cantwell, Dayton, Lieberman, Lincoln, and Feinstein.

Companion legislation will be introduced in the House by Congressman Sander Levin tomorrow.

I first introduced Trade Adjustment Assistance legislation in the last Congress, and I was very pleased when that legislation--the provisions relating to both individuals and communities--passed the Senate as part of the Trade Act of 2002. I would like to take this opportunity to thank all of my colleagues for their efforts in making this happen. But I would like to thank Senator Baucus in particular for making Trade Adjustment Assistance one of his priorities last session and pushing on it to the very end. And I would also like to thank Senator Grassley for understanding the importance of Trade Adjustment Assistance to the ongoing trade debate, and his decision to make it part of the trade package that went through Congress.

But I also have to express my disappointment with the way the process ended. In spite of the bi-partisan consensus that formed around Trade Adjustment Assistance during the negotiations last year and the efforts of my colleagues, I regret to say that the provisions related to communities did not make it out of conference. I can not tell you why this happened. However, I can tell you that it is incredibly naive to ignore the problems that are occurring right now across the country and not understand what it means for our country's long-term economic interests. Look at the newspaper and you will see that in many communities, people are pretty much out of work for good, at least when you look at the jobs they had and the wages they were making. And as the lay-offs have expanded, the impact the lay-offs have had on entire communities have become more pronounced. Now it is not just the individuals who are struggling, but the communities in which hundreds or thousands of people live, all because a company or a group of companies have closed their doors for good.

From what I can tell from statements some of my colleagues have made in committee or on the floor of the Senate, this is really nothing more than tough luck. This is the way markets work and you simply make do with what you have. I disagree completely. From where I sit you can't just let individuals who have worked their whole life at a company, who have played by the rules for their entire life, who have committed their entire life to keeping their communities intact, be reduced to little more than hope that something will change for the better. They deserve more than that. You also can't let the communities where these people live just die, because they form the foundation of what we are as a society. These are the networks that have lasted generations, that connect us, and define who we are. I firmly believe we need to do everything we can for these folks and the communities where they live, simply because we owe them something for what they have given us and our country. I believe we have a responsibility to give these communities a shot at a new future. The legislation I am introducing today does just that.

Let me make it clear that writing this legislation is not an abstract exercise. For me, this is about my friends and neighbors that I have known for years. Right now, in my hometown of Silver City, NM, I have folks that I grew up with, wondering what they are going to do next.

Over the last few years the copper mines closed, and then the businesses that supported the copper mines closed, and then the tax base began to disappear, and then services started to be cut, and it seems to everyone like the whole community has been caught in a downward spiral. In spite of what some of my colleagues might claim, this is not because of lack of effort on the part of the people of Silver City. These people are not content with the way things are. On the contrary, they are trying desperately to change direction. They have ideas about where they want to go and what they need to do to make things better. They have acted on these ideas to the best of their ability. And I want to commend them for that. But right now they are stuck because there is no money available to get things started, to take the first step so other steps can be taken afterward.

And this is the way it is across the country in a good many communities just like Silver City. I strongly believe this has to change. We have let things stand just the way they are for far too long. The status quo is not acceptable, and it is time for Congress to make a serious effort to change how we manage these kinds of problems.

My interest in Trade Adjustment Assistance actually began in November, 1997 when Levi-Strauss announced its decision to close most of its plants in the United States and transfer production to other countries. Levi-Strauss decided to close two plants in New Mexico one in Albuquerque and one in Roswell--with the Roswell facility alone losing close to 600 workers. This number didn't even include the contract workers and other folks that relied on Levi Strauss for their living. They lost their jobs as well. 600 plus individuals would be a significant blow in any town, but in a town of 50,000 people--which is what Roswell--is with a workforce of only 25,000 people, this lay-off was truly devastating. What exactly were these people going to do? Where could they go to get work so they could pay their mortgage, pay for health care, pay for their kids' education? Sure, some of them could be re-trained through Trade Adjustment Assistance, but the question that was on everyone's mind was: retrained for what? What do you re-train 600 people for when there are no other jobs available in town, and no new companies coming into town?

The questions surrounding what happened in Roswell--actually, what should have happened in Roswell if we had more effective Trade Adjustment Assistance policies in place--combined with other plant closures across the country in towns just like Roswell, made me ask what actually could be done to help individuals and communities adapt to this kind of collective crisis. In cooperation with Senators Roth and Moynihan, who were the Chair and Ranking Member of the Finance Committee at the time, I requested studies from the General Accounting Office on the over-all efficacy of Trade Adjustment Assistance program. I also asked them to study how communities across the country had responded to the changes that derive from international trade agreements and globalization.

I have to say that the answers we got back from the General Accounting Office were not very encouraging. To begin with, the Trade Adjustment Assistance for individuals program suffered from inconsistencies, incoherence, and a general lack of accountability. Some states managed their programs well, but others--my home State of New Mexico being one--did not. There was no Trade Adjustment Assistance for Communities program at the time, but in analyzing how particular communities responded to economic crises, the General Accounting Office report clearly stated that government funds available for economic recovery efforts were limited and the road to real recovery was difficult even when funds were available. There were no ``best practices'', no obvious answers, to refer to because success had been so limited. In most cases, there was no way out of the downward spiral at all.

But over time some individual lessons appeared, and interestingly enough, those lessons were very similar to the ones we learned in Roswell. Among other things, technical assistance is needed early on in the process to ensure that a community-wide recovery strategy can be developed. Funding needs to be made available to assist in strategic planning. Individual and institutional differences need to be bridged in the community so there is a tangible collective interest in the strategic plan. Short-term, medium-term, and long-term funding needs to be available for communities to use as they pursue their economic strategy. U.S. government agencies need to cooperate to ensure that their efforts are not duplicative or contradictory. State governments need to be involved in the recovery process to encourage cooperation where there has been none before.

