Floor Statements

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Mr. President, I suggest the absence of a quorum.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I have a short statement with respect to a vote we are going to take tomorrow.

Amendment No. 2814

In one of my favorite movies, a baseball field is built in the middle of Iowa and becomes a mecca for baseball players and fans that seemingly come from anywhere and everywhere to watch baseball. Today in Billings, MT, folks are hoping that the popular movie ``Field of Dreams'' was right. ``If we build it, they will come.''

Baseball is America's game. It is part of what defines us as Americans. There is something special about sitting in the bleachers on a summer's evening, eating peanuts, and watching a good baseball game. For over 60 years now, the best venue to watch a baseball game in Montana has been historic Cobb Field in Billings--Montana's largest city.

Opening in 1948, Cobb Field is the longtime home of the Billings Mustangs, a minor league baseball team. It also serves NCAA baseball as well as American Legion baseball.

Many notable professional baseball players--Dave McNally, George Brett, Trevor Hoffman, Rob Dibble, Paul O'Neill, and Stormin' Gorman Thomas, to name a few--have at one time called Cobb Field ``Home.''

Unfortunately, Cobb Field is an above-ground wooden structure stadium that is not compliant with building codes. Despite several major renovations and repairs, the stadium continues to deteriorate at an increasing rate due to water damage and wood rot. Conditions are unsafe for Montanans who want to watch a baseball game, particularly for children and Montanans with disabilities.

To solve this problem, the people of Billings have decided to build a new stadium to replace Cobb Field. In March, the city broke ground on this new stadium.

The new stadium will be a state-of-the-art venue that will meet the needs and wishes of the citizens of Billings to have a facility that can be a safe, multi-use venue to host baseball games, concerts, festivals, and markets.

More importantly, the new stadium will be an economic development center located in one of Billings' oldest neighborhoods in need of a shot of revitalization.

This new stadium will spur redevelopment efforts that are so needed in this area of downtown Billings. Over 100,000 people attended events at Cobb Field last year. For a state with 900,000 people, that's a lot. With the new stadium, it is estimated that there will be a 100 percent increase in ticket sales.

Last November, voters approved a bond election authorizing the city of Billings to sell bonds up to $12.5 million to design a new 3,500- seat baseball and multi-use stadium. The people of Billings have stepped forward with the lion's share of the costs of the stadium. In addition, Montanans have donated over $2 million in private pledges to offset the taxpayers' costs of repaying the $12.5 million in bonds.

Because of the local funding that has been secured for the project, our Montana delegation has requested $500,000 in Federal funding to support the funds that the local community has already stepped forward with.

I have fought hard over the years for my home State of Montana. My colleague from Montana, Senator Tester, has done the same. Each year, I make requests to the Appropriations Committee to provide funding for worthy Montana projects. I stand behind the requests I make.

A vote for the Coburn amendment is a vote against me and the people of Montana. We will remember.

This is such a small amount of Federal dollars compared to the contribution the people of Billings are making that I believe voting for Cobb Field is something Montanans prefer, but I think the people across this whole country who are big baseball fans would also agree.

Mr. President, I yield the floor.

Mr. President, last Friday the senior Senator from Virginia announced that he would not seek reelection to the Senate. I speak today, therefore, in tribute to Senator John Warner.

I have known John Warner for nearly 30 years. In 1978, the people of Montana and Virginia sent us both to the Senate for the first time. I thank the people of Montana and Virginia for giving me the opportunity to serve with John Warner. The election of 1978 brought 20 new Senators to the Senate. From that class, many Senators moved on to other pursuits: Bill Armstrong, David Boren, Rudy Boschwitz, Bill Bradley, Bill Cohen, David Durenberger, Gordon Humphrey, Roger Jepsen, Nancy Landon Kassebaum, Larry Pressler, David Pryor, Alan Simpson, Donald Stewart.

From that class, three have gone to their final rest. We all recall the memory of colleagues now departed: Jim Exon, Howell Heflin, Paul Tsongas. May their memories serve as a blessing.

From that class, four remain in the Senate: Thad Cochran, Carl Levin, this Senator, and John Warner.

As a young man, John Warner fought forest fires in Montana. Very often when I am talking to John, he recalls those times in Montana. His eyes brighten up. He very much reminisces about how much he enjoyed spending time in the State. Whether it was fighting fires or whether it was around Bozeman, MT, it comes to him very clearly when he talks about Montana in his early years.

At the age of 17, John Warner joined the Navy to fight in World War II, part of the ``greatest generation.'' John Warner is one of five World War II vets left in the Senate. He shares that distinction with Danny Akaka, Danny Inouye, Frank Lautenberg, and Ted Stevens.

John Warner went to college on the GI bill. Then he entered the University of Virginia law school. But when the Korean war broke out, John Warner, with his intense sense of patriotism, interrupted law school to fight for his country again. This time he served as an officer in the Marine Corps.

After returning from Korea, John Warner finished law school, clerked on the court of appeals, worked as an assistant U.S. attorney and worked as a lawyer in private practice. He returned to public service in 1969 as Under Secretary of the Navy. Then, in 1972, he succeeded our former colleague, John Chafee, as Secretary of the Navy. He represented the Defense Department at the Law of the Sea talks in Geneva.

In the Senate, John Warner has served as chairman of the Rules Committee. He has served as chairman and ranking member of the Armed Services Committee. He has come to be known as one of the Congress's most influential voices on matters of national defense.

But I have come to know John Warner on the Environment and Public Works Committee. John Warner and I have worked together on that committee for more than 20 years. I joined the committee in 1981 and John joined in 1987. There, for most of that time, both of us have worked together as chairman and ranking minority member of one subcommittee or another.

We worked together on transportation bills. Those are the bills with such colorful names as ISTEA, TEA-21, SAFET-LU. For a while, we were chairman and ranking minority member of the Transportation and Infrastructure Subcommittee. We worked on at least four renewals of the Water Resources Development Act.

I remember fondly working closely with John on the transportation legislation in 1997 and 1998, TEA-21. We worked with our late colleague, John Chafee. The three of us were a wonderful team. You will not believe the chemistry with which the three of us worked together. We decided early on we would stick together as a team: John Warner, basically the Southern donor States; John Chafee, basically the New England States; and I, representing in some sense the Western donee States. We represented the three major components who put together the Transportation bill.

We stuck together. We worked together. I mean we worked together. There is a lot of talk about we needing less partisanship around here. I have to tell you, John Warner, John Chafee and I, we sat down and worked things out. We had a terrific staff working for us, John, myself, and John Chafee. We were all together in John Chafee's office, sometimes in John Warner's office, deciding what was best on how to get a highway bill together.

It was a wonderful opportunity working in that office, working together. There were countless long days, many very long nights. You learn a lot about a person when things get tough, when the rubber meets the road. But I have to tell you, in our case, when anything was a little bit difficult, we did not ever get personal, did not get upset, did not ever attribute ulterior motives to anybody; we decided we were going to figure out how to get it done.

As I said earlier, there was a certain chemistry that came together with all six of us working together, my staff, his staff, their staffs, and the six of us all together. It was wonderful.

I think I learned a lot from watching John Warner and John Chafee, too, for that matter. They were two of the same. They both served as marines, and they both were Secretaries of the Navy. But John Warner was a person who listens. He sat there and listened; I had a point; John Chafee had a point. In other negotiations I have been in where John Warner has been there, John Warner is going to listen. John Warner will listen and say: ``Okay, that is interesting. Let's see how we can make that work.'' I might say also he is a very skilled statesman in that he cut to the core of matters pretty quickly.

Not a lot of fuss or muss, never got wrapped around the axle in details, when things kind of got off tangent in the wrong direction, but got to the core of the matter. He came to the core of the matter. He would sum it all up in a very wonderful, sort of statesmanlike, solid way, as only John can. We all sat there saying, ``Yes, that is about it. That is right.'' That is kind of what John said. ``That is probably right. We will go on from there.'' I learned a lot from John Warner. I hope I can use that in later years.

Both leaders spoke about how John Warner is not partisan, and it is true. I hope, frankly, that as we finish this year and next year, a lot of us remember the tone and the style with which John Warner conducts himself.

It is also very important to mention John Warner spoke up courageously in the State of Virginia; he did not support his party's nominee for the Senate. That was a gutsy thing to do, but he did it in a very civil way, not in a negative way, not in a partisan way. He spoke his mind about what was right. It was very courageous and also the tone made his message and his belief that much more important because people saw he was not personal, people saw he meant it, people saw he was courageous and he was doing what he thought was the right thing to do.

The same is true with respect to Senator Warner's decision about the war in Iraq. It is not the party line, John's statements. He is saying what he thinks is right. He is saying what he thinks is the right thing to do. It is not partisan. It is courageous and said in a very civil tone.

That is why people have called him a consensus builder. It is why people

often say he has a potential for bipartisan collaboration. I stand here saying I appreciate John Warner. When I got the news he was not going to seek reelection, I thought to myself this institution will be losing a great man. He is a wonderful person.

I hope all of us, when we finish these next 15 months or so working with John, thank John for what he is and also use John as a kind of point of departure, saying: ``I wish to be more like John Warner. I wish to do what is right; I wish to be courageous; I wish to be civil; and I wish to do what people of our States ask us to do.'' I salute John Warner.

Mr. President, I would like to enter into a brief colloquy with my colleague on the Environment and Public Works Committee regarding his understanding of congressional intent for monies authorized in the pending Minnesota, bridge disaster relief bill.

I want to clarify that this authorization comes from the general fund rather than the Highway Trust Fund. Is that your understanding?

I thank my colleague for his concurrence.

Yes, the Senator from Illinois has accurately described the proposed rule and its intent.

Yes, I plan to provide such a list with regard to legislation in my committee's jurisdiction.

disclosure of limited tax benefits

Mr. President, I would like to engage in a colloquy with the ranking Republican member of the Finance Committee about language in this bill regarding the disclosure of limited tax benefits. The ranking member and I have each been chairman of the committee in recent years. And we try whenever possible to work together. And nowhere is that more true than with regard to tax policy.

We have worked together to try to join in a policy about how to interpret the provisions in this bill on limited tax benefits. We hope that by explaining this joint policy now, we can help observers of the tax process to know how we intend to apply this new rule. I believe that the policy that I am about to tribe reflects our jointly held views.

I thank the Senator from Iowa. And I agree.

So here is our view. We wish to clarify the operation of the proposed rule change related to limited tax benefits. We know that it is impossible to foresee every possible application of the proposed disclosure rule for limited tax benefits. But we hope that this discussion will provide a more complete explanation of how the rule will operate.

For more guidance, we also recommend the interpretative guidelines developed by the staff of the Joint Committee on Taxation in response to the prior-law line item veto. These guidelines may also be applicable to the interpretation of the proposed earmark disclosure rules for limited tax benefits in this bill. The Joint Committee on Taxation documents are called, first, the ``Draft Analysis of Issues and Procedures for Implementation of Provisions Contained in the Line Item Veto Act, Public Law 104-130, relating to Limited Tax Benefits,'' that's Joint Committee on Taxation document number JCX-48-96, and second, the ``Analysis of Provisions Contained in the Line Item Veto Act, Public Law 104-130, relating to Limited Tax Benefits,'' that's Joint Committee on Taxation document number JCS-1-97.

