Floor Statements

Mr. President, I thank the distinguished ranking member of the Finance Committee.

Amendment No. 975, As Modified

Mr. President, in accordance with the agreement just entered into, I send a modification of my amendment to the desk and ask for its immediate consideration.

Mr. President, this amendment ensures that the Medicare prescription drug benefit we are debating is, in fact, truly universal. It is a principle we have all espoused over the years.

The underlying bill, which we are debating, precludes Medicare beneficiaries who are eligible for Medicaid from enrolling in the Medicare drug benefit. That would be the first time ever that Medicare beneficiaries would be, in fact, precluded from being Medicare beneficiaries.

The group, which is referred to as dual eligibles, consists of those who are the poorest seniors. They are those who have incomes below 74 percent of poverty. If my colleagues are interested, that income level is $6,645. That is their total gross income. The majority of them are single. The majority of them are women who are in poor health and more likely to be over the age of 85.

Precluding these people is wrong, and my amendment would fix it. I am happy to say the amendment is budget neutral. I will explain that in a minute.

Prescription drugs are optional as a benefit under Medicaid. We all know that. States can limit the number of prescriptions they make available. Some allow two or three prescriptions per year. They can cap the benefits. They can charge any copayments they want. They can end it altogether.

So you have States, predictably, already in a situation with very different Medicaid levels. Because of our financial situation nationally, and in our States, Medicaid is always going to be the very first benefit which will be cut. It has already happened, and will happen substantially more over the coming years.

I remind, again, my colleagues these are the poorest of the poor, the oldest of the old, and the sickest of the sick we are talking about.

I strongly urge my colleagues to provide all of the seniors in their States with the benefit of a real Medicare drug benefit by supporting this amendment.

If a State gets to the position where it is simply unable to continue with prescription drugs under the Medicaid program, and they virtually eliminate it, that poor person, below 74 percent of poverty--which is just a little bit over $6,000 a year--has nowhere else to go. Always-- including presently--that person can return to Medicare. This underlying bill would preclude that from happening. My amendment would fix that in a budget-neutral fashion.

I hope my colleagues will support this amendment which I consider one of the most moral and humane of amendments that has come before this body on this issue.

I thank the Presiding Officer.

Mr. President, this next amendment has to do with dual eligibility. Never in the history of Medicare have we precluded Medicare beneficiaries from being Medicare beneficiaries. In the underlying bill, for the very first time, we do.

The people I refer to are called dual eligibles. Their average income is $6,500 a year. They tend to be over 85, single women, and very sick. They are on Medicaid. Medicaid, however, is optional according to the States. We know the States to be broke. The fastest growing expense they face is Medicaid. So they are cutting the benefits. They are cutting Medicaid. They will continue to do that. The States have no choice but to cut Medicaid. Some will do it because they wish to, all will do it because they have to.

When that possibility is gone, there is no place for these poorest of the poor to go. They are then, under the underlying bill, precluded from being Medicare beneficiaries. That is wrong. In my budget-neutral amendment I attempt to fix it. I hope my colleagues will support the amendment.

Mr. President, I yield 3 minutes to the Senator from Connecticut.

Mr. President, the argument made by the Senator from Pennsylvania is interesting because what he is basically saying is that it is more important that corporate America not be allowed to keep one out of three of their people they currently sponsor, who are retirees who worked for them and who have been getting health benefits from them, out of the picture.

He talked about the cost to corporate America. My sort of worry is about the cost to the U.S. Government. That is what we do if we don't pass my amendment; we just dump everything on the U.S. Government.

So this amendment will make sure we do not jeopardize the drug coverage of millions of retirees, one out of every three, who already receive drug coverage from employer-sponsored plans. This amendment is going to ensure that the contributions made on the beneficiaries' behalf by their former employers count toward that beneficiary meeting the catastrophic limit. That is not now the case.

Employer-sponsored retiree health benefits are the single greatest source of coverage for retirees--the Presiding Officer understands what I am saying--the single greatest source of retiree health benefits available. In fact, 37 percent of all retirees who have corporate- sponsored plans simply lose them if this does not pass.

I hope we will pass my amendment. It is worse for employees. It is worse for employers. I hope my colleagues will support the amendment.

Mr. President, before offering my amendments, I am going to discuss both of them because they are being reviewed, at this point, in the majority cloakroom. But I am going to be offering two amendments this afternoon in order.

The first amendment I will offer is to ensure that all Medicare beneficiaries will be eligible for this new drug benefit, including low-income Medicare beneficiaries who are currently eligible for Medicaid and Medicare. They are known as dual eligibles.

The underlying bill precludes Medicare beneficiaries--makes it impossible for Medicare beneficiaries--who are eligible to receive a drug benefit through Medicaid from, in fact, enrolling in the Medicare drug benefit program.

This group is referred to as the dual-eligible group. They are the poorest seniors under Medicare. They are below 74 percent of poverty. That is their income level. A disproportionate share of them--to wit, 42 percent--are minorities. Women make up the majority of them all. Many are likely to have a poor education, live alone, and have more than two chronic illnesses.

The underlying bill precludes these folks that I have just talked about--these duel-eligible beneficiaries--from receiving the Medicare drug benefit. As a result, this prescription drug benefit is not, in fact, at all a universal bill. Now, that is important in a lot of ways. One is philosophical and the other is extremely practical.

The philosophical one is that in 1965, when we created Medicare, it was created as a universal benefit to all who qualify. It was the promise that society made to our seniors: That if you work, if you make your payroll contributions, then you, at the proper time, qualify for Medicare regardless of where you live, regardless of how old you might be, or your income.

As I have noted before, the underlying legislation, for the first time in the history of the Medicare Program, would prohibit some Medicare beneficiaries from receiving a Medicare benefit.

My amendment would make the Medicare prescription drug benefit a universal benefit by adopting the provisions that were, in fact, contained in the tripartisan proposal introduced last summer.

It would eliminate the exclusion of Medicaid beneficiaries and make the new Medicare Part D drug benefit--that is the new part we are creating--available to all Medicare beneficiaries regardless of income. Medicaid would be the secondary payer for Medicare beneficiaries eligible for Medicaid wrapping around this new Part D drug benefit and its low-income protections.

Again, this is exactly the same construction the majority of my Republican colleagues supported in the Grassley-Snowe-Hatch-Jeffords- Breaux Medicare bill that was voted on by the full Senate last summer. The National Governors Association sent a letter to Chairman Grassley and Senator Baucus which said the following about the exclusion of some of these seniors, that is, the dual-eligible seniors, those at 74 percent or below the poverty level, from Medicare:

The nation's Governors oppose this approach. It is not good

health policy. It is not good precedent. A major reason that

States currently have a long-run structural problem in their

fiscal outlook is that they have absorbed responsibility for

dual eligibles.

They go on to say:

This provision will continue to shift appropriate federal

costs to the states.

Governors Patton of Kentucky and Kempthorne of Idaho went on to say:

If the dual eligible populations continue to be a joint

responsibility, states will be forced to cut the optional

(Medicaid) benefits and populations--mostly women and

children--which are a key investment in the future.

The President agrees. In a speech he recently gave on Medicare, he said:

And all low-income seniors should receive extra help so

that all seniors will have the ability to choose a Medicare

option that includes a prescription drug benefit.

The Medicare prescription drug legislation being considered by the House of Representatives would shift the entire drug bill to Medicare. It is not on a frequent day that Chairman Thomas and I are in full agreement. But he does say such a shift ``ensures that all seniors across the country will have access to affordable prescription drugs, while alleviating much of the burden that states now confront.'' I say to my colleagues, as I indicate, I am not always in agreement, but we are going forward directly together on this policy, I hope.

The current system is uncoordinated and sometimes conflicting in terms of coverage policies. It actually creates worse health outcomes for people on both Medicaid and Medicare, either one. Fully integrating a key benefit for prescription drugs into Medicare is a critical first step toward improving the current system's flaws.

It needs to be clearly understood by my colleagues that Medicaid in the hands of Governors, which I had the honor of being at one point, is subject to whatever their whims might be. It is subject to budget pressures. Remember, they have to balance the budget. We don't; they do. And they frequently do it on the backs of Medicaid beneficiaries-- that is, that part of these Medicare-Medicaid dual eligibles--so they can increase the number of prescription drugs which are available under Medicaid in their State. They can change it in many ways because the programs vary widely. Not only is it unfair to exclude the poorest seniors from part of the Medicare program, it is a raw deal for some of our neediest seniors.

Prescription drugs are, as I said, an optional benefit under Medicaid. States can and do limit the number of prescriptions. Some States only cover three drugs or they could charge any copayments they want. Remember, what we are looking at here is a group of people who are below 74 percent of poverty which is clearly in single-digit gross income. So the patchwork of the benefits varies tremendously from State to State. For seniors who have worked all their lives, paid into the Medicare system, it is not fair for them to be at the mercy of State coverage decisions.

If you look around the country right now, the fastest growing expense of any State is Medicaid, part of this dual-eligible conundurm, and those programs are being cut. You can see it, read about it, and hear about it. So it is highly volatile, and it is not safe health care policy.

Medicare has failed in its efforts to provide comprehensive prescription drug coverage to seniors ever since the

repeal of the Medicare Catastrophic Act in 1988. Virtually all advances in drug coverage for seniors since then have been delivered not by us but by the States. While at the same time the States have been cutting back in recent years, they have also made improvements. We have done nothing. They have done whatever has been done.

Without some long-term restructuring of the State-Federal partnership for this population, this dual-eligible, 74-percent-of-poverty-minus population, much of the advances the States have made will be lost. All Medicare beneficiaries deserve to receive Medicare benefits. There should be no exceptions for drugs. It would be very bad precedent to make Medicaid pay for items that are clearly the responsibility of Medicare except at the present and in this bill for one particular discrete population.

