Max Baucus

Mr. BAUCUS

Mr. BAUCUS. Mr. President, today we have before us an important piece of legislation, the FDA Amendments Act of 2007. It has come to my attention that this bill includes a section that makes an effort to authorize the FDA to use and release Medicare claims data for use in postmarket surveillance of drugs approved by the FDA. I fully support the goal of making drugs safer for all Americans. As chairman of the Finance Committee, however, I am obligated to point out that any use of Medicare data is exclusively governed by title XVIII of the Social Security Act, and that the Finance Committee has exclusive jurisdiction over title XVIII. I would ask the distinguished chairman of the Health, Education, Labor and Pensions Committee, Senator Kennedy, to acknowledge that the Senate Finance Committee has sole jurisdiction over Medicare data and title XVIII of the Social Security Act and ask that he endeavor to consult us on matters before the HELP Committee that touch on the Senate Finance Committee's jurisdiction. I make the same commitment to him that he makes to me: I will commit to consult on matters before the Finance Committee that touch on the Senate HELP Committee's jurisdiction. To avoid unnecessary confusion as to the jurisdiction of the Finance Committee or further delay in the consideration of this important conference agreement, I would agree to accommodate your request to withhold any objection to the Senate's consideration of it with the acknowledgement that the release and use of Medicare data are governed by title XVIII of the Social Security Act and are under the exclusive jurisdiction of the Finance Committee. This does not represent any waiver of jurisdiction on the part of the Finance Committee on this subject. I would ask the chairman of the HELP Committee, Senator Kennedy, whether he would agree to this request.

Mr. BAUCUS. I thank the chairman. I intend to continue working with my good friend Senator Grassley to address the release and use of Medicare data by Federal health agencies and private researchers soon through legislation written by the Finance Committee.

Mr. BAUCUS

Mr. BAUCUS. I move to lay that motion on the table. The motion to lay on the table was agreed to.

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

Mr. BAUCUS

Mr. BAUCUS. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. BAUCUS

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

Mr. BAUCUS. Mr. President, I have a short statement with respect to a vote we are going to take tomorrow. Amendment No. 2814 In one of my favorite movies, a baseball field is built in the middle of Iowa and becomes a mecca for baseball players and fans that seemingly come from anywhere and everywhere to watch baseball. Today in Billings, MT, folks are hoping that the popular movie ``Field of Dreams'' was right. ``If we build it, they will come.'' Baseball is America's game. It is part of what defines us as Americans. There is something special about sitting in the bleachers on a summer's evening, eating peanuts, and watching a good baseball game. For over 60 years now, the best venue to watch a baseball game in Montana has been historic Cobb Field in Billings--Montana's largest city. Opening in 1948, Cobb Field is the longtime home of the Billings Mustangs, a minor league baseball team. It also serves NCAA baseball as well as American Legion baseball. Many notable professional baseball players--Dave McNally, George Brett, Trevor Hoffman, Rob Dibble, Paul O'Neill, and Stormin' Gorman Thomas, to name a few--have at one time called Cobb Field ``Home.'' Unfortunately, Cobb Field is an above-ground wooden structure stadium that is not compliant with building codes. Despite several major renovations and repairs, the stadium continues to deteriorate at an increasing rate due to water damage and wood rot. Conditions are unsafe for Montanans who want to watch a baseball game, particularly for children and Montanans with disabilities. To solve this problem, the people of Billings have decided to build a new stadium to replace Cobb Field. In March, the city broke ground on this new stadium. The new stadium will be a state-of-the-art venue that will meet the needs and wishes of the citizens of Billings to have a facility that can be a safe, multi-use venue to host baseball games, concerts, festivals, and markets. More importantly, the new stadium will be an economic development center located in one of Billings' oldest neighborhoods in need of a shot of revitalization. This new stadium will spur redevelopment efforts that are so needed in this area of downtown Billings. Over 100,000 people attended events at Cobb Field last year. For a state with 900,000 people, that's a lot. With the new stadium, it is estimated that there will be a 100 percent increase in ticket sales. Last November, voters approved a bond election authorizing the city of Billings to sell bonds up to $12.5 million to design a new 3,500- seat baseball and multi-use stadium. The people of Billings have stepped forward with the lion's share of the costs of the stadium. In addition, Montanans have donated over $2 million in private pledges to offset the taxpayers' costs of repaying the $12.5 million in bonds. Because of the local funding that has been secured for the project, our Montana delegation has requested $500,000 in Federal funding to support the funds that the local community has already stepped forward with. I have fought hard over the years for my home State of Montana. My colleague from Montana, Senator Tester, has done the same. Each year, I make requests to the Appropriations Committee to provide funding for worthy Montana projects. I stand behind the requests I make. A vote for the Coburn amendment is a vote against me and the people of Montana. We will remember. This is such a small amount of Federal dollars compared to the contribution the people of Billings are making that I believe voting for Cobb Field is something Montanans prefer, but I think the people across this whole country who are big baseball fans would also agree. Mr. President, I yield the floor.

