Floor Statements

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.

Mr. President, yesterday, I introduced the first part of a series of proposals to protect and strengthen our nation's health care safety net. That bill, the ``Strengthening Our States'' or SOS Act of 2003,'' seeks to protect and improve the Medicaid program--a critical component of our country's health system. To repeat the words of Diane Rowland and Jim Tallon of the Kaiser Commission on Medicaid and the Uninsured, ``Medicaid is the glue that helps hold our health system together and takes on the highest-risk, sickest, and most expensive populations from private insurance and Medicare.

Like a waterfront community that seeks to set up barricades against a rising river, defending the Medicaid program from attacks, such as the idea of a block grant, is a top priority.

However, once that is assured, we must also take the next step and confront the fact that an estimated 41.2 million people, or almost 15 percent of the population, was without health insurance during the entire year of 2001, which was an increase of 1.4 million people over 2000.

Moreover, the numbers in 2002 and this year have undoubtedly worsened. A report by the National Coalition on Health Care says, ``The confluence of powerful economic forces, fueled by the terrorist attacks on September 11, have unleashed a `perfect storm' that could increase dramatically the number of uninsured in the U.S.--with as many as 6 million people in total losing their coverage in 2001 and 2002.''

The number in New Mexico are staggering. New Mexico leads or ranks second only to Texas in the percentage of its citizens who are uninsured. In fact, New Mexico is the only state in the country with less than half of its population having private health insurance coverage.

A rather shocking statistic, which also continues to worsen, is that one out of every three Hispanic citizens are uninsured. In fact, less than 43 percent of the Hispanic population now has employer-based coverage nationwide, which is in sharp comparison to the 68 percent of non-Hispanic whites who have employer-based coverage.

To address this growing crisis, I have worked closely with the American College of Physicians since last fall on the legislative proposal, which I call the ``Health Coverage, Affordability, Responsibility, and Equity Act'' or the ``HealthCARE Act of 2003.'' The proposal seeks to: First, build upon programs that currently work, including Medicaid, employer coverage, and the private market; second, provide choices for uninsured individuals, states, and small businesses while rejecting either employer or individual mandates; third, use methods that have bipartisan support by borrowing the best ideas from Democratic and Republican proposals; and, fourth, simplify rather than complicate coverage.

This is in sharp contrast, in a number of ways, to past efforts to create untried schemes or to impose mandates upon either businesses or the individual. It also seeks to bridge the divide between Democrats and Republicans. This has certainly not been easy to put together and nor will it be easy to pass. On the other hand, we have tried to start with the tools and principles more likely to get beyond the partisan divide.

As Julie Rovner of the National Journal recently wrote, ``If reforming the nation's healthcare system was easy, the old saw goes, it would have been done long ago. But for the moment, those who care about the issue seem to be succeeding only in butting each other's heads. Republicans keep pushing market-oriented reforms while Democrats want to expand existing public programs. And each party continues to reject the other's ideas. . . .''

The ``Health CARE Act'' seeks to break that partisan gridlock. First, it adopts and builds upon the notion of many Republicans to offer tax credits for the uninsured. As such, the bill would enact a new health insurance tax credit that is both refundable and advanceable to uninsured Americans with incomes up to 200 percent of the poverty level to purchase health coverage through a variety of options, including employer-coverage, State purchasing pools, or even the individual market--something pushed by a number of Republicans for many years but rejected by many Democrats.

Second, the legislation expands coverage through a State option with Federal financial support through the Medicaid program to anyone up to 100 percent of the poverty level. Medicaid has been a tried and tested program for low-income Americans over the years and is a far better and more viable option to people with incomes below the poverty level than a tax credit would be. Furthermore, few beneath the poverty level have the option of employer-coverage. Therefore, public programs, such as Medicaid, for low-income Americans makes far more sense than a tax credit.

Furthermore, through the strengthened and improved state purchasing pools provided for in the legislation, individuals and small businesses would be afforded better options to get coverage with a choice of plans that is typically not available to them with, what we believe will be, lower costs due to the ability to purchase coverage as a group.

Consequently, this approach attempts to build upon the ideas of both political parties, as it has both public program and tax credit aspects to it. Our hope is that people will see the things both parties like in it rather than focusing on what they do not like. In fact, we have also added the creation of an on-going expert health commission to make recommendations for further reforms and mid-course corrections in the future.

This bill is introduced in the spirit of compromise. To those on the right, I recognize your concern about the expansion of Medicaid as not being as market-oriented as you might prefer, but would point out that tax credits are virtually unworkable and employer-sponsored coverage often unavailable for people below the poverty level and that Medicaid is largely contracted out to private health plans--the same that many of you are enrolled in.

To those on the left, I recognize your concerns about tax credits and the potential for adverse selection with people buying coverage through the individual market, but I say to you that these are tax credits for low-income people and that we have taken steps in the legislation to mitigate problems that the added options in the bill create with respect to adverse selection. I would add that any expansion of coverage to people without health insurance is a good thing.

The most important message that I hope this bill carries is that we must stop having the perfect be the enemy of the good. This proposal is certainly not perfect but we hope it makes a very good start.

I would like to thank the American College of Physicians, or ACP, for their outstanding leadership and help in putting this legislation together. ACP has been a long-standing advocate for expanding health coverage and has authored landmark reports on the important role that health insurance has in reducing people's morbidity and mortality. In fact, to cite the conclusion of one of those studies, ``Lack of insurance contributes to the endangerment of the health of each uninsured American as well as the collective health of the nation.''

I would also like to thank the many people at the Economic and Social Research Institute, or ERSI, on their forethought, advice, and counsel as we refined the proposal over the past number of months. Their non- partisan approach and expertise have been invaluable to making the bill a workable and well-reasoned reality.

It should also be noted that the ideas put forth in the bill are based upon much of the expert work commissioned by ESRI, funded by the Robert Wood Johnson Foundation, and the Task Force on the Future of Health Insurance, funded by the Commonwealth Fund. As a result, the work of a number of other experts is reflected in the legislation and we thank you as well.

Among the endorsing organizations for this legislation are all of the leading primary care physician groups in our country. In addition to the American College of Physicians, the bill has been endorsed by the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Geriatrics Society.

As a practicing physician in New Mexico, Dr. Robert Strickland sums it up well. As he wrote in an editorial

published in the Albuquerque Journal about this legislation yesterday, ``As a New Mexico internist for 31 years, I have seen many uninsured people go without care until it is too late for me to do much to help them. The HealthCARE Act offers the potential of breaking the political gridlock that has allowed this crisis in health care to go on for far too long.''

I hope we can break the gridlock and urge my colleagues to heed the call of our nation's primary care doctors to support this legislation.

I would ask unanimous consent that letters of endorsement from the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Geriatrics Society, and Families USA, and the text of the legislation printed in the Record.

There being no ojection, the material was ordered to be printed in

Mr. President, I rise today to introduce bipartisan legislation with Senators Lugar, Lincoln, Corzine, Landrieu, Breaux, Kerry, Murray, Cantwell, Clinton, and Miller. This legislation, entitled the ``Start Healthy, Stay Healthy Act of 2003,'' would significantly reduce the number of uninsured pregnant women and newborns by expanding coverage to pregnant women through Medicaid and the Children's Health Insurance Program, or CHIP, and to newborns through the first full year of life.

Sunday is Mothers' Day. Every year, we honor our Nation's mothers and we should take the time to assess how we can do better by them, including their health and well-being.

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

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

In fact, the United States ranks 21st in maternal mortality and 28th in infant mortality, the worst among developed nations. We should and must do better by our Nation's mothers and infants.

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

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

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

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

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

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

This legislation is a reintroduction of a bill that was introduced in 2001. Throughout that year, the Administration made numerous statements in support of the passage of this type of legislation, but unfortunately, reversed course in October 2002 after publishing a regulation allowing states to redefine a ``child'' as an ``unborn child'' and to provide prenatal care through CHIP in that manner. In a letter to Senator Nickles dated October 8, 2002, Secretary Thompson argued, ``I believe the regulation is a more effective and comprehensive solution to this issue.''

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

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

We support giving states the flexibility they need to cover

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

automatically enroll infants born to SCHIP-eligible mothers.

By establishing a uniform eligibility threshold for coverage

for pregnant women and infants, states will be able to

improve maternal health, eliminate waiting periods for

infants and streamline administration of publicly supported

health programs. Currently, according to the Department of

Health and Human Services' Centers for Medicare and Medicaid

Services and the National Governors' Association, 36 states

and the District of Columbia have income eligibility

thresholds that are more restrictive for women than for their

newborns. Encouraging states to eliminate this disparity by

allowing them to establish a uniform eligibility threshold

for pregnant women and their infants should be a national

policy priority.

Dr. Green adds:

Specifically, we are deeply concerned that final regulation

fails to provide to the mother the standard scope of

maternity care services recommended by the American College

of Obstetricians and Gynecologists (ACOG) and the American

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

regulation explicitly states that postpartum care is not

covered and, therefore, federal reimbursement will not be

available for these services. In addition, because of the

contentious collateral issues raised by this regulation

groups like the March of Dimes will find it even more

difficult to work in the states to generate support for

legislation to extend coverage to uninsured pregnant women.

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

ACOG is very concerned that mothers will not have access to

postpartum services under the regulation. The rule clearly

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

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

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

child.''

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

When new mothers develop postpartum complications, quick

access to their physicians is absolutely critical. Postpartum

care is especially important for women who have preexisting

medical conditions, and for those whose medical conditions

were induced by their pregnancies, such as gestational

diabetes or hypertension, and for whom it is necessary to

ensure that their conditions are stabilized and treated.

As a result, Dr. Riley concludes:

Limiting coverage to the fetus instead of the mother omits

a critical component of postpartum care that physicians

regard as essential for the health of the mother and the

child. Covering the fetus as opposed to the mother also

raises questions of whether certain services will be

available during pregnancy and labor if the condition is one

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

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

Bond, Bingaman and Lincoln and many others, and which

provides a full range of medical services during and after

pregnancy directly to the pregnant woman.

