Jeff Bingaman

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, I strongly support the amendment that Senator Domenici sent to the desk. I think it makes some very much needed improvements in the existing Low-Income Home Energy Assistance Program and also in the Weatherization Assistance Program. It also provides additional funds for development of State energy plans. I think these are very important provisions. We did not have that severe of a winter in many parts of the country this year. Accordingly, we didn't see as many headlines about the importance of this Low-Income Home Energy Assistance Program as we have in some previous years. But the truth is, this is an extremely important program for a great many of our citizens who are low income and who do need the help. It is important for them in heating their homes in the winter, and it is important for them in keeping their homes reasonably cool in the summer. We are starting the summer. I went through Dallas on the plane Friday on my way back to Washington. It was 96 degrees. I am sure that is a mild foretaste of what we are going to be seeing in the future as far as the temperature in Dallas and in many parts of the country, particularly in the southern sections of the country. The Low-Income Home Energy Assistance Program assists people in paying their utility bills for air-conditioning just like it assists them in paying their utility bills for heating. It is very clear when you look at studies that there are a significant number of people in this country, particularly elderly people in the Southern States, who, in fact, die because of excess heat and the inability to cool their apartments or their homes. This is a very important program. It is one that we need to deal with. It is one we tried to deal with in the Energy bill last year. We passed it through the Senate in very much this same form. We had general support from the House of Representatives to include it in a final bill to go to the President had we been able to get agreement on a final bill. But there was no disagreement about this part of the program or this part of the legislation. I believe very strongly this should be agreed to and should be included in this Energy bill. I notice the House has addressed it already in the Energy bill they have passed. It clearly needs to be part of our Energy bill as well so that when we go to conference we can, in a meaningful way, conference with the House of Representatives on this important issue. I hope this will be agreed to. I look forward to additional debate on it as necessary. I yield the floor. I suggest the absence of a quorum.