The intention is for this amendment to be budget neutral. I would like to say it is budget neutral, but I cannot in that I asked CBO for a cost estimate last week and I do not yet have one.

This is a concern and an agony shared by many. Once we have this estimate, we will either conclude that we can go ahead because we will know it is budget neutral or I will be happy to work with the chairman and ranking member on appropriate offsets.

I urge my colleagues to provide all the seniors in their States with the benefit of real Medicaid drug benefit by supporting this amendment.

I will at the appropriate time ask that it be acted upon. I am awaiting a particular series of sheets of paper but in the meantime, in the minute or so that will require, I send to the desk an amendment and ask for its immediate consideration.

Mr. President, I also have the amendment for which I just spoke. I ask unanimous consent that that be brought to the desk for its consideration and the pending amendment be set aside.

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

Mr. President, I wish to proceed with the amendment I was going to offer first but which will be my second amendment. That also will await the decision of the leadership.

Mr. President, I come to the floor again to offer an amendment that will ensure that contributions made on a beneficiary's behalf by their former employers count toward that beneficiary meeting the catastrophic limit. Let me just say, as I begin this, in our Finance Committee deliberations, it was this amendment which caused more stir, more angst, more sense of, oh, my heavens, we have not really done this, have we? We could not have made this mistake involving this many people. The amendment was handled in Finance--without success, from my point of view. Nevertheless, I was urged by colleagues on both sides of the aisle to bring this amendment to the floor because it has enormous implications. That will become apparent, hopefully, as I complete my statement.

This amendment is needed to protect the existing coverage of literally millions and millions of retirees who have earned drug coverage through their employer. That means they have been employed much of their lives by their employer and they have now retired and they are Medicare beneficiaries and the employer gave retiree benefits. We are accustomed to this in chemical, steel, and many other industries. But there is a problem that has arisen.

As much as we want to provide a new drug benefit for these seniors, we should not disrupt the basically foundational employer-provided drug coverage so many seniors have today. It is the largest source of drug coverage in the country and it is an honorable and a good one. It would be a very great mistake for my colleagues to walk away from this system and one that we would all very much regret.

Mr. President, in saying that employer-sponsored retiree health benefits are the largest single source of coverage for retirees, I simply say that one in every three Medicare beneficiaries is affected by the amendment I am now discussing. They will either lose their coverage or they will not, depending upon how this amendment is disposed.

Drug costs constitute 40 to 60 percent of employers' retiree health care costs. That is a lot. And steep price increases are prompting employers to, one, eliminate drug benefits in some circumstances; secondly, cap their contributions; thirdly, drop retiree coverage altogether. We all know this is a phenomenon of American life that has been going on in recent years.

Employers need immediate relief for their retiree prescription drug costs. A Medicare prescription drug benefit should relieve some of the burden on employers by covering a retiree's cost after a certain catastrophic limit. I recognize this gets technical, but it is profound. Instead, this benefit extends the amount of time before a retiree reaches that catastrophic benefit of about $4,000 by not being able to count as the employee's contribution--in fact, the employer's contribution toward that end is very substantial. Therefore, the employer receives no real relief from this benefit and is forced to drop the coverage they currently provide their retirees, leaving Medicare to pay the entire cost.

I think I do not have to explain that that means the Federal Government has to pick up even more of the cost of Medicare and prescription drugs than would otherwise be the case, for example, if this amendment were to pass.

The bill we are considering on the floor today exacerbates the current downward trend in retiree benefits by extending the amount of time the beneficiary relies on the employer before reaching the catastrophic limit. What does that say? It says if you extend the amount of time the employee has to keep paying and paying toward his catastrophic limit for a much longer time, there is therefore much more out-of-pocket costs to the employee.

This legislation discriminates against Medicare beneficiaries with employer-provided coverage with a trick definition--that is what is used--of out-of-pocket costs known, uninterestingly, as the ``true'' out-of-pocket costs. This plan would not allow any spending by employers to count toward meeting the catastrophic limit. In this way, the underlying legislation limits the overall spending by the Medicare Program at the expense of employers who offer retiree coverage.

The result is CBO estimates, as I indicated, that 37 percent of beneficiaries currently receiving a drug benefit from their employee will lose that coverage. Additionally, it extends the amount of time, as I have indicated, a beneficiary has to reach the catastrophic limit, exposing them to additional and more and more costs. I think we should all agree that one of the goals of this legislation should be to encourage employers who are currently providing drug coverage to their retirees to continue, in fact, to do so. It should reward and strengthen those employers because the benefit they are providing goes a long way toward helping American seniors afford prescription drugs. The legislation should not force employers to drop their coverage by making their contribution on a beneficiary's behalf meaningless or, rather, by not concluding that the employer's contribution as part of the retiree's expenditures counts toward the catastrophic limit. In other words, simply take what the employer contributes to this, include that on top of what the employee contributes, and you have a much better count toward the money that is spent toward getting to the catastrophic limit and the rate at which you get there.

Without adoption of my amendment, this plan penalizes employers who are trying to do the right thing by providing retiree health benefits. It is not in anybody's best interest for employers to decide that contributions for prescription drug coverage just keep retirees from reaching the catastrophic drug limit. Without modifying how employer contributions are treated under this legislation, we are ultimately threatening retiree coverage and driving millions more seniors to obtain Medicare coverage from their employers.

My amendment removes the so-called true out-of-pocket concept and replaces it with a real out-of-pocket concept which better reflects the seniors' true drug spending. According to CBO, the true out-of-pocket approach is a significant component of why employers drop coverage. Again, the underlying bill is the reason why 37 percent of those covered by their employers will be dropped. That I am trying to eliminate. Therefore, eliminating the true out-of-pocket expenses will go a long way toward keeping employers in the business of providing drug coverage for their retirees.

Mr. President, I urge my colleagues to adopt this amendment. I expect that the retirees in our States may well end up with a less comprehensive or more expensive prescription drug benefit as a result of this legislation should we fail to adopt this amendment.

I thank the Presiding Officer and yield the floor.

Will the Senator yield?

I thank the Senator, and this is in the form of a question. I fully understand the constraints of the $400 billion, as the chairman of the Finance Committee indicates, and I think we all understood that to do a full prescription drug benefit, it was going to take substantially more than that, particularly if one included other matters. But would the Senator not agree that there are really two ways of looking at dual eligibles and their dependence now upon Medicaid which is paid by the States?

Up until the fairly recent past, States were doing very well and Medicaid benefits, to some degree, were expanding. I reflected on that as to my State. The other way of looking at it is to look at what is happening to Medicaid now in the States because of the balanced constitutional amendment requirements and because of the fiscal condition of the States, which is getting worse every single day, and the fact that Medicaid is the fastest rising cost in any State government budget, and the fact that the States have complete control over what happens to the Medicaid benefit.

So would the Senator from Iowa not agree that if a State using Medicaid, which is a combination of State and Federal funds, nevertheless decides to cut--since that is optional within the State, under the Government's control, that the Governor can cut that and indeed has done so, as we have been reading and hearing about, and indeed can limit coverage, cap coverage and therefore cut back tremendously on the so-called drug coverage that the chairman of the Finance Committee was extolling?

I agree that if we were in a flush time and the States were able to afford a good drug benefit under Medicaid and use it for that particular dual-use population, the Senator is right, but I think we are looking now at a period of a number of years where we are not going to be in that situation. I think that puts the dual eligibles, 74 percent or less of poverty, at terrible risk, and that is not something I associate with my understanding of the values of the Senator from Iowa, whom I so much respect.

I apologize for not speaking through the Presiding Officer before, but will the Senator from Iowa yield for only one additional question?

The Senator has responded simply by saying he would have to answer it in 50 different ways because there are 50 different States. To that I say yes, and all of them are either in the process of or will be in the process of cutting Medicaid and, therefore, the dual beneficiaries.

I ask the Senator from Iowa, is there not a further consideration, and that is when we are dealing with this maximum poor number of people under Medicare, or Medicaid in the case of the dual eligibles, we are also dealing with something which has not been discussed on this floor or indeed was not discussed in the Finance Committee at any length at all, and that is a really frightening problem of assets that, for example, one can apply, one can be under this program up to 130 percent of poverty. Then there is another one that says you can be under this Part B plan up to 160 percent of poverty, but if your assets reach over $4,000, assets which you maintain, you are then kicked from the lower to the upper bracket without any discussion. There is enormous penalty, for example, for owning a car, for owning anything. You would not be living in rural Calhoun in West Virginia without a car. Your home is exempted but nothing else is.

At one point I was thinking of offering an amendment--and I may still do so--exempting burial plots from the asset test that would be applied to poor people.

I ask the Senator from Iowa if he would say a word on this whole question, adding to the dual eligibles and deciding if--as he said, we have to pick our priorities--we are going to leave it to the States, even though I argue that States will cut that. Is it not also bringing up this whole subject of the assets of the poor families and the effect on them if they become ineligible for the bracket in which they belong and, therefore, cannot afford prescription drugs.

Mr. President, today I rise to commemorate the 140th

birthday of the great state of West Virginia. On this day, 140 years ago, West Virginia was born amidst the conflict of the Civil War.

In 1964, I came to West Virginia as a VISTA worker and spent 2 years in Emmons, WV. Those 2 years changed my life and I decided to make West Virginia my home and make public service my career. Over the years, I have been proud to serve the people of West Virginia in various ways and I feel very privileged to represent West Virginia in the Senate.

On West Virginia Day, I believe it is important to reflect upon our State's rich history, scenic beauty, and its hard-working, independent citizens who truly reflect our State motto, ``Mountaineers are always free.''

