Floor Statements

Mr. President, I rise today to introduce the Medicare Independent Living Act of 2006 with Senators Santorum, Murray, Collins, Akaka, Jeffords, Kerry, Harkin, Kennedy, and Lieberman. This legislation would eliminate Medicare's ``in the home'' restriction for the coverage of mobility devices, including wheelchairs and scooters, for those with disabilities and expected long-term needs. This includes people with multiple sclerosis, paraglegia, osteoarthritis, and cerebrovascular disease that includes acute stroke and conditions like aneurysms.

As currently interpreted by the Centers for Medicare and Medicaid Services, CMS, the ``in the home'' restriction prevents beneficiaries from obtaining wheelchairs that are necessary for use outside the home. This precludes beneficiaries who need a wheelchair to access work, the community at-large, his or her place of worship, school, physician's offices, or pharmacies.

On July 13, 2005, 34 senators wrote Secretary Leavitt asking the Department of Health and Human Services, or HHS, to modify the ``in the home'' requirement so as to ``improve community access for Medicare beneficiaries with mobility impairments.''

Unfortunately, CMS continues to impose the ``in the home'' restriction on Medicare beneficiaries in need of mobility devices. The result is that people who may not need a wheelchair to get around their house but do need one to get around their communities, such as to a job, church, or the grocery store, can't get Medicare to pay for one. As the Medicare Rights Center in a report entitled ``Forced Isolation: Medicare's `In The home' Coverage Standards for Wheelchairs'' in March 2004 notes, ``This effectively disqualifies you from leaving your home without the assistance of others.''

Furthermore, in a Kansas City Star article dated July 3, 2005, Mike Oxford with the National Council on Independent Living noted, ``You look at mobility assistance as a way to liberate yourself.'' He added that the restriction ``is just backward.''

In fact, policies such as these are not only backward but directly contradict numerous initiatives aimed at increasing community integration of people with disabilities, including the Americans with Disabilities Act, the Ticket-to-Work Program, the New Freedom Initiative, and the Olmstead Supreme Court decision.

According to the Medicare Rights Center update dated March 23, 2006, ``This results in arbitrary denials. People with apartments too small for a power wheelchair are denied a device that could also get them down the street. Those in more spacious quarters get coverage, allowing them to scoot from room to room and to the grocery store. People who summon all their willpower and strength to hobble around a small apartment get no help for talks that are beyond them and their front door.''

In New Mexico, I have heard this complaint about the law repeatedly from our State's most vulnerable disabled and senior citizens. People argue the provision is being misinterpreted by the administration and results in Medicare beneficiaries being trapped in their home.

The ITEM Coalition adds in a letter to CMS on this issue in November 25, 2005, ``There continues to be no clinical basis for the `in the home' restriction and by asking treating practioners to document medical need only within the home setting, CMS is severely restricting patients from receiving the most appropriate devices to meet their mobility needs.''

Therefore, our bipartisan legislation would clarify that this restriction does not apply to mobility devices, including wheelchairs, for people with disabilities in the Medicare Program. The language change is fairly simple and simply clarifies that the ``in the home'' restriction for durable medical equipment does not apply in the case of mobility devices needed by Medicare beneficiaries with expected long- term needs for use ``in customary settings such as normal domestic, vocational, and community activities.''

This legislation is certainly not intended to discourage CMS from dedicating its resources to reducing waste, fraud, and abuse in the Medicare system, as those efforts are critical to ensuring that Medicare remains financially viable and strong in the future. However, it should be noted that neither Medicaid nor the Department of Veterans Affairs impose such ``in the home'' restrictions on mobility devices. As Senator Brownback said to the Kansas City Star, it is important to lift the restriction ``to reflect our goal of ensuring that Americans with disabilities are able to live independent, healthy, and productive lives.''

I thank Senators Santorum, Murray, Collins, Akaka, Jeffords, Kerry, Harkin, Kennedy, and Lieberman for cosponsoring this important legislation, and attached is a fact sheet that I request to be printed in the Record. I would also ask unanimous consent to have printed in the Record copies of the letter to the administration and the response that was received by Capitol Hill.

Mr. President, I rise today to introduce the Medicare Independent Living Act of 2006 with Senators Santorum, Murray, Collins, Akaka, Jeffords, Kerry, Harkin, Kennedy, and Lieberman. This legislation would eliminate Medicare's ``in the home'' restriction for the coverage of mobility devices, including wheelchairs and scooters, for those with disabilities and expected long-term needs. This includes people with multiple sclerosis, paraglegia, osteoarthritis, and cerebrovascular disease that includes acute stroke and conditions like aneurysms.

As currently interpreted by the Centers for Medicare and Medicaid Services, CMS, the ``in the home'' restriction prevents beneficiaries from obtaining wheelchairs that are necessary for use outside the home. This precludes beneficiaries who need a wheelchair to access work, the community at-large, his or her place of worship, school, physician's offices, or pharmacies.

On July 13, 2005, 34 senators wrote Secretary Leavitt asking the Department of Health and Human Services, or HHS, to modify the ``in the home'' requirement so as to ``improve community access for Medicare beneficiaries with mobility impairments.''

Unfortunately, CMS continues to impose the ``in the home'' restriction on Medicare beneficiaries in need of mobility devices. The result is that people who may not need a wheelchair to get around their house but do need one to get around their communities, such as to a job, church, or the grocery store, can't get Medicare to pay for one. As the Medicare Rights Center in a report entitled ``Forced Isolation: Medicare's `In The home' Coverage Standards for Wheelchairs'' in March 2004 notes, ``This effectively disqualifies you from leaving your home without the assistance of others.''

Furthermore, in a Kansas City Star article dated July 3, 2005, Mike Oxford with the National Council on Independent Living noted, ``You look at mobility assistance as a way to liberate yourself.'' He added that the restriction ``is just backward.''