Mr. BAUCUS

Mr. BAUCUS. Mr. President, last Friday the senior Senator from Virginia announced that he would not seek reelection to the Senate. I speak today, therefore, in tribute to Senator John Warner. I have known John Warner for nearly 30 years. In 1978, the people of Montana and Virginia sent us both to the Senate for the first time. I thank the people of Montana and Virginia for giving me the opportunity to serve with John Warner. The election of 1978 brought 20 new Senators to the Senate. From that class, many Senators moved on to other pursuits: Bill Armstrong, David Boren, Rudy Boschwitz, Bill Bradley, Bill Cohen, David Durenberger, Gordon Humphrey, Roger Jepsen, Nancy Landon Kassebaum, Larry Pressler, David Pryor, Alan Simpson, Donald Stewart. From that class, three have gone to their final rest. We all recall the memory of colleagues now departed: Jim Exon, Howell Heflin, Paul Tsongas. May their memories serve as a blessing. From that class, four remain in the Senate: Thad Cochran, Carl Levin, this Senator, and John Warner. As a young man, John Warner fought forest fires in Montana. Very often when I am talking to John, he recalls those times in Montana. His eyes brighten up. He very much reminisces about how much he enjoyed spending time in the State. Whether it was fighting fires or whether it was around Bozeman, MT, it comes to him very clearly when he talks about Montana in his early years. At the age of 17, John Warner joined the Navy to fight in World War II, part of the ``greatest generation.'' John Warner is one of five World War II vets left in the Senate. He shares that distinction with Danny Akaka, Danny Inouye, Frank Lautenberg, and Ted Stevens. John Warner went to college on the GI bill. Then he entered the University of Virginia law school. But when the Korean war broke out, John Warner, with his intense sense of patriotism, interrupted law school to fight for his country again. This time he served as an officer in the Marine Corps. After returning from Korea, John Warner finished law school, clerked on the court of appeals, worked as an assistant U.S. attorney and worked as a lawyer in private practice. He returned to public service in 1969 as Under Secretary of the Navy. Then, in 1972, he succeeded our former colleague, John Chafee, as Secretary of the Navy. He represented the Defense Department at the Law of the Sea talks in Geneva. In the Senate, John Warner has served as chairman of the Rules Committee. He has served as chairman and ranking member of the Armed Services Committee. He has come to be known as one of the Congress's most influential voices on matters of national defense. But I have come to know John Warner on the Environment and Public Works Committee. John Warner and I have worked together on that committee for more than 20 years. I joined the committee in 1981 and John joined in 1987. There, for most of that time, both of us have worked together as chairman and ranking minority member of one subcommittee or another. We worked together on transportation bills. Those are the bills with such colorful names as ISTEA, TEA-21, SAFET-LU. For a while, we were chairman and ranking minority member of the Transportation and Infrastructure Subcommittee. We worked on at least four renewals of the Water Resources Development Act. I remember fondly working closely with John on the transportation legislation in 1997 and 1998, TEA-21. We worked with our late colleague, John Chafee. The three of us were a wonderful team. You will not believe the chemistry with which the three of us worked together. We decided early on we would stick together as a team: John Warner, basically the Southern donor States; John Chafee, basically the New England States; and I, representing in some sense the Western donee States. We represented the three major components who put together the Transportation bill. We stuck together. We worked together. I mean we worked together. There is a lot of talk about we needing less partisanship around here. I have to tell you, John Warner, John Chafee and I, we sat down and worked things out. We had a terrific