Benjamin Cardin

Mr. CARDIN

Mr. CARDIN. Madam President, I see Senator Coons on the floor, and he is prepared to speak with regard to S. 615. First, I thank Senator Coons for his extraordinary leadership with regard to S. 615. He is one of those individuals who worked very closely with Senator Corker and me to find a common way to resolve some extremely challenging issues we had. Let me take you back just a few weeks, where most people thought it was totally impossible for the Senate to get together on a bill that would provide an orderly way for us to review a potential agreement with Iran on nuclear weapons. The Senate Foreign Relations Committee had scheduled a vote, there was a recess, and I think most of us felt that the bill would come out of the Senate Foreign Relations Committee but that it would be a bill on which the President would continue his veto threat, and its future was anything but certain. Then the Senate Foreign Relations Committee went to work under Senator Corker's leadership, and we were able to resolve these issues. But one of the key players was Senator Coons. Senator Coons was traveling during the recess. He was in Africa doing important work on behalf of the Senate Foreign Relations Committee. I doubt that he got any sleep because I was getting calls from him at times when it was the middle of the night in Africa giving us very constructive ways to deal with some of the very difficult issues of congressional review, the length of time necessary for congressional review, how we can make sure that we had the information we needed, and that it gave the President the strongest possible hand. I thank Senator Coons for his extraordinary leadership and work on behalf of the legislation we have before us. I yield the floor.

Mr. CARDIN

Mr. CARDIN. Mr. President, first, let me thank Senator Barrasso for his help in bringing this bill forward. He made valuable contributions during the committee's consideration and the managers' amendment. I know how strongly he feels about the certification issue. I want to point out--I know Senator Barrasso is aware of this--with his help and Senator Corker's help and all of the members' of the committee, we have added very strong language in this bill that requires the President to report to Congress periodically on the status of Iranian activity in the areas he is concerned about. For example, the President must make an assessment of whether any Iranian financial institutions are engaged in money laundering or terrorist finance activity, including names of specific financial institutions if applicable; Iran's advancements in the ballistic program, including developments related to its long-range and intercontinental ballistic missile program; an assessment of whether Iran directly supported, financed, planned or carried out an act of terrorism against the United States or United States persons anywhere in the world; whether and the extent to which Iran supported acts of terrorism, including acts of terrorism against the United States or United States persons anywhere in the world; all actions, including in international fora, being taken by the United States to stop, counter, and condemn acts by Iran to directly or indirectly carry out acts of terrorism against the United States and United States persons; the impact on the national security of the United States and the safety of U.S. citizens as a result of any Iranian actions reported in this paragraph. Then, we require an assessment of whether violations of internationally recognized human rights in Iran have changed, increased or decreased, as compared to the prior period. I just point that out because Senator Barrasso raises a very valid point about Congress having information in order to carry out its responsibilities. We made this bill very clear that our interest in Iran goes well beyond its nuclear weapons program. We are concerned about Iran's sponsorship of terrorism. We are concerned about Iran's human rights violations. We are concerned about Iran's ballistic missile program. As the framework in the April 2 agreement points out, nothing will affect the sanctions that are currently in place as it relates to terrorism, human rights violations or the ballistic missile program. So I understand the Senator's concerns. I thank him for helping us develop a bill that I think is well balanced in the area of his concerns. I yield the floor.

Mr. CARDIN. I suggest the absence of a quorum.

Mr. CARDIN. Mr. President, let me first thank Leader Reid for his comments about the circumstances in Baltimore. I spoke a little bit earlier today about Baltimore. It is my home city, the city I love. It is a people I love. We are really hurting from what happened. I appreciate the leader's comments about it. We are going to get through this, we are going to restore order in Baltimore, and there will be justice for Freddie Gray. We are all going to work together. I appreciate the outreach we have received from the White House and from the Federal and State in helping Baltimore restore the order in our city. Amendment No. 1150 Mr. President, I just want to respond very briefly. I see Senator Isakson is here. I will not take too much more of his time. Let me respond briefly in support of Senator Corker's concerns concerning Senator Johnson's amendment. I oppose that amendment. The determination of a treaty is an Executive decision. The ratification of a treaty is a legislative decision. When we go through treaty negotiations and ratification, we delegate legislative authority. It would then be up to a different entity to make decisions. I know my colleagues are very concerned about treaty obligations and the ratification of treaties. This clearly would raise some constitutional issues with this type of legislation. Let me just give you the practical problem we have here. In 2012, we entered into a treaty for disabilities. I don't believe it is controversial at all. It does not change any of our laws. We have not acted on that yet. In 1994, the United States entered into a treaty with the Law of the Seas. Most countries have ratified that treaty, not the United States. That was 1994. So now if Senator Johnson's amendment became law, the President would have no authority to implement this agreement because the waiver authorities will be gone and it would require ratification to move forward. We cannot pass a disability treaty in this body. We can't even pass a tax treaty in this body. It would be beyond belief that this really would allow us to move forward with a negotiation with Iran. This is what we call a poison pill. It would prevent this bill--one of a couple of things. This bill would not become law. It would not pass or it would be vetoed by the President, and he would not override the veto. If it became law, it would kill negotiations. There would be no negotiations. The United States would be isolated because our negotiating partners would be wondering why we are withdrawing from the negotiations, not Iran. The United States would be isolated. And the final line, it would make it more likely, not less likely, that Iran will become a nuclear weapon state. That is why Senator Corker and I strongly oppose Senator Johnson's amendment. At the appropriate time, we will be asking our colleagues to vote against it. I yield the floor.

Mr. CARDIN. Mr. President, first, I want to join Senator Corker in thanking Senator Menendez for his leadership on this issue--I said that on previous occasions on the floor--clearly, his leadership, working with Senator Corker and working with Senator Kaine, who developed the bill for the appropriate review for Congress. I wish to thank Senator Menendez very much for all of his hard work on this bill. I want to identify myself with the comments of Senator Corker in opposition to the Johnson amendment. But let me give you one more reason. I respect the intent of those who support this amendment, but let me tell you what it means. It means that if this were, in fact, a treaty, we would be saying that we would be delegating to other entities the decision on whether to eliminate the sanction regime we in Congress imposed. I have listened to my colleagues, particularly on the Republican side, who say they do not want to delegate that authority, that Congress should keep its legislative authority. If you believe Congress should keep its legislative authority, that it is up to us to determine whether we are going to change or eliminate or modify the sanction regime, then you cannot be for a treaty because a treaty would give away that power. I do not think you really mean to do that, but that is the intent, if this were to be turned into a treaty, that we would be giving up our power. Secondly, I don't know how we are going to explain it to our colleagues in the House of Representatives. The Presiding Officer served in the House. I served in the House. Senator Menendez served in the House. The last time I checked, we imposed these sanctions because a bill passed both the Senate and the House, and now we are saying that the approval process is going to ignore the House of Representatives, solely going to be a matter for the U.S. Senate on a ratification of a treaty? That does not seem like a workable solution. My point is to concur in the observations of Senator Corker. This is clearly an amendment that if it were adopted would say we are not going to have an orderly review process for Congress to be able to weigh in. We are not going to be able to get the material to set up the logical review by the Senate Foreign Relations Committee, that we are going to lose all the benefits of this bipartisan bill if this amendment were to be approved. For all those reasons, I would urge my colleagues to reject this amendment. I think I have about 1 minute remaining. I will be glad to yield that to Senator Johnson, if he would like to have a minute and a half to try to rehabilitate his amendment.

Mr. CARDIN. Mr. President, I ask for the yeas and nays.

Mr. CARDIN

Mr. CARDIN. Mr. President, I ask unanimous consent to speak for up to 2 minutes.