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

Recently, the Administration published a final rule

expanding SCHIP cover unborn children. The Academy is

concerned that, as written, this regulation falls dangerously

short of the clinical standards of care outlined in our

guidelines, which describe the importance of covering all

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

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

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

uninsured children by providing 12 months of continuous

eligibility for those children born. . . . This legislation

ensures that children born to women enrolled in Medicaid or

SCHIP are immediately enrolled in the program for which they

are eligible. Additionally, this provision prevents newborns

eligible for SCHIP from being subject to enrollment waiting

periods, ensuring that infants receive appropriate health

care in their first year of life.

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

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

for a healthy child.

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

I ask unanimous consent that the text of the bill and a series of letters be printed in the Record.

Mr. President, yesterday, I introduced the first part of a series of proposals to protect and strengthen our nation's health care safety net. That bill, the ``Strengthening Our States'' or SOS Act of 2003,'' seeks to protect and improve the Medicaid program--a critical component of our country's health system. To repeat the words of Diane Rowland and Jim Tallon of the Kaiser Commission on Medicaid and the Uninsured, ``Medicaid is the glue that helps hold our health system together and takes on the highest-risk, sickest, and most expensive populations from private insurance and Medicare.

Like a waterfront community that seeks to set up barricades against a rising river, defending the Medicaid program from attacks, such as the idea of a block grant, is a top priority.

However, once that is assured, we must also take the next step and confront the fact that an estimated 41.2 million people, or almost 15 percent of the population, was without health insurance during the entire year of 2001, which was an increase of 1.4 million people over 2000.

Moreover, the numbers in 2002 and this year have undoubtedly worsened. A report by the National Coalition on Health Care says, ``The confluence of powerful economic forces, fueled by the terrorist attacks on September 11, have unleashed a `perfect storm' that could increase dramatically the number of uninsured in the U.S.--with as many as 6 million people in total losing their coverage in 2001 and 2002.''

The number in New Mexico are staggering. New Mexico leads or ranks second only to Texas in the percentage of its citizens who are uninsured. In fact, New Mexico is the only state in the country with less than half of its population having private health insurance coverage.

A rather shocking statistic, which also continues to worsen, is that one out of every three Hispanic citizens are uninsured. In fact, less than 43 percent of the Hispanic population now has employer-based coverage nationwide, which is in sharp comparison to the 68 percent of non-Hispanic whites who have employer-based coverage.

To address this growing crisis, I have worked closely with the American College of Physicians since last fall on the legislative proposal, which I call the ``Health Coverage, Affordability, Responsibility, and Equity Act'' or the ``HealthCARE Act of 2003.'' The proposal seeks to: First, build upon programs that currently work, including Medicaid, employer coverage, and the private market; second, provide choices for uninsured individuals, states, and small businesses while rejecting either employer or individual mandates; third, use methods that have bipartisan support by borrowing the best ideas from Democratic and Republican proposals; and, fourth, simplify rather than complicate coverage.

This is in sharp contrast, in a number of ways, to past efforts to create untried schemes or to impose mandates upon either businesses or the individual. It also seeks to bridge the divide between Democrats and Republicans. This has certainly not been easy to put together and nor will it be easy to pass. On the other hand, we have tried to start with the tools and principles more likely to get beyond the partisan divide.

As Julie Rovner of the National Journal recently wrote, ``If reforming the nation's healthcare system was easy, the old saw goes, it would have been done long ago. But for the moment, those who care about the issue seem to be succeeding only in butting each other's heads. Republicans keep pushing market-oriented reforms while Democrats want to expand existing public programs. And each party continues to reject the other's ideas. . . .''

The ``Health CARE Act'' seeks to break that partisan gridlock. First, it adopts and builds upon the notion of many Republicans to offer tax credits for the uninsured. As such, the bill would enact a new health insurance tax credit that is both refundable and advanceable to uninsured Americans with incomes up to 200 percent of the poverty level to purchase health coverage through a variety of options, including employer-coverage, State purchasing pools, or even the individual market--something pushed by a number of Republicans for many years but rejected by many Democrats.

Second, the legislation expands coverage through a State option with Federal financial support through the Medicaid program to anyone up to 100 percent of the poverty level. Medicaid has been a tried and tested program for low-income Americans over the years and is a far better and more viable option to people with incomes below the poverty level than a tax credit would be. Furthermore, few beneath the poverty level have the option of employer-coverage. Therefore, public programs, such as Medicaid, for low-income Americans makes far more sense than a tax credit.

Furthermore, through the strengthened and improved state purchasing pools provided for in the legislation, individuals and small businesses would be afforded better options to get coverage with a choice of plans that is typically not available to them with, what we believe will be, lower costs due to the ability to purchase coverage as a group.

Consequently, this approach attempts to build upon the ideas of both political parties, as it has both public program and tax credit aspects to it. Our hope is that people will see the things both parties like in it rather than focusing on what they do not like. In fact, we have also added the creation of an on-going expert health commission to make recommendations for further reforms and mid-course corrections in the future.

This bill is introduced in the spirit of compromise. To those on the right, I recognize your concern about the expansion of Medicaid as not being as market-oriented as you might prefer, but would point out that tax credits are virtually unworkable and employer-sponsored coverage often unavailable for people below the poverty level and that Medicaid is largely contracted out to private health plans--the same that many of you are enrolled in.

To those on the left, I recognize your concerns about tax credits and the potential for adverse selection with people buying coverage through the individual market, but I say to you that these are tax credits for low-income people and that we have taken steps in the legislation to mitigate problems that the added options in the bill create with respect to adverse selection. I would add that any expansion of coverage to people without health insurance is a good thing.

The most important message that I hope this bill carries is that we must stop having the perfect be the enemy of the good. This proposal is certainly not perfect but we hope it makes a very good start.

I would like to thank the American College of Physicians, or ACP, for their outstanding leadership and help in putting this legislation together. ACP has been a long-standing advocate for expanding health coverage and has authored landmark reports on the important role that health insurance has in reducing people's morbidity and mortality. In fact, to cite the conclusion of one of those studies, ``Lack of insurance contributes to the endangerment of the health of each uninsured American as well as the collective health of the nation.''

I would also like to thank the many people at the Economic and Social Research Institute, or ERSI, on their forethought, advice, and counsel as we refined the proposal over the past number of months. Their non- partisan approach and expertise have been invaluable to making the bill a workable and well-reasoned reality.

It should also be noted that the ideas put forth in the bill are based upon much of the expert work commissioned by ESRI, funded by the Robert Wood Johnson Foundation, and the Task Force on the Future of Health Insurance, funded by the Commonwealth Fund. As a result, the work of a number of other experts is reflected in the legislation and we thank you as well.

Among the endorsing organizations for this legislation are all of the leading primary care physician groups in our country. In addition to the American College of Physicians, the bill has been endorsed by the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Geriatrics Society.

As a practicing physician in New Mexico, Dr. Robert Strickland sums it up well. As he wrote in an editorial

published in the Albuquerque Journal about this legislation yesterday, ``As a New Mexico internist for 31 years, I have seen many uninsured people go without care until it is too late for me to do much to help them. The HealthCARE Act offers the potential of breaking the political gridlock that has allowed this crisis in health care to go on for far too long.''

I hope we can break the gridlock and urge my colleagues to heed the call of our nation's primary care doctors to support this legislation.

I would ask unanimous consent that letters of endorsement from the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Geriatrics Society, and Families USA, and the text of the legislation printed in the Record.

There being no ojection, the material was ordered to be printed in

Mr. President, I rise today to introduce bipartisan legislation with Senators Lugar, Lincoln, Corzine, Landrieu, Breaux, Kerry, Murray, Cantwell, Clinton, and Miller. This legislation, entitled the ``Start Healthy, Stay Healthy Act of 2003,'' would significantly reduce the number of uninsured pregnant women and newborns by expanding coverage to pregnant women through Medicaid and the Children's Health Insurance Program, or CHIP, and to newborns through the first full year of life.

Sunday is Mothers' Day. Every year, we honor our Nation's mothers and we should take the time to assess how we can do better by them, including their health and well-being.

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

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

In fact, the United States ranks 21st in maternal mortality and 28th in infant mortality, the worst among developed nations. We should and must do better by our Nation's mothers and infants.

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

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

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

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

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

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

This legislation is a reintroduction of a bill that was introduced in 2001. Throughout that year, the Administration made numerous statements in support of the passage of this type of legislation, but unfortunately, reversed course in October 2002 after publishing a regulation allowing states to redefine a ``child'' as an ``unborn child'' and to provide prenatal care through CHIP in that manner. In a letter to Senator Nickles dated October 8, 2002, Secretary Thompson argued, ``I believe the regulation is a more effective and comprehensive solution to this issue.''

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

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

We support giving states the flexibility they need to cover

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

automatically enroll infants born to SCHIP-eligible mothers.

By establishing a uniform eligibility threshold for coverage

for pregnant women and infants, states will be able to

improve maternal health, eliminate waiting periods for

infants and streamline administration of publicly supported

health programs. Currently, according to the Department of

Health and Human Services' Centers for Medicare and Medicaid

Services and the National Governors' Association, 36 states

and the District of Columbia have income eligibility

thresholds that are more restrictive for women than for their

newborns. Encouraging states to eliminate this disparity by

allowing them to establish a uniform eligibility threshold

for pregnant women and their infants should be a national

policy priority.

Dr. Green adds:

Specifically, we are deeply concerned that final regulation

fails to provide to the mother the standard scope of

maternity care services recommended by the American College

of Obstetricians and Gynecologists (ACOG) and the American

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

regulation explicitly states that postpartum care is not

covered and, therefore, federal reimbursement will not be

available for these services. In addition, because of the

contentious collateral issues raised by this regulation

groups like the March of Dimes will find it even more

difficult to work in the states to generate support for

legislation to extend coverage to uninsured pregnant women.

