Kit Bond

Mr. BOND

Mr. BOND. I ask for the yeas and nays on the question of germaneness.

Mr. BOND. Mr. President, the argument about political retribution for somebody who demands scientific evidence and wants to provide a fair hearing and a scientific basis for action is one which does not, I think, serve this body well. I think we have a proper procedure for determining whether there is scientific evidence. To date, there has been none shown. That is why when I said this is entitlement legislation being offered on an appropriations bill, it is not germane to the appropriations process. And, for that reason, I raise this point of order that this amendment is not germane.

Mr. BOND. Mr. President, we have had a lot of debate, a lot of heated rhetoric, and a lot of stirring stories of personal tragedies during this morning's session and tonight, and there is a lot of emotion involved. I think it is reasonable to understand why there is emotion, because every year in the United States there are approximately 150,000 babies born with serious birth defects. There are congenital heart defects, Down's syndrome, neural tube defects, primarily spina bifida. Of those birth defects, about 4,000 babies have spina bifida. Over the past several years, I have worked with the March of Dimes attempting, with some success, to get the Centers for Disease Control funding for their prevention programs in research to find out what causes these problems, to set up a surveillance and monitoring program so that we can have some sound evidence as to what causes these defects. Some research on spina bifida is already bearing fruit. There is a connection between mothers taking folic acid early in pregnancy, and reduced rates of the incidence of spina bifida have been found. This is good news. This is good science. We are making some progress. But a lot more work needs to be done on the causes, the incidence, and the protections. Now we come to the recent actions by the National Academy of Sciences. Let me be clear that the agent orange law does not require us to expand an entitlement on this bill. The Agent Orange law does not apply to children or offspring of veterans. The agent orange law sets up some presumptions, but they have to be based on science, which is not present here. The National Academy of Sciences in their review this past spring found in one study what the authors called a possible association between exposure and spina bifida in the offspring of veterans. The National Academy of Sciences then presented this information to the Veterans' Administration with the caution on how the study should be used. In fact, in that study, the task force emphasizes that its conclusions ``made for the limited purposes of PL-10234 do not reflect a judgment that a particular health outcome has shown to be caused by, or in some cases even definitely associated with, herbicide exposure under the standards ordinarily governing such conclusions for purposes of scientific inquiry and medical care.'' So much for the contentions that there is compelling scientific evidence. They said there was not. Later this summer, the author of the study, the Ranch Hand study, told us in testimony before the House that his study was not adequate to make a decision that there was a causal link. He cautioned the House, and said do not count on a causal link from this study. It does not show it. Then, on July 29, the minority leader introduced legislation which used the study to create this new entitlement program. There has not been a hearing held on it in the authorizing committee. But there is also some new information that, frankly, I just came across. The Air Force has now sent a letter to Congress, dated August 29, in which they state in their 1996 progress report on the bottom of page 3--this is on the Ranch Hand study, the one study which reported to show any connection: We found no indication of increased birth defects severity, delays in development, or hyperkinetic syndrome with paternal dioxin. The data provides little or no support for the theory that external exposure to Agent Orange and its dioxin contaminant is associated with adverse reproductive outcomes. Mr. President, I think that there is a very real question of whether there is any--certainly this has not been demonstrated--scientific evidence of a linkage. It is time for cooler heads to prevail. We have all expressed our concerns over birth defects. The amendment is not supported by sound scientific evidence. It is not even uniformly supported by veterans groups who recognize that the impact of the amendment will mean reduced benefits to veterans as a result of new entitlements and health care for dependents. There are many questions which the debate has raised which deserve full consideration in the normal legislative process before the authorizing committee. The opponents of this amendment have every bit as much compassion for people with these disabilities such as spina bifida. All we are saying is let us get the science that establishes the linkage. It is not there. Let us not jump into something that is so lacking in scientific evidence. That is precisely why we have a separate procedure in this body to consider legislation, particularly legislation setting up an entitlement program with hearings and actions before an authorizing committee. Since this is an attempt to set up an entitlement program, and it has not been heard before or acted upon by the authorizing committee, I raise a point of order that this amendment is not germane.

