Benjamin Cardin

Mr. CARDIN

Mr. CARDIN. Mr. President, Senators Smith, Lieberman, Durbin and I offer this amendment to grant Iraqi and Afghan special immigrant visa holders 6 months of eligibility for resettlement assistance when they arrive here in the United States. The United States currently provides up to 500 special immigrant visas, SIVs, to translators from Iraq and Afghanistan. To be eligible for an SIV, an individual from either of those two countries must: (1) faithfully serve as a translator with the U.S. military or chief of mission for at least a year and (2) be recommended to the program by a general, flag officer, or chief of mission. Visas are also issued for the spouse and dependent children of the SIV applicant. According to the Department of State, the U.S. issued 823 special immigrant visas to Iraqis this year. This included 432 visas for principal applicants and 391 visas for family members. As a matter of course, immigrants who come to the United States through the U.S. Refugee Admissions Program, including Iraqis and Afghans, are eligible for travel loans to help them get to the United States and for resettlement assistance once they arrive here. As a matter of course, the Federal Government tries to ensure that refugees are able to make the transition to a productive life in the United States by providing preliminary housing; school enrollment; and job training assistance. In spite of their service to our country, however, individuals from Iraq and Afghanistan who come here on Special Immigrant Visas receive no help with travel or readjustment. The U.S. Government does not keep track of how many of the 823 Iraqis admitted into this program actually have been able to travel to the United States. Experts believe that many translators with SIVs are still trapped in the region because they cannot afford the cost of the SIV fees and the plane tickets, especially if they are bringing members of their immediate family. Like refugees, many Iraqi and Afghan special immigrants face hardships that make it difficult to immediately adapt to their new home. Many have been forced to leave their homes and all their personal wealth in Iraq. Many have been forced to pay ransoms or have been robbed by criminals while fleeing the country. Moreover, while translators are paid well by Iraqi standards, that compensation doesn't amount to much for people trying to live in the United States. U.S. soldiers are paying for the plane tickets of their Iraqi interpreters out of their own pockets and acting as hosts and social workers for the individuals and families they are unofficially ``sponsoring'' when they arrive here in the U.S. This puts a heavy strain on our soldiers attempting to make their own tough readjustment to life back home. Special immigrant translators have no past experience obtaining work permits, Social Security numbers, bank accounts, and all the other documents and necessities of everyday life in this country. While special immigrant translators have valuable job skills, they often need further training and assistance with job placement. So Senator Smith and I have introduced this amendment to make these special immigrants from Iraq and Afghanistan eligible for 6 months-- of resettlement assistance. They have been the eyes and ears of our military, and they have saved so many American lives. They now have a target on their back because of their service to our country, and we need to protect them by granting them safe refuge in the United States. Frankly, I don't know how we could justify doing any less for people forced to flee their homes and their country because they have been helping us. This is just for 6 months--just enough to get them on their feet. I would note that the Congressional Budget Office, CBO, has estimated that the amendment would have no effect on direct spending under current law. The Iraqis and Afghans admitted under the special immigrant visa program have risked their lives to serve the United States. Without the assistance my amendment offers, they may remain trapped in the region or they may face a tougher time than is necessary or right adjusting to U.S. society. My amendment is a helping hand to people who have helped us. It's a way to repay them for their service by helping them to get here and begin living safe and productive lives in America. We have a strong obligation to keep faith with the Iraqis and Afghans who have worked so bravely with us--and have often paid a terrible price for it. I urge my colleagues to support this amendment. Mr. President, I yield the floor.

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

Mr. CARDIN. Mr. President, I ask unanimous consent to lay aside the pending amendment so I may call up amendment No. 3400.

Mr. CARDIN

Mr. CARDIN. Mr. President, the Russian Federation is, in many respects, a democratic state. Elections are held at regular intervals, local and national elective bodies meet and pass legislation. Referenda may be held on major issues, both at the national and local level, although this exercise may be reduced in the near future. But there is another consideration, in which the Russian Federation falls short in its democratic characterization. Freedom of the press is vital to the existence of a stable democratic state. Journalists must be able to openly report on all issues without fear of physical harassment or economic pressures. It is no accident that Napoleon said that four newspapers were more effective than a thousand bayonets. Therefore, it is regrettable that a number of Russian journalists have recently been murdered while reporting on subjects sensitive to the Russian government. Other have been beaten or otherwise prevented from doing their job. One recent victim was involuntarily incarcerated in a psychiatric hospital. Among those Russian journalists who have given their lives for their profession was Anna Politkovskaya, who reported extensively on the brutal war in Russia's secessionist region of Chechnya. Last week, friends, colleagues, and supporters of this courageous woman marked the one-year anniversary of her assassination. Politkovskaya was fearless in her efforts to bring correct and unbiased information on the Chechen war to her readers. This was a hard-earned counterpoint to the propaganda that much of the electronic media turned out daily on the conflict . . . when there was any mention of it at all. While other journalists reported on the conflict from afar, she routinely traveled to troublesome areas to view and describe first-hand the problems and issues in the war-torn region. She was one of few Russian reporters to actively engage the Chechen people in open dialogue, and she presented her findings in a fair and balanced manner. Her resume included a long list of awards and commendations for her investigative skills and professional competence. On October 7th, 2006, Ms. Politkovskaya was carrying groceries up to her Moscow apartment when, according to authorities, a gunman clad in black fired twice, shooting her once in the head. The murderer left the weapon at her side, a brazen gesture indicating, or meant to indicate, the commission of a contract murder. The Moscow newspaper Novaya Gazeta, where Ms. Politikovskaya worked, suggested the assassin or assassins had been following her closely and probably for a long time. Indeed, she was used to being watched and harassed. Numerous threats had already been made on her life, and at one point in 2001 she was forced to flee to Vienna. As Co-chairman of the Helsinki Commission, I would also note that Anna Politkovksya delivered memorable and compelling testimony on the conflict in Chechnya at Commission hearings on Capitol Hill in September 2003, and she was awarded the OSCE Parliamentary Assembly's annual Prize for Journalism and Democracy in that year. Recently, several suspects were arrested in connection with the murder. However, there are disturbing reports that the investigation has been marked by irregularities and apparent political considerations. For instance, Russian officials have been quick to assert that certain individuals and factions outside of the Russian Federation must have ordered the killing, although they have presented no credible proof. The fact is that Politkovskaya's work was extremely critical of corrupt and incompetent officials in the Russian government. At the time of her death, she had been working on a story about the torture of detainees in the jails of the pro-Moscow Chechen authorities. The true instigator of this murder might well reside in Moscow, London, Grozny, or Murmansk. In any event, Russian President Vladimir Putin stated during a visit last week to Germany that the investigation is ``on the right track.'' Let us hope that he is correct. And let us also remember the sacrifice and the journalistic integrity of Anna Politkovskaya and her colleagues in Russia and throughout the world, who risk life and limb every day to discern the truth and bring it to their fellow citizens.