In fact, policies such as these are not only backward but directly contradict numerous initiatives aimed at increasing community integration of people with disabilities, including the Americans with Disabilities Act, the Ticket-to-Work Program, the New Freedom Initiative, and the Olmstead Supreme Court decision.

According to the Medicare Rights Center update dated March 23, 2006, ``This results in arbitrary denials. People with apartments too small for a power wheelchair are denied a device that could also get them down the street. Those in more spacious quarters get coverage, allowing them to scoot from room to room and to the grocery store. People who summon all their willpower and strength to hobble around a small apartment get no help for talks that are beyond them and their front door.''

In New Mexico, I have heard this complaint about the law repeatedly from our State's most vulnerable disabled and senior citizens. People argue the provision is being misinterpreted by the administration and results in Medicare beneficiaries being trapped in their home.

The ITEM Coalition adds in a letter to CMS on this issue in November 25, 2005, ``There continues to be no clinical basis for the `in the home' restriction and by asking treating practioners to document medical need only within the home setting, CMS is severely restricting patients from receiving the most appropriate devices to meet their mobility needs.''

Therefore, our bipartisan legislation would clarify that this restriction does not apply to mobility devices, including wheelchairs, for people with disabilities in the Medicare Program. The language change is fairly simple and simply clarifies that the ``in the home'' restriction for durable medical equipment does not apply in the case of mobility devices needed by Medicare beneficiaries with expected long- term needs for use ``in customary settings such as normal domestic, vocational, and community activities.''

This legislation is certainly not intended to discourage CMS from dedicating its resources to reducing waste, fraud, and abuse in the Medicare system, as those efforts are critical to ensuring that Medicare remains financially viable and strong in the future. However, it should be noted that neither Medicaid nor the Department of Veterans Affairs impose such ``in the home'' restrictions on mobility devices. As Senator Brownback said to the Kansas City Star, it is important to lift the restriction ``to reflect our goal of ensuring that Americans with disabilities are able to live independent, healthy, and productive lives.''

I thank Senators Santorum, Murray, Collins, Akaka, Jeffords, Kerry, Harkin, Kennedy, and Lieberman for cosponsoring this important legislation, and attached is a fact sheet that I request to be printed in the Record. I would also ask unanimous consent to have printed in the Record copies of the letter to the administration and the response that was received by Capitol Hill.

Mr. President, I thank my colleagues for their courtesy. I call up amendment No. 4591 and ask for its immediate consideration.

Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. President, this amendment is the Border Law Enforcement Relief Act which I have introduced before, along with Senators Domenici, Cornyn, and Hutchison. I offer this amendment on behalf of all of us again. It provides local law enforcement agencies in border communities with much-needed assistance in combatting border- related criminal activity.

During the debate on the immigration bill, this same legislation was proposed and agreed to by the Senate with a vote of 84 in favor and 6 against.

For far too long, law enforcement agencies that operate along the border have had to incur significant costs due

to the inability of the Federal Government to secure our Nation's borders. It is time the Federal Government recognize that border communities should not have to bear that burden alone.

Specifically, the amendment establishes a competitive grant program within the Department of Homeland Security to help local law enforcement agencies that are situated along the borders cover some of the costs they incur as a result of dealing with illegal immigration, drug trafficking, stolen vehicles, and other border-related crimes.

The amendment authorizes $50 million a year and enables law enforcement within 100 miles of the border to hire additional personnel, to obtain necessary equipment, and to cover the cost of overtime and transportation costs. Law enforcement outside of this geographic limit, this 100-mile limit, would be eligible if the Secretary of Homeland Security certified they were located in what we designate as a ``high impact area.''

The United States shares 5,525 miles of border with Canada and 1,989 miles of border with Mexico. Many of the local law enforcement agencies that are located along the border are small. They are rural departments charged with patrolling large areas of land with few officers and with very limited resources. According to a 2001 study of the U.S.-Mexico Border Counties Coalition, criminal justice costs associated with illegal immigration exceed $89 million every year. Counties along the southwest border are some of the poorest in the country and are not in a good position to cover these additional costs.

The States of Arizona and New Mexico have declared states of emergency in order to provide local law enforcement with immediate assistance in addressing criminal activity along the border. It is time, in my view, that the Federal Government step up and share some of that burden. So I urge my colleagues to support this important measure and to give law enforcement the resources they need to meet these challenges.

Mr. President, I met last week with sheriffs and local police chiefs in communities along the southern New Mexico border with Mexico and talked to them about the challenges they face and the need for additional personnel, the need for modern equipment. Clearly, they are faced with a very significant challenge because of the increased illegal activity going on along our U.S.-Mexico border. The assistance provided in this amendment is assistance that would be very important to them in carrying out their responsibilities to the citizens of those communities.

So I urge my colleagues again to support this amendment. I am informed this is an amendment the chairman has indicated might be acceptable. I am hoping we can have a vote, but I will at this point yield the floor until my colleague who is managing the bill can respond to the amendment.

Mr. President, I object for just a minute. My understanding is we were going to dispose of my amendment before we--

Mr. President, I'm pleased today to join my colleague Senator Domenici in sponsoring the Pueblo of Isleta Settlement and Natural Resources Restoration Act. This bill would settle a longstanding dispute over federal mismanagement of lands that resulted in lands within the Pueblo being rendered unusable due to water intrusion. The money provided under the settlement would be designated towards remedying these losses.

Like any settlement, I imagine neither side is completely happy with the result but it is a significant step and will begin the process of restoring inundated lands and acquiring substitute lands. I am happy both sides were able to work out their differences and come up with a solution we can support in Congress. I hope that, in addition to the financial commitment in the bill, the Department of Interior will continue to be a partner with the Pueblo in achieving the restoration of their lands.

I hope my colleagues will join us to quickly move this legislation along so we can begin to restore these lands for the people of the Pueblo of Isleta.