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

ACOG is very concerned that mothers will not have access to

postpartum services under the regulation. The rule clearly

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

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

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

child.''

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

When new mothers develop postpartum complications, quick

access to their physicians is absolutely critical. Postpartum

care is especially important for women who have preexisting

medical conditions, and for those whose medical conditions

were induced by their pregnancies, such as gestational

diabetes or hypertension, and for whom it is necessary to

ensure that their conditions are stabilized and treated.

As a result, Dr. Riley concludes:

Limiting coverage to the fetus instead of the mother omits

a critical component of postpartum care that physicians

regard as essential for the health of the mother and the

child. Covering the fetus as opposed to the mother also

raises questions of whether certain services will be

available during pregnancy and labor if the condition is one

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

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

Bond, Bingaman and Lincoln and many others, and which

provides a full range of medical services during and after

pregnancy directly to the pregnant woman.

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

Recently, the Administration published a final rule

expanding SCHIP cover unborn children. The Academy is

concerned that, as written, this regulation falls dangerously

short of the clinical standards of care outlined in our

guidelines, which describe the importance of covering all

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

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

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

uninsured children by providing 12 months of continuous

eligibility for those children born. . . . This legislation

ensures that children born to women enrolled in Medicaid or

SCHIP are immediately enrolled in the program for which they

are eligible. Additionally, this provision prevents newborns

eligible for SCHIP from being subject to enrollment waiting

periods, ensuring that infants receive appropriate health

care in their first year of life.

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

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

for a healthy child.

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

I ask unanimous consent that the text of the bill and a series of letters be printed in the Record.

Mr. President, our Nation's States and health safety net are simultaneously facing a crisis. According to State budget officers, the states are facing a nearly $30 billion budget shortfall this year and an $80 billion gap in fiscal year 2004 due to the economic recession. At the same time, it is estimated that the number of uninsured increased from 41 to 45 million this past year. And, due to the State budget shortfalls, the numbers of uninsured may increase even further.

In fact, the lead paragraph in the New York Times in an article entitled ``Cutbacks Imperil Health Coverage for States' Poor'' on April 28, 2003, reads, ``Millions of low-income Americans face the loss of health insurance or sharp cuts in benefits, like coverage for prescription drugs and dental care, under proposals now moving through state legislatures around the country.''

The article continues, ``State officials and health policy experts say the cuts will increase the number of uninsured, threaten recent progress in covering children and impose severe strains on hospitals, doctors and nursing homes.''

As a result, I believe the Federal Government should take immediate steps to fundamentally reassert and reassert its role in helping the States with this fiscal crisis and rising Medicaid costs, lowering the number of uninsured, and finally, confronting infant and maternal mortality and morbidity statistics that are unworthy of our great Nation.

To address these issues, today and tomorrow, I will be introducing three relevant bills. The first addresses the fiscal crisis confronting States and the Medicaid program entitled ``Strengthening Our States,'' or the ``SOS Act.''

The second addresses our Nation's long-standing and growing crisis of the uninsured that is entitled the ``Health Coverage, Affordability, Responsibility, and Equity Act'' or the ``Health CARE Act.''

The final bill takes on our Nation's high infant and mortality rates and is called the ``Start Healthy, Stay Health Act.''

First things first. In any campaign--whether in sports, business, or politics--you have to have both offensive and defensive strategies. In trying to reduce the number of uninsured in our country, we must first, as an emergency room doctor would, stop the bleeding. Therefore, our first priority should be to support and strengthen the Medicaid program.

Unfortunately, the Center on Budget and Policy Priorities estimated in March that as many as 1.7 million Americans could lose coverage altogether under proposals advanced by governors or adopted by State legislative committees this year.

Therefore, I am introducing today with Senators Corzine, Clinton, Kerry, Lautenberg, Dayton, and Johnson legislation entitled the ``Strengthening Our States Act of 2003.'' This bill is a companion bill to that being introduced by Representative Dingell, Brown of Ohio, Waxman, and others and is aimed at improving Medicaid and providing support to States to enhance their ability to provide coverage to their uninsured residents in these difficult times.

The SOS Act uses a combination of approaches which: first, provide additional Federal fiscal relief to States; second, provide additional flexibility to States in administering and improving the Medicaid program; and third, provide incentives and assistance to stave off cuts to existing coverage, and facilitate coverage expansions in the future.

The legislation will simplify Medicaid and enable States to strengthen the program and stands in sharp contrast to the President's proposal to convert Medicaid into a block grant that would erode health insurance coverage.

In fact, the Administration's prescription is the wrong medicine for the wrong ailment. The Federal Government should be stepping up its commitment to seniors, people with disabilities, and low-income children rather than stepping away and leaving States holding the bag.

First and foremost, our legislation acknowledges and reflects on the important role that Medicaid plays in our entire health care system. As Diane Rowland and Jim Tallon of the Kaiser Commission on Medicaid and the Uninsured have noted: ``. . . it is hard to envision our health system and society without a program like Medicaid. Medicaid is the glue that helps hold our health system together and takes on the highest-risk, sickest, and most expensive populations from private insurance and Medicare. For low-income Medicare beneficiaries, Medicaid picks

up Medicare premiums and some cost sharing as well as filling the gaps in coverage for long-term care services, prescription drugs, and vision and dental care.''

Medicaid addresses the failure of the marketplace to deliver affordable health coverage to our Nation's most fragile and vulnerable citizens. However, there is no reason why it should also have to play the role of picking up the slack of the Medicare program. A central tenet of our SOS proposal is for the Federal Government to begin taking the steps to assume 100 percent of the costs associated with care and services in Medicaid for Medicare beneficiaries, also known as dual eligibles.

This, I would add, is in keeping with long-standing policy of the National Governors' Association, or NGA, and is in sharp contrast to the Administration's proposal to maintain the current Medicaid financing system for mandatory populations and services while block granting care of optional populations and services to States. Who are these optional populations? They are largely the elderly and people with disabilities, many of whom are dually eligible for Medicare and Medicaid.

According to the Kaiser Commission on Medicaid and the Uninsured, 83 percent of all Medicaid spending on the elderly is for either optional populations or services, such as prescription drugs and long-term care. In fact, according to Cindy Mann of Georgetown University and a former Medicaid director under the Clinton Administration, an estimated 35 percent of all State Medicaid costs are for so-called ``dual eligibles.''

Therefore, rather than stepping up to the plate, the Administration is instead stepping away from its commitment to the elderly and disabled, which should be our responsibility at the Federal level, by moving these groups and their health care services into a block grant. Groups representing the elderly and disabled communities have already spoken out against this.

As AARP Executive Director and CEO Bill Novelli says, ``This [Administration's block grant] proposal handcuffs states because it leaves people more vulnerable in future years as States struggle to meet increased needs with decreased dollars.''

The Consortium for Citizens with Disabilities adds, ``The Bush Administration proposal fails people with disabilities and dishonors the Nation's commitment to its residents--it is not in the national interest. . . . What the Medicaid program calls `optional' services are, in reality, mandatory disability services for the children and adults who need them. These services often are not only life-saving, but also the key to a positive quality of life--something everyone in our nation deserves.''

Again, the Federal Government should be stepping up its commitment to seniors and people with disabilities rather than stepping away, as the President's proposal does.

With respect to the fiscal crisis facing states, the Administration has long opposed fiscal relief to States as part of its economic stimulus package. Instead, the Administration points out that its Medicaid block grant proposal provides more funding up front to States, in the amount of $3.5 billion over one year and $12.7 billion over the first seven years to help States. But the proposal has strong elements of a typical bait and switch by yanking every dime of that money away starting in 2011. Secretary Thompson noted at the press conference that he would not be around at the time of the $12.7 billion in reductions eight years from now and the plan clearly counts on the fact that most of this crop of governors would not be either.

However, that is exactly when our Nation's baby boomers hit retirement age in rapidly increasing numbers and the long term care costs within Medicaid will significantly increase.

In sharp contrast, the SOS Act includes a temporary increase in the Federal matching assistance percentage, or FMAP, to state Medicaid programs in the amount of $15 billion and another $15 billion in additional aid to States--far more than the temporary $3 billion offered by the Administration.

Also, unlike a block grant, the current Medicaid matching rate is responsive to States in times of recessions by providing Federal matching funds to States for each additional person who becomes eligible for Medicaid. Moreover, our SOS Act recognizes the formula can be even more responsive by preserving coverage during difficult times and includes a General Accounting Office study of ways to make the formula more responsive to fiscal distress during either a national or State recession.

In addition, the Strengthening Our States Act would increase Federal payments for certain services critical for special populations or federally-imposed services. It would provide enhanced Federal funding for urban Indian health services, translation services, outstationed workers, and reimbursement to health providers for emergency services delivered undocumented individuals who are otherwise eligible for Medicaid. Again, the Administration's proposal simply block grants funding for these services and steps away from its Federal responsibility.

For example, services delivered to Native Americans by Indian Health Service providers and health organizations are reimbursed at 100 percent federal match currently in recognition of the Federal responsibility and role in delivering services to Native Americans apart from States. Under a block grant, the Federal match is eliminated and the Federal role in providing care to Native Americans is abandoned. This is contrary to longstanding Federal policy and its relationship with tribes and tribal organizations and to policy by the National Governors' Association.

And finally, with respect to giving States flexibility and assistance to expand upon existing coverage options, the Strengthening Our States Act is far better and responsive to states than a block grant. Block grants do not adjust for population changes, recessions, or efforts to expand coverage by States. At its unveiling, Secretary Thompson spoke about the added options the block grants offer States to expand coverage. However, it does so with no new funding. This offer of flexibility is, therefore, illusory.

In fact, because Federal funding is capped for optional opulations by the Administration's block grant, states cannot draw down additional Federal support when it chooses to expand coverage. Under current law and the SOS Act, they can. Some of the more ground-breaking efforts by states such as those by Vermont, Washington, Minnesota, Rhode Island, Hawaii, and even Wisconsin, would have likely never come to pass without that added Federal support.