Mr. CARDIN

Mr. CARDIN. Mr. President, I would like to engage the chair of the Commerce, Justice, Science, and Related Agencies Appropriations Subcommittee, my distinguished colleague from Maryland, in a colloquy concerning current Federal investments in space research programs that provide hands-on training experience for university students in the space science and engineering disciplines. The senior Senator from Maryland has a long history of successfully championing Federal investment in the National Aeronautics & Space Administration, NASA. That history of Federal investment has kept the United States at the forefront in exploring space and expanding our knowledge of the complex world in which we live today. This investment in NASA has also made NASA an important partner of our Nation's colleges and universities in providing unparalleled educational experiences in the critical areas of science, technology, and engineering. Scientific research is critical to innovation, yet federally funded science programs have not kept pace with our need to train future generations of scientists and engineers, thereby diminishing the research and training opportunities offered to university students across the country. In the last 40 years, U.S. suborbital experimental launches have decreased 80 percent--from 270 per year to 50 planned launches in 2007. Decreases in suborbital launches have resulted in a corresponding drop in the hands-on training opportunities our universities provide to undergraduate, masters, and doctoral students in hard sciences. These training opportunities are essential for recruiting and maintaining a highly trained workforce and for protecting our national preeminence in science, engineering, and exploration. The National Research Council released a report in June on ``Building a Better NASA Workforce and Meeting the Workforce Needs for the National Vision for Space Exploration.'' The report recommended that NASA focus more of its education budget on workforce-related programs such as the Graduate Student Researchers Program and other co-op programs. We know that some of NASA's programs involving sounding rockets, weather balloons, and small satellite launches are outstanding examples of worthy Federal investment that not only produces usable scientific data but provides outstanding hands-on learning opportunities for the next generations of scientists and engineers. Our investment in these programs has not kept pace with demand, and that is a problem we may want to address in future years as we consider the NASA budget. But before we make a decision about the right level of future Federal funding for these programs, I think it would be helpful for NASA, as one of our premier research institutions, to provide a report on its current investment in suborbital experimental launches and what will be needed in the future. I ask my colleague from Maryland, in her role as chairman of the Commerce-Justice-Science Appropriations Subcommittee, whether she would agree that it would be useful for NASA to study this issue and report back to the Congress on it in time for our consideration of the fiscal year 2009 CJS appropriations bill.

Mr. CARDIN. Mr. President, I rise today in strong support of H.R. 3093, the fiscal year 2008 Commerce-Justice-Science appropriations bill. I congratulate the senior Senator from Maryland, Ms. Mikulski, and the ranking member, Mr. Shelby, for their fine work in producing a bill that supports law enforcement, scientific research and technology, and enhances U.S. competitiveness. I would like to take a moment to note just a few of the bill's important provisions. This body recently passed the DOD appropriations bill supporting our troops overseas. The CJS bill supports our day-to-day warriors here at home. That is, our law enforcement officers. It funds the FBI, the DEA, and the ATF; Federal law enforcement agencies charged with protecting our citizens from internal terrorist threats, international drug cartels, and the rising threat of violent crime. Further, the bill provides for important victims' assistance programs for those whose lives are forever altered by violent crime. The CJS bill focuses on what is right with America by providing the resources needed to compete in the global economy. In my home state of Maryland, we are very fortunate to have The National Institute of Standards and Technology, or NIST. NIST assists industry in developing technology, modernizing manufacturing processes, ensuring product reliability, and facilitating rapid commercialization of products based on new scientific discoveries. Advances in avionic navigation systems and modern-day mammograms and semiconductors are indicators of the value of NIST. This bill provides $186 million above the administration's request for this significant agency that is crucial to U.S. competitiveness. Maryland is also fortunate to be home to several National Oceanic and Atmospheric Administration facilities. NOAA provides scientific, technical, and management expertise to promote safe and efficient marine and air navigation; assess the health of coastal and marine resources; monitor and predict the coastal, ocean, and global environments, including weather forecasting; and protect and manage the Nation's coastal resources. NOAA's significance is strongly felt in Maryland which, with the Chesapeake Bay, boasts 4,000 miles of coastal land. I am proud that this bill strongly supports NOAA through the provision of $4.21 billion. I join my colleagues to note the importance of NASA. NASA programs serve a number of functions, such as planetary exploration, pioneering aeronautic technologies, and space operations. This includes maintaining the space shuttle and supporting the International Space Station. Previous cuts, combined with the Columbia tragedy have strained NASA's resources. We must provide the necessary funding in order for America to remain a leader in space exploration, aeronautics, and planetary science. I applaud the committee for identifying this truth and supporting NASA. I would like to further thank the committee for supporting several key programs in Maryland, including: Chesapeake Bay Programs--The health condition of America's largest estuary is critical. Programs that assess, manage, and monitor bay ecosystems are imperative to preserving this vast natural resource. I thank my colleagues for recognizing the significance of focusing on the Chesapeake Bay. Funded bay programs will not only research viable restoration solutions but also focus on educating the public as to the importance of preserving the bay. These education efforts include the successful Chesapeake Bay Watershed Education and Training Program, or B-WET, that enhances environmental literacy in K-12 students. In addition, there are Chesapeake Interpretive Buoys that act as markers for the newly established Captain John Smith Chesapeake National Historical Trail, providing interpretive information for both trail users and educators while also providing essential science information about bay health. Maryland Eastern Shore Broadband Coverage--The bill provides funding for the continued construction of a broadband link between the Wallops Island Flight Facility and the Patuxent River Naval Station. This telecommunication enhancement will help pave the way for high-tech business and employment opportunities on Maryland's eastern shore. Maryland Radio Interoperability Project--The State of Maryland has committed to developing a radio interoperability Project that will link State and local law enforcement agencies. Cooperation and shared information between agencies will develop a more effective, efficient law enforcement system for the protection of our citizens. Baltimore Felony Diversion Program--The city of Baltimore has developed a pilot project designed to divert drug addicted offenders to long-term substance abuse treatment, aftercare, and monitoring as an alternative to detention and method of reducing recidivism. This bill is good for Maryland and good for America. I am honored to support it.