Mr. President, I rise today to introduce legislation with Senators Lautenberg, Menendez, Dorgan, Kennedy, Stabenow, Dayton, Johnson, Clinton, and Akaka entitled the ``Helping to Fill the Medicare Rx Gap Act of 2006.'' This legislation and companion legislation to be introduced by Congressman Dingell fixes an important problem for Medicare beneficiaries and safety net providers by allowing costs incurred by AIDS Drug Assistance Programs, ADAPs, the Indian Health Service, IHS, federally qualified health centers, certain safety net hospitals, and pharmaceutical manufacturer-sponsored Patient Assistance Programs, PAPs--entities that provide prescription drugs or drug assistance for populations under their care--to count toward a beneficiary's annual out-of-pocket threshold as established under the Medicare Modernization Act, MMA.

With the Medicare drug benefit now in effect for more than six months, approximately 3.4 million seniors are reaching the point at which coverage is eliminated until they reach the catastrophic limit. Under the MMA, Medicare pays 75 percent of drug costs until a beneficiary's expenses reach $2,250 in a year. Then it stops paying until costs exceed $5,100, leaving a so-called ``doughnut hole'' of $2,850 that seniors are expected to manage on their own. According to the Kaiser Family Foundation, about 6.9 million Medicare beneficiaries will have to deal with a gap in their drug coverage at some point this year.

An important part of the MMA's prescription drug benefit requires the tracking of beneficiaries' ``true out-of-pocket'' costs, TrOOP, to determine the point at which a beneficiary becomes eligible for catastrophic coverage. In an additional effort to constrain the cost of the prescription drug benefit, the MMA limited the types of expenditures that could count toward a beneficiary's TrOOP, including only:

Cost-sharing related to the annual deductible; costs borne by the Part D enrollee (or contributions by friends or family members on the beneficiary's behalf); contributions from qualifying State Pharmacy Assistance Programs, SPAPs; contributions from eligible charitable organizations; and waivers or reductions by commercial pharmacies of cost-sharing requirements of Medicare prescription drug plans.

Under current law, costs incurred by AIDS Drug Assistance Programs, Indian Health Service, IHS, pharmacies, community health centers, and certain safety net hospital pharmacies on behalf of Part D enrollees during their coverage gap--i.e. while the enrollee is in the so-called ``doughnut hole''--are not permitted to count for TrOOP purposes. In turn, many individuals with HIV/AIDS, Native Americans, and other low- income individuals receiving assistance through community health centers or other qualified safety net hospital pharmacies are never able to reach the catastrophic limit--the point at which Medicare would pay 95 percent of the beneficiary's drug costs. As a result, these beneficiaries are forced to pay premiums to their Medicare drug plan and to absorb the monthly drug costs for a benefit they are not able to access.

A study that was recently published in the New England Journal of Medicine found that prescription drug plans that include doughnut hole- like coverage gaps may lower beneficiary drug costs but any savings are offset by increases in the costs of hospitalizations and emergency room use. Specifically, the study found that patients with such capped benefits had higher rates of nonelective hospitalizations, visits to the emergency department, and even death. It certainly is not surprising that the coverage gap will result in many Americans going without needed medications but it is important to note that overall medical costs are not reduced and that providers will be disproportionately affected when the doughnut hole is reached.

And just when charity pharmaceutical assistance programs are needed most, the current policy is making it difficult for pharmaceutical companies to continue to provide free pharmaceuticals to our nation's poor elderly. The HHS OIG has issued guidance that prohibits costs incurred on behalf of Part D beneficiaries by pharmaceutical manufacturer-sponsored Pharmaceutical Assistance Programs, PAPs-- programs run by the pharmaceutical industry that provide free or low- cost drugs to eligible poor and low-income individuals to count toward a patient's TrOOP due to concerns that providing drugs through these programs might violate the federal anti-kickback statute. The anti- kickback statute prohibits offering or receiving payment to increase the use of products or services--in this case, to steer prescription drug use--at the cost of Federal health care programs. In turn, several pharmaceutical manufacturers are considering terminating their PAPs to avoid running afoul of the law. According to a January article in the Washington Post, 37 pharmaceutical companies donated 22 million prescriptions worth $4.1 billion through PAPs. Across the Nation seniors who benefit from these programs are fearful that they will be forced to go off needed medications or to go into bankruptcy if these programs are not available to help them.

While HHS is working with the pharmaceutical industry to develop guidelines that would allow PAPs to continue to operate in compliance with current law, the HHS OIG maintains that PAP costs will not be permitted to count toward a patient's TrOOP in any circumstance. As a result, similar to the ADAPs, IHS pharmacies, community health centers and safety net hospital pharmacies, PAPs that provide prescription drugs for patients during the coverage gap are forced to become the ``payer of last resort'' because the costs they incur are not permitted to count toward TrOOP expenses and thus, the patient is unable to reach the catastrophic limit.

Pharmacy Assistance Programs, AIDS Drug Assistance Programs, community health centers, and safety net hospital pharmacies will maintain their commitment to provide assistance to low-income senior citizens and people with disabilities in the coverage gap but the current policy imposes a significant financial burden on our nation's health care safety net. While we all recognize the importance of controlling costs, this policy stands to harm vulnerable beneficiaries and safety net providers by permitting the Medicare program to shift the cost burden on to a variety of other federal programs, including discretionary safety net programs, and PAPs. It does not make sense that the Federal Government pays private drug plans a capitated rate to provide services and beneficiaries pay monthly premiums to Medicare while ADAPs, IHS pharmacies, community health centers and certain safety net hospital pharmacies and pharmaceutical manufacturer PAPs are left to shoulder the cost of providing prescription medications to their population of enrollees who will never reach the catastrophic limit. Just as current policy allows SPAP spending to count toward the catastrophic limit so should the costs incurred by these entities.