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, today, I am introducing a bill with Senators Daschle, Boxer, and Lincoln that will be jointly introduced by Representatives Ciro Rodriguez, Hilda Solis, and others in the House of Representatives entitled the ``Hispanic Health Improvement Act of 2003.'' This bill addresses the tremendous health disparities that confront the Hispanic community in our Nation. Even if you know the statistics, they remain shocking. Over one- third, a 35 percent of Hispanic adults lack health insurance. Despite that passage of the Children's Health Insurance Program, 27 percent of Latino children remain uninsured, which is sharp comparison to 9 percent of white, 18 percent of black and 17 percent of Asian/Pacific Islander children. In testimony before the Senate Health, Education, Labor and Pensions Committee on September 23, 2002, on Hispanic health issues, Dr. Glenn Flores, chair of the Latin Consortium of the American Academy of Pediatrics Center for Child Health Research, added: ``Among uninsured poor children in the U.S., Latinos outnumber all other racial/ethnic groups, including whites: there are 1 million poor, uninsured Latino children, compared with 766,000 white, and 533,000 African-American poor, uninsured children. Although 1999 marked the first time in many years that the proportion of uninsured Latino children actually decreased (from 30 percent to 27 percent), recent national data suggest that outreach efforts to enroll Latino children have largely been unsuccessful. A Kaiser Commission report found that only 26 percent of parents of eligible uninsured children said that they had ever talked to someone or received information about Medicaid enrollment, and 46 percent of Spanish-speaking parents were unsuccessful at enrolling their uninsured children in Medicaid because materials were unavailable in Spanish.'' In order to address the lack of health care coverage, the legislation would expand CHIP to cover pregnant women and parents of children enrolled in CHIP. The legislation provides $50 million in grants to community-based groups to improve outreach and enrollment of children in Medicaid and CHIP with the grants targeted to Hispanic communities. In addition, the bill eliminates a number of enrollment barriers within Medicaid. And finally, it provides States the option to enroll legal immigrant pregnant women and children in Medicaid or CHIP. This comes from legislation introduced by Senator Graham earlier in this Congress. In addition to poor coverage rates, according to the Centers for Disease Control and Prevention, or CDC, the Hispanic population has morbidity and mortality rates that more often than not exceed that of any other ethnic groups. For example, age-adjusted mortality rates for diabetes are over 50 percent higher among Hispanic persons than non- Hispanic whites. HIV infection rates are over 3 times those of non- Hispanic whites. Tuberculosis rates among Latino children are 13 times that of whites. The legislation addresses these problems in a number of ways. In the area of access and affordability, our bill requires an annual report to Congress on how federal programs are responding to improve the health status of Hispanic individuals with respect to diabetes, cancer, asthma, HIV infection, AIDS, substance abuse, and mental health. The bill provides $100 million for targeted diabetes prevention, education, school-based programs, and screening activities in the Hispanic community. In addition, the legislation specifically addresses the problems facing communities along the U.S.-Mexico border, a 2,000-mile stretch of land that contains 11 million people, 5 of the 7 poorest metropolitan statistical areas in the country, and disease rates in some areas that are extraordinary. If the region were a state, the border would rank 1st in the number of uninsured, last in terms of per capita income, and 1st in a number of diseases. As Dr. Francisco Cigarroa, president of the University of Texas Health Sciences Center at San Antonio, noted in testimony at the hearing last year on Hispanic health, ``Germs respect no INS regulations. We truly must work with our neighbors to the South if we are to avoid a major influx of new conditions and diseases. It can be seen so clearly on a map. Just as there are `rivers of commerce' there are `rivers of infectious disease' and though they may start at the Border, they are eventually seen all the way to the northern Border that we share with Canada.'' In response, the bill provides $200 million to border communities to improve health services and infrastructure along the U.S.-Mexico border. The numbers I have cited thus far indicate what we do know. Almost as much of a concern is what we do not know with respect to the status of Hispanic health in this Nation. According to one study, only 22 percent of all articles published in major medical journals included non- English-speaking patients. The bill provides funding to do additional research and work on reducing health disparities in this Nation. The various provisions include efforts to improve the recruitment and retention of Hispanic health professionals and programs that support training health professionals who can provide culturally competent and linguistically appropriate care. With respect to training more minority health professionals, Dr. Cigarroa said at last year's hearing, ``We should do this because it is the smart thing to do. If we fail to take steps to address the gap between the health of the majority population and the health of the Nation's rapidly growing minority populations, we are on a court leading to a collision. We are far too great a nation to allow this to happen.'' Representative Ciro Rodriguez, chairman of the Congressional Hispanic Caucus, and I, have worked together on this legislation to respond to the challenge before us with regard to coverage, access, and health disparities in the last Congress and have reintroduced the bill with the hope to move it forward this year. Before closing, it should be noted that while the legislation puts forth a number of initiatives to address what are disproportionately Hispanic problems, each section of the bill, including those to reduce the number of uninsured and to improve access to care, would improve the overall health of our entire Nation regardless of race or ethnicity. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, today, I am introducing a bill with Senators Daschle, Boxer, and Lincoln that will be jointly introduced by Representatives Ciro Rodriguez, Hilda Solis, and others in the House of Representatives entitled the ``Hispanic Health Improvement Act of 2003.'' This bill addresses the tremendous health disparities that confront the Hispanic community in our Nation. Even if you know the statistics, they remain shocking. Over one- third, a 35 percent of Hispanic adults lack health insurance. Despite that passage of the Children's Health Insurance Program, 27 percent of Latino children remain uninsured, which is sharp comparison to 9 percent of white, 18 percent of black and 17 percent of Asian/Pacific Islander children. In testimony before the Senate Health, Education, Labor and Pensions Committee on September 23, 2002, on Hispanic health issues, Dr. Glenn Flores, chair of the Latin Consortium of the American Academy of Pediatrics Center for Child Health Research, added: ``Among uninsured poor children in the U.S., Latinos outnumber all other racial/ethnic groups, including whites: there are 1 million poor, uninsured Latino children, compared with 766,000 white, and 533,000 African-American poor, uninsured children. Although 1999 marked the first time in many years that the proportion of uninsured Latino children actually decreased (from 30 percent to 27 percent), recent national data suggest that outreach efforts to enroll Latino children have largely been unsuccessful. A Kaiser Commission report found that only 26 percent of parents of eligible uninsured children said that they had ever talked to someone or received information about Medicaid enrollment, and 46 percent of Spanish-speaking parents were unsuccessful at enrolling their uninsured children in Medicaid because materials were unavailable in Spanish.'' In order to address the lack of health care coverage, the legislation would expand CHIP to cover pregnant women and parents of children enrolled in CHIP. The legislation provides $50 million in grants to community-based groups to improve outreach and enrollment of children in Medicaid and CHIP with the grants targeted to Hispanic communities. In addition, the bill eliminates a number of enrollment barriers within Medicaid. And finally, it provides States the option to enroll legal immigrant pregnant women and children in Medicaid or CHIP. This comes from legislation introduced by Senator Graham earlier in this Congress. In addition to poor coverage rates, according to the Centers for Disease Control and Prevention, or CDC, the Hispanic population has morbidity and mortality rates that more often than not exceed that of any other ethnic groups. For example, age-adjusted mortality rates for diabetes are over 50 percent higher among Hispanic persons than non- Hispanic whites. HIV infection rates are over 3 times those of non- Hispanic whites. Tuberculosis rates among Latino children are 13 times that of whites. The legislation addresses these problems in a number of ways. In the area of access and affordability, our bill requires an annual report to Congress on how federal programs are responding to improve the health status of Hispanic individuals with respect to diabetes, cancer, asthma, HIV infection, AIDS, substance abuse, and mental health. The bill provides $100 million for targeted diabetes prevention, education, school-based programs, and screening activities in the Hispanic community. In addition, the legislation specifically addresses the problems facing communities along the U.S.