staff working for us, John, myself, and John Chafee. We were all together in John Chafee's office, sometimes in John Warner's office, deciding what was best on how to get a highway bill together. It was a wonderful opportunity working in that office, working together. There were countless long days, many very long nights. You learn a lot about a person when things get tough, when the rubber meets the road. But I have to tell you, in our case, when anything was a little bit difficult, we did not ever get personal, did not get upset, did not ever attribute ulterior motives to anybody; we decided we were going to figure out how to get it done. As I said earlier, there was a certain chemistry that came together with all six of us working together, my staff, his staff, their staffs, and the six of us all together. It was wonderful. I think I learned a lot from watching John Warner and John Chafee, too, for that matter. They were two of the same. They both served as marines, and they both were Secretaries of the Navy. But John Warner was a person who listens. He sat there and listened; I had a point; John Chafee had a point. In other negotiations I have been in where John Warner has been there, John Warner is going to listen. John Warner will listen and say: ``Okay, that is interesting. Let's see how we can make that work.'' I might say also he is a very skilled statesman in that he cut to the core of matters pretty quickly. Not a lot of fuss or muss, never got wrapped around the axle in details, when things kind of got off tangent in the wrong direction, but got to the core of the matter. He came to the core of the matter. He would sum it all up in a very wonderful, sort of statesmanlike, solid way, as only John can. We all sat there saying, ``Yes, that is about it. That is right.'' That is kind of what John said. ``That is probably right. We will go on from there.'' I learned a lot from John Warner. I hope I can use that in later years. Both leaders spoke about how John Warner is not partisan, and it is true. I hope, frankly, that as we finish this year and next year, a lot of us remember the tone and the style with which John Warner conducts himself. It is also very important to mention John Warner spoke up courageously in the State of Virginia; he did not support his party's nominee for the Senate. That was a gutsy thing to do, but he did it in a very civil way, not in a negative way, not in a partisan way. He spoke his mind about what was right. It was very courageous and also the tone made his message and his belief that much more important because people saw he was not personal, people saw he meant it, people saw he was courageous and he was doing what he thought was the right thing to do. The same is true with respect to Senator Warner's decision about the war in Iraq. It is not the party line, John's statements. He is saying what he thinks is right. He is saying what he thinks is the right thing to do. It is not partisan. It is courageous and said in a very civil tone. That is why people have called him a consensus builder. It is why people often say he has a potential for bipartisan collaboration. I stand here saying I appreciate John Warner. When I got the news he was not going to seek reelection, I thought to myself this institution will be losing a great man. He is a wonderful person. I hope all of us, when we finish these next 15 months or so working with John, thank John for what he is and also use John as a kind of point of departure, saying: ``I wish to be more like John Warner. I wish to do what is right; I wish to be courageous; I wish to be civil; and I wish to do what people of our States ask us to do.'' I salute John Warner.

Mr. BAUCUS

Mr. BAUCUS. Mr. President, I would like to enter into a brief colloquy with my colleague on the Environment and Public Works Committee regarding his understanding of congressional intent for monies authorized in the pending Minnesota, bridge disaster relief bill. I want to clarify that this authorization comes from the general fund rather than the Highway Trust Fund. Is that your understanding?