Mr. BOND. Mr. President, reluctantly I state that I cannot support the Harkin amendment. The amendment, as has been recognized, is directly in conflict with the McCain amendment we adopted yesterday, which the Senate approved in a 79 to 18 vote. I am very sympathetic to the concerns of the Senator from Iowa that certain VA facilities may be losing resources relative to other facilities as the Veterans Administration changes its operations to become more like an efficient, modern, managed care organization. I am fully supportive of the steps VA is taking to change the way it operates. Frankly, I believe the changes initiated by the VA under Secretary for Health Dr. Ken Kaizer represent very positive steps for the betterment of veterans' health care, and the McCain amendment is completely consistent with the bold and necessary steps being taken by Dr. Kaizer to ensure approved quality of care for veterans. I do not minimize that the steps being taken are painful. The VA has never experienced so much change in so little time. However, with declining discretionary resources, a shift in the veteran population to Sunbelt States, a decline in the veteran population, and rapid changes in health care delivery, the VA must, indeed, make changes. The McCain amendment reflected the findings of a GAO report of February 1996 which found the VA's traditional method of allocating resources was not equitable, it was not population based, and some facilities were receiving twice as much funding per patient as other facilities. In response to GAO's findings and in recognition of the need to change its traditional resource allocation method, the Veterans' Administration has begun moving toward a parity-based capitated model for resource allocation. I emphasize that, despite what some newspaper stories may have stated, no final allocations have yet been determined. In the process of allocating the resources more equitably, a process which is to be fully implemented in fiscal year 1998, there are going to be some areas in some facilities which are winners. There are going to be some facilities which are losers. There are different populations served by those facilities. It is the right direction for the VA to be pursuing. It will bring about efficiencies, fairness, and improved care. We should not stand in the way of these important improvements. We have already seen the elimination of some redundancies as closely located facilities merge their administrative services and as VA opens community-based outpatient clinics in lieu of providing high-cost hospital-based care. In my own State of Missouri, the Poplar Bluff, MO, Veterans' Administration recently closed inpatient surgical procedures because of the inadequate workload and excessive mortality rates. The decision to close that portion of the facility was painful and four doctors lost their jobs. But it was the right decision. It was the right decision for the facility, for the system, but, most importantly, it was the right decision for veterans' health care. The Harkin amendment is unacceptable partly because at this time VA does not know what the specific allocation to each hospital will be for fiscal year 1997 since the model for resource allocation for fiscal year 1997 is still under development. Frankly, it is possible that some facilities could receive less than the fiscal year 1996 level. Moreover, the allocation will not be individually to hospitals but rather to the 22 networks, each of which encompass several VA facilities and which we can hope will be based on the need and the population in each area. I should add, very importantly, that the Veterans' Administration is opposed to the amendment as it takes a step backward to the progress it is attempting to make. The VA has said the only obstacle to better health care for veterans is likely to be Congress. If we are looking at how many jobs in how many facilities and trying to legislate those into place and into being, we will prevent an improvement in the system. The VA has stated it intends to provide health care services to the 2.8 million veterans currently receiving care. Even with the resource adjustments within the system, VA does not expect to deny patients care who are now getting care in any of its 22 networks. I reserve the remainder of my time.

Mr. BOND. Mr. President, the Senator from Arizona has agreed that his 2 minutes can be allocated to the Senator from Florida. So I ask the full 4 minutes be allocated to the Senator from Florida.

Mr. BOND. Mr. President, reserving the right to object, I think there are a couple minutes for both the Senator from Arizona and the Senator from Florida. I had 5 minutes. We started this at 8 o'clock. And I notified the Senator from Iowa we were trying to get going. If we could divide this. He has had an opportunity. If he could take 5 more minutes, and we could have 10 minutes.

Mr. BOND. Mr. President, I see the Senator from Iowa is present. I yield the floor.

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

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

Mr. BOND

Mr. BOND. I move tolay that motion on the table. The motion to lay on the table was agreed to. Mr. BRADLEY addressed the Chair.