Therefore, the SOS Act continues and expands upon that Federal support by giving States additional coverage options, such as to set uniform eligibility levels for families rather than covering parents and children separately. The SOS Act also would make States eligible for enhanced matching funds to cover low-income working parents under Medicaid.

States should also beware of the Administration's promise of 9 percent growth rates for the next 10 years. Earlier this year, the House of Representatives passed a budget that would have reduced Medicaid spending by $92 billion over 10 years. While that was rejected in conference, such efforts become much easier under the rubric of a block grant. Again, recent history contains many such promises and examples.

For example, as the NGA policy on the Social Service Block Grant notes, during passage of TANF, ``Congress and the Administration made a commitment to Governors to fund SSBG at $2.38 billion each year through fiscal year 2002, with the funding increasing to $2.8 billion in fiscal 2003 and each year thereafter.'' The reality is that funding has been reduced to $1.7 billion in fiscal years 2002 and 2003, 65 percent below the promised funding levels.

There is an old saying, which goes, ``Fool me once, shame on you. Fool me twice, shame on me.'' When members of Congress and future Administrations see 9 percent growth rates in these Medicaid block grants and have a particular tax cut, Medicare change, transportation program, or whatever they wish to fund, you can already hear them saying, ``What if we just reduce the growth rates to 8 percent or 7 percent or 6 percent or 5 percent. . . .'' Well, we all can see where this rapidly heads and we have all been fooled once before.

Some governors, including Secretary Thompson, seem to have a short memory on these matters. On April 14, 1997, 41 Governors, including Secretary Thompson, Bush Administration Cabinet Members Tom Ridge, and Christine Todd Whitman, wrote President Clinton, and said: ``We adamantly oppose a cap on federal Medicaid spending in any form. Unilateral caps in federal Medicaid spending will result in cost shifts to states, enabling the federal government to balance its budget at the expense of the states.''

What was true then remains true 6 years later.

Moreover, on behalf of the NGA, Governors Bob Miller of Nevada and Mike Leavitt testified before the Senate Finance Committee and made the following statement: ``. . . caps could result in states becoming solely responsible for unexpected program costs, such as a loss in a lawsuit on reimbursement rates or the development of expensive new therapies that drive up treatment costs beyond the federal allowable rate.

They added: ``. . . the cost shift resulting from a unilateral cap would present states with a number of bad alternatives. States essentially would have to choose between cutting back on payment rates to providers, eliminating optional benefits provided to recipients, ending coverage for optional beneficiaries, or coming up with additional state funds to absorb 100 percent of the cost of services.''

I do not see why this needs to be an all-or-nothing proposition. Why do we have to throw out the entire Medicaid financing structure, which benefits States, beneficiaries, and providers, in order to grant States additional flexibility to their programs?

In 1997, we rejected the all-or-nothing proposal and worked with the States and gave them a package of added flexibility, including the ability to enroll much of their Medicaid population in managed care without the need for a waiver.

Secretary Thompson talks a great deal about the flexibility the block grant offers and cites the need to allow States the ability to move people out of institutional settings into more appropriate home- and community-based settings and is right. Under the block grant, States are only granted additional flexibility to do so if they accept a block grant. In contrast, the SOS Act provides States an enhanced Federal matching rate to provide home- and community-based services.

However, rather than saying to States that they can only do so through the acceptance of a block grant, why can't we provide them this option without the imposition of a Federal limit on funding? Both states and beneficiary groups are asking for it and we can and should act.

It is on this point that I must add that the Medicaid program was not created for Federal officials or governors. We all clearly need to be reminded that there are other stakeholders in the Medicaid program, including the 43 million people served by the program.

As Alan Weil of the Urban institute and the former Medicaid director of the State of Colorado wrote in a recent article published in Health Affairs: ``If money is at the heart of debates over Medicaid, the millions of indigent people whose varied and complex medical needs are met by the program are its sole. The amount of human suffering the program alleviates is immense.''

As the Administration attempts to proceed on negotiations with the governors on a deal on block grants, let's not forget the children, mothers, seniors, and people with disabilities served by Medicaid. The SOS Act provides a far better alternative.

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

Mr. President, our Nation's States and health safety net are simultaneously facing a crisis. According to State budget officers, the states are facing a nearly $30 billion budget shortfall this year and an $80 billion gap in fiscal year 2004 due to the economic recession. At the same time, it is estimated that the number of uninsured increased from 41 to 45 million this past year. And, due to the State budget shortfalls, the numbers of uninsured may increase even further.

In fact, the lead paragraph in the New York Times in an article entitled ``Cutbacks Imperil Health Coverage for States' Poor'' on April 28, 2003, reads, ``Millions of low-income Americans face the loss of health insurance or sharp cuts in benefits, like coverage for prescription drugs and dental care, under proposals now moving through state legislatures around the country.''

The article continues, ``State officials and health policy experts say the cuts will increase the number of uninsured, threaten recent progress in covering children and impose severe strains on hospitals, doctors and nursing homes.''

As a result, I believe the Federal Government should take immediate steps to fundamentally reassert and reassert its role in helping the States with this fiscal crisis and rising Medicaid costs, lowering the number of uninsured, and finally, confronting infant and maternal mortality and morbidity statistics that are unworthy of our great Nation.

To address these issues, today and tomorrow, I will be introducing three relevant bills. The first addresses the fiscal crisis confronting States and the Medicaid program entitled ``Strengthening Our States,'' or the ``SOS Act.''

The second addresses our Nation's long-standing and growing crisis of the uninsured that is entitled the ``Health Coverage, Affordability, Responsibility, and Equity Act'' or the ``Health CARE Act.''

The final bill takes on our Nation's high infant and mortality rates and is called the ``Start Healthy, Stay Health Act.''

First things first. In any campaign--whether in sports, business, or politics--you have to have both offensive and defensive strategies. In trying to reduce the number of uninsured in our country, we must first, as an emergency room doctor would, stop the bleeding. Therefore, our first priority should be to support and strengthen the Medicaid program.

Unfortunately, the Center on Budget and Policy Priorities estimated in March that as many as 1.7 million Americans could lose coverage altogether under proposals advanced by governors or adopted by State legislative committees this year.

Therefore, I am introducing today with Senators Corzine, Clinton, Kerry, Lautenberg, Dayton, and Johnson legislation entitled the ``Strengthening Our States Act of 2003.'' This bill is a companion bill to that being introduced by Representative Dingell, Brown of Ohio, Waxman, and others and is aimed at improving Medicaid and providing support to States to enhance their ability to provide coverage to their uninsured residents in these difficult times.

The SOS Act uses a combination of approaches which: first, provide additional Federal fiscal relief to States; second, provide additional flexibility to States in administering and improving the Medicaid program; and third, provide incentives and assistance to stave off cuts to existing coverage, and facilitate coverage expansions in the future.

The legislation will simplify Medicaid and enable States to strengthen the program and stands in sharp contrast to the President's proposal to convert Medicaid into a block grant that would erode health insurance coverage.

In fact, the Administration's prescription is the wrong medicine for the wrong ailment. The Federal Government should be stepping up its commitment to seniors, people with disabilities, and low-income children rather than stepping away and leaving States holding the bag.

First and foremost, our legislation acknowledges and reflects on the important role that Medicaid plays in our entire health care system. As Diane Rowland and Jim Tallon of the Kaiser Commission on Medicaid and the Uninsured have noted: ``. . . it is hard to envision our health system and society without a program like Medicaid. Medicaid is the glue that helps hold our health system together and takes on the highest-risk, sickest, and most expensive populations from private insurance and Medicare. For low-income Medicare beneficiaries, Medicaid picks

up Medicare premiums and some cost sharing as well as filling the gaps in coverage for long-term care services, prescription drugs, and vision and dental care.''

Medicaid addresses the failure of the marketplace to deliver affordable health coverage to our Nation's most fragile and vulnerable citizens. However, there is no reason why it should also have to play the role of picking up the slack of the Medicare program. A central tenet of our SOS proposal is for the Federal Government to begin taking the steps to assume 100 percent of the costs associated with care and services in Medicaid for Medicare beneficiaries, also known as dual eligibles.

This, I would add, is in keeping with long-standing policy of the National Governors' Association, or NGA, and is in sharp contrast to the Administration's proposal to maintain the current Medicaid financing system for mandatory populations and services while block granting care of optional populations and services to States. Who are these optional populations? They are largely the elderly and people with disabilities, many of whom are dually eligible for Medicare and Medicaid.

According to the Kaiser Commission on Medicaid and the Uninsured, 83 percent of all Medicaid spending on the elderly is for either optional populations or services, such as prescription drugs and long-term care. In fact, according to Cindy Mann of Georgetown University and a former Medicaid director under the Clinton Administration, an estimated 35 percent of all State Medicaid costs are for so-called ``dual eligibles.''

Therefore, rather than stepping up to the plate, the Administration is instead stepping away from its commitment to the elderly and disabled, which should be our responsibility at the Federal level, by moving these groups and their health care services into a block grant. Groups representing the elderly and disabled communities have already spoken out against this.

As AARP Executive Director and CEO Bill Novelli says, ``This [Administration's block grant] proposal handcuffs states because it leaves people more vulnerable in future years as States struggle to meet increased needs with decreased dollars.''

The Consortium for Citizens with Disabilities adds, ``The Bush Administration proposal fails people with disabilities and dishonors the Nation's commitment to its residents--it is not in the national interest. . . . What the Medicaid program calls `optional' services are, in reality, mandatory disability services for the children and adults who need them. These services often are not only life-saving, but also the key to a positive quality of life--something everyone in our nation deserves.''

Again, the Federal Government should be stepping up its commitment to seniors and people with disabilities rather than stepping away, as the President's proposal does.