Mr. BAUCUS. I thank my colleague for his concurrence.

Mr. BAUCUS

Mr. BAUCUS. Mr. President, I very much compliment the Senator from North Dakota. He is absolutely correct. This legislation is on a must- pass list. I have given my commitment to mark the bill up on September 12 in the Finance Committee. The leader has indicated he will give every assurance to try to get the legislation up on the Senate floor and go on to pass it. It has passed before, but it got hung up in the last Congress. It is high time we get this legislation passed, and I thank the Senator for, first, pushing the issue so hard and, second, working with the Senate to find an expeditious way to get this legislation passed. Mr. President, I ask unanimous consent that after Senator Vitter is recognized, Senator Kohl be recognized for 5 minutes and Senator Allard be recognized for 10 minutes.

Mr. BAUCUS. Madam President, as I have said many times in this debate, the Children's Health Insurance Program Reauthorization Act is good for America. I wish to take a few minutes to talk about why this children's health bill is good for my home State of Montana. Montana ranks fifth highest in the Nation for the percentage of children without health insurance. In 2006, 37,000 Montana children did not have health insurance. That is one in every six children. More than half of those uninsured children, that is 19,000, were either eligible for Medicaid or for CHIP, the Children's Health Insurance Program, but not enrolled. One of the reasons for our higher rate of uninsured kids is because the percentage of employers offering health care to Montana's working families is quite low. Less than half of all employers in the State of Montana offered health coverage in 2005. This means many working families do not have access to health coverage. Although families who do not have access to coverage through work could buy it on their own, health coverage is often priced out of reach for lower income families. The average cost of a family health plan on the open market in Montana is about $8,000 a year. That is nearly one-fifth of the family's income for a family of four earning $41,300, which is twice the poverty level. Again, the average cost is about $8,000, which is about one-fifth of a family's income for a family of four earning $40,000, and most families simply obviously cannot afford that cost. CHIP, the legislation before us, offers affordable, comprehensive health coverage for working families. CHIP works, and it has helped thousands of Montana families. Abigail Tuhy's family is one of those families. Abigail's mom, Fawn, is a mother of four, and Fawn's story tells volumes about why we need CHIP. She writes: I don't know what our family of six would do without [CHIP]. . . . In one year, my 2\1/2\-year-old had nine stitches because she split her head open and my 6 year old broke his arm two times. CHIP paid for the surgery, hospital stay and all of the care provided. CHIP has also paid for all of my children to receive all of their shots and their check- ups. Without CHIP, I would not have insurance for my children. Abigail is only one of the more than 38,000 children helped by CHIP over the past decade. Today more than 14,000 Montana children are covered by it and the number is growing. This year, the Montana legislature, for example, took a positive step forward, changing the CHIP eligibility level from 150 percent to 175 percent of the Federal poverty line. That is just over $36,000 for a family of four. Montana started implementing this expansion in July, which will bring an additional 2,000 children next year. This is clearly good news, but we cannot rest on our laurels. There are more uninsured children who need our help. The CHIP Reauthorization Act will provide Montana with the funding it needs to maintain current CHIP enrollment, fund its expansion, and make significant strides toward covering more of the uninsured children. Under this legislation, Montana would receive about $28 million next year. That is $12 million more than its allotment for last year. New CHIP allotments, combined with new funds in the State to expand coverage to low-income children, could allow the State to cover as many as 12,000 children who are uninsured today. The legislation before us also includes new funding to help Montana improve access to health care, including $200 million in new Federal grant money for States to improve the availability and comprehensiveness of dental health for children, and $100 million in Federal grants to improve outreach and enrollment, especially in rural areas. This bill also includes provisions that specifically target Indian Country. Although Indian children are eligible for coverage through the Indian Health Service and tribal facilities, the IHS, the Indian Health Service, is only funded at 60 percent of need today, leading to tragic denials of care when funds run out. I mean it is abominable. This bill makes important changes to improve the health of Indian children. It provides new funds for outreach and enrollment in Medicaid and in CHIP. It also allows those Indians to use tribal documents to prove citizenship for Medicaid. It gives States a higher Federal match for translation and interpretation services in the program. And it requires the Secretary to monitor racial and ethnic disparities in care. All move us to a healthier future for Indian children in Montana. As we debate CHIP today, let us remember the uninsured children in our home States, those kids who need help. In Montana, there are mothers whose daughters have cystic fibrosis. There are Native American children without health care coverage because they do not have a birth certificate. So let's keep in mind the children of Montana and every other State who need and deserve our help. Let's reauthorize this Children's Health Insurance Program today and improve the health of all American children. Madam President, I ask unanimous consent the following Senators be recognized for the following amounts of time: first, Senator Dodd for 5 minutes; Senator Clinton for 5 minutes; and Senator Coburn for 15 minutes.