West Virginia's scenic trails and winding roads make it one of the most beautiful States in the country. Its mountainous terrain, breathtaking scenery, and raging rivers make it perfect for hiking, skiing, biking, rafting, fishing, and many other types of recreation. West Virginia truly earns the travel slogan of ``wild and wonderful''.

The small farms and growing industry of early West Virginia set it apart from the tobacco plantations of eastern Virginia. West Virginia was made up of large numbers of immigrants, along with rugged, hard- working frontiersmen and women who instilled the values and ideals that West Virginians embody today.

The people of West Virginia remain its greatest asset. West Virginians are industrious, ambitious, open, and fun-loving people. They value equality and liberty which tie them to both our State and country. West Virginians have been some of the most innovative and creative people, contributing to all aspects of American society and culture.

After his family left Virginia and slavery for a better life west of the mountains, Booker T. Washington was raised in Malden, Kanawha County, WV, and began working in the salt furnaces at the age of seven. He rose up from slavery and illiteracy to become the foremost educator and leader of Black Americans at the turn of the 20th century. He founded the Tuskegee Normal and Industrial Institute, later known as Tuskegee University.

Jerry West was born in Cabin Creek, WV and attended West Virginia University, where he was a two time All-American basketball player. After he won a gold medal for the U.S. Olympic team in Rome in 1960, he moved west to play for the Los Angeles Lakers. He excelled throughout his playing career, gaining a reputation as a perfectionist. He helped the Lakers win a championship in 1972 and was elected to the Basketball Hall of Fame in 1979.

Col. Ruby Bradley, a native of Spencer, WV, was the most highly decorated woman ever to serve in the U.S. military. Her military record included 34 medals and citations of bravery, including two Legion of Merit medals, two Bronze stars, two Presidential Emblems, the World War II victory medal, and the U.N. Service Medal. She was also the recipient of the Florence Nightingale Medal, the highest distinction given by the International Red Cross. She was a U.S. Army nurse and a POW for 2 years in the Philippines and was known as the ``Angel in Fatigues'' at Santo Tomas Internment Camp in Manila. On July 2, 2002, she was laid to rest at Arlington National Cemetery.

These three West Virginians are but a few representative examples of the kind of talented, successful, courageous, and independent people in our great State. Their lives and stories provide a glimpse into the spirit of our State, and they also serve as an inspiration to the young people in our State today.

The natural beauty, the people of West Virginia, and their countless achievements should be celebrated and remembered every day. As we strive to promote our economic growth, I hope we will also be mindful of our responsibilities to preserve what makes our state so special, the values and character of its people.

I hope all Americans have the opportunity to experience some of West Virginia's beautiful vistas and to meet the wonderful people I have come to know and love throughout my service to West Virginia.

I am proud to represent my home State of West Virginia and am honored to be able to recognize the 140th anniversary of the Mountain State.

Mr. President, I would like to speak briefly on the underlying amendment.

We are here to consider legislation that is going to create a much needed prescription drug benefit. We have been here to consider that matter for some years now. We have 41 million seniors and disabled people in this country who require and need that benefit. So it is a momentous time. It is also a moment of opportunity, which we will either grab or not grab, where we can craft a prescription drug benefit that provides the coverage seniors desperately need, coverage that is both affordable and reliable for all seniors.

I intend to offer amendments--not now, but later--that will improve the proposed coverage and delivery system for the Medicare prescription drug benefit so that this bill will better meet the real needs of our senior citizens.

In 1965, this Nation recognized that health care costs were the primary reason that one-third of our Nation's seniors lived in absolute poverty. With the establishment of a universal health care benefit for seniors, financed through both individual payroll tax contributions and the General Treasury--the Medicare program--we lifted most American seniors out of poverty.

That is something to be profoundly proud of, but it is the work of our predecessors. And now there is work for us

to do. Medicare is one of America's great achievements, but it has long needed to include a prescription drug benefit. At the time Medicare was enacted, prescription drugs were not a popular form of treatment. Now they are a critical part of health care.

A Medicare prescription drug benefit is something I have heard seniors tell me they want and need almost every time I have ever run into them or have had meetings with them in my State. And I daresay the Presiding Officer has had the same situation in his State of Kentucky.

I have worked on this for nearly 2 decades as a Senator, and we are perhaps at the point--or perhaps we are not. I don't know. I hope so.

Fifteen years ago, Congress acted to provide a catastrophic drug benefit under Medicare. The fact of the matter is, it was a very good bill. I led the fight on this floor three times to defeat repeal by the House because it was a very good benefit. There has never been anything that approached that in terms of catastrophic drug benefits since that time.

However, seniors did not understand the bill because we did not do a good job of putting it out to them, and we passed it perhaps too quickly. So the catastrophic benefit was rejected by the very people that it was intended to help through the votes of their elected representatives.

We should not repeat that experience. We should do our very best as the legislative process moves forward to offer a benefit that will be widely welcomed by Medicare beneficiaries and by their families. This will be a very hard thing to do, working with only $400 billion, as that is not the full cost of what we need. But that is what we have. We are operating, therefore, under a very tough budget constraint. I understand and accept that. But I think we should keep in mind that if we can achieve more than 50 votes for a Medicare prescription drug benefit, we might be able to achieve more than 60 votes to pay for a strengthened drug benefit. We shall see whether the Senate is able to successfully amend this proposal over the next several days, weeks, whatever the situation will be.

For my part, I remain committed to fight to improve the Medicare prescription drug benefit that is before us because I know the need is tremendous. The average total gross income for the average Medicare beneficiary in West Virginia is about $10,800. My guess is for the State of Kentucky, it is not a great deal more. It probably is somewhat over that, but $10,800 in West Virginia. If they have various kinds of internal problems, they may be paying $3-, $4-, $5,000. That doesn't give them very much to live on.

When I talk about this, I think about senior citizens in Mingo and Raleigh Counties in West Virginia; Charleston and Weirton, in Martinsburg and Parkersburg. They want and expect a prescription drug benefit that will meet their needs, and they have that right. I would like to believe that 2003 could be another landmark date in the passage of Medicare legislation that will improve the basic health of more than 40 million Americans. But even as I say that, I need to acknowledge that there are a few things in this bill that are very troubling to me and which may well make the difference between a welcome and sustained Medicare drug benefit and a long road of complaints and criticisms from the very people we are, in fact, trying to help.

Let me take a minute to talk about a couple of them. There is a substantial gap in coverage under this bill. That gap is about $1,300. Under the bill, there will still be times when seniors are paying a premium and receiving no benefits whatsoever. We should eliminate that coverage gap.

I fundamentally disagree with the notion that we should pay private insurers more than traditional fee-for-service Medicare to deliver a drug benefit. Either they are more efficient or they are not. If they have marketing costs, well, then that has to be factored in, but there is no reason to pay private insurers more than other providers.

All Medicare beneficiaries should get the same benefit. They should pay the same premium, just as they do under Part A or Part B. There should not be different benefits or premiums for Medicare beneficiaries just because they happen to live in West Virginia or Montana or, on the other hand, in New York or California.

Seniors who don't have access to a private insurer or choose to stay in traditional Medicare should be able to still receive additional benefits such as a catastrophic limit on their medical expenses. We should do our best to make sure that employers do not drop coverage because there is not a sufficient incentive for them to continue providing this coverage to their retirees. That should not be an excuse. We could fix this by allowing employer contributions to count toward the out-of-pocket costs seniors currently are paying.

In addition, I have serious concerns about the fallback in the proposal. It is, in my judgment, unstable. Under this proposal, if there are not at least two quality bids for plans to serve a region, as we all know by now, the fallback moves into place for 1 year. The next year, a new bidding process begins. And if two plans show up, the fallback disappears. This means seniors, especially seniors in rural areas where PPOs and private plans are not likely to come or perhaps have not ever been, may end up bouncing between a fall back, then a private plan the next year, and then back to a fallback. All the while seniors will be forced to change doctors and pharmacists. Their cost sharing will be changed, and there will be other changes. This will be of profound concern to them, confusing to them. I think it is a frightening scenario which takes me back to the catastrophic bill to which I referred a few moments ago. I don't think that kind of coverage represents a stable, genuine, or guaranteed fallback for seniors.

Finally, there have been a number of Members on the floor of the Senate referring to this as a universal drug benefit. We should all be very clear this is not a universal drug benefit. In fact, this legislation specifically excludes some Medicare beneficiaries from enrolling in the Medicare drug benefit. Those Medicare beneficiaries who are low income, 74 percent of poverty or below, and therefore, qualify to receive a drug benefit under Medicaid, are excluded from enrolling in the Medicare benefit. This is the first time in the history of the program that we would prohibit some Medicare beneficiaries from receiving a Medicare benefit.

Not only is it unfair to exclude the poorest seniors from part of the Medicare Program, it gives them a bad deal. Prescription drugs are an optional benefit under Medicaid. States can and are limiting the number of prescriptions. Some States only cover three drugs or charge any copayments that they choose to or that they have to. Since 1965, Medicare has provided a universal benefit to all of its beneficiaries. That has been its magnificent social contract. It is the promise that society made to our seniors: If you work and make your payroll contributions, then you get Medicare, regardless of where you live, how old you are, or what your income might be.

This legislation--for the very first time in the history of the program--would prohibit some Medicare beneficiaries from receiving a Medicare benefit. We should provide all seniors with a dependable Medicare guarantee of prescription drug coverage. That is what seniors expect when we tell them we are giving them a Medicare drug benefit. And we should make sure that they have a drug plan they can always count on, even if some believe private plans are the future of the program.

I have a word on the pending Daschle amendment. The current Senate plan offers no protection against varying premiums. The estimate that is given, $35 as an average premium, is precisely that. It is an estimate. The proposed legislation gives PPOs broad discretion in assigning premiums. Senator Daschle's amendment will limit variations in the amount the beneficiaries have to pay to only 10 percent above the national average, no matter where they live. So it does not limit the amounts plans could charge as a whole; i.e., the total premium. It would also not prevent lower premiums.