Mr. BOND. The Senator from North Carolina has some comments, as I will, on this measure. We do want to wait for the ranking member before moving to acceptance of the amendment. I thank the Chair, and I thank my colleague.

Mr. BOND. Madam President, I was going to make a few comments in support of the amendment, and I suggest that we await the arrival of the ranking member before actually moving to adoption of the amendment.

Mr. BOND. Yes.

Mr. BOND. On behalf of my ranking member, I want to be sure that has been incorporated. They have worked very closely with us. We appreciate their cooperation, and we particularly appreciate your work on this. I apologize for interrupting. I wanted to make sure that change had been made in the amendment submitted to the desk.

Mr. BOND. Madam President, if I may interrupt, with respect to my colleague from North Carolina, I think there was one additional change that had been suggested by the minority side. I have not seen whether that was incorporated.

Mr. BOND

Mr. BOND. Madam President, earlier today we were worrying about whether we could get a 4-hour time agreement to limit debate on the amendment that the minority leader is going to offer. There was a good couple of hours, 2\1/2\ hours, of debate, and the amendment has not been offered. We are open to do business. If anybody has arguments for or against it, I would invite him or her to come present those arguments. I understand the minority leader is temporarily involved in another hearing and has not been able to present his amendment. There is no amendment pending. We welcome anyone who wants to discuss the bill or discuss amendments which they will offer. This is the prime time of day when we ought to be doing the business of the Senate. This is the third day we have been on this bill. The ranking member and I have been here, ready and willing to move forward. We are running short of time in this legislative session, and we have this and a number of other very important measures to conclude. So I make an earnest plea to people on both sides of the aisle who want to talk about this bill, or particular issues, to come forward and do so, please. Let us use the time of the Senate productively. We are here. We are ready. We are waiting to do business. We welcome such views and such enlightenment as our colleagues would wish to share with us. I yield the floor and suggest the absence of a quorum.