Mr. CARDIN. Mr. President, I want to thank Senator Kaine and Senator Corker. This is the second day that we have been debating the nuclear oversight bill. Members have had a chance to express their concerns. They have had a chance to put forward amendments, to file them at this particular moment. We have been working with several Members to try to see whether we can work out an orderly way for the consideration of those amendments. I want all of the Members to know we are open for business. Senator Corker has been meeting with Members, and I have been talking to Members. We hope we can find a way to move this bill forward tomorrow for the consideration of amendments. I would urge Members--we are not encouraging amendments because we think we took up these issues in the committee and we worked out a bipartisan bill to get this done. But please talk to us so we can try to work out in an orderly way the consideration of amendments starting tomorrow and hopefully finish the bill shortly thereafter. I yield the floor.

Mr. CARDIN

Mr. CARDIN. Mr. President, I wish to thank and congratulate Senator Corker for his extraordinary work in reaching this moment where we have brought to the floor of the Senate a bill that deals with congressional oversight of the nuclear discussions and agreements taking place between the P5+1, our negotiating partners in Iran. It was just 3 weeks ago that the framework was announced by the White House and that Senator Corker and I started our discussions to see whether we could find a common path forward on a bill which, to say the least, was very controversial; a bill which the President of the United States had threatened to veto; a bill in which there were Democrats and Republicans lined up on different sides of this issue, and it appeared just about impossible that we would be able to reach a bipartisan agreement on a path forward for the legislation. Senator Corker exercised the greatest leadership and diplomacy. He mentioned all the members of our committee. Each of those members has pretty strong views on this issue. This was not a simple matter of people saying: Gee, I will just yield to the thoughts of others. The only way we could reach this moment was to ask and solicit and listen to each member of the committee, and that is what Senator Corker did. He encouraged me to do the same in regard to not just the Democratic members, because Senator Corker talked to some of the Democratic members and I talked to some of the Republican members. We had to have that type of confidence. I again congratulate Senator Corker on his leadership. It has been a real pleasure to work with him. I am proud that we bring this bill forward with a 19-to-0 vote from the Senate Foreign Relations Committee. We have a long history in this country of putting aside partisan differences on foreign policy issues. I know we often quote from one of our former colleagues, but I think it is worth putting into the Record the comments of Senator Arthur Vandenberg, Jr. He was a Republican Member of this body who said 63 years ago: To me ``bipartisan foreign policy'' means a mutual effort under our indispensable two-Party system, to unite our official voice at the water's edge so that America speaks with maximum authority against those who would divide and conquer us and the free world. It does not involve the remotest surrender of free debate in determining our position. On the contrary, frank cooperation and free debate are indispensable to ultimate unity. In a word, it simply seeks national security ahead of partisan advantage. Mr. President, that is exactly what the Foreign Relations Committee did. We had a very robust debate, there were many different views, but at the end of the day we spoke with unity. In speaking with unity, our country today is stronger, and that is exactly where we needed to be. What we are trying to do, and I think as a result of the actions of the Senate Foreign Relations Committee--and I hope it will be approved by this body and by the House and sent to the President for signature-- we are in a stronger position to accomplish our goal. Our goal is pretty simple, to prevent Iran from ever acquiring a nuclear weapon because we know that is a game changer in the region--a game changer in regard to not just one country in that region but to just about every country in that region. Their security is threatened and the U.S. security is threatened. So what we did in the bill that we bring forward to you is a compromise--a compromise. Each of us gave and listened and we found common ground. We could use more compromise on the issues that confront this country in the work we do. I would hope my colleagues would look at how we worked out these issues and use it as a model for other opportunities to move forward on issues that are important. Senator Corker pointed out why we are here--why we had a bill for congressional review. It started in the 1990s, when Congress passed sanctions against Iran because we saw, at the time, that Iran was developing the nuclear capacity to develop a nuclear weapon, and we said that could not happen. We imposed sanctions against Iran. Congress did this on several occasions in an effort to prevent Iran from becoming a nuclear weapons state, telling them there would be an economic price to pay until they changed course. Administrations--including President Obama's administration--worked with the international community and we were able to get U.N. sanctions. Congress's action was responsible for leading Iran to being willing to negotiate, and that is where we are today. Only Congress-- only Congress--can permanently remove those sanctions or permanently change those sanctions. So Congress must be involved in the sanctions and in the discussions. That is exactly what this legislation does. It provides an orderly process for us to review any agreement reached by the President and our negotiating partners with Iran. No congressional action will take place until and unless the President submits an agreement that he has made with our negotiating partners and Iran. The April 2 framework that was recently announced is not an agreement and is not subject to review. There would be a 30-day review period, during which Congress would have the opportunity to review the agreement. No sanctions or additional sanction relief could be imposed during that 30-day period. If you read the April 2 framework, the President has made it clear that Iran will only get sanction relief if they earn sanction relief, if there is concrete progress made in dismantling their nuclear program. It is hard to believe that could take place within 30 days. So this 30-day period is a very reasonable period for Congress to be able to review any agreement. As Senator Corker pointed out, all information--all information-- would be presented to us, and we would have an opportunity for full hearings and debate as to what we should do. It would follow the regular congressional order as far as committee hearings and potential action on the floor of the Senate and the House. Senator Corker pointed out the options we would have. We could approve the agreement, we could disapprove the agreement, we could pass legislation affecting the sanctions, we could take whatever action we think is appropriate, but no action is required. The agreement can commence without congressional action. If we do take congressional action, the President has the prerogative of a veto, and if the President vetoes, we have the prerogative of an override of the veto. That is how the checks and balances system of our country should operate. There is a second major component to this legislation and that is for the oversight of an agreement after it is reached; that is, there would be a quarterly certification by the President of the United States to Congress that Iran is in compliance with the agreement. If there is a material breach, it would trigger an expedited process so Congress could act, that we could not only snap back sanctions that may have been relieved, but if appropriate, we could impose additional sanctions if Iran had a material breach of the agreement. That is very important because I think we all agree, if we are going to have an effective agreement, that agreement must give us time before Iran can become a nuclear weapons country; that we can, through full inspections, determine if they have breached the agreement because, quite frankly, no agreement is going to be based on trust because we don't trust Iran. It is going to be based upon inspections and being able to confirm their compliance with the agreement. If they don't comply with the agreement, we need to make sure we have adequate time and take adequate steps to prevent them from becoming a nuclear weapons state. This review process and an expedited process in Congress puts Congress in the position of working with the administration to make sure we take those effective steps. As Senator Corker pointed out, there are other issues with Iran in addition to the nuclear proliferation issues. We have serious concerns about Iran. It sponsors terrorism. Its human rights violations against its own citizens is horrible. Its ballistic missile program is of great concern. The threats against Israel and other countries in that region are all of direct interest to the United States. So, in this legislation, we provide for regular reports twice a year to the Congress of the United States about the activities that Iran is participating in, in regard to terrorism and human rights. I call our colleagues' attention to the detailed requirements, on pages 37 and 38 of the bill, concerning issues about whether Iran's financial institutions are engaged in money laundering, whether Iran is advancing its ballistic missile program, an assessment of whether Iran has directly supported, financed, planned or carried out any terrorism against the United States, ``whether, and to the extent to which, Iran supported acts of terrorism . . . all actions, including international fora, being taken by the United States to stop, counter, and condemn acts by Iran'' involving terrorism; ``the impact on the national security of the United States and the safety of United States citizens as a result of any Iranian actions reported under this paragraph. . . . '' It is all required that that information be given to us because we may want to use that for other strategies against Iran. An amendment that was added requires ``an assessment of whether violations of internationally recognized human rights in Iran have changed, increased, or decreased, as compared to the prior 180-day [period].'' We are going to monitor their human rights record, and we will have that information. So, yes, we are concerned about issues beyond nuclear proliferation, but this agreement that is now being negotiated by the President deals with preventing Iran from becoming a nuclear weapons state. It is clear. I want to underscore this because Senator Corker was very strong to make sure it got into the bill. It says that ``United States sanctions on Iran for terrorism, human rights abuses, and ballistic missiles will remain in place under an agreement. . . .'' We are not talking about actions we have taken against Iran for terrorism or human rights violations. That is a separate issue--a major concern to us. What we are talking about is how do we implement oversight and review an agreement concerning nuclear weapons programs. And lastly, we make it very clear in this agreement that ``the President should determine the agreement in no way compromises the commitment of the United States to Israel's security, nor its support for Israel's right to exist.'' Israel is a key ally of the United States and our friendship is deep. Our commitment is solid. We make that very clear in the bill that is before you. Let me conclude with two additional points--one dealing with the amendment process. As Senator Corker pointed out, we asked Members who believe they can approve this bill to come forward. Let's see the amendments and try to work with you on the amendments. Let's maintain the bipartisan cooperation we have. Let's maintain a strong bill that accomplishes its purpose. Come down and let us take a look at it. Remember, we have a lot of strong views in the Senate Foreign Relations Committee and we came together. Let's keep that same spirit, and I would just urge those who may have amendments to come on down and let us see them. We have today and up to before next Tuesday. Share them with us so we have an opportunity to keep the unity we have. Then, lastly, I just want to join where Senator Corker began, and that is to thank the incredible effort that took place on behalf of this bill. Senator Corker already mentioned all my colleagues who were involved here. Senator Menendez and Senator Kaine are both on the floor. On the Democratic side, they are the authors of this bill. They are the ones who drafted it. They are the ones who are responsible for why we are here today--from the Democrats. I thank both of them. From the beginning they said: We want a process to review. We are not talking about the merits. The merits are something we will pick up later. We want to preserve the normal prerogatives of the Senate, and we want to keep politics out of it. That was their intent from day one. Quite frankly, working with Senator Corker, that is what I carried out in my negotiations with Senator Corker; to maintain that balance that was the intent of the legislation. So I thank both of them and the other members of our committee who were involved. Lastly, on a point of personal privilege right now, because I might forget to do this later, I want to thank Jodi Herman of our staff and Margaret Taylor, Algene Sajery, and Chris Lynch for the extraordinary amount of time they put in. I want to thank President Obama. I want to thank President Obama for giving me his time so I understood what he was trying to achieve and how we could work together in order to achieve the objectives of the United States, and I thank Katie Fallon and Denis McDonough of his staff for the work they put in so we could reach this moment. With that, Mr. President, I yield the floor.