I admit that it is very difficult to make sure all these things happen, especially in communities that are struggling to stay on an even keel. Clearly much of the burden for the activities fall on communities, because they are the ones that have to decide what is best for them. And that is the way it should be. But Congress can play a role in helping communities attain the

goals they have set for themselves, and I believe the bill I am introducing today offers a very good start. The key components of the legislation are as follows: First, the legislation establishes a Trade Adjustment Assistance for Communities Program at the Department of Commerce, signaling that communities that are negatively impacted by trade are deserving of a separate stream of funds to help them through their economic crisis. Ideally this program will be located at the Economic Development Administration, which has the expertise and experience to manage a program of this type.

Second, the legislation establishes a U.S. government inter-agency Trade Adjustment Assistance for Communities working group, the goal being to ensure that agencies work in cooperation to assist communities negatively impacted by trade, integrating personnel, activities, and resources as they respond to existing or anticipated problems.

Third, the legislation provides funding for strategic planning and development grants for communities negatively impacted by trade. As written, there is no limit on the funds that a community can receive. Instead, the level of funding is determined by the individual needs of each community, the coherence of their strategic plan, and the cooperation that exists among the stakeholders applying for the grant.

Fourth, the legislation allows funding from programs at other agencies to be used in concurrence with Trade Adjustment Assistance for Communities funding, and, furthermore, allows Federal funding to be used to fulfill most non-Federal matching requirements that exist. In the past, some economic development efforts have been stopped in their tracks because communities don't have the matching funds necessary to get grants. This legislation would give communities that are now suffering under serious financial constraints some initial flexibility in their effort to get funding.

Fifth, the legislation gives preference to rural communities in funding guidelines, since these are the communities that have the fewest options available to them as they attempt to respond to trade related problems.

Sixth, the legislation authorizes $350 million per year for the Trade Adjustment Assistance for Communities program, essentially doubling the funds that are currently available for economic adjustment in the United States. I believe this amount is consistent with the needs that we see of communities across the United States.

Seventh, the legislation establishes a lookback to January 1998, allowing communities that were negatively impacted by trade and have yet to overcome their problems an opportunity to obtain funds and begin their recovery.

Finally, the legislation establishes a set of new triggers for eligibility that are designed to help not only communities that have been negatively impacted by trade, but also communities that have experienced some negative impacts but want to set a new course so any future impacts will be limited. This approach is far different than anything that has been done before in Trade Adjustment Assistance legislation--far different even than the legislation that my colleagues and I introduced last year--and is designed specifically to avoid the criticism that Trade Adjustment Assistance is really nothing but ``death insurance''.

The inclusion of the category of ``affected domestic producers'' as a trigger, for example, would allow certain companies to work with their communities to create a coherent strategic plan to renovate or construct basic or advanced infrastructure, diversify the local economy, attract new investment, and encourage long-term economic stability and global competitiveness--all this before a company is closed and the entire community is affected. The inclusion of TAA for firms as a trigger would allow restructuring at a firm to occur in tandem with restructuring in a community. The inclusion of TAA for workers as a trigger would allow funds to be directed into a community at the initial onset of problems at a company--at the moment when lay- offs are first occurring--not when the problems are so far down the line that there is very little that can be done about it.

Let me say straight out that this legislation cannot be considered a substitute for a strong trade or manufacturing policy. But I do believe this legislation is complementary to those policies. From where I sit, there will always be individuals and communities negatively impacted by trade, and it is incumbent upon Congress to ensure that these individuals and communities are treated with the respect they deserve and with the strategic economic interests of our country in mind. The economic ideology that suggests we just let things take their course and things will work out the way they are supposed to is, from my perspective, wrongheaded and misguided. The fact is we must look very carefully at the changes that are occurring to our national economy as a result of globalization and position ourselves to do better than we are now.

This legislation carves out an area of real need and addresses it in a coherent, comprehensive, and innovative fashion. If enacted, it will have an immediate, concrete, and important impact on communities across the country. Every State in the country would benefit from the legislation. It will allow communities to take charge of the future and contribute to the economic welfare of the Nation. It is a practical approach that is designed to keep our communities intact and our country competitive and strong. I urge my colleagues to support it.

Mr. President, I rise today to introduce the Trade Adjustment Assistance for Communities Act of 2003. This legislation is co-sponsored by Senators Baucus, Rockefeller, Daschle, Murray, Cantwell, Dayton, Lieberman, Lincoln, and Feinstein.

Companion legislation will be introduced in the House by Congressman Sander Levin tomorrow.

I first introduced Trade Adjustment Assistance legislation in the last Congress, and I was very pleased when that legislation--the provisions relating to both individuals and communities--passed the Senate as part of the Trade Act of 2002. I would like to take this opportunity to thank all of my colleagues for their efforts in making this happen. But I would like to thank Senator Baucus in particular for making Trade Adjustment Assistance one of his priorities last session and pushing on it to the very end. And I would also like to thank Senator Grassley for understanding the importance of Trade Adjustment Assistance to the ongoing trade debate, and his decision to make it part of the trade package that went through Congress.

But I also have to express my disappointment with the way the process ended. In spite of the bi-partisan consensus that formed around Trade Adjustment Assistance during the negotiations last year and the efforts of my colleagues, I regret to say that the provisions related to communities did not make it out of conference. I can not tell you why this happened. However, I can tell you that it is incredibly naive to ignore the problems that are occurring right now across the country and not understand what it means for our country's long-term economic interests. Look at the newspaper and you will see that in many communities, people are pretty much out of work for good, at least when you look at the jobs they had and the wages they were making. And as the lay-offs have expanded, the impact the lay-offs have had on entire communities have become more pronounced. Now it is not just the individuals who are struggling, but the communities in which hundreds or thousands of people live, all because a company or a group of companies have closed their doors for good.

From what I can tell from statements some of my colleagues have made in committee or on the floor of the Senate, this is really nothing more than tough luck. This is the way markets work and you simply make do with what you have. I disagree completely. From where I sit you can't just let individuals who have worked their whole life at a company, who have played by the rules for their entire life, who have committed their entire life to keeping their communities intact, be reduced to little more than hope that something will change for the better. They deserve more than that. You also can't let the communities where these people live just die, because they form the foundation of what we are as a society. These are the networks that have lasted generations, that connect us, and define who we are. I firmly believe we need to do everything we can for these folks and the communities where they live, simply because we owe them something for what they have given us and our country. I believe we have a responsibility to give these communities a shot at a new future. The legislation I am introducing today does just that.