-Mexico border, a 2,000-mile stretch of land that contains 11 million people, 5 of the 7 poorest metropolitan statistical areas in the country, and disease rates in some areas that are extraordinary. If the region were a state, the border would rank 1st in the number of uninsured, last in terms of per capita income, and 1st in a number of diseases. As Dr. Francisco Cigarroa, president of the University of Texas Health Sciences Center at San Antonio, noted in testimony at the hearing last year on Hispanic health, ``Germs respect no INS regulations. We truly must work with our neighbors to the South if we are to avoid a major influx of new conditions and diseases. It can be seen so clearly on a map. Just as there are `rivers of commerce' there are `rivers of infectious disease' and though they may start at the Border, they are eventually seen all the way to the northern Border that we share with Canada.'' In response, the bill provides $200 million to border communities to improve health services and infrastructure along the U.S.-Mexico border. The numbers I have cited thus far indicate what we do know. Almost as much of a concern is what we do not know with respect to the status of Hispanic health in this Nation. According to one study, only 22 percent of all articles published in major medical journals included non- English-speaking patients. The bill provides funding to do additional research and work on reducing health disparities in this Nation. The various provisions include efforts to improve the recruitment and retention of Hispanic health professionals and programs that support training health professionals who can provide culturally competent and linguistically appropriate care. With respect to training more minority health professionals, Dr. Cigarroa said at last year's hearing, ``We should do this because it is the smart thing to do. If we fail to take steps to address the gap between the health of the majority population and the health of the Nation's rapidly growing minority populations, we are on a court leading to a collision. We are far too great a nation to allow this to happen.'' Representative Ciro Rodriguez, chairman of the Congressional Hispanic Caucus, and I, have worked together on this legislation to respond to the challenge before us with regard to coverage, access, and health disparities in the last Congress and have reintroduced the bill with the hope to move it forward this year. Before closing, it should be noted that while the legislation puts forth a number of initiatives to address what are disproportionately Hispanic problems, each section of the bill, including those to reduce the number of uninsured and to improve access to care, would improve the overall health of our entire Nation regardless of race or ethnicity. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. BINGAMAN. Mr. President, the legislation I am introducing today with Senators Cochran, Lincoln, Collins, Daschle, Jeffords, Clinton, Cantwell, and Johnson is entitled the Children's Dental Health Improvement Act of 2003. This legislation is designed to improve the access and delivery of dental health services to our Nation's children through Medicaid, the State Children's Health Insurance Program, (SCHIP), the Indian Health Services, IHS, and our Nation's safety net of community health centers. The oral health problems facing children are highlighted in a landmark report issued by the Surgeon General and the Department of Health and Human Services, HHS, in 2000 entitled ``Oral Health in America: A report of the Surgeon General'' in which he observed that our Nation is facing what amounts to ``a `silent epidemic' of dental and oral diseases.'' In fact, dental caries, which refers to both decayed teeth or filled cavities, is the most common childhood disease. According to the Surgeon General,``Among 5- to 17-years olds, dental caries is more than 5 times as common as a reported history of asthma and 7 times as common as hay fever.'' In short, dental care is, as the Surgeon General adds,``the most prevalent unmet health need among American children.'' I was pleased to chair a hearing in the Health, Education, Labor and Pensions Committee on June 25, 2002, entitled ``The Crisis in Children's Dental Health: A Silent Epidemic'' in which the Surgeon General, Dr. David Satcher, testified. Dr. Satcher's testimony was strong and compelling. In his words, ``Over 108 million children and adults lack dental insurance, which is over 2.5 times the number who lack medical insurance.'' Dr. Satcher also highlight the following information specific to the oral health problems in children: There are striking disparities in dental disease by income. Poor children suffer twice as much dental cries as their more affluent peers, and their disease is more likely to be untreated. These poor- nonpoor differences continue into adolescence. One out of four children in America is born into poverty, and children living below the poverty line--annual income of $17,000 for a family of four--have more severe and untreated decay. Other birth defects such as hereditary ectodermal dysplasias, where all or most teeth are missing or misshapen, cause lifetime problems that can be devastating to children and adults. Unintentional injuries, many of which include head, mouth, and neck injuries, are common in children. Intentional injuries commonly affect the craniofacial tissues. Tobacco-related oral lesions are prevalent in adolescents who currently use smokeless--spit tobacco. Professional care is necessary for maintaining oral health, yet 25 percent of poor children have not seen a dentist before entering kindergarten. Medical insurance is a strong predictor of access to dental care. Uninsured children are 2.5 times less likely than insured children to receive dental care. Children from families without dental insurance are three times more likely to have dental needs than children with either public or private insurance. For each child without medical insurance, there are at least 2.6 children without dental insurance. Medicaid has not been able to fill the gap in providing dental care to poor children. Fewer than one in five Medicaid-covered children received a single dental visit in a recent year-long study period. While recent CMS data indicate progress in this area with 1 million more Medicaid-eligible children now receiving annual dental care than was the case in 1996, there is still a long way to go to ensuring greater access. Although new programs such as the State Children's Health Insurance Program, SCHIP, may increase the number of insured children, many will still be left without effective dental coverage. The social impact of oral diseases in children is substantial. More than 51 million school hours are lost each year to dental-related illness. Poor children suffer nearly 12 times more restricted-activity days than children from higher income families. Pain and suffering due to untreated diseases can lead to problems in eating, speaking, and attending to learning. Over 50 percent of 5- to 9-year-old children have at least one cavity or filling, and that proportion increases to 78 percent among 17-year- olds. Nevertheless, these figures represent improvements in the oral health of children compared to a generation ago. The Senate also heard the testimony of Dr. Burton Edelstein, founding director of the Children's Dental Health Project; Dr. Gregory Chadwick, president of the American Dental Association; Dr. Lynn Douglass Moundon, director of oral health in the Arkansas Department of Health; Ed Martinez, chief executive officer at San Ysidro Health Center in California; and, Dr. Timothy Shriver, president and chief executive officer of Special Olympics, Inc. Dr. Edelstein underscored the need for more attention to this issue. As he said, ``The too-widespread belief that childhood dental disease has been vanquished states in contrast to the thousands upon thousands of toothaches and acute abscesses experienced daily by America's children--many as young as 2 years of age.'' In endorsing this legislation, Dr. Chadwick added, ``. . . we cannot forget the fact that millions of people in this country--particularly children--aren't getting even basic preventive and restorative dental care. These children are out there suffering.'' The Children's Dental Health Improvement Act of 2003 seeks to end that suffering. One important provision in the bill would grant States flexibility to provide dental coverage to low-income children through the State Children's Health Insurance Program, or SCHIP, just as States currently are able to do through Medicaid. Unfortunately, SCHIP law prohibits coverage of children for services unless they are completely uninsured. As authors Ruth Almeida, Ian Hill, and Genevieve Kenney of an Urban Institute report entitled ``Does SCHIP Spell Better Dental Care for Children? An Early Look at New Initiatives write'', ``. . . many low-income children are covered by employer-based or other private health insurance for their medical care, but do not have a comprehensive dental benefit. Because these children are privately insured, they are not eligible for SCHIP and cannot avail themselves of dental coverage under SCHIP. Expanding SCHIP to furnish dental services on a wraparound basis to private covered low-income children without dental coverage could help achieve broader improvements in children's oral health.'' For low-income children with medical coverage but no dental insurance through the private sector, their only option would be to completely dump their private coverage for their children in order to access SCHIP coverage. Instead, the Children's Dental Health Improvement Act of 2003 creates an option for States to provide low-income families with the ability to receive wraparound dental coverage through SCHIP without having to completely drop their private insurance. This reduces the crowd-out of private insurance, which was a priority of the Congress during passage of SCHIP, and it provides low-income children with dental services that other children in the same economic circumstance are already receiving through SCHIP. In implementing such a change, I want to make it clear that I am in strong support of providing additional funding to SCHIP to ensure that these services are provided without reducing current levels of SCHIP funding. With those additional funds, I strongly believe that SCHIP, just as Medicaid, should provide services to low-income children who are both uninsured and underinsured. Children need a comprehensive set of child health services, including dental services, to ensure their appropriate health and development. However, coverage for these services is often not enough. Even when children do have dental coverage, the access to care is often sorely lacking. Medicaid is the largest insurer of dental coverage to children. Yet despite the