Floor Statements

Mr. President, I rise to introduce, with Senators Leahy, Schumer, Grassley, Feinstein, DeWine, and Edwards, the Criminal Spam Act of 2003. This legislation, which enjoys bipartisan support, targets the most egregious types of spammers--those who hijack computer systems and those who use other fraudulent means to send unsolicited commercial electronic mail.

Over the course of the past several years, the amount of unsolicited commercial email, or spam, has grown at an exponential rate. During a recent Senate hearing before the Committee on Commerce, Science and Transportation, Brightmail Inc., a provider of spam filtering software that serves six of the ten largest U.S. Internet service providers, estimated that in April 2003, 46 percent of all email traffic was spam. This figure represented a nearly five fold increase in spam in merely 18 months. At the same hearing, America Online testified that on any given day, it blocks approximately 2.3 billion spam messages.

This tremendous growth rate is due in large part to sophisticated spammers who use abusive tactics to send millions of email messages quickly, at an extremely low cost. By using deceptive methods, these spammers conceal their identities, evade Internet service provider filters, and exploit the Internet by advertising and promoting pornographic web sites, illegally pirated software, questionable health products, pyramid schemes and other ``get rich quick'' or ``make money fast'' scams. The extraordinary volume of spam generated by their schemes imposes significant costs on Internet users, threatens to disrupt Internet services, and undermines the public's confidence in online commerce.

A recent study conducted by the Federal Trade Commission demonstrates the alarming frequency with which spammers are using the Internet to conceal their true identities and the electronic paths of their messages. This study found that 40 percent of email messages contain indicia of falsity in the body of the message; approximately 33 percent contain indicia of falsity in the ``from'' lines of the spam; 22 percent contain indicia of falsity in the ``subject'' line; and some 66 percent contain at least one form of deception.

The Criminal Spam Act of 2003 targets fraudulent and deceptive spam by enhancing the ability of federal law enforcement authorities to prosecute and punish the most egregious wrongdoers. Specifically, the Act makes it a crime to hack into a computer, or to use a computer system that the owner has made available for other purposes, as a conduit for bulk commercial email. The Act also prohibits sending bulk commercial email that conceals the true source, destination, routing or authentication information of the email, or is generated from multiple email accounts or domain names that falsify the identity of the actual registrant.

The Act subjects violators to stiff criminal penalties of up to 5 years' imprisonment where the offense is committed in furtherance of any felony, or where the defendant has previously been convicted of a similar Federal or state offense, and up to 3 years' imprisonment where other aggravating factors exist. It also contains criminal forfeiture provisions and directs the Sentencing Commission to consider enhancements for offenders who obtain email addresses through illegal means, such as harvesting.

The strong deterrent effect of the legislation is further enhanced by civil enforcement provisions that authorize the Department of Justice and aggrieved Internet service providers to bring suit for violations of the Act. In appropriate cases, courts may grant injunctive relief, impose civil fines, and award damages of up to $25,000 per day of violation, or between $2 and $8 per email initiated in violation of the Act.

Recognizing that spammers can send their fraudulent and deceptive messages from any location in the world, the Act directs the Department of Justice and the Department of State to work through international fora to gain the cooperation of other countries in investigating and prosecuting spammers worldwide and to report to Congress about their efforts and any recommendations for addressing international predatory spam.

The Criminal Spam Act represents an important legislative step toward curbing predatory and abusive commercial email. However, broader legislative measures, coupled with technological

solutions, are also needed. Any effective solution to the spam problem requires cooperative efforts between the government and the private sector, as well as the assistance of our international partners.

Recent years have witnessed extraordinary technological advances. These innovations, and electronic communications in particular, have significantly increased the efficiencies, productivity and conveniences of our modern world. The abusive practices of fraudulent spammers threaten to choke the lifeblood of the electronic age. This is a problem that warrants swift but deliberative legislative action. I am committed to working with my colleagues in both Houses to address the spam problem on all fronts.

I ask unanimous consent that a section-by-section analysis be printed in the Record.

Mr. President, I rise to introduce today the ``Protect the Pledge Act of 2003.'' The Pledge of Allegiance to the Flag has been an integral part of this Nation's identity since its early days. It was first written by a Baptist minister in 1892 as part of the commemoration of the 400th Anniversary of the discovery of America. For over a century, children and adults have recited this Pledge in schools, in government and military ceremonies, and on other formal occasions. It represents a promise of loyalty to the Flag itself, to the country it represents, and to the government that unites all fifty states. Perhaps more importantly, for many people, its recitation represents as essential element of what it means to be an American.

In United States v. Newdow, the Ninth Circuit jeopardized the integrity of the Pledge of Allegiance. It held that a school district's policy of teacher-led recitation of the Pledge violates the First Amendment Establishment Cause because it includes the phrase ``under God.'' This decision is simply wrong. It claims that the American flag symbolizes monotheism. It does no such thing. The Pledge represents our country, our independence, our government--simply, it represents liberty and justice for all. While the phrase ``under God'' undeniably has some religious connotation, it is a term of art with de minimus theological significance. It is not intended to establish a national religion or to prohibit the free exercise of religious beliefs. The thirty-one words of the Pledge of Allegiance, however, are worthy of reverence and respect. To eliminate the phrase ``under God'' would be equivalent to depicting the flag with forty-nine stars or twelve stripes. It changes the constitution of our American identity.

The ``Protect the Pledge Act of 2003'' prevents further judicial encroachment by eliminating federal jurisdiction of claims that the recitation of the Pledge violates the First Amendment. By passing this legislation, Congress is exercising its Constitutional duty to preserve the separation of powers. When the judiciary has oversteps its boundaries, as it has done in Newdow, Congress must act to protect the sanctity of the Pledge of Allegiance. This bill represents a reasoned response to Newdow. By limiting its scope to federal jurisdiction, it leaves open a potential remedy in state court, thereby obviating any due process concerns.

I am hopeful that my colleagues in both Houses will work expeditiously, on a bi-partisan basis, to enact this important legislation.

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

Mr. President, I rise to introduce, with Senators Leahy, Schumer, Grassley, Feinstein, DeWine, and Edwards, the Criminal Spam Act of 2003. This legislation, which enjoys bipartisan support, targets the most egregious types of spammers--those who hijack computer systems and those who use other fraudulent means to send unsolicited commercial electronic mail.

Over the course of the past several years, the amount of unsolicited commercial email, or spam, has grown at an exponential rate. During a recent Senate hearing before the Committee on Commerce, Science and Transportation, Brightmail Inc., a provider of spam filtering software that serves six of the ten largest U.S. Internet service providers, estimated that in April 2003, 46 percent of all email traffic was spam. This figure represented a nearly five fold increase in spam in merely 18 months. At the same hearing, America Online testified that on any given day, it blocks approximately 2.3 billion spam messages.

This tremendous growth rate is due in large part to sophisticated spammers who use abusive tactics to send millions of email messages quickly, at an extremely low cost. By using deceptive methods, these spammers conceal their identities, evade Internet service provider filters, and exploit the Internet by advertising and promoting pornographic web sites, illegally pirated software, questionable health products, pyramid schemes and other ``get rich quick'' or ``make money fast'' scams. The extraordinary volume of spam generated by their schemes imposes significant costs on Internet users, threatens to disrupt Internet services, and undermines the public's confidence in online commerce.

A recent study conducted by the Federal Trade Commission demonstrates the alarming frequency with which spammers are using the Internet to conceal their true identities and the electronic paths of their messages. This study found that 40 percent of email messages contain indicia of falsity in the body of the message; approximately 33 percent contain indicia of falsity in the ``from'' lines of the spam; 22 percent contain indicia of falsity in the ``subject'' line; and some 66 percent contain at least one form of deception.

The Criminal Spam Act of 2003 targets fraudulent and deceptive spam by enhancing the ability of federal law enforcement authorities to prosecute and punish the most egregious wrongdoers. Specifically, the Act makes it a crime to hack into a computer, or to use a computer system that the owner has made available for other purposes, as a conduit for bulk commercial email. The Act also prohibits sending bulk commercial email that conceals the true source, destination, routing or authentication information of the email, or is generated from multiple email accounts or domain names that falsify the identity of the actual registrant.

The Act subjects violators to stiff criminal penalties of up to 5 years' imprisonment where the offense is committed in furtherance of any felony, or where the defendant has previously been convicted of a similar Federal or state offense, and up to 3 years' imprisonment where other aggravating factors exist. It also contains criminal forfeiture provisions and directs the Sentencing Commission to consider enhancements for offenders who obtain email addresses through illegal means, such as harvesting.

The strong deterrent effect of the legislation is further enhanced by civil enforcement provisions that authorize the Department of Justice and aggrieved Internet service providers to bring suit for violations of the Act. In appropriate cases, courts may grant injunctive relief, impose civil fines, and award damages of up to $25,000 per day of violation, or between $2 and $8 per email initiated in violation of the Act.

Recognizing that spammers can send their fraudulent and deceptive messages from any location in the world, the Act directs the Department of Justice and the Department of State to work through international fora to gain the cooperation of other countries in investigating and prosecuting spammers worldwide and to report to Congress about their efforts and any recommendations for addressing international predatory spam.

The Criminal Spam Act represents an important legislative step toward curbing predatory and abusive commercial email. However, broader legislative measures, coupled with technological

solutions, are also needed. Any effective solution to the spam problem requires cooperative efforts between the government and the private sector, as well as the assistance of our international partners.

