Floor Statements

Mr. President, this bipartisan sense-of-the-Senate resolution would help ensure that any economic growth package includes $30 billion in desperately needed fiscal aid to the States. Half of the money would have to be used for the Medicaid Program which has been severely cut. Forty-nine States are facing budget shortfalls.

This approach would have no impact on the deficit. It would not change the caps in this resolution. I urge my colleagues to vote yes on the Rockefeller, Collins, Nelson, and Smith amendment.

Mr. President, I am pleased to be introducing America's National Maritime Museum Designation Act of 2003. This legislation would designate an additional 19 maritime museums as ``America's National Maritime Museums'' nationwide. Maritime Museums are dedicated to advancing maritime and nautical science by fostering the exchange of maritime information and experience and by promoting advances in nautical education.

The America's National Maritime Museum designation would include a

commitment on the part of each institution toward accomplishing a coordinated education initiative, resources management program, awareness campaign, and heritage grants program. Maritime museums in America are dedicated to illuminating humankind's experience with the sea and the events that shaped the course and progress of civilization.

Museum collections are composed of hundreds of thousands of maritime items, including ship models, scrimshaw, maritime paintings, decorative arts, intricately carved figureheads, working steam engines, and much more. Maritime museums offer a variety of learning experiences for children and adults through hands-on workshops and programs that focus on maritime history.

Maritime lecture series offer an opportunity to learn about the history and lore of the sea from some of the Nation's leading maritime experts. Visitors learn the broad concept of sea power--the historic and modern importance of the sea in matters commercial, military, economic, political, artistic, and social.

The legislation that I am proposing would help museums better interpret maritime and social history to the public using their extensive collections of artifacts, exhibits and expertise. These programs and facilities are used by schools, civic organizations, genealogists, maritime scholars, and the visiting public, thus, serving students of all ages.

I urge all members of the Senate to join me in support of The America's National Maritime Museum Designation Act of 2003.

Mr. President, I am pleased to be introducing America's National Maritime Museum Designation Act of 2003. This legislation would designate an additional 19 maritime museums as ``America's National Maritime Museums'' nationwide. Maritime Museums are dedicated to advancing maritime and nautical science by fostering the exchange of maritime information and experience and by promoting advances in nautical education.

The America's National Maritime Museum designation would include a

commitment on the part of each institution toward accomplishing a coordinated education initiative, resources management program, awareness campaign, and heritage grants program. Maritime museums in America are dedicated to illuminating humankind's experience with the sea and the events that shaped the course and progress of civilization.

Museum collections are composed of hundreds of thousands of maritime items, including ship models, scrimshaw, maritime paintings, decorative arts, intricately carved figureheads, working steam engines, and much more. Maritime museums offer a variety of learning experiences for children and adults through hands-on workshops and programs that focus on maritime history.

Maritime lecture series offer an opportunity to learn about the history and lore of the sea from some of the Nation's leading maritime experts. Visitors learn the broad concept of sea power--the historic and modern importance of the sea in matters commercial, military, economic, political, artistic, and social.

The legislation that I am proposing would help museums better interpret maritime and social history to the public using their extensive collections of artifacts, exhibits and expertise. These programs and facilities are used by schools, civic organizations, genealogists, maritime scholars, and the visiting public, thus, serving students of all ages.

I urge all members of the Senate to join me in support of The America's National Maritime Museum Designation Act of 2003.

The Senator is correct.

Mr. President, the Senator from West Virginia, on behalf of the Senator from Maine, the Senator from Oregon, the Senator from Nebraska, and several cosponsors, is sending an amendment to the desk to ask for its consideration. I ask that the pending amendment be set aside.

Mr. President, I thank my colleague from West Virginia for his comments. It has been such a pleasure to work with him. He is an eloquent and compassionate advocate for health care for low-income families. I am delighted to be his partner in this regard.

I also acknowledge the hard work of Mr. Nelson, the Senator from Nebraska, and Senator Gordon Smith of Oregon. The four of us have worked very hard on this initiative for over a year. We are also delighted to have the Presiding Officer's critical support in this initiative.

States from Maine to Nebraska, from West Virginia to Oregon, are facing the most serious budget shortfalls in 50 years. The bipartisan amendment that we are offering tonight takes the first step toward providing States with a measure of much needed fiscal relief.

Regardless of the size of the tax cut, we believe it is imperative that the economic growth package include a significant amount for State fiscal relief. Therefore, our amendment expresses the sense of the Senate that at least $30 billion of the economic growth package be targeted to State fiscal relief over the next 18 months to help our States cope with an aggregate budget shortfall that is nearly four times that size.

This bipartisan amendment has been drafted in a way that is both budget and deficit neutral, and I stress that for the information of my colleagues. It neither increases nor decreases the amount provided for reconciliation in the budget resolution. Therefore, our amendment does not add to the deficit. It does not change the spending caps that are included in this resolution.

The attacks of September 11 on our Nation, coupled with the subsequent recession and resulting unemployment, have placed tremendous and unanticipated strains on Government services and resources. At the same time, the States, which are after all our partners in providing health care, education, and other essential services, are facing a dramatic and unexpected decline in Government revenues at precisely the time when the demand for Government services is the greatest because of the lagging economy.

State budgets are under siege. The combination of increasing demands for services and resources, coupled with the dramatic drop in revenues, is causing a fiscal crisis for States from coast to coast.