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

Mr. BOND. Mr. President, I think we have now seen why this is such a difficult question, because there is no arguing with the fact that individuals suffering from disabling diseases, particularly such as spina bifida, which is a congenital birth defect, which, in most severe cases, can cause paralysis, deserve our compassion. There are some studies underway which have shown that one of the causes of spina bifida is a lack of folic acid. This is a disease, this is a defect which deserves our greatest attention because it is a debilitating, truly awful disability, and the compassion with which the minority leader speaks is justifiable. We all have compassion for these people, but we are considering an appropriations bill today. It is the most tortuous reasoning to say, when the minority leader has waited until July 29 to introduce a piece of legislation, and then without hearings in the relevant authorizing committee expects without the hearings and over the objection of the authorizing committee which wishes to explore what is clearly questionable scientific evidence on which any findings should be based, that this should be put in an appropriations bill. This would be an entitlement program stuck on an appropriations bill. As the chairman of the Veterans Committee has already pointed out, the so-called offset has already been used for the entitlement. The Senate Veterans' Affairs Committee marked up a bill just prior to the August recess. No Member raised the issue and, as I said, the Senate Veterans Affairs Committee has held no hearings on it. There are many issues which need to be considered regarding the provision of benefits to children with spina bifida. They have not been discussed and debated in a normal legislative process. A view expressed by the Disabled American Veterans executive director, David Gorman, in a May 1996 letter to the VA Secretary said: Because the basis of [these children's] entitlement is dissimilar to both the conventional direct and derivative eligibility for VA programs, benefits for them would appear to be beyond the parameters of traditional VA benefits, and more properly under the scope of other compensatory programs. Benefits for these children might be more appropriately included under authority and appropriations for military claims. Similarly, the Vietnam Veterans of America wrote to the Secretary in April stating: We urge you to specifically request the VA task force seek outside expertise from both governmental and nongovernmental entities on these issues. VVA aims to ensure that the appropriate questions are being considered and addressed by policymakers in the VA and Congress. The Vietnam Veterans Association raised a number of questions which need answering such as how many veterans' families are affected by spina bifida. We have only an estimate based on a flawed study which led to the assumption for the numbers which the minority leader gave. And the minority leader has been unable to tell us what governmental or nongovernmental services might already be available to these veterans and families and what agencies should be tasked with providing health care and compensation. The Veterans' Administration does not even know how many offspring of veterans of Vietnam are actually affected by this terrible disease, their ages, their degree of disability, or the extent to which they are already receiving Federal assistance, nor does the VA have any firm estimate on the cost of care and compensation. These are very important issues. These are truly critically important issues to the families affected. They deserve the attention and deliberation of this body but, I suggest, through the normal legislative process. The views of the veterans service organizations certainly should be taken into consideration on this important issue. Their views--and there are views on both sides--deserve the proper forum of hearings in the authorizing committee. As I noted, some of the organizations do support and some do not support the Daschle amendment. There are much greater problems with this, and the minority leader brushed them off. But the amendment sets several precedents. First, to my knowledge, expanding entitlements on an appropriations bill has not been done--to my knowledge. If there is ever an instance in which the American people can see why the Federal Government is spinning out of control, it is when on the basis of limited scientific evidence, not hard scientific evidence, without hearings, without legislative consideration of all points of view, without even knowing how many people are affected and what other benefits are available, a brandnew entitlement program is set up; it is set in motion without consideration of its impact. When young people ask us how did the Federal Government spending get out of control, this is probably one small example. It is an example, where there are people who have a severe birth defect. We are concerned about them. But we are setting up a Government program without reliable scientific knowledge on what the cause is or how it is going to be dealt with. Are we dealing with all of the children of veterans who deserve this kind of help? What about the children of gulf war veterans who suffer from heart-wrenching disabilities, possibly as a result of their parents' service? This amendment opens up a whole host of questions which deserve to be considered through the normal legislative process. But let us be clear about the scientific basis. Has there been a scientifically established link between exposure to agent orange and spina bifida in offspring? The answer is no. There has been only ``limited/suggestive evidence'' of an association based on a single study. The author of that study says: Do not rely on it. The cause of spina bifida is unknown. Work is going forward on the folic acid approach. The VA's task force report on agent orange, issued in May in response to the National Academy of Sciences/Institute of Medicine update on agent orange, said ``Most of the studies cited did not show statistically significant differences. Notwithstanding these scientific questions, sufficient data exist of a possible association that the task force concluded that spina bifida meets the liberal standards set forth in Public Law 102-4,'' the Agent Orange Act of 1991. The task force report also said: The Task Force believes the legal standard governing the finding of a ``positive association'' under P.L. 102-4 is an imperfect framework for analyzing the relevant scientific evidence and, further, raises a risk that VA's findings of a ``positive association'' may be misinterpreted to mean more than they do. The Task Force is concerned that VA's finding of a ``positive association'' under the liberal standard of P.L. 102-4 may be misconstrued as reflecting a scientific judgment that a causal association exists between herbicide exposure and a particular disease. The Task Force emphasizes that its conclusions made for the limited purposes of P.L. 102-4 do not reflect a judgment that a particular health outcome has been shown to be caused by, or in some cases even definitely associated with, herbicide exposure under the standards ordinarily governing such conclusions for purposes of scientific inquiry and medical care. The NAS looked at one study referred to as the ``Ranch Hand'' study. The author of this so-called Ranch Hand study said his own findings did not support a conclusion of linkage between herbicide and spina bifida. He said before a House hearing earlier this year: ``It is my opinion that the accumulated evidence does not yet establish that there is a cause-and-effect relationship between herbicide exposure and spina bifida.'' The NAS noted that the studies relative to spina bifida had ``methodological limitations such as small sample size and possible recall bias'' which mean that further study is required. And finally, there is at least one study which would seem to contradict an association between herbicide exposure and spina bifida. An herbicide production plant exploded in the town of Seveso, Italy, with residents exposed to substantial quantities of herbicide. A study on the frequency of birth defects in Seveso failed to demonstrate any increased risk of birth defects. Let us be clear about the impact of this amendment on other veterans entitlements. Because the so-called Gardner decision is being used to offset this new entitlement, the effect is that the Veterans' Affairs Committee, in meeting its reconciliation instructions next year, will be forced to cut veterans entitlements in other areas to pay for this entitlement. I should also add that the benefits which would be authorized to veterans' offspring in some cases would exceed compensation benefits currently provided to service-connected veterans. One must question whether this is fair and appropriate. And finally, Mr. President, while the costs of compensation would be offset in this amendment by reducing benefits related to the ``Gardner decision,'' there is no provision to cover medical costs. VA would be required to provide comprehensive health care benefits--at an estimated cost of at least $14 million a year. VA would have to absorb these additional costs--at a time when VA's medical care budget, as requested by the President and recommended by the committee, is estimated to cover only those veterans currently served by the VA medical system. We would have to take away health care from those who are already served to meet these new benefits. It seems to me, to expand medical benefits to an additional population will mean the care of those veterans--the vast majority of whom are service-connected disabled or very low income--will be put at risk. And I should also add that the medical benefits which would be authorized are more generous that VA's current authorities for medical care to veterans. These issues deserve close study and debate. That, I think, can only occur in the authorizing committee in an appropriate legislative consideration. I think it is highly inappropriate to play election year politics with such an important issue as this one. I think we have normal legislative procedures which should be followed to determine whether there is any scientific evidence suggesting that we should provide this entitlement, this expanded entitlement. Trying to place it on an appropriations measure is, I think, inappropriate and totally unwarranted. Mr. DASCHLE addressed the Chair.