Let me make it clear that writing this legislation is not an abstract exercise. For me, this is about my friends and neighbors that I have known for years. Right now, in my hometown of Silver City, NM, I have folks that I grew up with, wondering what they are going to do next.

Over the last few years the copper mines closed, and then the businesses that supported the copper mines closed, and then the tax base began to disappear, and then services started to be cut, and it seems to everyone like the whole community has been caught in a downward spiral. In spite of what some of my colleagues might claim, this is not because of lack of effort on the part of the people of Silver City. These people are not content with the way things are. On the contrary, they are trying desperately to change direction. They have ideas about where they want to go and what they need to do to make things better. They have acted on these ideas to the best of their ability. And I want to commend them for that. But right now they are stuck because there is no money available to get things started, to take the first step so other steps can be taken afterward.

And this is the way it is across the country in a good many communities just like Silver City. I strongly believe this has to change. We have let things stand just the way they are for far too long. The status quo is not acceptable, and it is time for Congress to make a serious effort to change how we manage these kinds of problems.

My interest in Trade Adjustment Assistance actually began in November, 1997 when Levi-Strauss announced its decision to close most of its plants in the United States and transfer production to other countries. Levi-Strauss decided to close two plants in New Mexico one in Albuquerque and one in Roswell--with the Roswell facility alone losing close to 600 workers. This number didn't even include the contract workers and other folks that relied on Levi Strauss for their living. They lost their jobs as well. 600 plus individuals would be a significant blow in any town, but in a town of 50,000 people--which is what Roswell--is with a workforce of only 25,000 people, this lay-off was truly devastating. What exactly were these people going to do? Where could they go to get work so they could pay their mortgage, pay for health care, pay for their kids' education? Sure, some of them could be re-trained through Trade Adjustment Assistance, but the question that was on everyone's mind was: retrained for what? What do you re-train 600 people for when there are no other jobs available in town, and no new companies coming into town?

The questions surrounding what happened in Roswell--actually, what should have happened in Roswell if we had more effective Trade Adjustment Assistance policies in place--combined with other plant closures across the country in towns just like Roswell, made me ask what actually could be done to help individuals and communities adapt to this kind of collective crisis. In cooperation with Senators Roth and Moynihan, who were the Chair and Ranking Member of the Finance Committee at the time, I requested studies from the General Accounting Office on the over-all efficacy of Trade Adjustment Assistance program. I also asked them to study how communities across the country had responded to the changes that derive from international trade agreements and globalization.

I have to say that the answers we got back from the General Accounting Office were not very encouraging. To begin with, the Trade Adjustment Assistance for individuals program suffered from inconsistencies, incoherence, and a general lack of accountability. Some states managed their programs well, but others--my home State of New Mexico being one--did not. There was no Trade Adjustment Assistance for Communities program at the time, but in analyzing how particular communities responded to economic crises, the General Accounting Office report clearly stated that government funds available for economic recovery efforts were limited and the road to real recovery was difficult even when funds were available. There were no ``best practices'', no obvious answers, to refer to because success had been so limited. In most cases, there was no way out of the downward spiral at all.

But over time some individual lessons appeared, and interestingly enough, those lessons were very similar to the ones we learned in Roswell. Among other things, technical assistance is needed early on in the process to ensure that a community-wide recovery strategy can be developed. Funding needs to be made available to assist in strategic planning. Individual and institutional differences need to be bridged in the community so there is a tangible collective interest in the strategic plan. Short-term, medium-term, and long-term funding needs to be available for communities to use as they pursue their economic strategy. U.S. government agencies need to cooperate to ensure that their efforts are not duplicative or contradictory. State governments need to be involved in the recovery process to encourage cooperation where there has been none before.

I admit that it is very difficult to make sure all these things happen, especially in communities that are struggling to stay on an even keel. Clearly much of the burden for the activities fall on communities, because they are the ones that have to decide what is best for them. And that is the way it should be. But Congress can play a role in helping communities attain the

goals they have set for themselves, and I believe the bill I am introducing today offers a very good start. The key components of the legislation are as follows: First, the legislation establishes a Trade Adjustment Assistance for Communities Program at the Department of Commerce, signaling that communities that are negatively impacted by trade are deserving of a separate stream of funds to help them through their economic crisis. Ideally this program will be located at the Economic Development Administration, which has the expertise and experience to manage a program of this type.

Second, the legislation establishes a U.S. government inter-agency Trade Adjustment Assistance for Communities working group, the goal being to ensure that agencies work in cooperation to assist communities negatively impacted by trade, integrating personnel, activities, and resources as they respond to existing or anticipated problems.

Third, the legislation provides funding for strategic planning and development grants for communities negatively impacted by trade. As written, there is no limit on the funds that a community can receive. Instead, the level of funding is determined by the individual needs of each community, the coherence of their strategic plan, and the cooperation that exists among the stakeholders applying for the grant.

Fourth, the legislation allows funding from programs at other agencies to be used in concurrence with Trade Adjustment Assistance for Communities funding, and, furthermore, allows Federal funding to be used to fulfill most non-Federal matching requirements that exist. In the past, some economic development efforts have been stopped in their tracks because communities don't have the matching funds necessary to get grants. This legislation would give communities that are now suffering under serious financial constraints some initial flexibility in their effort to get funding.

Fifth, the legislation gives preference to rural communities in funding guidelines, since these are the communities that have the fewest options available to them as they attempt to respond to trade related problems.

Sixth, the legislation authorizes $350 million per year for the Trade Adjustment Assistance for Communities program, essentially doubling the funds that are currently available for economic adjustment in the United States. I believe this amount is consistent with the needs that we see of communities across the United States.

Seventh, the legislation establishes a lookback to January 1998, allowing communities that were negatively impacted by trade and have yet to overcome their problems an opportunity to obtain funds and begin their recovery.