Recent years have witnessed extraordinary technological advances. These innovations, and electronic communications in particular, have significantly increased the efficiencies, productivity and conveniences of our modern world. The abusive practices of fraudulent spammers threaten to choke the lifeblood of the electronic age. This is a problem that warrants swift but deliberative legislative action. I am committed to working with my colleagues in both Houses to address the spam problem on all fronts.

I ask unanimous consent that a section-by-section analysis be printed in the Record.

Mr. President, I rise to introduce today the ``Protect the Pledge Act of 2003.'' The Pledge of Allegiance to the Flag has been an integral part of this Nation's identity since its early days. It was first written by a Baptist minister in 1892 as part of the commemoration of the 400th Anniversary of the discovery of America. For over a century, children and adults have recited this Pledge in schools, in government and military ceremonies, and on other formal occasions. It represents a promise of loyalty to the Flag itself, to the country it represents, and to the government that unites all fifty states. Perhaps more importantly, for many people, its recitation represents as essential element of what it means to be an American.

In United States v. Newdow, the Ninth Circuit jeopardized the integrity of the Pledge of Allegiance. It held that a school district's policy of teacher-led recitation of the Pledge violates the First Amendment Establishment Cause because it includes the phrase ``under God.'' This decision is simply wrong. It claims that the American flag symbolizes monotheism. It does no such thing. The Pledge represents our country, our independence, our government--simply, it represents liberty and justice for all. While the phrase ``under God'' undeniably has some religious connotation, it is a term of art with de minimus theological significance. It is not intended to establish a national religion or to prohibit the free exercise of religious beliefs. The thirty-one words of the Pledge of Allegiance, however, are worthy of reverence and respect. To eliminate the phrase ``under God'' would be equivalent to depicting the flag with forty-nine stars or twelve stripes. It changes the constitution of our American identity.

The ``Protect the Pledge Act of 2003'' prevents further judicial encroachment by eliminating federal jurisdiction of claims that the recitation of the Pledge violates the First Amendment. By passing this legislation, Congress is exercising its Constitutional duty to preserve the separation of powers. When the judiciary has oversteps its boundaries, as it has done in Newdow, Congress must act to protect the sanctity of the Pledge of Allegiance. This bill represents a reasoned response to Newdow. By limiting its scope to federal jurisdiction, it leaves open a potential remedy in state court, thereby obviating any due process concerns.

I am hopeful that my colleagues in both Houses will work expeditiously, on a bi-partisan basis, to enact this important legislation.

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

Mr. President, I have been listening to this debate and listening to the distinguished Senator from Michigan. If you love the Federal Government and the Federal Government's control over all of our lives, boy, this is the program for you, because it certainly would fly in the face of everything we have been trying to do to create a program where you have some options, some choices, and where people can make their own decisions as to what type of health care they want, seniors in particular.

So I rise in opposition to the Stabenow amendment. The way I understand the amendment, it would require a permanent fallback to be offered to beneficiaries in addition to the private stand-alone drug plans. Making the fallback plan a permanent option will completely undermine the very structure upon which this bill is built.

First and foremost, including a permanent fallback plan creates an uneven playing field. Frankly, we hope the Government fallback plan is never needed. The only reason it is in this bill is to take care of those situations where there are no bidding competitors to provide the health care. We believe there would be bidding competitors, and there is no real reason to have a fallback other than in those rural areas or tough areas where it is uneconomical for business to compete for the business, where you are going to need a no-risk, Government sponsored and subsidized, and completely controlled fallback plan.

So first and foremost, including a permanent fallback plan creates an uneven playing field. The Government fallback is a non-risk-bearing entity. The fallback plan will operate in regions without any risk for gains or losses. The Government pays for the fallback plan's administrative costs associated with delivering the drug benefit. If we make the fallback plan permanent, as the distinguished Senator from Michigan would do, we are basically requiring privately delivered drug plans, which are at least partially responsible for bearing the risk of delivering this benefit, to enter this same market and compete with these Government fallback plans.

This would not only be unfair, but it also sets up our drug plan for failure. There isn't a private health plan out there that will enter such a lopsided market where we give their competitors such a large financial advantage. Simply put, this amendment would discourage the initial entry of private plans, dooming the effort to provide beneficiaries the drug benefit through competing private plans with all of the cost savings and benefits that would come from competition.

In addition, including a permanent fallback plan would add billions of dollars to the cost of this bill. CBO estimates that the cost of this fallback plan would be at least $50 billion over 10 years. So, literally, by including a permanent fallback plan that will cost $50 billion-plus over 10 years to the cost of this bill, we would be relying, at least partially, on an inefficient, more costly, Government-controlled, Government-style delivery system to provide beneficiaries with drug coverage.

When the Senate was debating the Medicare prescription drug issue last year, this was one of the biggest criticisms against the Graham drug benefit. The Graham drug benefit plan created a one-size-fits-all drug benefit delivered by the Federal Government. This is not what Medicare beneficiaries want.

Beneficiaries want choice in drug coverage. They do not want to be forced into a Government-run plan and offered a one-size-fits-all benefit. The Stabenow amendment would place the drug benefit right back in the hands of Government-run health care, Government micromanagement, and, worst of all, price controls. Government bureaucrats would ultimately put the Government in charge of setting drug prices. We simply do not want Government bureaucrats in charge of setting drug prices. We want the private market to make these decisions, not the Federal Government.

My colleague from Florida was just reminiscing about the 1988 catastrophic law. I was here. I argued against it. We all saw the people jumping up and down on Danny Rostenkowski's car when they realized they had to pay for their drug expenses. Well, you can imagine what is going to happen if we have Government take over this program.

If this amendment passes, we will be creating another Medicare catastrophe. In fact, we already know the Federal Government does not do the best job of reimbursing for prescription drugs due to years of overpayments for the drugs already covered under Part B of Medicare.

Medicare has been overpaying for Part B drugs for years because of its inability to keep up with the marketplace. The intent of S. 1 is to introduce a new model to deliver care to Medicare beneficiaries. We want to offer Medicare beneficiaries a meaningful drug benefit. This drug benefit will include multiple choices but it only works when all options are expected to participate under the same rules. You

don't set it up so that all the options that have a chance of working fail because you have a government-run, government-subsidized, government-controlled, government-bureaucratized program, which is exactly what the Stabenow amendment would establish.

Those who are extremely liberal will love that program, because it just means Government controls every aspect of our lives in health care. In S. 1, we included the Government fallback as a safety net to ensure that every senior has access to pharmaceutical drug coverage. But it is a fallback of last resort. We hope we will never have to have a fallback plan for any region or any area. But it is a last resort, if we need it. That is because even the Congressional Budget Office concludes that the permanent fallback plan is a more costly, less efficient model to deliver pharmaceutical benefits.

Again, let me remind everybody that the CBO says the Stabenow amendment will cost at least $50 billion over the next 10 years. Knowing the Government as I do, I say at least $50 billion. It will probably be a lot more than that. It will take all the incentives to keep costs down out of the program, as we take away risk, which is what the competing companies have to meet. They have to meet risk factors.

In conclusion, the Stabenow amendment would deny Medicare beneficiaries the opportunity to enroll in the plan that best fits their needs. They would be denied that opportunity. The Stabenow plan would force all our seniors into a government-run, government- controlled, government-bureaucratized drug benefit. It would basically undermine every possible competitive aspect that might possibly hold costs in line and bring them down.

This amendment by the distinguished Senator from Michigan would effectively deny beneficiaries a private plan option thus denying beneficiaries a choice in drug coverage, one of the fundamental principles of this bill--choice, the right to pick the coverage you want. That is what our prescription drug program would give beneficiaries.

There are those who believe that socialism is the answer to everything. Let government do it. Government can do it more efficiently. If you believe that, you haven't watched the last 50 years. I urge my colleagues to defeat this amendment because it will take away important drug coverage choices for Medicare beneficiaries. It will lead us into a situation where Government is going to control everything, and, as a result, Medicare beneficiaries will be left with no choices in drug coverage. I don't want to go back to those days when they were jumping up and down on Danny Rostenkowski's car because the senior citizens realized they had to pay for it. I want to give Medicare beneficiaries choices and make sure there is some competition in the marketplace so that the choices will be good ones. I don't want to go to just a one-size-fits-all government program which literally will not work except at a tremendously costly expense to U.S. taxpayers.

For these reasons, I urge my colleagues to oppose the Stabenow amendment.

I yield the floor.

Madam President, I compliment the distinguished majority leader for his excellent set of remarks today. The comparison between the two PDR books is startling. Anyone who looks at it has to admit we have come a long way since 1965.

This bill was a great addition to the health care for our people. It could not have happened without the distinguished Senator from Tennessee, our leader, plus the distinguished Senator from Iowa, Senator Grassley, and the distinguished leader from Montana, Senator Baucus. I appreciate having a doctor in the Senate. As a former medical liability defense lawyer, I have to say I have always respected Senator Frist very greatly, but nothing comes close to how much I respect him as a physician, as somebody who cares for people and has given so much of his life to healing people.

I am very grateful to have heard these remarks today.

Madam President, I will only take a few minutes, but I rise in opposition to the Bingaman amendment.

First, let me make one thing clear, and perfectly clear:

The assets test in S. 1 is the same assets test used for determining eligibility for the qualified Medicare beneficiaries, QMBs, specified low-income Medicare beneficiaries, SLMBs, and qualified individuals, QI-1s.