With respect to the fiscal crisis facing states, the Administration has long opposed fiscal relief to States as part of its economic stimulus package. Instead, the Administration points out that its Medicaid block grant proposal provides more funding up front to States, in the amount of $3.5 billion over one year and $12.7 billion over the first seven years to help States. But the proposal has strong elements of a typical bait and switch by yanking every dime of that money away starting in 2011. Secretary Thompson noted at the press conference that he would not be around at the time of the $12.7 billion in reductions eight years from now and the plan clearly counts on the fact that most of this crop of governors would not be either.

However, that is exactly when our Nation's baby boomers hit retirement age in rapidly increasing numbers and the long term care costs within Medicaid will significantly increase.

In sharp contrast, the SOS Act includes a temporary increase in the Federal matching assistance percentage, or FMAP, to state Medicaid programs in the amount of $15 billion and another $15 billion in additional aid to States--far more than the temporary $3 billion offered by the Administration.

Also, unlike a block grant, the current Medicaid matching rate is responsive to States in times of recessions by providing Federal matching funds to States for each additional person who becomes eligible for Medicaid. Moreover, our SOS Act recognizes the formula can be even more responsive by preserving coverage during difficult times and includes a General Accounting Office study of ways to make the formula more responsive to fiscal distress during either a national or State recession.

In addition, the Strengthening Our States Act would increase Federal payments for certain services critical for special populations or federally-imposed services. It would provide enhanced Federal funding for urban Indian health services, translation services, outstationed workers, and reimbursement to health providers for emergency services delivered undocumented individuals who are otherwise eligible for Medicaid. Again, the Administration's proposal simply block grants funding for these services and steps away from its Federal responsibility.

For example, services delivered to Native Americans by Indian Health Service providers and health organizations are reimbursed at 100 percent federal match currently in recognition of the Federal responsibility and role in delivering services to Native Americans apart from States. Under a block grant, the Federal match is eliminated and the Federal role in providing care to Native Americans is abandoned. This is contrary to longstanding Federal policy and its relationship with tribes and tribal organizations and to policy by the National Governors' Association.

And finally, with respect to giving States flexibility and assistance to expand upon existing coverage options, the Strengthening Our States Act is far better and responsive to states than a block grant. Block grants do not adjust for population changes, recessions, or efforts to expand coverage by States. At its unveiling, Secretary Thompson spoke about the added options the block grants offer States to expand coverage. However, it does so with no new funding. This offer of flexibility is, therefore, illusory.

In fact, because Federal funding is capped for optional opulations by the Administration's block grant, states cannot draw down additional Federal support when it chooses to expand coverage. Under current law and the SOS Act, they can. Some of the more ground-breaking efforts by states such as those by Vermont, Washington, Minnesota, Rhode Island, Hawaii, and even Wisconsin, would have likely never come to pass without that added Federal support.

Therefore, the SOS Act continues and expands upon that Federal support by giving States additional coverage options, such as to set uniform eligibility levels for families rather than covering parents and children separately. The SOS Act also would make States eligible for enhanced matching funds to cover low-income working parents under Medicaid.

States should also beware of the Administration's promise of 9 percent growth rates for the next 10 years. Earlier this year, the House of Representatives passed a budget that would have reduced Medicaid spending by $92 billion over 10 years. While that was rejected in conference, such efforts become much easier under the rubric of a block grant. Again, recent history contains many such promises and examples.

For example, as the NGA policy on the Social Service Block Grant notes, during passage of TANF, ``Congress and the Administration made a commitment to Governors to fund SSBG at $2.38 billion each year through fiscal year 2002, with the funding increasing to $2.8 billion in fiscal 2003 and each year thereafter.'' The reality is that funding has been reduced to $1.7 billion in fiscal years 2002 and 2003, 65 percent below the promised funding levels.

There is an old saying, which goes, ``Fool me once, shame on you. Fool me twice, shame on me.'' When members of Congress and future Administrations see 9 percent growth rates in these Medicaid block grants and have a particular tax cut, Medicare change, transportation program, or whatever they wish to fund, you can already hear them saying, ``What if we just reduce the growth rates to 8 percent or 7 percent or 6 percent or 5 percent. . . .'' Well, we all can see where this rapidly heads and we have all been fooled once before.

Some governors, including Secretary Thompson, seem to have a short memory on these matters. On April 14, 1997, 41 Governors, including Secretary Thompson, Bush Administration Cabinet Members Tom Ridge, and Christine Todd Whitman, wrote President Clinton, and said: ``We adamantly oppose a cap on federal Medicaid spending in any form. Unilateral caps in federal Medicaid spending will result in cost shifts to states, enabling the federal government to balance its budget at the expense of the states.''

What was true then remains true 6 years later.

Moreover, on behalf of the NGA, Governors Bob Miller of Nevada and Mike Leavitt testified before the Senate Finance Committee and made the following statement: ``. . . caps could result in states becoming solely responsible for unexpected program costs, such as a loss in a lawsuit on reimbursement rates or the development of expensive new therapies that drive up treatment costs beyond the federal allowable rate.

They added: ``. . . the cost shift resulting from a unilateral cap would present states with a number of bad alternatives. States essentially would have to choose between cutting back on payment rates to providers, eliminating optional benefits provided to recipients, ending coverage for optional beneficiaries, or coming up with additional state funds to absorb 100 percent of the cost of services.''

I do not see why this needs to be an all-or-nothing proposition. Why do we have to throw out the entire Medicaid financing structure, which benefits States, beneficiaries, and providers, in order to grant States additional flexibility to their programs?

In 1997, we rejected the all-or-nothing proposal and worked with the States and gave them a package of added flexibility, including the ability to enroll much of their Medicaid population in managed care without the need for a waiver.

Secretary Thompson talks a great deal about the flexibility the block grant offers and cites the need to allow States the ability to move people out of institutional settings into more appropriate home- and community-based settings and is right. Under the block grant, States are only granted additional flexibility to do so if they accept a block grant. In contrast, the SOS Act provides States an enhanced Federal matching rate to provide home- and community-based services.

However, rather than saying to States that they can only do so through the acceptance of a block grant, why can't we provide them this option without the imposition of a Federal limit on funding? Both states and beneficiary groups are asking for it and we can and should act.

It is on this point that I must add that the Medicaid program was not created for Federal officials or governors. We all clearly need to be reminded that there are other stakeholders in the Medicaid program, including the 43 million people served by the program.

As Alan Weil of the Urban institute and the former Medicaid director of the State of Colorado wrote in a recent article published in Health Affairs: ``If money is at the heart of debates over Medicaid, the millions of indigent people whose varied and complex medical needs are met by the program are its sole. The amount of human suffering the program alleviates is immense.''

As the Administration attempts to proceed on negotiations with the governors on a deal on block grants, let's not forget the children, mothers, seniors, and people with disabilities served by Medicaid. The SOS Act provides a far better alternative.

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

Mr. President, I thank my colleague for his statement and for yielding the floor.

Mr. President, today we are beginning a second attempt on the Senate floor--in the last Congress and this Congress--to craft a comprehensive national energy policy. Last year, as colleagues will remember, we passed an energy bill with an 81-to-11 vote. It was bipartisan. It was, in my view, a balanced approach to energy supply, energy efficiency, and many other important issues centrally related to energy, such as climate change.

This year, I first begin by congratulating Senator Domenici on the process he has followed and his success in getting an energy bill to the floor. We have had disagreements, and continue to have disagreements, on particular issues dealt with in the bill, but I appreciate very much the courtesy he has afforded to me and to my staff in the process he has followed in developing the bill.

In spite of the process that has been followed, I fear we are beginning with a bill that does not, at this point at least, command the same broad level of support perhaps that we were able to finally arrive at last year.

I voted against the bill as it came out of committee because I did not think it was a sufficiently balanced and comprehensive package. I hope by the time we are finished with floor consideration of the bill, the reservations that I and nearly every other Democratic member of the committee had can be addressed and that we can support the final product.

There can be no doubt that America needs a comprehensive and balanced energy policy for the 21st century. President Bush, when he ran for office in 2000, spoke of the need for such a comprehensive energy policy. Within 3 weeks of taking office in 2001, he had commissioned Vice President Cheney to lead a task force to develop and improve national energy policy.

The President was right in stating the need for such a policy. During the 1990s, energy prices had remained relatively stable due to at least three factors.

First, there was increased productivity which we benefited from substantially in the 1990s. Second, there was lower energy use per dollar of gross domestic product. Third, there was the introduction of market competition in sectors such as electricity.

All of these factors acted to hold down prices in spite of the very robust economic growth and increased demand for energy we saw in the 1990s.

Before the introduction of competition into energy markets in the 1980s and 1990s, we had national policies that required large excess capacity margins. Consumers paid a great deal for this excess capacity, but they also benefited from the buffer that capacity provided. It kept the system functioning as markets restructured. As the economic growth of the past decade has used up that excess capacity in the fuels and the power and the natural gas sectors, the frictions and imperfections in those markets became more apparent.

One obvious illustration of that development was the California electricity crisis. When electricity was in plentiful supply in the West, the flaws in the design of the California electricity system-- specifically the discouragement of long-term contracts and the near total reliance on the spot market to set electricity prices--were not so apparent. But when electricity suddenly became more scarce in 2000, due to unusually dry weather and increased demand in other Western States, those market flaws came to the fore. The result was very high prices for electricity and extraordinary financial stress on both California's regulated utilities and their consumers.

These market flaws were exacerbated by the unscrupulous behavior of a number of energy marketers and the inadequate initial responses by regulators. Even so, we should not lose sight of the overall lesson to be derived from that California electricity crisis. That is, the loss of our energy infrastructure cushion means future events will more easily highlight whatever energy market or regulatory flaws do exist. That makes it more important than ever for us to have a comprehensive national energy policy that proactively deals with market flaws before they result in a crisis.

In the energy policy plan issued by President Bush in May of 2001, his administration laid out a series of goals and objectives that generally made sense in terms of a proactive energy policy. Some of the themes he had were very similar to conclusions reached by a number of individual States that have formulated and adopted their own energy policies over the past several years. The President's proposal, though, came to Congress in a very generic fashion, without any legislative specifics. At no time during the last Congress or during this Congress so far have we ever received an actual legislative proposal on energy from the administration.