The proposed rule in this bill would require the disclosure of limited tax benefits. It would define a limited tax benefit to mean any revenue provision that, first, provides a Federal tax deduction, credit exclusion, or preference to a particular beneficiary or limited group of beneficiaries under the Internal Revenue Code of 1986; and second, contains eligibility criteria that are not uniform in application with respect to potential beneficiaries of such provision.

The proposed rule would apply in most cases where the number of beneficiaries is 10 or fewer for a particular tax benefit. But the Finance Committee will not be bound by an arbitrary numerical limit such as ``10 or fewer.'' Rather, we will apply the standard appropriately within the unique circumstances of each proposal. For example, if a proposal gave a tax benefit directed only to each of the 11 head football coaches in the Big Ten Conference, we may conclude that the rule would nonetheless require disclosure of this benefit, even though the number of beneficiaries would be more than 10.

We will not limit the application of the proposed rule to proposals that result in a reduction in Federal receipts relative to the applicable present-law baseline. We believe that the proposed rule would have application to limited tax benefits that provide a tax cut relative to present law for certain beneficiaries, like, for example, a tax rate reduction for certain beneficiaries. But we also believe that the rule would apply to limited tax benefits that provide a temporary or permanent tax benefit relative to a tax increase provided in the proposal, like, for example, exempting a limited group of beneficiaries from an otherwise applicable across-the board tax rate increase.

For example, a new tax credit for any National Basketball Association players who scored 100 points or more in a single game would be covered by the rule. And the rule would also cover a new income tax surtax on players in the National Hockey League that exempted from the new income surtax any players who were exempted from the league's requirement that players wear helmets when on the ice.

The rule defines a beneficiary as a taxpayer; that is, a person liable for the payment of tax, who is entitled to the deduction, credit, exclusion, or preference. Beneficiaries include entities that are liable for payroll tax, excise tax, and the tax on unrelated business income on certain activities.

The rule does not define a beneficiary as the person bearing the economic incidence of the tax. For example, in some instances, a taxpayer may pass the economic incidence of a tax liability or tax benefit to that taxpayer's customers or shareholders. The proposed rule would look to the number of taxpayers. That number is easier to identify than the number of persons who might bear the incidence of the tax.

In determining the number of beneficiaries of a tax benefit, we will use rules similar to those used in the prior-law line item veto legislation. For example, we will treat a related group of corporations as one beneficiary for these purposes. Without such a rule, a parent corporation could avoid application of the disclosure rule by simply creating a sufficient number of subsidiary corporations to avoid classification as a limited tax benefit under the proposed rule.

For example, if a related group of corporations--like parent- subsidiary corporations or brother-sister corporations--owns a football team, then the related group will be considered one beneficiary. That treatment is analogous to the team being one entity, not separate entities, like the coaching staff, offensive unit, defensive unit, specialty unit, and practice squad.

The time period that we will use for measuring the existence of a limited tax benefit will be the same time period that is used for Budget Act purposes. That is the current fiscal year and 10 succeeding fiscal years. Those are also all the fiscal years for which the Joint Committee on Taxation staff regularly provide a revenue estimate.

For purposes of determining whether eligibility criteria are uniform in application with respect to potential beneficiaries of such a proposal, we will need to determine the class of potential beneficiaries. In the case of a closed class of beneficiaries--for example, all individuals who hit at least 755 career home-runs before July 2007--that class is not subject to interpretation, since only Henry Aaron satisfies this criteria. If, instead, the defined class of beneficiaries is all individuals who hit at least 755 career home-runs, then we will determine the class of potential beneficiaries by assessing the

likelihood that others will join that class over the time period for measuring the existence of a limited tax benefit.

Whether the eligibility criteria are not uniform in application with respect to potential beneficiaries will be a factual determination. To continue with the previous hypothetical, a proposal that provides a tax benefit to all individuals who hit at least 755 career home-runs may still not require disclosure if it is uniform in application. If the same proposal is altered so as to exclude otherwise eligible career home-run hitters who played for the Pittsburgh Pirates at some point in their career, then that kind of a limited tax benefit would require disclosure under the proposed rule.

Some of the guidelines in the Joint Taxation Committee's reports numbered JCX-48-96 and JCS-1-97 would not be directly applicable, but may be helpful in determining the class of potential beneficiaries. For example, the same industry, same activity, and same property rules might provide useful analysis.

So that is how we propose to apply the new rule.

Mr. President, I ask unanimous consent that the Senator from Virginia, Senator Webb, be recognized for 1 minute; and then following him, the Senator from Oregon would like 3 minutes on the bill, and then Senator Vitter would be No. 3, with no time for Senator Vitter.

Mr. President, I very much compliment the Senator from North Dakota. He is absolutely correct. This legislation is on a must- pass list. I have given my commitment to mark the bill up on September 12 in the Finance Committee. The leader has indicated he will give every assurance to try to get the legislation up on the Senate floor and go on to pass it. It has passed before, but it got hung up in the last Congress. It is high time we get this legislation passed, and I thank the Senator for, first, pushing the issue so hard and, second, working with the Senate to find an expeditious way to get this legislation passed.

Mr. President, I ask unanimous consent that after Senator Vitter is recognized, Senator Kohl be recognized for 5 minutes and Senator Allard be recognized for 10 minutes.

Madam President, as I have said many times in this debate, the Children's Health Insurance Program Reauthorization Act is good for America. I wish to take a few minutes to talk about why this children's health bill is good for my home State of Montana.

Montana ranks fifth highest in the Nation for the percentage of children without health insurance. In 2006, 37,000 Montana children did not have health insurance. That is one in every six children. More than half of those uninsured children, that is 19,000, were either eligible for Medicaid or for CHIP, the Children's Health Insurance Program, but not enrolled.

One of the reasons for our higher rate of uninsured kids is because the percentage of employers offering health care to Montana's working families is quite low. Less than half of all employers in the State of Montana offered health coverage in 2005. This means many working families do not have access to health coverage. Although families who do not have access to coverage through work could buy it on their own, health coverage is often priced out of reach for lower income families. The average cost of a family health plan on the open market in Montana is about $8,000 a year. That is nearly one-fifth of the family's income for a family of four earning $41,300, which is twice the poverty level. Again, the average cost is about $8,000, which is about one-fifth of a family's income for a family of four earning $40,000, and most families simply obviously cannot afford that cost.

CHIP, the legislation before us, offers affordable, comprehensive health coverage for working families. CHIP works, and it has helped thousands of Montana families.

Abigail Tuhy's family is one of those families. Abigail's mom, Fawn, is a mother of four, and Fawn's story tells volumes about why we need CHIP. She writes:

I don't know what our family of six would do without

[CHIP]. . . . In one year, my 2\1/2\-year-old had nine

stitches because she split her head open and my 6 year old

broke his arm two times. CHIP paid for the surgery, hospital

stay and all of the care provided. CHIP has also paid for all

of my children to receive all of their shots and their check-

ups. Without CHIP, I would not have insurance for my

children.

Abigail is only one of the more than 38,000 children helped by CHIP over the past decade. Today more than 14,000 Montana children are covered by it and the number is growing.

This year, the Montana legislature, for example, took a positive step forward, changing the CHIP eligibility level from 150 percent to 175 percent of the Federal poverty line. That is just over $36,000 for a family of four. Montana started implementing this expansion in July, which will bring an additional 2,000 children next year.

This is clearly good news, but we cannot rest on our

laurels. There are more uninsured children who need our help.

The CHIP Reauthorization Act will provide Montana with the

funding it needs to maintain current CHIP enrollment, fund

its expansion, and make significant strides toward covering

more of the uninsured children.

Under this legislation, Montana would receive about $28 million next year. That is $12 million more than its allotment for last year. New CHIP allotments, combined with new funds in the State to expand coverage to low-income children, could allow the State to cover as many as 12,000 children who are uninsured today.

The legislation before us also includes new funding to help Montana improve access to health care, including $200 million in new Federal grant money for States to improve the availability and comprehensiveness of dental health for children, and $100 million in Federal grants to improve outreach and enrollment, especially in rural areas.

This bill also includes provisions that specifically target Indian Country. Although Indian children are eligible for coverage through the Indian Health Service and tribal facilities, the IHS, the Indian Health Service, is only funded at 60 percent of need today, leading to tragic denials of care when funds run out. I mean it is abominable. This bill makes important changes to improve the health of Indian children. It provides new funds for outreach and enrollment in Medicaid and in CHIP. It also allows those Indians to use tribal documents to prove citizenship for Medicaid. It gives States a higher Federal match for translation and interpretation services in the program. And it requires the Secretary to monitor racial and ethnic disparities in care. All move us to a healthier future for Indian children in Montana.

As we debate CHIP today, let us remember the uninsured children in our home States, those kids who need help. In Montana, there are mothers whose daughters have cystic fibrosis. There are Native American children without health care coverage because they do not have a birth certificate. So let's keep in mind the children of Montana and every other State who need and deserve our help. Let's reauthorize this Children's Health Insurance Program today and improve the health of all American children.

Madam President, I ask unanimous consent the following Senators be recognized for the following amounts of time: first, Senator Dodd for 5 minutes; Senator Clinton for 5 minutes; and Senator Coburn for 15 minutes.

Madam President, it is being written up right now.

We do have a block of votes. It has been agreed to.

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

I might say to my good friend, we have noticed.

I don't see the Senator from New York here yet, but she is on her way. In the meantime, I ask unanimous consent that the Senator from Georgia be recognized and, following the Senator from Georgia, Senator Clinton be recognized.

Mr. President, I ask unanimous consent that the time until 4:30 p.m. today be for debate with respect to the amendments listed below, and that they be debated concurrently; that all time be between the managers; that no amendments be in order to any of the amendments covered in this agreement prior to the votes; that the votes with respect to the amendments occur in the order in which the amendments are listed here; further that after the first vote, the time for votes be limited to 10 minutes, and there be 2 minutes of debate prior to each vote; and that at 4:30, the Senate proceed to vote in relation to the amendments; that the Graham amendment No. 2558 be modified with the changes at the desk; that Senators Kyl and Graham be recognized respectively at 3:45 and 4 p.m. The amendments are Specter amendment No. 2557, Graham amendment No. 2558, Ensign amendment No. 2540, Thune amendment No. 2579, and Kyl amendment No. 2537.

Yes--well, I struck some of those words you read and inserted ``the managers.'' The thought was, it gives more flexibility so the two managers of the bill could then work with the sponsors of the amendments to allocate time. Some may want to speak longer than others. I felt that was just a way to better organize the time.

I am sure he does.

Mr. President, it is my understanding under the previous order Senator Clinton is the next to be recognized.