Stable premiums limit seniors' cost of liability and complement the provisions of the fallback plan. Stable premiums increase the safety net for seniors in geographic regions where private insurers are less likely to offer affordable coverage. This amendment is especially important for seniors who

live in rural areas because it is in rural areas where private insurers are more likely to charge higher premiums to offset the increased costs associated with benefit deliveries.

Stable premiums do not inhibit competition. Instead they increase the safety net for seniors. Beneficiaries in rural areas, such as West Virginia, are often older and sicker. Competition among private insurance plans in these areas is likely to be less under any circumstances. Seniors' ability to plan for prescription drug expenditures within their limited budgets hinges upon a great degree of certainty. That is what seniors depend on. Their ability to have this assurance should not be decided by private HMOs, who respond to market forces and attempt to correct deficiencies by varying and fluctuating premiums. Seniors should not have to wait and see what private insurance companies are going to charge them from year to year.

I support Senator Daschle's amendment. He is working to pass a Medicare package--as we all are--that works for all Medicare beneficiaries no matter where they live.

I yield the floor.

Mr. President, I am very proud today to join my colleague, the Senator from Maine, Ms. Collins, in introducing the Homeland Security Grant Enhancement Act of 2003. This legislation will bring much-needed coordination to the fund application process for our first responders and State and local officials.

The coordination of grant programs called for by this bill will go a long way to make certain that those who will be first called upon to deal with a threat to the security of the United States will be better prepared to face it. By enacting the Homeland Security Grant Enhancement Act, we can free

municipal governments and first responders of bureaucratic guesswork, allowing them to focus instead on training and execution of response plans.

Currently, Federal programs within the Department of Homeland Security, the Department of Justice, the Department of Health and Human Services, and other Federal agencies provide our first responders with a basic level of support with respect to training and equipment procurement. However, in order to receive this support, State and local officials often must complete separate emergency plans and redundant grant application forms. The information demanded by the various homeland security plans is frequently similar; nonetheless, different Federal agencies require grant applicants to start from square one in each case.

The Homeland Security Grant Enhancement Act of 2003 will put an end to this inefficient practice. Our bill creases an interagency committee, composed of representatives from the Department of Homeland Security, the Department of Health and Human Services, the Department of Transportation, the Department of Justice, and the Environmental Protection Agency, as well as any other department or agency deemed necessary by the President, to eliminate duplication in planning requirements and to simplify the application process. The committee will engage in a three-step process to accomplish this goal. First, within 2 months, it will compile a list of the homeland security assistance programs, identifying planning and administrative requirements for each program. Second, it will conduct a 4-month review of these requirements. Finally, within 8 months, it will report to Congress and to the President with recommendations as to how to streamline and standardize requirements.

In order to provide first responders with the support they need, our bill also creates a Homeland Security Information Clearinghouse. The clearinghouse will work with the interagency committee to make grant information available to first responders and local officials, easing the application process. Many State and local agencies, as well as firefighters, police, and emergency service officials, have found the Homeland Security Act provides insufficient guidance from Federal agencies as to the use of government funding and technical expertise in order to meet security needs. Through the clearinghouse, our bill will provide the coordination needed to locate grant information and other resources within the Federal Government. Easy access to this kind of information will improve immeasurably our State and local agencies' ability to deal with potential threats.

First responders have also cited the Homeland Security Act's lack of guidance regarding how Federal dollars can be spent and to whom these funds can be allocated. Neither the Homeland Security Act nor the Department of Homeland Security's efforts to implement the law has done much to relieve this problem. Our bill seeks to remedy this by streamlining the Office for Domestic Preparedness homeland security grant process from as many as 12 deliberate steps to just 2 commonsense requirements.

When enacted, the Homeland Security Grant Enhancement Act will put in place grant application processes that are much more efficient and user-friendly. State and local authorities will be called upon to develop a single, 3-year homeland security plan that outlines vulnerabilities and capabilities. Federal grant programs will be reconciled to establish a process for a more logical allocation of resources to meet State and local needs. Local agencies or government officials will then apply for funds based on this plan, which can be revised each year pending approval by the Secretary of Homeland Security. These steps will lead to greater ease in securing funding for local police, fire, and emergency service departments. This means greater security for West Virginians and all Americans.

Perhaps more importantly, this will make certain that State and local officials and first responders are all included in the homeland security planning process, allowing them to access funds and equipment in a timely and efficient manner. Our legislation requires that 80 percent of homeland security funding and resources will reach the local level within 60 days of allocation. The bill encourages flexibility in the use of these funds by authorizing local officials to determine their allocation to planning, equipment, exercises, training, or other homeland security functions.

In order to ensure that rural States are included in Federal grant programs whose eligibility criteria sometime favor urban areas, the Homeland Security Grant Enhancement Act follows a procedure that benefited my State of West Virginia earlier this year when we partially funded first responder programs in the Emergency Supplemental Appropriations bill. As with that legislation, our bill provides that any State whose application for funding through this grant program is approved will receive a minimum of .75 percent of the total amount appropriated for homeland security in a given fiscal year, thereby providing an adequate preparedness funding baseline for all States. The Secretary, acting in cooperation with congressional appropriators, would naturally exercise the authority to make upward adjustments with the remaining funds. However, the .75 percent baseline will make certain that rural first responders are not left out. At the same time, this mechanism will see to it that areas facing higher risk and greater vulnerabilities might receive more funds. Rural areas will not be left out, but areas that are home to elements of the Nation's critical infrastructure, as well as areas with higher population density--both of which are the most likely targets for international terrorists--will be safeguarded.

Finally, this bill also provides a logical flexibility for Federal officials who oversee unspent funds previously appropriated to the Office for Domestic Preparedness. Rather than allowing this money to sit idle while our first responders clamor for adequate funding, this legislation will enable DHS to dispense funds to those States that obtain a waiver from the Secretary. Funds earmarked for one purpose, such as training, may then be used to pay costs associated with another first responder need, such as equipment.

I commend the Senator from Maine for her close personal attention to the matter at hand, and for her hard work in putting this legislation together. She has worked closely with many of the groups who will benefit directly from this legislation. While many of these organizations do not endorse legislation, the approach we offer today has been supported by the National Governors Association, the National Conference State Legislatures, the Council of State Governments, the National Association of Counties, the National League of Cities, the International City/County Management Association, and the International Association of Fire Fighters.

I believe the Homeland Security Grant Enhancement Act will greatly improve coordination between the various agencies that distribute homeland security funds to our States, communities, and first responders. Relevant information will flow more freely and the grant application and funding process will become more clear and more flexible. While we have made great strides in our efforts against international terrorists, stifling their ability to conduct operations, the danger of an attack remains. This legislation improves efficiency within a multiagency bureaucracy, easing the burdens on those who are charged with defending the homeland. These changes will also better prepare our first responders to meet the threats they face.

Will the Senator yield time?

I thank the Senator. Mr. President, I also rise in support of the managers' amendment, and particularly for dropping the provision on adding long-haul flights at National Airport. The current aviation system, as it has evolved, is an intricately connected web of hubs, spokes, and direct flights. Some airlines thrive on the hub and spoke network, and some derive the ability to operate by flying directly between communities. However, I want to make clear a point on why it is so important that we maintain this balance between National Airport and Dulles Airport that was maintained by Congress in 1987, when we leased the facilities to the Metropolitan Washington Airports Authority. The slot rules have been in place since 1968 and should not be changed now.

When the Interstate Highway System was developed in the 1950s, many communities located in the path of the new interstates suddenly prospered by being directly connected to the rest of the Nation. Communities that were once sound economic entities, but were left miles from any access to the interstate system suffered, shuttered their doors and many times just barely survived. The same is true in the aviation system. Not every community in this country can maintain an airport. Not every community can enjoy the economic benefits of a hub. But hub economics dictate that feed from small- and medium-sized communities is necessary for them to survive.

National Airport is an important asset for those, like my constituents in West Virginia, who are trying to reach the capital region. Obviously, however, it can never become an international hub. The airport has only one runway and no ability to expand. National Airport serves a good and valuable purpose. My greatest concern is that by changing National Airport, Congress will hurt this area's ability to serve small- and medium-sized communities on the east coast, including my home State, West Virginia. The slot rule and perimeter rule were put in place at National Airport to maintain its important function while at the same time allowing the DC area to create a major international hub serving both Europe and South America. I would look forward to working with the chairman of the Senate Commerce Committee, the ranking member Senator Hollings and Senators Allen and Warner to find a permanent solution to this issue. I yield back to the Senator from Virginia.

Mr. President, I am pleased to join my friend and colleague, the Senator from Arizona, to bring before you S. 824, the Aviation Investment and Revitalization Vision Act, which reauthorizes the Federal Aviation Administration (FAA) and its programs for the next 3 years.

The reauthorization of the FAA is a vitally important piece of legislation that the Senate must pass this year. It is the first real economic stimulus bill that the Senate has considered this year.

I cannot emphasize the importance of a vibrant and strong aviation industry. It is critical to our Nation's long-term economic growth. It is also vitally important to the economic future of countless small and local communities that are linked to the rest of the nation and world through aviation.

The significance of aviation to our economy cannot be overstated. Over 10 million people are employed directly in the aviation industry. For every job in the aviation industry, 15 related jobs are produced. The aviation industry accounts for over $800 billion of our gross domestic product.

The growth of the modern aviation system has created vast economic efficiencies such as just in time delivery, allowed the air cargo industry to grow exponentially, and has opened up the world to millions of Americans.