S. 1 provides a generous low-income subsidy for those who are below 160 percent of the Federal poverty level. Currently, in order for some individuals under 160 percent of poverty to receive limited Medicaid protections, they must meet both an income limit and an assets test.

In S. 1, we simply follow these same rules in order for low-income beneficiaries to receive assistance with their prescription drug coverage.

By including the Medicaid assets test for Medicare prescription drug subsidies, we are providing beneficiaries with seamless health coverage. We are not confusing beneficiaries and we are not adding additional administrative burdens to States.

Let me give you some background on the current assets test included in the Medicaid program.

Qualified Medicare beneficiaries are individuals below 100 percent of poverty. In 2006, the annual income limit is $9,670 for individuals and $13,051 for couples. QMBs are allowed to have assets below $4,000 for individuals and $6,000 for couples.

Specified low-income Medicare beneficiaries and QI-1s are those with incomes between 100 percent of poverty and 135 percent of poverty. In 2006, the annual income limit is $13,054 for individuals and $17,618 for couples. SLMBs and QI-1s are allowed to have assets below $4,000 for individuals and $6,000 for couples.

Beneficiaries between 136 percent and 159 percent of poverty will have annual income limits of $15,472 for individuals and $20,881 for couples in 2006. Beneficiaries between 136 and 159 percent of poverty would not be subjected to assets tests.

Current law establishes resource limits for low-income elderly or disabled individuals. Let met emphasize, this is not a newly added restriction on certain low-income Medicare beneficiaries. However, current law also provides States with the flexibility to choose to disregard all or part of these resources.

The Bingaman amendment, which eliminates the Medicaid assets test limits would add significantly to the number of eligible beneficiaries.

A study prepared for the Kaiser Family Foundation estimates that as many as 11 million individuals would be newly eligible for low-income assistance if the assets test were eliminated. I have no idea how much that will cost but it will be expensive.

In addition to increasing the Federal cost of the bill, this amendment would impose a significant, new, unfunded mandate on States, which must pay a share of Medicaid benefits by paying for the dual eligible beneficiary's liability for premiums, deductibles, and coinsurance.

Also, some States may experience an additional administrative or financial impact from potential program redesigns because, in some cases, States link eligibility for their state-only programs with the eligibility requirements for these special categories of the dually eligible.

S. 1 includes a provision to require the GAO to conduct a study and make recommendations to Congress by 2007 regarding the extent to which drug utilization and access to covered drugs differs between qualifying dual eligibles who receive subsidies and individuals who do not qualify solely because of the application of an assets test.

This amendment will not only cost money, it will cause confusion. I urge my colleagues to defeat the Bingaman amendment.

Madam President, I rise today to speak to an issue that we need to promptly address. As part of the Protect Act of 2003, we authorized a pilot program to study the feasibility of instituting a national background check for those who volunteer in children's activities. The National Center for Missing and Exploited Children will provide its expertise to assist volunteer organizations in evaluating the criminal records of volunteers to determine if the volunteers are fit to interact and provide care for children.

Currently, the Protect Act tasks the National Center with operating the cyber tip line in addition to its participation in the pilot program. The Protect Act presently immunizes the National Center for operating the cyber tip line as long as it does so consistent with the purpose of the tip line. However, no similar protection was provided with respect to the National Center's activities related to the pilot program. The bill I have offered will extend the immunity to the National Center for its participation in the pilot program.

I would urge my colleagues to vote in favor of this technical fix so that the worthy goals of the pilot program can commence.

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

Madam President, I would like to take this opportunity to discuss a particular interest of mine: how the ``Prescription Drug and Medicare Improvement Act of 2003'' will protect beneficiaries in rural areas.

As we worked to develop S. 1, members of the committee were especially attuned to the concerns expressed by some that private entities will be unwilling--or perhaps unable--to provide services to Medicare beneficiaries living in rural communities. That is why we included a number of safeguards to make certain that rural elderly and disabled patients have access to the Medicare improvements made in S. 1.

I cannot overstate how particularly important this is for my home state of Utah, since most of the 29 counties and 82,144 square miles in Utah are rural.

According to the 2000 Census, Utah's population density was only 27.2 persons per square mile, roughly one third of the national average of 79.6 persons per square mile.

So I am very interested in seeing to it that Medicare beneficiaries in rural areas--whether they are in Utah or for that matter in the State of New York, I want to make sure these beneficiaries get a fair shake.

There is no question that the Medicare beneficiaries who live in these rural communities--towns and small cities like Moab, St. George, Green River, Blanding, Beaver and Vernal--deserve access to the same services that are available to Medicare beneficiaries living in Salt Lake City, or for that matter, New York City.

I cannot criticize colleagues who are concerned that the new private sector-oriented delivery mechanisms we have designed in S. 1 may not be available to beneficiaries in rural areas. That being said, I want to provide assurances to my colleagues that the Committee worked hard to design a plan that would protect the elderly and disabled who reside in rural areas.

Indeed, it is not surprising that criticisms have been expressed that there could be gaps in coverage in rural areas given the experience with Medicare+Choice and Medicare HMOs.

These Medicare+Choice plans were established with the intent of providing Medicare beneficiaries throughout the country with access to both traditional Medicare and Medicare+Choice plans.

Unfortunately, it has not worked out that way. For a variety of reasons, the companies responsible for these plans found that they could not offer services in all areas.

Not surprisingly, many of the communities that were left without access to these HMOs are in rural areas.

I am particularly sensitive to this, because Utah is one of those States in which the Medicare+Choice plan operated for one year and then chose to discontinue.

This was a great disappointment to all--beneficiaries, the provider, and the Government alike.

So I, among all others, find it completely understandable that there may be a question about whether the plans will be available in rural communities.

I have a simple answer to that question. The new private drug plans created in A. 1 are completely different from the Medicare+Choice model.

We have learned from our experience with Medicare+Choice and we have worked to ensure we do not repeat past mistakes.

Let me take this opportunity to explain how the program will work.

Our legislation establishes a new Center for Medicare Choices within the Department of Health and Human Services. This new Center will be headed by an administrator who will oversee both the new drug plan and the new Medicare Advantage program.

To operate the prescription drug plan, the new administrator will create at least 10 regions throughout the country. These regions must be at least the size of a State.

If beneficiaries remain in the traditional Medicare program, they may receive pharmaceutical assistance through a new stand-alone program certified by the Government to provide coverage in that region. S. 1 requires that at least two stand-alone drug plans would be offered to Medicare beneficiaries in each region.

Now some may ask, ``How does that ensure rural Medicare beneficiaries will have access to prescription drugs distributed by private companies? How is this different from the Medicare+Choice HMOs?''

The answer is this.

The Medicare+Choice program is organized by counties. In other words, Medicare+Choice plans can choose to offer coverage in one county, but not in another.

These plans may ``cherry pick,'' or choose to operate in the more lucrative areas, ignoring the less profitable ones. For example, they can offer coverage in suburban counties where the cost of doing business might be lower or in counties where, for one reason or another, Medicare beneficiaries are healthier.

Under the new program, plans offering stand-alone prescription drug coverage will not be able to cherry pick in this way, because they must operate in all areas of a much larger region.

If a plan wants to offer coverage in Salt Lake City, it will be required to offer coverage in St. George, Moab, Beaver, Vernal, and Green River. In order to provide coverage in Salt Lake City, a plan will be required to offer coverage in every county and every community and to every Medicare beneficiary in Utah. That is true of other states and their rural problems as well. I am naturally talking about my own home State of Utah but it applies throughout the country.

We envision these regions, in many cases, encompassing more than one state, and combining rural areas and urban areas.

Medicare+Choice does not work this way. And so, we have designed the plans envisioned under S. 1 based on the lessons learned with Medicare+Choice.

Another criticism some in this body have voiced relates to the concern that prescription drugs might be available in a predominantly rural region, but with higher premiums for Medicare beneficiaries living in rural areas.

Once again, the concept of regions addresses this issue. Plans will be required to charge the same premium for an option throughout the region.

Let me add, however, that this does not ensure premiums will be identical between regions.

This important issue was raised during the Finance Committee's consideration of this legislation by my friend and colleague, Senator Olympia Snowe.

In order to address this very valid concern, our legislation gives the Secretary of Health and Human Services the discretion to make adjustments in geographic regions so there will not be a large discrepancy in Medicare prescription drug premiums across the country.

Other may wonder why we establish regions at all. Why not have a single premium throughout the country and private entities would bid to provide prescription drugs nationwide?

One reason we did choose this approach is that only a few private entities are currently able to provide nationwide coverage. Limiting competition to those few companies would neither ensure beneficiaries the best prescription drug prices nor a significant choice among coverage options.

The approach we have chosen is one that ensures beneficiaries will have access to prescription drug coverage. It provides for competition, and minimizes regional differences in beneficiary premium costs.

But some may still wonder whether private plans will choose to enter predominantly rural States or regions?

My Finance Committee colleagues and I have worked hard to ensure that plans have the appropriate incentives to participate in all 50 states.

Even so, no one can guarantee with complete certainty that private prescription drug plans will choose to operate in all of the States all of the time.

For this reason, we worked very hard to make certain there is a safety net, a ``fallback'' plan that would provide seniors with the coverage they need in the event only one or even no private sector plans enter a region.

If only one plan, or even if no plans, are willing to offer stand- alone prescription drug coverage within a region, the government will enter into an annual contract with an entity to provide a prescription drug fallback plan.