Mr. President, I see the Senator from Texas is seeking recognition. I ask unanimous consent that she be allowed to speak next for--10 minutes?

Certainly.

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

Mr. President, I ask that the time consumed by the Senator from Texas be charged against the time controlled by the minority, and further, that the time for the quorum call be equally divided.

Mr. President, I suggest the absence of a quorum.

Mr. President, a couple of words with respect to the amendment offered by the Senator from Nevada. I might as well finish them now, since he spoke. Basically, his amendment means that no State, after the date of enactment, could provide for adults--childless adults or parents, parents of kids. No State. That is what this is.

I also point out that the standard of 95 percent is an impossible standard. No State can meet that standard. There is no State in the Nation that could meet 95 percent. We have mandatory driver's license requirements in States, and even those mandatory requirements average, nationwide, about 85 percent. That is mandatory, and we are talking about something voluntary here.

So no State can possibly reach 95 percent compliance, which would mean, at the beginning of the date of enactment, all adults would be off--right now, immediately; all parents off--right now, immediately. And I don't think that is what we want to do. Why? Because the administration has granted lots of waivers to a lot of States for a lot of adults, and States are reliant on them.

In this legislation, over a 2-year period, we are stopping that, but we give States 2 years to stop providing coverage for childless adults and for parents. States can provide for parents with those waivers, but it is written in a way to discourage the use of CHIP money for parents unless States go the extra mile and seek out more low-income kids to provide coverage for them.

The legislation before us is a good compromise, but the amendment offered by the Senator from Nevada is way too Draconian. I might also add that all experts say if you cover parents, you will cover more kids. If you don't cover more parents, you are going to cover fewer kids. There is a very strong correlation between health insurance coverage for parents and parents getting good health care for their children. Put in reverse, there is a strong correlation of parents who do not have health insurance--we are talking low-income families here-- who will not provide good health care, on average, for their kids.

On the basis of policy, I don't think it is a good idea. It totally disrupts the compromise worked out on both sides of the aisle on this legislation. Senator Grassley, Senator Hatch, myself, and Senator Rockefeller worked very hard to get a compromise here. This legislation starts to squeeze down on adults, but it doesn't cold turkey say no. That would be unfair, especially with respect to parents, because parents who have health insurance themselves will tend to provide better health care for their kids.

When the appropriate time comes to vote on this amendment, I think the right thing to do would be not to support this amendment because of the reasons I indicated.

I yield the floor.

Mr. President, the Senator is always interesting, sometimes entertaining, but the Senator from Mississippi raised a couple of good questions. The real question is what are the answers to the questions.

One question is, what about adults? This is a children's program, and I think most Senators react a little adversely to covering adults. This Senator does too. It is a children's program, not an adult program. The Senator acknowledged graciously that most of the adult coverage problem is due to waivers this administration has given the States. The States want to cover adults. Why do they want to cover adults? Well, basically, because of the match rate, the money the States get under the Children's Health Insurance Program is higher, so they want to cover adults. What we are trying to do is figure how are we going to put the lid back on this. That is what we are trying to do here. It probably gets to the question of what is a fair transition period. What is the fair way to wean the States off of covering adults?

I guess it is important to remember there are a lot of people, adults out in the country who are getting health insurance, and they do not know what we are debating here in Washington, DC. They do not know the difference between CHIP, Medicaid, and match rates. All they know is they are getting some health insurance. And I don't know if it is right to just willy-nilly, automatically, cold turkey cut them off entirely, because they are depending on it.

I do think it is right, however, to wean States off this, and the States can, when their legislatures meet, figure out ways to cover adults they wish to but not on this program. That is what we are doing. That is what this legislation does. It says in the first year you can get a free ride, but in the second year your match rate is way down to the Medicaid match rate, which is basically about 30 percent less than the match rate under the Children's Health Insurance Program. A 30- percent cut will have a real effect on a lot of these States and discourage them from proceeding further.

In addition, legislation not too long ago repealed waivers so the States could no longer apply for waivers to get childless adult coverage. So question No. 1 is, what is the right thing to do about some States adding adults? Let us not forget, 91 percent of beneficiaries under the Children's Health Insurance Program today, 91 percent, are kids under 200 percent of poverty. Today. The vast bulk are kids. So when we talk about adults, we are talking about less than 9 percent, because some States have up to 200 percent of poverty. We are talking not too many people when we are talking about adults. This is kind of a philosophical question as much as anything else.

What is the best way to put the lid back on the can, to keep States from providing it for too many adults? We think we have a fair way to do it, as I just described, a fair transition period, and that is why we negotiated out this position.

Point No. 2 is, what is going to happen in conference. I have no idea. Senators know there are lots of ways to skin a cat around here. On the surface it looks like maybe if the Senate and House go to conference on these two bills--the Senate bill is much less, the House bill is much larger. They contain the Medicare provisions, physicians update provisions, and they are two different animals. When that happens, generally some other solution presents itself. That is why I say to my good friend from Mississippi, I hear what he is saying about the views of many Senators who do not want the conference report to come back with a number that is too difficult for many Senators to swallow, especially on the Republican side of the aisle. But I also say to my good friend, there are ways to do this. We may not go to conference exactly; the House may send back something else, maybe just a CHIP bill, and we will do the physicians update at a later date. There are many kinds of ways to do things around here.

Our goal is to help low-income kids who do not have insurance today so a few more get it. This is not a huge, massive expansion. This has nothing to do with national health insurance, none of that.

We are saying: Here is a program passed in 1997, it is bipartisan, Senators on both sides of the aisle like this program, there have never been any problems with it, it has worked real well, it just came up with reauthorization. The only slight problem is waivers for adults, but we are managing that. That is not a big deal. We can take care of that. So let's just reauthorize it, give it a little bump up to help a few more--not a lot, a few more kids get health insurance, and it costs a few dollars because health care costs are going up so much in this country.

While we are helping a few kids get health insurance, at a later date, next year, the following couple of years--clearly, Congress has to address the rising cost of health insurance in this country. But as a bottom line, this is a good thing to do, to help low-income kids get some health insurance.

Let's remember, in the United States of America there are about 48 million people without health insurance. We are the only industrialized country with that many people without health insurance. It is an outrage. The very least we can do is help our kids get some health insurance, particularly those who are low-income kids. That is what we are trying to do in a fair and reasonable way.

I am honored to yield to my friend from North Dakota.

That is correct.

The Senator is correct. But not only is it 3 million, it is 3 million low-income kids.

And they usually do not have health insurance because they can't afford it, even if their employer provides it.

Mr. President, I expect, frankly, the Senate will finish tonight, late tonight, and get this legislation passed--as well it should. In addition to the five amendments pending beginning at 4:30, there could be at least about 10 more later today--maybe a package about 8:00, another about 10 o'clock, something like that. My hope is some of those will not all be offered.

Mr. President, I don't know if we have much time left. I am trying to figure out how much time we have.

Sure. How about 3 minutes?

Sure.

I say to my good friend, this is not a new program. We are just reauthorizing a current program. It is not new.

Currently, there are about 6.6 million children covered.

About 3.3 million, roughly.

Actually, the Senator is making another point, which is about 6 million kids are eligible today under the current law but just are not covered. So we are saying we are not increasing the eligibility, we just want to help give a little stimulus so those who are currently eligible but not covered--a few more of them will be covered by health insurance.

The Senator is correct. There are many medical associations that support this bill.

I don't know if I want to answer that question, because I can think of one major bill that many thought was socialized medicine but they now strongly support.

That is a very good point. I might say, this legislation received endorsements from over 50 different organizations, major organizations--AARP, pharmaceutical companies, the American Medical Association. This bill has wide endorsements.

As the Senator has just implied--yes, this program says: OK, States, you figure out how you want to administer it. It is up to you, the States, not Uncle Sam.

Most States say we are going to utilize health insurance companies, private health insurance companies to administer this, with copays and deductibles, and so forth.

That is correct. This legislation also provides assistance for States to provide--the fancy term is ``premium assistance''; that is, to help families pay the insurance companies.

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

Mr. President, we have five votes now. Senator Specter is detained. I suggest the absence of a quorum.

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

Mr. President, I ask unanimous consent that the first amendment we vote on in the package would be the Kyl amendment. I see Senator Kyl on the floor. I make that request that we proceed immediately to the Kyl amendment, with 2 minutes equally divided prior to the vote, and subsequent to the Kyl amendment, that we go back in the same order; that 10 minutes be allotted between votes.

Yes.

I appreciate that. I am trying to move this along. The Judiciary Committee did break up some time ago.

No, longer than that.

Mr. President, I suggest the absence of a quorum.

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

I ask for the regular order.

Amendment No. 2557

Mr. President, I very much share the concerns of the Senator from Pennsylvania, I think every Member of this body does. That is, no one wants the Americans who currently do not pay the alternative minimum tax to have to pay it next year. They will have to unless this body, this Congress, makes the appropriate change in the adjustment.

I am fully committed to finding a solution so anybody who has not paid alternative minimum tax in 2006, when he or she files their tax returns next April, does not have to pay it for 2007.

This is not a good solution. Frankly, with this solution by the Senator from Pennsylvania, many more Americans are going to have to pay the AMT; it is not paid for, it is at a cost of about $420 billion.

Therefore, I raise a point of order that the pending amendment violates section 201 of the Senate Concurrent Resolution 21, the Concurrent Resolution on the Budget for fiscal year 2008.

Mr. President, the Senator clearly described his amendment. There is a slight problem that the cost of about $36 billion over 10 years is not paid for. I think we should adhere to the Budget Act and pay for provisions we enact.

So, Mr. President, I raise a point of order that the pending amendment violates section 201 of Senate Concurrent Resolution 21, the concurrent resolution on the budget for fiscal year 2008.

Mr. President, this is a poison pill. The effect of it is to kill this legislation.

The Senator is correct, no State can meet 95 percent. No state currently meets 95 percent. Driver's license participation, which is mandatory and not voluntary, is 85 percent. Participation in Medicare Part D, which is voluntary and not mandatory, is only 56 percent. There is no way in the world any State can meet a voluntary compliance rate of 95 percent, so this is a killer amendment. It kills the bill. It ostensibly applies to adults, but it kills the bill. I urge Senators not to kill the SCHIP program and vote against the amendment.

Mr. President, the Senator raises two issues, the AMT and this legislation. They are two entirely separate, independent issues. We will deal with the AMT at the appropriate time, not on this bill. The AMT is a huge problem. This Congress and the committee are going to, as sure as I am standing here, make sure we have some kind of AMT patch so taxpayers who did not pay the AMT tax in 2006 will not have to pay it for 2007.

We should not try to solve the AMT problem on the backs of the low- income kids. It is wrong, dead wrong. I strongly urge Senators to keep first things first. This is a kids bill, not an AMT bill. We deal with kids today and help low-income kids and we will deal with the AMT at a later date. Believe me, we will find a solution to that.

I urge Senators to keep their eye on the ball with kids and not to support the amendment.