The task of taking the President's general statements and fashioning them into specifics has fallen to both the House of Representatives and the Senate. Of course, the two bodies of the Congress have interpreted those general principles in some very different ways. That proved to be a decisive factor in our inability to come to closure on energy legislation last Congress.

The approach I pursued in crafting an energy bill in the last Congress, and which was supported in the end by a substantial majority of Senators, was based on a number of basic principles. I believe these basic principles are crucial to any energy legislation we might consider, and the bill now before us deals with those principles only in part. Let me elaborate what those are.

First, and perhaps most important, we need an energy policy and an energy bill that strike a balance between measures to increase energy supplies and measures to encourage additional energy efficiency. To say we only need to increase energy production or we only need to increase conservation is to propose a fairly false choice. The reality is the country needs both kinds of measures.

On the supply side, perhaps one of the most important national goals is to meet our ever-growing demand for natural gas. Natural gas is the fuel of choice for most electric generation that is now being planned. It will play an important role in any new distributed generation that is planned in the future. It is favored by alternative fueled vehicle programs in both the Government and in the private sector. It is the most likely feedstock to produce hydrogen when and if we come to use hydrogen as a major fuel source. And apart from its energy uses, natural gas is also a critical feedstock in the petrochemical industry and in the fertilizer industry.

Because natural gas consumption is outstripping the amounts produced in the lower 48 States, we are in the early stages, as a Nation, of developing a national dependence on imported natural gas, particularly liquefied natural gas from countries with unstable politics. So just as we have for several decades now become more and more dependent upon imported oil to meet our energy needs, we now face the prospect of perhaps a growing dependence on imported natural gas as well.

At the same time this dependence on imported natural gas is growing, we have at least 33 trillion cubic feet of natural gas that is stranded on the North Slope of Alaska at Prudhoe Bay. That gas has been produced, along with the oil we are now producing from that location. But the gas is currently being pumped back into the ground because there is no way to transport it to the lower 48 States where it is needed. We need to provide effective incentives to the private sector to build a pipeline that can bring this gas to the lower 48 States. Such a project would be a boon not only to our national energy security but also to our domestic steel and construction industries.

On this topic, the bill now before us does a fairly good job. It has retained from last year's bill many of the regulatory streamlining measures on which I worked with Senator Frank Murkowski and that were included in last year's bill. There is a critical part of the problem we have not yet solved. That is to provide effective fiscal incentives for the pipeline to accompany what is now in the bill on the regulatory side. I hope we can add those effective fiscal incentives as we consider this bill in the Senate.

Along with providing more robust domestic supplies of natural gas, we obviously need to look for ways to diversify our energy generation away from such a strong reliance on gas in the coming years. Here I fear we have been less successful in the bill.

One important arena in which we can diversify our energy generation away from overreliance on gas is in electricity generation. Part of what must be done is to find new technology for existing sources of electricity supply. This means research and development on ultra clean ways to burn coal and research and development on new generation from safe nuclear powerplants. This bill, similar to last year's bill, does have very strong R&D programs on both topics, and Chairman Domenici deserves credit for those provisions.

Another key piece of the solution would be to tap into opportunities for distributed generation such as combined heat and power at industrial facilities. Here the bill begins to fall short, as it does not really address the barriers that have been erected to uniform interconnection of distributed generation to the grid.

It is not enough to have the technology. We need to rid ourselves of the redtape that is keeping this technology from being used, and this bill does not do that.

Along with these steps, though, we need to make a greater push to introduce renewable energy technologies for electricity generation. Some of these technologies--wind power in particular--are already cost competitive. But in order to see widespread exploitation of these opportunities, both financial and regulatory incentives will be needed. That means both a meaningful production tax credit for renewable energy, which I hope will be added as part of the package of tax provisions coming out of the Finance Committee, and also a flexible renewable portfolio standard for electric utilities. Both measures are essential, in my view, in order to give enough certainty to the fledgling market to allow economies of scale to drive down costs and improve the manufacturing capacity for renewable energy equipment in the United States.

The lack of an effective renewable portfolio as this bill comes to the floor is a major flaw. There are those who may argue that we should leave everything to the hypothetical free market. My problem with that is that electricity markets are not free markets, and renewable energy will not get a fair shake unless there is some pressure from us for that to happen. If the Senate does nothing in this bill to push forward on increasing the use of renewables in our electric system, then we will be making a choice in favor of the existing trends toward an overreliance on natural gas for future electricity generation. That choice will leave our citizens with future natural gas and electricity bills that are more volatile, resulting in more frequent price spikes.

Renewable energy technologies can help with another energy supply issue that we face, and that relates to transportation fuels. We already use renewable fuels, such as ethanol, to some extent as oxygenates in the winter formula for gasoline. But ethanol can make a greater contribution than this. A phased introduction of up to 5 billion gallons per year into our gasoline supply by 2012 is not, in my view, unreasonable. What we need to do, though, as we attempt such a transition, is to ensure that we do not wind up with a highly balkanized and inflexible system of fuel specifications around the country.

We already have a problem with so-called boutique fuel specifications in several parts of the country. These mandates for boutique fuels cause local price spikes to consumers when the specific formula for a specific area suddenly is in short supply. That can easily happen, for example, due to unexpected demand or shutdown problems at a refinery or at a pipeline.

Our national energy policy should be to use the transition to greater use of renewable fuels as a means of making sure we have a more rational national fuels system. This issue was not dealt with during the consideration of the bill in the Energy Committee and, as the chairman has indicated, we expect to be dealing with that on the floor perhaps as early as this week.

Even with the greater use of renewable fuels in cars, we will still be very dependent upon oil in the transportation sector. It is in our national interest to support the domestic production of oil. Many of our oil resources are not as economical to produce as those in the Middle East and elsewhere. This is largely because the U.S. has been producing oil longer than other places around the world. We have exhausted the easiest geologic formations.

When oil prices fall, our domestic producers lose their shirts faster than do their overseas competitors. Accordingly, our producers, in many cases, are forced to stop production. When prices start back up, though, their wells are not able to be restarted as easily as foreign wells.

An important policy to put in place, at both the Federal and State levels, would be to reduce taxes on oil production during times of low world prices, and restore those taxes when prices rebound. That sort of a countercyclical measure would help us to retain a significant amount of our domestic production that otherwise would be at risk.

In the Finance Committee, such incentives are part of the bipartisan package of tax provisions that we adopted which I expect will be added to this bill later in the Senate's consideration of the overall bill.

We also need to look to increase oil production in areas where it is generally agreed to move ahead. There are places, such as the Alaska National Wildlife Refuge, that are seen as having special environmental values that make oil production very controversial. Last year and this year, a solid bipartisan majority voted against opening the Arctic Refuge to oil development. I hope we do not spend a great deal of time on the Senate floor debating and reopening this issue. We spent a tremendous amount of time on it in the bill last year.

The proposal to open the Arctic Refuge is a dead end precisely because there are many areas with significant amounts of oil and gas that are not considered environmentally exceptional. We need to look to those areas.

For example, Alaska is also home to a Federal Reserve called the National Petroleum Reserve Alaska, NPRA. No less an environmentalist than Bruce Babbitt, a former Secretary of the Interior, strongly pushed for leasing of the NPRA for oil production when he was the Secretary of the Interior. He found strong industry interest, and there have been significant finds in that region. We should continue to support further leasing of NPRA as part of our national energy policy.

As another example, energy resources on Indian land in the U.S. have not been as extensively developed as they might be. According to the Bureau of Indian Affairs, over 90 Indian reservations have significant untapped energy resource potential. That includes oil and gas, coal, coalbed methane, wind, and geothermal resources. In last year's energy bill, I worked to see that we assisted these tribes in developing those resources.

Early this year I reintroduced many of those same provisions in a new bill, parts of which are incorporated into the bill that is now on the Senate floor. Unfortunately, in my view, the provisions have been marred by a proposal to make energy leasing on Indian lands both exempt from environmental analysis under NEPA, and exempt from the normal trust protections afforded Indian tribes. I fear this is a substantial flaw that needs to be addressed if the bill is to keep its balance among energy, environment, and the public interest.

Even with strong efforts to support domestic oil production, we are in a losing race with rising domestic oil consumption. We have gone from less than 25-percent dependence upon foreign oil at the time of the Arab oil embargo to over 50 percent today, with projections of well over 60-percent dependence a decade from now.

That brings us to the other important part of a national energy policy, and that is energy efficiency. If we are serious about reducing our dependence upon foreign oil, we have to address our ever-increasing national consumption of oil in the transportation sector. Greater vehicle fuel efficiency is clearly in the national interest.

According to a study Congress commissioned from the National Academy of Sciences, we now have the technology to realize significant gains in fuel efficiency without sacrificing either safety or passenger comfort. All we lack is the national will to make this a priority. That will was not on display in the last Congress when the Senate and House took only minimal steps to set higher standards for fuel efficiency. Similarly, it has not been on display in the bill that has now come before us. In fact, this bill contains a provision that will increase gasoline demand over current law by 11 billion gallons by 2020. I don't know how we can justify passing a bill that takes us in the wrong direction relative to what our national energy security requires.

Greater fuel efficiency is an answer to another energy problem that is

brewing. We are pretty close to the capacity limits of our present system of refineries and gasoline pipelines.

Refineries and pipelines are notoriously hard to site. We have not built a new petroleum refinery in this country in decades, and there are real limits to how much further we can add to the existing refineries. Unless we want to greatly add to the siting pressures we already have related to energy infrastructure, or unless we want to start importing much more refined gasoline than we now import, we need to push for more efficient use of the gasoline we already consume.

Energy efficiency is also a key element in maintaining a reliable and affordable system of electricity generation and transmission. New electricity infrastructure is also very difficult to site. President Bush's call for Federal eminent domain authority for new electricity transmission has not found many supporters in Congress.