Mr. CARDIN. Mr. President, I thank Senator Kaine. I appreciate his outline of how this legislation went from unlikely to have much impact, because we didn't have the consensus and the numbers necessary to get it through the finish line. It would have had a very, very difficult time getting through the committee--let alone the floor of the Senate, the House, and signed by the President--but for how people listen to each other. So I am pleased the two of you went on the trip together because I think we need to do more of that in the Senate. Senator Kaine and Senator Corker are both individuals who have a deep respect for the proper role of the Senate, the Senate Foreign Relations Committee, and the Senators. I am proud to serve with both of you. I am pleased to see that we have found ways that we really can bridge differences in order to achieve a common purpose. We were not interested in scoring political points. We are interested in doing what our responsibility is all about. So Senator Corker is now probing a way in which we can reauthorize the State Department, the role that our committee should have, and, therefore, to directly deal with our responsibilities in the Senate through the appropriate committee. I think all of these are efforts with which, working together, we can have the Senate perform the proper role in this government of ours to make sure that the legislative branch weighs in where it is appropriate on foreign policy issues. I thank Senator Kaine and Senator Corker for giving us a good model as to how legislation should be developed. I was proud to work with Senator Corker so that we could get the White House and get some of our Members who didn't quite share the enthusiasm of this legislation to a place where they are comfortable in supporting the bill--not only supporting the bill but enthusiastically supporting the bill in order to get it done. I also appreciate your mentioning Warren Weinstein. Warren Weinstein was a resident of Maryland. His wife, Elaine, I talked to on frequent occasions. She is a very brave woman and did everything she could to bring her husband home. Warren Weinstein was a USAID worker in Pakistan. He did that because he wanted to do good for the world. He was very well respected, carrying out his mission in a most professional way. He was on his way home, basically, when he was kidnapped in 2011 by Al Qaeda. As we know, the President announced today that he was killed in January, along with an Italian national who was also serving. Our thoughts and prayers first go out to the families. Our hearts are broken. Senator Mikulski, Congressman Delaney, and I have frequently met with the family over the years to try to put a spotlight at the appropriate time in dealing with the hostage situation. It is very difficult to deal with a hostage situation when it is not a government that is holding the person, and it makes it much more complicated. But I do think that in addition to doing everything we can to keep our Americans safe who go to these countries on our behalf, using diplomacy, basically, and developing assistance for a more stable country, we have to do everything we can to keep them safe. We have to recognize the risk factors in circumstances such as this. We have to have strategies to do everything we possibly can to bring these people back home safely. I know you all share that. But then we have to make the world a little bit safer, and that is what this review statute is all about. I do believe it does give us a better opportunity to get the right agreement from Iran that would prevent it from becoming a nuclear weapons power, which is a game changer for the security in that region. I wish to mention just one other example. There was an enormous human tragedy when another boat carrying desperate refugees and migrants capsized in the Mediterranean Sea. In the most recent instance over 850 men, women, and children have died. Now these are very desperate situations when you take these dangerous voyages. The number of people who have died in the Mediterranean--in 2014 we know that well over 218,000 refugees and migrants crossed the Mediterranean Sea, many fleeing violence, conflicts, and persecution in Syria, Iraq, and Eritrea. We also know that Yemen is involved here. Last year's death total surpassed 1,750 victims. I mention that because what Iran is doing in this region is adding to the migration and refugee issues. Its support of terrorism, its involvement in Yemen, its involvement in Syria, and its involvement in other countries are causing people to take desperate action in order to stay safe. So we are here today to do something about that. It is just another motivation for us to do everything we can to provide the types of policies that are necessary in that region of the world to make people safer and to have sustainable countries that can protect all of their citizens. I suggest the absence of a quorum.

Mr. CARDIN

Mr. CARDIN. Mr. President, I rise today to introduce the Supporting Colorectal Examination and Education Now, SCREEN, Act. This legislation promotes access to colorectal cancer screenings in an effort to help prevent colorectal cancer and save lives. Colorectal cancer affects far too many Americans. The American Cancer Society, ACS, estimates that 1 in 18 Americans will be diagnosed with colorectal cancer in 2015, totaling an estimated 133,000 new cases. Colorectal cancer is expected to take the lives of nearly 50,000 Americans in 2015, making it the second leading cause of cancer deaths in this country. Fortunately, colorectal cancer is also highly preventable, and colorectal cancer screening tests rank among the most effective preventive screenings available. Colonoscopy screenings are different from other types of preventive or screening services because pre- cancerous polyps found during a screening can be removed during the same visit, before they progress to colorectal cancer. Early detection and intervention are key to preventing colon cancer. A 2012 study in the New England Journal of Medicine found that removal of precancerous polyps during a screening colonoscopy may prevent up to 53 percent of colorectal cancer deaths. The need to address barriers to colorectal cancer screening, particularly in the Medicare population, is clear. The Medicare population makes up approximately two-thirds of all new cases of colorectal cancer. However, according to the Centers for Medicare & Medicaid Service, CMS, only about half of Medicare beneficiaries have had a colorectal cancer screening test, and less than two-thirds of Medicare-aged adults are up to date with recommended screenings. The Centers for Disease Control and Prevention, CDC, American Cancer Society, ACS, American College of Gastroenterology, ACG, and more than 200 national, State and local organizations have committed to work toward eliminating colorectal cancer through a national goal of screening 80 percent of eligible adults in the United States for colorectal cancer by 2018. Currently, Medicare waives cost-sharing for colorectal cancer screenings recommended by the U.S. Preventive Services Task Force, USPSTF, including screening colonoscopies. However, if the doctor finds and removes a pre-cancerous polyp during a screening colonoscopy, the procedure is no longer considered a ``screening'' by Medicare, and the beneficiary is required to pay the Medicare coinsurance. Because it is impossible to know in advance whether polyps will be found and removed during a screening colonoscopy, Medicare beneficiaries do not know whether the procedure will be fully covered until it is over. In February 2013, the administration announced that private insurers participating in State-based health insurance exchanges are required to waive all cost-sharing for screening colonoscopies during which a polyp is removed. Similarly, the SCREEN Act would waive Medicare's cost- sharing requirement for screening colonoscopies during which polyps are removed in order to prevent the development of colorectal cancer. In addition, the SCREEN Act would waive cost-sharing for follow-up colonoscopies necessary to complete the ``screening continuum'' following a positive finding from another recommended colorectal cancer screening test. The SCREEN Act also seeks to improve coordination of care and promote other important age-based recommended screenings for Medicare beneficiaries, such as Hepatitis C virus, HCV, screening, by creating a demonstration project. The demonstration project would allow reimbursement for an office visit or consultation so that a Medicare beneficiary may sit down and discuss the screening with a doctor prior to the colonoscopy procedure. According to the National Institutes of Health, ``fear of the procedure itself'' is a barrier to increasing colorectal cancer screening utilization rates. This pre-procedure visit would allow providers to allay patient anxiety about the procedure, address any questions related to the colonoscopy, assess the patient's family history and risk factors for developing colorectal cancer, and educate the patient about the importance of following the pre-procedure instructions. In addition, this visit would provide an opportunity to educate Medicare beneficiaries about the importance of HCV screening. The CDC and the United States Preventive Services Task Force recommend a one-time HCV screening for all individuals born between 1945 and 1965, and a recent study suggests offering the HCV screening in connection with colonoscopies may be an effective means of increasing HCV screening rates. Finally, the SCREEN Act would provide incentives for Medicare providers to participate in nationally recognized quality improvement registries to ensure that Medicare beneficiaries are receiving the quality screening they deserve. I urge my colleagues to join me in supporting the SCREEN Act, in order to help prevent colorectal cancer and save lives. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CARDIN