Finally, the legislation establishes a set of new triggers for eligibility that are designed to help not only communities that have been negatively impacted by trade, but also communities that have experienced some negative impacts but want to set a new course so any future impacts will be limited. This approach is far different than anything that has been done before in Trade Adjustment Assistance legislation--far different even than the legislation that my colleagues and I introduced last year--and is designed specifically to avoid the criticism that Trade Adjustment Assistance is really nothing but ``death insurance''.

The inclusion of the category of ``affected domestic producers'' as a trigger, for example, would allow certain companies to work with their communities to create a coherent strategic plan to renovate or construct basic or advanced infrastructure, diversify the local economy, attract new investment, and encourage long-term economic stability and global competitiveness--all this before a company is closed and the entire community is affected. The inclusion of TAA for firms as a trigger would allow restructuring at a firm to occur in tandem with restructuring in a community. The inclusion of TAA for workers as a trigger would allow funds to be directed into a community at the initial onset of problems at a company--at the moment when lay- offs are first occurring--not when the problems are so far down the line that there is very little that can be done about it.

Let me say straight out that this legislation cannot be considered a substitute for a strong trade or manufacturing policy. But I do believe this legislation is complementary to those policies. From where I sit, there will always be individuals and communities negatively impacted by trade, and it is incumbent upon Congress to ensure that these individuals and communities are treated with the respect they deserve and with the strategic economic interests of our country in mind. The economic ideology that suggests we just let things take their course and things will work out the way they are supposed to is, from my perspective, wrongheaded and misguided. The fact is we must look very carefully at the changes that are occurring to our national economy as a result of globalization and position ourselves to do better than we are now.

This legislation carves out an area of real need and addresses it in a coherent, comprehensive, and innovative fashion. If enacted, it will have an immediate, concrete, and important impact on communities across the country. Every State in the country would benefit from the legislation. It will allow communities to take charge of the future and contribute to the economic welfare of the Nation. It is a practical approach that is designed to keep our communities intact and our country competitive and strong. I urge my colleagues to support it.

Madam President, I call up amendment No. 765 and ask for its immediate consideration.

Madam President, I offer this amendment on behalf of myself, Senator Dorgan, Senator Reed, and Senator Biden. This is an amendment I hope can be approved to clarify that this Congress, this Senate, does not intend to be authorizing--by this bill, the language we have before us here in the legislation--does not intend to be authorizing the weaponization of space.

The amendment proposes to require specific authorization from Congress if we are going to proceed to design or develop or deploy hit- to-kill interceptors or other weapons we intend to have placed in space.

This is an issue that has not had a great deal of debate in the Senate in recent years. In fact, I think we discussed it some when the former President Bush--not this President Bush, but the former President Bush--had his proposal for the program called Brilliant Pebbles. But there has not been a lot of discussion in the last few years. I do not believe this issue was addressed, either, in the markup of the Defense authorization bill in the Armed Services Committee. In my view, it is a very important issue.

Specifically, within this program there is a new start for fiscal year 2004 that is titled: ``Space-Based Interceptor Test Bed.'' This program proposes to develop a test bed in outer space consisting of several satellites that would deploy kinetic energy rounds to strike missiles in their boost phase. They also, of course, could be used to strike satellites as well.

I have great concern with this whole proposal. As all colleagues know, as a nation this President chose to withdraw from the ABM treaty. Now, the ABM treaty did contain a prohibition against deploying antiballistic missile systems in space. As I see this new start that is in the bill the administration has proposed to the Congress, we really are seeing here a follow-on to our decision to withdraw from the ABM treaty. In my view, it sends a very unfortunate signal to other countries--to China, to Russia, to North Korea, to other countries-- that might have capability to follow our lead.

It essentially sends them the signal that we are beginning the process of weaponizing space. This is not a signal I think this Congress or this administration should be sending.

I note we have a longstanding policy, a policy that has been in place since President Eisenhower was in the White House, not to put weapons in space. There is a crucial distinction I want to make here between using space for military purposes and actually putting weapons in space. We do use space for military purposes. We use space for reconnaissance. We use space to gather information in a great variety of ways to support our defense needs. But we have never stepped over the threshold and actually put weapons in space. I think for us to choose to do so is a very important decision which should not be taken lightly and should not be taken without great care.

This program that is in the bill contains a seed element which I think should concern all Members. Under the Department of Defense so- called Spiral Development Policy, initial test beds--which is what this provision calls for--but initial test beds, such as the ground-based test bed at Fort Greely, are seen as being used simultaneously, at least for partial deployment of systems. It is my fear a similar result could happen with regard to this space-based test bed; that is, the initial fielded satellites would be converted, like the ground system at Fort Greely, to a fielded weapons system in space.

For that reason, I think it is important we make clear--we in the Congress make clear--we do not want that to happen, we do not want funds in this bill used for design and development and deployment of weapons in space unless Congress focuses on the issue and actually authorizes that action to take place.

There is a great deal I could point to here that elaborates on what I have been saying. I think the main point I want to make, again, is I do not believe most Americans support the notion that the United States should become the first country to deploy weapons in space. I do not think a military need has been demonstrated. In particular, I do not think the administration and the Congress should do so without a thorough discussion and debate about the issue, so that we, in fact, know what we are doing and the implications of what we are doing.

This is a very large step for us to take, to become the first nation to proceed to put weapons in space, and I do not think this is something that should be done lightly. This decision is one I think we will hear about for a very long time, and I think it will have repercussions for a very long time. I think this amendment I have proposed tries to make it clear we do not want to make that decision today, that the Congress has not debated this adequately, that the Armed Services Committee has not debated this adequately, and we are not prepared today to authorize--or at least we have not as yet, in my view, taken the step of specifically authorizing the design and development and deployment of weapons in space.

Mr. President, how much time remains?

Mr. President, let me just talk about one other aspect. The Pentagon's Missile Defense Agency, which oversees missile defense research and development, did an interview in February talking about their so-called space-based test bed, which is what I am addressing my amendment to here.

The thrust of what they described in that interview was they intend to field satellites armed with multiple hit-to-kill interceptors that are capable of destroying a ballistic missile through a high-speed collision shortly after it is launched.

This might be something we decide we have to do, but, to my knowledge, that debate has not occurred in Congress, and I do not want to see us proceeding down that road without the Congress having focused on it, having actually specifically authorized it.