We can reduce the pressure on our electric power grid and natural gas infrastructure by taking commonsense steps to improve the efficiency of end use of energy in buildings and appliances, and industry. Energy- efficient lighting, energy-efficient appliances, and energy-efficient buildings also generate benefits in terms of emission reductions and human health improvements, making them even more attractive as part of a comprehensive energy policy.

One of the unheralded success stories of last year's energy bill was a set of new standards and programs for energy efficiency that was developed cooperatively with the affected industries. These provisions survived intact. They have been expanded somewhat in this bill, and they have been reported as part of the bill now before us.

Last year's energy bill also reauthorized important Federal grant programs that helped low-income families pay their energy bills and reduce their energy costs, including LIHEAP, the Low-Income Home Energy Assistance Program, and State weatherization grants. Those programs continue to be a high priority in any new energy legislation. I hope we can add an effective measure along these lines early in our deliberations on this bill.

Our national commitment to increasing energy supply and increasing energy efficiency must involve a long-term commitment to the development of new energy technologies. Last year's energy bill established a framework for a comprehensive research and development program that would have addressed a variety of challenges on both the supply and demand sides of the energy equation. A robust commitment to a coordinated, comprehensive research and development program is essential if we are to meet the challenges that lie before us.

One of the biggest disappointments of the Bush administration to date is its lack of attention to the importance of science and technology in general and of energy research and development in particular. With the exception of the President's recent enthusiasm for hydrogen and fuel cells, an enthusiasm on which I certainly compliment him, the Bush administration has consistently proposed underfunding Department of Energy energy technology programs relative to their importance to our national security.

Federal energy technology R&D today is equivalent, in constant dollars, to what it was in 1966. Yet our economy is three times larger today than it was in 1966. It is hard to see how we can build a 21st century energy system on 1960s level-of-effort research and development budgets.

Fortunately, Congress has seen things somewhat differently than the administration. Last year and this year, energy bills in both the House and the Senate have attempted to rebuild energy R&D budgets in a rational way to levels that, by 2007 or 2008, would give us a robust energy R&D effort to support our national energy policy.

A final imperative for national energy policy and legislation has been to recognize the ways in which energy use and energy policy are intertwined with the topic of climate change.

Climate change is so closely related to energy policy because the two most prominent greenhouse gases--that is, carbon dioxide and methane-- are largely released due to energy production and use. In the United States, 98 percent of the CO2 emissions are energy related. Every study of how to mitigate the possibility of global change, climate change comes up with a list of policy measures that relies heavily on increased energy efficiency and new energy production technologies with lower greenhouse gas emissions.

Because of this intimate connection between energy and climate change, much of energy policy and much of climate change policy have to be discussed together. To do one, by implication, is to do the other; to ignore one while doing the other is to risk unfortunate and unintended consequences.

For this reason, last year the Senate was able to pass a bill with numerous provisions to ensure we integrate climate change strategy with energy policy, that we develop better climate change science, that we focus on breakthrough technologies with better environmental performance, and that the United States take the lead in exporting the clean energy technologies we develop.

These provisions were not propounded by fringe elements in the Senate. The bulk of them came from a bill that was introduced by Senator Byrd of West Virginia and Senator Stevens of Alaska. That bill was reported unanimously by the Senate Governmental Affairs Committee. Unfortunately, these provisions were resisted by the administration and were opposed by the Republican leadership in the House, which did not propose to address climate change in any way in the House energy bill. These provisions were also opposed in the Energy Committee by certain of the Senators. I regret that their views carried the day and that we were not able to move ahead at that time. But the opportunity still is ahead of us. I think leaving climate change out of an energy bill by the time we complete action on an energy bill would be a very shortsighted approach, both in terms of energy policy and in terms of our overall relations with others in the world.

Climate change proposals that I plan to propose and advance on the Senate floor will focus on programs which will protect the environment while being highly beneficial to U.S. industry. We need to make sure that our energy choices do not lead to inefficient or wasted energy investments that have to be written off prematurely because we did not consider their climate consequences. Industry needs to have certainty about rules of the road linking energy and climate.

In terms of our long-term economic prosperity, there are jobs to be created, worldwide markets to be captured in climate-friendly energy technologies of the future. So far, the energy bill we are considering does not measure up in this regard. I believe many in this body will share my view that addressing global warming is a major element required for any balanced energy policy.

Before I close, let me discuss what the chairman referred to as the most difficult and contentious issue we tried to deal with and have dealt with as we have worked on this bill; that is, the problem of how to regulate electricity markets in the future.

Our system for generating and transmitting electricity has been undergoing a profound transformation over the last decade as electricity markets become increasingly regional. That increases the degree to which consumers are affected by interstate commerce in electricity and, thereby, by factors that may be beyond the effective reach of State regulatory utility commissions.

During the California electricity crisis, we saw how decisions made in or for California affected consumers across the entire West. Well- functioning and well-regulated markets are in everyone's interests, although the way to get there was a matter of intense debate during consideration of the energy bill and is being strongly debated now in the context of FERC's so-called standard market design rulemaking, or

I suggest the absence of a quorum.

Mr. President, I ask unanimous consent that Dr. Jonathan Epstein, a legislative fellow in my office, and Ms. Poonum Agrawal, who is a Presidential management intern with the Energy Committee, both be given floor privileges during the pendency of S. 14 and any votes thereon.

Mr. President, I rise today to recognize the celebration of El dia de los ninos, a day for parents, families, and communities to celebrate, value, and uplift all children in the United States. As cochair of the Senate Democratic Hispanic Task Force, I believe it is important that we set aside a time to commemorate the essential role of children in the future of every nation. On this day, April 30, cities throughout the United States are promoting the well- being of children by hosting a variety of special events, including parades, book festivals, and health fairs. In my own State, for example, the New Mexico State University Library, in conjunction with the Southern New Mexico Engaging Latino Communities for Education Collaborative, ENLACE, is hosting an exhibit of bilingual, Spanish- English, children's books. This activity serves to help communities celebrate and promote the importance of reading in many languages.

As we continue to discuss the well-being of our children, I invite my colleagues to join with me in taking time on this day, El dia de los ninos, to rededicate ourselves to working together and acting on behalf of our children throughout the year.

Mr. President, yesterday I joined my colleagues in voting for S. 151, the PROTECT Act, legislation that is intended to help reduce the incidence of child abduction in our country. The bill passed unanimously on a vote of 98 to 0. I voted for this bill because I believe it contains many important and needed provisions, but I did so with reservations about a couple of different sections of the bill that, in my view, deserved further deliberation.

Before I discuss these reservations, let me start by discussing the most important provisions in this bill. First, this legislation establishes a national AMBER alert system, which includes the establishment of an AMBER alert coordinator within the Department of Justice to assist states with their AMBER alert plans, and which will help to eliminate gaps in the network through better regional coordination among plans. I was pleased to be a cosponsor of the stand- alone version of this bill in both the 107th and 108th Congresses. My home State of New Mexico already has an Amber alert plan, which was recently codified by our State legislature, and I am hopeful that this new Federal legislation will allow my State to receive funding under the new grant programs created by this bill.

Second, the bill includes the so-called ``Code Adam Act,'' which would require Federal buildings to establish procedures to locate a child that is missing in the building. The original Code Adam--one of the country's largest child safety programs--was created by Wal-Mart in 1994 and is now used in more than 36,000 stores nationwide. It is also supported by the National Center for Missing and Exploited Children

Third, in spite of the many extraneous provisions added by the House, the bill includes much of the original PROTECT Act, which passed the Senate unanimously last year. These provisions provide needed tools to prosecutors to help them deal with the problem of child pornography in a way that should pass constitutional muster. Congress first addressed this issue in the 1996 Child Pornography Protection Act, but a significant portion of that law was struck down by the Supreme Court last year. I am pleased with the work of the Senate Judiciary Committee in working through the issues raised by the Supreme Court in a thoughtful and bipartisan way, and I am hopeful that this new measure will help ensure that child pornographers are held accountable for their actions.

I would like to say a few words now about my reservations in voting for this bill. Title IV of the bill makes significant new changes to Federal sentencing procedures in the name of reform. While many of these changes may turn out to be beneficial, at no point in the legislative history of this bill was there an opportunity for critical questions to be raised and answered about these new sentencing reforms. Title IV was added in conference as an amendment with little opportunity for the minority to even read the amendment or engage in a thoughtful debate. Further, several of my colleagues on the Judiciary Committee have noted their objections to what they view as a misrepresentation of the amendment in conference. I do not believe this is the way in which we should do business, and I am disappointed that there was not an opportunity for my colleagues to debate their legitimate concerns further.

In particular, Senator Leahy raised concerns that this amendment could potentially undermine the Federal sentencing system and prevent judges from imposing just and responsible sentences. As justification, Senator Leahy cites remarks by Chief Justice Rehnquist on the nearly identical Feeney amendment, which was added to the bill on the House floor. In those remarks, the Chief Justice said, ``This legislation, if enacted, would do serious harm to the basic structure of the sentencing guideline system and would seriously impair the ability of courts to impose just and responsible sentences.''

Whether one agrees with the sentencing reform provisions in this bill or not, the very fact that the Chief Justice of the United States Supreme Court has voiced concerns about it leads me to believe that more time was needed for both the Senate and the House to consider the scope and potential impact of this legislation.

Finally, I would like to comment on another piece of the PROTECT Act, which was added as an amendment in conference by Senator Biden. The Illicit Drug Anti-Proliferation Act, previously known as the RAVE Act, modifies the current so-called ``crack house'' statute to make clear that anyone who knowingly or intentionally uses his or her property, or allows another person to use his or her property, for the purpose of distributing, manufacturing, or using illegal drugs will be held accountable. The provision also allows for civil suits against violators.