This fallback plan would be given a one year contract to offer the standard drug plan to all Medicare Part D beneficiaries in the region. The fallback plan will be an insurance policy provided by the federal government to ensure that Medicare beneficiaries in rural communities have prescription drug coverage available in the event that private plans are slow to begin providing service in their area.

Some in this body argue that if the fallback option is so attractive we should make it available all the time to anyone who wants it. Indeed, these colleagues argue that this so-called ``permanent fallback'' should be offered to beneficiaries in addition to the private stand-alone drug plans that would be offered to those Medicare beneficiaries remaining in traditional Medicare.

While this may sound attractive at first, it is not.

Making the fallback plan a permanent option will undermine the very structure upon which we have built S. 1.

Not only would it drastically increase costs--thus pushing the bill over the $400 billion 10-year limit--it would also be a disincentive for private plans to enter the market.

I will oppose any amendment that will make the fallback plan permanent.

First and foremost, including a permanent fallback plan creates an uneven playing field.

The government fallback is a non-risk bearing entity which means that it will operate in regions without any risk for gains or losses. The government pays the fallback plan for the administrative costs associated with delivering the drug benefit.

If we make the fallback plan permanent, we are basically requiring privately delivered drug plans, which are at least partially responsible for bearing the risk of delivering this benefit, to enter this same market and compete with these government fallback plans.

I think this is not only unfair, but it also sets up our drug plan for failure. There isn't a private health plan out there that will enter such a lopsided market where we give their competitors such a large financial advantage.

In addition, including a permanent fallback plan will add billions of dollars to the cost of this bill because we will be relying, at least partially, on an inefficient, more costly government-style delivery system to provide beneficiaries with drug coverage.

When the Senate was debating the Medicare prescription drug issue last year, this was one of the biggest criticisms against the drug benefit plan offered by our colleague from Florida, Senator Graham.

The Graham drug benefit plan created a one-size-fits-all drug benefit delivered by the federal government. This is not what Medicare beneficiaries want. Beneficiaries want choice in drug coverage. They do not want to be forced into government-run plans and offered a one-size fits all benefit.

The intent of S. 1 is to introduce a new model to deliver care to Medicare beneficiaries.

We are harnessing the efficiencies and quality of a private-delivery system in order to offer Medicare beneficiaries a meaningful drug benefit. This drug benefit will include multiple choices, but it only works when all options are expected to participate under the same rules.

In S. 1, we included the government fallback as a safety net to ensure that every senior or disabled beneficiary has access to prescription drug coverage, but it is a fallback of last resort. And that is because even the Congressional Budget Office estimates that it is a more costly, less efficient model to deliver care.

I urge my colleagues to remember these points when the Senate considers an amendment that would make the fallback plan a permanent option under the stand-alone drug plans.

Let me make one thing perfectly clear. The stand-along benefit offered under Medicare Part D will not be the only way in which Medicare beneficiaries in rural areas can obtain prescription drug coverage.

In addition, the Medicare Advantage plans--including the current HMOs and new preferred provider organizations, called PPOs--will offer beneficiaries comprehensive, integrated coverage, including coverage for hospital services, outpatient care, and prescription drugs.

Private sector entities will bid to become one of three PPO plans in a region.

And, HMOs can continue to contract to provide all Medicare services-- including drugs--for a county.

My Finance Committee colleagues and I have worked very hard to provide appropriate incentives to encourage the preferred provider organizations to participate in every region and in every State, whether they are predominantly rural or urban. However, if for some reason, PPOs decide not to bid in a specific region, the beneficiaries in these regions still will have the option to obtain prescription drug coverage through traditional Medicare and the new Medicare Part D plans that I described earlier.

The bill that we approved in committee provides options for Medicare beneficiaries in urban and rural areas to obtain prescription drugs through traditional Medicare and the new Part D prescription drug program, or through the new Medicare Advantage program with its comprehensive health care coverage plans.

Furthermore, the ``Prescription Drug and Medicare Improvement Act of 2003'' ensures all Medicare beneficiaries that prescription drug coverage will be available even if private entities are unable to provide the coverage in their region.

This legislation is preferable to previous bills we have considered, because it provides Medicare beneficiaries with more choices and more comprehensive coverage. It provides private entities with more incentives to cover rural communities, and it assures Medicare beneficiaries who live in those rural communities that they will have access to prescription drug coverage.

Just think of what we are doing here. We have a drug benefit that will begin

January 1, 2006, and it is a voluntary program.

We will issue a prescription drug card which will be offered to beneficiaries from January 1, 2004, through at least January 1, 2006, 6 months after the prescription drug benefit plan is implemented. The prescription drug plan will be implemented on January 1, 2004.

The drug benefit with the Medicare Part D is a Medicare Program. At least two stand-alone drug plans must be offered in each region. All Medicare beneficiaries will be able to participate. Those who remain in traditional Medicare will have a drug benefit equal to those who go into the new Medicare Advantage Program, formerly known as Medicare+Choice. Beneficiaries will be offered either standard drug coverage or drug coverage that is an actuarial equivalent to the standard drug plan. Either drug plan will be available to those remaining in traditional Medicare or those who begin the Medicare Advantage Program, this new program.

The national average of monthly premiums for the drug benefit will be $35 per month in 2006. All drug plans will have mandatory deductibles and beneficiary out-of-pocket cost-sharing limits.

Every beneficiary will have a choice between three prescription drug plans. The Medicare Advantage Program will offer either a PPO option or an HMO option. A stand-alone drug benefit will be offered to beneficiaries remaining in traditional Medicare. A maximum of three Medicare Advantage PPO plans will be offered per region. They will compete for the opportunity and the privilege of serving the people in that particular region. Health and Human Services will certify all of these drug plans before they are offered to Medicare beneficiaries. In any event, they will be offered to all Medicare beneficiaries, seniors and disabled.

I was a member of the tripartisan group last year that put forth the tripartisan plan. Had we not done that, we wouldn't be as far along today as we are. I have to say I was proud to be a member of that tripartisan plan, along with Senators Grassley, Snowe, Breaux, and Jeffords. There were five of us. We took on that assignment, and we came up with a lot of ideas that have been improved upon in this bill. This was a very important bill.

There is no easy solution in these areas. In spite of the desire of some to have simple private sector solutions, those are not in the cards with the votes we have in the Senate today or in the near future, I have to say as well.

This bill is as close as we can go towards having two completely different but nevertheless useful options: traditional Medicare for those who do not want to leave, but this new Medicare Advantage for those who really want to try something different where they may have advantageous benefits over time.

We believe the competition fostered by this bill is going to be good competition, that it should help to keep costs down. But, most importantly, we believe all seniors should have a right to prescription drug benefits, and this plan will give it to them.

We will have lots of crying and moaning and groaning about different ideas around here, some of which I might like just as much as what we have in here, but we could not get them done. So we have come together in the art of the doable to get a bill that literally gives both sides of these options a chance to be able to excel and do better for our senior citizens. That is important. That is real important. This bill is important. It is the first time in history we have done this. Frankly, a $400 billion bill over 10 years is a very important bill that will do an awful lot of good for our seniors and for those who really are hard up in our society and for those who have to do without food or split their pills or do any number of things in order to be able to get the medications they need.

I am proud of this bill. Each one of us probably could, if we were dictators, come up with what we think might even be a better bill. But, fortunately, that isn't the way this representative republic works. We have to work within the framework of the Congress. Sometimes that is a messy, mixed up, sometimes very inefficient method of legislating, but, in the end, this country has survived because we have the greatest form of government in the history of the world. And this process, as sloppy as it might be from time to time is bringing about a bill that will do an awful lot of good for an awful lot of seniors in our society at a time when they need it the most.

I just hope we can reduce the number of amendments and get this bill passed as soon as we can, get together with the House in a conference, and, of course, come up with a final package that, hopefully, will even be improved that will take us throughout this next century in a way that will protect our seniors and those who have suffered for want of pharmaceutical prescription drugs.

I yield the floor.

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

Mr. President, I rise to express my strong support for S. 1, the Prescription Drug and Medicare Improvement Act of 2003. Medicare beneficiaries have been waiting decades for a comprehensive and permanent prescription drug benefit. Debate on this legislation is truly a landmark occasion for America's seniors, the disabled, and the United States of America, including our own Senate. I congratulate both the Senate Finance Committee Chairman, Senator Grassley, and the ranking member, Senator Baucus, on a job well done. Both of them worked well together. It has been bipartisan. They have done everything they possibly can to bring people together so that we can pass a bill out of the Senate, and they both deserve a lot of credit.

Both of them have been able to put together a Medicare prescription drug bill that not only has bipartisan support but was also approved by the Senate Finance Committee, both remarkable feats. I am so proud of both of them.

The majority leader, Bill Frist, also deserves credit for his commitment to this issue. He is to be congratulated not only for his behind-the-scenes efforts to move this bill forward but also for his vision in developing with Senator Breaux the model upon which many of the improvements in this bill are based. Of course, Senator Breaux deserves a great deal of credit. He has consistently fought to try and get a prescription drug benefit bill, and of course was a member of the tripartisan group in the last Congress.

Finally, I would be remiss unless I recognized the central role the President played in this matter by insisting that Medicare drug coverage must be a top domestic priority. Many believed it could not be done, especially in this, a non-election year.

President Bush's persistence, his commitment, and, indeed, his leadership on this issue will prove those naysayers wrong.