Mr. CARDIN. Mr. President, I rise today to introduce the Supporting Colorectal Examination and Education Now, SCREEN, Act. This legislation promotes access to colorectal cancer screenings in an effort to help prevent colorectal cancer and save lives. Colorectal cancer affects far too many Americans. The American Cancer Society, ACS, estimates that 1 in 18 Americans will be diagnosed with colorectal cancer in 2015, totaling an estimated 133,000 new cases. Colorectal cancer is expected to take the lives of nearly 50,000 Americans in 2015, making it the second leading cause of cancer deaths in this country. Fortunately, colorectal cancer is also highly preventable, and colorectal cancer screening tests rank among the most effective preventive screenings available. Colonoscopy screenings are different from other types of preventive or screening services because pre- cancerous polyps found during a screening can be removed during the same visit, before they progress to colorectal cancer. Early detection and intervention are key to preventing colon cancer. A 2012 study in the New England Journal of Medicine found that removal of precancerous polyps during a screening colonoscopy may prevent up to 53 percent of colorectal cancer deaths. The need to address barriers to colorectal cancer screening, particularly in the Medicare population, is clear. The Medicare population makes up approximately two-thirds of all new cases of colorectal cancer. However, according to the Centers for Medicare & Medicaid Service, CMS, only about half of Medicare beneficiaries have had a colorectal cancer screening test, and less than two-thirds of Medicare-aged adults are up to date with recommended screenings. The Centers for Disease Control and Prevention, CDC, American Cancer Society, ACS, American College of Gastroenterology, ACG, and more than 200 national, State and local organizations have committed to work toward eliminating colorectal cancer through a national goal of screening 80 percent of eligible adults in the United States for colorectal cancer by 2018. Currently, Medicare waives cost-sharing for colorectal cancer screenings recommended by the U.S. Preventive Services Task Force, USPSTF, including screening colonoscopies. However, if the doctor finds and removes a pre-cancerous polyp during a screening colonoscopy, the procedure is no longer considered a ``screening'' by Medicare, and the beneficiary is required to pay the Medicare coinsurance. Because it is impossible to know in advance whether polyps will be found and removed during a screening colonoscopy, Medicare beneficiaries do not know whether the procedure will be fully covered until it is over. In February 2013, the administration announced that private insurers participating in State-based health insurance exchanges are required to waive all cost-sharing for screening colonoscopies during which a polyp is removed. Similarly, the SCREEN Act would waive Medicare's cost- sharing requirement for screening colonoscopies during which polyps are removed in order to prevent the development of colorectal cancer. In addition, the SCREEN Act would waive cost-sharing for follow-up colonoscopies necessary to complete the ``screening continuum'' following a positive finding from another recommended colorectal cancer screening test. The SCREEN Act also seeks to improve coordination of care and promote other important age-based recommended screenings for Medicare beneficiaries, such as Hepatitis C virus, HCV, screening, by creating a demonstration project. The demonstration project would allow reimbursement for an office visit or consultation so that a Medicare beneficiary may sit down and discuss the screening with a doctor prior to the colonoscopy procedure. According to the National Institutes of Health, ``fear of the procedure itself'' is a barrier to increasing colorectal cancer screening utilization rates. This pre-procedure visit would allow providers to allay patient anxiety about the procedure, address any questions related to the colonoscopy, assess the patient's family history and risk factors for developing colorectal cancer, and educate the patient about the importance of following the pre-procedure instructions. In addition, this visit would provide an opportunity to educate Medicare beneficiaries about the importance of HCV screening. The CDC and the United States Preventive Services Task Force recommend a one-time HCV screening for all individuals born between 1945 and 1965, and a recent study suggests offering the HCV screening in connection with colonoscopies may be an effective means of increasing HCV screening rates. Finally, the SCREEN Act would provide incentives for Medicare providers to participate in nationally recognized quality improvement registries to ensure that Medicare beneficiaries are receiving the quality screening they deserve. I urge my colleagues to join me in supporting the SCREEN Act, in order to help prevent colorectal cancer and save lives. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CARDIN