Mr. BAUCUS. Madam President, it is being written up right now.

Mr. BAUCUS. We do have a block of votes. It has been agreed to. Madam President, I yield the floor and I suggest the absence of a quorum.

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

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

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

Mr. BAUCUS. Mr. President, a couple of words with respect to the amendment offered by the Senator from Nevada. I might as well finish them now, since he spoke. Basically, his amendment means that no State, after the date of enactment, could provide for adults--childless adults or parents, parents of kids. No State. That is what this is. I also point out that the standard of 95 percent is an impossible standard. No State can meet that standard. There is no State in the Nation that could meet 95 percent. We have mandatory driver's license requirements in States, and even those mandatory requirements average, nationwide, about 85 percent. That is mandatory, and we are talking about something voluntary here. So no State can possibly reach 95 percent compliance, which would mean, at the beginning of the date of enactment, all adults would be off--right now, immediately; all parents off--right now, immediately. And I don't think that is what we want to do. Why? Because the administration has granted lots of waivers to a lot of States for a lot of adults, and States are reliant on them. In this legislation, over a 2-year period, we are stopping that, but we give States 2 years to stop providing coverage for childless adults and for parents. States can provide for parents with those waivers, but it is written in a way to discourage the use of CHIP money for parents unless States go the extra mile and seek out more low-income kids to provide coverage for them. The legislation before us is a good compromise, but the amendment offered by the Senator from Nevada is way too Draconian. I might also add that all experts say if you cover parents, you will cover more kids. If you don't cover more parents, you are going to cover fewer kids. There is a very strong correlation between health insurance coverage for parents and parents getting good health care for their children. Put in reverse, there is a strong correlation of parents who do not have health insurance--we are talking low-income families here-- who will not provide good health care, on average, for their kids. On the basis of policy, I don't think it is a good idea. It totally disrupts the compromise worked out on both sides of the aisle on this legislation. Senator Grassley, Senator Hatch, myself, and Senator Rockefeller worked very hard to get a compromise here. This legislation starts to squeeze down on adults, but it doesn't cold turkey say no. That would be unfair, especially with respect to parents, because parents who have health insurance themselves will tend to provide better health care for their kids. When the appropriate time comes to vote on this amendment, I think the right thing to do would be not to support this amendment because of the reasons I indicated. I yield the floor.