Mr. President, this is plainly, simply, clearly a killer amendment. There is no way in the world that CBO can certify 20 percent crowd-out. They cannot do it.

There are many organizations trying to figure out what is the so- called crowd-out rate. They are all over the lot. It is almost impossible to tell what it is. That is the reason for the big range to which the Senator referred. The one to one is not accurate. If you read the CBO table closely and go down to the next line, you will see it is much less, about one-third under the table. There is no way CBO can certify this. It cannot happen.

If this amendment is adopted, you are basically saying no State can have a Children's Health Insurance Program. This is clearly a killer amendment. We should not kill the Children's Health Insurance Program. We should help more kids get health insurance, kids who are not now getting it.

I urge refusal of this amendment.

Mr. President, before we vote, I wish to set up a series of colloquies among several Senators after this vote. I ask unanimous consent that the following Senators be recognized for the following amounts of time on the Lincoln amendment No. 2621: Senator Lincoln, 5 minutes; Senator Nelson of Nebraska, 3 minutes; and Senator Snowe, 3 minutes.

Mr. President, this amendment is one that certainly cannot be accepted. Essentially, it allows insurance companies to race to the bottom, race to the State with the lowest level of standards of insurance regulation, to market and sell in any State, irrespective of what the standards would be in the other States. I don't think that is good policy. I understand what the Senator is driving at but certainly not tonight. Without a closer examination of what our State insurance regulation policies should be, this is not the time to get into this issue.

Certainly.

That is up to people in those States and their insurance commissioners, the decisions they make with respect to how their State sets up insurance regulation and sets up insurance commissioners.

That is correct. And that is the problem with the amendment. It would encourage companies to race to the bottom. I don't think we want that encouragement. We want a national program.

At the appropriate time, if the Senator wishes to spend more time--I don't know where we are right now, frankly.

Mr. President, if the Senator would like to have a vote on his amendment, we will at the appropriate time.

I suggest the absence of a quorum.

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

Mr. President, I ask unanimous consent that the pending amendments be temporarily laid aside, and I call up amendment No. 2619 on behalf of Senators Nelson of Florida and Alexander; that the amendment be agreed to and the motion to reconsider be laid on the table.

I ask unanimous consent that the following amendments be agreed to: No. 2631 on behalf of Senators Dodd and Clinton, and No. 2588 on behalf of Senator Obama en bloc, and that the motion to reconsider be laid upon the table.

Mr. President, I ask unanimous consent that at 7:45 this evening, the Senate proceed to vote in relation to the following amendments; that no amendment be in order to any of the amendments listed here prior to the vote; that there be 2 minutes of debate equally divided prior to each vote;

that after the first vote, the vote time be limited to 10 minutes; that the amendments be voted in the order listed: Coburn No. 2627, Vitter No. 2596, Allard No. 2535, Hutchison No. 2620, Kyl No. 2562, and Sanders No. 2600.

I amend that to be equally divided.

Mr. President, I ask unanimous consent that at the conclusion of the next group of votes, the Senate proceed to executive session to consider Calendar No. 240, Timothy DeGiusti, of Oklahoma, to be a U.S. district judge; that there be 2 minutes for debate equally divided between the chairman and ranking member; that the Senate then vote on the nomination, the motion to reconsider be laid on the table, the President be immediately notified of the Senate's action, and the Senate return to legislative session.

Mr. President, I ask that at this time Senators Klobuchar and Coleman be granted 10 minutes for a colloquy.

Mr. President, I thank the Senator for her efforts on this amendment. She has worked very hard on it, and I urge the adoption of the amendment.

Mr. President, I understand we have worked on another amendment, a Senator Wyden amendment, on juvenile diabetes. I understand it has been worked out all the way around. I urge the Senator to offer it now so we can get that out of the way, and the Senator from Oklahoma can then speak.

Mr. President, as the Senator indicated, it has been agreed to by both sides.

Mr. President, before the Senate proceeds, I ask unanimous consent that amendment No. 2618 be withdrawn.

What did the Senator request?

No objection.

Mr. President, we are close to 7:45. I suggest that the voting begin now.

Mr. President, I understand there is 2 minutes allowed equally divided prior to the vote; is that correct?

Does the Senator wish to speak for 1 more minute?

Mr. President, this is not wise. I do not think we should adopt this amendment. What does the amendment do? Basically it would require at least 34 States would have to resign their successful Children's Health Insurance Programs in ways that force children into potentially inferior coverage; that is, their health insurance coverage would be worse than under SCHIP. Why? Because sometimes private health insurance requires deductibles or limits hospital stays, may prevent insulin from being available for diabetes. It forces premium assistance. It forces people into coverage they may not want. I don't think we want to do that.

Second, it would force children to take the premium assistance to purchase HSAs. That is not a good idea. HSAs work better for wealthier Americans, healthier Americans. We are talking about low-income kids, and they have to spend a lot of money on high-deductible HSAs. I don't think it is a good thing to do.

We are here to help kids. We are not here to force kids into private coverage plans and use their premium assistance to buy HSAs.

I urge the amendment not be agreed to.

Mr. President, since the Senator took an extra minute, I ask to respond and then get to the vote.

Essentially, this amendment forces kids to use premium assistance in two negative ways. One, it forces them into private coverage. They may not want it because the private coverage might be worse. Second, this amendment has the effect of forcing premium assistance to buy HSAs.

I don't want to encourage it at this point because HSAs are better for the healthier and wealthier and not low-income kids. I urge the amendment not be agreed to.

Mr. President, I don't think we want to do this. This requires--it mandates--that States deny kids coverage under the program if their employer offers health insurance. It requires it. I don't know where we have those kinds of requirements today in the health care area. Senior citizens are not required to sign up for Medicare Part B. There is no requirement. Why should we require States to prevent children's health insurance coverage if by chance the child's family is offered private health insurance? The private health insurance may be inferior to what the child would otherwise get in the program. The benefits might be much less. Who knows what doctors are available. Who knows?

I don't think we want to require States to prevent families and low- income kids from getting CHIP coverage simply because an employer offers health insurance. That is not a fair choice. I think we should, therefore, reject the amendment.

Mr. President, just assume that you are a person who is maybe in one city and move to another town or have relatives in one city or town in the same State. You don't know what the match is going to be. You don't know whether you qualify or don't qualify. I don't understand this amendment at all. I am really quite astounded that we would want to even countenance doing something like this. Essentially it says: OK, MSA, State, you don't get the 300 percent match rate in Medicaid. You get 200 percent. You get Medicaid which is adjusted by cost of living, and MSA with a county or a State. I don't get it. I think we have to get some simplicity, some continuity, allow some people to have some idea of what the law is. I urge Senators to not support the amendment.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Mr. President, I ask unanimous consent that Sanders amendment No. 2600 be withdrawn.

Mr. President, this world is filled with irony. It is ironic, frankly, that we are here in this situation. But, essentially, first, I support what the Senator is trying to do. We reported this same provision out of the Finance Committee, as the Senator stated, at an earlier time as part of that small business-minimum wage package. It was then paid for.

I say to my friends and my colleagues that we will find a time to do this provision. It is part of the extenders package. Extenders are taken up at the end of the year. That is when we put them all together and find out what we want to do, not here on this legislation. It is not paid for. This costs $5 billion. I do not think it belongs on this bill. I, frankly, have to now raise a point of order.

Mr. President, I raise a point of order that the pending amendment violates section 201 of S. Con. Res. 21, the concurrent resolution on the budget for fiscal year 2008.

Mr. President, I ask unanimous consent that Senator Kerry be recognized now to offer a sense of the Senate, which will be agreed to.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Mr. President, I ask unanimous consent that Senator Cardin be recognized for the purpose of offering an amendment that also has been cleared on both sides.

Mr. President, I urge adoption of the amendment.

Mr. President, I ask unanimous consent that all pending amendments be withdrawn, with the exception of the DeMint amendment No. 2577; that no further amendments be in order, except a managers' amendment which has been cleared by the

managers and the leaders; that upon disposition of the DeMint amendment and the managers' package, Senator Dole be recognized for 5 minutes to make a budget point of order against the substitute amendment; that once the point of order has been raised, Senator Baucus be recognized to move to waive the applicable point of order; that upon disposition of waiver, if waived, then the substitute amendment, as amended, be agreed to, the bill, as amended, be read the third time, and without further intervening action or debate, the Senate proceed to vote on passage of the bill.

Mr. President, it is pretty clear we have one more vote that I am aware of before final passage. There will be a little bit of intervening business that should not take much time. So we are about done.

Mr. President, this amendment effectively eliminates State insurance protections. The States with the least regulation would become the home of private health insurers who sit back and watch a race to the bottom. States would be inclined to--and encouraged to-- pass regulations that are very weak, and that would mean the insurer could qualify in that State and then market anyplace else in the country. It is totally opposed to the current system, where each State has its own insurance regulations. One can argue whether that is a good system, but that is what it is.

We should not, at this point, adopt this amendment, which has the effect of appealing the current structure and allowing a race to the bottom in health insurance coverage.

Yes.

Mr. President, the Senator made my point. It is a race to the bottom. I urge rejection of the amendment.

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

The motion to lay on the table was agreed to.

Amendment No. 2645 to Amendment No. 2530

Mr. President, I send a managers' technical amendment to the desk and ask for its immediate consideration.

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

Mr. President, I ask that the amendment be agreed to.

Mr. President, I very much appreciate the words of the Senator from North Carolina. I know she means well, and is fighting very hard for her State. But pursuant to section 904 of the Congressional Budget Act of 1974, I move to waive the applicable sections of that act for the purpose of the consideration of this amendment, and I ask for the yeas and nays.

I would be happy to have a colloquy with the distinguished Senator.

I first thank the Senator from Michigan for her leadership on the Healthy Schools Act and school-based health centers. I, too, recognize the importance of school-based health centers. Clearly, efforts must be made to ensure that not only children have coverage but also access to health care providers. I support this amendment and will work with my colleague to address this issue in conference.

I want to thank the Senators from New Mexico and North Dakota for their leadership on this important issue. I have worked hard in previous Congresses to support this program and helped shepherd its last reauthorization as part of the 107th Congress. It is important that we work together to make sure our Native American and rural communities have the resources they need to provide treatment and prevention programs. It is important to support research to work to find a cure for this disease. Although we were not able to include this provision in the bill that is before us on the floor, I am aware that these critical programs expire in 2008; and that the reauthorization of these programs is a priority for the Finance Committee.

Mr. President, we are about to vote final passage tonight. I am not going to take the time of Senators for all the customary thank-yous. I will do that at a later date. But I do very much want to thank Senators Grassley, Hatch, and Rockefeller and all the great team who helped make this possible.

I also thank the parents across the country who love their children and are determined to provide the best possible health care for them. I say to the parents, to all Americans, I hope this bill helps you provide that health care, and I think it will. I thank all Senators for their cooperation in helping make this happen tonight.

Mr. President, I ask for the yeas and nays.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Amendment No. 2646

Mr. President, I ask unanimous consent that the title amendment at the desk be considered and agreed to and the motion to reconsider be laid on the table.