Mr. CARDIN. Mr. President, I wish to ask my colleagues to join me in recognizing April as National Minority Health Month. 2015 marks the 30th anniversary of this event, which provides us with an opportunity to celebrate the progress we have made in addressing minority health issues and health disparities in our country and to renew our commitment to continue this critically important work. Minorities now make up more than 35 percent of the American population and that number is expected to rise in the future. However, study after study has shown that minorities, especially African Americans and Latinos, continue to face significant health disparities in diseases such as diabetes, HIV/AIDS, and asthma. Currently, over 26 million Americans suffer from diabetes. But African Americans are twice as likely to be diagnosed with, and to die from, diabetes compared to non-Hispanic whites. African Americans are also more than 2\1/2\ times more likely to suffer from diabetes-related end-stage renal disease than non-Hispanic whites, and are more likely to have other complications, such as lower extremity amputations. Obesity, which increases the risk of developing diabetes, is also more prevalent in minority communities. Nearly 4 out of 5 African- American women are overweight or obese, as well as 78 percent of Hispanic men. It is no coincidence that, nationwide, 27.2 percent of African Americans and 23.5 percent of Latinos lived below the Federal poverty line in 2013. Limited means and the lack of access to fresh fruits and vegetables in ``food deserts'' prevent many people from accessing the nutrition they need to lead healthy lives. Those living in impoverished areas are also much more likely to be exposed to polluted air, which exacerbates respiratory conditions like asthma. According to the Department of Health and Human Services, in 2012, African Americans were 20 percent more likely to have asthma versus non-Hispanic whites. HIV and AIDS, which are especially prevalent in low-income neighborhoods with widespread drug use, continue to devastate minorities across the country. African American women are 23 times more likely to have AIDS than their white counterparts and Hispanic women are four times more likely to be infected. In Maryland, African Americans are diagnosed with HIV at more than 10 times the rate of white Marylanders. The role that access to resources, proper nutrition, and clean air plays in our well-being cannot be overstated. According to a 2012 report about Baltimore neighborhoods from the Joint Center for Political and Economic Studies, those living in higher-income parts of the city live, on average, nearly 30 years longer than their neighbors in impoverished areas. Fortunately, thanks to the Affordable Care Act, ACA, we have recently made health coverage more accessible and affordable than it has been in decades. By reducing the number of uninsured Americans across the country, the ACA is working to address health inequalities. Between 2013 and 2014, the percentage of uninsured Latinos dropped by 7.7 percent, and the percentage of uninsured African Americans fell by 6.8 percent. Also, as a result of the ACA, increased funding is available for community health clinics. Mr. President, 300,000 Marylanders, including more than 140,000 African Americans and 38,000 Latinos, are served by these clinics. Under the ACA, preventive services, which are critical to the early detection and treatment of many diseases that disproportionately affect minorities, are now free for 76 million Americans, including 1.5 million Marylanders. In 2011, African American women in Maryland died from cervical cancer at nearly twice the rate of white women. This disparity is simply unacceptable and illustrates the importance of access to preventive health care services: cervical cancer is preventable through regular screening tests and follow-up and, when detected and treated early, it is highly curable. In our country, we are incredibly fortunate to have the National Institutes of Health, NIH, which works tirelessly to improve the health of all Americans, and the NIH's National Institute for Minority Health & Health Disparities, NIMHD, has the specific mission of addressing minority health issues and eliminating health disparities. I am proud of my role in the establishment of the NIMHD, which supports groundbreaking research at universities and medical institutions across our country. This critically important work ranges from enhancing our understanding of the basic biological processes associated with health disparities to applied, clinical, and translational research and interventions that seek to address those disparities. Some examples of recent NIMHD-funded projects include exploring racial disparities in sudden infant death syndrome, SIDS, to inform health education interventions about safe infant sleep practices, which historically have been shown to be less effective among African Americans; evaluating a community-based intervention to promote follow- up among uninsured minority women with abnormal breast or cervical cancer screening results; and developing a culturally tailored lifestyle intervention to prevent diabetes among African American and Hispanic adults. Enhancing our understanding of the complex disparities across racial, ethnic, and other minority populations and their specific risk factors will help us develop better preventive health care, reduce long-term health care costs, and improve the quality of life for millions of Americans. Minority health disparities cost many of our constituents their health and even their lives, and they cost our health care system and economy, as well. A 2009 joint center study found that direct medical costs resulting from health inequities among minorities totaled nearly $230 billion between 2003 and 2006. With indirect costs such as lowered work productivity and lost tax revenue added to the equation, the tab amounts to more than $1.24 trillion. We owe it to our constituents to do everything in our power to fight for affordable, high-quality health care for everyone. One's ethnic or racial background should never determine the quality of his or her health or the length of his or her life. This month, let us renew our commitment to ensuring access to affordable, high-quality health care for all Americans, and pledge to do everything we can to eliminate health disparities in our country.

Mr. CARDIN

Mr. CARDIN. Mr. President, I wish to discuss an enormous human tragedy: another boat carrying desperate refugees and migrants capsized in the Mediterranean Sea and, in this most recent instance, over 850 men, women, and children have died. It is profoundly heartwrenching to view the anguished images of innocent refugees and migrants, men and women, old and young, who embarked on this desperate journey bound for a more hopeful future, but which instead ended in death on the Mediterranean Sea for so many people. In 2014, we know that well over 218,000 refugees and migrants crossed the Mediterranean Sea, many fleeing violence, conflict, and persecution in Syria, Iraq, Eritrea and elsewhere, traveling on overcrowded and unseaworthy boats. Last year, over 3,500 women, men, and children died or went missing in their desperate attempts to reach Europe. According to the International Organization on Migration, IOM, this year's death toll in the Mediterranean Sea is believed to have surpassed 1,750 victims already--a drastic spike when compared to the same period last year. During the first 3 weeks of April alone, more than 11,000 people have been rescued. This is a journey of unimaginable peril, and only the most despairing families with nothing to lose would sacrifice their lives in the hopes that this voyage will deliver an escape from misery. From Syria to Iraq, from South Sudan to Yemen, multiplying conflicts, gross human rights violations, statelessness, the effects of climate change, and food and water insecurity are all contributing to millions of people being forced from their homes in search of safety and survival. The international community is witnessing the enormous costs of unending wars and the failure to resolve or prevent conflict. The number of refugees, asylum-seekers and internally displaced people worldwide has, for the first time in the post-World War II era, exceeded 50 million people, according to the United Nations High Commission on Refugees, UNHCR. This massive increase is largely driven by the war in Syria, which is now in its fifth year. The Assad regime's ruthless attacks on Syrian civilians--compounded by horrific violence by armed extremists--has led to Syria's disintegration and massive internal and external displacement of its people. Europe, facing conflicts to its south in Libya, east in Ukraine, and southeast in Syria, Iraq and the Horn of Africa, is currently seeing the largest numbers of refugees and migrants arriving by boat across the Mediterranean. To confront this enormous challenge, European Council President Donald Tusk called on member states on Monday, April 20, to meet their funding commitments for Trident, the European Union's, EU, naval operation in the Mediterranean. EU leaders also agreed to meet on Thursday, April 23, to consider increasing resources for rescue operations and the 10-point action plan on migration proposed by the Joint Foreign Affairs and Home Council. The proposed plan would alleviate pressure on the member states receiving the majority of those rescued and also aims to combat trafficking and smuggling. The EU's proposed 10-point plan is an important first step, but a bold and comprehensive response is urgently needed. First, rescue at sea is and should be the top priority. It is a moral imperative based on European values, as well as a fundamental principle of maritime law. A robust search and rescue operation, comparable to Mare Nostrum, that focuses on saving lives must be reinstated. While the reinforcement of the Joint Operations in the Mediterranean is welcomed, border surveillance operations are not an answer to this crisis. Second, there needs to be a credible and firm commitment from countries both in Europe and across the globe to resettle significant numbers of refugees. Moreover, efforts to encourage legal alternatives to such dangerous voyages must be pursued. These include enhanced family reunification, private sponsorship programs, and study and labor migration programs for people in need of international protection. Finally, I urge the U.S. Government to provide robust assistance, and to work closely with our European partners, so that we might all rise to the demands presented by this humanitarian crisis and commit to the measures needed to prevent tragedies such as the drowning deaths of 850 men, women, and children off the coast of Libya this past weekend.