The State of Maine, for example, faces a budget shortfall over the next 2 years of approximately $1.2 billion. Let me put that in perspective. The entire budget for Maine is only $5.3 billion, which means it faces a shortfall of more than 20 percent. To put the plight of Maine into perspective, I point out if the Federal Government were facing a 20-percent shortfall, it would have to close a $440 billion budget gap, and it would have to do so under its Constitution without borrowing a single dime. That is the dilemma facing our States.

The States have to balance their budgets. They cannot print more money. They cannot borrow more money. They have to balance their budgets. States have been using rainy day funds, delaying capital projects, cutting spending, increasing taxes. They are doing whatever they can to balance their budgets.

According to a February report by the National Conference on State Legislatures, States have been forced to cut a number of critical programs, ranging from education to corrections. Mr. President, 29 States have imposed across-the-board budget cuts, and at least 24 States are considering tax increases to help close those budget gaps.

Moreover, at a time when the number of people without health insurance is climbing, 49 States have either already taken action to cut their Medicaid Program, or are planning to do so. Medicaid provides medical care for 44 million low-income people nationwide, including 218,000 individuals in my home State. States are cutting benefits, increasing copays, restricting eligibility, or removing poor families from the rolls because of soaring costs and plunging revenues. As a consequence, the National Governors Association estimates as many as 2 million low-income individuals across this country will lose their health care coverage as a result of the loss of Medicaid coverage.

Let me be clear, I am not saying Congress should bail out the States. I am not saying States should not have to make hard choices. I am not saying States should not cut their budgets, that they should not balance their budgets. The States do need to tighten their belts during these austere fiscal times, but the nature and the severity of the fiscal crisis facing our States has convinced me we simply must help. The consequences are too dire, otherwise, and too many very low-income individuals will suffer if we do not step in and help.

That is why I joined in this effort to provide for a temporary increase in the February Medicaid matching rate as well as some flexible funds that go to every State. Specifically, our amendment, which has strong bipartisan support, provides $30 billion to the States, at least half of which would have to be provided through a temporary increase in the Medicaid matching rate.

Our amendment is strongly supported by a host of health care patient and consumer advocacy groups, including the American Hospital Association, the American Health Care Association, the Visiting Nurses Associations of America, the American Dental Association, Families USA, the Child Welfare League of America, the Alzheimer's Association, the National Alliance for the Mentally Ill, the Children's Defense Fund, the Consortium for Citizens with Disabilities, and many other critically important organizations.

The support our proposal has received underscores how important it is we act now to provide assistance to the States at a time when many are looking toward further cuts in their health care programs to help balance their budgets.

We have focused particularly on Medicaid because of our concern about the impact on low-income families in America. But there is another reason it makes sense to target this assistance to the Medicaid Program; that is, Medicaid is the fastest growing component of State budgets.

While State revenues are stagnant or declining in most States, Medicaid costs are increasing at a rate of more than 13 percent a year. My home State of Maine is one of many States that has been forced to consider cuts in its Medicaid Program to compensate for its budget shortfalls.

Legislation enacted as a consequence of our amendment, I stress again, will not free States from making very painful and difficult choices in crafting their budgets for the year. But it will help prevent the most harmful cuts, those that would affect the families who can least afford them, those who

are already under strain as we see the number of uninsured continue to climb to 41 million Americans without insurance.

To Maine, our amendment could mean as much as $190 million over the next 18 months for health care and social services that would help our most needy citizens. In other words, this is about helping those who are most vulnerable in our society. In addition, our proposal makes sound economic sense. Putting money into the hands of the States is a good way to stimulate economic growth.

After all, if we cut taxes in Washington only to have taxes increased in State capitals across this country, we will wipe out the good that we do by cutting taxes. We know if we get money into the hands of the States, they will put it directly into the economy, and that is just the kind of stimulus our economy needs.

Congress is most effective when it stands arm in arm, not toe to toe, with our partners, the States. Our States face a crisis of vast and still-expanding dimensions. We need to help. This amendment is a critical step forward in doing just that. I hope we will have another very strong bipartisan vote for our proposal so that we can ensure any fiscal relief is included in any economic growth package that we consider later this year.

I am happy to yield to my colleague from West Virginia.

The Senator from West Virginia raises an excellent question. Again, I stress that what our direction to the Finance Committee would say, when you report an economic growth package, fiscal relief up to at least $30 billion should be part of that package.

So our sense-of-the-Senate amendment does not increase the deficit. It does not increase the overall spending in this resolution. It does not increase the budget caps that are in this resolution. All it says is, when an economic growth package is reported by the Finance Committee, it should include the $30 billion in State fiscal relief.

So this proposal is budget neutral and it is deficit neutral. It does not have the impact that might cause some people otherwise to oppose it.

I am happy to yield to my friend.

Mr. President, I would respond to that concern in two ways. First of all, the dramatic decline in revenues is not the fault of State governments. It is a product of the lagging economy we are in, and the lingering effects of the attacks on our Nation of September 11. The States have been prudent, have taken appropriate steps, but when you have 49 States, every single State but Wyoming, struggling to close budget gaps, it is clear it is not the result of profligate spending by one or two particular States but, rather, reflects our declining economy or our lagging economy.

What we have here is a confluence of the impact of September 11 and a recession with declining revenues that have caused these budget gaps in 49 States.

A second point is, despite our best efforts, the States are still going to have to make some very painful and difficult choices. In the State of Maine, we are facing a budget gap of over $1 billion. Under our proposal, Maine would get a much welcomed $190 million. There is still a long ways to go.