Just as the aviation industry is a catalyst of growth for the national economy, airports are a catalyst of growth for their local communities. Airports create over $500 billion in economic activity and directly employ 1.9 million people. Almost 2 million people and 38,000 tons of cargo pass through our nation's airports each day. In my State of West Virginia, aviation represents $3.4 billion of the State's gross domestic product and directly and indirectly employs over 51,000 people.

Aviation also links our Nation's small and rural citizens and communities to the national and world marketplace. My home State of West Virginia has been able to attract firms from Asia and Europe because of reliable access to their West Virginia investments.

Without access to an integrated air transportation network, small communities can not attract the investment necessary to grow or allow home grown businesses to expand. A modern and adequately funded network is fundamental to making sure that all Americans can participate in the economy.

No question exists that since the tragedy of September 11, aviation in this country has been permanently changed.

When the Senate debated the last FAA reauthorization bill, capacity and competition issues were at the forefront of that debate. We have seen a decrease in the demand for air travel, hundreds of thousand of aerospace and aviation employees have lost their jobs and the economic pain has rippled through the economy. We will not have an economic recovery in this country until we have a recovery in the aviation industry.

Even though these issues seem less important today, they will again become serious challenges for the industry. In the drive to expand our aviation infrastructure to meet future needs, the resources for aviation security will also have to increase. More passenger and cargo will add strains to aviation security.

Now is the time to make the investments in air traffic modernization and airport development and research. Aviation security must be ready to

handle the future growth that will occur. We must also continue to develop new aviation security processes and technologies to meet future challenges.

The legislation before us builds upon our commitment to improving the aviation infrastructure of the nation that started with the landmark Aviation Investment and Reform Act for the 21st Century. I believe that this legislation meets the challenges facing the FAA and the aviation industry in the years ahead.

This bill focuses on improving our nation's aviation safety and security, airport and air service development, and aeronautical research. While my distinguished colleague has provided an excellent overview of the bill, I would like to highlight some areas of the bill that I believe are particularly important.

In this bill, we have created a stable stream of funding for security upgrades at our Nation's airports. Not only will these funds allow airports to improve security they will allow airports to improve the efficiency of these security measures.

In addition, the legislation provides for increases in funding for airport safety and capacity projects, which are a true economic stimulus.

I am very proud that the bill expands upon our commitment to making sure small and rural communities have access to air transportation services.

Finally, we have authorized a significant increase in aeronautical and aviation research in order to preserve America's leadership in these industries.

No higher goal exists than the safety and security of the Nation's airports and airspace. Over the past 18 months, we have worked every day to improve security in our airports and on our airplanes. However, until this bill, we have fallen short on providing funding to make sure our Nation's airports have the resources available to make the required improvements.

Airports estimate that they have $3 billion in unmet security infrastructure needs. The administration's Homeland Security proposal did not include any provisions to address this huge need. Airports have been forced to tap their expansion and development funds to pay for security. It makes no sense to raid funds for safety improvements for security improvements. The security of our Nation is a Federal responsibility and the Federal Government must pay for it.

One of the most important provisions in this bill is the creation of a $500 million fund, financed by security fees established by the Aviation and Transportation Security Act to assist airports with capital security costs. This new fund will also stop the diversion of airport development funds meant for safety and capacity enhancements. We will be able to pay for new security requirements while simultaneously improving safety and expanding capacity.

Even in these difficult budgetary times, we were able to modestly increase the Airport Improvement Program funding, which will provide the economy a real stimulus through direct and indirect job creation. Airport development is economic development as airports are economic development for their local communities. It is estimated that U.S. Airports are responsible for nearly $507 billion each year in total economic activity nationwide. Investment in airport infrastructure is a real economic stimulus that creates both immediate jobs and long-term economic development.

In order to facilitate airport development, I am pleased that this bill includes much of the text of the legislation that Senator Hutchison and I worked on last Congress to streamline and expedite the airport development process. This country needs to expand its airport infrastructure. Without a substantial increase in this area, aviation delays would increase resulting in billions of dollars of costs to the economy.

Today, we also meet the challenge of making sure our small and rural communities have access to the nation's air transportation network. I am very concerned that air carriers have abandoned small and rural markets disproportionately when reducing their service levels. We cannot let these communities go without adequate and affordable air service--their future depends upon it.

I am enormously pleased that the bill extends and expands the Small Community Air Service Development Program, which I fought for in AIR 21. One hundred forty communities applied for 40 available grants under this initiative. This program has assisted these 40 communities, including Charleston, WV, in attracting new air service. This program has proven an innovative and flexible tool for communities to address air service needs. Under our legislation, another 120 communities will be able to participate.

Many of our most isolated and vulnerable communities whose only service is through the Essential Air Service Program have indicated that they would like to develop innovative and flexible programs similar to those communities who received Small Community Air Service Development grants to improve the quality of their air service.

It is for this reason that I, along with Senator Lott, developed the Small Community and Rural Air Service Revitalization Act of 2003, which has been included in this legislation. The legislation reauthorizes the Essential Air Service (EAS) program and creates a series of new innovative pilot programs for EAS communities to participate in to stimulate passenger demand for air service in their communities.

Under the bill, communities are given the option on continuing their EAS as is or they may apply to participate in new incentive programs to help them develop new and innovative solutions to increasing local demand for air service. The EAS Marketing and Community Flexibility Programs would provide communities new resources and tools to implement locally developed plans to improve their air service. By providing communities the ability to design their own service proposals, a community has the ability to develop a plan that meets its locally determined needs, improves air service choices, and gives the community a greater stake in the EAS program.

Small and rural communities are the first to bear the brunt of bad economic times and the last to see the benefits of good times. The general economic downturn and the dire straits of the aviation industry have placed exceptional burdens on air service to our most isolated communities. The Federal Government must provide additional resources and tools for small communities to help themselves attract adequate air service. The Federal Government must make sure that our most vulnerable towns and cities are linked to the rest of the nation. This legislation authorizes the tools and resources necessary to attract air service, related economic development, and most importantly expand their connections to the national and global economy.

This bill meets the challenges facing our aviation system--increasing security, expanding airport safety and capacity, and making sure our smallest communities have access to the network. We can all be proud of this bill.

Finally, I would like to again thank Senator McCain, Senator Lott, and Senator Hollings for all their hard work and commitment to developing and securing passage of this legislation.

Mr. President, I am very pleased to support Senator Lincoln's legislation to make the recent increase in the child tax credit available to more families. I thank the Senator from Arkansas for her tenacious fight on behalf of America's working families. I was disappointed that the tax cuts passed by this Congress last month left out eight million children whose parents are working everyday and struggling to make ends meet. Today we will begin to correct that injustice.

In West Virginia, there are about 57,000 children whose parents earn between $10,500 and $26,625. While these parents currently receive some benefit from the child tax credit, they do not stand to get any additional benefit based on last month's tax cut. For average families, who don't make money from dividends or capital gains, the child tax credit was the most valuable provision included in the recent tax cut package. The families of 57,000 West Virginia children should not be left out. Let's be clear that these families pay taxes. Payroll tax, sales tax, excise tax, property tax--these families are struggling to make ends meet, and they are paying their fair share in tax.

It seems to me that families who are working hard but earning low wages are just the sort of families we ought to be seeking to help. These parents play by the rules, but struggle to provide the same things that all parents want to provide: enough food, a good home, schoolbooks, new shoes, perhaps a soccer uniform. In addition, we know that providing additional tax relief to these families will stimulate the economy, because these families are likely to immediately spend any additional cash.

During the recent tax cut debate, the Senate was right to increase the amount of the child tax credit that low-income working families could receive. But during partisan negotiations to finalize that tax bill, these families were abandoned in order to provide more tax cuts to wealthy investors. One of the reasons that I opposed the recent tax cut package was that I could not condone a deal that provided $150 billion in tax cuts to wealthy investors but dropped a provision to help our neediest working families that would cost just $3.5 billion. There are a lot of pieces of that deal that I wish we would undo. I realize that we won't. But at least today, by passing Senator Lincoln's legislation, we will take one important step toward making those tax cuts more fair for America's working families.

The legislation before us today has a number of other important provisions. It will ensure that two single parents would not lose their child tax credit if they got married. The bill also simplifies the tax code, something we should seek to do with every new tax law. I am especially pleased that the bill includes a provision to offset the cost of these new tax cuts. I have serious concerns about the record deficits we face, especially in light of the enormous tax cuts recently enacted. This bill will not add a penny to our national debt.

In short, this is a balanced, responsible, and fair piece of legislation. While this bill does not do everything that I would like to do to improve the child tax credit and truly make it available to all low-income working families, it is still a major improvement on the tax cuts enacted last month. I hope that all of my colleagues will support this bill and send the message to hard working families that are struggling to make ends meet that we are on their side. And I ask all of my colleagues to encourage the House of Representatives to act quickly on this bill so that the President can sign it into law as soon as possible. Refund checks for the child tax credit increase are scheduled to be mailed this summer. If we act quickly we can ensure that an additional 8 million families will receive checks.

Mr. President, I come to the floor today to introduce the Medicare Chronic Care Improvement Act of 2003. For the last three decades, the Medicare program has fulfilled our promise to care for older Americans who have spent a lifetime working and contributing to our Nation's economy. Currently, 41 million seniors depend on Medicare for critical health care assistance. Those seniors have been asking Congress for many years to strengthen Medicare. This Congress, we must respond by taking action. We must enact legislation this year that fills the gaps in Medicare.

When Congress and President Johnson designed the Medicare program in 1965, they could not have foreseen the health care system that exists today. New technology, advances in research and an aging population have changed both what beneficiaries need and the system that is responding to those needs. One of the unforseen implications of these changes is a growing number of Americans living with chronic conditions.