Mr. CARDIN

Mr. CARDIN. Mr. President, I rise today to express my concern regarding the most recent revelations of administration memos effectively authorizing the use of interrogation techniques that most certainly rise to the level of cruel, inhuman, or degrading treatment or punishment, if not to the level of torture. In 2002, senior administration officials prepared a classified memo that sought to provide legal cover for interrogation practices that would clearly violate U.S. and international law. This ``torture memo'' was leaked to the press after the Abu Ghraib scandal broke and, in turn, caused such outrage that it was quickly disavowed by the Justice Department. A new, improved, and sanitized legal memo on interrogation norms was then issued in December 2004. It now appears, according to a report published by the New York Times on October 4, that the Department of Justice's Office of Legal Counsel subsequently issued two additional legal memos that once again defined torture as ``not torture'' and--in an apparent effort to end run congressional efforts to close loopholes in the existing prohibition against cruel, inhuman, or degrading treatment or punishment--simply declared that no CIA interrogation practices violated that prohibition. I would also draw my colleagues' attention to a subsequent, highly troubling report published by the New York Times on October 11 stating that the Director of the CIA, Michael Hayden, has ordered an investigation of the inspector general, John L. Helgerson. The CIA inspector general is known to have undertaken critical examinations of CIA interrogation procedures. With these latest developments in mind, I would like to share three observations. First, the revelation that--even while the Abu Ghraib scandal was still being investigated--the administration was issuing additional secret memos authorizing abusive interrogation techniques, stands as the latest blow to the credibility of the United States as a global advocate for human rights and democracy. We simply cannot win hearts and minds around the globe if we are perceived to condone a violation of basic human rights, our own laws, and international law. As cochairman of the Helsinki Commission, I am painfully aware of the extent to which these policies have undermined our nation's reputation, and even our ability to build support for counterterrorism operations worldwide. Second, these revelations once again draw attention to this administration's breathtaking interpretation of the scope of executive power. In fact, the 2002 ``torture memo'' actually consisted of two parts. One part effectively sought to define torture as ``not torture.'' The second part addressed the authority of the President to authorize torture. In essence, that part of the memo described the Presidency--when the President is acting as Commander in Chief--as virtually unrestrained by the Congress, the Constitution, or the courts. The Justice Department's renunciation of the 2002 torture memo only appeared to renounce the first part of that memo. Accordingly, during the January 2005 confirmation hearing for Attorney General Gonzalez, he was repeatedly questioned regarding his views on the scope of Presidential authority--and he repeatedly stonewalled. His refusal to answer those questions, coupled with the President's signing statements attached to the 2005 Detainee Treatment Act and the 2006 Military Commissions Act and most recent revelations of additional torture memos, suggest that President Bush does believe himself to be beyond or above the law. Many retired military leaders have argued that abusive interrogation techniques undermine America's moral authority, fuel jihadist recruitment, and weaken international norms that have protected American service men and women for decades. Moreover, a now declassified report issued by the Government's Intelligence Science Board has concluded there is no scientific evidence that coercive interrogation methods even produces good intelligence. And we now know that the use of these techniques has, in actual cases, produced false or misleading intelligence. Sadly, the one of the greatest tragedies of the President's misguided policies on torture is this: this administration's justification of abusive techniques has not made us any safer.

Mr. CARDIN

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

Mr. CARDIN

Mr. CARDIN. I yield back my time.

Mr. CARDIN. Mr. President, I wanted to come back to Judge Elrod and comment on some of the points Senator Cornyn raised in his statements on the floor. As I explained to Senator Specter, at no time do I raise at all the issue of age. I don't even know Judge Elrod's age, nor should that ever be a factor in our consideration on a confirmation, and it was not in my judgment; nor do I think there is a mathematical formula as to what is an appropriate amount of experience to be qualified to be an appellate court judge; nor do I think there is a specific path that one must follow in order to become an appellate court judge. But with Judge Elrod, just look at her background and record. You would think, for an appellate court judge, you would want a nominee to have appellate court experience. She does not have it. You would think, for a Federal appellate court judge, you would want someone who has experience in our Federal courts. She doesn't have that. You would think, for a Federal appellate court judge, you would want someone who has experience in criminal law. She doesn't have that. You would expect, for someone who is going to be a nominee confirmed for the appellate court, that we would be able to evaluate her ability to express herself through opinions. We don't have that. You would expect, for an appellate court judge, we would have her speeches or articles that would explain some of her philosophy on life. We don't have that. You would expect, for an appellate court judge, you would have some other way of being able to evaluate her approach to interpreting the Constitution of the United States. She will be confirmed to sit on the court that will do more interpretation of our Constitution than any other court; that is, the appellate court because so few cases get to the Supreme Court of the United States. And she doesn't have that either. So it was that point that I thought the Members of this body should be aware of, not that she didn't follow a particular course to become an appellate court judge or her age. It has to do with having something to evaluate for a person who is going to be on the appellate court with a lifetime position. And that is how I drew my conclusion. I appreciate the courtesy to be able to share that with our colleagues. Mr. President, I reserve the remainder of my time.

Mr. CARDIN

Mr. CARDIN. Would my distinguished chairman yield for a moment?

Mr. CARDIN. As you know, I am going to be opposing the nomination of Jennifer Walker Elrod, but I will not be seeking a record vote.