Mr. BOND. That is not the question. Are they receiving Federal assistance in any form?

Mr. BOND. Mr. President, the legal link is merely that there are suggestions, there is not evidence, and this is one of the facts that would be brought out were there to be a hearing. Perhaps the minority leader could tell us what kind of services the potential beneficiaries of this amendment are now receiving. Are they now receiving federally supported care? Are they receiving privately supported care?

Mr. BOND. Mr. President, I am sorry that the word has not gotten around. I was under the impression that the full leadership of this body had said that we were not going to attempt a broad range of authorizing activities where the authorizing committee objected. Certainly in this instance I think there are many questions which legitimately should be resolved before the authorizing committee. I wonder if the minority leader is familiar with the testimony which was produced in the House by the principal investigator on the one study, a ``ranch-hand study,'' which examined the possibility of a link between dioxin and offspring with spina bifida, and the fact this investigator testified before the House appropriations committee concluded in his testimony by saying that ``The Institute of Medicine has recently interpreted available evidence on spina bifida and exposure to herbicide as `suggestive of an association' but `limited because chance bias and confounding could not be ruled out with confidence' the results of our study of ranch hand veterans and comparisons were apparently important to the Institute of Medicine in reaching their conclusion. However, it is my opinion that the accumulated evidence does not yet establish that there is a cause-and- effect relationship between herbicide exposure and spina bifida today.'' Is the Senator familiar with that testimony?

Mr. BOND. Mr. President, there will be a point of order. Who knows? There may be several of them. But let me ask the minority leader if he does not agree that there are instances of legislation on appropriations bills where the authorizing committee has agreed that it is appropriate to make changes which could not be made in the normal course of business and whether it has not been the agreement of the leadership that on this appropriations cycle we would only include legislation which had the approval of the authorizing committees? Was the minority leader not involved in that leadership discussion?

Mr. BOND. Mr. President, going back to the basic questions and assumptions, again I note the difficulty we have as we are asked on an appropriations bill to approve legislation to establish a new entitlement program. Did I understand the minority leader to say that he believes it is entirely appropriate for an appropriations bill to include a new entitlement program which has not been the subject of hearings in an authorizing committee, and which the chairman of the authorizing committee opposes on an appropriations bill? Is this the new procedure we follow?

Mr. BOND. Well, since we went out of session in August, and it was introduced in the latter part of July, it would not be unreasonable that legislative hearings could not be held on a bill which had not been introduced, is it?

Mr. BOND. Mr. President, let me ask the minority leader when the legislation to provide this was introduced. When did you introduce legislation to provide these benefits?