Mr. CARDIN

Mr. CARDIN. Mr. President, today is Earth Day, and on Earth Day it is important for all of us to reflect not only on how human activity impacts the environment but also how those impacts on the environment affect people. Unfortunately, one of the impacts of climate change that is increasingly being documented by the military and intelligence communities is that climate change is a threat to our national security. This threat takes many forms. Perhaps the simplest manifestation is the threat of sea level rise on the Pentagon's 700 costal facilities. Naval Station Norfolk in Virginia is the largest naval base in the world, but the station and the surrounding community is being inundated by coastal flooding from sea level rise. Norfolk is experiencing high tides 1\1/2\ feet higher than it did a century ago. This has already caused the naval base to have to abandon some piers, but perhaps the real worry is how flooding could prevent sailors from reaching the base during a weather event. One local minister quipped to the Washington Post that the local church that is now up for sale faced the prospect of putting ``the tide chart on their Web site'' so people would know whether they could get to church. Norfolk and the Navy are exploring various solutions, including a costly flood gate proposal, but the reality is that Naval Station Norfolk and U.S. Navy infrastructure around the world is at threat around the world, and in a time of tightening budgets, that can have real impacts on military readiness. A similar problem exists in my home State, in Annapolis, home to the U.S. Naval Academy. NOAA's 2014 ``Sea Level Rise and Nuisance Flood Frequency Changes Around the United States'' found that ``Annapolis and Baltimore, Maryland, lead the list with an increase in number of flood days of more than 920 percent since 1960.'' NOAA goes on to conclude that sea level rise in the waters of the Chesapeake Bay is the cause of these ``nuisance flooding'' events. On Monday, I visited the Patuxant River Naval Air Station in Southern Maryland on the western shore of the Chesapeake Bay. I raised the issue of how sea level rise is expected to affect the important work this installation does to ensure our Navy's defense preparedness and aircraft testing and what sort of preparation and mitigation work they were doing to meet these imminent challenges. Critical to the function of Pax River's operations is that the base be located at sea level, so if sea level is changing, even by just a few feet, they have to account for these changes and essentially raise the base. Fortunately, the Navy is already putting a lot of thought into this issue; however, the infrastructure adaptation and mitigation projects that are essential to keeping our military prepared are coming at the expense of the taxpayer. Climate change is also a threat to national security because it can serve as a threat multiplier. For as long as there have been humans, there has been conflict over resources, especially when those resources are scarce and essential. Many national security and defense experts have commented on how climate change's impacts on food production, freshwater resources, and the destruction of critical infrastructure is contributing to political instability in a number of countries, particularly in developing countries where political leadership is already tenuous. As former colonel and current Department of Defense consultant Pete Newell put it, ``As a precursor to conflict, lack of access to basic human needs is a major driver and it's only getting worse.'' Prolonged drought and other serious environmental disasters are also made more likely in a warming world, and these kinds of conditions can overwhelm governments and cause government collapse. The potential of conflict, radicalism, and terrorism are heightened when states fail. Former Chairman of the Joint Chiefs of Staff, Michael Mullin, was quoted in the DOD's 2010 Quadrennial Defense Review: The scarcity of and potential competition for resources . . . compounded by the influx of refugees . . . creates conditions of hopelessness that could lead to failed states and make populations vulnerable to radicalization. CNA Corporation's Military Advisory Board issued a 2014 report titled ``National Security and the Accelerating Risks of Climate Change ``calling for political leadership to address the causes and impacts of climate change: The national security risks of projected climate change are as serious as any challenges we have faced . . . .Political posturing and budgetary woes cannot be allowed to inhibit discussion and debate over what so many believe to be a salient national security concern for our nation. Scholars at U.C. Santa Barbara and Columbia University have shown how Syria is an example of how climate change can help create conditions that lead to conflict. The ongoing tragedy of ISIS cannot be explained by any one single cause, but studies are pointing to climate change as an important factor. Between 2006 and 2010, Syria experienced its worst drought in decades. Reportedly this caused crop failure on 60 percent of Syria's arable land and the country lost 8o percent of its head of cattle. Rural farmers had nowhere to go but to Syria's cities. Syria's Government, which was already dealing with 1 million displaced people from Iraq, was overwhelmed by an influx of 1 million people internally displaced by drought. As we know all too well from recent history, failed states and the chaotic conditions within them are breeding grounds of terrorism and radicalism such as that practiced by ISIS. Climate change helped create stresses on the Syrian Government it could not handle, and its collapse has helped lead to the emergence of ISIS. Leaders and experts attribute other global conflicts to climate change. Ban Ki-moon holds that violence in Darfur was sparked by a decline in rainfall that devastated cattle herds. Others believe that the 2011 Arab spring relates to heat waves that forced cereal-exporting countries to take grain off the global market. A severe drought in the Horn of Africa has starved off tens of thousands of Somalis, and many more are on the brink of starvation in crowded refugee camps nearby. This displacement and desperation can only compound other crises and issues, such as civil conflict, fragile societies, and underdevelopment. Many Pacific Island nations, such as Kiribati and Tuvalu, are being swallowed up by the ocean. While no single extreme weather event can be attributed to climate change, and the Earth has certainly experienced hurricanes and cyclones since the dawn of time, what is worth noting is the trend in increased intensity and frequency of extreme weather events is clear. Since 2000, there have been 18 category 5 hurricanes and cyclones--18 storms in the last 14 years. The previous 18 category 5 storms occurred over a 39- year period from 1961 to 2000. In other words, the phenomenon is becoming a more common occurrence in our world. Last month, Cyclone Pam quite literally leveled the island nation of Vanuatu in the South Pacific. An overwhelming majority of the island's structures were destroyed. As the days went on and the media began to lose focus on the humanitarian crisis that was unfolding, access to food and freshwater became increasingly difficult for the people of Vanuatu. Foreign aid has slowly made its way to the stricken people of Vanuatu. The World Health Organization has noted a rise in illnesses related to lack of access to safe drinking water and exposure to mosquito-borne diseases. We must remain mindful of the pace and quality of recovery efforts in Vanuatu. Cyclone Pam has created a situation that could very easily destabilize the government if conditions on the ground in Vanuatu do not continue to improve. Extremist organizations feed on instability and chaos, and if the people of Vanuatu feel their government is not adequately addressing their needs in a timely fashion, concerned nations need to be vigilant of what forces may take hold. As climate change worsens, more countries may become vulnerable to its effects. Lack of food, water, and living space is displacing and killing people. To protect our national security, we need to listen to the Department of Defense and an emerging group of scholars who are showing the connections between climate change and conflict. That means heeding the warnings of humanitarian need, providing adequate aid to maintain stability during crises, and helping vulnerable countries build resilient infrastructure. But most fundamentally it means we need to fight climate change. Global warming pollution is harming our planet, harming nature, and endangering wildlife. But Earth Day is not just about the Earth; it is also about the people inhabit it. Let's remember the most severe human impacts of climate, its impacts on our national security, and avert the worst affects of global warming. Let's do justice to Earth Day and make fighting climate change a true national priority.

Mr. CARDIN

Mr. CARDIN. Mr. President, this Sunday, I will be honored and pleased to participate in a celebration of Bishop Walter Scott Thomas' 40th anniversary as pastor of the New Psalmist Baptist Church in Baltimore, MD. Bishop Thomas is one of the great leaders of the faith community in Baltimore. When he became pastor of New Psalmist Baptist Church in 1975, the congregation numbered 200 or so people. Today, the church has over 7,000 active members. There are Bible study classes held every day of the week, a 3-year discipleship program, leadership classes, and a school for future ministers. New Psalmist has a nationally televised broadcast, ``Empowering Disciples,'' that can be viewed locally on WJZ TV and on the Word Network. There are three worship services on Sundays and one on Wednesday. New Psalmist is committed to caring for community and for God's creation. Classes are held to teach members how to Go Green and conserve God's creation. Every year, the church helps over 500 families at Christmas, and feeds 100 disadvantaged families each month. Bishop Thomas is known as a pastor's pastor. He makes himself available as a mentor and source of strength for other pastors. Ten years ago, 28 sons and daughters of the New Psalmist Baptist Church who pastor churches across the Nation gathered and voted unanimously to elect Bishop Thomas as president of Kingdom Association of Covenant Pastors and to the office of bishop. Later that year, Bishop Thomas was elevated to the office of bishop and presiding prelate of The Kingdom Association of Covenant Pastors. That historic occasion was held at the First Mariner Arena in front of over 10,000 people. The Kingdom Association of Covenant Pastors is a newly established association consisting of men and women who have been influenced by the ministry of New Psalmist Baptist Church and Bishop Thomas. Bishop Thomas isn't content just to lead New Psalmist Baptist Church. He served as the president of the Hampton University Minister's Conference from 1999 to 2002. Under his leadership, conference attendance doubled. Bishop Thomas is also an inspirational author of books such as ``Spiritual Navigation for the 21st Century'' and ``Good Meat Makes Its Own Gravy''. He is the editor of ``Outstanding Black Sermons, Volume 4''. Bishop Thomas received his bachelor of science degree from the University of Maryland in economics. He earned his master of divinity degree from the Howard University School of Religion in Washington, DC and a doctor of ministry degree from Saint Mary's Seminary & University in Baltimore. In addition to his earned degrees, Bishop Thomas was bestowed with an honorary doctor of divinity degree from Virginia Seminary and Bethune Cookman College. Bishop Thomas and his wife and committed partner in ministry, Patricia, have three children, Joi, Walter Jr., and Joshua. New Psalmist Baptist Church has a rich history that spans over 100 years. The church was founded by Rev. Junius Gray in 1899 as the Right Independent Freewill Baptist Church. The first members--fewer than 20 people--met in the basement of a house on Russell Terrace. In 1901, the church purchased and moved to a two-story building at 1102 Parrish Alley. In 1911, the church, renamed Psalmist Baptist Church, purchased and remodeled property at Riggs Avenue and Woodyear Street. Reverend Gray pastored Psalmist Baptist Church for 47 years. Rev. Frederick C. Atkins was called to pastor Psalmist Baptist Church in June 1948. Under his leadership, membership grew and, because of that growth, the church purchased and moved to a new building at Druid Hill and North Avenues in 1954. The $56,000 mortgage was paid in full and burned in 1960 and the church was renamed the New Psalmist Baptist Church. Reverend Atkins served as pastor until his sudden death on March 16, 1974. Bishop Thomas, who was called to proclaim the Word of God in 1973 under the anointed leadership of Dr. Harold Carter, pastor of the New Shiloh Baptist Church in Baltimore, took over in 1975. In 1978, New Psalmist moved from Druid Hill and North Avenues to Cathedral and Franklin Streets. While in downtown Baltimore, New Psalmist grew tremendously. In 1994, New Psalmist broke ground and 2 years later, moved from Franklin and Cathedral Street to Old Frederick Road, a multi-million dollar worship center and ministry complex on 19 acres of land. The church continued to grow and in the fall of 2010, it moved into a brand new 4,000-seat worship facility. New Psalmist Baptist Church is a vibrant and welcoming place. Past attendees have included the Reverend Martin Luther King, Jr., the Reverend Jesse Jackson, the Reverend T.D. Jakes, former President Bill Clinton in 1998, and then-Senator Barack Obama in 2007. New Psalmist Baptist Church members walk in faith and work together for the common good. The church provides job training and a fitness and health ministry; donates school supplies to children; ministers to the deaf, homeless, and prisoners and their families; hosts blood drives; partners with 12 schools across Maryland to help students, parents, and school staff members succeed in their educational mission; and is an accredited organization under the United Nations Environment Program, which seeks to create global policies that will protect our planet. I encourage my Senate colleagues to join me in congratulating Bishop Thomas and his family and friends on his 40th pastoral anniversary at New Psalmist Baptist Church and sending along best wishes to all the members of New Psalmist who know, as President John F. Kennedy said at his inauguration 54 years ago, ``that here on earth God's work must truly be our own.''