I have received many calls and letters from people in my State who have raised legitimate concerns about this legislation. While I fully support efforts to ensure that our youth do not fall victim to drugs, and while I understand that Senator Biden modified his bill slightly from the previous Congress to address concerns that were raised, I would have preferred that this legislation be allowed to go through the normal legislative process. This would have allowed a public airing of the many concerns that I have heard, and would have provided an opportunity for the Senate Judiciary Committee to address those concerns, as necessary.

I hope very much that during the remainder of this Congress we can revisit both these new provisions related to sentencing and the RAVE Act.

Mr. President, I rise today to introduce a bill entitled the Department of Energy Catalysis Research and Development Act.

Catalysis is at the heart of fuels production in the petroleum and chemical industries. Catalytic converters help reduce emissions of cars. Catalysis can help reduce carbon dioxide from industrial plants, which can contribute to global warming. The science of catalysis can help our pharmaceutical industry by one day mimicking nature's enzymes which are nature's catalysts. The industries I just mentioned contribute $500 billion to our gross national product; they all rely on catalysis to produce new compounds as efficiently as possible.

The catalysis science program is one of the hidden gems at the Department of Energy's Office of Science. The Department supports over 60 percent of the catalysis research in the Federal Government. I feel it is important that our energy bill highlights its basic research, and recommends a steady increase in funding levels for it.

The bill seeks to help the Department meet what it called the ''grand challenge'' in catalytic chemistry. The ``grand challenge'' which this bill seeks to address is first, the ability to design, at the atom level, catalytic structures to control ``catalytic activity'', or the rate at which a chemical reaction proceeds. The second part of this ``grand challenge'' is to control the ``selectivity'' of a catalytic reaction, or the ability of a catalytic compound to precisely seek out other chemicals through which to start a reaction. To achieve this `'grand challenge'', this bill directs the Department to design new catalytic compounds using the latest advancements in scientific computing. Today's computers are rapidly approaching a point where we can model a chemical reaction by simulating its atom level constituents. This bill directs the Department to utilize its state-of- the-art diagnostic equipment at its national laboratories and universities to analyze catalytic reactions in real time, and at the atomic level. These diagnostics will be used to validate computational models being developed in the advanced scientific computing program. This bill directs the Department to use the emerging field of nanoscience to tailor new catalytic compounds atom by atom, so as to accelerate reactions to produce clean fuels at rates that far exceed what we know today. In that regard, I expect the Department to utilize its nanoscience facilities to help design these new compounds. If we are successful in meeting this grand challenge, we will bring fuels to market quicker to meet increasing energy demands, while using less overall energy to produce them.

Finally, the bill directs the Secretary fund these efforts in multidisciplinary teams including computer scientists, chemists, biochemists, materials scientists and physicists. It requires the Department to transfer its catalysis research to industry so that they can bring to market the full fruits of our Government's advanced energy research in the shortest time possible.

We are currently debating an energy bill in the Energy and Natural Resources Committee. We plan to shortly mark up the research and development section, and, I think it is vitally important that this section address the topic of catalysis to produce future fuels for our Nation.

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

Mr. President, I rise today to introduce a bill entitled the Department of Energy Catalysis Research and Development Act.

Catalysis is at the heart of fuels production in the petroleum and chemical industries. Catalytic converters help reduce emissions of cars. Catalysis can help reduce carbon dioxide from industrial plants, which can contribute to global warming. The science of catalysis can help our pharmaceutical industry by one day mimicking nature's enzymes which are nature's catalysts. The industries I just mentioned contribute $500 billion to our gross national product; they all rely on catalysis to produce new compounds as efficiently as possible.

The catalysis science program is one of the hidden gems at the Department of Energy's Office of Science. The Department supports over 60 percent of the catalysis research in the Federal Government. I feel it is important that our energy bill highlights its basic research, and recommends a steady increase in funding levels for it.

The bill seeks to help the Department meet what it called the ''grand challenge'' in catalytic chemistry. The ``grand challenge'' which this bill seeks to address is first, the ability to design, at the atom level, catalytic structures to control ``catalytic activity'', or the rate at which a chemical reaction proceeds. The second part of this ``grand challenge'' is to control the ``selectivity'' of a catalytic reaction, or the ability of a catalytic compound to precisely seek out other chemicals through which to start a reaction. To achieve this `'grand challenge'', this bill directs the Department to design new catalytic compounds using the latest advancements in scientific computing. Today's computers are rapidly approaching a point where we can model a chemical reaction by simulating its atom level constituents. This bill directs the Department to utilize its state-of- the-art diagnostic equipment at its national laboratories and universities to analyze catalytic reactions in real time, and at the atomic level. These diagnostics will be used to validate computational models being developed in the advanced scientific computing program. This bill directs the Department to use the emerging field of nanoscience to tailor new catalytic compounds atom by atom, so as to accelerate reactions to produce clean fuels at rates that far exceed what we know today. In that regard, I expect the Department to utilize its nanoscience facilities to help design these new compounds. If we are successful in meeting this grand challenge, we will bring fuels to market quicker to meet increasing energy demands, while using less overall energy to produce them.

Finally, the bill directs the Secretary fund these efforts in multidisciplinary teams including computer scientists, chemists, biochemists, materials scientists and physicists. It requires the Department to transfer its catalysis research to industry so that they can bring to market the full fruits of our Government's advanced energy research in the shortest time possible.

We are currently debating an energy bill in the Energy and Natural Resources Committee. We plan to shortly mark up the research and development section, and, I think it is vitally important that this section address the topic of catalysis to produce future fuels for our Nation.

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

Mr. President, I rise today to introduce the Business Links Act, on behalf of myself, Senator Rockefeller and Senator Breaux.

The Business Links Act is a companion bill to the Education Works Act, which I introduced a short time ago. Both of these bills address the need to support State efforts to use welfare to work strategies that combine work with a flexible mix of education, training and other supports. The Business Links Act, more specifically, provides resources to States seeking to implement one of the most effective of these types of programs: transitional jobs programs. These programs provide subsidized, temporary, wage-paying jobs for 20 to 35 hours a week, along with access to job readiness, basic education, vocational skills, and other barrier-removal services based on individualized plans. The Business Links Act would provide states with funding to implement these transitional jobs programs and other training and support programs such as Business Links.

Existing transitional jobs programs are achieving great outcomes. Research has shown that 81 percent to 94 percent of those who completed transitional jobs programs went on to unsubsidized jobs with wages, and that most of these individuals moved into full-time employment. Transitional jobs can be particularly effective for the hardest to serve welfare recipients. For people who face barriers, or who lack the skills or experience to compete successfully in the labor market, paid work in a supportive environment, together with access to needed services provides a real chance to move into stable, permanent employment. Transitional jobs not only help individuals, but communities as well. In providing work opportunities for hard-to-employ individuals, these programs reduce pressure on local emergency systems and decrease government expenditures on health care, food stamps, and cash assistance.

Our legislation also supports ``business link'' programs that provide individuals with fewer barriers and those who have historically found only very low wage employment with intensive training and skill development activities designed to lead to long-term, higher paid employment. These programs are based on partnerships with the private sector. In my home State, just such a program is producing great results the Teamworks program. During a 12-week course, participants are provided with training in life and employment skills, necessary supports such as childcare and transportation, assistance in their job search efforts and ongoing support for 18 months after job placement. Impressively, the average wage of those completing the program is $1.50 per hour higher than other programs and job retention rates are 20 percent higher.

Additional Federal support for transitional job and business link programs is sorely needed. The Welfare-to-work funds that have previously been used to support these programs are nearly exhausted. In addition, in a period of rising caseloads and state budget crises such as we are now facing, funding transitional jobs solely with existing TANF funds will be very difficult.

I urge my colleagues to join me in supporting the Business Links Act, which will provide States with the tools they need to implement programs that work. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I rise today to introduce the Business Links Act, on behalf of myself, Senator Rockefeller and Senator Breaux.

The Business Links Act is a companion bill to the Education Works Act, which I introduced a short time ago. Both of these bills address the need to support State efforts to use welfare to work strategies that combine work with a flexible mix of education, training and other supports. The Business Links Act, more specifically, provides resources to States seeking to implement one of the most effective of these types of programs: transitional jobs programs. These programs provide subsidized, temporary, wage-paying jobs for 20 to 35 hours a week, along with access to job readiness, basic education, vocational skills, and other barrier-removal services based on individualized plans. The Business Links Act would provide states with funding to implement these transitional jobs programs and other training and support programs such as Business Links.

Existing transitional jobs programs are achieving great outcomes. Research has shown that 81 percent to 94 percent of those who completed transitional jobs programs went on to unsubsidized jobs with wages, and that most of these individuals moved into full-time employment. Transitional jobs can be particularly effective for the hardest to serve welfare recipients. For people who face barriers, or who lack the skills or experience to compete successfully in the labor market, paid work in a supportive environment, together with access to needed services provides a real chance to move into stable, permanent employment. Transitional jobs not only help individuals, but communities as well. In providing work opportunities for hard-to-employ individuals, these programs reduce pressure on local emergency systems and decrease government expenditures on health care, food stamps, and cash assistance.

Our legislation also supports ``business link'' programs that provide individuals with fewer barriers and those who have historically found only very low wage employment with intensive training and skill development activities designed to lead to long-term, higher paid employment. These programs are based on partnerships with the private sector. In my home State, just such a program is producing great results the Teamworks program. During a 12-week course, participants are provided with training in life and employment skills, necessary supports such as childcare and transportation, assistance in their job search efforts and ongoing support for 18 months after job placement. Impressively, the average wage of those completing the program is $1.50 per hour higher than other programs and job retention rates are 20 percent higher.

Additional Federal support for transitional job and business link programs is sorely needed. The Welfare-to-work funds that have previously been used to support these programs are nearly exhausted. In addition, in a period of rising caseloads and state budget crises such as we are now facing, funding transitional jobs solely with existing TANF funds will be very difficult.

I urge my colleagues to join me in supporting the Business Links Act, which will provide States with the tools they need to implement programs that work. I ask unanimous consent that the text of the bill be printed in the Record.