At last, we will provide senior and disabled citizens across the country with the prescription drug coverage they need.

In fact, prescription drug coverage for Medicare beneficiaries has been one of my top priorities, as well, and think everyone knows.

I was the principal cosponsor with then-Chairman Bill Roth of the 1997 legislation creating the Bipartisan Medicare Commission.

That commission, as my colleagues are aware, was charged with making recommendations on how to improve the current Medicare program.

And although commission members were unable to report a recommendation due to the ``super-majority'' vote requirement, the work they did laid the groundwork for efforts to improve Medicare by including the private competition that could provide prescription drug coverage.

Through their leadership on the commission, my friend and colleague, Senator John Breaux, and our House colleague, Ways and Means Committee

Chairman Bill Thomas, were instrumental in laying the groundwork for Medicare prescription drug legislation.

More recently, I worked closely with Chairman Grassley, Senator Snowe, Senator Breaux, and Senator Jeffords in an effort to develop a centrist, Medicare prescription drug bill that the Congress could adopt free from partisan politics. This was an 18-month effort.

We called our effort ``tripartisan,'' because Senators participated from the Democratic, Republican and Independent parties.

I took great pride in our effort, which I believe would have passed the Senate but for election-year maneuvering.

The goal of the tripartisan legislation was to provide all Medicare beneficiaries with quality drug coverage through private health plans. In addition, the tripartisan bill gave seniors and the disabled a choice in health coverage: They could have traditional Medicare, a Medicare+Choice plan or a new enhanced Medicare plan.

It was truly a labor of love. We are proud of that effort and the fact that it laid the foundation for S. 1, the Prescription Drug and Medicare Improvement Act of 2003, which we are considering today.

I predict that S. 1 will not only pass by the Senate by the end of the month, it will be signed into law at the end of the summer. What a difference a year makes.

S. 1 builds on several important foundations we laid in the tripartisan initiative.

And, in many ways, it is far superior to our tripartisan initiative.

It offers beneficiaries a meaningful and reliable drug benefit through the private sector with reasonable and fair cost-sharing. Beneficiaries will have the ability to obtain the drugs of their choice without Government interference and with better coverage choices.

In contrast to last year's bill, the measure we have before us today provides beneficiaries with several choices: A stand-alone drug benefit, a drug benefit through a Preferred Provider Option, PPO, or a drug benefit through an HMO.

Those who do have drug coverage will have the choice of remaining in the existing plans or choosing a Medicare prescription drug benefit. S. 1 also offers beneficiaries a temporary drug discount card available to seniors no later than January 1, 2004. This drug card would be in operation until the Medicare prescription drug benefit is fully implemented.

In sum, S. 1 offers additional assistance to those who cannot afford to purchase their prescriptions.

In a country as prosperous as ours, we can no longer tolerate situations where seniors have to split their pills in half or cannot fill necessary prescriptions because they do not have the money.

A land as great as ours owes it to needy seniors and disabled to help these individuals who many times cannot help themselves.

Another important point is that S. 1 also ensures access to drug benefits for beneficiaries who live in rural areas. This is a must-do for my home State of Utah. S. 1 provides reliable coverage everywhere in America. Wherever there is Medicare coverage, there will be Medicare prescription drug coverage.

In addition, this bill includes important consumer protections. Every plan offered to Medicare beneficiaries will have to be certified by the Federal Government.

A key point is that S. 1 recognizes the role of employers in providing their retirees with health coverage. Let me make it perfectly clear that the intent of this plan is not to disrupt that important relationship between employers and their retirees. We should encourage employers to continue to offer retiree health coverage.

Finally, I must note that this legislation does nothing to dismantle or weaken the traditional Medicare program. The bill offers beneficiaries more coverage options, and does nothing to disrupt the existing physician-patient relationship. That is a fundamental principle that was very important to me as I worked with committee members to draft this legislation.

At this point, I would like to take some time to go into the details of the principles I have just outlined. First, and most important, this legislation provides beneficiaries with more coverage choices.

Let me emphasize, S. 1 does not, I repeat, does not, take anything away from Medicare beneficiaries. If beneficiaries like what they have, they may keep their current coverage. However, if they want coverage similar to private health insurance, S. 1 offers them this choice.

Those remaining in traditional Medicare will be able to receive prescription drug coverage equal to that received by beneficiaries who elect to receive their prescription drug coverage through the new MedicareAdvantage program. MedicareAdvantage is the new name for the current Medicare+Choice program, also known as Medicare Part C.

As my colleagues are aware, today we have Medicare Part A, which is for hospitalizations, and Part B, which is for outpatient and physician coverage.

This legislation will then add Part C, for Medicare Advantage. And, beginning on January 1, 2006, a Medicare prescription drug benefit will be established under a new program which will be codified as Part D of Medicare.

Beneficiaries will have the choice of either adding a new stand-alone drug plan to their current coverage, delivered through fee-for-service reimbursement or they may participate in a program which integrates their basic medical coverage with added pharmaceutical benefits through either a health maintenance organization, HMO, or a preferred provider organization, PPO.

There will be a new Center for Medicare Choices established at the Department of Health and Human Services, with an administrator who will oversee both the new drug plan under Medicare Part D and the new MedicareAdvantage program under Medicare Part C.

To operate the prescription drug plan, the Administrator will create at least 10 regions throughout the country, which must be at least the size of a state. States will not be allowed to be divided among regions.

Private-sector entities will bid to provide coverage. For PPOs, they will contract to provide the entire spectrum of Medicare services, including drug coverage, for the region. For HMOs, they will contract to provide Medicare services, including drugs, for a county.

If a beneficiary elects to remain in the traditional Medicare program, he or she may receive pharmaceutical assistance through a new add-on program which will be administered by a private insurer who has been certified by the government to provide coverage in that region. Many have been concerned that in some areas of the country there will not be private sector entities that wish to provide this new coverage. I share that concern, especially after my own State's experience with Medicare+Choice program.

For this reason, we worked very hard to make certain that there was a safety net, a ``fall-back'' plan that would provide seniors with the coverage they need if no private sector plans came forward.

I will discuss how the fall-back operates in a few minutes, but I did want to assure my constituents that there will be safety net if it is needed.

Another assurance this bill provides to our constituents is that beneficiaries will be allowed to change plans on an annual basis. We do not want any beneficiary to feel that he or she is locked into a program that is not a good fit. So, I have insisted that the flexibility to change plans was present in the bill, and I am pleased it was included.

As I mentioned earlier, one important principle of our plan is that beneficiaries who continue in traditional Medicare or those who enter a new integrated plan should have the same level of coverage.

So beneficiaries can either purchase standard coverage form an insurer or they will have the benefit of participating in a new HMO or PPO plan that includes pharmaceutical coverage valued at the equivalent amount of the subsidy the government is providing for the stand-alone plan.

In 2006, standard coverage would have a $275 annual deductible. For spending over the deductible up to $4,500, beneficiaries would pay one half, and the government the other half.

Eighty-eight percent of Medicare beneficiaries will not reach this limit of $4500 in 2006.

Even so, the plan envisions generous subsidies for beneficiaries who cannot afford their drug coverage, in this case those with incomes less than 160 percent of the federal poverty level.

However, for those with incomes at the above 160 percent of the federal poverty level, there would be no government subsidy for out-of- pocket expenditures once drug costs in total reach $4,500, of which the government would have paid roughly half once the deductible was satisfied.

As a protection against extremely high drug costs, which can prove catastrophic to a beneficiary, we have included a provision limiting a beneficiary's spending to 10 percent of costs once their out-of-pocket expenditures for drugs reaches $3,700.

We want this program to be as affordable as possible for beneficiaries. Indeed, the committee was torn.

We needed to make certain that the program is affordable to Federal taxpayers and does not exceed the $400 billion we have planned for in our budget.

On the other hand, we wanted the coverage to be meaningful and really help seniors and disabled who need assistance.

This is one reason the bill contemplates an affordable, national average premium for pharmaceutical assistance of $35 per month. I know this can be very confusing--even for those of us who drafted the bill-- so I want to take this opportunity to explain the standard drug plan and the actuarial equivalent drug plan--the two types of drug plans that will be offered to Medicare beneficiaries.

First, both the standard drug plans and the actuarial equivalent drug plans would have the same deductible.

Second, beneficiary out-of-pocket expenditures would be the same in both the standard and actuarial equivalent plans.

Both the stand-alone drug plan and the MedicareAdvantage PPO plan could offer beneficiaries standard coverage that is described in the statute, or they can offer differing coverage as long as certain provisions are met: The actuarial value of the prescription drug plan would have to be at least equal to the actuarial value of the standard plan; and the coverage would be designed to cover the same percentage of costs up to the initial benefit limit as that provided under the standard plan. Again, the limits on beneficiary out-of-pocket expenses and annual deductibles would be the same in both the standard plan and the actuarial equivalent plan.

Finally, actuarially-equivalent plans would be allowed to vary the monthly beneficiary premium and the beneficiary copayments. In addition, if these plans wanted to offer additional benefits to seniors, they may do so and the beneficiary would be responsible for paying additional costs.

In sum, a beneficiary is permitted to choose a drug plan that best suits his or her health care needs.

In S. 1, we are offering seniors choice in drug coverage. Medicare beneficiaries may stay in traditional Medicare fee-for-service and receive their drug plan through a stand-alone drug plan. Or, they may receive their drug coverage through the new MedicareAdvantage program either through an HMO or the new PPO option.