Therefore, my amendment tries to clarify that is, in fact, what is required before we can proceed down that road.

There is funding also in this same program element, and that is the PE 060886C. There is funding in there for the ground-based interceptors, for their development.

Certainly that is a decision we have made as a country, and I am not trying to revisit that. I do think we go a substantial additional step when we decide we are also going to be designing, developing, and deploying weapons in space. We will do so. We will begin that process by setting up this so-called test bed in space. Those satellites will be the beginning of that process.

I reserve the remainder of my time and yield the floor.

Let me respond that I am certainly not trying to kill the development of any of the program that is ground based. I am saying, however, that we should not proceed to establish, to design, develop, and deploy a space-based weapons capability absent some debate about it.

That is correct. I think that should not be done without much more deliberation than we have given it.

Mr. President, in response to my colleague's question, I am aware that we put substantial funding in and most of that funding was for research.

There is nothing in my amendment that would interfere with research. What I am trying to head off is the actual design and development and deployment of space-based weapons as part of this new program start. But research has proceeded. We have funded it at a high level. I have supported that.

I yield to the Senator as much time as he needs.

Mr. President, in response to my colleague's question, I think it is very clear what my amendment is trying to do, that the Department of Defense cannot obligate or expend funds to design, develop, or deploy hit-to-kill interceptors or other weapons for placement in space, unless they get specific authorization.

So if they want to do more research or go back and look at previously performed research or analyses, certainly I have no problem with that. I think that is----

I think the operative language is on page 2, where I say what this sentence is intended to mean: that no amount authorized to be appropriated by this act for research, development, test, and evaluation may be expended for design, development, or the deployment of these types of weapons in space.

I think I have made it very clear we are trying to head off the use of funds for designing weapons in space until Congress has a chance to debate this issue and until there is a specific authorization required.

Prior to that, I yield 3 minutes to the Senator from Rhode Island. He has been waiting to speak on this general issue, if that is possible.

We can postpone a vote until we visit.

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

Madam President, what is the business before the Senate?

I ask unanimous consent that the amendment be set aside and that we return to the amendment I offered, No. 765.

Madam President, I send a modification of the amendment to the desk.

Madam President, let me explain to my colleagues what we have done, both working with Senator Levin and Senator Allard and Senator Warner and the various staff who have worked on this issue.

First, let me describe very briefly what my amendment does. The language of the amendment I offered originally was fairly clear in that we were trying to restrict the use of funds in a particular program element so that they could not be used, obligated, or expended to design, develop, or deploy hit-to-kill interceptors or other weapons for placement in space unless there was specific authorization by Congress. That is an important provision to try to get into the law. And in order to do that, I have agreed to a modification of that which Senator Allard recommended.

That modification would add a subsection (b) that would say:

Of the amounts authorized to be appropriated for fiscal

year 2004 for Ballistic Missile Defense System Interceptors,

$14,000,000 is available for research and concept definition

for the space based test bed.

As I see the effect of this modified amendment, the general provision would be agreed to that there cannot be funds used for either design or development or deployment of these weapons in space out of these funds, with the only exception being that $14 million is available for research and concept definition with regard to this space-based test bed. That is an acceptable alteration and one that still keeps intact the basic provision I intended with my amendment. On that basis, I have agreed to modify it.

I yield to Senator Allard. I know he wants to describe the amendment.

Madam President, I move to reconsider the vote.

I thank the Chair.

Mr. President, I start by saying I have always been a strong supporter of maintaining our nuclear arsenal. I do believe that nuclear weapons have a significant role in our defense strategy, but their use for us in that defense strategy is to deter others from using nuclear weapons. That has been the essential role they played.

It has been a very important role. It was an important role in winning the cold war, and it remains an important role for our military. But the amendment that has been put forward by Senator Feinstein and Senator Kennedy is not dealing with nuclear weapons as a deterrent. What it is trying to get at is the change in philosophy that seems to have taken place among some in the administration that nuclear weapons are not just to be used as a deterrent; they are also to be used as a weapon. They are to be used in warfighting. They are to be used to counter preemptive threats that may present themselves to us, and that is a substantial change from what we have done with nuclear weapons in the past. I strongly believe it is important to maintain in law the ban that was put in law sometime ago.

This Spratt language, named for Congressman Spratt, whom we all know and respect, was developed in 1994, and it was developed as a follow-on to an action by George H. W. Bush, Sr., our current President's father, when he was in the White House. He made the decision on September 27, 1991, to take out of our inventory nuclear artillery shells, tactical bombs, landmines--the various tactical low-yield nuclear weapons we had fielded at that time, primarily in Europe.

That decision was made as a follow-on to the end of the cold war. It was a decision which was intended to reduce the risk of some kind of nuclear misstep by a field commander or by accident. It was a step intended to reduce the risk of a nuclear weapon being detonated when, in fact, it was not desired.

There is a lot of history behind this issue. Some might think, if they just tune in and watch this debate, this is a new idea this administration has come up with: Let's develop new low-yield nuclear weapons; let's do the research and gear up for development.

The truth is, we have had many so-called low-yield nuclear weapons in our stockpile in the past. Let me review a little bit of that history.

This first paragraph I have reproduced for folks to look at is the Davy Crockett MK-54 warhead which was a nuclear warhead that was capable of producing the same damage as up to 1,000 tons of TNT. When they talk about low-yield nuclear weapons, they are talking about up to 5,000 tons of TNT. So this is substantially less powerful than that. This was developed back in the fifties. It is technology about which everyone knows. It was launched from a recoilless rifle. This was a weapon capable of being launched that way. One could send it off anywhere. The range was 1.2 to 2.5 miles. As I say, it had a yield of up to 1,000 tons of TNT. This, to me, is an example of some of the history we know about on low-yield nuclear weapons.

Let me also point to a second example. This is the so-called MADM, the Medium Atomic Demolition Munition. Looking at the photograph, you might say I am talking about the one in the center. I am not. I am talking about the much smaller warhead that is over on the left in this photograph. This could go up to as high as 15,000 tons of TNT. It was in our arsenal until 1986. It was intended for use in destroying dams or bridges, and it was entirely portable. As one can see from the size of this warhead, this would be easily carried by a single person.