In 2000, over 45 percent of Americans had a chronic condition. That number continues to grow and, by 2020, more than 48 percent or 157 million Americans, will have at least one chronic condition. Chronic conditions encompass an array of health conditions that are persistent, recurring, and cannot be cured. They include severely impairing conditions like Alzheimer's disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, depression, hypertension, and arthritis.

Treating serious and disabling chronic conditions is the highest cost and fastest growing segment of health care. People with chronic conditions represent 78 percent of all health care spending. These people are the heaviest users of home health care visits, prescriptions, physician visits, and inpatient stays.

As we grow older, the chances of developing a chronic condition increase. Thus, it should be no surprise that nearly 80 percent of Medicare beneficiaries have at least one chronic condition and two- thirds have two or more chronic conditions. However, the Medicare fee- for-service program does not currently cover many of the services needed to provide quality care to beneficiaries who are managing complex chronic conditions.

To meet the needs of these individuals, our Medicare fee-for-service system must reflect a person-centered, system-oriented approach to care. Payers and providers who serve the same person must be empowered to work together to help people with chronic conditions prevent, delay, or minimize disease and disability progression and maximize their health and well being.

That is why I am here to reintroduce a much needed solution--the Medicare Chronic Care Improvement Act of 2003. This bill establishes a comprehensive plan to improve and strengthen the Medicare fee-for- service and Medicare+Choice systems by generating better health outcomes for beneficiaries with chronic conditions and increasing efficiency.

This bill would achieve these results by, first, helping to prevent, delay, and minimize the progression of chronic conditions by authorizing the Secretary of Health and Human Services to expand coverage of preventive health benefits. The bill permits providers to waive deductibles and co-payments for preventive and wellness services currently covered by Medicare and streamlines the process of approving new preventive benefits.

Second, this bill provides a person-centered, system-oriented approach to care for this extremely vulnerable segment of our population by expanding Medicare coverage to include assessment, care- coordination, self-management services, and patient and family caregiver education and counseling.

For more detail, I am also entering a section-by-section bill summary into the Congressional Record following this statement.

The Medicare Chronic Care Improvement Act provides a comprehensive solution to improving the quality of life and health for millions of Americans who are struggling with serious and disabling chronic conditions. Not only that, it has the potential to save the Medicare program money, by better managing and treating chronic conditions before costly complications result. That is good for seniors and good for Medicare--a win-win situation.

It is time to step up to the plate and fulfill our obligation to our Nation's most vulnerable citizens. Improving Medicare is the right thing to do, but only if we do it the right way. I believe that this bill is a critical component of the right recipe for strengthening the Medicare program for today and tomorrow's beneficiaries. Unlike the administration's Medicare reform plan, the Medicare Chronic Care Improvement Act gives beneficiaries better care while maintaining consumer choice and improving the program's efficiency. Because these are the results that West Virginians want, I will fight to include the provisions of this bill in any Medicare reform package that moves through the Finance Committee or the Senate floor.

I would like the record to reflect that the following groups publically support this legislation: Alzheimer's Association; American Geriatrics Society; Center for Medicare Advocacy; Families USA; and Medicare Rights Center.

National Chronic Care Consortium, representing such organizations as: Aging and Disability Services Administration, State of Washington (Olympia, WA); Aging in America, Inc (Bronx, NY); Albert Einstein Healthcare Network (Philadelphia, PA); Area Agency on Aging 10B Inc. (Akron, OH); Baylor Health Care System (Dallas, TX); Benjamin Rose (Cleveland, OH); Beth Abraham Family of Health Services (Bronx, NY); Blue Cross & Blue Shield of Minnesota (Eagan, MN); Carle Foundation Hospital-Health Systems Research Center (Mahomet, IL); Catholic Health Initiatives (Parker, CO); Centura Health (Denver, CO); Community Health Partnership, Inc. (Eau Claire, WI); Fairview Health Services/Enbenezer (Minneapolis, MN); Halleland Health Consulting (Minneapolis, MN); Hebrew Home and Hospital (Hartford, CT); Highmark Blue Cross Blue Shield (Pittsburgh, PA); Inglis Innovative Services (Philadelphia, PA); Lancaster General Hospital (Lancaster, PA); Masonicare (Wallingford, CT); Mercy Medical Center--North Iowa (Mason City, IA); MetroHealth System (Cleveland, OH); Metropolitan Jewish Health System (Brooklyn, NY); Minnesota Senior Health Options (MSHO) (St. Paul, MN); Motion Picture and Television Fund (Woodland Hills, CA); Northeast Health (Troy, NY); Presbyterian SeniorCare (Pittsburgh, PA); Saint Michael's Hospital (Stevens Point, WI); SCAN (Long Beach, CA); Sierra Health Services (Las Vegas, NV); Summa Health System (Akron, OH); Sutter Health (Sacramento, CA); Total Longterm Care, Inc. (Denver, CO); Upstate NY Network of the U.S. Dept. of Veterans Affairs, VISN 2 (Albany, NY); ViaHealth (Rochester, NY); Visiting Nurse Service of New York (New York, NY); Volunteers of America National Services (Eden Prairie, MN); and Wisconsin Partnership Program at Community Living Alliance (Madison, WI).

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

I have said from the beginning of this debate that my guiding principle would be the best interests of the people of West Virginia. I cannot support the deal that has been reached because it is so clearly designed to benefit the elite members of our society at the expense of average taxpayers in West Virginia and across the Nation. Proposals that could have stimulated the economy and helped working families got short-changed to make room for enormous tax cuts for wealthy investors. I have little hope that this bill will stimulate economic growth; on the other hand, our national debt will be guaranteed to grow if we pass the bill.

I would also like to comment briefly on the process that has brought us to this point. I am extremely disappointed that this deal was struck behind closed doors in an entirely partisan manner. Since it adds hundreds of billions of dollars to our national debt, it affects every American now and for the next generation. Whenever we are considering something of such tremendous importance, the process ought to be bipartisan and inclusive. This is not how Americans expect us to conduct business.

For 2 years, I have fought to ensure adequate fiscal relief to States that are struggling with crippling budget deficits. I am pleased that this bill provides $20 billion in State aid. Our most vulnerable citizens are at risk when States cut Medicaid and other services. And any effort that we make to stimulate economic growth would be futile if States are forced to cut spending and increase taxes. Yet this legislation still falls well short of what 80 Senators voted for during debate on the budget resolution earlier this year. I am disappointed that we did not fulfill our commitment to $30 billion in State aid.

If we were truly interested in stimulating economic growth and creating jobs we would have not only provided more aid to States, we would have focused tax relief on working families who are the most likely to immediately spend any tax cut. But tax cuts that help working families got squeezed to make room for more tax cuts for wealthy investors. The proponents of this bill may talk a lot about the acceleration of the child tax credit, marriage penalty relief, and the expansion of the 10 percent bracket. But all of these provisions are set to expire after next year, and they pale in comparison to the new tax breaks provided to millionaire stockholders.

I fought to expand the child tax credit to serve more families, and to provide a greater benefit to those families who currently qualify for only a partial credit. I am disappointed that no such provisions are included in this final bill. While I am pleased that the size of the child tax credit increases from $600 to $1,000, albeit for only the next 2 years, I am still worried about the 130,000 children in West Virginia who will see no benefit from this increase. We should be doing more to help our neediest families.

I am also disappointed that we are spending $35 billion, 10 percent of the cost of the bill, to reduce the highest marginal income tax rate. Only Americans with more than $312,000 of annual income are affected by the highest rate. That is less than 2 percent of our taxpayers nationwide, and in my State of West Virginia it is less than 1 percent of taxpayers. The income tax cut that had the most potential to help hard-working people in my State is the expansion of the 10 percent bracket. But this provision, like so many other good ideas, was reduced in order to make room for other things. The expansion of the 10 percent bracket expires after next year, while the income tax cuts for the wealthiest few stay in place much longer. I cannot condone such misplaced priorities.

The most expensive part of this bill is the tax cuts for investors, estimated to cost more than $150 billion. These tax cuts are the least likely to help average Americans. While many Americans today are invested in the stock market, they typically hold these assets in retirement accounts that already enjoy preferential tax treatment. Only one-quarter of America's taxpayers will get any benefit from tax reductions on dividends or capital gains. And for the vast majority, the benefit will be very small. So why then does it cost so much? Because the wealthy few will receive enormous tax cuts. More than 40 percent of all dividend income is claimed by the top 2 percent of taxpayers. Capital gains are even more concentrated among wealthy Americans. I cannot justify huge cuts in dividends and capital gains taxes when the benefits to average Americans are so small.

Too many important proposals have been completely left out of this package. Despite the fact that more than 8 million Americans are currently out of work, many of them for extended periods of time, this bill provides no assistance for the unemployed. Incentives for investment in the construction of new schools or the deployment of broadband services--proposals that could have created new jobs immediately--are completely absent. For a bill euphemistically referred to as a ``Jobs and Growth Package'' there is very little here that will create jobs or growth.

Finally, this bill cannot be justified in the contest of our Government's current fiscal situation. Later today, Congress will be asked to increase the debt limit by almost $1 trillion, an unprecedented increase. Yet we are about to approve a tax package that will increase the deficit by $350 billion over the next 10 years--more when interest expenses are included. If this legislation really had the potential to help working families and reinvigorate our economy, we could justify increasing deficits. But instead we have short-changed the most important provisions to make room for $150 billion in tax cuts to investors. It is unconscionable to ask the next generation of Americans to foot the bill for this legislation. I cannot support it.

Mr. President, I rise today in strong support of extending the Temporary Extended Unemployment Compensation (TEUC) program. Congress created this program in March of last year to provide federally funded unemployment benefits for millions of Americans who have exhausted their regular State-funded benefits after falling victim to our weakening economy. This vital program is nearing expiration and now millions of Americans need our help.