design of the Medicaid Program to ensure access to comprehensive services for children, including dental care, the inspector general of the Department of Health and Human Services reported in 1996 that only 18 percent of children eligible for Medicaid received even a single preventive dental service. The same report shows that no State provides preventive services to more than 50 percent of eligible children. The factors are complex but the primary one is due to limited dental participation in Medicaid. According to GAO, in its September 2000 report entitled ``Oral Health: Factors Contributing to Low Use of Dental Services by Low- Income Populations.'' ``Of 39 states that provided information about dentists' participation in Medicaid, 23 reported that fewer than half of the states' dentists saw at least one Medicaid patient during 1999.'' Even worse, a 1998 survey by the National Conference of State Legislatures indicates that fewer than 20 percent of dentists participate in the Medicaid Program nationwide. The GAO concludes poor participation rates by dentists is due in large part to poor reimbursement rates in Medicaid. As the GAO points out, ``Our analysis showed that Medicaid payment rates are often well below dentists' normal fees. Only 13 states had Medicaid rates that exceeded two-thirds of the average regional fees dentists charged. . . .'' Clearly, Medicaid is chronically underfunded with respect to dental care. The Surgeon General's report notes, ``On average, state Medicaid agencies contribute only 2.3 percent of their child health expenditures to dental care, whereas nationally, the percentage of all child health expenditures dedicated to dental care is more than 10 times that rate, almost 30 percent.'' The good news is that many States, including New Mexico, have taken recent actions to improve the participation of dentists in the Medicaid Program by raising low payment rates and reducing administrative requirements. These efforts were highlighted by the GAO in its September 2000 report. To further encourage such efforts, the ``Children's Dental Health Improvement Act of 2003'' provides $50 million annually as financial incentives and planning grants to States to undertake additional improvements in their Medicaid Programs delivery of dental health services to children. In addition to Medicaid and SCHIP, the Federal Government administers other health care programs providing dental services or providers for low-income children and their families, including services administered by community health centers and the Indian Health Service, or IHS. Unfortunately, both of these programs are underfunded and, as the GAO found, ``report difficulty in meeting the dental needs of their target populations.'' For example, the GAO found that ``HHS and health center officials report that the demand for dental services significantly exceeds the [urban and rural health] centers' capacity to deliver it. In 1998 . . ., a little more than half of the nearly 700 health center grantees funded under this program had active dental programs.'' This is also true for public health departments across the country. To assist the health centers and public health departments with this need, the Children's Dental Health Improvement Act of 2003 provides $40 million to community health centers and public health departments to expand dental health services through the hiring of additional dental health professionals to serve low-income populations. This is particularly a problem that needs to be addressed in areas with severe dental health professional shortages, such as New Mexico. For example, New Mexico ranked next to last in the Nation with just 32.1 dentists per 100,000 population in 1998, according to HHS. This compares to the national average of 48.4 per 100,000. Moreover, the number of dentists in New Mexico declined by 7 percent between 1991 and 1998 while the State's population grew 12 percent. The result was a 17 percent decline in dentists per capita during the period. With regard to American Indian and Alaska Native populations, the need is so great and the funding so little that a comprehensive solution is requiring throughout the IHS system. With respect to the unmet need, the GAO notes that ``American Indian and Alaska Native children aged 2 to 4 years old have five times the rate of decay that all children have.'' Unfortunately, the GAO adds, ``. . . about one-fourth of IHS' dentist positions at 269 IHS and tribal facilities were vacant in April 2000. Vacancies have been chronic at IHS facilities--in the past 5 years, at least 67 facilities have had one or more dentist positions vacant for at least a year. According to IHS officials, the primary reason for these vacancies is that IHS is unable to provide a competitive salary for new dentists . . .'' The GAO continues, ``The IHS' dental personnel shortages translate into a large unmet need for dental services among American Indians and Alaska Natives. IHS reports that only 24 percent of the eligible population had a dental visit in 1998. The personnel shortages have also reduced the scope of services that facilities are able to provide. According to IHS officials, available services have concentrated more on acute and emergency care, while routine and restorative care have dropped as a percentage of workload. Emergency services increased from one-fifth of the workload in 1990 to more than one-third of the workload in 1999.'' To help alleviate this workforce shortage, the Children's Dental Health Improvement Act of 2003 provides IHS with the authority to offer multiyear retention bonuses to dental providers offering services through the IHS and tribal programs. The bill also provides for some technical amendments to ensure that tribal organizations and community health centers are allowed to apply for school-based dental sealant funding from the Centers for Disease Control and Prevention, or CDC. The legislation also has a new provision that addresses a technical and unintended problem with the implementation of provisions changing the way Medicare graduate medical education, or GME, is funded. As background in the Balanced Budget Act of 1997, or BBA, Congress recognized the unfairness of subjecting dentistry to GME policies based on the oversupply of physician specialists by exempting dental residency positions from caps placed on the number of residents supported by Medicare GME. However, the two provisions in that law--both enacted primarily to alleviate the impact on hospitals that decrease physician slots--have had the opposite impact on hospitals that increase their dental residency positions. While successful in achieving the purpose of reducing the number of physicians being trained, these provisions have hurt dentistry and access to oral health care in the United States and are contrary to the congressional goal in 1997 to increase the number of postgraduate dental residency slots. As a result, the legislation would exempt dental residency training positions from the 3-year rolling average provision used to calculate the number of residents for Medicare GME payments. The bipartisan legislation I am introducing today would improve the access and delivery of dental health services to our Nation's children through Medicaid, SCHIP, IHS, and our Nation's safety net of community health centers. These problems are well documented and call out for congressional action as soon as possible. I would like to thank the American Dental Association, the American Dental Education Association, the American Academy of Pediatric Dentistry, the National Association of Community Health Centers, Inc., the National Association of Children's Hospitals, the American Dental Hygienists' Association, and the Children's Dental Health Project for their outstanding support and/or their technical advice on this legislation. This bill is a result of their outstanding work. In particular, I want to thank Dr. Burt Edelstein, Libby Mullin, and Ann De Biasi of the Children's Dental Health Project for their vast knowledge and technical assistance on this issue. I want to thank Judy Sherman of the American Dental Association, Myla Moss and Jack Bresch of the American Dental Education Association, Dr. Herber Simmons and Scott Litch of the American Academy of Pediatric Dentistry, Karen Sealander of the American Dental Hygienists' Association, Dr. Jim Richeson and Judy Kloss Bynum of the Academy of General Dentistry, Dr. Stephen Corbin of Special Olympics, Inc., and Dan Hawkins, Chris Koppen, and Roger Schwartz of the National Association of Community Health Centers, Inc., for their valuable insight, technical advice, and continued support for this legislation. I look forward to working with them all to ensure that we achieve increased access to oral health care for our children. In addition to those organizations, I would like to thank the following groups for their support of the bill, whether in the past session of Congress or this year. They include: the Academy of General Dentistry, American Academy of Child and Adolescent Psychiatry, American Academy of Oral and Maxillofacial Pathology, American Academy of Periodontology, American Association of Dental Examiners, American Association of Dental Research, American Association of Endodontists, American Association of Public Health Dentistry, American Association of Oral and Maxillofacial Surgeons, American Association of Orthodontists, American Association of Women Dentists, American College of Dentists, American College of Preventive Medicine, American Dental Trade Association, American Public Health Association, American Society of Dentistry for Children, American Student Dental Association, Association of Clinicians for the Underserved, Association of Maternal and Child Health Programs, Association of State and Territorial Dental Directors, Dental Dealers of America, Dental Manufacturers of America, Inc., Family Voices, Hispanic Dental Association, International College of Dentists--USA, March of Dimes, National Association of City and County Health Officers, National Association of Local Boards of Health, National Dental Association, National Health Law Program, New Mexico Department of Health, Partnership for Prevention, Society of American Indian Dentists, Special Care Dentistry, and United Cerebral Palsy Associations. Mr. President, I ask unanimous consent for the text of the bill to be printed in the Record.