The third example, and the last example I want to show, is this W-79. This is one of the weapons that was in our arsenal and was taken out of our arsenal. This is the so-called neutron bomb. We have heard of the neutron bomb. There was a lot of discussion about the neutron bomb a couple decades ago. It had what was then designated a C-plus safety rating because they determined after a while that they could detonate one of these if there was a stray bullet that hit the high explosive and, therefore, one of the reasons it was taken out of the field as an artillery shell was because of the safety problem involved.

To give an idea of the detonation of this neutron bomb, it is pictured in this photograph. One can see that the amount of radioactivity, the amount of damage, the collateral damage from it was very substantial.

Let me go to the last of these charts just to make another point.

My colleague from South Carolina was saying what we need is a nuclear weapon; we need to see about developing a nuclear weapon that can be used to go deep underground and, thereby, get at chemical weapons fabrication activities or perhaps biological weapons fabrication activities.

The truth is, if you put one of these weapons on a rocket and send it off, you cannot get it very deep into the ground. If it is a 12-foot long weapon, the maximum it can go is 48 feet into the ground. If it is 100-ton TNT equivalent, the experts tell us you have to bury that at least 140 feet under the ground or else you are going to have radioactive fallout. If you have a 1,000-ton weapon, you have to bury it at least 450 feet when it is exploded to contain the fallout. The truth is, we cannot put this on a rocket and get it down 450 feet. It is just not practical.

The points I am making are these are not sophisticated weapons. This is not a new technology all of a sudden which someone decided to develop.

This is technology that was in our arsenal. We are now seeing this administration say, OK, let's come back and once again begin to look at this as a viable part of our warfighting capability. I do not see the justification for it; I do not think it makes sense; and it poses enormous additional risks for us in terms of proliferation potential.

One of the other comments the Senator from Alabama made a few minutes ago was: We already have a great many nuclear weapons. What can be so wrong about developing some that are small?

One thing that could be wrong is that the risk of proliferation of much smaller, more portable weapons, is substantially greater. The smaller the weapon, the easier it is to move. These weapons are not sophisticated. These are not like the very large, high-yield weapons that are difficult to reproduce. There are many countries in this world that have the capability to produce low-yield nuclear weapons, and many of them, I am sure, will get more interested as time goes on if they see this is the direction in which we are moving.

I think Senator Kennedy made reference to the speech Mr. Putin gave last Friday. The article in the New York Times on Saturday summed it up well when speaking of President Putin. He appeared to be responding to the Bush administration's new nuclear strategy announced last year when he said Russia, too, was considering developing new variants of nuclear weapons.

This was his statement to the Russian Duma. He said: I can inform you that at present the work to create new types of Russian weapons, weapons of the new generation, including those regarded by specialists as strategic weapons, is in the practical implementation stage.

He did not elaborate, nor did his advisers, though some analysts said he appeared to be referring to Russia's efforts to modernize its nuclear arsenal and to develop low-yield nuclear devices. That remark was greeted with applause.

This is a dangerous road we start down if we decide to rely more on tactical nuclear weapons and once again commence the development of tactical nuclear weapons. I think it is an unwise course. My own view of our overall defense strategy is that we have always thought it served our interests to emphasize those areas in which we have a comparative advantage.

We know today, more than perhaps ever in our history, that we have an enormous comparative advantage over any potential adversary in the world in the area of conventional weaponry. We have precision-guided weapons. We have smart weapons. We have demonstrated their use extremely effectively in the recent conflict in Iraq. Our comparative advantage does not lie in developing small, easily transportable nuclear weapons. Many other countries have the capability to do that, and not only countries but perhaps groups as well.

Once development of those weapons is pursued by us, the likelihood of proliferation increases and the likelihood of similar activities by other countries

increases. Those types of weapons can be easily fabricated. They can be easily transported. They can be easily concealed. It is certainly not in our interest.

I know several of my colleagues have said all this provision is, that everyone is getting upset about, is a provision to repeal the ban on research and development, so what could be so wrong with repealing the ban on research and development?

I do think that the reason many of us are concerned is we believe very much that if one of these weapons--if a new type or a new suite of these weapons is developed, it will ultimately be fielded. We believe that is the wrong way to go to maintain our security and to maintain the security of the world in general.

Fred Celec, who is the Deputy Assistant to the Secretary of Defense for Nuclear Matters, recently said that the administration wants the weapon; that is, the robust nuclear earth penetrator--and that is a separate amendment. Senator Dorgan from North Dakota is going to be offering an amendment relating to the robust nuclear earth penetrator sometime later this afternoon. But Mr. Celec said the administration wants the weapon and will move forward with its development and production. If a hydrogen bomb can be successfully designed to survive a crash through hard rock or concrete and still explode, it will ultimately be fielded. That is a news article from the San Jose Mercury.

So there is reason to be concerned with this provision. Congressman Spratt, I believe, showed good judgment when he proposed this provision in 1994. The Congress showed good judgment when it adopted this provision as a follow-on to the decision by former President Bush to take these kinds of weapons out of our arsenal. I believe we would do well to keep this ban on research and development in place. I hope my colleagues will agree and support the amendment by the Senator from California and the Senator from Massachusetts.

I yield the floor.

Mr. President, today I am pleased to introduce the Reclamation Rural and Small Community Water Enhancement Act, which is being co-sponsored by my colleagues, Senator Daschle, Senator Dorgan, and Senator Baucus.

In introducing this bill, let me note that the Economic Research Service at the Agriculture Department estimates that 56 million Americans--around 20 percent of the population--live in nonmetropolitan areas. In the arid west, this percentage is likely much higher. In my home State of New Mexico, for example, over 50 percent of the population resides outside the four major metropolitan areas--clearly a significant number of people.

This bill is intended to address a critical issue facing many small towns and rural areas--access to adequate water supplies to provide for present and future needs. A stable and reliable water supply is the foundation for the economic activity that sustains our communities. Addressing this most basic need, however, poses a challenge that many of these localities simply cannot meet on their own. The challenge is magnified by the prolonged drought that many are predicting for the arid West.