Mr. President, today I am pleased to join Senator Grassley in introducing the Continuing the Advancement of Quality Improvement Act of 2007.

This bill represents another step in our commitment to improving the quality of care provided for Medicare beneficiaries and all Americans.

The Medicare program funds Quality Improvement Organizations, known as QIOs, in part to work with health care providers to help them improve the quality of care they provide.

QIOs have played an evolving role in Medicare. Recently, the QIO program has received a great deal of attention. Not only did Senator Grassley and I have the Senate Finance Committee look into aspects of QIO operations, but the Institute of Medicine, the Government Accountability Office, and the Health and Human Services' Inspector General have all opined about QIOs as well. It seems there is a consensus that the QIO program could be doing more to help improve the quality of care.

That is not to say that QIOs have not been doing good work and providing valuable services up until now. Quite the opposite. However, over the course of time, QIOs have been tasked with a number of responsibilities and the program's mission has become blurred.

What Senator Grassley and I found, as well as the IOM, the GAO, and the HHS, OIG, is that the QIO program needs a sharper focus. Its mission to improve quality must be clear and unambiguous. Therefore, the Continuing the Advancement of Quality Improvement, or CAQI, Act would focus QIOs on providing technical assistance for quality improvement and performance measurement.

The bill would separate the beneficiary complaint process from QIOs and give this responsibility to Medicare Provider Review Organizations, which will be required to report to the complainant and refer the provider to a QIO for technical assistance and/or the appropriate regulatory body for sanctions. This will make the complaint review process stronger.

The CAQI Act would ensure that QIOs devote their attention to the health care providers that need help the most. It would also permit sharing QIO data with providers for quality improvement and patient safety purposes.

The Finance Committee investigation of the QIO program led Senator Grassley and I to include certain provisions we believe will enhance the integrity of the program. So, the CAQI Act would promote competition by allowing other types of organizations to serve as QIOs and eliminating noncompetitive renewals.

To ensure ``corporate'' integrity, the CAQI Act would establish requirements for governance and boards of directors at the QIOs, as well as requiring CMS to establish ways to avoid conflicts of interest.

The CAQI Act aims to ensure greater accountability for individual QIOs, and the QIO program as a whole. It would require the Secretary to perform evaluations of the effectiveness of each QIO and the whole program. QIOs would be evaluated on consistent measures that are based on nationwide priorities for quality improvement. The Secretary would be required to report to Congress annually on QIO performance, including how program funds were spent.

The QIO program is an asset to the Medicare program and the health care system in general. We have an opportunity to improve its effectiveness. We can make it a more useful tool as we continue advancing toward quality improvement. We have a duty to make the Medicare program as strong and robust as it can be. The Continuing the Advancement of Quality Improvement Act presents an opportunity to do just that. Senator Grassley and I urge our Colleagues to support it.

Mr. President, today I am introducing the Pharmacy Access Improvement Act of 2007. This is an updated version of a bill I introduced last year, and I am proud to bring it back.

I am excited that this year's bill is bipartisan. I am happy that Senator Grassley has joined me in introducing this bill. Given all of our work together on the Medicare prescription drug benefit, I am glad he is a cosponsor. I also am pleased to have our Senate colleagues join us on this important piece of legislation.

The Medicare prescription drug benefit got off to a bumpy start last year. A lot of the problems have been fixed, and the benefit is providing millions of seniors with access to affordable prescription drugs. Unfortunately, a number of the problems facing pharmacists remain. We need to help them.

The Medicare drug benefit brought about big changes to the pharmacy business. Dual eligible beneficiaries switched from Medicaid to Medicare drug coverage. Many more seniors have drug coverage. Dozens of new private drug plans are available.

I have heard from pharmacists in Montana who are struggling. They are trying to help their patients. But they face great difficulty. The success of the Medicare drug benefit depends on the pharmacists who deliver the drugs. So we have to help them. We must act now, before pharmacists find that they are no longer able to provide drugs to Medicare beneficiaries, or to provide drugs at all.

The Pharmacy Access Improvement Act would do several things to help pharmacies. First, it would strengthen the access standards that drug plans have to meet. It is important that the drug plans contract with broad and far-reaching networks of pharmacies. This bill would ensure that the pharmacies that drug plans count in their networks provide real access to Medicare beneficiaries.

It would also help safety net pharmacies to join drug plan networks. These pharmacies serve the most vulnerable patients and should be able to continue to do so. Drug plans should not be allowed to exclude safety net pharmacies. Excluding them does a huge disservice to needy beneficiaries. This bill would rectify the problems that safety net pharmacies have encountered in participating in the Medicare drug benefit.

The Pharmacy Access Improvement Act would speed up reimbursement to pharmacies. The delays in receiving payment from drug plans have forced pharmacies to seek additional credit, dip into their savings, or worse, as they try to continue operations. This bill would require drug plans to pay promptly. Most claims would be reimbursed within 2 weeks. And the bill would impose a monetary penalty on plans that pay late.

One of the most common complaints from beneficiaries has been how confusing the practice of co-branding is. Co-branding is when a drug plan partners with a pharmacy chain and then includes the pharmacy's logo or name on its marketing materials and identification cards. This is confusing, because it sends the message that drugs are available only from that pharmacy. That is not true. To help end this confusion, the Pharmacy Access Improvement Act would prohibit drug plans from placing pharmacy logos or trademarks on their identification cards and restrict other forms of co-branding.

This bill would also require that plans provide pharmacists with more accurate and updated information about reimbursement rates. Currently, some plans do not divulge to pharmacists how much a particular prescription will be reimbursed prior to dispensing. This bill would require disclosure before a pharmacist dispenses. It would require regular updating and disclosure of pricing standards.

The problems that pharmacists are facing are real. And they are not going away. We must act on the Pharmacy Access Improvement Act before it is too late for many pharmacists and the beneficiaries whom they serve. We have a duty to make the Medicare drug benefit as strong and robust as it can be. And the Pharmacy Access Improvement Act presents an opportunity for us to do just that. My cosponsors and I urge our colleagues to support it.

Mr. President, I want to begin my remarks by commending the thousands of case workers, foster families, neighbors and friends across the country that work to provide safety, stability, and love for the more than half a million children in the Nation's foster care system. More than a third of foster children in Montana are Native American. Across America, most of the Native American children in foster care are under the jurisdiction of tribal courts. But Native American tribes that want to administer their own child welfare systems are not eligible for Title IV-E funds to run their own foster care and adoption programs.

Today I am proud to introduce with Senators Domenici, Bingaman, Smith, Stabenow, McCain, and Cantwell the Tribal Foster Care and Adoption Act of 2007. This legislation is a demonstration of the commitment on both sides of the aisle to provide tribes with the opportunity to care for their own children. Children that need foster care and adoption services because of the abuse and neglect that they have already suffered. This bill provides tribes with the ability to serve their children directly with culturally appropriate care and understanding. The legislation also recognizes the good work of states and their collaborative efforts with tribes on behalf of tribal children.

This legislation has had a long history in the Senate and I am pleased to have been a part of that history since the 107th congress. It has been introduced in every Congress since then always with bipartisan support. This bill's time has come.

We have worked very hard to fine tune this legislation in away that is fair to states and finally gives Tribes direct access to the child welfare system. We want a system set up to protect those that need our protection the most not to exclude the most vulnerable members of our society from direct participation.

The child welfare system is languishing because of inadequate funding. And the system also suffers from a lack of culturally- appropriate approaches to help tribal children to find loving, permanent homes. I am further committed to working on behalf of our child welfare system with Chairman Grassley and with Senator Rockefeller who have always been dedicated to child welfare issues. The Tribal Foster Care and Adoption Act provides a pivotal opportunity to ensure that tribes across our country have the ability to access the child welfare system. I see this as a first step in making much needed improvements to the country's child welfare system, without significant costs or new federal programs.

We owe the first inhabitants of this great Nation and their children a child welfare system that works for them. We must do all we can to provide help.

Mr. President, today I am pleased to join Senator Grassley in introducing the Continuing the Advancement of Quality Improvement Act of 2007.

This bill represents another step in our commitment to improving the quality of care provided for Medicare beneficiaries and all Americans.

The Medicare program funds Quality Improvement Organizations, known as QIOs, in part to work with health care providers to help them improve the quality of care they provide.

QIOs have played an evolving role in Medicare. Recently, the QIO program has received a great deal of attention. Not only did Senator Grassley and I have the Senate Finance Committee look into aspects of QIO operations, but the Institute of Medicine, the Government Accountability Office, and the Health and Human Services' Inspector General have all opined about QIOs as well. It seems there is a consensus that the QIO program could be doing more to help improve the quality of care.

That is not to say that QIOs have not been doing good work and providing valuable services up until now. Quite the opposite. However, over the course of time, QIOs have been tasked with a number of responsibilities and the program's mission has become blurred.

What Senator Grassley and I found, as well as the IOM, the GAO, and the HHS, OIG, is that the QIO program needs a sharper focus. Its mission to improve quality must be clear and unambiguous. Therefore, the Continuing the Advancement of Quality Improvement, or CAQI, Act would focus QIOs on providing technical assistance for quality improvement and performance measurement.

The bill would separate the beneficiary complaint process from QIOs and give this responsibility to Medicare Provider Review Organizations, which will be required to report to the complainant and refer the provider to a QIO for technical assistance and/or the appropriate regulatory body for sanctions. This will make the complaint review process stronger.

The CAQI Act would ensure that QIOs devote their attention to the health care providers that need help the most. It would also permit sharing QIO data with providers for quality improvement and patient safety purposes.

The Finance Committee investigation of the QIO program led Senator Grassley and I to include certain provisions we believe will enhance the integrity of the program. So, the CAQI Act would promote competition by allowing other types of organizations to serve as QIOs and eliminating noncompetitive renewals.

To ensure ``corporate'' integrity, the CAQI Act would establish requirements for governance and boards of directors at the QIOs, as well as requiring CMS to establish ways to avoid conflicts of interest.

The CAQI Act aims to ensure greater accountability for individual QIOs, and the QIO program as a whole. It would require the Secretary to perform evaluations of the effectiveness of each QIO and the whole program. QIOs would be evaluated on consistent measures that are based on nationwide priorities for quality improvement. The Secretary would be required to report to Congress annually on QIO performance, including how program funds were spent.

The QIO program is an asset to the Medicare program and the health care system in general. We have an opportunity to improve its effectiveness. We can make it a more useful tool as we continue advancing toward quality improvement. We have a duty to make the Medicare program as strong and robust as it can be. The Continuing the Advancement of Quality Improvement Act presents an opportunity to do just that. Senator Grassley and I urge our Colleagues to support it.

Mr. President, today I am introducing the Pharmacy Access Improvement Act of 2007. This is an updated version of a bill I introduced last year, and I am proud to bring it back.