The plans offered through MedicareAdvantage are integrated health plans which means these plans are similar to private health insurance which combines health and drug benefits in one insurance plan. In order to encourage plans to participate as stand-alone drug plans, interested entities would submit bids to the administrator. This bid would include information on benefits, the actuarial value of the prescription drug coverage, the service area for the plan, and the monthly premium.

Plans could submit bids to provide coverage for a specific region, as established by the Administrator, or the entire area covered by Medicare. Plans could also submit bids for more than one region and they may also bid nationally.

A plan would not be accepted by the Secretary unless the premium, for both standard coverage and for any additional benefits, accurately reflected the actuarial value of the benefits.

The administrator will work with bidding plans so a region will have at least with two stand-alone drug plans that will offer prescription drug coverage to Medicare beneficiaries in an area. These contracts would be awarded for 2 years. Finally, the stand-alone drug plans would be required to accept some level risk.

If only one plan, or even no plans, are unwilling to offer stand- alone prescription drug coverage within a region, the Administrator will enter into an annual contract with an entity to provide a prescription drug fallback plan. This fallback plan, which would be given a 1 year contract, would offer Medicare beneficiaries the standard drug plan.

We have designed this fallback plan to ensure that seniors will have prescription drug coverage across the country. In addition, seniors could be offered prescription drug coverage through a MedicareAdvantage HMO or PPO.

During the Finance Committee mark-up, an amendment was offered that would have given the fallback plan a two-year contract instead of a one-year contract.

While I am sympathetic to some of the concerns raised about the administrative difficulties surrounding choosing a fallback plan within a few months, I do not believe that a 2-year fallback plan is the solution.

I believe that having a two-year fallback plan makes it even more difficult to encourage other private plans to bid in a region. As a result, a two-year fallback plan could prevent a private plan from ever wanting to enter the region and beneficiaries are left with a fallback plan that does not offer much flexibility. Therefore, I would strongly oppose such an amendment.

With regard to the low-income, I believe that we should provide additional assistance to the low-income Medicare beneficiaries when it comes to prescription drug coverage. S. 1 provides additional subsidies for drug coverage for Medicare beneficiaries under 160% of the federal poverty level, individuals with income limits of $14,368 for individuals and $19,360 for couples.

Let's face it, these beneficiaries, in many cases, are struggling with their bills and are barely making ends meet. These are the individuals who are deciding between paying the rent and paying for food. This population makes up 37.4 percent of Medicare beneficiaries.

S. 1 continues to provide drug coverage for the dual eligible population, those who are currently eligible for both Medicare and Medicaid, through the Medicaid program.

Dual eligibles have incomes that are below 74 percent of the Federal poverty level--annual income limits are $6,555 for individuals and $8,848 four couples.

During the Committee's consideration of S. 1, I authored a provision that would reward states that already provide both Medicare and Medicaid coverage for low income individuals between 74 percent and 100 percent of the Federal poverty level.

For the 19 States that have expanded their Medicaid coverage to these seniors, the Federal Government would pay for the Medicare Part A cost- sharing of these beneficiaries. The provision is important because it gives incentives to States that expand their dual eligible programs.

This legislation provides these beneficiaries who are below 160 percent of poverty with additional subsidies for their drug coverage.

There are some who are concerned about the Federal Government heavily subsidizing this population because drug coverage is so expensive. In my opinion, providing additional assistance to these lower-income beneficiaries is the right thing to do. End of story.

With regard to the comprehensive drug program, some have expressed concern that the program will not begin until January 1, 2006. I understand the concerns of those who advocate for immediate coverage for seniors. That's why we created the Medicare Prescription Drug Discount Card available to Medicare beneficiaries no later than January 1, 2004 and would provide discounts up to 25 percent on their prescription drugs.

Medicare beneficiaries would be charged an annual enrollment fee of $25 and could only be enrolled in one endorsed card program. The prescription drug card program would continue to operate for at least 6 months after the implementation of the Medicare Prescription Drug Benefit Plan.

At the beginning of 2004 and 2005, low-income beneficiaries under 135 percent of poverty would be given $600 per year for their drug expenses. These beneficiaries would be permitted to carry any left-over money from year to year. Additionally, spouses may share their drug cards.

I worked very hard to make certain that our new plan does not disadvantage rural areas such as my home state of Utah. The bill before us provides assurances that any Medicare beneficiary, regardless of where he or she lives, will have access to prescription drug coverage.

For example, the legislation requires that at least two stand-alone drug plans would be offered to Medicare beneficiaries in each region. And, if only one plan, or worst case scenario, no plans, bid to offer stand-along coverage, there will be a fallback plan to provide prescription drug coverage. No beneficiary, regardless of where he or she lives, would be without prescription drug coverage.

In addition, for those living in rural areas, the MedicareAdvantage plans will offer beneficiaries a maximum of three PPO plans per region. If PPOs decide not to bid in a specific area, these beneficiaries still will have coverage through traditional Medicare and will also have optional prescription drug coverage.

S. 1 also gives the Secretary of Health and Human Services the discretion to make adjustments in geographic regions so there will not be a large discrepancy in Medicare prescription drug premiums across the country.

However, our first and foremost goal in S. 1 is to provide drug coverage to those who currently have no coverage. We need to help beneficiaries first, but we also need to continue our work with the employer community to ensure that they will continue to offer retiree health benefits.

Finally, I want to take a minute to talk about traditional Medicare and why I believe that the PPO option under the MedicareAdvantage program is the better choice.

Most will agree that the current Medicare program is an archaic system that still looks very much like the program when it was created in 1965. Do any of you remember what was popular in 1965? Most of you probably do not but, unfortunately, I do.

What we are trying to do in S. 1 is provide seniors with the same health choices available to those under 65 today, and not offer them only health choices that were available in 1965! While most seniors are comfortable with the current Medicare coverage, traditional Medicare is outdated in several ways. Besides not offering seniors prescription drug coverage, it does not provide protections for the sickest beneficiaries. To me, that is a major flaw of the program. Most drug plans offer catastrophic coverage for seniors once they spend a certain amount of money for their health care costs. Not traditional Medicare. Medicare requires the sickest seniors to continue to pay for their health coverage out of pocket without assistance.

In addition, beneficiaries currently receive their coverage through Medicare Part A, which covers hospital expenses, and Medicare Part B, which covers providers' expenses, such as physicians. There are deductibles for Medicare Part A, which is $840 in 2003, per spell of illness.

Simply put, this means that a beneficiary who is admitted to the hospital for different illnesses ends up paying this hospital deductible more than once per year. The Medicare Part A program also has copayments and other beneficiary cost-sharing that could be very expensive. On top of it, beneficiaries also must pay a $100 annual deductible for Medicare Part B, along with beneficiary copayments for these services.

The bottom line? Medicare beneficiaries are paying two different deductibles each year for different health services. How fair is that to seniors? And why should seniors be the only ones who have to adhere to such a crazy system?

Private health insurance does not operate like this. Those under 65 do not have to pay arbitrary copayments and deductibles. They have prescription drug coverage in many cases. And they typically do not have to pay extra money out of pocket if they are seriously ill.

I believe that Medicare beneficiaries should have those same choices and that's why we created the MedicareAdvantage program in S. 1.

MedicareAdvantage improves the choices offered to beneficiaries. They would have their choice of coverage in MedicareAdvantage through HMOs, the same Medicare+Choice plans many have been offered or the new preferred provider organization, better known as PPOs.

MedicareAdvantage PPOs would have a network of providers that will agree to offer Medicare beneficiaries coverage for benefits in the traditional Medicare program. Through this PPO system, beneficiaries will be able to see their same doctors, and go to the same hospitals.

If these medical providers are in the PPO network, the beneficiaries will pay the standard coverage for participating network providers. If they do not participate in the PPO network, seniors will pay more to see them. The important point is that, through PPOs, beneficiaries would still be able to see the doctor of their choice.

Similar to the regions created for the Medicare prescription drug benefit, S.1 also creates 10 regions for PPO coverage. To make things simpler, the secretary of Health and Human Services would be allowed to use the same regions as the ones established for the prescription drug program.

Again, these regions must include at least one State--and parts of one State could not be divided up into separate regions. A maximum of three PPO plans per region would be offered to Medicare beneficiaries. The HHS Secretary would calculate what the benchmark payment from the federal government would be for these new PPOs. This benchmark would be based on the higher payment of traditional Medicare FFS or the Medicare+Choice payment for the specific region.

The MedicareAdvantage PPO will provide beneficiaries with the health coverage that is similar to private health insurance. Instead of the crazy patchwork of deductibles and copayments imposed on beneficiaries in traditional Medicare, it would offer them a combined deductible, instead of separate deductibles like traditional Medicare.

MedicareAdvantage PPOs will offer beneficiaries with catastrophic health coverage. If beneficiaries choose the PPO option, they will not longer be completely responsible for bills associated with catastrophic illnesses. The PPO plans would determine appropriate levels of beneficiary cost-sharing--deductibles, catastrophic limits and copayments, not the federal government.

In addition, plans under the MedicareAdvantage program will provide beneficiaries with coordination of care.

It is unfortunate that the traditional Medicare program does not have any disease management or chronic care management programs available for all Medicare beneficiaries. This is something many of us had hoped to improve for years.

Under S. 1, MedicareAdvantage plans will create disease management programs and, in my opinion, do a much better job of monitoring the health care needs of individual Medicare beneficiaries than traditional Medicare.