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, the legislation I am introducing today with Senators Cochran, Lincoln, Collins, Daschle, Jeffords, Clinton, Cantwell, and Johnson is entitled the Children's Dental Health Improvement Act of 2003. This legislation is designed to improve the access and delivery of dental health services to our Nation's children through Medicaid, the State Children's Health Insurance Program, (SCHIP), the Indian Health Services, IHS, and our Nation's safety net of community health centers. The oral health problems facing children are highlighted in a landmark report issued by the Surgeon General and the Department of Health and Human Services, HHS, in 2000 entitled ``Oral Health in America: A report of the Surgeon General'' in which he observed that our Nation is facing what amounts to ``a `silent epidemic' of dental and oral diseases.'' In fact, dental caries, which refers to both decayed teeth or filled cavities, is the most common childhood disease. According to the Surgeon General,``Among 5- to 17-years olds, dental caries is more than 5 times as common as a reported history of asthma and 7 times as common as hay fever.'' In short, dental care is, as the Surgeon General adds,``the most prevalent unmet health need among American children.'' I was pleased to chair a hearing in the Health, Education, Labor and Pensions Committee on June 25, 2002, entitled ``The Crisis in Children's Dental Health: A Silent Epidemic'' in which the Surgeon General, Dr. David Satcher, testified. Dr. Satcher's testimony was strong and compelling. In his words, ``Over 108 million children and adults lack dental insurance, which is over 2.5 times the number who lack medical insurance.'' Dr. Satcher also highlight the following information specific to the oral health problems in children: There are striking disparities in dental disease by income. Poor children suffer twice as much dental cries as their more affluent peers, and their disease is more likely to be untreated. These poor- nonpoor differences continue into adolescence. One out of four children in America is born into poverty, and children living below the poverty line--annual income of $17,000 for a family of four--have more severe and untreated decay. Other birth defects such as hereditary ectodermal dysplasias, where all or most teeth are missing or misshapen, cause lifetime problems that can be devastating to children and adults. Unintentional injuries, many of which include head, mouth, and neck injuries, are common in children. Intentional injuries commonly affect the craniofacial tissues. Tobacco-related oral lesions are prevalent in adolescents who currently use smokeless--spit tobacco. Professional care is necessary for maintaining oral health, yet 25 percent of poor children have not seen a dentist before entering kindergarten. Medical insurance is a strong predictor of access to dental care. Uninsured children are 2.5 times less likely than insured children to receive dental care. Children from families without dental insurance are three times more likely to have dental needs than children with either public or private insurance. For each child without medical insurance, there are at least 2.6 children without dental insurance. Medicaid has not been able to fill the gap in providing dental care to poor children. Fewer than one in five Medicaid-covered children received a single dental visit in a recent year-long study period. While recent CMS data indicate progress in this area with 1 million more Medicaid-eligible children now receiving annual dental care than was the case in 1996, there is still a long way to go to ensuring greater access. Although new programs such as the State Children's Health Insurance Program, SCHIP, may increase the number of insured children, many will still be left without effective dental coverage. The social impact of oral diseases in children is substantial. More than 51 million school hours are lost each year to dental-related illness. Poor children suffer nearly 12 times more restricted-activity days than children from higher income families. Pain and suffering due to untreated diseases can lead to problems in eating, speaking, and attending to learning. Over 50 percent of 5- to 9-year-old children have at least one cavity or filling, and that proportion increases to 78 percent among 17-year- olds. Nevertheless, these figures represent improvements in the oral health of children compared to a generation ago. The Senate also heard the testimony of Dr. Burton Edelstein, founding director of the Children's Dental Health Project; Dr. Gregory Chadwick, president of the American Dental Association; Dr. Lynn Douglass Moundon, director of oral health in the Arkansas Department of Health; Ed Martinez, chief executive officer at San Ysidro Health Center in California; and, Dr. Timothy Shriver, president and chief executive officer of Special Olympics, Inc. Dr. Edelstein underscored the need for more attention to this issue. As he said, ``The too-widespread belief that childhood dental disease has been vanquished states in contrast to the thousands upon thousands of toothaches and acute abscesses experienced daily by America's children--many as young as 2 years of age.'' In endorsing this legislation, Dr. Chadwick added, ``. . . we cannot forget the fact that millions of people in this country--particularly children--aren't getting even basic preventive and restorative dental care. These children are out there suffering.'' The Children's Dental Health Improvement Act of 2003 seeks to end that suffering. One important provision in the bill would grant States flexibility to provide dental coverage to low-income children through the State Children's Health Insurance Program, or SCHIP, just as States currently are able to do through Medicaid. Unfortunately, SCHIP law prohibits coverage of children for services unless they are completely uninsured. As authors Ruth Almeida, Ian Hill, and Genevieve Kenney of an Urban Institute report entitled ``Does SCHIP Spell Better Dental Care for Children? An Early Look at New Initiatives write'', ``. . . many low-income children are covered by employer-based or other private health insurance for their medical care, but do not have a comprehensive dental benefit. Because these children are privately insured, they are not eligible for SCHIP and cannot avail themselves of dental coverage under SCHIP. Expanding SCHIP to furnish dental services on a wraparound basis to private covered low-income children without dental coverage could help achieve broader improvements in children's oral health.'' For low-income children with medical coverage but no dental insurance through the private sector, their only option would be to completely dump their private coverage for their children in order to access SCHIP coverage. Instead, the Children's Dental Health Improvement Act of 2003 creates an option for States to provide low-income families with the ability to receive wraparound dental coverage through SCHIP without having to completely drop their private insurance. This reduces the crowd-out of private insurance, which was a priority of the Congress during passage of SCHIP, and it provides low-income children with dental services that other children in the same economic circumstance are already receiving through SCHIP. In implementing such a change, I want to make it clear that I am in strong support of providing additional funding to SCHIP to ensure that these services are provided without reducing current levels of SCHIP funding. With those additional funds, I strongly believe that SCHIP, just as Medicaid, should provide services to low-income children who are both uninsured and underinsured. Children need a comprehensive set of child health services, including dental services, to ensure their appropriate health and development. However, coverage for these services is often not enough. Even when children do have dental coverage, the access to care is often sorely lacking. Medicaid is the largest insurer of dental coverage to children. Yet despite the design of the Medicaid Program to ensure access to comprehensive services for children, including dental care, the inspector general of the Department of Health and Human Services reported in 1996 that only 18 percent of children eligible for Medicaid received even a single preventive dental service. The same report shows that no State provides preventive services to more than 50 percent of eligible children. The factors are complex but the primary one is due to limited dental participation in Medicaid. According to GAO, in its September 2000 report entitled ``Oral Health: Factors Contributing to Low Use of Dental Services by Low- Income Populations.'' ``Of 39 states that provided information about dentists' participation in Medicaid, 23 reported that fewer than half of the states' dentists saw at least one Medicaid patient during 1999.'' Even worse, a 1998 survey by the National Conference of State Legislatures indicates that fewer than 20 percent of dentists participate in the Medicaid Program nationwide. The GAO concludes poor participation rates by dentists is due in large part to poor reimbursement rates in Medicaid. As the GAO points out, ``Our analysis showed that Medicaid payment rates are often well below dentists' normal fees. Only 13 states had Medicaid rates that exceeded two-thirds of the average regional fees dentists charged. . . .'' Clearly, Medicaid is chronically underfunded with respect to dental care. The Surgeon General's report notes, ``On average, state Medicaid agencies contribute only 2.3 percent of their child health expenditures to dental care, whereas nationally, the percentage of all child health expenditures dedicated to dental care is more than 10 times that rate, almost 30 percent.'' The good news is that many States, including New Mexico, have taken recent actions to improve the participation of dentists in the Medicaid Program by raising low payment rates and reducing administrative requirements. These efforts were highlighted by the GAO in its September 2000 report. To further encourage such efforts, the ``Children's Dental Health Improvement Act of 2003'' provides $50 million annually as financial incentives and planning grants to States to undertake additional improvements in their Medicaid Programs delivery of dental health services to children. In addition to Medicaid and SCHIP, the Federal Government administers other health care programs providing dental services or providers for low-income children and their families, including services administered by community health centers and the Indian Health Service, or IHS. Unfortunately, both of these programs are underfunded and, as the GAO found, ``report difficulty in meeting the dental needs of their target populations.'' For example, the GAO found that ``HHS and health center officials report that the demand for dental services significantly exceeds the [urban and rural health] centers' capacity to deliver it. In 1998 . . ., a little more than half of the nearly 700 health center grantees funded under this program had active dental programs.'' This is also true for public health departments across the country. To assist the health centers and public health departments with this need, the Children's Dental Health Improvement Act of 2003 provides $40 million to community health centers and public health departments to expand dental health services through the hiring of additional dental health professionals to serve low-income populations. This is particularly a problem that needs to be addressed in areas with severe dental health professional shortages, such as New Mexico. For example, New Mexico ranked next to last in the Nation with just 32.1 dentists per 100,000 population in 1998, according to HHS. This compares to the national average of 48.4 per 100,000. Moreover, the number of dentists in New Mexico declined by 7 percent between 1991 and 1998 while the State's population grew 12 percent. The result was a 17 percent decline in dentists per capita during the period. With regard to American Indian and Alaska Native populations, the need is so great and the funding so little that a comprehensive solution is requiring throughout the IHS system. With respect to the unmet need, the GAO notes that ``American Indian and Alaska Native children aged 2 to 4 years old have five times the rate of decay that all children have.'' Unfortunately, the GAO adds, ``. . . about one-fourth of IHS' dentist positions at 269 IHS and tribal facilities were vacant in April 2000. Vacancies have been chronic at IHS facilities--in the past 5 years, at least 67 facilities have had one or more dentist positions vacant for at least a year. According to IHS officials, the primary reason for these vacancies is that IHS is unable to provide a competitive salary for new dentists . . .'' The GAO continues, ``The IHS' dental personnel shortages translate into a large unmet need for dental services among American Indians and Alaska Natives. IHS reports that only 24 percent of the eligible population had a dental visit in 1998. The personnel shortages have also reduced the scope of services that facilities are able to provide. According to IHS officials, available services have concentrated more on acute and emergency care, while routine and restorative care have dropped as a percentage of workload. Emergency services increased from one-fifth of the workload in 1990 to more than one-third of the workload in 1999.'' To help alleviate this workforce shortage, the Children's Dental Health Improvement Act of 2003 provides IHS with the authority to offer multiyear retention bonuses to dental providers offering services through the IHS and tribal programs. The bill also provides for some technical amendments to ensure that tribal organizations and community health centers are allowed to apply for school-based dental sealant funding from the Centers for Disease Control and Prevention, or CDC. The legislation also has a new provision that addresses a technical and unintended problem with the implementation of provisions changing the way Medicare graduate medical education, or GME, is funded. As background in the Balanced Budget Act of 1997, or BBA, Congress recognized the unfairness of subjecting dentistry to GME policies based on the oversupply of physician specialists by exempting dental residency positions from caps placed on the number of residents supported by Medicare GME. However, the two provisions in that law--both enacted primarily to alleviate the impact on hospitals that decrease physician slots--have had the opposite impact on hospitals that increase their dental residency positions. While successful in achieving the purpose of reducing the number of physicians being trained, these provisions have hurt dentistry and access to oral health care in the United States and are contrary to the congressional goal in 1997 to increase the number of postgraduate dental residency slots. As a result, the legislation would exempt dental residency training positions from the 3-year rolling average provision used to calculate the number of residents for Medicare GME payments. The bipartisan legislation I am introducing today would improve the access and delivery of dental health services to our Nation's children through Medicaid, SCHIP, IHS, and our Nation's safety net of community health centers. These problems are well documented and call out for congressional action as soon as possible. I would like to thank the American Dental Association, the American Dental Education Association, the American Academy of Pediatric Dentistry, the National Association of Community Health Centers, Inc., the National Association of Children's Hospitals, the American Dental Hygienists' Association, and the Children's Dental Health Project for their outstanding support and/or their technical advice on this legislation. This bill is a result of their outstanding work. In particular, I want to thank Dr. Burt Edelstein, Libby Mullin, and Ann De Biasi of the Children's Dental Health Project for their vast knowledge and technical assistance on this issue. I want to thank Judy Sherman of the American Dental Association, Myla Moss and Jack Bresch of the American Dental Education Association, Dr. Herber Simmons and Scott Litch of the American Academy of Pediatric Dentistry, Karen Sealander of the American Dental Hygienists' Association, Dr. Jim Richeson and Judy Kloss Bynum of the Academy of General Dentistry, Dr. Stephen Corbin of Special Olympics, Inc., and Dan Hawkins, Chris Koppen, and Roger Schwartz of the National Association of Community Health Centers, Inc., for their valuable insight, technical advice, and continued support for this legislation. I look forward to working with them all to ensure that we achieve increased access to oral health care for our children. In addition to those organizations, I would like to thank the following groups for their support of the bill, whether in the past session of Congress or this year. They include: the Academy of General Dentistry, American Academy of Child and Adolescent Psychiatry, American Academy of Oral and Maxillofacial Pathology, American Academy of Periodontology, American Association of Dental Examiners, American Association of Dental Research, American Association of Endodontists, American Association of Public Health Dentistry, American Association of Oral and Maxillofacial Surgeons, American Association of Orthodontists, American Association of Women Dentists, American College of Dentists, American College of Preventive Medicine, American Dental Trade Association, American Public Health Association, American Society of Dentistry for Children, American Student Dental Association, Association of Clinicians for the Underserved, Association of Maternal and Child Health Programs, Association of State and Territorial Dental Directors, Dental Dealers of America, Dental Manufacturers of America, Inc., Family Voices, Hispanic Dental Association, International College of Dentists--USA, March of Dimes, National Association of City and County Health Officers, National Association of Local Boards of Health, National Dental Association, National Health Law Program, New Mexico Department of Health, Partnership for Prevention, Society of American Indian Dentists, Special Care Dentistry, and United Cerebral Palsy Associations. Mr. President, I ask unanimous consent for the text of the bill to be printed in the Record.