Mr. CARDIN

Mr. CARDIN. Mr. President, pursuant to section 904 of the Congressional Budget Act of 1974 and the waiver provisions of applicable budget resolutions, I move to waive all applicable sections of that act and applicable budget resolutions for purposes of the pending amendment, and I ask for the yeas and nays.

Mr. CARDIN. This deals with the therapy cap on which we now have had 12 patches. It is almost the identical problem we have with the SGR, which is the underlying bill. It deals with seniors, Medicare beneficiaries, having access to therapy services, those who have had strokes, those who have serious issues and need rehab therapy. The cap never made sense in 1997 when it was put into effect. It was not the right policy. We have had bipartisan support to correct this as we have the SGR, and my underlying amendment does that. I ask my colleagues to support the amendment.

Mr. CARDIN. Mr. President, I call up amendment No. 1119.

Mr. CARDIN. Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. CARDIN. Mr. President, I have explained this amendment a little earlier. I ask unanimous consent that Senator Klobuchar be added as a cosponsor of the amendment.

Mr. CARDIN

Mr. CARDIN. Mr. President, I am hopeful--and most of us are--that soon we will be able to consider Medicare legislation that has passed the House of Representatives. It is probably best known as the SGR permanent fix. The SGR, which is a payment system that affects physicians under the Medicare system, is badly broken. On 17 previous occasions we have extended the current policy in order to make sure that physicians don't get an automatic cut that would deny many Medicare beneficiaries access to their physicians. These are pretty extreme measures. We all understand that it is time to permanently fix this--not just to eliminate the problem but to substitute a payment system that encourages physicians to provide high quality care and to deal with incentives that reduce the volume of care. And that is what the legislation that passed the House of Representatives does. It fixes the problem on a permanent basis. I am certainly hopeful we can get that enacted shortly because it already passed the deadline in regard to when the current patch expired. The bill also provides for an extension for the Children's Health Insurance Program. I do hope we can provide a longer extension than the 2 years that is provided in the House bill. I know there will be amendments offered to deal with that. I want to talk about an amendment I will be offering. I am not sure how much time will be available when a consent arrangement is entered into--which I hope will be soon--to consider this. It is an amendment I am offering with Senator Vitter. It is a bipartisan amendment. In previous Congresses, we have had many of my Republican colleagues who have joined me, we have had many of my Democratic colleagues. This should be, I hope, a noncontroversial amendment we can adopt. What it does is provide a permanent fix, as we do for physicians, for the physical therapy cap. I was in the House of Representatives in 1997 when we passed the Balanced Budget Act of 1997. I was on the Ways and Means Committee. I remember a chairman's mark coming to us. For the first time there was a cap placed on physical therapy services. I asked the chairman of the committee why was this being done. There was absolutely no policy reason whatsoever for imposing an arbitrary cap on the amount of physical therapy services. When you think about it, what it does is discriminate against those who have the greatest needs, those who have severe needs, those who have a stroke or traumatic brain injury or a spinal cord injury or managing Parkinson's disease, multiple sclerosis, arthritis. These are the individuals who run up against the cap and therefore could be denied the ability to deal with their needs, causing them, in many cases, to incur much greater costs. It makes no sense whatsoever, the therapy cap. For that reason, on a pretty regular basis, we have extended the revised policy. Twelve times we have done it to prevent the implementation of the therapy cap. We have acknowledged the negative consequences that would result from the imposition of such limits. In 2009, a report issued by the Medicare Payment Advisory Committee, MEDPAC, it was estimated that the therapy cap, if enforced without an exception process, could harm 931,000 Medicare beneficiaries. So we have an identical situation on the therapy cap as we do with the SGR physician reimbursement issue. That is why historically these two measures have always been moved together in tandem. What my amendment will do, cosponsored by Senator Vitter, is permanently fix the therapy cap issue by replacing the arbitrary limits on outpatient rehab therapy services with a more rational system which will require prior authorizations in certain circumstances. So we fix it permanently, as we do the physicians' reimbursement issue. I do not need to tell the Presiding Officer that we do not always have an opportunity to get legislation done here. I do think we have a chance--an excellent chance--that this bill we will be taking up is going to be signed by the President in the next few days. This is our opportunity to get several matters taken care of. The therapy cap cries out for that type of attention. So I would urge my colleagues, when this amendment comes up--it is cosponsored by a large number of my colleagues. As I already mentioned, Senator Vitter, who is my cosponsor. On the Democratic side, we have both Senator Reid and Senator Reed, Senator Whitehouse, Senator Hirono, Senator Casey, Senator Shaheen, Senator Menendez, Senator Mikulski, Senator Brown, Senator Stabenow, Senator Leahy, Senator Cantwell, Senator Bennet, Senator Booker. I could mention many of my Republican colleagues who have joined me in the past in the repeal of the therapy cap that are expressing an interest to help in this regard. I hope I will have their support on this amendment. Let's get it done. I think it is important for Medicare beneficiaries to know they are not at risk of losing the opportunity for their physician to treat them under the Medicare system. If we do not take care of the SGR problem, that is a real, real concern of Medicare beneficiaries, as to whether their physicians will be available for them. The same thing is true with the therapy cap. Let's remove this uncertainty. Let's get it fixed. We have the opportunity to do that. So I would urge my colleagues to support my efforts that are supported by AARP and many of the outside groups. Let's vote for the SGR bill but also vote for the amendment I will offer with Senator Vitter that will permanently fix the therapy cap. We will have a chance to do that I hope either later tonight or tomorrow. I yield the floor and suggest the absence of a quorum.