In addition, this legislation would correct the inequity in the current policy which unfairly discriminates between beneficiaries who receive their prescription drugs from commercial pharmacies and those who receive their medications through PAPs or from safety net pharmacies run by the IHS, community health centers, and certain public hospitals. Currently, only commercial pharmacies' waivers or reductions in Medicare Part D cost-sharing requirements are allowed to count towards TrOOP. This legislation would prevent lower-income Medicare beneficiaries from getting trapped in the doughnut hole by leveling the playing field so that beneficiaries who get their drugs through PAPs or pharmacies run by the IHS, community health centers, or public hospitals pharmacies can move just as quickly toward the catastrophic coverage benefit.

Mr. President, I urge your support for this important legislation to allow Part D-related costs incurred by ADAPs, IHS, federally qualified health centers, and certain safety net hospitals as well as pharmaceutical manufacturer PAPs to count toward a beneficiary's TrOOP expenses. This bill would ensure that all Part D enrollees are permitted appropriate access to the catastrophic coverage that was promised under the MMA.

Mr. President, I commend to my colleagues the New England Journal of Medicine study entitled ``Unintended Consequences of Caps on Medicare Drug Benefits,'' and I ask unanimous consent that the Washington Post article and the text of the bill to be printed in the Record.

Mr. President, I'm pleased today to join my colleague Senator Domenici in sponsoring the Pueblo of Isleta Settlement and Natural Resources Restoration Act. This bill would settle a longstanding dispute over federal mismanagement of lands that resulted in lands within the Pueblo being rendered unusable due to water intrusion. The money provided under the settlement would be designated towards remedying these losses.

Like any settlement, I imagine neither side is completely happy with the result but it is a significant step and will begin the process of restoring inundated lands and acquiring substitute lands. I am happy both sides were able to work out their differences and come up with a solution we can support in Congress. I hope that, in addition to the financial commitment in the bill, the Department of Interior will continue to be a partner with the Pueblo in achieving the restoration of their lands.

I hope my colleagues will join us to quickly move this legislation along so we can begin to restore these lands for the people of the Pueblo of Isleta.

Mr. President, I rise today to introduce legislation with Senators Lautenberg, Menendez, Dorgan, Kennedy, Stabenow, Dayton, Johnson, Clinton, and Akaka entitled the ``Helping to Fill the Medicare Rx Gap Act of 2006.'' This legislation and companion legislation to be introduced by Congressman Dingell fixes an important problem for Medicare beneficiaries and safety net providers by allowing costs incurred by AIDS Drug Assistance Programs, ADAPs, the Indian Health Service, IHS, federally qualified health centers, certain safety net hospitals, and pharmaceutical manufacturer-sponsored Patient Assistance Programs, PAPs--entities that provide prescription drugs or drug assistance for populations under their care--to count toward a beneficiary's annual out-of-pocket threshold as established under the Medicare Modernization Act, MMA.

With the Medicare drug benefit now in effect for more than six months, approximately 3.4 million seniors are reaching the point at which coverage is eliminated until they reach the catastrophic limit. Under the MMA, Medicare pays 75 percent of drug costs until a beneficiary's expenses reach $2,250 in a year. Then it stops paying until costs exceed $5,100, leaving a so-called ``doughnut hole'' of $2,850 that seniors are expected to manage on their own. According to the Kaiser Family Foundation, about 6.9 million Medicare beneficiaries will have to deal with a gap in their drug coverage at some point this year.

An important part of the MMA's prescription drug benefit requires the tracking of beneficiaries' ``true out-of-pocket'' costs, TrOOP, to determine the point at which a beneficiary becomes eligible for catastrophic coverage. In an additional effort to constrain the cost of the prescription drug benefit, the MMA limited the types of expenditures that could count toward a beneficiary's TrOOP, including only:

Cost-sharing related to the annual deductible; costs borne by the Part D enrollee (or contributions by friends or family members on the beneficiary's behalf); contributions from qualifying State Pharmacy Assistance Programs, SPAPs; contributions from eligible charitable organizations; and waivers or reductions by commercial pharmacies of cost-sharing requirements of Medicare prescription drug plans.

Under current law, costs incurred by AIDS Drug Assistance Programs, Indian Health Service, IHS, pharmacies, community health centers, and certain safety net hospital pharmacies on behalf of Part D enrollees during their coverage gap--i.e. while the enrollee is in the so-called ``doughnut hole''--are not permitted to count for TrOOP purposes. In turn, many individuals with HIV/AIDS, Native Americans, and other low- income individuals receiving assistance through community health centers or other qualified safety net hospital pharmacies are never able to reach the catastrophic limit--the point at which Medicare would pay 95 percent of the beneficiary's drug costs. As a result, these beneficiaries are forced to pay premiums to their Medicare drug plan and to absorb the monthly drug costs for a benefit they are not able to access.

A study that was recently published in the New England Journal of Medicine found that prescription drug plans that include doughnut hole- like coverage gaps may lower beneficiary drug costs but any savings are offset by increases in the costs of hospitalizations and emergency room use. Specifically, the study found that patients with such capped benefits had higher rates of nonelective hospitalizations, visits to the emergency department, and even death. It certainly is not surprising that the coverage gap will result in many Americans going without needed medications but it is important to note that overall medical costs are not reduced and that providers will be disproportionately affected when the doughnut hole is reached.

And just when charity pharmaceutical assistance programs are needed most, the current policy is making it difficult for pharmaceutical companies to continue to provide free pharmaceuticals to our nation's poor elderly. The HHS OIG has issued guidance that prohibits costs incurred on behalf of Part D beneficiaries by pharmaceutical manufacturer-sponsored Pharmaceutical Assistance Programs, PAPs-- programs run by the pharmaceutical industry that provide free or low- cost drugs to eligible poor and low-income individuals to count toward a patient's TrOOP due to concerns that providing drugs through these programs might violate the federal anti-kickback statute. The anti- kickback statute prohibits offering or receiving payment to increase the use of products or services--in this case, to steer prescription drug use--at the cost of Federal health care programs. In turn, several pharmaceutical manufacturers are considering terminating their PAPs to avoid running afoul of the law. According to a January article in the Washington Post, 37 pharmaceutical companies donated 22 million prescriptions worth $4.1 billion through PAPs. Across the Nation seniors who benefit from these programs are fearful that they will be forced to go off needed medications or to go into bankruptcy if these programs are not available to help them.