Our proposal will certainly help the States avoid some of the most harmful cuts, particularly in health care, which is our greatest concern, but it certainly does not mean States are let off the hook in any way.

The Senator is absolutely correct. Medicaid is a partnership between the Federal Government and our partners, the States, to provide health care to low-income families, the very poor individuals, to those who need it most. Medicaid is the fastest growing component in State budgets. So States certainly are contributing to this program. It has been a successful partnership. We are suggesting a temporary increase over the next 18 months. I hope we will grant that.

I have several letters which I am going to have printed in the Record, which talk about protecting the States' ability to provide and deliver this health care, and points out, again, that these are health care services to the most vulnerable Americans we serve.

I ask unanimous consent that a letter from the National Association for Home Care and Hospice be printed in the Record.

Mr. President, I rise today to express my opposition to the

inclusion of provisions in the fiscal year 2004 budget resolution that would provide for oil drilling in the Arctic National Wildlife Refuge.

The United States critically needs to reduce its dependence on foreign oil. Some believe we can drill our way to energy independence. That is simply not the case.

If we were today to start drilling in ANWR, our largest remaining domestic oil reserve, we would do almost nothing to decrease our reliance on foreign oil. It is a cold, hard fact: the United States uses about 25 percent of the world's oil, but only possesses 3 percent of the world's known oil reserves.

The Department of Energy has projected that if current trends continue, we will need an additional 5 million barrels of oil per day by 2020. Even under the most optimistic scenarios, ANWR could supply only a small fraction of that amount.

The alternative is to increase energy efficiency and develop alternative technologies. Simply increasing fuel economy standards for automobiles would do far more to reduce our imports of foreign oil than would drilling in the Arctic. Not only that, but it would also save Americans billions of dollars.

Protecting the Arctic National Wildlife Refuge is the right thing to do for the environment. Along with increased fuel efficiency and renewable energy production, protecting the Arctic is also the right thing to do for the economy and for America's energy security. Most important, it is the right thing to do for future generations.

I call on my colleagues to join me in support of removing provisions from the fiscal year 2004 budget resolution that would open ANWR to oil drilling.

Mr. President, the textile mills and tanneries of Maine helped fuel our country's economic growth. But as these industries closed, brownfields replaced once vibrant factories. In many communities across Maine these sites remain a legacy of our industrial history.

Left undeveloped, brownfields pose threats to the public health, environmental quality and economic strength of our communities. But redeveloped, these sites offer opportunities for new industries, job growth and economic development. I am pleased to join Senators Levin and Jeffords in introducing the Brownfields Redevelopment Assistance Act. This legislation will provide communities with economic development resources to redevelop brownfields and return them to productive uses.

The legislation we are introducing today would provide EDA with increased funding flexibility to help States, local communities, Indian tribes and nonprofit organizations return brownfield sites to productive use. The bill authorizes $60 million each year for five years for brownfields redevelopment. This funding authorized by this bill will result in hundreds of millions of dollars worth of economic benefits for States and local communities through the leveraging of local and State funds and private investments.

The bill gives EDA the authority to provide grants for brownfield redevelopment projects, including: development of public facilities and public services; business development; activities to help communities diversify their economies; and collaborative economic development planning. This will help States and communities facilitate effective economic development planning for brownfield reuse; develop infrastructure necessary to prepare sites for re-entry into the market; and, provide the capital necessary to support new business development.

The decline of the New England textile industry led to the closure of many textile mills throughout the region, including the Bates Mill in the City of Lewiston, ME. The Bates Mill was once the State's largest employer providing more than 5,000 jobs. Economic decline and layoffs left the residents of Lewiston with large abandoned mill buildings that have been a challenge to redevelop. As a small city of 36,000 people, continued support for redeveloping brownfields located in the heart of downtown is critical to the city's future economic vitality. In 1998, the city received a $200,000 grant from the Environmental Protection Agency to help facilitate the cleanup and redevelopment of the one million square foot mill complex. Today, the City has redeveloped about one-third of the mill and created 1,000 new jobs. The City estimates that it will require $54 million to develop the remaining buildings in the Bates Mill Complex. The economic development resources provided in the Brownfields Redevelopment Assistance Act will help Lewiston and other communities across the nation rebuild their communities and create new economic opportunity.

Brownfields redevelopment is a fiscally responsible strategy for strengthening local economies and reusing existing infrastructure while protecting open space. We recycle cans, bottles and newspapers now we must try harder to recycle our land. I am proud to be an original co- sponsor of the bill to aid in this effort.

Mr. President, the textile mills and tanneries of Maine helped fuel our country's economic growth. But as these industries closed, brownfields replaced once vibrant factories. In many communities across Maine these sites remain a legacy of our industrial history.

Left undeveloped, brownfields pose threats to the public health, environmental quality and economic strength of our communities. But redeveloped, these sites offer opportunities for new industries, job growth and economic development. I am pleased to join Senators Levin and Jeffords in introducing the Brownfields Redevelopment Assistance Act. This legislation will provide communities with economic development resources to redevelop brownfields and return them to productive uses.

The legislation we are introducing today would provide EDA with increased funding flexibility to help States, local communities, Indian tribes and nonprofit organizations return brownfield sites to productive use. The bill authorizes $60 million each year for five years for brownfields redevelopment. This funding authorized by this bill will result in hundreds of millions of dollars worth of economic benefits for States and local communities through the leveraging of local and State funds and private investments.