For a number of reasons, including limited access to water supplies and the requirements of the Federal Clean Water and Safe Drinking Water Acts, many small communities in the western United States are taking a regional approach to water that involves the cooperative development of water

projects serving several communities over a large area. In New Mexico, the State Water Trust Board prioritizes funding assistance to those projects that represent a partnership of communities on a regional basis. Currently, there are three such projects rapidly taking shape in 1. Eastern New Mexico; 2. the Santa Fe Area; and 3. the Espanola Valley.

In other areas of the country, this regional approach has already taken root. Currently, the Bureau of Reclamation is authorized to construct seven rural water supply projects--most of these in the Great Plains region. The authorized cost of these projects is approximately $1.8 billion. In just two years, however, the administration has cut back the appropriations requests for authorized rural water projects by 80 percent, or almost $60 million. This includes zeroing out the funding for most of these projects--a policy choice severely impacting those communities relying on this infrastructure.

The bill being introduced today is intended to ensure there exists an active Federal program to address water needs in the rural West. It does so in a manner that respects the role of the States in water resources management and is fiscally responsible by requiring a financial partnership between Federal, State, and local entities. The bill utilizes the experience and expertise of the Bureau of Reclamation to implementation a rural water program that complements, not duplicates, existing Federal programs at the Environmental Protection Agency and the Department of Agriculture; ensures that existing projects move towards full and timely implementation; and ensures that Reclamation is fully authorized to provide assistance in evaluating all water supply options if requested by rural communities.

I believe that this is a bill for which there should be strong bipartisan support. Having helped to reclaim the West during the 20th century, the Bureau of Reclamation should help sustain it in the 21st century. Accordingly, I urge my colleagues to support this legislation and, by that, support rural and small communities within our States.

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

Mr. President, today I am pleased to introduce the Reclamation Rural and Small Community Water Enhancement Act, which is being co-sponsored by my colleagues, Senator Daschle, Senator Dorgan, and Senator Baucus.

In introducing this bill, let me note that the Economic Research Service at the Agriculture Department estimates that 56 million Americans--around 20 percent of the population--live in nonmetropolitan areas. In the arid west, this percentage is likely much higher. In my home State of New Mexico, for example, over 50 percent of the population resides outside the four major metropolitan areas--clearly a significant number of people.

This bill is intended to address a critical issue facing many small towns and rural areas--access to adequate water supplies to provide for present and future needs. A stable and reliable water supply is the foundation for the economic activity that sustains our communities. Addressing this most basic need, however, poses a challenge that many of these localities simply cannot meet on their own. The challenge is magnified by the prolonged drought that many are predicting for the arid West.

For a number of reasons, including limited access to water supplies and the requirements of the Federal Clean Water and Safe Drinking Water Acts, many small communities in the western United States are taking a regional approach to water that involves the cooperative development of water

projects serving several communities over a large area. In New Mexico, the State Water Trust Board prioritizes funding assistance to those projects that represent a partnership of communities on a regional basis. Currently, there are three such projects rapidly taking shape in 1. Eastern New Mexico; 2. the Santa Fe Area; and 3. the Espanola Valley.

In other areas of the country, this regional approach has already taken root. Currently, the Bureau of Reclamation is authorized to construct seven rural water supply projects--most of these in the Great Plains region. The authorized cost of these projects is approximately $1.8 billion. In just two years, however, the administration has cut back the appropriations requests for authorized rural water projects by 80 percent, or almost $60 million. This includes zeroing out the funding for most of these projects--a policy choice severely impacting those communities relying on this infrastructure.

The bill being introduced today is intended to ensure there exists an active Federal program to address water needs in the rural West. It does so in a manner that respects the role of the States in water resources management and is fiscally responsible by requiring a financial partnership between Federal, State, and local entities. The bill utilizes the experience and expertise of the Bureau of Reclamation to implementation a rural water program that complements, not duplicates, existing Federal programs at the Environmental Protection Agency and the Department of Agriculture; ensures that existing projects move towards full and timely implementation; and ensures that Reclamation is fully authorized to provide assistance in evaluating all water supply options if requested by rural communities.

I believe that this is a bill for which there should be strong bipartisan support. Having helped to reclaim the West during the 20th century, the Bureau of Reclamation should help sustain it in the 21st century. Accordingly, I urge my colleagues to support this legislation and, by that, support rural and small communities within our States.

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

Mr. President, am I on the list? I was not read off.

I have no objection.

Mr. President, I have amendment No. 603, which was a

follow-on to the amendment Senator Santorum of Pennsylvania was intending to offer. If we had extended the tax exclusion we are providing here for dividends to annuities as well, this would put small business retirement plans at a disadvantage. My amendment was trying to ensure that that not happen.

Since he has chosen to withdraw his amendment, I will not offer this amendment, No. 603. I withdraw it as well.

Mr. President, I am pleased to cosponsor and support amendment No. 594 being offered by the chairman of the Finance Committee with respect to the Medicare Program.

The amendment provides approximately $25 billion over 10 years to reduce the inequity in the Medicare Program between urban and rural areas and between the States that has so penalized health care providers in New Mexico and includes language from four bills that I have either introduced this year or introduced last year.

First, I am pleased the Grassley amendment includes the language from S. 379, the Medicare Incentive Payment Program Improvement Act of 2003, which I introduced with Senator Thomas and makes automatic the 10 percent bonus payment intended to physicians

in rural, medically underserved areas. Under current law, physicians must go through a cumbersome application process, if they even know they are eligible and can apply, and subject themselves to increased scrutiny for audits if they do apply. Consequently, few doctors are receiving the payment intended to provide physicians incentives to treat Medicare patients in medically underserved areas and to retain those doctors already providing services in those areas.

Second, the Grassley amendment includes language that significantly reduces the geographic inequities that are a part of the current Medicare physician payment system and disadvantages New Mexico physicians. This language is similar to that in S. 881, the Rural Equity Payment Index Reform, REPaIR, Act of 2003, which I introduced with Senator Cochran and is a companion bill to H.R. 33, introduced in the House of Representatives by Representative Bereuter. Reducing the inequity in just the work component of the physician payment schedule will increase payments to New Mexico physicians by an estimated $3 million annually.