While HHS is working with the pharmaceutical industry to develop guidelines that would allow PAPs to continue to operate in compliance with current law, the HHS OIG maintains that PAP costs will not be permitted to count toward a patient's TrOOP in any circumstance. As a result, similar to the ADAPs, IHS pharmacies, community health centers and safety net hospital pharmacies, PAPs that provide prescription drugs for patients during the coverage gap are forced to become the ``payer of last resort'' because the costs they incur are not permitted to count toward TrOOP expenses and thus, the patient is unable to reach the catastrophic limit.

Pharmacy Assistance Programs, AIDS Drug Assistance Programs, community health centers, and safety net hospital pharmacies will maintain their commitment to provide assistance to low-income senior citizens and people with disabilities in the coverage gap but the current policy imposes a significant financial burden on our nation's health care safety net. While we all recognize the importance of controlling costs, this policy stands to harm vulnerable beneficiaries and safety net providers by permitting the Medicare program to shift the cost burden on to a variety of other federal programs, including discretionary safety net programs, and PAPs. It does not make sense that the Federal Government pays private drug plans a capitated rate to provide services and beneficiaries pay monthly premiums to Medicare while ADAPs, IHS pharmacies, community health centers and certain safety net hospital pharmacies and pharmaceutical manufacturer PAPs are left to shoulder the cost of providing prescription medications to their population of enrollees who will never reach the catastrophic limit. Just as current policy allows SPAP spending to count toward the catastrophic limit so should the costs incurred by these entities.

In addition, this legislation would correct the inequity in the current policy which unfairly discriminates between beneficiaries who receive their prescription drugs from commercial pharmacies and those who receive their medications through PAPs or from safety net pharmacies run by the IHS, community health centers, and certain public hospitals. Currently, only commercial pharmacies' waivers or reductions in Medicare Part D cost-sharing requirements are allowed to count towards TrOOP. This legislation would prevent lower-income Medicare beneficiaries from getting trapped in the doughnut hole by leveling the playing field so that beneficiaries who get their drugs through PAPs or pharmacies run by the IHS, community health centers, or public hospitals pharmacies can move just as quickly toward the catastrophic coverage benefit.

Mr. President, I urge your support for this important legislation to allow Part D-related costs incurred by ADAPs, IHS, federally qualified health centers, and certain safety net hospitals as well as pharmaceutical manufacturer PAPs to count toward a beneficiary's TrOOP expenses. This bill would ensure that all Part D enrollees are permitted appropriate access to the catastrophic coverage that was promised under the MMA.

Mr. President, I commend to my colleagues the New England Journal of Medicine study entitled ``Unintended Consequences of Caps on Medicare Drug Benefits,'' and I ask unanimous consent that the Washington Post article and the text of the bill to be printed in the Record.

Mr. President, I speak on behalf of an amendment being offered by Senator Byrd which would enhance funding for border security infrastructure. I am pleased to be a cosponsor of this important legislation, and I thank the Senator from West Virginia for his hard work on this important bill.

The amendment would provide an additional $350 million for critical border security needs. The amendment would allocate $105 million for customs and border protection to purchase new Border Patrol replacement helicopters, fixed wing aircraft, and additional unmanned aerial vehicles. And $25 million is added to the bill to purchase approximately 540 additional replacement vehicles for the Border Patrol.

The amendment would also provide an additional $90 million for tactical infrastructure. This funding can be used to construct vehicle barrier, fencing, and facility upgrades. This funding will be of great assistance to the state of New Mexico, where such upgrades are needed to secure our border. The underlying bill allocates about $57 million for tactical infrastructure in Arizona and about $30 million for San Diego. However, the El Paso Sector, which includes the entire State of New Mexico, is only provided about $7.5 million. The additional $90 million under this amendment will help ensure that New Mexico receives the resources that it needs.

The amendment would also prove $30 million for ICE to purchase 800 vehicles, including buses and vans, used to transport undocumented immigrants. And USCIS is allocated $38 million to enhance fraud detection systems.

These additional resources are greatly needed and I urge my colleagues to support this important measure.

Mr. President, I'm pleased today to join my colleague Senator Domenici in sponsoring the Albuquerque Indian School Act. This bill would direct the Secretary of Interior to take lands no longer being used by the Bureau of Indian Affairs in Albuquerque and hold them in trust for the benefit of the 19 pueblos. The bill disallows gaming on the property.

In addition to being a good thing for the pueblos, this transfer promises to be beneficial to the surrounding community, as several deteriorating structures will be renewed and new jobs brought in. Since the bill would not alter the standard public process for taking the lands into trust, I hope this will result in a consensus among all concerned on the best uses of the property.

I am pleased we are taking the first step today on a process that should be beneficial to the pueblos, the Federal Government, and local residents.

Mr. President, I'm pleased today to join my colleague Senator Domenici in sponsoring the Albuquerque Indian School Act. This bill would direct the Secretary of Interior to take lands no longer being used by the Bureau of Indian Affairs in Albuquerque and hold them in trust for the benefit of the 19 pueblos. The bill disallows gaming on the property.

In addition to being a good thing for the pueblos, this transfer promises to be beneficial to the surrounding community, as several deteriorating structures will be renewed and new jobs brought in. Since the bill would not alter the standard public process for taking the lands into trust, I hope this will result in a consensus among all concerned on the best uses of the property.

I am pleased we are taking the first step today on a process that should be beneficial to the pueblos, the Federal Government, and local residents.

Mr. President, I rise today to commend the efforts and extraordinary dedication of the volunteer firefighters and emergency rescue teams throughout New Mexico who have been working tirelessly to assist in fighting fires and meeting the needs of citizens throughout the State as they cope with the worst fire season in decades.