The bill gives EDA the authority to provide grants for brownfield redevelopment projects, including: development of public facilities and public services; business development; activities to help communities diversify their economies; and collaborative economic development planning. This will help States and communities facilitate effective economic development planning for brownfield reuse; develop infrastructure necessary to prepare sites for re-entry into the market; and, provide the capital necessary to support new business development.

The decline of the New England textile industry led to the closure of many textile mills throughout the region, including the Bates Mill in the City of Lewiston, ME. The Bates Mill was once the State's largest employer providing more than 5,000 jobs. Economic decline and layoffs left the residents of Lewiston with large abandoned mill buildings that have been a challenge to redevelop. As a small city of 36,000 people, continued support for redeveloping brownfields located in the heart of downtown is critical to the city's future economic vitality. In 1998, the city received a $200,000 grant from the Environmental Protection Agency to help facilitate the cleanup and redevelopment of the one million square foot mill complex. Today, the City has redeveloped about one-third of the mill and created 1,000 new jobs. The City estimates that it will require $54 million to develop the remaining buildings in the Bates Mill Complex. The economic development resources provided in the Brownfields Redevelopment Assistance Act will help Lewiston and other communities across the nation rebuild their communities and create new economic opportunity.

Brownfields redevelopment is a fiscally responsible strategy for strengthening local economies and reusing existing infrastructure while protecting open space. We recycle cans, bottles and newspapers now we must try harder to recycle our land. I am proud to be an original co- sponsor of the bill to aid in this effort.

Mr. President, I first want to commend the Senator for his eloquent statement. I think it is always important to remind Americans, no matter where they live, of the productivity of American agriculture and the importance, particularly, of our family farmers. There is no one who is a greater advocate for America's farmers than the Senator from Iowa. So I am very pleased to have had the privilege of hearing his comments today.

(The remarks of Ms. Collins pertaining to the introduction of the legislation are located in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Mr. President, I want to discuss the upcoming budget resolution and its impact on home health agencies. According to the Congressional Budget Office, the Post-Balanced Budget Act reductions in home health care have totaled more than $72 billion between fiscal years 1998 and 2002. This is more than four times the $16 billion that CBO originally estimated for that time period and it is a clear indication that the Medicare home health cutbacks have been far deeper than Congress ever intended.

As a consequence of these reductions, cost-efficient home health agencies across the country have experienced acute financial difficulties and cashflow problems which have inhibited their ability to deliver vital care. Home health spending has been cut in half since 1997. More than 3,400 home health care agencies have either closed their doors or stopped serving Medicare patients. Moreover, the number of Medicare patients receiving home health care nationwide has dropped by 1.3 million, more than a third. This points out the most central and critical issue: Cuts of this magnitude simply cannot be sustained without ultimately affecting patient care, without ultimately diminishing the provision of care to some of the most vulnerable citizens in our Nation.

It, therefore, is my intent to offer an amendment to the budget resolution this week calling on the Senate to stabilize and promote fairness in Medicare home health reimbursements by avoiding further cuts in home health spending, preserving the full market basket update, and restoring funding for this important benefit, including the extension of the 10 percent rural add-on reimbursement I have discussed today. I hope all of my colleagues will join me in supporting this amendment.

I yield the floor.

Mr. President, I rise today to introduce the Rural Home Health Payment Fairness Act, which would extend the 10 percent add-on payment under Medicare for home health care services in rural areas that is currently scheduled to sunset on April 1. This legislation would help to ensure seniors and disabled citizens living in rural America continue to receive the home health care benefits and services they depend on and deserve.

Health care in this country has gone full circle. Patients are spending less time in the hospital. More and more procedures are being done on an outpatient basis and recovery and care for patients with chronic diseases and conditions have increasingly been taking place in the home. As a consequence, home health care has become an increasingly important part of our health care. The kinds of highly skilled and often technically complex services our Nation's home health nurses provide have enabled millions of our most frail and vulnerable senior citizens to avoid hospitals and nursing homes and stay where they want to be, in the security, privacy, and comfort of their very own homes.

I have visited home health patients throughout my State in northern, central, and southern Maine. Regardless of where they live, the impact of home health care on their lives has been the same. It has made the difference between couples staying together in their own home for their golden years, despite the ill health of one of the spouses, or being forced prematurely into a nursing home or into repeated hospitalizations.

One elderly gentleman told me all he wanted was to live out the remaining days of his life with his wife, whom he had been married to for decades, and that home health care allowed them to be together in the home where they had always lived, as he completes his final years.

Home health care is also a bargain. It makes a great deal of sense to care for people in their own homes and avoid the extra costs of nursing homes and hospitalization. Our home health care system is fragile. Extension of the 10 percent add-on payment for rural home

health care agencies will help to ensure that patients living in rural communities continue to have access to vital home health services. Surveys have shown the delivery of home health services in rural areas can be as much as 12 to 15 percent more costly because of the extra travel time required to cover long distances between patients, higher transportation expenses, and other cost factors.

Rural agencies also experience higher costs relative to productivity. Because of the longer travel distances, rural caregivers are unable to perform as many visits in a single day as their urban counterparts. Saundra Scott-Adams, the Executive Director of Visiting Nurses of Aroostook in northern Maine, tells me her agency covers 6,600 square miles to serve a population of only 73,000. Her costs are understandably much higher and her hard-working nurses are not able to see as many patients in a day as their urban counterparts. The long distances they must drive mean they are able to see fewer patients each day.