Mr. BINGAMAN

Mr. BINGAMAN. I appreciate the committee's help in this important matter.

Mr. BINGAMAN. The Senator is correct. There is concern on the signal that this repeal could send to other nations, especially those we are working with to stem the proliferation of nuclear weapons. In particular, my intent in submitting this amendment was the effect that the repeal would have on the Cooperative Threat Reduction Program, which was started by Senators Nunn, Lugar, and Domenici. I want to be assured that we do not send any bad-faith signals to Russia, and other countries, that participate in the program. The United States spends over a billion dollars a year in this effort; the repeal of the low- yield ban must not negatively affect this investment of the taxpayers' money.

Mr. BINGAMAN. I have submitted an amendment which has been accepted, that requires the Secretaries of the Departments of Defense, Energy, and State, to provide Congress by March 1, 2004, an assessment of the effects, if any, that such a repeal will have on the ability of the United States to achieve its nonproliferation objectives, and whether or not, changes in programs or activities would be required to achieve these objectives. I have asked that this report be submitted in an unclassified form with a classified annex, if needed.

Mr. BINGAMAN. Mr. President, we have in the Senate repealed the ban on low-yield nuclear weapons, specifically, section 3136 of the National Defense Authorization Act for fiscal year 1994, Public Law 103-160.

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, I rise today to introduce the Trade Adjustment Assistance for Communities Act of 2003. This legislation is co-sponsored by Senators Baucus, Rockefeller, Daschle, Murray, Cantwell, Dayton, Lieberman, Lincoln, and Feinstein. Companion legislation will be introduced in the House by Congressman Sander Levin tomorrow. I first introduced Trade Adjustment Assistance legislation in the last Congress, and I was very pleased when that legislation--the provisions relating to both individuals and communities--passed the Senate as part of the Trade Act of 2002. I would like to take this opportunity to thank all of my colleagues for their efforts in making this happen. But I would like to thank Senator Baucus in particular for making Trade Adjustment Assistance one of his priorities last session and pushing on it to the very end. And I would also like to thank Senator Grassley for understanding the importance of Trade Adjustment Assistance to the ongoing trade debate, and his decision to make it part of the trade package that went through Congress. But I also have to express my disappointment with the way the process ended. In spite of the bi-partisan consensus that formed around Trade Adjustment Assistance during the negotiations last year and the efforts of my colleagues, I regret to say that the provisions related to communities did not make it out of conference. I can not tell you why this happened. However, I can tell you that it is incredibly naive to ignore the problems that are occurring right now across the country and not understand what it means for our country's long-term economic interests. Look at the newspaper and you will see that in many communities, people are pretty much out of work for good, at least when you look at the jobs they had and the wages they were making. And as the lay-offs have expanded, the impact the lay-offs have had on entire communities have become more pronounced. Now it is not just the individuals who are struggling, but the communities in which hundreds or thousands of people live, all because a company or a group of companies have closed their doors for good. From what I can tell from statements some of my colleagues have made in committee or on the floor of the Senate, this is really nothing more than tough luck. This is the way markets work and you simply make do with what you have. I disagree completely. From where I sit you can't just let individuals who have worked their whole life at a company, who have played by the rules for their entire life, who have committed their entire life to keeping their communities intact, be reduced to little more than hope that something will change for the better. They deserve more than that. You also can't let the communities where these people live just die, because they form the foundation of what we are as a society. These are the networks that have lasted generations, that connect us, and define who we are. I firmly believe we need to do everything we can for these folks and the communities where they live, simply because we owe them something for what they have given us and our country. I believe we have a responsibility to give these communities a shot at a new future. The legislation I am introducing today does just that. Let me make it clear that writing this legislation is not an abstract exercise. For me, this is about my friends and neighbors that I have known for years. Right now, in my hometown of Silver City, NM, I have folks that I grew up with, wondering what they are going to do next. Over the last few years the copper mines closed, and then the businesses that supported the copper mines closed, and then the tax base began to disappear, and then services started to be cut, and it seems to everyone like the whole community has been caught in a downward spiral. In spite of what some of my colleagues might claim, this is not because of lack of effort on the part of the people of Silver City. These people are not content with the way things are. On the contrary, they are trying desperately to change direction. They have ideas about where they want to go and what they need to do to make things better. They have acted on these ideas to the best of their ability. And I want to commend them for that. But right now they are stuck because there is no money available to get things started, to take the first step so other steps can be taken afterward. And this is the way it is across the country in a good many communities just like Silver City. I strongly believe this has to change. We have let things stand just the way they are for far too long. The status quo is not acceptable, and it is time for Congress to make a serious effort to change how we manage these kinds of problems. My interest in Trade Adjustment Assistance actually began in November, 1997 when Levi-Strauss announced its decision to close most of its plants in the United States and transfer production to other countries. Levi-Strauss decided to close two plants in New Mexico one in Albuquerque and one in Roswell--with the Roswell facility alone losing close to 600 workers. This number didn't even include the contract workers and other folks that relied on Levi Strauss for their living. They lost their jobs as well. 600 plus individuals would be a significant blow in any town, but in a town of 50,000 people--which is what Roswell--is with a workforce of only 25,000 people, this lay-off was truly devastating. What exactly were these people going to do? Where could they go to get work so they could pay their mortgage, pay for health care, pay for their kids' education? Sure, some of them could be re-trained through Trade Adjustment Assistance, but the question that was on everyone's mind was: retrained for what? What do you re-train 600 people for when there are no other jobs available in town, and no new companies coming into town? The questions surrounding what happened in Roswell--actually, what should have happened in Roswell if we had more effective Trade Adjustment Assistance policies in place--combined with other plant closures across the country in towns just like Roswell, made me ask what actually could be done to help individuals and communities adapt to this kind of collective crisis. In cooperation with Senators Roth and Moynihan, who were the Chair and Ranking Member of the Finance Committee at the time, I requested studies from the General Accounting Office on the over-all efficacy of Trade Adjustment Assistance program. I also asked them to study how communities across the country had responded to the changes that derive from international trade agreements and globalization. I have to say that the answers we got back from the General Accounting Office were not very encouraging. To begin with, the Trade Adjustment Assistance for individuals program suffered from inconsistencies, incoherence, and a general lack of accountability. Some states managed their programs well, but others--my home State of New Mexico being one--did not. There was no Trade Adjustment Assistance for Communities program at the time, but in analyzing how particular communities responded to economic crises, the General Accounting Office report clearly stated that government funds available for economic recovery efforts were limited and the road to real recovery was difficult even when funds were available. There were no ``best practices'', no obvious answers, to refer to because success had been so limited. In most cases, there was no way out of the downward spiral at all. But over time some individual lessons appeared, and interestingly enough, those lessons were very similar to the ones we learned in Roswell. Among other things, technical assistance is needed early on in the process to ensure that a community-wide recovery strategy can be developed. Funding needs to be made available to assist in strategic planning. Individual and institutional differences need to be bridged in the community so there is a tangible collective interest in the strategic plan. Short-term, medium-term, and long-term funding needs to be available for communities to use as they pursue their economic strategy. U.S. government agencies need to cooperate to ensure that their efforts are not duplicative or contradictory. State governments need to be involved in the recovery process to encourage cooperation where there has been none before. I admit that it is very difficult to make sure all these things happen, especially in communities that are struggling to stay on an even keel. Clearly much of the burden for the activities fall on communities, because they are the ones that have to decide what is best for them. And that is the way it should be. But Congress can play a role in helping communities attain the goals they have set for themselves, and I believe the bill I am introducing today offers a very good start. The key components of the legislation are as follows: First, the legislation establishes a Trade Adjustment Assistance for Communities Program at the Department of Commerce, signaling that communities that are negatively impacted by trade are deserving of a separate stream of funds to help them through their economic crisis. Ideally this program will be located at the Economic Development Administration, which has the expertise and experience to manage a program of this type. Second, the legislation establishes a U.S. government inter-agency Trade Adjustment Assistance for Communities working group, the goal being to ensure that agencies work in cooperation to assist communities negatively impacted by trade, integrating personnel, activities, and resources as they respond to existing or anticipated problems. Third, the legislation provides funding for strategic planning and development grants for communities negatively impacted by trade. As written, there is no limit on the funds that a community can receive. Instead, the level of funding is determined by the individual needs of each community, the coherence of their strategic plan, and the cooperation that exists among the stakeholders applying for the grant. Fourth, the legislation allows funding from programs at other agencies to be used in concurrence with Trade Adjustment Assistance for Communities funding, and, furthermore, allows Federal funding to be used to fulfill most non-Federal matching requirements that exist. In the past, some economic development efforts have been stopped in their tracks because communities don't have the matching funds necessary to get grants. This legislation would give communities that are now suffering under serious financial constraints some initial flexibility in their effort to get funding. Fifth, the legislation gives preference to rural communities in funding guidelines, since these are the communities that have the fewest options available to them as they attempt to respond to trade related problems. Sixth, the legislation authorizes $350 million per year for the Trade Adjustment Assistance for Communities program, essentially doubling the funds that are currently available for economic adjustment in the United States. I believe this amount is consistent with the needs that we see of communities across the United States. Seventh, the legislation establishes a lookback to January 1998, allowing communities that were negatively impacted by trade and have yet to overcome their problems an opportunity to obtain funds and begin their recovery. Finally, the legislation establishes a set of new triggers for eligibility that are designed to help not only communities that have been negatively impacted by trade, but also communities that have experienced some negative impacts but want to set a new course so any future impacts will be limited. This approach is far different than anything that has been done before in Trade Adjustment Assistance legislation--far different even than the legislation that my colleagues and I introduced last year--and is designed specifically to avoid the criticism that Trade Adjustment Assistance is really nothing but ``death insurance''. The inclusion of the category of ``affected domestic producers'' as a trigger, for example, would allow certain companies to work with their communities to create a coherent strategic plan to renovate or construct basic or advanced infrastructure, diversify the local economy, attract new investment, and encourage long-term economic stability and global competitiveness--all this before a company is closed and the entire community is affected. The inclusion of TAA for firms as a trigger would allow restructuring at a firm to occur in tandem with restructuring in a community. The inclusion of TAA for workers as a trigger would allow funds to be directed into a community at the initial onset of problems at a company--at the moment when lay- offs are first occurring--not when the problems are so far down the line that there is very little that can be done about it. Let me say straight out that this legislation cannot be considered a substitute for a strong trade or manufacturing policy. But I do believe this legislation is complementary to those policies. From where I sit, there will always be individuals and communities negatively impacted by trade, and it is incumbent upon Congress to ensure that these individuals and communities are treated with the respect they deserve and with the strategic economic interests of our country in mind. The economic ideology that suggests we just let things take their course and things will work out the way they are supposed to is, from my perspective, wrongheaded and misguided. The fact is we must look very carefully at the changes that are occurring to our national economy as a result of globalization and position ourselves to do better than we are now. This legislation carves out an area of real need and addresses it in a coherent, comprehensive, and innovative fashion. If enacted, it will have an immediate, concrete, and important impact on communities across the country. Every State in the country would benefit from the legislation. It will allow communities to take charge of the future and contribute to the economic welfare of the Nation. It is a practical approach that is designed to keep our communities intact and our country competitive and strong. I urge my colleagues to support it.