It has already been an incredibly difficult fire season for the people of the Southwest. New Mexico is suffering a drought of historic proportions. The State spent the winter preparing for a summer fire season they hoped wouldn't happen. Unfortunately, the worst fears of the State are quickly becoming a reality. By the end of June, more than 100,000 acres of land will have burned and the State will have already faced more than 20 named fires and countless unnamed fires of varying size and intensity. Hundreds of people have been evacuated, property lost, and communities changed forever. Bear Paw, Rivera Mesa, Energen, Martinez, Skates, Bear, Eicks, Wilson, and Malpais, are the names of just a few of the large fires that the State has already faced this year.

Throughout this time I have been deeply impressed by the work of Federal, State, Tribal, and local fire fighters. But the work of these professionals would be impossible without the commitment of the volunteer firefighters and rescue teams who have unfailingly answered the call to service. These volunteers exemplify the best spirit of New Mexico. They have courageously worked the fire lines, offered their support and a shoulder to cry on, provided a bed and warm meal to evacuees, and helped to corral and move pets and livestock out of harm's way. They do all this while some of their own families and homes face the same fire danger. While I am not surprised at the selflessness of my fellow New Mexicans, I am forever grateful to these volunteers.

The work of these volunteer firefighters and rescue teams has been essential in meeting the challenges of a very active fire season. Throughout New Mexico volunteer firefighters and rescue teams have responded at all times of the day and night. Some have worked for many days in a row to ensure that all the needs of their community were met and the necessary resources were in place. Their bravery and selflessness has been an example to all New Mexicans, and I strongly commend them for their work.

I know that I am joined today by every New Mexican in saying thank you to our volunteer firefighters and rescue teams and in the hope for their continued safety in the face of the fire dangers they face.

Mr. President, I am pleased to introduce legislation today to protect a site of worldwide scientific significance in the Robledo Mountains in New Mexico. The bill, which is cosponsored by my colleague from New Mexico, Senator Domenici, would create a national monument to preserve and allow for the continuing scientific investigation of a remarkable ``megatracksite'' of 280,000,000 year-old fossils and trackways.

The vast tidal mudflats that made up much of modern New Mexico 60 million years before the first dinosaurs preserved the marks of some of the earliest life on our planet to make its way out of the ocean. The fossil record of this time is scattered throughout New Mexico but, until this discovery, there were few places where the range of life and their interactions with each other could be studied.

Las Cruces resident and paleontologist Jerry MacDonald first brought the find to light in 1988 when he revealed that there was far more to be found in the Robledos than the occasional fossil that local residents had been seeing for years. The trackways he hauled out on his back, some over 20 feet long, showed that there was a great deal of useful information buried in the rock there. The trackways include footprints of numerous amphibians, reptiles, and insects, including previously unknown species. These trackways help complete the puzzle of how these ancient creatures lived in a way that we cannot understand from only studying their fossilized bones.

Senator Domenici and Representative Skeen joined me in sponsoring legislation, passed in 1990, to protect the area and study its significance. In 1994, the Bureau of Land Management, along with scientists from the New Mexico Museum of Natural History & Science, the University of Colorado, and the Smithsonian Institution, completed their study and documented the importance of the find. Particularly owing to the quality of the specimens and the wide range of animals that had left their imprint there, the study found that the site was of immense scientific value. The study concluded, in part, ``[t]he diversity, abundance and quality of the tracks in the Robledo Mountains is far greater than at any other known tracksite or aggregation of tracksites.'' The study also described the site as containing ``the most scientifically significant Early Permian tracksites'' in the world. However, despite the recognition of the significance of the site, it has remained essentially unprotected, and many of the trackways and fossils have been lost or damaged. This bill would take the next logical step to follow up from these efforts and set in place permanent protections and allow for scientific investigation of these remarkable resources.

In addition to permanently protecting the fossils, the bill would authorize the continuation of existing uses in the area, such as motorized recreation, as long as the trackway resources aren't harmed. The bill would also help ensure that local residents get the opportunity to see these unique specimens and participate in their curation. This should provide a unique scientific and educational opportunity to Las Cruces and the surrounding community.

I look forward to working with my colleagues to protect these important resources and allow for their continuing contribution to our understanding of life on the ancient Earth.

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

Mr. President, I rise today to introduce legislation entitled the Save Our Safety--SOS--Net Act of 2006. This legislation will help repair the fraying safety net that provides critical health care to patients throughout the United States. This legislation is important to the continued survival of many of our Nation's emergency departments and rural hospitals that provide services to millions of American's on a daily basis. It is these facilities that are there for us in the most remote regions of the country, it is these facilities that are there for us at all times of day and night, and it is these facilities that will be there for us in time of disaster. We need to take the steps to ensure the survival of this safety net.

This week, The Institute of Medicine's--IOM--Committee on the Future of Emergency Care in the United States Health System released a series of reports detailing the problems facing emergency care in the U.S. These reports make it clear that emergency departments--EDs--struggle daily with overcrowding, ambulance diversion, the boarding of admitted patients in the ED, limited staffing, and poor reimbursement. They face all of these challenges while continuing to provide access to safe, high-quality care without regard to ability of the patient to

pay for their care. Similarly, rural hospitals face shortages of staff and specialists, poor reimbursement, and the isolation that sometimes complicates medical care. This system is stressed and is poorly prepared to accept the additional burdens that could occur in a disaster or terrorist attack. These safety net systems and the people who work within them deserve our support and yet the trends are not promising.

The demand for emergency departments has been growing fast. In the recent study conducted by the Institute of Medicine, emergency department visits grew by 26 percent between 1993 and 2003, but due to lack of funding 425 emergency departments have closed resulting in almost 200,000 less hospital beds in the U.S. In my own State of New Mexico, we have seen a decrease from 4.2 to 3.6 beds per 1,000 population from 1990 to 2002. Ambulances are frequently diverted from overcrowded emergency departments an average of once every minute. With the growth of the number of elderly patients and the growth of uninsured patients seeking care in the ED, these statistics will only worsen if nothing is done.