Moreover, agencies in rural areas are frequently smaller than their big city counterparts, which means their relative costs are higher due to smaller scale operations and an ability to take advantage of economies of scale. Smaller agencies with fewer patients and fewer visits mean that fixed costs, particularly those associated with meeting regulatory requirements, are spread over a smaller number of patients and visits, increasing overall per-patient and per-visit costs. If the rural add-on payment is eliminated on April 1, it will only put more pressure on our rural home health agencies that are already operating on a very narrow margin, and it could, in fact, force some of these agencies to close.

Some agencies operating in rural areas are the only home health providers for a vast geographic area. If any of these agencies are forced to close, the Medicare patients in that region will completely lose their access to home health care.

Earlier this year, the Medicare Payment Advisory Commission voted unanimously to extend the rural add-on payment for home health services for one year. I urge all of my colleagues to join me in cosponsoring this important legislation to ensure that all of our seniors, no matter where they live, whether they live in big cities, in suburbs, or the smallest communities, continue to have access to quality home health services.

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

Mr. President, I ask unanimous consent that I be recognized as in morning business for up to 10 minutes for the purpose of introducing a bill.

I yield the floor and suggest the absence of a quorum.

Mr. President, I rise today to introduce the Mercury Reduction Act of 2003. I am pleased that my colleagues, Senators Jeffords,

Chafee, Kerry, Hutchison, Reed, Lieberman, Voinovich, Dorgan, and Leahy have joined me in this initiative. Our legislation addresses the very serious problems of mercury in the environment and mercury disposal. It takes special aim at one of the most common and widely distributed sources of mercury mercury fever thermometers while also for the first time creating a nationwide policy for dealing with surplus mercury.

Mercury is a potent neurotoxin that is widespread in the environment and particularly harmful to developing children. In fact, according to a draft report recently released by the EPA, approximately 5 million American women of childbearing age have mercury levels in their bloodstream above safe levels. Tragically, the children of these women will have an elevated risk of birth defects.

When mercury enters the environment, it takes on a highly toxic organic form known as methylmercury. Methylmercury is almost completely absorbed into the blood and distributed to all tissues including the brain. This organic mercury can accumulate in the food chain and become concentrated in some species of fish, posing a health threat to some people who consume them. For this reason, 40 States have issued freshwater fish advisories that warn certain individuals to restrict or avoid consuming fish from affected bodies of water.

One prevalent source of mercury in the environment is from mercury fever thermometers. Many of us know from personal experience that they are easily broken. In fact, in 1998 the American Poison Control Center received 18,000 phone calls from consumers who had broken mercury thermometers.

One mercury thermometer contains a little under one gram of mercury. Despite its small size, the mercury in one thermometer, if it were released annually into the environment, is enough to contaminate all the fish in a 20-acre lake.

The bill we are introducing today calls for a nationwide ban on the sale of mercury fever thermometers. It would also provide grants for swap programs to help consumers exchange mercury thermometers for digital or other alternatives.

Our legislation would allow millions of consumers across the Nation to receive free digital thermometers in exchange for their mercury thermometers. By bringing mercury thermometers in for proper disposal, consumers will ensure the mercury from their thermometers does not end up polluting our lakes and threatening our health. It will also reduce the risk of breakage and contamination inside the home.

An important component of our bill is the safe disposal of the mercury collected from thermometer exchange programs, which are increasingly popular in communities throughout our country. I want to make sure that we are actually removing surplus mercury from the environment and from commerce, rather than simply recycling it. It obviously does little good to collect all this mercury from thermometer exchange programs if it is going to be recycled into new products and put back into commerce and eventually into our environment. This bill directs the EPA to ensure that the mercury is properly collected and stored in order to keep it out of the environment and out of commerce. Once the mercury is collected, my intention is it will never again be able to pose a threat to the health of our children.

The mercury collected from thermometer exchange programs is only part of the problem. There is a bigger problem, and that is the global circulation of mercury. Let me give an example. When the HoltraChem manufacturing plant in Orrington, ME, shut down a few years ago, the plant was left with over 100 tons of unwanted mercury and no known way to permanently and safely dispose of it. In total, about 3,000 tons of mercury is held at similar plants across the country.

Yet despite this surplus mercury, large amounts of mercury are still being mined around the world. In addition, the Department of Defense currently has a stockpile of over 4,000 tons of surplus mercury it does not know what to do with and for which it does not have any use.

In view of these facts, why are Algeria and other countries still mining huge amounts of an element that is a known neurotoxin, when the United States and other countries are doing their best to remove this extremely toxic element from the environment? How will the United States dispose of the huge amounts of mercury at chlor-alkali plants and other sources that no longer are understood?

Our bill would create an interchange task force to address these very questions. The task force would be chaired by the Administrator of the Environmental Protection Agency and would be comprised of members from other Federal agencies involved with mercury. Our legislation directs this task force to find ways to reduce the mercury threat to humans and to our environment, to identify long-term means of disposing of mercury safely and properly, and to address the excess mercury problems from mines as well as industrial sources. This task force would also be directed to identify comprehensive solutions to the global mercury problem. One year from the creation of this task force, it would be required to submit its recommendations to the Congress for permanently disposing of mercury and for reducing the amount of new mercury mined every year.