Third, this amendment includes language from legislation I introduced late last year entitled the Medicare Hospital Outpatient Department Fair Payment Act with Senator Snowe to extend the hold harmless for rural hospitals in outpatient departments, and adds a 5 percent add-on payment for clinics and emergency room visits in rural hospitals.

And fourth, the amendment lifts the rural cap in the Medicare disproportionate share hospital, DSH, program, which comes from the Medicare Safety Net Hospital Improvement Act that I introduced last year with Senator Roberts. This provision will add an estimated $4 million annually to New Mexico rural hospitals.

In addition, I would like to applaud the chairman for including language from legislation, S. 816, introduced by Senator Conrad that I was an original cosponsor of and entitled the Health Care access and Rural Equity Act. Among other things, the language eliminates the disparity in hospital payments caused by the differential paid to rural and small urban hospitals compared to large urban hospitals and significantly reduces the disparity caused by the wage index in the hospital payment formula. Although rather arcane provisions in the hospital payment formula, they result in significant disparities in payments and the changes will have an important impact on hospitals throughout New Mexico.

Before closing, I would like to express profound concern with respect to the offsets used by the amendment, which include the addition of copayments for clinical services and the impact the change in payments for outpatient department prescription drugs will have on oncology physicians. However, Chairman Grassley has committed to work to address the need for a revision in payments to oncology doctors and we will work to change the language with respect to copayments for clinical laboratory services as this language moves forward.

Mr. President, I would like to thank the chairman and ranking member of the Finance Committee, Senators Grassley and Baucus, for agreeing to accept the language in the amendment being offered by me and Senators Enzi, Lincoln, Smith, and Nelson of Nebraska, that would increase the Federal allotment to States for Medicaid disproportionate share hospital, or DSH, payments to what are called ``extremely low-DSH States'' from 1 percent of overall Medicaid spending in each State to 3 percent. The language comes from legislation, S. 204, that I introduced with Senators Enzi, Lincoln, Baucus, Smith Harkin, Domenici, Johnson, Nelson of Nebraska, and Dayton, and was cosponsored by Senators Pryor, Dorgan, and Daschle, entitled the Medicaid Safety Net Improvement Act of 2003.

This amendment is important to the continued survival of many of our Nation's safety net hospitals that provide critical health care access to a number of our Nation's 41.2 million uninsured citizens, including 373,000 in New Mexico, through the Medicaid disproportionate share hospital, or DSH, program.

At a time of growing numbers of uninsured and increased financial strain on our Nations' safety net, we need to increase the ability of ``extremely low-DSH States' to address the problems facing their safety net and to reduce

the current inequity in funding among the States. In fact, many hospitals have resorted to cutting services or eliminating jobs to deal with the growing uncompensated care problem, and it threatens the health care safety net across this country.

At Memorial Medical Center in Las Cruces, NM, the hospital recently announced the elimination of its maternity and mental health care services due to the rapidly growing burden of uncompensated care. While the elimination of those services has been temporarily forestalled, the uncompensated care burden and bottom line deficits at that hospital remain and the personnel layoffs of over 100 staff members in that community has already occurred.

Indeed, the stories about the growing burden on hospital emergency rooms across the country are well known. This is completely and directly related to the economic recession facing our country and makes this amendment directly relevant to this legislation.

It is also why the amendment has the support of the American Association, the National Association of Public Hospitals and Health Systems, the National Association of Children's Hospitals, the Federation of American Hospitals, the Association of American Medical Colleges, and the Catholic Health Association of the United States. As they write, ``Today, safety net hospitals face a confluence of challenges--including increased uncompensated care as more Americans find themselves without health insurance--that put critical pressure on hospitals' ability to serve their entire communities.''

The 20 States that would benefit from this amendment include: Alaska, Arkansas, Delaware, Hawaii, Idaho, Iowa, Kansas, Maryland, Minnesota, Montana, Nebraska, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Tennessee, Utah, Wisconsin, and Wyoming. I would add that the legislation does not impact the Federal DSH allotments in other States but only seeks to give ``extremely low-DSH States'' the ability to respond to the growing burdens of uncompensated care in their States.

I would note that Hawaii and Tennessee have been included in their amendment because their respective States currently do not have DSH programs and are prohibited from making such payments. The amendment provides them that authority under certain circumstances.

I would like to once again thank Senator Grassley and his staff members, Ted Totman, Colan Roskey, Jennifer Bell, and Leah Kegler, Senator Baucus and his staff members, Bill Dauster, Liz Fowler, Kate Kirchgraber, and Andrea Cohen, for their help in getting this amendment passed. In addition, this would have never come to fruition without the strong support by Senators Enzi, Lincoln, Smith, Nelson of Nebraska, and the other cosponsors of S. 204.

Amendment No. 666

Mr. President, today I am pleased to introduce a bill to authorize the Secretary of the Interior to study a proposed water conservation project in eastern New Mexico. This project, involving the Arch Hurley Conservancy District near Tucumcari, NM, could play a significant role in helping to address the chronic water supply issues that exist in the eastern part of the state.

The Conservancy District receives its water supply from Conchas Lake on the Canadian River, and delivers it through an unlined canal to irrigate approximately 41,400 acres of farmland in the area. The district has suggested that it might be possible to line its canal, eliminate a large amount of seepage, and convey a portion of the saved water to address water supply needs in the Pecos River basin. The non- conveyed portion of the conserved water would be available to shore up the district's supply in times of drought.

While further investigation is warranted to test the feasibility of the proposed project and any issues associated with its implementation, the project does hold significant promise, making this legislation timely. I appreciate the district's leadership in developing this proposal which represents a creative effort to improve water management and efficiency within New Mexico. If, in the 21st century, we are to maintain the standard of life that we've grown accustomed to in the arid West, creative solutions to our water supply problems are necessary. This bill is a step in the right direction by encouraging efforts to develop, analyze, and ultimately implement those creative solutions. I hope my colleagues will support this modest effort to address New Mexico's water needs.

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