I am excited that this year's bill is bipartisan. I am happy that Senator Grassley has joined me in introducing this bill. Given all of our work together on the Medicare prescription drug benefit, I am glad he is a cosponsor. I also am pleased to have our Senate colleagues join us on this important piece of legislation.

The Medicare prescription drug benefit got off to a bumpy start last year. A lot of the problems have been fixed, and the benefit is providing millions of seniors with access to affordable prescription drugs. Unfortunately, a number of the problems facing pharmacists remain. We need to help them.

The Medicare drug benefit brought about big changes to the pharmacy business. Dual eligible beneficiaries switched from Medicaid to Medicare drug coverage. Many more seniors have drug coverage. Dozens of new private drug plans are available.

I have heard from pharmacists in Montana who are struggling. They are trying to help their patients. But they face great difficulty. The success of the Medicare drug benefit depends on the pharmacists who deliver the drugs. So we have to help them. We must act now, before pharmacists find that they are no longer able to provide drugs to Medicare beneficiaries, or to provide drugs at all.

The Pharmacy Access Improvement Act would do several things to help pharmacies. First, it would strengthen the access standards that drug plans have to meet. It is important that the drug plans contract with broad and far-reaching networks of pharmacies. This bill would ensure that the pharmacies that drug plans count in their networks provide real access to Medicare beneficiaries.

It would also help safety net pharmacies to join drug plan networks. These pharmacies serve the most vulnerable patients and should be able to continue to do so. Drug plans should not be allowed to exclude safety net pharmacies. Excluding them does a huge disservice to needy beneficiaries. This bill would rectify the problems that safety net pharmacies have encountered in participating in the Medicare drug benefit.

The Pharmacy Access Improvement Act would speed up reimbursement to pharmacies. The delays in receiving payment from drug plans have forced pharmacies to seek additional credit, dip into their savings, or worse, as they try to continue operations. This bill would require drug plans to pay promptly. Most claims would be reimbursed within 2 weeks. And the bill would impose a monetary penalty on plans that pay late.

One of the most common complaints from beneficiaries has been how confusing the practice of co-branding is. Co-branding is when a drug plan partners with a pharmacy chain and then includes the pharmacy's logo or name on its marketing materials and identification cards. This is confusing, because it sends the message that drugs are available only from that pharmacy. That is not true. To help end this confusion, the Pharmacy Access Improvement Act would prohibit drug plans from placing pharmacy logos or trademarks on their identification cards and restrict other forms of co-branding.

This bill would also require that plans provide pharmacists with more accurate and updated information about reimbursement rates. Currently, some plans do not divulge to pharmacists how much a particular prescription will be reimbursed prior to dispensing. This bill would require disclosure before a pharmacist dispenses. It would require regular updating and disclosure of pricing standards.

The problems that pharmacists are facing are real. And they are not going away. We must act on the Pharmacy Access Improvement Act before it is too late for many pharmacists and the beneficiaries whom they serve. We have a duty to make the Medicare drug benefit as strong and robust as it can be. And the Pharmacy Access Improvement Act presents an opportunity for us to do just that. My cosponsors and I urge our colleagues to support it.

Mr. President, I want to begin my remarks by commending the thousands of case workers, foster families, neighbors and friends across the country that work to provide safety, stability, and love for the more than half a million children in the Nation's foster care system. More than a third of foster children in Montana are Native American. Across America, most of the Native American children in foster care are under the jurisdiction of tribal courts. But Native American tribes that want to administer their own child welfare systems are not eligible for Title IV-E funds to run their own foster care and adoption programs.

Today I am proud to introduce with Senators Domenici, Bingaman, Smith, Stabenow, McCain, and Cantwell the Tribal Foster Care and Adoption Act of 2007. This legislation is a demonstration of the commitment on both sides of the aisle to provide tribes with the opportunity to care for their own children. Children that need foster care and adoption services because of the abuse and neglect that they have already suffered. This bill provides tribes with the ability to serve their children directly with culturally appropriate care and understanding. The legislation also recognizes the good work of states and their collaborative efforts with tribes on behalf of tribal children.

This legislation has had a long history in the Senate and I am pleased to have been a part of that history since the 107th congress. It has been introduced in every Congress since then always with bipartisan support. This bill's time has come.

We have worked very hard to fine tune this legislation in away that is fair to states and finally gives Tribes direct access to the child welfare system. We want a system set up to protect those that need our protection the most not to exclude the most vulnerable members of our society from direct participation.

The child welfare system is languishing because of inadequate funding. And the system also suffers from a lack of culturally- appropriate approaches to help tribal children to find loving, permanent homes. I am further committed to working on behalf of our child welfare system with Chairman Grassley and with Senator Rockefeller who have always been dedicated to child welfare issues. The Tribal Foster Care and Adoption Act provides a pivotal opportunity to ensure that tribes across our country have the ability to access the child welfare system. I see this as a first step in making much needed improvements to the country's child welfare system, without significant costs or new federal programs.

We owe the first inhabitants of this great Nation and their children a child welfare system that works for them. We must do all we can to provide help.

Mr. President, on behalf of Senator Dodd, I ask unanimous consent that Dr. Carmen Green, a fellow in his office, be granted floor privileges. I ask unanimous consent that Ben Miller of the Finance Committee be granted floor privileges, both for the remainder of debate on this legislation.

Mr. President, it is important to look at what this amendment actually does. It is a remarkable amendment. What does it do? It would try to spend the same dollar twice, take a dollar from tobacco taxes, spend it in the trust fund and spend it on CHIP--doing two things at once. I don't think we can do that in the real world. It is too good to be true. We can't do it. That is what the amendment says, basically. I do not think the Senator wants to take money away from kids, from the CHIP fund, the CHIP program. The amendment doesn't say that. I am sure he doesn't intend to do that. But what the amendment does say is the same dollars are going to be spent twice--one way we spend it is for this trust fund, the other way is we spend it on kids. I don't know how we do that; how in the real world we can do that. It is fantasy land. We can't do it.

Again, surely the Senator does not want to repeal the entire Children's Health Insurance Program. I am sure he doesn't want to do that. He does not do that in this amendment. But he still sets up the tension between the two, between research and all the good causes the Senator talks about on the one hand, and children's health insurance on the other, pitting one against the other. I don't think he wants to do that. He does not do that directly but he does that indirectly by trying to spend the same dollar twice. That might be possible in Hogwarts; it might be possible in Harry Potter's world. But I don't think it is possible in the real world.

Back here in the real world I want Senators to know this amendment is a thinly veiled attempt to steal the funding from the children's health care program. It is an attempt to undermine children's health care coverage. That is what this bill does. It takes a dollar from the tobacco tax--it is amazing--and that dollar is going to be spent on this trust fund and that same dollar is going to be spent on children's health care. We can't do that.

I urge my colleagues to reject the amendment.

I reserve the remainder of my time.

Will the Senator yield for a question on that one point?

I will take it on our time.

So the Senator wishes to take all the tobacco taxes in the underlying amendment, take all those dollars away from kids?

It is exactly right.

No, take it from the Children's Health Insurance Program.

Will the Senator yield for another question again, again on my time?

I don't mean to be condescending here, but has the Senator read the CBO analysis? I am sure he has. And, having read that, isn't it clear that a large share of the dollars in this bill from the tobacco tax are to maintain current coverage? That is, if we do not provide the $35 billion in this bill, that is the funds from the tobacco tax, that many kids are going to lose coverage? In fact, isn't it true that CBO says about 1.4 million children will lose coverage-- not just maintain, but lose coverage if we do not have this bill?

Of course not.

Mr. President, I think it is important to talk about the amendment, not all these other very important points with respect to health care. The effect of this amendment, the way it is written, will be to spend the same dollar twice. If the effect is what the Senator says it is, and he intends it--although that is not the amendment--if he intends to have all additional tobacco taxes go to the trust fund, then the net effect of this amendment is about 1.4 million American low-income kids will lose coverage. That is CBO. They will lose it, if that is the intent of the amendment.

The actual effect of the amendment the way it is written is the dollars have to be spent twice. We can't do that. I don't know how we do that. But, again, if the intent of the amendment is dollars do not go to kids, then the effect of the amendment is about 1.4 million

children will lose health insurance coverage; that is 5.7 million fewer kids will be covered under insurance than under our amendment.

In the Senator's own statements, he admits it. He apparently does not want to add dollars, he wants to take away the $35 billion raised by the tobacco tax and the honest effect of that $35 billion is to help prevent about 1.4 million kids from losing coverage as well as adding additional coverage. It is both. If the amendment is what the Senator wants it to do and says it is, then about 1.4 million kids will lose coverage.

I don't want to belabor the point. Some of the points the Senator makes are very good. Sure, he wants to do more research, but still the fact is the amendment takes dollars away from kids, away from the Children's Health Insurance Program.

In the children's health care program, 1.4 million American children will lose coverage under the Senator's amendment. That is CBO, that is not me. That is CBO. I do not think we want to take away our current coverage under the program.

One minor point that is not relevant to the amendment, but is relevant to the bill, is the Senator talks a little about something called crowd-out; that is, the number of kids who might not have private coverage who move to the CHIP program. That happens in every single program.

Do you know what the crowd-out estimate was with the Medicare Modernization Act, Part D? It was 75 percent. That was the estimate on how much crowd-out there would be for that legislation, which this body strongly supported. It actually turned out to be much less than that.

When this program was initially enacted in 1997, the Children's Health Insurance Program, CBO estimated crowd-out to be 70 percent. It was much less than that. We have asked the CBO Director to design this legislation to minimize crowd-out as well as we possibly can. And he, in testimony before the committee, said: You have done a very efficient job to minimize so-called crowd-out.

So we are cognizant of the point. But the main point is to get more health insurance coverage for kids. That is what the underlying bill does.

Mr. President, I yield back the remainder of our time.

Mr. President, I move to reconsider the vote.

I do.

Mr. President, I yield to the Senator from Delaware.

Mr. President, I am very happy to see the Committee on Homeland Security doing its work. I think the country is very pleased. Thank you.

I would object to that.

Mr. President, I had the floor, and I yielded to the Senator from West Virginia.

Mr. President, I say to the Senator, you do.

Mr. President, I yield to the Senator from Nevada.

Mr. President, I suggest we get back to business.

Mr. President, I understand Senator Gregg is ready for a vote with respect to his amendment, so I ask unanimous consent that there be 2 minutes equally divided in the usual form for debate prior to a vote in relation to the amendment, that no amendment be in order to the amendment prior to the vote, and that upon the use of time, the Senate proceed to vote in relation to the amendment, with no intervening action.

It may be.

Mr. President, four quick points. No. 1, we clearly want to bring this program down for kids, and this legislation does that. No. 2, the current expansion--not to point fingers anywhere--is basically as a result of the waivers this administration has given to States. That is the main reason for others. That is the main reason we have expansion to cover adults in States. No. 3, we are addressing this in this bill. We cut back on adults in this bill. But No. 4 is, we want to draw the line here a bit, and not totally cut adults off cold turkey, but, rather, childless adults would be cut back and zeroed out after 2 years, but then parents are phased down. But CBO has said when you do not cover parents, then you are also not covering some kids. The goal is to cover kids. I think the legislation is a fair, good, solid way to restrict coverage of adults, and I urge my colleagues, do not support this amendment, which is too draconian and goes too far.