In the meantime, this legislation would make significant progress toward reducing one of the most widespread sources of mercury contamination in the environment, a source that is found in many of our homes; that is, the mercury thermometer. Perhaps even more important, this legislation would, for the first time ever, establish a national policy, which is what we need to deal with surplus mercury in order to protect our environment in the long term, as well as our health, and particularly the health of developing children, from this highly toxic element.

I hope many more of my colleagues will join me in cosponsoring this legislation and that it will be signed into law this year.

Mr. President, I rise today to introduce the Mercury Reduction Act of 2003. I am pleased that my colleagues, Senators Jeffords,

Chafee, Kerry, Hutchison, Reed, Lieberman, Voinovich, Dorgan, and Leahy have joined me in this initiative. Our legislation addresses the very serious problems of mercury in the environment and mercury disposal. It takes special aim at one of the most common and widely distributed sources of mercury mercury fever thermometers while also for the first time creating a nationwide policy for dealing with surplus mercury.

Mercury is a potent neurotoxin that is widespread in the environment and particularly harmful to developing children. In fact, according to a draft report recently released by the EPA, approximately 5 million American women of childbearing age have mercury levels in their bloodstream above safe levels. Tragically, the children of these women will have an elevated risk of birth defects.

When mercury enters the environment, it takes on a highly toxic organic form known as methylmercury. Methylmercury is almost completely absorbed into the blood and distributed to all tissues including the brain. This organic mercury can accumulate in the food chain and become concentrated in some species of fish, posing a health threat to some people who consume them. For this reason, 40 States have issued freshwater fish advisories that warn certain individuals to restrict or avoid consuming fish from affected bodies of water.

One prevalent source of mercury in the environment is from mercury fever thermometers. Many of us know from personal experience that they are easily broken. In fact, in 1998 the American Poison Control Center received 18,000 phone calls from consumers who had broken mercury thermometers.

One mercury thermometer contains a little under one gram of mercury. Despite its small size, the mercury in one thermometer, if it were released annually into the environment, is enough to contaminate all the fish in a 20-acre lake.

The bill we are introducing today calls for a nationwide ban on the sale of mercury fever thermometers. It would also provide grants for swap programs to help consumers exchange mercury thermometers for digital or other alternatives.

Our legislation would allow millions of consumers across the Nation to receive free digital thermometers in exchange for their mercury thermometers. By bringing mercury thermometers in for proper disposal, consumers will ensure the mercury from their thermometers does not end up polluting our lakes and threatening our health. It will also reduce the risk of breakage and contamination inside the home.

An important component of our bill is the safe disposal of the mercury collected from thermometer exchange programs, which are increasingly popular in communities throughout our country. I want to make sure that we are actually removing surplus mercury from the environment and from commerce, rather than simply recycling it. It obviously does little good to collect all this mercury from thermometer exchange programs if it is going to be recycled into new products and put back into commerce and eventually into our environment. This bill directs the EPA to ensure that the mercury is properly collected and stored in order to keep it out of the environment and out of commerce. Once the mercury is collected, my intention is it will never again be able to pose a threat to the health of our children.

The mercury collected from thermometer exchange programs is only part of the problem. There is a bigger problem, and that is the global circulation of mercury. Let me give an example. When the HoltraChem manufacturing plant in Orrington, ME, shut down a few years ago, the plant was left with over 100 tons of unwanted mercury and no known way to permanently and safely dispose of it. In total, about 3,000 tons of mercury is held at similar plants across the country.

Yet despite this surplus mercury, large amounts of mercury are still being mined around the world. In addition, the Department of Defense currently has a stockpile of over 4,000 tons of surplus mercury it does not know what to do with and for which it does not have any use.

In view of these facts, why are Algeria and other countries still mining huge amounts of an element that is a known neurotoxin, when the United States and other countries are doing their best to remove this extremely toxic element from the environment? How will the United States dispose of the huge amounts of mercury at chlor-alkali plants and other sources that no longer are understood?

Our bill would create an interchange task force to address these very questions. The task force would be chaired by the Administrator of the Environmental Protection Agency and would be comprised of members from other Federal agencies involved with mercury. Our legislation directs this task force to find ways to reduce the mercury threat to humans and to our environment, to identify long-term means of disposing of mercury safely and properly, and to address the excess mercury problems from mines as well as industrial sources. This task force would also be directed to identify comprehensive solutions to the global mercury problem. One year from the creation of this task force, it would be required to submit its recommendations to the Congress for permanently disposing of mercury and for reducing the amount of new mercury mined every year.

In the meantime, this legislation would make significant progress toward reducing one of the most widespread sources of mercury contamination in the environment, a source that is found in many of our homes; that is, the mercury thermometer. Perhaps even more important, this legislation would, for the first time ever, establish a national policy, which is what we need to deal with surplus mercury in order to protect our environment in the long term, as well as our health, and particularly the health of developing children, from this highly toxic element.

I hope many more of my colleagues will join me in cosponsoring this legislation and that it will be signed into law this year.

Mr. President, I rise in support of the amendment offered by my friend and colleague from Illinois, Senator Durbin, to ban all late-term abortions, including partial-birth abortions that are not necessary to save the woman's life or to protect her physical health from grievous harm.

This debate should not be about one particular method of abortion but, rather, about the larger question of under what circumstances should late-term or post-viability abortions be legally available. Let me be clear from the outset that I am strongly opposed not just to partial birth abortions, but to all late-term abortions. I agree they should be banned.