In the worst case scenario, if PPO plans do not offer coverage for a specific region, the Medicare beneficiary would have traditional Medicare coverage along with a prescription drug benefit. Seniors will always have health insurance coverage and the option of prescription drug coverage as well.

Before I close, I want to address one of other important priority of mine.

Although we have worked for several years to pass a Medicare prescription benefit in the Senate, we have worked just as long to pass a Medicare regulatory reform bill.

That is why I am delighted that the ``Prescription Drug and Medicare Improvement Act of 2003'' includes ``The Medicare Education, Regulatory Reform and Contracting Improvement Act'' a bill that I am introducing this year in the Senate. This bill is called MERCI [mercy] because it provides regulatory relief for Medicare providers and improved services for beneficiaries.

Medicare's antiquated regualtions--three times longer than the U.S. tax

code--prevent providers from delivering health care efficiently and beneficiaries from receiving the care they need.

Secretary Thompson has said, ``Patients and providers alike are fed up with excessive and complex paperwork. Rules are constantly changing. Complexity is overloading the system, criminalizing honest mistakes and driving doctors, nurses, and other health care professionals out of the program.''

Failure or just the perception of failure to follow Medicare's needlessly complex rules can result in audits, withholding of payments, and crippling of a physicians' practice. Furthermore, obsolete restrictions on Medicare contracting authority impose burdens and inefficiencies on contractors, taxpayers, providers and beneficiaries.

This bill improves the Medicare program for beneficiaries and provides by clarifying regulations, rewarding quality and by enhancing services.

The bill decreases waste, fraud and abuse in Medicare in ways that are just and fair for beneficiaries, contractors, and providers by eliminating retroactive application of regulatory changes, and by expediting the appeals processes for beneficiaries, providers, and suppliers of Medicare services.

It improves communication between HHS and both Medicare providers and beneficiaries by enhancing central toll-free telephone services and providing for provider and beneficiary ombudsmen. It increases competition, improves service and reduces costs by providing for a competitive bidding process for Medicare contractors that takes into account performance quality, price and other factors that are important to beneficiaries.

And, it decreases Medicare billing and claims payment errors by improving education and training programs for Medicare providers and at the same time creates an expedited appeals process for Medicare claim denials.

These provisions will improve the delivery of health care services to Medicare beneficiaries by enhancing the efficiency of the program for all concerned.

It is high time that we made Medicare more user-friendly. I want to thank my colleagues Senators Grassley and Baucus for working with me on these provisions.

In conclusion, I believe that this will assist all Medicare beneficiaries, especially those without prescription drug coverage, by providing them with a choice of quality prescription drug coverage and a choice of quality health coverage. Passing this legislation is the right thing to do for our seniors.

It is remarkable to me that close to a year ago, we were having the same debate on the Senate floor.

Last year's outcome was a major disappointment to me and my tripartisan colleagues. At the time, I honestly believed that last year was our final chance to make improvements to the Medicare program for a long time.

But here we are, almost a year later, debating this important issue once again. Thankfully, we have a Finance Committee chairman who has been able to guide this legislation through the Senate in a timely manner. Thankfully, we have a President who made Medicare prescription drug coverage for seniors one of his top priorities.

This year is different than 2002.

This year, we have accomplished what we could not accomplish last year.--We have put partisan politics aside and written a bill that is truly bipartisan.

And because of this bipartisan effort, I believe a Medicare prescription drug benefit will become a reality for Medicare beneficiaries across the country. The wait for Medicare prescription drug coverage will soon be over thanks to the hard work of the Senate Finance Committee, especially Senator Grassley, Senator Baucus, Senator Snowe, Senator Breaux and Senator Jeffords.

This is a historic time for the United States Senate.

I notice my esteemed colleague who has done so much in the field of health care in the House, and who has started anew here in the Senate in many ways, is here to speak.

I yield the floor.

Mr. President, I thank my colleague. He is a definite leader in health care. I enjoy working with him and appreciate his kind remarks.

Mr. President, I ask unanimous consent that a member of my staff, Alan Fishman, and my legislative fellow, Dr. Jon Tilburt, be granted the privilege of the floor during debate on S.1, the Prescription Drug and Medicare Improvement Act of 2003.

Mr. President, I ask unanimous consent that the following staff members be allowed on the Senate floor for the duration of the debate on the Prescription Drug and Medicare Improvement Act of 2003: Nicholas J. Podsiadly, Collen Haddow, and Molly Zito.

Mr. President, I rise in support of R. Hewitt Pate's nomination for Assistant Attorney General for the Antitrust Division.

I would note that Mr. Pate's nomination was unanimously approved by the Judiciary Committee. I fully expect that the Senate will follow suit and quickly approve his nomination to this important position.

Over the last decade, the position of the Assistant Attorney General for Antitrust has grown in importance. The rapid transformation of our country's economy, particularly in new technologies and international markets, has raised public attention and policy focus on a variety of important antitrust issues. The Assistant Attorney General plays a crucial role in formulating competition policy and enforcing existing antitrust laws to make

sure that our free-market economy operates efficiently and serves the public.

Mr. Pate comes before the United States Senate with an impressive track record of public service in the Antitrust Division. In June 2001, he was appointed as the Deputy Assistant Attorney General responsible for Regulatory Matters, and served ably under then Assistant Attorney General Charles James. In November 2002, after Mr. James' departure, Mr. Pate was appointed as Acting Assistant Attorney general for the Antitrust Division. During that time, he has demonstrated his talent and ability to lead the Antitrust Division.

Prior to joining the Justice Department in 2001, Mr. Pate practiced at the distinguished law firm of Hunton & Williams in Richmond, Virginia, where he had a distinguished record in representing both plaintiffs and defendants in a variety of antitrust and business law cases. After graduating first in his class at the University of Virginia Law School in 1987, Mr. Pate went on to clerk for the honorable J. Harvie Wilkinson, at the United States Court of Appeals for the Fourth Circuit, Supreme Court Justice Lewis Powell, and Supreme Court Justice Anthony Kennedy. During his tenure at the firm of Hunton & Williams, Mr. Pate found time to teach at the University of Richmond and University of Virginia Law Schools.

With such an impressive background, both in private practice and in antitrust enforcement, particularly given his proven track record, I am confident that Mr. Pate will be an excellent Assistant Attorney General for the Antitrust Division. I am hopeful that this Senate will act quickly to confirm Mr. Pate's nomination.

Mr. President, I rise today to express my enthusiastic support for the nomination of John A. Woodcock to be a United States District Judge for the District of Maine. Mr. Woodcock possesses over 25 years of litigation experience and will serve his country well as a Federal judge.

After graduating from the University of Maine Law School in 1976, Mr. Woodcock joined the law firm of Stearns, Finnegan & Needham where he practiced general civil litigation until 1980. From 1977-1978, Mr. Woodcock was a part-time assistant district attorney. While in the district attorney's office, he handled all criminal appeals from two different counties to the Maine Supreme Judicial Court and was the lead prosecutor in approximately 20 criminal jury trials. In 1980, Mr. Woodcock joined Mitchell & Stearns until forming the smaller law firm of Weatherbee, Woodcock, Burlock & Woodcock in 1991, where he currently practices general civil litigation.

During his career, Mr. Woodcock has been involved in 47 separate appeals to the Maine Supreme Judicial Court on issues ranging from criminal law to trust law. Mr. Woodcock has volunteered his time as a member of several community boards and he is also the attorney-coach for the local high school mock trial team.

After reviewing his record, the ABA gave Mr. Woodcock their highest rating of unanimously well qualified. The committee also received a letter from former Clinton administration Secretary of Defense William Cohen praising Mr. Woodcock's skills as a litigator. He writes, ``I have known John Woodcock for many years. . . . The U.S. District Court for the District of Maine has a long practice of excellence in its judicial appointments and the nomination of John Woodcock is in every way consistent with that tradition.''

I will submit a copy of this letter for the Record. These are words of high praise and I applaud Mr. Woodcock on his many accomplishments. I am certain he will bring great credit to the Federal bench and I urge my colleagues to join me in supporting this highly qualified nominee.

I ask unanimous consent that the above-mentioned letter be printed in the Record.

Mr. President, I am pleased that we are considering the nomination of Richard C. Wesley, who has been nominated by President Bush to serve on the United States Court of Appeals for the Second Circuit. He has an outstanding record of distinguished public service and will be a great addition to the Second Circuit.

Judge Wesley currently serves as an associate judge on the New York Court of Appeals, the State's highest court, having been unanimously confirmed by the State senate in 1997. His 16 years on the trial and appellate bench, plus prior service as a member of the New York State Assembly, has given him the experience and background to make an outstanding Second Circuit Judge.

In addition to his judicial experience, Judge Wesley has had a distinguished legal career. After graduating from Cornell Law School, he began his legal career in 1974 as an associate at the Pittsford, NY, office of Harris, Beach and Wilcox. He achieved a partnership at Welch, Streb, Porter, Meyer & Wesley in Geneseo, NY, in 1977 and in 1979, became assistant counsel to the minority leader of the New York State Assembly in Albany. In 1983, he was elected to the New York Assembly himself, representing his home district in western New York.