Mr. BAUCUS. Mr. President, the Senator is always interesting, sometimes entertaining, but the Senator from Mississippi raised a couple of good questions. The real question is what are the answers to the questions. One question is, what about adults? This is a children's program, and I think most Senators react a little adversely to covering adults. This Senator does too. It is a children's program, not an adult program. The Senator acknowledged graciously that most of the adult coverage problem is due to waivers this administration has given the States. The States want to cover adults. Why do they want to cover adults? Well, basically, because of the match rate, the money the States get under the Children's Health Insurance Program is higher, so they want to cover adults. What we are trying to do is figure how are we going to put the lid back on this. That is what we are trying to do here. It probably gets to the question of what is a fair transition period. What is the fair way to wean the States off of covering adults? I guess it is important to remember there are a lot of people, adults out in the country who are getting health insurance, and they do not know what we are debating here in Washington, DC. They do not know the difference between CHIP, Medicaid, and match rates. All they know is they are getting some health insurance. And I don't know if it is right to just willy-nilly, automatically, cold turkey cut them off entirely, because they are depending on it. I do think it is right, however, to wean States off this, and the States can, when their legislatures meet, figure out ways to cover adults they wish to but not on this program. That is what we are doing. That is what this legislation does. It says in the first year you can get a free ride, but in the second year your match rate is way down to the Medicaid match rate, which is basically about 30 percent less than the match rate under the Children's Health Insurance Program. A 30- percent cut will have a real effect on a lot of these States and discourage them from proceeding further. In addition, legislation not too long ago repealed waivers so the States could no longer apply for waivers to get childless adult coverage. So question No. 1 is, what is the right thing to do about some States adding adults? Let us not forget, 91 percent of beneficiaries under the Children's Health Insurance Program today, 91 percent, are kids under 200 percent of poverty. Today. The vast bulk are kids. So when we talk about adults, we are talking about less than 9 percent, because some States have up to 200 percent of poverty. We are talking not too many people when we are talking about adults. This is kind of a philosophical question as much as anything else. What is the best way to put the lid back on the can, to keep States from providing it for too many adults? We think we have a fair way to do it, as I just described, a fair transition period, and that is why we negotiated out this position. Point No. 2 is, what is going to happen in conference. I have no idea. Senators know there are lots of ways to skin a cat around here. On the surface it looks like maybe if the Senate and House go to conference on these two bills--the Senate bill is much less, the House bill is much larger. They contain the Medicare provisions, physicians update provisions, and they are two different animals. When that happens, generally some other solution presents itself. That is why I say to my good friend from Mississippi, I hear what he is saying about the views of many Senators who do not want the conference report to come back with a number that is too difficult for many Senators to swallow, especially on the Republican side of the aisle. But I also say to my good friend, there are ways to do this. We may not go to conference exactly; the House may send back something else, maybe just a CHIP bill, and we will do the physicians update at a later date. There are many kinds of ways to do things around here. Our goal is to help low-income kids who do not have insurance today so a few more get it. This is not a huge, massive expansion. This has nothing to do with national health insurance, none of that. We are saying: Here is a program passed in 1997, it is bipartisan, Senators on both sides of the aisle like this program, there have never been any problems with it, it has worked real well, it just came up with reauthorization. The only slight problem is waivers for adults, but we are managing that. That is not a big deal. We can take care of that. So let's just reauthorize it, give it a little bump up to help a few more--not a lot, a few more kids get health insurance, and it costs a few dollars because health care costs are going up so much in this country. While we are helping a few kids get health insurance, at a later date, next year, the following couple of years--clearly, Congress has to address the rising cost of health insurance in this country. But as a bottom line, this is a good thing to do, to help low-income kids get some health insurance. Let's remember, in the United States of America there are about 48 million people without health insurance. We are the only industrialized country with that many people without health insurance. It is an outrage. The very least we can do is help our kids get some health insurance, particularly those who are low-income kids. That is what we are trying to do in a fair and reasonable way.

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

Mr. BAUCUS. That is correct.