Such a ban, however, must have an exception for those rare cases when it is necessary to save the life of the woman or to protect her physical health from grievous harm. Fortunately, late-term abortions are extremely rare. In my state, according to the Maine Department of Human Services, just five late term abortions have been performed in the last 20 years.

Our amendment goes far beyond, in many ways, what the Senator from Pennsylvania is attempting to accomplish. His legislation would only prohibit one specific form of abortion. In fact, the bill he supports would not prevent a single late-term abortion. Let me emphasize that point. The partial-birth legislation before us would not prevent a single late-term abortion. A

physician could simply use another, perhaps more dangerous, method to end the pregnancy.

By contrast, Senator Durbin's proposal would prohibit the abortion of any viable fetus by any method unless the abortion is necessary to preserve the life of the woman or to prevent grievous injury to her physical health.

Those of us who have worked with Senator Durbin on this amendment have taken great care to tightly limit the health exception. Grievous injury is limited to physical health. It is defined as a severely debilitating disease or impairment specifically caused or exacerbated by the pregnancy or an inability to provide necessary treatment for a life-threatening condition.

The Maine Medical Association has said that when ``a pregnant woman develops a life or health-threatening medical condition that makes continuation of the pregnancy dangerous, abortion may be medically necessary. In these cases, intact dilation and evacuation procedures may provide substantial medical benefits or, in fact, may be the only option. This procedure may be safer than the alternatives, maintain uterine integrity, reduce blood loss, and reduce the potential for other complications.'' That is what the experts the doctors are telling us.

Senator Durbin's amendment also includes a very important second safeguard. If the treating physician determines that continuation of the pregnancy would threaten the woman's life or risk grievous injury to her physical health, before the abortion could be performed, a second opinion, in writing, must be obtained from an independent physician. This second opinion must come from a physician who would not be involved in the abortion procedure and who has not been involved in the treatment of the woman.

Unlike the pending bill, which I believe is unconstitutional, the Durbin amendment is consistent with the U.S. Supreme Court's 2000 decision in Stenberg v. Carhart. In Stenberg, the Court struck down Nebraska's partial-birth abortion ban statute because it lacked any exception for the preservation of the health of the woman. The Court reaffirmed its earlier decisions in Roe v. Wade and Planned Parenthood v. Casey that abortion regulation must include an exception where it is ``necessary, in appropriate medical judgment, for the preservation of the life or health of the woman.''

The Durbin amendment is a fair and compassionate compromise on this extremely difficult issue. It would ensure that all late-term abortions--including partial-birth abortions--are strictly limited to those rare and tragic cases where the life or the physical health of the woman is in serious jeopardy. This amendment presents an unusual opportunity for both ``pro-choice'' and ``pro-life'' advocates to work together on a reasonable approach, and I urge our colleagues to join us in supporting it.

I yield the floor.

Mr. President, I am pleased to join with Senators Miller, Dole, McCain, Kerry, Chambliss and Specter in introducing the David Jayne Medicare Homebound Modernization Act of 2003 to modernize Medicare's outdated ``homebound'' requirement that has impeded access to needed home health services for many of our Nation's elderly and disabled Medicare beneficiaries.

Health care in America has gone full circle. People are spending less time in institutions, and recovery and care for patients with chronic diseases and conditions have increasingly been taking place in the home. The highly skilled and often technically complex care that our home health agencies provide has enabled millions of our most vulnerable older and disabled individuals to avoid hospitals and nursing homes and stay just where they belong--in the comfort and security of their own homes.

Under current law, a Medicare patient must be considered ``homebound'' if he or she is to be eligible for home health services. While an individual is not actually required to be bedridden to qualify for benefits, his or her condition must be such that ``there exists a normal inability to leave home.'' The statute does allow for absences from the home that are ``infrequent'' or of ``relatively short duration.'' It also gives specific permission for the individual to leave home to attend medical appointments, adult day care or religious services.

Unfortunately, however, the statute does not define precisely what ``infrequent'' or ``relatively short duration'' means. It leaves it to the fiscal intermediaries to interpret just how many absences qualify as ``frequent'' and just how short those absences must be. Interpretations of this definition have therefore varied widely.

As a consequence, there have been far too many instances where an overzealous or arbitrary interpretation of the definition has turned elderly or disabled Medicare beneficiaries--who are dependent upon Medicare home health services and medical equipment for survival--into virtual prisoners in their own home.

The current homebound requirement is particularly hard on younger, disabled Medicare patients. For example, last year I met with David Jayne, a 41-year-old man with Lou Gehrig's disease, who is confined to a wheelchair and cannot swallow, speak or even breathe on his own. Mr. Jayne needs skilled nursing visits each week to enable him to remain independent and out of an inpatient facility. Despite his disability, Mr. Jayne meets frequently with youth and church groups. Speaking through a computerized voice synthesizer, he gives inspirational talks about how the human spirit can endure and even overcome great hardship.

The Atlanta Journal Constitution ran a feature article on Mr. Jayne and his activities, including a report about how he had, with the help of family and friends, attended a football game to root for the University of Georgia Bulldogs. A few days later, at the direction of the fiscal intermediary, his home health agency--which had been sending a health care worker to his home for two hours, four mornings a week-- notified him that he could no longer be considered homebound, and that his benefits were being cut off. While his benefits were subsequently reinstated due to the media attention given the case, this experience motivated him to launch a crusade to modernize the homebound definition and led him to found the National Coalition to Amend the Medicare Homebound Restriction.