There are approximately 535 sole community hospitals in 46 States. Congress has long recognized the special role of these facilities, because they serve as safety net providers offering hospital services to isolated communities and regions. These hospitals struggle with poor reimbursement and difficulty finding staff. Despite the service they provide, these facilities face the possibility of closing on a yearly basis.

To improve the ability of our safety net facilities to function, this bill proposes several steps. By improving Medicare payments for emergency department services, this bill would provide SOS payments to physicians and hospitals for the care that is provided in the emergency department. It would improve reimbursement to emergency departments by an additional 10 percent for outpatient services delivered to Medicare beneficiaries.

This legislation will also permanently extend outpatient hold harmless payment protections to some of the Nation's most vulnerable institutions, small rural hospitals and sole community hospitals that serve as safety net providers in rural communities.

Finally, to further strengthen the rural hospital safety net, this bill will improve disproportionate share hospital--DSH--payments to these facilities. Congress has historically provided additional payments to health care providers who treat large numbers of indigent patients. Disproportionate share hospital payments are made in addition to the base payments hospitals receive from the Medicare and Medicaid Programs for inpatient services. This bill will eliminate the cap that is present on DSH add-on payments to rural hospitals. This will remove some of the inequities between urban and rural hospitals.

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

Mr. President, I am pleased to introduce legislation today to protect a site of worldwide scientific significance in the Robledo Mountains in New Mexico. The bill, which is cosponsored by my colleague from New Mexico, Senator Domenici, would create a national monument to preserve and allow for the continuing scientific investigation of a remarkable ``megatracksite'' of 280,000,000 year-old fossils and trackways.

The vast tidal mudflats that made up much of modern New Mexico 60 million years before the first dinosaurs preserved the marks of some of the earliest life on our planet to make its way out of the ocean. The fossil record of this time is scattered throughout New Mexico but, until this discovery, there were few places where the range of life and their interactions with each other could be studied.

Las Cruces resident and paleontologist Jerry MacDonald first brought the find to light in 1988 when he revealed that there was far more to be found in the Robledos than the occasional fossil that local residents had been seeing for years. The trackways he hauled out on his back, some over 20 feet long, showed that there was a great deal of useful information buried in the rock there. The trackways include footprints of numerous amphibians, reptiles, and insects, including previously unknown species. These trackways help complete the puzzle of how these ancient creatures lived in a way that we cannot understand from only studying their fossilized bones.

Senator Domenici and Representative Skeen joined me in sponsoring legislation, passed in 1990, to protect the area and study its significance. In 1994, the Bureau of Land Management, along with scientists from the New Mexico Museum of Natural History & Science, the University of Colorado, and the Smithsonian Institution, completed their study and documented the importance of the find. Particularly owing to the quality of the specimens and the wide range of animals that had left their imprint there, the study found that the site was of immense scientific value. The study concluded, in part, ``[t]he diversity, abundance and quality of the tracks in the Robledo Mountains is far greater than at any other known tracksite or aggregation of tracksites.'' The study also described the site as containing ``the most scientifically significant Early Permian tracksites'' in the world. However, despite the recognition of the significance of the site, it has remained essentially unprotected, and many of the trackways and fossils have been lost or damaged. This bill would take the next logical step to follow up from these efforts and set in place permanent protections and allow for scientific investigation of these remarkable resources.

In addition to permanently protecting the fossils, the bill would authorize the continuation of existing uses in the area, such as motorized recreation, as long as the trackway resources aren't harmed. The bill would also help ensure that local residents get the opportunity to see these unique specimens and participate in their curation. This should provide a unique scientific and educational opportunity to Las Cruces and the surrounding community.

I look forward to working with my colleagues to protect these important resources and allow for their continuing contribution to our understanding of life on the ancient Earth.

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

Mr. President, I rise today to introduce legislation entitled the Save Our Safety--SOS--Net Act of 2006. This legislation will help repair the fraying safety net that provides critical health care to patients throughout the United States. This legislation is important to the continued survival of many of our Nation's emergency departments and rural hospitals that provide services to millions of American's on a daily basis. It is these facilities that are there for us in the most remote regions of the country, it is these facilities that are there for us at all times of day and night, and it is these facilities that will be there for us in time of disaster. We need to take the steps to ensure the survival of this safety net.

This week, The Institute of Medicine's--IOM--Committee on the Future of Emergency Care in the United States Health System released a series of reports detailing the problems facing emergency care in the U.S. These reports make it clear that emergency departments--EDs--struggle daily with overcrowding, ambulance diversion, the boarding of admitted patients in the ED, limited staffing, and poor reimbursement. They face all of these challenges while continuing to provide access to safe, high-quality care without regard to ability of the patient to

pay for their care. Similarly, rural hospitals face shortages of staff and specialists, poor reimbursement, and the isolation that sometimes complicates medical care. This system is stressed and is poorly prepared to accept the additional burdens that could occur in a disaster or terrorist attack. These safety net systems and the people who work within them deserve our support and yet the trends are not promising.

The demand for emergency departments has been growing fast. In the recent study conducted by the Institute of Medicine, emergency department visits grew by 26 percent between 1993 and 2003, but due to lack of funding 425 emergency departments have closed resulting in almost 200,000 less hospital beds in the U.S. In my own State of New Mexico, we have seen a decrease from 4.2 to 3.6 beds per 1,000 population from 1990 to 2002. Ambulances are frequently diverted from overcrowded emergency departments an average of once every minute. With the growth of the number of elderly patients and the growth of uninsured patients seeking care in the ED, these statistics will only worsen if nothing is done.

There are approximately 535 sole community hospitals in 46 States. Congress has long recognized the special role of these facilities, because they serve as safety net providers offering hospital services to isolated communities and regions. These hospitals struggle with poor reimbursement and difficulty finding staff. Despite the service they provide, these facilities face the possibility of closing on a yearly basis.