Mr. BAUCUS

Mr. BAUCUS. Mr. President, today I am introducing the Pharmacy Access Improvement Act of 2007. This is an updated version of a bill I introduced last year, and I am proud to bring it back. I am excited that this year's bill is bipartisan. I am happy that Senator Grassley has joined me in introducing this bill. Given all of our work together on the Medicare prescription drug benefit, I am glad he is a cosponsor. I also am pleased to have our Senate colleagues join us on this important piece of legislation. The Medicare prescription drug benefit got off to a bumpy start last year. A lot of the problems have been fixed, and the benefit is providing millions of seniors with access to affordable prescription drugs. Unfortunately, a number of the problems facing pharmacists remain. We need to help them. The Medicare drug benefit brought about big changes to the pharmacy business. Dual eligible beneficiaries switched from Medicaid to Medicare drug coverage. Many more seniors have drug coverage. Dozens of new private drug plans are available. I have heard from pharmacists in Montana who are struggling. They are trying to help their patients. But they face great difficulty. The success of the Medicare drug benefit depends on the pharmacists who deliver the drugs. So we have to help them. We must act now, before pharmacists find that they are no longer able to provide drugs to Medicare beneficiaries, or to provide drugs at all. The Pharmacy Access Improvement Act would do several things to help pharmacies. First, it would strengthen the access standards that drug plans have to meet. It is important that the drug plans contract with broad and far-reaching networks of pharmacies. This bill would ensure that the pharmacies that drug plans count in their networks provide real access to Medicare beneficiaries. It would also help safety net pharmacies to join drug plan networks. These pharmacies serve the most vulnerable patients and should be able to continue to do so. Drug plans should not be allowed to exclude safety net pharmacies. Excluding them does a huge disservice to needy beneficiaries. This bill would rectify the problems that safety net pharmacies have encountered in participating in the Medicare drug benefit. The Pharmacy Access Improvement Act would speed up reimbursement to pharmacies. The delays in receiving payment from drug plans have forced pharmacies to seek additional credit, dip into their savings, or worse, as they try to continue operations. This bill would require drug plans to pay promptly. Most claims would be reimbursed within 2 weeks. And the bill would impose a monetary penalty on plans that pay late. One of the most common complaints from beneficiaries has been how confusing the practice of co-branding is. Co-branding is when a drug plan partners with a pharmacy chain and then includes the pharmacy's logo or name on its marketing materials and identification cards. This is confusing, because it sends the message that drugs are available only from that pharmacy. That is not true. To help end this confusion, the Pharmacy Access Improvement Act would prohibit drug plans from placing pharmacy logos or trademarks on their identification cards and restrict other forms of co-branding. This bill would also require that plans provide pharmacists with more accurate and updated information about reimbursement rates. Currently, some plans do not divulge to pharmacists how much a particular prescription will be reimbursed prior to dispensing. This bill would require disclosure before a pharmacist dispenses. It would require regular updating and disclosure of pricing standards. The problems that pharmacists are facing are real. And they are not going away. We must act on the Pharmacy Access Improvement Act before it is too late for many pharmacists and the beneficiaries whom they serve. We have a duty to make the Medicare drug benefit as strong and robust as it can be. And the Pharmacy Access Improvement Act presents an opportunity for us to do just that. My cosponsors and I urge our colleagues to support it.