If Congress and the President do not act before May 31, 2003, nearly 4 million long-term unemployed workers will lose benefits, including almost 14,000 West Virginians. These unemployed workers and their families need and deserve an extension--every one of them. Unless immediate action is taken, American workers who have lost their jobs through no fault of their own will be left vulnerable to economic hardship, and without a safety net. How will these families pay their mortgages and provide for their children? During these difficult economic times, how can we turn our backs on 4 million Americans?

Earlier this month, the Department of Labor announced that the Nation's unemployment rate had risen to 6 percent, representing 8.79 million Americans out of work. This is the highest national unemployment rate we have witnessed in nearly a decade. When President Bush released his growth and stimulus package, he maintained that creating jobs was his No. 1 priority. Yet, despite rising unemployment--500,000 more Americans in February and March alone--and unprecedented fiscal crises in our States, the President's proposal fails to provide assistance for unemployed workers, adequate State fiscal relief, and neglects Americans who need help the most.

West Virginia families will soon be faced with some very difficult choices. Choices between paying their mortgage or defaulting; between having health insurance or going without; between sending their children to college or dipping into their pensions to cover everyday living expenses while ruining their retirement. These are West Virginians who want to work--who are trying to work--but simply cannot find a job in the current economy. I urge my colleagues to act swiftly so that American families aren't forced to make these kinds of decisions so this dire situation is not further exacerbated.

I feel strongly about this issue because of the very real impact inaction could have on my constituents. Just recently, I was contacted by Janice Walters from Mercer County in my home state of West Virginia. She called my office searching for help. Ms. Walters truly epitomizes the American worker that we must help.

In September of last year, Ms. Walters was laid off from a communications company. As a 49-year-old single mother of two with many cost-of-living expenses, she now has no income and no health insurance coverage, forcing her to face some of the stark choices I discussed earlier. To support her family, she began collecting unemployment insurance. In addition, she took a part-time job and began taking classes in computer sciences at a local college to learn new skills that she could apply to a new career. Unfortunately, she will not exhaust her State benefits until the week after the current TEUC program expires, leaving her ineligible for TEUC benefits. If the TEUC program is permitted to expire, Ms. Walters, and millions like her, will be left unemployed and unassisted.

Fortunately, such a tragedy is preventable. If we act on an extension today, Ms. Walters will get an extension and she will receive benefits. This is progress. It is good to pass an extension for 2.5 million workers, including about 9,000 West Virginians. This is good news for families in need.

One particular extension leaves out and leaves behind the long-term unemployed families. A simple extension, which is all that the majority will consider, excludes 1.1 million unemployed workers, and 3,900 of those people live in West Virginia. They face real hardship, and they too deserve help.

Throughout this debate, I have supported the efforts of Senator Kennedy and others to provide comprehensive unemployment benefits to all 3.6 million unemployed workers. If we can enact a huge tax cut targeted to the wealthiest Americans, shouldn't we also help every unemployed worker?

Providing unemployment benefits helps the unemployed, and it also helps our economy as a stimulus. History tells us that unemployment benefits are spent quickly, and every $1 of such benefits generates $1.73 in economic activity. This is a real and an immediate stimulus for local economies. There is no certainty about how changes in corporate dividends will affect the economy. This administration should recognize the urgent needs of all unemployed workers.

I am pleased that we are taking action to help many unemployed workers, like Ms. Walters. I also believe we should help the 1.1 million long-term unemployed. This is the definition of real economic stimulus and real compassion.

Mr. President, today I would like to congratulate Senator and Mrs. Robert C. Byrd on their 66th anniversary, which they will celebrate on May 29. What a wonderful occasion this is--a truly joyous celebration.

Senator and Mrs. Byrd's devotion to one another is truly powerful. In a world that is far from old-fashioned, they have shown that old- fashioned dedication and commitment can go a long way. The Byrds have risen from humble beginnings, and proven to our State and country that honesty and devotion comes first. Senator Byrd said earlier this year on the Senate floor, ``There are only two duties that will exceed my duties in the Senate. One is my duty to God and the second is duty to my family. I think my duty is to my wife.'' Many of us heard this speech and were struck by that line. We know that with Erma's recent illness, Senator Byrd on occasion had to request an absence from the Senate to be by the side of his lifelong sweetheart. The devotion he has shown to Erma is plain, and these last few weeks have simply been an extension of 60-plus years of love between these two people. This couple is a real gift to the State of West Virginia. We are more than lucky to have them as leaders of our State.

I have had the honor of serving in the Senate with Senator Byrd for the last 18 years, and in that time I have had the pleasure of getting to know Erma as well. Erma is a positively delightful woman. Senator and Mrs. Byrd's dedication to one another is genuine and should be inspiring to us all. They have been devoted to one another from an early age. In recalling his high school days when he got a candy from a classmate to give to his sweetheart Erma, Senator Byrd said, ``I never chewed the gum; I never ate the candy. But when the classes changed, I found Erma in the hall and gave her that candy and chewing gum. I never told her someone had given it to me, but that's the way you court a girl--with another boy's bubble gum.'' Erma and their family has been the top priority in the Senator's life from the start.

When the valedictorian of Mark Train High School married his sweetheart, Erma Ora James, in May of 1937, no one knew that the coal miner's daughter and adopted young boy would together become one of the most influential couples in the history of West Virginia. Even though Senator Byrd could not afford to go to college, he persisted as a young West Virginian working for his family--pumping gas, working as a produce salesman, and serving his country as a shipbuilder and welder. Mrs. Byrd became the head of the family's finances, and the glue that held their household together as she remains today. Starting as a family of two, the couple worked together to succeed.

While Senator Byrd was spending endless hours at the Capitol building serving his State and country, Mrs. Byrd raised their two lovely daughters, Mona and Marjorie. To this day, Mrs. Byrd continues to remain the stronghold in her family, proudly helping to raise their six grandchildren, and three great-granddaughters. Mrs. Byrd quietly stays out of the spotlight , and instead focuses on her responsibilities as a wife, mother, grandmother, and great-grandmother. Senator Byrd once said, ``She [Erma] has been my anchor all of these years. I don't know what I would have amounted to if it wasn't for her steadfastness, her integrity, her strength,'' It is evident that the Senator and Mrs. Byrd have so much respect for one another, and enjoy their lives together every day. Senator and Mrs. Byrd have devoted their lives to better their family and fellow West Virginians. They have proven that working together as a team, husband and wife, can accomplish so much.

It is positively refreshing to see such an amazing couple recognized for their leadership and because of their caring. They truly exemplify a loving and happy marriage. The Byrds are both leaders, grandparents, and great-grandparents, and compassionate and honorable West Virginians. Senator and Mrs. Byrd have set a great standard. Please join me in congratulating this wonderful couple on their 66th year together.

Mr. President, I call up my amendment numbered 618, which is the modification at the desk. Senators Reid, Mikulski, Bingaman, and others are cosponsoring it.

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

The average public school in this country is 42 years old. Last week, I visited two in West Virginia; one was 88 years old, and the other was built the year the Titanic was sunk. It is a disgrace.

This amendment will provide $25 billion which, because of interest- free payments, would actually only cost the Federal Treasury less than $8 billion over a period of 2 years and create 500,000 jobs, build new schools, and create opportunities for our young people.

I hope my amendment will pass. I ask for a vote on my amendment. A voice vote is acceptable.

No.

Thank you, Mr. President, and I thank my friend and leader from Montana.

Amendment No. 578

Mr. President, I rise to speak about an amendment which was offered earlier. I am particularly proud to be cosponsoring, with Senator Blanche Lincoln of Arkansas, and others, improvements to the child tax credit. I will speak on it very briefly.

I think it is one of the most valuable provisions. I thank the chairman of the Finance Committee--while I see he is still in the Chamber--for accepting one of Senator Lincoln's amendments on the child tax credit. It is a particularly welcome addition.

I think common sense tells us that if we put money in the hands of people who will indeed spend it, and will spend it on clothes and kitchen utensils, and all kinds of other items, there is a stimulative effect.

But quite apart from that, almost half of the benefits of this child tax credit go to families who make less than $50,000. In the State that I represent--this Senator represents the State of West Virginia--only 20 percent of the people make more than $50,000 a year. So this is very welcome.

The bill we are looking at, what is in the package, makes very important improvements to the child tax credit. Basically, it increases the value of the credit from $600 to $1,000, which is real money, as they say, for real people, who need it and deserve it.

I was happy that we did this. I was grateful that it was accepted by the Finance Committee chairman. It is going to have a big effect.

I will say this: Refundability will go from 10 percent to 15 percent of earnings above $10,500. That means families can benefit from this bill more than otherwise would have been the case. On the other hand, the bill still does not do anything--and I have to say this in fairness--for 72,000 kids who do not qualify for any child tax credit in West Virginia because their parents do not have enough income to qualify on a low-income basis.

But all things being equal, as they rarely are in this life, one has to take what one can work out in the democratic process. And the Finance chairman was extremely fair and helpful. Obviously, the Senator from Arkansas was outstanding in her leadership on these matters.

I am proud to a be a cosponsor of the amendment that Senator Lincoln offered today that will expand the reach of the child tax credit to more of our nation's poorest families. In my own state, 27,000 more kids would qualify for the child tax credit. This amendment would increase the amount of the child tax credit that can be refunded to low income parents. Specifically a parent would qualify for a child tax credit equal to 5% of earnings between $5,000 and $13,250.

These folks whom we are helping are at risk. That is important. And I am very proud this is happening. I ask my colleagues to support this amendment when it comes up for a vote on tomorrow.

I thank the Presiding Officer and yield the floor.

Mr. President, I thank the Chair.