Mr. CARDIN

Mr. CARDIN. Mr. President, I would like to take a few moments to remember and honor the late Ivan E. Perlman, who served as the president of the Cantors Assembly of America from 1983 to 1985. Cantor Perlman was devoted to his faith, his family, his community, and his country. He served in the U.S. Marine Corps during World War II and received the Bronze Star for his heroism at Iwo Jima. He stood next to Lt. Roland B. Gittelsohn, the Marine Corps' first Jewish chaplain, at the dedication of the 5th Marine Division Cemetery on Iwo Jima in March 1945. He chanted a version of ``El Malei Rachamim,'' which is only sung for fallen U.S. soldiers. The division chaplain had asked Chaplain Gittelsohn to deliver the sermon at a joint service for all those who were killed in the epic battle, but some Catholic and Protestant chaplains objected, so three separate services were held. But three of the Protestant chaplains boycotted their own service to join Chaplain Gittelsohn. They sent copies of his sermon, ``The Purest Democracy'', extolling the cause of democracy and freedom and equality to the entire regiment. It was widely circulated, appearing in newspapers and magazines nationwide, and was read on the radio and into the Congressional Record. After the war ended, Cantor Perlman, who was born in Flushing, NY, married Muriel Herman in 1947 and completed his cantorial studies at the Jewish Theological Seminary in 1950. Cantor Perlman served congregations in Lyndhurst and Fairlawn, NJ; Tulsa, OK; Des Moines, IA; Providence, RI; Stockholm, Sweden; and Sarasota, Boca Raton, and Tamarac, FL. Along the way, he and his wife had four sons: Eli, Emanuel ``Manny'', Richard ``Rick'', and Josh. He trained all four of his sons in the cantorial arts, and they have carried on the family tradition is an exemplary way. Cantor Perlman was cantor emeritus at Temple Emanu-El in Providence, RI, where he served for 23 years. After he retired from Temple Emanu- El, at the age of 76, Cantor Perlman became the cantor at Temple Beth Kodesh in Boynton Beach, FL. Two years later, he was elected the congregation's Ritual Leader. Cantor Perlman conducted his last service there in 2005 and then he and his wife returned to Rhode Island, where he was a founder of the Friends of the Rhode Island School for the Deaf. Cantor Perlman was a life member of the Marine Corps League, the Jewish War Veterans, JWV, and the Knights of Pythias. He served as the JWV post commander in New York City, and the department chaplain in Iowa, Nebraska, Rhode Island, and Florida. He was the JWV's first national cantor. I mentioned that all four of Ivan Perlman's sons also became cantors. Manny Perlman is the cantor at Chizuk Amuno in Baltimore. He and his brother Eli--the religious leader of Congregation Beit Shalom in Monroe, NJ--participated in the October 24, 2011 dedication of the memorial at Arlington National Cemetery to the 14 Jewish military chaplains killed in action in World War II, the Korean war, and the Vietnam war. The memorial stands near separate monuments honoring fallen Protestant and Catholic chaplains that have been on Chaplains Hill since 1981 and 1989, respectively. Manny and Eli, like their father before them at Iwo Jima 66 years earlier, sang the ``El Malei Rachamim'' memorial prayer. Cantor Eli Perlman rose to the rank of captain in the Army's Special Forces during the Vietnam War era. He served in 1967 with CPT Morton Harold Singer, who was killed in a plane crash in 1968 on his way to lead Hanukkah festivities for American servicemen and women. Captain Singer's name is one of the 14 listed on the memorial. I would ask my Senate colleagues to join me in commemorating the wonderful life and legacy of Cantor Ivan Perlman and expressing our deepest condolences to his beloved wife Muriel; his son Rabbi Eli Perlman and his wife Lynne of East Brunswick, NJ; his son Cantor Emanuel Perlman and his wife Janice of Baltimore, MD; his son Rabbi Richard Perlman and his wife Kit of Coventry, RI; his son Cantor Josh Perlman and his wife Sherri of Germantown, MD; his sister Annette Ziegelstein of Baltimore, MD; his 13 grandchildren, 7 great- grandchildren; and all the other family and friends of this extraordinary man.

Mr. CARDIN

Mr. CARDIN. Mr. President, I wish to take a few minutes to talk a little bit about the amendments. I see Senator Portman on the floor, and I want to talk about amendment No. 899, which provides a deficit-neutral reserve fund for financial literacy. The two of us have been working for over a decade to increase the amount of savings for Americans, particularly retirement savings. We know that at early ages people need to understand the importance of saving. I offer this amendment, and Senator Portman has been very helpful to me in developing this amendment. I hope we will be able to act on this a little bit later. Amendment No. 364 deals with oral health, which establishes a deficit-neutral reserve fund relating to improving oral health care for pregnant women and children under Medicaid. Let me point out to my colleagues something they may not be aware of; that is, the oral health of a pregnant woman very much impacts the baby. Therefore, it is important pregnant women have attention to their oral health care needs. It is transmitted to their babies. I urge my colleagues to help us in supporting this effort. We have taken major steps to improve pediatric dental care. This is another step we can take by dealing with pregnant women. With regard to amendment No. 367, which sets up the deficit-neutral reserve fund to provide for voter reenfranchisement initiatives, once again I think my colleagues would be surprised to learn there is an estimated 5.85 million citizens who cannot vote as a result of criminal convictions and nearly 4.4 million of those have already been released from prison. We have 4.4 million people living in our community whom we expect to be productive citizens, and yet they have been disenfranchised from voting. Nationwide 1 in 13 African Americans of voting age have lost their right to vote, a rate four times the national average. I think that should give us all concern. Latino citizens are also impacted because they are disproportionately overrepresented in the criminal justice system. States have vastly different approaches to people voting with criminal convictions. This patchwork of State laws has caused confusion among the election officials and the public, sometimes resulting in the disenfranchisement of even eligible voters. So this amendment would provide much needed information into the hands of citizens returning from incarceration. I thank my colleague Senator Paul for his work with regard to this issue. The two of us are trying to find a way we can bring forward together a workable way that can help many who have been released from our prisons to have the right to vote and participate in our community. With regard to two amendments I am offering, amendments Nos. 439 and 440, both are related to my work as the ranking Democrat on the Small Business and Entrepreneurship Committee. One would set up a deficit reserve fund to deal with surety bonds. We have increased the limit of the surety bond by the SBA for small companies, which is very important. This would help make that a more permanent increase. The small companies, if they try to get a surety bond, have to pledge just about every one of their assets in order to get it. The SBA program helps with that credit so they can get affordable surety bonds without jeopardizing their ability to raise capital. This amendment calls attention to that need where we can help small businesses in this country. I also set up the deficit-neutral reserve fund for family funds within the small business investment company. I thank Senator Risch. He has been working on this issue, and I have been working with him on this issue. I think we will hopefully be able to come together on legislation that will increase the opportunities under the small business investment companies, which is, again, an avenue for capital for small companies, the driving force for job innovation in our community. This amendment would allow us again to focus on that legislation, which we hope to move through the Small Business and Entrepreneurship Committee. Lastly, I have offered a deficit-neutral reserve fund, amendment No. 900, concerning civic education. I have taken the floor to point out that, yes, we need to stress areas of excellence in the sciences, et cetera, in education, but let's not forget civic education. The bedrock of our country's values are based upon our civic system, and it is important that young people have a full understanding of civic education. This amendment would give us an opportunity, in this Congress, to move forward in promoting civic education for our school system. I yield the floor.

Mr. CARDIN

Mr. CARDIN. Mr. President, there is an estimated 5.85 million citizens who can't vote as a result of criminal convictions and nearly 4.4 million of those have already been released from prison. One out of every 13 African Americans of voting age have lost their right to vote. This amendment creates a deficit-neutral reserve fund in order to consider voter reenfranchisement initiatives. It is not descriptive as to the type. Senator Paul has introduced legislation on this subject. I have introduced legislation on this subject. I would hope this would be accepted by voice vote. It spells out in the amendment that we would like the U.S. attorney to inform during plea agreements the impact on defendants on their rights to vote, and that we would like to have data concerning the impact on minority populations. I hope we could move forward with this, and I would be willing to accept this on a voice vote.