Mr. BAUCUS

Mr. BAUCUS. Mr. President, I want to begin my remarks by commending the thousands of case workers, foster families, neighbors and friends across the country that work to provide safety, stability, and love for the more than half a million children in the Nation's foster care system. More than a third of foster children in Montana are Native American. Across America, most of the Native American children in foster care are under the jurisdiction of tribal courts. But Native American tribes that want to administer their own child welfare systems are not eligible for Title IV-E funds to run their own foster care and adoption programs. Today I am proud to introduce with Senators Domenici, Bingaman, Smith, Stabenow, McCain, and Cantwell the Tribal Foster Care and Adoption Act of 2007. This legislation is a demonstration of the commitment on both sides of the aisle to provide tribes with the opportunity to care for their own children. Children that need foster care and adoption services because of the abuse and neglect that they have already suffered. This bill provides tribes with the ability to serve their children directly with culturally appropriate care and understanding. The legislation also recognizes the good work of states and their collaborative efforts with tribes on behalf of tribal children. This legislation has had a long history in the Senate and I am pleased to have been a part of that history since the 107th congress. It has been introduced in every Congress since then always with bipartisan support. This bill's time has come. We have worked very hard to fine tune this legislation in away that is fair to states and finally gives Tribes direct access to the child welfare system. We want a system set up to protect those that need our protection the most not to exclude the most vulnerable members of our society from direct participation. The child welfare system is languishing because of inadequate funding. And the system also suffers from a lack of culturally- appropriate approaches to help tribal children to find loving, permanent homes. I am further committed to working on behalf of our child welfare system with Chairman Grassley and with Senator Rockefeller who have always been dedicated to child welfare issues. The Tribal Foster Care and Adoption Act provides a pivotal opportunity to ensure that tribes across our country have the ability to access the child welfare system. I see this as a first step in making much needed improvements to the country's child welfare system, without significant costs or new federal programs. We owe the first inhabitants of this great Nation and their children a child welfare system that works for them. We must do all we can to provide help.

Mr. BAUCUS

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

Mr. BAUCUS

Mr. BAUCUS. Mr. President, today I am pleased to join Senator Grassley in introducing the Continuing the Advancement of Quality Improvement Act of 2007. This bill represents another step in our commitment to improving the quality of care provided for Medicare beneficiaries and all Americans. The Medicare program funds Quality Improvement Organizations, known as QIOs, in part to work with health care providers to help them improve the quality of care they provide. QIOs have played an evolving role in Medicare. Recently, the QIO program has received a great deal of attention. Not only did Senator Grassley and I have the Senate Finance Committee look into aspects of QIO operations, but the Institute of Medicine, the Government Accountability Office, and the Health and Human Services' Inspector General have all opined about QIOs as well. It seems there is a consensus that the QIO program could be doing more to help improve the quality of care. That is not to say that QIOs have not been doing good work and providing valuable services up until now. Quite the opposite. However, over the course of time, QIOs have been tasked with a number of responsibilities and the program's mission has become blurred. What Senator Grassley and I found, as well as the IOM, the GAO, and the HHS, OIG, is that the QIO program needs a sharper focus. Its mission to improve quality must be clear and unambiguous. Therefore, the Continuing the Advancement of Quality Improvement, or CAQI, Act would focus QIOs on providing technical assistance for quality improvement and performance measurement. The bill would separate the beneficiary complaint process from QIOs and give this responsibility to Medicare Provider Review Organizations, which will be required to report to the complainant and refer the provider to a QIO for technical assistance and/or the appropriate regulatory body for sanctions. This will make the complaint review process stronger. The CAQI Act would ensure that QIOs devote their attention to the health care providers that need help the most. It would also permit sharing QIO data with providers for quality improvement and patient safety purposes. The Finance Committee investigation of the QIO program led Senator Grassley and I to include certain provisions we believe will enhance the integrity of the program. So, the CAQI Act would promote competition by allowing other types of organizations to serve as QIOs and eliminating noncompetitive renewals. To ensure ``corporate'' integrity, the CAQI Act would establish requirements for governance and boards of directors at the QIOs, as well as requiring CMS to establish ways to avoid conflicts of interest. The CAQI Act aims to ensure greater accountability for individual QIOs, and the QIO program as a whole. It would require the Secretary to perform evaluations of the effectiveness of each QIO and the whole program. QIOs would be evaluated on consistent measures that are based on nationwide priorities for quality improvement. The Secretary would be required to report to Congress annually on QIO performance, including how program funds were spent. The QIO program is an asset to the Medicare program and the health care system in general. We have an opportunity to improve its effectiveness. We can make it a more useful tool as we continue advancing toward quality improvement. We have a duty to make the Medicare program as strong and robust as it can be. The Continuing the Advancement of Quality Improvement Act presents an opportunity to do just that. Senator Grassley and I urge our Colleagues to support it.