Mr. CARDIN

Mr. CARDIN. I want to make it clear for the record that I have never at all challenged this nominee for the appellate court on age. I have never raised the issue of age, and I would never raise the issue of age.

Mr. CARDIN. Mr. President, will my colleague yield for one clarification on that point?

Mr. CARDIN. Mr. President, I serve on the Judiciary Committee, and Chairman Leahy asked that I chair the nomination hearings, the confirmation hearings on the three judges whom we are considering today. I agree completely with our colleagues from the State of Washington and the State of Mississippi. I think Richard Jones is well qualified and should be confirmed for the U.S. District Court in the Western District of Washington. I think Sharion Aycock is well qualified, and I strongly support her confirmation to the District Court in Mississippi. In regard to Jennifer Walker Elrod, for the U.S. Circuit Court for the Fifth Circuit, I opposed her nomination in the Judiciary Committee, and I take this time to explain to my colleagues why I believe she should not be confirmed. Let me begin by saying that I agree with my friend from Texas about Judge Elrod's commitment to pro bono legal services. She served as chair of the board of the Gulf Coast Legal Foundation, now known as Loan Star Legal Aid, the largest provider of pro bono services in southeast Texas. That is important to me because I think all lawyers have a responsibility to help out to make sure our system is available to all. After serving 8 years in private practice as an associate of Baker Botts in Houston, TX, she was appointed to the bench by the Governor in 2002 as a judge, the 190th District Court in Houston, TX. She was reelected to the bench in 2006. However, no one is entitled to a circuit court judgeship. In the vast majority of cases, these courts are the final law of the land for the States in their circuit when it comes to interpreting complex Federal statutes and our Constitution. These judges have lifetime appointments and are second only to the Supreme Court Justices in terms of their power and authority. I think we need to exercise a higher standard when we look at the confirmation of our appellate court judges. In many cases, they will be the final arbitrators of disputes among the people of our States. In meeting with Judge Elrod, chairing her nomination hearings, and reviewing her written responses to additional questions I posed to her, I am not convinced Judge Elrod has the experience for this position. I start with the undisputed fact about Judge Elrod's record. By her own admission, Judge Elrod has never written a single judicial opinion. In response to the Judiciary Committee's questionnaire asking for her opinions as a judge, she stated: ``I do not write opinions, I sign orders.'' She provided over 6,000 orders to the committee, but most are one-page documents that do not contain any discussion of substantive law. Indeed, Judge Elrod said that most questions in our committee questionnaire about her judicial opinions were not applicable to her because certiorari was not granted in any of her cases; appellate opinions or orders rarely reviewed her orders and decisions; she had no list of unpublished opinions; and she never sat on a judicial panel with other colleagues deciding cases. In short, we have no record of her ability to write opinions or the rationale for her decisions. A nominee for circuit court judge should have experience in writing substantive judicial opinions. Judge Elrod does not have this requisite experience. Judge Elrod, by her own admission, has very little experience in criminal cases. When she litigated at Baker Botts for 5 years, she responded that her practice involved ``100 percent civil proceedings'' and ``0 percent criminal proceedings.'' Her current job as a judge on the 190th District Court of Houston, TX, involves almost exclusively civil cases. A nominee for circuit court judge should have broad experience in both criminal and civil cases. Her work in a handful of pro bono cases does not give me confidence that she has sufficient understanding of the criminal justice system and the rights of defendants. In fact, her major initiative in criminal issues involved the amicus brief in the case of Texas v. Cobb before the Supreme Court, in which she argued that the sixth amendment only applies to ``charged offenses'' and therefore a police interrogation without counsel about a subsequent offense was admissible. She did not further explain her views about this case in her written responses to our committee. Judge Elrod, by her own admission, has very little experience in Federal court. In response to the committee questionnaire, she stated that her private practice involved ``80 percent state court'' cases and ``20 percent federal'' cases. Her current job as a State district court judge involves almost exclusively State issues. A nominee for circuit court judge should have broad experience on Federal court issues and in the complex questions, often of first impression, of Federal law, statutory law, and constitutional interpretation that are routinely raised. Judge Elrod, by her own admission, has very little experience in appellate litigation, with exception of the Cobb case noted above. Her current job as a State district court judge involves exclusively trial level proceedings. A nominee for the circuit court--this is our appellate court, our second highest court--who handles these types of cases should have significant experience in appellate work. Judge Elrod, by her own admission, does not ``write opinions.'' She ``signs orders.'' Given that circuit court judges are often the final say on law of the land in a given circuit--due to the low rate of granting certiorari by the Supreme Court--a circuit court judge has an unusual amount of authority and decisionmaking power. We do not have any track record by which to weigh Judge Elrod's views on substantive legal issues, such as civil rights, civil liberties, workers' rights, reproductive freedom, environmental protection, consumers' rights, or employees' rights. The speeches Judge Elrod provided for the record did not shed any more light on her opinions on substantive legal issues. She stated she did not have notes for many of her speeches. She also has not written any substantive legal or journal articles on complex legal or policy issues. Judge Elrod does not meet my test for Federal judicial nominees since she does not have the requisite experience for an appellate judge. I want to talk about a separate issue. I talked about experience, which I think is important for a nominee who wants to serve on our appellate courts. I also think the issue of diversity is an important issue that needs to be talked about in this Chamber. I wish to talk about the issue of diversity in the Fifth Circuit Court of Appeals. The U.S. Court of Appeals for the Fifth Circuit, which includes Mississippi, Louisiana, and Texas, presides over the largest percentage of minority residents, 44 percent, which includes African Americans and Latino citizens, of any regional circuit courts of appeal in this country outside of Washington, DC. Mississippi has the highest African-American population, 36 percent, of any State in the country. Louisiana has the second largest African- American population, at 32 percent, of any State in this country. It is disappointing that none of President Bush's 10 nominations to the Federal bench in this circuit were African American. Of the 19 Federal judges who now sit on the Fifth Circuit Court of Appeals, only one is African American. We all agree that diversity at all levels of our judicial system is important. Most recently, we have seen mass protests over double standards in our criminal justice system used to treat African American and White youths in Jena, LA. Surely, in 2007 we can do better. I take this time to point out that when the President submits a nominee for the appellate court, our second highest court, I expect that nominee will have the type of experience that is appropriate for a judge to be on the appellate court. I certainly am disappointed by the President's nominations on this circuit as it relates to diversity. I wanted to make sure that was included in the Record. Mr. President, I reserve the remainder of my time.