The fact is that the current requirement reflects an outmoded view of life for persons who live with serious disabilities. The homebound criteria may have made sense thirty years ago, when an elderly or disabled person might have expected to live in the confines of their home--perhaps cared for by an extended family. The current definition, however, fails to reflect the technological and medical advances that have been made in supporting individuals with significant disabilities and mobility challenges. It also fails to reflect advances in treatment for seriously ill individuals that allow them brief periods of relative wellness.

It also fails to recognize that an individual's mental acuity and physical stamina can only be maintained by use, and that the use of the body and mind is encouraged by social interactions outside the four walls of a home.

The David Jayne Medicare Homebound Modernization Act of 2003 will create an exception to the homebound restriction based on the severity of the patient's functional limitations and clinical condition. The specific, limited exception to the homebound rule would apply to individuals who: one, have been certified by a physician as having a permanent and severe condition that will not improve; two, who will need assistance with three or more of the five activities of daily living, such as eating, dressing and bathing, for the rest of their lives; three, who require technological and/or personal assistance with the act of leaving home; and four, who are only able to leave home because the services provided through the home health benefit makes it possible for them to do so.

We believe that our legislation is budget neutral because it is specifically limited to individuals who are already eligible for Medicare and whose conditions require the assistance of a skilled nurse, therapist or home health

aide to make it functionally possible for them to leave the home. Our legislation does not expand Medicare eligibility--it simply gives people who are already eligible for the benefit their freedom.

This issue was first brought to my attention by former Senator Bob Dole, who has long been a vigorous advocate for people with disabilities, and I ask unanimous consent that the editorial Senator Dole wrote for the Washington Post last summer entitled ``Imprisoned by Medicare'' be printed in the Congressional Record at the conclusion of my remarks.

Our proposal is also supported by the Consortium of Citizens with Disabilities, the Visiting Nurse Associations of America, the National Association for Home Care, Advancing Independence: Modernizing Medicare and Medicaid, AIMM, the National Coalition to Amend the Medicare Homebound Restriction, the Paralyzed Veterans of America, and the Half the Planet Foundation.

Moreover, the David Jayne Medicare Homebound Modernization Act of 2003 is consistent with President Bush's ``New Freedom Initiative'' which has, as its goal, the removal of barriers that impede opportunities for those with disabilities to integrate more fully into the community. By allowing reasonable absences from the home, our legislation will bring the Medicare home health benefit into the 21st Century, and I look forward to working with my colleagues to get it done.

Mr. President, I am pleased to join my colleague from Arkansas, Senator Lincoln, in introducing this important bill to provide Medicare coverage for laboratory diagnostic tests and other services used to screen for diabetes.

As the founder and co-chair of the Senate Diabetes Caucus, I have learned a great deal about this serious disease and the difficulties and heartbreak that it causes for so many Americans and their families. Diabetes is a devastating, lifelong condition that disproportionately affects the elderly, children and minorities. It is one of our Nation's most costly diseases in both human and economic terms, and is the leading cause of kidney failure, blindness in adults, and amputations not related to injury. Moreover, it is a major risk factor for stroke, heart disease and other chronic conditions. According to a new study released by the American Diabetes Association, diabetes cost our Nation $132 billion last year, and health care spending for people with diabetes is almost double what it would be if they did not have diabetes.

Unfortunately, diabetes frequently goes undiagnosed. Of the more than 17 million Americans who have diabetes, 7 million of whom are 65 and older, it is estimated that as many as one third don't know it. They simply do not know that they have this very serious condition that places them at increased risk of developing devastating and costly complications such as blindness, kidney failure and amputations.

Moreover, an additional 16 million Americans have a newly identified condition known as ``pre-diabetes,'' an increasingly common condition in which blood glucose levels are higher than normal, but not yet diabetic. Pre-diabetes dramatically raises the risk for developing Type 2 diabetes and increases the risk of heart disease by 50 percent. According to research supported by the Department of Health and Human Services, most people with pre-diabetes are likely to develop diabetes within a decade unless their condition is diagnosed and they make the lifestyle changes necessary to reduce their risks for the disease.

Secretary of Health and Human Services Tommy Thompson has made diabetes prevention and management a key part of the Bush Administration's broader efforts to encourage a healthier America. As a part of this effort, the Centers for Disease Control and Prevention, the National Institutes of Health and the Department of Health and Human Services have joined together in a national education campaign to inform people about diabetes and encourage people age forty-five and older to get screened for diabetes.

Unfortunately, however, current law does not allow Medicare to pay for diabetes testing, even for patients with serious risk factors for diabetes, such as obesity, high blood pressure, or high cholesterol. Astoundingly, even if a patient is experiencing early evidence of diabetes complications such as blindness or kidney disease, Medicare will not pay for diabetes testing.

This coverage omission is particularly irrational given the fact that one out of every four Medicare dollars is currently spent on medical care for seniors who are living with diabetes.

Early detection and treatment are essential if we are to improve the quality of life for people with diabetes and prevent or delay the onset of the costly and sometimes deadly complications associated with the disease. We have the technology to identify diabetes even before the onset of any symptoms. These tests have the potential of improving and saving thousands of lives, not to mention countless Medicare dollars. It only makes sense that Medicare should cover them.

Both the American Diabetes Association and the American Association of Clinical Endocrinologists support our legislation, and I encourage all of our colleagues to join us as cosponsors.