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, I rise today to introduce the Trade Adjustment Assistance for Communities Act of 2003. This legislation is co-sponsored by Senators Baucus, Rockefeller, Daschle, Murray, Cantwell, Dayton, Lieberman, Lincoln, and Feinstein. Companion legislation will be introduced in the House by Congressman Sander Levin tomorrow. I first introduced Trade Adjustment Assistance legislation in the last Congress, and I was very pleased when that legislation--the provisions relating to both individuals and communities--passed the Senate as part of the Trade Act of 2002. I would like to take this opportunity to thank all of my colleagues for their efforts in making this happen. But I would like to thank Senator Baucus in particular for making Trade Adjustment Assistance one of his priorities last session and pushing on it to the very end. And I would also like to thank Senator Grassley for understanding the importance of Trade Adjustment Assistance to the ongoing trade debate, and his decision to make it part of the trade package that went through Congress. But I also have to express my disappointment with the way the process ended. In spite of the bi-partisan consensus that formed around Trade Adjustment Assistance during the negotiations last year and the efforts of my colleagues, I regret to say that the provisions related to communities did not make it out of conference. I can not tell you why this happened. However, I can tell you that it is incredibly naive to ignore the problems that are occurring right now across the country and not understand what it means for our country's long-term economic interests. Look at the newspaper and you will see that in many communities, people are pretty much out of work for good, at least when you look at the jobs they had and the wages they were making. And as the lay-offs have expanded, the impact the lay-offs have had on entire communities have become more pronounced. Now it is not just the individuals who are struggling, but the communities in which hundreds or thousands of people live, all because a company or a group of companies have closed their doors for good. From what I can tell from statements some of my colleagues have made in committee or on the floor of the Senate, this is really nothing more than tough luck. This is the way markets work and you simply make do with what you have. I disagree completely. From where I sit you can't just let individuals who have worked their whole life at a company, who have played by the rules for their entire life, who have committed their entire life to keeping their communities intact, be reduced to little more than hope that something will change for the better. They deserve more than that. You also can't let the communities where these people live just die, because they form the foundation of what we are as a society. These are the networks that have lasted generations, that connect us, and define who we are. I firmly believe we need to do everything we can for these folks and the communities where they live, simply because we owe them something for what they have given us and our country. I believe we have a responsibility to give these communities a shot at a new future. The legislation I am introducing today does just that. Let me make it clear that writing this legislation is not an abstract exercise. For me, this is about my friends and neighbors that I have known for years. Right now, in my hometown of Silver City, NM, I have folks that I grew up with, wondering what they are going to do next. Over the last few years the copper mines closed, and then the businesses that supported the copper mines closed, and then the tax base began to disappear, and then services started to be cut, and it seems to everyone like the whole community has been caught in a downward spiral. In spite of what some of my colleagues might claim, this is not because of lack of effort on the part of the people of Silver City. These people are not content with the way things are. On the contrary, they are trying desperately to change direction. They have ideas about where they want to go and what they need to do to make things better. They have acted on these ideas to the best of their ability. And I want to commend them for that. But right now they are stuck because there is no money available to get things started, to take the first step so other steps can be taken afterward. And this is the way it is across the country in a good many communities just like Silver City. I strongly believe this has to change. We have let things stand just the way they are for far too long. The status quo is not acceptable, and it is time for Congress to make a serious effort to change how we manage these kinds of problems. My interest in Trade Adjustment Assistance actually began in November, 1997 when Levi-Strauss announced its decision to close most of its plants in the United States and transfer production to other countries. Levi-Strauss decided to close two plants in New Mexico one in Albuquerque and one in Roswell--with the Roswell facility alone losing close to 600 workers. This number didn't even include the contract workers and other folks that relied on Levi Strauss for their living. They lost their jobs as well. 600 plus individuals would be a significant blow in any town, but in a town of 50,000 people--which is what Roswell--is with a workforce of only 25,000 people, this lay-off was truly devastating. What exactly were these people going to do? Where could they go to get work so they could pay their mortgage, pay for health care, pay for their kids' education? Sure, some of them could be re-trained through Trade Adjustment Assistance, but the question that was on everyone's mind was: retrained for what? What do you re-train 600 people for when there are no other jobs available in town, and no new companies coming into town? The questions surrounding what happened in Roswell--actually, what should have happened in Roswell if we had more effective Trade Adjustment Assistance policies in place--combined with other plant closures across the country in towns just like Roswell, made me ask what actually could be done to help individuals and communities adapt to this kind of collective crisis. In cooperation with Senators Roth and Moynihan, who were the Chair and Ranking Member of the Finance Committee at the time, I requested studies from the General Accounting Office on the over-all efficacy of Trade Adjustment Assistance program. I also asked them to study how communities across the country had responded to the changes that derive from international trade agreements and globalization. I have to say that the answers we got back from the General Accounting Office were not very encouraging. To begin with, the Trade Adjustment Assistance for individuals program suffered from inconsistencies, incoherence, and a general lack of accountability. Some states managed their programs well, but others--my home State of New Mexico being one--did not. There was no Trade Adjustment Assistance for Communities program at the time, but in analyzing how particular communities responded to economic crises, the General Accounting Office report clearly stated that government funds available for economic recovery efforts were limited and the road to real recovery was difficult even when funds were available. There were no ``best practices'', no obvious answers, to refer to because success had been so limited. In most cases, there was no way out of the downward spiral at all. But over time some individual lessons appeared, and interestingly enough, those lessons were very similar to the ones we learned in Roswell. Among other things, technical assistance is needed early on in the process to ensure that a community-wide recovery strategy can be developed. Funding needs to be made available to assist in strategic planning. Individual and institutional differences need to be bridged in the community so there is a tangible collective interest in the strategic plan. Short-term, medium-term, and long-term funding needs to be available for communities to use as they pursue their economic strategy. U.S. government agencies need to cooperate to ensure that their efforts are not duplicative or contradictory. State governments need to be involved in the recovery process to encourage cooperation where there has been none before. I admit that it is very difficult to make sure all these things happen, especially in communities that are struggling to stay on an even keel. Clearly much of the burden for the activities fall on communities, because they are the ones that have to decide what is best for them. And that is the way it should be. But Congress can play a role in helping communities attain the goals they have set for themselves, and I believe the bill I am introducing today offers a very good start. The key components of the legislation are as follows: First, the legislation establishes a Trade Adjustment Assistance for Communities Program at the Department of Commerce, signaling that communities that are negatively impacted by trade are deserving of a separate stream of funds to help them through their economic crisis. Ideally this program will be located at the Economic Development Administration, which has the expertise and experience to manage a program of this type. Second, the legislation establishes a U.S. government inter-agency Trade Adjustment Assistance for Communities working group, the goal being to ensure that agencies work in cooperation to assist communities negatively impacted by trade, integrating personnel, activities, and resources as they respond to existing or anticipated problems. Third, the legislation provides funding for strategic planning and development grants for communities negatively impacted by trade. As written, there is no limit on the funds that a community can receive. Instead, the level of funding is determined by the individual needs of each community, the coherence of their strategic plan, and the cooperation that exists among the stakeholders applying for the grant. Fourth, the legislation allows funding from programs at other agencies to be used in concurrence with Trade Adjustment Assistance for Communities funding, and, furthermore, allows Federal funding to be used to fulfill most non-Federal matching requirements that exist. In the past, some economic development efforts have been stopped in their tracks because communities don't have the matching funds necessary to get grants. This legislation would give communities that are now suffering under serious financial constraints some initial flexibility in their effort to get funding. Fifth, the legislation gives preference to rural communities in funding guidelines, since these are the communities that have the fewest options available to them as they attempt to respond to trade related problems. Sixth, the legislation authorizes $350 million per year for the Trade Adjustment Assistance for Communities program, essentially doubling the funds that are currently available for economic adjustment in the United States. I believe this amount is consistent with the needs that we see of communities across the United States. Seventh, the legislation establishes a lookback to January 1998, allowing communities that were negatively impacted by trade and have yet to overcome their problems an opportunity to obtain funds and begin their recovery. Finally, the legislation establishes a set of new triggers for eligibility that are designed to help not only communities that have been negatively impacted by trade, but also communities that have experienced some negative impacts but want to set a new course so any future impacts will be limited. This approach is far different than anything that has been done before in Trade Adjustment Assistance legislation--far different even than the legislation that my colleagues and I introduced last year--and is designed specifically to avoid the criticism that Trade Adjustment Assistance is really nothing but ``death insurance''. The inclusion of the category of ``affected domestic producers'' as a trigger, for example, would allow certain companies to work with their communities to create a coherent strategic plan to renovate or construct basic or advanced infrastructure, diversify the local economy, attract new investment, and encourage long-term economic stability and global competitiveness--all this before a company is closed and the entire community is affected. The inclusion of TAA for firms as a trigger would allow restructuring at a firm to occur in tandem with restructuring in a community. The inclusion of TAA for workers as a trigger would allow funds to be directed into a community at the initial onset of problems at a company--at the moment when lay- offs are first occurring--not when the problems are so far down the line that there is very little that can be done about it. Let me say straight out that this legislation cannot be considered a substitute for a strong trade or manufacturing policy. But I do believe this legislation is complementary to those policies. From where I sit, there will always be individuals and communities negatively impacted by trade, and it is incumbent upon Congress to ensure that these individuals and communities are treated with the respect they deserve and with the strategic economic interests of our country in mind. The economic ideology that suggests we just let things take their course and things will work out the way they are supposed to is, from my perspective, wrongheaded and misguided. The fact is we must look very carefully at the changes that are occurring to our national economy as a result of globalization and position ourselves to do better than we are now. This legislation carves out an area of real need and addresses it in a coherent, comprehensive, and innovative fashion. If enacted, it will have an immediate, concrete, and important impact on communities across the country. Every State in the country would benefit from the legislation. It will allow communities to take charge of the future and contribute to the economic welfare of the Nation. It is a practical approach that is designed to keep our communities intact and our country competitive and strong. I urge my colleagues to support it.