Mr. CARDIN

Mr. CARDIN. Mr. President, I rise in opposition to the amendment offered by the junior Senator from Oklahoma. One of the items he seeks to eliminate funding for is the Chesapeake Bay Interpretive Buoy System. This system has support from both the President and the Congress. To develop the system, the NOAA Chesapeake Bay Office partnered with the National Park Service, National Geographic Society, Conservation Fund, the Chesapeake Bay Foundation, Sultana, Verizon, and others to determine the requirements for the interpretive buoy system. These requirements defined needs for a new type of buoy, capable of collecting environmental data--winds, waves, and currents--for users; water quality data for monitoring the health of the bay; and a system for communicating historical and cultural information through cell phone technology and shore-based computer networks to the public and into the classroom. These buoys are an innovative component of the U.S. Integrated Ocean Observing System, IOOS, a NOAA priority, which supports safety and efficiency of marine operations, public safety, studies of climate change and variability, and protection and restoration of healthy marine ecosystems. In addition to providing interpretive information-- environmental, geographical, historical--to citizens of the watershed, this system is part of the NOAA Education Program, developing and delivering new science curriculum based on real-time environmental observations to Chesapeake Bay classrooms, thus serving as a pilot for similar national programs. The interpretive buoy system is a part of IOOS. IOOS is a priority both in the President's Ocean Action Plan and for NOAA. CBIBS is a component of the Chesapeake Bay Observing System, part of IOOS, providing water quality measurements such as dissolved oxygen, salinity, temperature, clarity, and chlorophyll content; wind speed and direction, wave height and direction, air temperature, barometric pressure, and relative humidity; and current velocity and direction from the surface to the bottom. The Chesapeake Bay is the largest estuary in the United States, being 200 miles long. The width of the bay varies from 3.4 miles across to 35 miles across, near the mouth of the Potomac River. The shoreline of the Chesapeake Bay and its tidal tributaries, including all tidal wetlands and islands, is over 11,600 miles. Until these buoys were deployed, NOAA weather forecasters only had one platform, Thomas Point Light, providing measurements for daily forecasts for the bay. With these additional real-time data sets, forecasters can better predict weather and water conditions on the bay supporting safety and efficiency of marine operations, public safety, and marine navigation. This congressionally designated project is not just a merit-based program. It is an especially economical one. We get multiple benefits from this single science platform in the bay. It is a worthwhile program and warrants our strong support. Mr. President, I yield the floor. I suggest the absence of a quorum.

Mr. CARDIN

Mr. CARDIN. Madam. President, I rise today to express my support for H.R. 3222, the fiscal year 2008 Department of Defense Appropriations bill. We have no greater obligation as elected officials, than to take care of our troops and their families who have sacrificed on our behalf. I am proud to support my colleagues on the Appropriations Committee who have crafted a bill that sets the right priorities for our military and our country by providing critical equipment and training, strengthening military health care for our troops and their families, and giving our military families the pay raise they deserve. The legislation before us today provides over $1 billion more for National Guard equipment than the administration requested. This funding is critical, not only to support National Guard troops who are fighting for our country overseas but to the Guard's ability to protect us here at home. National Guard units across the country have been giving up the great majority of their equipment to units headed to Iraq and Afghanistan. The resulting shortages were felt just recently in Greenburg, KS, when that town was flattened by a tornado. Kansas Governor Kathleen Sebelius said the State's response was hampered because much of the equipment usually positioned around the State to respond to emergencies was in Iraq. While Maryland does not face the same threat of tornadoes, my home State, like every State, has its own unique challenges. Maryland must be prepared to respond not only to hurricanes and severe snow storms but to attacks against Federal assets in the national capital region. After the mobilization of several Maryland Guard units to Iraq, the Guard has said it is without the necessary equipment to provide the robust response that Marylanders and the rest of our Nation expect. H.R. 3222 takes action to address this critical shortfall in my State and every State. This important bill provides military personnel 3.5 percent pay raise, half a percent more than the administration requested. President Bush has threatened to veto this bill over the 0.5 percent additional increase stating that the ``[t]roops don't need bigger pay raises.'' Well, I disagree. The 3 percent raise would be enough to keep pace with the average increase in private sector wages last year. The 3.5 percent raise is enough to not just match the private sector but to slightly close the estimated 4 percent gap that remains between average military and private sector raises. This gap hurts recruiting and retention for our All-Volunteer Force and is not a handicap our military should shoulder when the war effort has forced the military to increase its overall size at the same time it has depressed recruiting efforts. H.R. 3222 makes care for our mentally and physically wounded military men and women a priority. The legislation adds $948.9 million above the President's request for military health care, totaling $23.5 billion. Of the $23.5 billion, $486 million was added to reverse planned cuts to military hospitals. In addition, H.R. 3222 provides significant funds to develop treatments for the signature injuries of the wars in Iraq and Afghanistan including brain injury and loss of limbs. Uncontrolled internal or external hemorrhage is the foremost preventable cause of death in the prehospital period for military combat trauma. Some 50 percent of the deaths our troops have suffered in Iraq and Afghanistan could have been prevented if better products were available to control bleeding. The measure provides $73 million to fund programs authorized in the Senate-passed Dignified Treatment of Wounded Warrior Act. The Wounded Warriors bill addresses the urgent medical needs of wounded servicemembers, especially those suffering from post-traumatic stress disorder and traumatic brain injuries. I am particularly proud that H.R. 3222 funds promising techniques being pioneered in Maryland to develop bandages that are capable of stopping severe bleeding in the field and limb and tissue transplants that are viable over the many years we hope our young wounded warriors will live after returning home from war. H.R. 3222 places a premium not only on providing our troops the equipment they need to avoid injury in the first place but to develop better technology going forward. The legislation provides $75.4 billion, $268.9 million above the administration's request for research, development, test, and evaluation of new technologies. Some money will go to folks in Maryland developing methods of detecting explosives at a greater distance as well as hybrid and alternative fuel source engines. These engines not only reduce our dependence on oil and decrease emissions; they reduce the need to ship fuel along supply routes in Iraq and Afghanistan that have been a point of vulnerability for our forces. Today, I am proud to be part of a body that is meeting its obligations to our troops, their families, and our military as an institution. I applaud Senators Byrd, Cochran, Inouye, and Stevens and my other colleagues on the Appropriations Committee for their excellent work and look forward to quick passage of this critical legislation.