I rise in support of the amendment offered by Senator Burns and a number of others. This is an amendment I have been working on for many years. At times it has had 75 cosponsors. It is one of those amendments that always comes up. Everybody knows it should get done and it never seems to. The answer to that is you keep trying. You just keep trying.

For individuals, businesses, schools, libraries, hospitals, there is no end to the need for this amendment. We did the E-rate. The E-rate is still being done. But we all know we have moved past that. We need much faster telecommunications now.

What the Burns-Rockefeller broadband amendment does is it says to broadband providers, if you will extend your networks to hard-to-reach, underserved and/or rural areas, you will get a break on your taxes. As the distinguished Senator from Montana indicated, it also encourages a leapfrog to the next generation. It has two different categories of tax breaks depending upon what generation of broadband you are dealing with. In any event, it is going to be faster than the DSL and cable modem services most typical today.

The best thing is to say that you don't obviously get a tax credit unless you make a whole lot of things happen in this amendment. There is nothing automatic about it. You have to make an investment. You have to buy new equipment. You have to pay people to install that new equipment.

I am very pleased to join with my friend from Montana in what I think can very well be described as the future competitiveness of America. He mentioned South Korea and Japan. He is absolutely right. We all remember what happened with the VCR. We had it all, then all of a sudden we had none of it. We do not want this to happen in the most important form of telecommunications. I hope my colleagues will support the Burns amendment.

I yield the floor.

I thank my dear friend, the very distinguished Senator from Maine. I thank the Presiding Officer for allowing me to talk briefly about this amendment of Senator Collins, myself, Senators Nelson and Smith, and Senators, et al, as the Senator from Maine kept saying, including Senator Clinton and many others. It is something we have been working on for 2 years. It is something we have been working very hard on for 2 years. It is something the National Governors Association has worked hard for, for obvious reasons, which I will get into in a moment, although my remarks will not be long.

The Senator from Maine really did cover the logic and the need in very clear terms. If those who are listening heard her, they heard the best possible argument. I just want to add a few comments.

I also thank the chairman of the Finance Committee, Senator Grassley from Iowa, for his generosity and good judgment in accepting this $20 billion package as part of the chairman's mark. Is it everything in amount and scope that the Senator from West Virginia would wish? No. Because the Senator is from West Virginia and the needs on a proportional basis across the country are greater in West Virginia than many other places. I would support $30 billion. I support $40 billion provided that one-half is used for Medicaid, and then others could be negotiated out.

So I do not think the $20 billion is enough, but $20 billion is what we have, and $20 billion is more than we started out with last year. We will hope people forget that, even though 75 of them on this floor voted for it then, and then, for a $30 billion bill, 80 on this floor voted for it this year. That does not happen a lot around here.

That was not a free vote. That was not a trivial vote. That was a vote people made after thinking about it. So we will prevail, and we will rejoice in that. And we will not do that just because we win an amendment; we do that because we know we are helping real people.

We have almost 300,000 people in West Virginia who are on Medicaid. One of the things that always strikes me: We always talk about health care in statistics, and somehow that separates us from being able to get down to what the Senator from Iowa, Mr. Harkin, calls ``real people.'' And I am of that school, the so-called real people school.

I picked up the paper this morning. I read that 60 million Americans, at some point during the year, do not have health care. That is not a Medicaid statement. That is a health care statement. That means some of them

never have it, and others of them only have it on a part-time basis. But that means that all of them--60 million Americans out of 260 million, how ever many we are--worry all the time about health care.

But here comes a Medicaid amendment in which we can do some good for people. The Senator from Maine mentioned 1,700,000 people are at risk if we do not. I am not sure the $10 billion will take care of all those 1,700,000 people, but it will take care of a lot of people, and it is going to take care of them with very good health care. People need to understand that Medicaid, unlike Medicare, does provide a prescription drug benefit. And Medicaid, probably known to most of my colleagues, provides 6 million elderly, poor Americans--who do not have health care otherwise and prescription drugs otherwise--it provides this to them. So it has an enormous capacity and reach. It is superb health care. It does EPSDT for children. That is early screening. It does all kinds of things that Medicare, obviously being a different area, does not do. So it is a superb program.

The Senator from Maine pointed out it is very good in terms of being a stimulus to the economy. She is quite correct about that. And it is about a 3 to 1 relationship. For every $1 you spend in the State, about $3 is actually churned beyond that. So it is a stimulus program. Yes, it is actually a stimulus program. I think that is one of the reasons the chairman of the Finance Committee put it in the mark.

But there is another aspect here. The Senator from Maine used the words ``safety net.'' I will use the word ``underpinning.'' Either one is the same. This is a sacred concept. This is a country, because of our original history under the British crown, in which we wanted to protect the minority, not protect the majority. The majority, we figured, were able to do that.

There are protections and checks and balances in all these things, but people sometimes say: Well, if somebody is on Medicaid, that means they are not working or they don't deserve it. That is so untrue.

When I go back to the way I was introduced to West Virginia--and what caused me to stay in West Virginia--when I became a Vista volunteer for 2 years, and I dealt with people, none of whom had health care, they fed me every meal I had, because I ate in some home or some mobile home or whatever it was. I depended upon them. My life was them. If it was a good day for them; it was a good day for me. If it was a bad day for them; it was a bad day for me. It changed me in every single way.

But these are people who need this. There is nothing that hurts so much as to know a child cannot get screened for autism when they should be, or that a child has no dental care whatsoever. I had to deal with that. I would have to load kids from this little community into my jeep, and we would go down to the one place in Charleston, WV, which offered free dental care. And, obviously, you can't do that for 38 years. So it is a tragic situation.

These are good people. These are people sometimes who cannot find work simply because they live too far out in the country, as was the case in this community, or they did not have automobiles to be able to get to work. Or if they got to work, they didn't know how to take a job exam or have a job interview, or they had never been up in an elevator and they were scared by that, or they were asked to lower a Venetian blind because the Sun was in their eyes, and they had never seen a Venetian blind before, so they would just sort of shut up and hunker down and be defeatist.

Don't tell me those people are not worth keeping healthy because things did not break their way. Things broke well in my life. Things have not broken well in some people's lives in Maine and Alaska and West Virginia, and we cannot pretend that somehow these are not people and that they don't deserve help. The spirit of America is one in which you try to protect those who cannot protect themselves, as much as possible, within reason.

Incidentally, this also happens to do an enormous amount for our hospitals and nursing homes. And that was the one thing that was not said by the Senator from Maine. Eighty-five percent of any hospital in West Virginia depends on Medicare and Medicaid--all of them.

So by doing this--and by pouring millions of dollars into West Virginia, and $10 billion across America--for a temporary period of 18 months, we strengthen our entire health care system as well as stimulating the economy. So it helps the economy and it helps the people--and people who really do need it.

The Senator pointed out that the other $10 billion--which I was less involved with because I was focused on the Medicaid relief--is spent wisely: in education, job training, transportation. She talked about it. And it is a good expenditure. Governors and local groups can decide how to spend that.

I was worried it would be kind of a revenue-sharing thing. I remember back when I was Governor in 1982, we had revenuesharing, and, all of a sudden, county courthouses all over the State of West Virginia got new roofs and got refurbished, which is not exactly what I think the revenuesharing was meant to be for.

So it is a serious business when you give Medicaid help to people who need it.

I will conclude with this. And this really gets my goat. I have heard a lot around here the argument that you cannot give money to States. What are we, two nations? Are we 50 States, on the one hand? Is that called America? Or are we a Federal Government? Is that America? Or are we somehow bound up that we work together and that we help each other?

I was not elected by a country. I was elected by a State. I am a Senator from West Virginia. That means we work together.

To say the States have been irresponsible is so wrong because if you go back to the end of the Second World War or if you go back just 10 years, you will find the States have been far more discrete and responsible in their spending than has the Federal Government.

Now, you can say: Well, the Federal Government has very broad responsibilities, the Department of Defense, and other endeavors. And I understand that. But the fact is, the States have been responsible.

When we took in less money in 1982 than we did in 1981, I had to fire 10,000 Department of Highway workers. I had to fire them. I had to fire those people--good people who worked. So don't tell me that States don't sacrifice.

West Virginia has just raised its cigarette tax to 55 cents, and all of the money is being spent by the Governor on Medicaid. And, at the same time, the State is having to cut services.

This morning, I talked to the president of our very largest university, with 31,000 students, West Virginia University. His budget, and every other State public education budget at the college/university level, has been cut by 13 percent. And it will happen again next year. It is a devastating cut. Why? Because, as the Senator from Maine said, you have to balance the budget.

So we are dealing with real States here, but, most importantly, we are dealing with real people who need the help in an America which was created to protect those who needed that help.

I ask my colleagues to join the Senator from Maine, the Senator from Nebraska, and others who have sponsored this bill, and been working on it for a long time. I am thrilled that, at last, it has a very good chance of passing.

I thank the Presiding Officer and I yield the floor.

I am happy to address that issue. The FMAP is currently calculated annually under the following formula. The FMAP is at least 50 percent and is calculated based on the ratio of a State's 3-year average of per capita income to the 3-year average of per capita income of the Nation. Given the nature of this formula, the previous year's FMAP in no way affects the calculation of future FMAPs. Basically, if the State's average per capita income is below the national per capita average, the State gets a higher FMAP. The FMAP is calculated usually 6 months to a year in advance of the start of a Federal fiscal year. The amendment would take the FMAP that has already been calculated by HHS under this formula for fiscal year 2003 and fiscal year 2004 and increase it by 2.95 percentage points for a portion of those years. It does not adjust the underlying formula. Because the FMAP is calculated annually, and the calculation is still based on the current per capita income ratio, our amendment in no way increases the baseline for future FMAP calculations.

I would like to add that I completely concur with the Senator from Nebraska's statement on the temporary nature of the FMAP.