Mr. President, Senator Cantwell is on her way to speak. She is not here. I see the Senator from Pennsylvania on the floor. I know he desires to seek time. I urge the Chair recognize the Senator from Pennsylvania who I think is going to speak about 8 to 10 minutes.

Mr. President, I might inquire of the Senator from South Carolina, how long does he wish to speak? We have been trying to go back and forth.

Because that will be three on your side in a row before we go back to this side. Is the Senator speaking on the same subject?

I urge the Presiding Officer to recognize the Senator from South Carolina.

Mr. President, we now have had three speakers from the Republican side of the aisle, three in a row, so I ask unanimous consent that the following speakers be recognized: Senator Harkin immediately, and following Senator Harkin, Senator Cantwell will speak, and that would be the request at this point.

I thank the Chair.

Mr. President, I know Senator Hatch wishes to speak on the underlying bill, the Children's Health Insurance Program. He is on his way to the floor. In the meantime, I see the Senator from Michigan is here, a very valuable member of the Finance Committee. She works very hard. She would like to speak on this bill. I thank her for coming to the floor. I urge the Chair to recognize the Senator from Michigan.

Mr. President, I understand the Senator from Massachusetts, Mr. Kerry, is about to speak. As he gets ready to speak, there are a couple of points I wish to make. We are still working the numbers on the McConnell-Lott amendment. I wish to point out a couple of points.

No. 1, the McConnell-Lott amendment, although it is advertised to do this, does not put kids first. Despite prohibiting coverage of nonpregnant adults and limiting all State income disregards, this legislation does not cover substantial numbers of additional children.

On the surface, they think they may cover 700,000 additional kids, but we are trying to get the numbers from CBO and trying to determine the actual effect; whereas, the Finance Committee bill the CBO has analyzed very carefully it will cover an additional 4 million children. About two-thirds of those will be on Medicaid, and roughly a million will be under the Children's Health Insurance Program.

The big difference is the different effects between the Finance Committee-passed bill and the McConnell-Lott bill on uninsured Medicaid-eligible children; that is, children today who are not on Medicaid but are eligible--what is the effect of the two various approaches on those low-income kids.

Again, I give the caveat we do not have all the actual language and do not have all the numbers exactly crunched by CBO, but a first analysis essentially looks like this. It looks basically like the McConnell-Lott bill will not add many new kids to be covered under Medicaid; whereas, the Finance Committee bill has about 1.7 million children now not covered under Medicaid who will be covered.

It is complex legislation we are considering. This is a Children's Health Insurance Program. But as we work to get more kids covered under the Children's Health Insurance Program, by definition there are going to be more kids also covered under Medicaid--that is children whose income levels are so low they are covered under Medicaid as opposed to the Children's Health Insurance Program.

There is a huge difference there. It looks like the McConnell-Lott bill will not help the very low-income kids who are currently eligible under Medicaid to be covered. In fact, the Finance Committee bill covers at least five times more.

I might say a word about the so-called crowding out. Senators are concerned this legislation will have the net effect of encouraging some children, now under private health insurance, to drop their private health insurance coverage to take advantage of the Children's Health Insurance Program expansion. There are a couple of points about that.

No. 1, under the McConnell-Lott amendment, it looks like their so- called crowd-out ratio is even more adverse from their perspective than the crowd-out ratio under the Senate Finance Committee bill. I don't wish to belabor the point. It is roughly the same, roughly 30 percent, but their crowd-out rate is a little greater on a percentage basis as to how many kids are there who will drop private health insurance for the Children's Health Insurance Program. But theirs is no better in fact a little worse, from that perspective.

Also, it is important and worth noting that when Congress passed the Medicare Modernization Act a few years ago and it provided for the Part D benefits for senior citizens, CBO said the crowd-out rate for that program would be much higher--and it was. I think there is one estimate beginning at 75 percent. I think it dropped to around 40 percent. I might not be entirely accurate on those numbers, but it is much higher than the 30 percent predicted under the Finance Committee CHIP bill and also about the same under the McConnell-Lott substitute.

In addition to that, we on the Finance Committee wanted to reduce the so-called crowd-out as much as we possibly could. We asked the Congressional Budget Office, especially the Director of the Budget Office, Peter Orszag, to tell us on the committee what did we have to do on this legislation; tell us how we should write it to minimize crowd-out as much as we possibly can, be as efficient as we possibly can. He told us what to do and we did it.

In the Finance Committee markup, when asked about crowding out; that is, kids moving from private health insurance coverage over to the Children's Health Insurance Program, he said you have done it efficiently. You have done it as well as you can do it.

I wish to make the point very clear. While we are helping children, while we are helping low-income kids get health insurance--as we clearly should--we also do not want to disrupt the private industry any more than need be.

It is important to remember that States are given power to decide how they want to administer the Children's Health Insurance Program. It is up to the State. Some States add it to Medicaid. Some States have separate programs. Most States use health insurance companies to administer the health insurance program, the Children's Health Insurance Program, with copays and deductibles, and so forth. So those who on the surface might be concerned if their ideology is it should be private health insurance, not the Children's Health Insurance Program, should not be too concerned, frankly, because we have gone the extra mile to make sure that so-called crowd-out is minimized as much as we possibly could.

I will have other points to make later on about the McConnell substitute. Basically, I wish to say it states that if you are at 200 percent poverty or a little above 200 percent of poverty, despite what we anticipated when we passed this legislation in 1997, I am sorry, you can't go above 200 percent if you want to have the benefit of the Children's Health Insurance Programs match rate, which is a little more beneficial to the States than the Medicaid match rate. That is not right. So many States are at least above 200 percent of poverty. I think that is wrong.

The other major thrust of the McConnell substitute is if you are above 200 percent of poverty, you have to go into the private market. That encourages them very strongly. That is not right either. Fundamentally, the Children's Health Insurance Program was written first, in 1997--again, it is a block grant program that gives States flexibility and recognizes that every State is different.

So often Senators say we should not enact one size fits all. I have heard that 100 times around here. Basically, that is correct--not always but basically. Senators who are advocating McConnell-Lott say one size fits all, basically, not recognizing that different States have different costs of living, some States are much more expensive to live in than others.

I saw a chart the other day that showed if you take 200 percent of poverty and matched that against the cost of living in various States in our country, in some States, the parity level would be maybe down around, oh, say, 150 percent of poverty. But there is one State that was 300 percent. If you translate the 200-percent nationwide figure to what the cost of living is in that State, it comes out to 300 percent. I think that is fair because different States are so different.

I ask unanimous consent, now, that the pending amendment also be temporarily laid aside so Senator Kerry may offer an amendment.

Will the Senator yield for a question?

Are there any States that cover 400 percent of poverty?

That cover children at 400 percent of poverty.

No, that is not correct.

No. Is it true if a State wants to cover, say, above 300 percent of poverty, is it true the State has to get concurrence with the Secretary of HHS?

Has New York received that concurrence?

Actually, I would not say it is 100 percent incorrect, but HHS has discretion, as HHS had discretion granting other waivers which the Senator is concerned with, and, frankly, this Senator is concerned with. As the Senator knows, this bill is designed to crack down on the effect of those waivers and prevent any future waivers with a lot of the adults I know the Senator is concerned about.

I wished to make the point that no State covers at 400 percent of poverty today. Secondly, if New York does seek 400 percent--if any State seeks 400 percent, it has to get the concurrence of the Secretary of HHS.

Will the Senator yield for another question?

I appreciate the willingness of the Senator to engage in a dialogue. Is it true, first, that the match rates States are getting; that is, the Federal proportion and the State proportion, are more favorable to States under the CHIP program than it is under Medicaid?

The Senator is correct. That is correct. Is it also true that, on average, the differential is about 30 percent? That is, the match rate that States get under the Children's Health Insurance Program is about 30 percent better, from the State's perspective, than the State gets from Medicaid; is that also true?

It is true.

It is true it is about 30 percent. Is it also true that different States have different costs of living?

And so some States--

Different States have different costs of living. Some are more expensive to live in than other States.

Although the Senator is correct that States have set their eligibility rates at 300 percent of poverty, that actually, at that point, States no longer receive the Children's Health Insurance Program match rate, which is 30 percent higher on average than they receive in Medicaid. They can go to 300 percent or above 300 percent, but if they do--if they do--isn't it also true they get a much lower match rate than they receive today; that is, at the CHIP rate rather than the Medicaid rate?

Well, if the Senator is asking me the question, that is true, as in the case of Medicaid but reminding us that we are talking about very low-income kids here.

Will the Senator yield on that point for a question?

A question designed for Senators to have more information about the basic point the Senator was talking about, crowd-outs, which the Senator understands is people on private insurance leaving private health insurance to go to the program that Congress may have enacted.

Does the Senator have any idea--I found this very interesting--when Congress passed the Medicare Modernization Act, which included Part D drug benefits--I don't know whether the Senator voted for that bill. I assume the Senator voted for that.

Does the Senator know at that time what the so-called crowd-out was? In fact, put it this way: Does the Senator know what percent of people who at that time were on private health insurance who might then have gone to a program the Government offered? Does the Senator have any idea--I am not saying the Senator should know. Does the Senator have any idea what was estimated at that time when we passed that bill what the crowd-out would be?

The Senator is correct.

Correct. There is no real official conclusion of what the actual crowd-out has been. But does the Senator know the basic unofficial statistic is about 66 percent; there was about a 66-percent crowd-out under the Medicare Modernization Act?

I want to ask another question. Does the Senator know what the anticipated crowd-out was when this Children's Health Insurance Program was originally enacted in 1997? What was the estimated crowd-out then, when we passed this bill in 1997?

It is about 40 percent. And does the Senator know what the actual experience has been? About between 25 and 50 percent are the best numbers we can get.

Between 25 and 50.

You are close. Does the Senator know that when we wrote this bill we asked the CBO Director, Peter Orszag, to tell us in the Finance Committee what we have to do to minimize the phenomenon of crowding out? Of course the Senator doesn't know we asked him, but does the Senator know when we asked Peter Orszag during the markup--it is on the public record--were we extremely efficient and minimized the crowd- out as much as we possibly could, does the Senator know Mr. Orszag said, Yes, we were extremely efficient and minimized crowd-out as much as we possibly could?

Let me answer that question by asking this question in return: Would the Senator want even more crowd-outs under a different approach? All experts say if we try to address more coverage for low- income kids through private coverage that the crowd-out would be even greater. Would the Senator want that greater crowd-out to occur, compared with the Children's Health Insurance Program?

I respond to the Senator, I have forgotten the exact statistic, but intuitively the answer is the one the Senator is suggesting, but actually the fact is, as we established earlier, no State has 400 percent of poverty. No State does. No State does. But for those States above 300 percent, the kids who are actually covered, the greatest preponderance of kids covered is still low-income kids. I say of all the beneficiaries to date under the Children's Health Insurance Program today, 91 percent are children at or below 200 percent of poverty.