Mr. CARDIN

Mr. CARDIN. Mr. President, when it comes to running the Federal Government and its workforce, the Bush administration is driven too much by ideology and not enough by common sense. In its quest to scuttle a civil service system that has served us well during peace time and war, the administration has embarked on an unprecedented campaign to privatize what most would agree are ``inherently governmental'' functions. The Office of Management and Budget, OMB, has spearheaded privatization, claiming it can save taxpayers money. One example: relinquishing tax collection to private contractors. In May 2007, OMB claimed that contracting out Internal Revenue Service, IRS, debt collection to private contractors resulted in saving $35 million in fiscal year 2006. OMB failed to mention that the contractor had missed several deadlines imposed under the contract, leaving IRS employees to perform the bulk of the work. Another concern about that particular contract: our Government is turning over sensitive and private financial information entrusted to it by its citizens and placing that information in the hands of private debt collectors with grave potential for abuse. An article from the February 3, 2007, New York Times neatly summarizes the situation: ``Without a public debate or formal policy decision, contractors have become a virtual fourth branch of government. On the rise for decades, spending on federal contracts has soared during the Bush Administration, to about $400 billion last year from $207 billion in 2000, fueled by the war in Iraq, domestic security and Hurricane Katrina, but also by a philosophy that encourages outsourcing almost everything government does.'' This unofficial branch of Government is not subject to the same checks and balances of accountability found in the civil service system. The true cost of the executive branch's decision to privatize is the countless number of dedicated and highly trained Federal workers who will seek employment elsewhere rather than face the uncertainty of working in an environment that is subject to the political whims of an administration that pursues ideology over common sense and sound business policies. Even worse, such a hostile atmosphere will deter highly skilled candidates from ever considering public service, thereby depriving the public sector of the best and brightest who would otherwise seek careers in public service. Left unchecked, this notion that the Federal Government is divisible and its functions can be auctioned off to the lowest bidder will ultimately deprive us of an experienced Federal workforce and the institutional memory that are essential for the Government to function effectively, especially in a crisis. We don't need each new contractor to start from scratch reinventing the wheel when old problems arise. At a minimum, Federal employees should be allowed to compete with private contractors on an equal footing, which is where the Kennedy- Mikulski amendment comes in. Currently, the contracting rules as spelled out in OMB Circular A-76 are overwhelmingly weighed in favor of contractors and against Federal employees. This amendment will correct inequities in the public-private competitive process at the Department of Defense, DOD, to ensure that hardworking civilian defense employees are not unfairly deprived of their jobs. It will also provide basic protection from unfair competition for other Federal employees at other agencies. The amendment excludes the costs of health and retirement benefits from bids in public-private competitions, so contractors are not rewarded for providing bad benefits or even no benefits at all. Contractors currently have an incentive to shortchange their employees' benefits to gain an unfair advantage in bidding for Government work. The amendment would eliminate this incentive. The amendment prohibits the use of ``privatization quotas.'' It is unlawful for OMB to set quotas for the amount of work that agencies should outsource away from the Federal workforce, but there is substantial evidence that the administration has a de facto quota system. The amendment would protect agencies' independent decisionmaking by requiring that any decision to conduct a public- private competition be wholly independent of OMB. The amendment allows Federal employees the same appeal rights as contractors. When Federal employees win a privatization review, contractors can have the agency's decision reviewed by independent third parties, by appealing to the Government Accountability Office, GAO, or the Court of Federal Claims. Federal employees currently have no such appeal rights. The amendment requires DOD to issue long overdue guidance on outsourcing Federal jobs. These guidelines were due in January, but DOD has failed to act. The amendment requires DOD to issue this guidance. Finally, the amendment provides a fair opportunity to renew contracts won by Federal employees. Currently, DOD requires managers to ``re- compete'' contracts that are won by Federal employees at the end of each contract term, rather than extending the contract. But the same managers have discretion to extend contracts for jobs that are awarded to private contractors without reopening them to competition. The amendment gives managers discretion to extend contracts awarded to public employees. We can and should have a discussion about the proper role of Government, and we should try to make the Government as efficient as possible. What we shouldn't do is carve it up and outsource its essential functions willy-nilly to politically favored contractors. There is money at stake but much more too. The Kennedy-Mikulski amendment is a proper way to proceed with regard to public-private competitions, and I urge my colleagues to support it.

Mr. CARDIN

Mr. CARDIN. Mr. President, I yield myself 2 minutes.