Mr. BINGAMAN

Mr. BINGAMAN. Mr. President, let me just talk about one other aspect. The Pentagon's Missile Defense Agency, which oversees missile defense research and development, did an interview in February talking about their so-called space-based test bed, which is what I am addressing my amendment to here. The thrust of what they described in that interview was they intend to field satellites armed with multiple hit-to-kill interceptors that are capable of destroying a ballistic missile through a high-speed collision shortly after it is launched. This might be something we decide we have to do, but, to my knowledge, that debate has not occurred in Congress, and I do not want to see us proceeding down that road without the Congress having focused on it, having actually specifically authorized it. Therefore, my amendment tries to clarify that is, in fact, what is required before we can proceed down that road. There is funding also in this same program element, and that is the PE 060886C. There is funding in there for the ground-based interceptors, for their development. Certainly that is a decision we have made as a country, and I am not trying to revisit that. I do think we go a substantial additional step when we decide we are also going to be designing, developing, and deploying weapons in space. We will do so. We will begin that process by setting up this so-called test bed in space. Those satellites will be the beginning of that process. I reserve the remainder of my time and yield the floor.

Mr. BINGAMAN. Madam President, I move to reconsider the vote.

Mr. BINGAMAN. Madam President, I call up amendment No. 765 and ask for its immediate consideration.

Mr. BINGAMAN. Madam President, let me explain to my colleagues what we have done, both working with Senator Levin and Senator Allard and Senator Warner and the various staff who have worked on this issue. First, let me describe very briefly what my amendment does. The language of the amendment I offered originally was fairly clear in that we were trying to restrict the use of funds in a particular program element so that they could not be used, obligated, or expended to design, develop, or deploy hit-to-kill interceptors or other weapons for placement in space unless there was specific authorization by Congress. That is an important provision to try to get into the law. And in order to do that, I have agreed to a modification of that which Senator Allard recommended. That modification would add a subsection (b) that would say: Of the amounts authorized to be appropriated for fiscal year 2004 for Ballistic Missile Defense System Interceptors, $14,000,000 is available for research and concept definition for the space based test bed. As I see the effect of this modified amendment, the general provision would be agreed to that there cannot be funds used for either design or development or deployment of these weapons in space out of these funds, with the only exception being that $14 million is available for research and concept definition with regard to this space-based test bed. That is an acceptable alteration and one that still keeps intact the basic provision I intended with my amendment. On that basis, I have agreed to modify it. I yield to Senator Allard. I know he wants to describe the amendment.

Mr. BINGAMAN. I yield to the Senator as much time as he needs.

Mr. BINGAMAN. Madam President, I send a modification of the amendment to the desk.

Mr. BINGAMAN. I ask unanimous consent that the amendment be set aside and that we return to the amendment I offered, No. 765.

Mr. BINGAMAN. Madam President, what is the business before the Senate?

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

Mr. BINGAMAN. We can postpone a vote until we visit.

Mr. BINGAMAN. Prior to that, I yield 3 minutes to the Senator from Rhode Island. He has been waiting to speak on this general issue, if that is possible.

Mr. BINGAMAN. I think the operative language is on page 2, where I say what this sentence is intended to mean: that no amount authorized to be appropriated by this act for research, development, test, and evaluation may be expended for design, development, or the deployment of these types of weapons in space. I think I have made it very clear we are trying to head off the use of funds for designing weapons in space until Congress has a chance to debate this issue and until there is a specific authorization required.

Mr. BINGAMAN. Mr. President, in response to my colleague's question, I think it is very clear what my amendment is trying to do, that the Department of Defense cannot obligate or expend funds to design, develop, or deploy hit-to-kill interceptors or other weapons for placement in space, unless they get specific authorization. So if they want to do more research or go back and look at previously performed research or analyses, certainly I have no problem with that. I think that is----

Mr. BINGAMAN. That is correct. I think that should not be done without much more deliberation than we have given it.