This program is for kids. I know all this concern about adults and I share the Senator's concern about adults. I share it very strongly. We worked very hard on this bill to cut down adults, as the Senator knows. Childless adults are phased out after 2 years and parents are much lower--get a poorer rate. The third category of adults, pregnant women, there is a State option.

But the biggest concern, I am sure, of the Senator from Alabama is childless adults. This is supposed to be a kid's program, not an adult's program. We say, OK, after 2 years you are off. As the Senator also knows, back in the Deficit Reduction Act, when that was passed, we prevented HHS from granting any waivers for childless adults in the future.

I am not going to belabor this crowd-out issue. A lot of people watching are probably asking what in the world is crowd-out. For those wondering what in the world crowd-out is that we are talking about here, basically it is how many people of those this legislation covers--how many people would be crowded out of private health care insurance. That is, if they are on private health care insurance today, how many would leave private health insurance to go to the Government program.

A couple of points here. No. 1, those who might be inclined to vote for the McConnell substitute know this, but actually the so-called crowd-out is greater in the McConnell-Lott proposal than it is on a percentage basis under my bill. On a percentage basis, under the McConnell-Lott bill, more people would be leaving private health insurance to go to the Children's Health Insurance Program.

Second, the figure we hear is 1 to 1. That is not accurate. That is selective use of the tables. If you look at the real facts, at the bottom line under CBO's estimates, they actually say it is more in the neighborhood of--it is not 50 percent that is represented here, but actually it is about 30 percent.

It also has been represented here that maybe under tax credits, which is a better way to go to cover health insurance, the implication is there will be less crowd-outs. Well, let me just point out that there is a fellow named John Gruber, and he is an MIT professor, a health economist. He is often quoted by the President. Professor Gruber is often quoted by President Bush in this general area. What does Professor Gruber say? He says that the tax credit crowd-out is, in his estimate, 77 percent. Much higher.

So for those concerned about the so-called crowd-out, I would think they would like the underlying bill because of all of the approaches we have discussed here, there is less crowd-out in the underlying bill than in the substitute or under the Kyl-Lott amendment and much less than would be the case under a tax credit approach to help low-income kids. I think the record should show that so Senators have full information and those watching this debate, wherever they may be, also have the facts before them.

Madam President, I suggest that the Chair recognize Senator Murray.

Mr. President, first, I thank Senator Hatch. He has been very hardworking and dedicated to the goal of trying to find a balanced, bipartisan solution to help expand the Children's Health Insurance Program. I compliment him very deeply for all of his terrific work.

He has just gone above and beyond. Senators and the people from the State of Utah, I think, should know that. He has done a super job.

I know a number of Senators have been seeking to speak, and I want to protect them. So I ask unanimous consent that the following Senators be recognized in the following order: first, Senator Nelson of Florida, then Senator Thune of South Dakota, and then Senator Lautenberg of New Jersey.

Mr. President, I ask unanimous consent that at 6 p.m. the Senate vote in relation to Senator Dole's amendment No. 2554; that following that vote the Senate vote in relation to Senator Bunning's amendment No. 2547; that following that vote the Senate vote in relation to Senator Lott's amendment, as modified, No. 2593; and following that vote the Senate vote in relation to Senator Kerry's amendment No. 2602, as modified; that there be 2 minutes for debate, equally divided, prior to each vote; that no other amendments be in order prior to these votes; that any amendment not disposed of remain debatable and amendable, and that the time between now and 6 p.m. be equally divided between the two leaders or their designees.

First, Mr. President, I modify the unanimous consent request to say that after the first vote, there be 10 minutes between votes--that they be 10-minute votes.

Mr. President, I will do my best to allocate time from one of the remaining speakers so that the Senator from Idaho could speak as much as he can. We are trying to use the time as best we can between now and 6 o'clock.

Mr. President, the order has been Senator Nelson and Senator Thune--excuse me, the Senator from Florida, Senator Thune, and Senator Lautenberg. I think given the time, if the Senators understand the three remaining speakers have a total of a half hour, we can work that out. The Senator would get at least 10 minutes, and depending upon the length of time other Senators speak, he may get more. Senator Thune still has the floor.

Mr. President, I know the Senator from New Jersey wishes to speak. He has a very deep interest in one of the amendments. He wants to speak for 15 minutes. Maybe he can speak a little less than that. I would appreciate it.

Mr. President, I yield whatever time the Senator from Iowa desires.

Madam President, I suggest the absence of a quorum.

Madam President, I understand the Senator does not like the way we are paying for this bill. The more appropriate response would be for the Senator to offer an amendment to strike it or to find some other way to pay for it. I do not think it is wise for this body to enact another procedural hurdle as we consider legislation generally here; that is, another hurdle that would block attempts for us to help people in the States we represent. I don't think that is needed.

Secondly, this is the wrong time to consider changing Senate procedure. The more appropriate time is during consideration of the budget resolution, when the Senate has all the budget issues before it. I don't think it makes any sense to put another procedural obstacle before us to make it more difficult for Congress to respond to the needs of the American people.

I encourage Senators to, therefore, not support the amendment.

Madam President, I move to reconsider the vote.

Madam President, I move to table the Bunning amendment and ask for the yeas and nays.

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

The motion to lay on the table was agreed to.

Amendment No. 2593

Madam President, effectively, the Lott amendment is actually going to cause in some States a reduction in kids who are covered. It is very nominal, a slight increase overall. It does not begin to address the 6.6 million kids we need to cover under CHIP, as I think most of us want to. The basic point is, this amendment has lots of other provisions in it which I do not think we should appropriately consider at this point. The small business health plans, HSAs, is a debate for another day. It has nothing to do with the Children's Health Insurance Program. I don't think it is wise to put those battles on the backs of kids. We should get this legislation passed. It helps kids. It cuts back adults. It is moderate. It cuts back on some excessive coverage in some States, but it is unwise to radically restructure health insurance with the health insurance provision as well as HSAs.

Mr. President, I move to reconsider the vote.

Mr. President, I object.

Mr. President, I want to move things along here and set an order of speakers. I ask unanimous consent that Senator Mikulski be recognized to speak for 5 minutes; following that, Senator Chambliss be recognized to speak for 5 minutes. Following him, Senator Brown be allowed to speak for 8 minutes; following him, Senator Coburn, for 10 minutes; following that, Senator Webb be allowed to speak for 10 minutes.

Mr. President, if I may have the indulgence of the Senator from Georgia, I ask unanimous consent that the pending amendment be set aside, and on behalf of Senator Specter, I call up amendment No. 2557.

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

I thank my friend from Georgia. I yield the floor.

Mr. President, I am proud to join with Senator Hatch to introduce the Trade Enforcement Act of 2007. This bill will provide the administration additional tools, resources, and accountability to enforce international trade agreements abroad and domestic trade remedy laws here at home.

Over 400 years ago, William Shakespeare wrote ``The law hath not been dead, though it hath slept.'' The same could be said of our trade enforcement laws today.

The administration has many tools at its disposal to enforce international trade agreements. It can file dispute settlement cases in the World Trade Organization, WTO. It has Section 301 to fight market access barriers. It has Special 301 to address intellectual property violations abroad. It has Section 421 to remedy Chinese import surges that cause injury here at home.

But having these rules on the books is not enough. We need to enforce them.

There is a very real sense among Americans that our trading partners do not play by the rules. And there is a very real sense that the U.S. Government is allowing them to get away with it.

That is why I am introducing the Trade Enforcement Act of 2007--to ensure that the administration has the resources to enforce our existing trade laws, to provide political accountability when it does not, and to create new tools that address the enforcement priorities of American farmers, ranchers, manufacturers, and service suppliers.

This legislation bolsters enforcement of U.S. trade agreements in three important ways.

First, it requires the U.S. Trade Representative, USTR, to dedicate more time to enforcement. The bill requires USTR to provide an annual report to Congress identifying the most significant barriers to U.S. companies abroad and to take enforcement action to resolve them. It also makes trade enforcement more accountable to Congress. The bill allows the Senate Finance Committee or the House Ways and Means Committee to require USTR to identify a specific barrier in its annual report. And, significantly, the bill creates a Senate-confirmed Chief Enforcement Officer at USTR to investigate and prosecute trade enforcement cases.

Second, the bill addresses serious concerns that have been raised about the quality of recent World Trade Organization dispute settlement decisions. It does so by establishing a commission of retired judges and international trade law experts to review the decisions and determine whether they impose obligations on the U.S. that are not found in the text of the WTO agreements. The bill also prevents the administration from changing a regulation to comply with an adverse WTO decision until Congress receives the commission's report.

Third, the bill ensures that other U.S. government agencies do not use foreign policy and other noneconomic rationales to block USTR from taking tough enforcement actions. It clarifies that while USTR must carefully consider any advice provided by the interagency trade organization established under the Trade Expansion Act of 1962, it need not, and shall not, seek approval of its actions from the organization.

The bill also bolsters enforcement of U.S. trade remedy laws in four important ways.

First, the bill limits the President's discretion to deny relief in Section 421 cases to address Chinese import surges. This administration has utterly failed to use this trade remedy as Congress intended. It has denied relief in every case where the International Trade Commission, ITC, determined that relief was warranted. Our bill remedies this deficiency by requiring the President to proclaim any import relief that the ITC recommends unless the President finds, in extraordinary cases, that the relief would seriously harm our national security or would have an adverse impact on our economy that clearly and significantly outweighs the benefits. Congress may override the economic determination and reinstate the ITC's decision if it enacts a joint resolution of disapproval.

Second, the bill makes it easier for U.S. companies to obtain relief from subsidized imports from certain countries. It clarifies that the Commerce Department may apply countervailing duties to nonmarket economies like China. The Commerce Department has long taken the position that our countervailing duty laws do not apply to nonmarket economies, and it has refused to do so until very recently. The bill closes this loophole and eliminates any remaining uncertainty.

Third, the bill makes it easier for U.S. companies to obtain relief from subsidized and dumped imports from all countries by overriding the Federal Circuit's recent Bratsk decision. The bill provides that the ITC must make its injury determinations in antidumping and countervailing duty cases without regard to whether imports from other countries are likely to replace imports from the country under investigation.

Fourth, the bill increases intellectual property expertise at the ITC. It authorizes the ITC to appoint hearing officers, rather than administrative law judges, ALJs, to take evidence and make initial decisions in intellectual property investigations under Section 337 of the Tariff Act of 1930. Unlike the current ALJs, the hearing officers would be required to have technical expertise and experience in intellectual property law.

The overarching goal of this bill is, as Shakespeare might say, to ``wake up'' our trade laws from their current slumber and ensure that the administration enforces them to the fullest extent. Our farmers, ranchers, and companies deserve nothing less.

I therefore hope that my colleagues will support the Trade Enforcement Act of 2007.

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