Mr. CARDIN. Mr. President, today is truly an important day for America's children. On Tuesday, the House passed the Children's Health Insurance Bill, and very soon, the Senate will vote. We will provide $35 billion over the next 5 years to expand health insurance coverage for the children of America's working families. We know that there is a crisis in health care in this country. More than 46 million Americans don't have any health insurance coverage; 9 million of them are children, and most of them are in working families. That is a disgrace. Now there are many proposals out there to increase the number of Americans with health insurance coverage. As Congress begins to consider these proposals, there is something we can do today to decrease the number of uninsured children by nearly 4 million. Earlier this year, in February, I introduced to the Senate Finance Committee a Baltimore family that has benefited from CHIP. Craig and Kim Lee Bedford are working parents who own a small business and simply cannot afford health insurance for their 5 children through the commercial market. Through the Maryland MCHP program, the Bedford Family's 5 children receive affordable, quality health care. We have the evidence that enrollment in the CHIP program improves the health of the children who are enrolled, their families, and the communities in which they live. When previously uninsured children are enrolled in CHIP, they are far more likely to receive regular primary medical and dental care, and they are less likely to use the emergency room for visits that could be handled in a doctor's office. They are more likely to get necessary immunizations and other preventive care, and to get the prescription drugs they need. But there are still millions of children who have not enrolled in the programs offered by their States. Our States are making progress--simplifying their enrollment procedures, expanding outreach efforts, and using joint applications for Medicaid and CHIP so that families can enroll together. But this reauthorization bill, with $35 billion in added funding, is needed to help them make real progress. I want to talk for a moment about Maryland's program. It has one of the highest income eligibility thresholds in the Nation, and this is important because of the high cost of living in our State. It is at 300 percent not because our Governor wants to move people from private insurance to public insurance plans. It is at 300 percent because working families at this income level do not have access to affordable health insurance policies. Those families need CHIP. Children under the age of 19 may be eligible for MCHIP if their family income is at or below 200 percent of the Federal poverty level, or up to $34,000 for a family of three. We also have an MCHIP Premium program, which extends coverage to children at moderate income levels--between 200 and 300 percent of poverty, or up to $51,500 for a family of 3. The premiums, which are paid per family, regardless of the number of eligible children, are between $44 and $55 a month. Our program has been a true success. Enrollment has grown from about 38,000 enrollees in 1999 to more than 101,000 today. In my State of Maryland, the need has always exceeded the available funds. The Federal match through the CHIP formula established in 1997 is not enough to meet all of the costs of the MCHIP program. Some States do not use their entire allotment, while other States, like Maryland, have expenditures that exceed their allotments. Congress has addressed this problem by redistributing the excess to the shortfall States. The 109th Congress passed provisions to address the Fiscal Year 2007 funding shortfalls. That bill didn't include any new money, but it allowed the redistribution of $271 million already in the program, and that was important for thousands of Maryland families. Without that legislation, Maryland would have been forced to either freeze enrollment or reduce eligibility for CHIP. Now, we must move forward for future years. That is what we are doing on the floor of the Senate today. This conference report increases the allotment for Maryland for next year from its current projected level of $72.4 million for fiscal year 2008 to $178.8 million. It also allows us to continue to cover children in families with incomes up to 300 percent of poverty. Maryland would also have access to a contingency fund if a shortfall arises and additional funds based on enrollment gains. With this new money, Maryland can cover as many as 42,800 children who are now uninsured over the next 5 years. There is another vitally important part of this conference report that I want to talk about. Title 5 ensures that dental care is a guaranteed benefit under CHIP. According to the American Academy of Pediatric Dentistry, dental decay is the most common chronic childhood disease among children in the United States. It affects one in five children aged 2 to 4; half of those aged 6-8, and nearly three-fifths of 15-year-olds. Tooth decay is five times more common than asthma among school age children. Children living in poverty suffer twice as much tooth decay as middle and upper income children. Thirty-nine percent of black children have untreated tooth decay in their permanent teeth; 11 percent of the Nation's rural population have never visited a dentist; an estimated 25 million people live in areas that lack adequate dental care services. I want to say a few words about a young man named Deamonte Driver. He was only 12 years old when he died last February from an untreated tooth abscess. It started with an infected tooth. Deamonte began to complain about a headache on January 11. By the time he was evaluated at Children's Hospital's emergency room, the infection had spread to his brain, and after several surgeries and a lengthy hospital stay, he passed away. For want of a tooth extraction that would have cost about $80, he was subjected to extensive brain surgery that eventually cost more than a quarter of a million dollars. That is more than 3,000 times as much as the cost of the extraction. After Deamonte's death, the public took note of the link between dental care and overall health that medical researchers have known for years. His death showed us that, as C. Everett Koop once said, ``there is no health without oral health.'' Deamonte's brother, DaShawn, is still in need of extensive dental care, and, like him, there are millions of other American children who rely on public health care systems for their dental needs. No child should ever go without dental care. I have said before that I hoped Deamonte Driver's death would serve as a wake-up call for the 110th Congress. I believe that it has. Earlier this year, I brought Deamonte's picture down to the floor. I have it with me again today. It is here because we must never forget that behind all the data about enrollment and behind every CBO estimate, there are real children in need of care. When I spoke about Deamonte right after his death, I urged my colleagues to ensure that the CHIP reauthorization bill we send to the President includes guaranteed dental coverage. This bill would make guaranteed dental coverage under CHIP the law of the land, and I want to take this time to personally thank the members of the conference committee for ensuring that a dental guarantee is in this bill. One other tragic piece of Deamonte's story is that, once his dental problems came to light, his social worker had to call 20 dental offices before finding one who would accept him as a patient. The conference report includes a provision that will make it much easier for parents and social workers to locate participating providers. It requires the Secretary of Health and Human Services to include on its Web site www.insurekidsnow.gov and the HHS toll free number, 1-877- KIDS-NOW, information about the dental coverage provided by each State's CHIP and Medicaid programs, as well as an up-to-date list of providers who are accepting CHIP and Medicaid patients. Parents will be able--with one phone call or a few mouse clicks--to find out what their child is covered for and where they can receive care. There is more work to do, as I have learned from working with my dedicated colleagues here on this issue, particularly Senators Bingaman and Snowe. We still have to improve reimbursement for dental providers, and get grants to the states to allow them to offer dental wraparound coverage for those who may have health coverage, but no dental insurance. But these provisions are a very good start. I am deeply disappointed by the President's statements about CHIP. When he says that this is Government-run insurance, he is mistaken. This program is administered by our States, with help from the Federal Government, to ensure that working families who cannot afford private health insurance, can enroll their children in private health insurance plans. I would hope that after today's vote in the Senate, he will reconsider his position on this bipartisan, responsible, and paid-for bill. CHIP covers urban and rural children, who live in every state, whether Democratic or Republican. Congress has come together after months of work to reauthorize a program that's been a proven success and has served the needs of America's working families. I urge the President to join us in this truly bipartisan effort and sign this bill into law. I thank the leadership for bringing forward this bill. We have talked about the fact that we have 46 million people without health insurance, 9 million children without health insurance. We can do something about it today. This bill will cover 4 million uninsured children. We can do something about the uninsured. During the course of the hearings in the Senate Finance Committee, I brought Craig and Kim Lee Bedford, constituents from Maryland, to testify before the committee. These are working parents with five children. They simply could not afford health insurance. But the CHIP program has allowed us in our State to cover these children. Mrs. Bedford said: I no longer have to decide whether my child is sick enough to go to a doctor. That is the practical effect of this legislation. It is going to help families in our State. I heard the arguments about over 200 percent of poverty. In our State, we cover up to 300 percent of poverty. That is $51,500 a year. You have to pay a premium. The premium is between $44 to $55 a month for the entire family. But in Maryland, you can't afford health insurance if you make that type of income for a family. This bill will allow us to cover those children. For my own State of Maryland, bottom line means we are going to be able to cover 42,800 more children. In Maryland, we had the tragic circumstances of Deamonte Driver, a 12- year-old who died as a result of untreated tooth decay. That should never happen in America. This bill will help us to cover American families and our children. I urge my colleagues to support the bill and yield the floor.