Judge Wesley began his judicial career in 1987, when he was elected to the Seventh Judicial District of the Supreme Court of New York. From 1991 to 1994, he served as the supervising judge for the Criminal Courts within the Supreme Court, and in 1994 Governor Cuomo appointed him to the Appellate Division of the Supreme Court in Rochester, where he heard appeals of Supreme Court trial decisions from central and western New York. On December 3, 1996, Governor Pataki nominated Judge Wesley to the New York Court of Appeals. Judge Wesley was confirmed by a unanimous vote of the New York State Senate on January 14, 1997, and has served with distinction on the State's highest court ever since. His 16 years as a judge at both trial and appellate levels, plus prior service as a State assemblyman in New York, have given him the experience and background to make an outstanding Second Circuit judge.

Judge Wesley is a native of Livonia, NY, and has served his community, State, and Nation in a variety of ways. Not only has he served in his professional capacity, but also he believes in community service and has been involved in community service organizations such as the United Church of Livonia, Chances and Changes, a community-based organization in Livingston County that provides safe housing to battered women, and the Myers Foundation, a foundation based in his hometown that helps needy families in the area. Judge Wesley is also active in a number of local youth sports programs and serves as a driver for the Livonia Volunteer Ambulance.

In addition to his public and community service, Judge Wesley has been actively involved in efforts to improve the legal and judicial process. He has been a leader in numerous bar associations and law- related organizations. For example, he serves on the Cornell Law School Advisory Council and the Cornell University Council, and is a Fellow of the New York State Bar Foundation. In January of 1991, Judge Wesley was appointed by the chief administrator of the courts to be the supervising judge of the Criminal Courts in the Seventh Judicial District, and in this capacity developed case management systems that greatly improved the efficiency of the court's criminal docket. These reforms have since served as models for other jurisdictions with heavy criminal caseloads.

Judge Wesley comes to us highly recommended and warmly endorsed by his colleagues and former colleagues on the New York State courts, litigants who know him personally and have practiced in his courtrooms, the president of the New York State Bar Association, community leaders in his hometown of Livonia, NY, Gov. George Pataki, and New York's attorney general, Eliot Spitzer. Let me read a few statements made by some of his many supporters. Jonathan Lippmann, chief administrative judge of the State of New York, writes that Judge Wesley, ``has been a model of the wisdom, temperament, craftsmanship, and personal qualities that make for the most outstanding judges.'' Joseph Bellacosa, dean of the St. John's University Law School and a former colleague on the New York Court of Appeals, writes that Judge Wesley ``is intellectually curious and open to fresh ideas and insights of others, respectful of the great strength derived from collegial shared wisdom of others, yet confident and resolute in his personal conviction on values and fundamental principles. He is also a tireless worker and seeker of equal justice for all. He loves being a Judge and is devoted to the fair administration of justice under the rule of law.'' And Governor Pataki has also written, praising Judge Wesley's excellence as an appellate jurist and specifically noting his ``wealth of experience, intellect, integrity and judicial temperament.''

The legal bar's wide regard for Judge Wesley is further reflected in his evaluation by the American Bar Association. The ABA evaluates judicial nominees based on their professional qualifications, their integrity, their professional competence, and their judicial temperament. The ABA has bestowed upon Judge Wesley its highest rating of Unanimously Well Qualified.

The record is clear that Judge Wesley is worthy of confirmation for this position of high responsibility on the Court of Appeals for the Second Circuit. I strongly support his confirmation and urge my colleagues to do likewise.

Madam President, I rise in support of the nomination of James Ronnie Greer to the U.S. District Court for the Eastern District of Tennessee. Mr. Greer has extensive experience in both the private and public sectors of the legal community.

Upon graduating from the University of Tennessee College of Law, Mr. Greer became the special assistant to then-Gov. Lamar Alexander.

For the past 20 years, Mr. Greer has maintained a successful general legal practice. During this time, his practice has consisted of considerable litigation involving both jury and bench trials in the areas of State and Federal criminal defense, personal injury, and workers compensation. He has also practiced in the areas of domestic relations and has represented a number of clients on environmental issues. From 1985 to 1986, Mr. Greer was county attorney for Green County, TN.

From 1986 to 1994, Mr. Greer served as a State senator in the Tennessee General Assembly, during which time he was a member of the Judiciary Committee, and chairman of the Environment, Conservation and Tourism Committee. During his tenure, he helped pass bills which rewrote the Tennessee Criminal Code, revised the Rules of Evidence, Civil Procedure, and Criminal Procedure. Mr. Greer was also the author and chief sponsor of the Tennessee Solid Waste Management Act.

I am confident that he will serve on the bench with integrity and fairness, and I urge my colleagues to confirm him today.

Madam President, I rise today in support of Mark. R. Kravitz to be a United States District Judge for the District of Connecticut. I am confident that with his accomplishments and experience, Mr. Kravitz will make an excellent Federal judge. After graduating from Georgetown University Law Center, where he was managing editor of the Georgetown Law Journal, Mr. Kravitz clerked for the Honorable James Hunter III of the U.S. Court of Appeals for the Third Circuit. He then went on to clerk for the Honorable William H. Rehnquist on the U.S. Supreme Court.

Mr. Kravitz has spent the bulk of his legal career at the firm of Wiggin & Dana in New Haven, CT, where he is currently a partner. He also serves as an adjunct professor of law at the University of Connecticut School of Law and has also been a visiting lecturer at Yale University Law School. For the past 12 years, Mr. Kravitz has been recognized in the publication ``The Best Lawyers in America.'' He enjoys the support of both home State Democrat Senators and was unanimously approved by the Judiciary Committee. I urge my colleagues to vote in favor of this exceptional nominee.

I yield back our remaining time.

Mr. President, I rise today to introduce a bill to designate the newly-constructed annex to the E. Barrett Prettyman United States Courthouse as the ``James L. Buckley Annex.'' As members of this body well know, Judge Buckley served in this Senate from 1971- 77, as a trusted colleague from the State of New York. During his tenure here, Judge Buckley was greatly admired for his dedication, integrity, and professionalism.

Judge Buckley's lengthy public service career is one of great distinction. In addition to the time he spent here in the Senate, Judge Buckley served in the United States Navy during World War II, as Undersecretary of State for Security Assistance, and as President of Radio Free Europe. Most recently, he served for more than a decade as a Circuit Judge on the United States Court of Appeals for the District of Columbia Circuit, in the E. Barrett Prettyman courthouse.

Earlier this Congress, we honored Judge Buckley, on the celebration of his 80th birthday, by passing unanimously a resolution, S. Res. 88, acknowledging his distinguished career in the executive, legislative, and judicial branches of the United States.

Naming the new annex to the E. Barrett Prettyman courthouse after Judge Buckley would be a fitting tribute to our former colleague and prominent jurist. I am honored to offer this legislation, and I urge my colleagues to support this well-deserved commendation.

Mr. President, I am proud to join Senator Mikulski as cosponsor of the ``National Great Black Americans Commemoration Act of 2003.'' This legislation will help offer a more complete portrayal of our Nation's proud history--one that includes an increased awareness of the contributions made by many great black Americans of various fields and accomplishments.

This legislation seeks to recognize the contributions of African Americans who have served in Congress or other government capacities, in the military, or in other important roles as educators, authors, scientists, inventors, athletes, clergy and civil rights leaders. Clearly, there are few, if any, areas of American culture and history that have not been touched and improved upon by the impact of black individuals. As we recognize this, it is important that we also recognize those whose goal is to make available the history of these outstanding people.

One such institution is The Great Blacks in Wax Museum, a nonprofit organization in Baltimore, MD, whose mission is to present the history of black Americans and to highlight their contributions to our nation. I believe that this institution's work thus far and its goals for the future make it worthy of our support. This legislation not only commends the efforts made by this museum to date, but authorizes the appropriation of funds that will help the museum to improve and expand. Appropriate Federal assistance, coupled with other funding raised by the museum, will allow the current institution to become the National Great Blacks in Wax Museum and Justice Learning Center, which will be better equipped to serve its purposes. This improved museum will be a bright example for projects with similar goals and will provide an excellent source of historical education for all who visit.

I am a strong believer that our history should be presented in a complete and accurate manner. Where we have understated in the past, we should make amends. The development of the National Great Blacks in Wax Museum and Justice Learning Center will be a valuable statement recognizing the contributions of so many great African Americans. I hope that my colleagues will see the merit in this endeavor and will lend their support to the National Great Black Americans Commemoration Act.

Mr. President, I rise today to introduce a bill to designate the newly-constructed annex to the E. Barrett Prettyman United States Courthouse as the ``James L. Buckley Annex.'' As members of this body well know, Judge Buckley served in this Senate from 1971- 77, as a trusted colleague from the State of New York. During his tenure here, Judge Buckley was greatly admired for his dedication, integrity, and professionalism.

Judge Buckley's lengthy public service career is one of great distinction. In addition to the time he spent here in the Senate, Judge Buckley served in the United States Navy during World War II, as Undersecretary of State for Security Assistance, and as President of Radio Free Europe. Most recently, he served for more than a decade as a Circuit Judge on the United States Court of Appeals for the District of Columbia Circuit, in the E. Barrett Prettyman courthouse.

Earlier this Congress, we honored Judge Buckley, on the celebration of his 80th birthday, by passing unanimously a resolution, S. Res. 88, acknowledging his distinguished career in the executive, legislative, and judicial branches of the United States.

Naming the new annex to the E. Barrett Prettyman courthouse after Judge Buckley would be a fitting tribute to our former colleague and prominent jurist. I am honored to offer this legislation, and I urge my colleagues to support this well-deserved commendation.