To improve the ability of our safety net facilities to function, this bill proposes several steps. By improving Medicare payments for emergency department services, this bill would provide SOS payments to physicians and hospitals for the care that is provided in the emergency department. It would improve reimbursement to emergency departments by an additional 10 percent for outpatient services delivered to Medicare beneficiaries.

This legislation will also permanently extend outpatient hold harmless payment protections to some of the Nation's most vulnerable institutions, small rural hospitals and sole community hospitals that serve as safety net providers in rural communities.

Finally, to further strengthen the rural hospital safety net, this bill will improve disproportionate share hospital--DSH--payments to these facilities. Congress has historically provided additional payments to health care providers who treat large numbers of indigent patients. Disproportionate share hospital payments are made in addition to the base payments hospitals receive from the Medicare and Medicaid Programs for inpatient services. This bill will eliminate the cap that is present on DSH add-on payments to rural hospitals. This will remove some of the inequities between urban and rural hospitals.

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

Mr. President, today marks the anniversary of the passage of a sense-of-the-Senate resolution on climate change. One year ago the Senate convened to debate the appropriate policy direction for the United States on this issue.

The Senate debate on climate change included discussions on various proposals from Senators Hagel and Pryor, as well as Senators McCain and Lieberman and others. Although I had worked very closely with Senator Domenici on a specific policy proposal of our own, we were not able in the time allotted to find agreement on various aspects of that proposal. We ultimately decided that we should put the question to the Senate of whether or not our efforts should continue over the remainder of the 109th Congress.

I am pleased to say that passage of the sense-of-the-Senate resolution gave us the foundation to continue our collaboration. Over the course of the last year, I have worked with Chairman Domenici and others to explore the basic workings of a mandatory market-based system to limit greenhouse gases. We have held hearings in the Energy Committee, participated in workshops and conferences, and engaged interested stakeholders through a White Paper process that culminated in an important day-long conference in April.

Other Members of this body have been actively engaged in the continuing conversation, such as Senators Carper, Feinstein, Lugar, and Biden just to name a few, but it is important for us to recognize how much faster this issue is progressing outside of Washington, DC.

The European Union Emissions Trading Scheme is in its second year of existence. There has been some debate about how the program is progressing, but there is no debate about the fact that they are moving forward and addressing global warming in a ground-breaking manner. Here in the United States, my colleagues from California and the Northeastern States are intimately aware of State initiatives to address global warming. My own State of New Mexico has been a leader in reducing emissions as well.

Most importantly, I think we need to recognize how much we have learned in the past year about the science of climate change. Last year, the National Academies of Science from 11 countries, including the United States, declared that ``scientific understanding of climate change is now sufficiently clear to justify nations taking prompt action.'' According to NASA scientists, 2005 was the warmest year since the late 1800s. 1998, 2002, 2003, and 2004 followed as the next four warmest years.

With regard to the impacts of global warming, a recent study shows that we are on track to initiate the melting of the Greenland ice sheet, which will contribute to continued sea-level rise and will also have major impacts on oceanic circulation from freshwater influx. Even small amounts of sea-level rise will have substantial impacts on coastal erosion, increased susceptibility to storm surges and groundwater contamination by salt intrusion. The effect on many of the world's coastal areas and population centers could be devastating.

We are also in the early stages of hurricane season. I have not yet seen any studies that would indicate global warming will create more hurricanes, but I have seen two recent studies that conclude that the warming we are seeing in the world's oceans is caused by human-induced climate change. In addition, there are more studies that have recently concluded that the intensity of individual hurricanes has increased, which in part is attributed to the warming of the oceans.

In conclusion, I believe that this is evidence that we need to act now. Since the sense-of-the-Senate resolution passed last year, the U.S. has emitted roughly 6 billion metric tons of carbon dioxide. EIA forecasts continued steady emissions growth at a rate that, if not slowed and ultimately stopped and reversed, will make it increasingly difficult to avoid dangerous climate impacts.

I want to thank Senators Domenici and Specter, along with all of the cosponsors of the sense-of-the-Senate Resolution and everyone who supported it. We have learned a great deal over the course of the last year, and I would like to continue the progress. I would like to urge all of my colleagues who are interested in this issue to work with us to find a solution we can implement sooner, rather than later.

I would like the references to some of the studies I have mentioned printed in the Record so that others can review them as well.

Mr. President, I rise today to speak about an amendment that I intended to offer to the Defense Authorization bill to address the situation in Guantanamo Bay, Cuba.

The amendment would have required that the United States charge, repatriate, or release individuals held at Guantanamo within 180 days of the enactment of the Defense Authorization bill. If for some reason the Government failed to comply within the timeframe provided under the amendment, the Department of Defense would have to provide a report regarding why they have not complied. The amendment would not have closed Guantanamo, and nothing in the amendment would have required the Government to release individuals who are a threat to our national security.

I think this is a reasonable approach. These are all options that the President has said that he is moving forward on. I have decided, however, not to offer my amendment at this time for a number of reasons. First, given the looming cloture vote, it is clear we will not have time to have a full and open debate on this issue. I believed that this is an important issue that deserved more time. I have also been advised by other Senators that they need additional time to study the proposal.

I strongly believe that the indefinite imprisonment of persons without charges is inconsistent with the traditions and values of the United States, and that it will continue to cause difficulty in our relations with other nations, including the allies that we rely on in confronting the threat of terrorism.

As President Bush said on June 14, 2006:

No question, Guantanamo sends a signal to some of our

friends--provides an excuse, for example, to say the United

States is not upholding the values that they're trying to

encourage other countries to adhere to.

I think the President is right.

According to an article in today's Miami Herald, Retired Army GEN Barry McCaffery, who recently visited Guantanamo, said: ``We are in a political and legal mess that is beyond belief'' and political leaders need to fix the ``legal schizophrenia'' that exists by continuing to hold individuals at Guantanamo.

I completely agree, and it is my hope that the Senate will afford time to debate this issue in the near future.