Mr. CARDIN

Mr. CARDIN. I thank all of my colleagues--both those responsible for the FAA reauthorization and those responsible for appropriating the funding for EAS--for making it clear that they expect the airports in Hagerstown, Lancaster, and Bookings to receive EAS funding under the continuing resolution.

Mr. CARDIN. Mr. President, with regard to the fiscal year 2008 continuing resolution that the Senate is taking up today, I would like to pose a question to the Senators from West Virginia and Washington. It is my understanding that the Commerce Committee has drafted a bill to reauthorize the Federal Aviation Administration, FAA, and that bill, S. 1300, should reach the Senate floor this session. That bill includes language with regard to Essential Air Service, EAS, to extend the state-determined mileage waiver. I thank the Committee for its work on that provision as it affects an airport in my State, as well as airports in South Dakota and Pennsylvania. In the interim, I would like to clarify that it is the intention of the Appropriations and Commerce Committees that EAS support continue for the airports in Hagerstown, MD; Brookings, SD; and Lancaster, PA along with the other airports nationwide that will continue to receive EAS funding through the Continuing Resolution today. I would direct this question to the chairman of the Commerce Subcommittee on Aviation Operations, Safety & Security if it his intent to continue EAS support for airports in Hagerstown, MD; Brookings, SD; and Lancaster, PA?

Mr. CARDIN. I would further like to get the views of the chairman of the Appropriations Subcommittee on Transportation, Housing and Urban Development, and Related Agencies on this matter.

Mr. CARDIN

Mr. CARDIN. Mr. President, I rise to introduce the Medicare Preventive Services Coverage Act of 2007. It has been ten years since Congress enacted the first comprehensive package of preventive services for Medicare beneficiaries. At the time Medicare was created in 1965, it was modeled closely after the indemnity health insurance policies of the time. As such, Medicare only covered the treatment of illnesses, and it paid for tests only when a symptom was present, but it did not cover preventive services. Over the next 3 decades, the medical community learned a great deal about the importance of preventive care. Although as early as the 1970s, health maintenance organizations had begun to cover cancer screenings and other wellness services, traditional Medicare had not kept pace. The Balanced Budget Act of 1997 changed that. Working across the aisle, I introduced legislation that year to provide coverage for lifesaving screenings to Medicare beneficiaries. With strong bipartisan support, Congress added our language to BBA 1997, ensuring coverage for preventive services, including: an annual screening mammography for women over age 39; screening pap smear and pelvic examination for cervical cancer; prostate cancer screening; colorectal cancer screening; bone mass measurement for osteoporosis; and diabetes testing supplies and self-management training services. Congress expanded this list of benefits in subsequent Medicare legislation. Now traditional Medicare also covers cardiovascular screenings to help prevent heart attacks and strokes; diabetes screenings; flu shots to help prevent influenza, glaucoma screening, medical nutrition therapy services, Hepatitis B vaccine, and ultrasound screening for aortic aneurysm. Medicare also now covers a one-time ``Welcome to Medicare Visit'' within the first 6 months of Part B enrollment. This is an initial physical examination where beneficiaries can receive education and counseling about their medical history and needs, have some preventive screenings performed, and get referrals for other services. Yes, over the past decade, Medicare has indeed made great strides toward helping our seniors get screened for diseases. But we have far to go. The participation rate for Medicare preventive benefits is low. One key obstacle is financial. America's seniors still have the highest out-of-pocket costs of any age group. A 2007 Kaiser Family Foundation study compared out-of-pocket health care spending among age groups. For nonprescription drug expenses, it found that average spending for the over-65 population was nearly twice that for under-65 group. It also showed that on average, seniors in one-person households are spending 12.5 percent of their incomes on health care, versus 2.2 percent of those under 65. This means that excluding prescription drug costs, despite Medicare Part D, seniors will have very high medical bills that stretch their fixed incomes. It is no wonder that preventive services that require cost-sharing will be delayed or not received at all. Over the years, we have also improved the benefits. We have waived the deductible for mammograms and colorectal cancer screenings. But cost sharing is still an obstacle for many seniors. They still must satisfy the deductible before getting reimbursed for the physical exam and most other services, and they must pay coinsurance for all other services except laboratory tests. The bill that I am introducing today will waive the cost sharing for all preventive screenings and the Welcome to Medicare physical examination. It will also grant the Secretary of Health and Human Services the authority to add additional benefits as he or she determines to be ``reasonable and necessary for the prevention or early detection of an illness or disability.'' These determinations would take into account evidence-based recommendations by the U.S. Preventive Services Task Force and other organizations. Finally, my bill would extend eligibility for the Welcome to Medicare Visit from its current time frame of 6 months to 1 year. This bill will mean the difference between early screening and delayed diagnosis and treatment. It will mean the difference between detecting a serious illness and providing hundreds of thousands of dollars of services later. Let me explain why. Preventive services such as mammography and colonoscopy are important tools in the fight against serious disease. The earlier they are detected, the greater the chances of survival. For example, when caught in the first stages, the 5-year survival rate for breast cancer is 98 percent. But if the cancer has spread, that rate declines to 26 percent. Similarly, if colorectal cancer is detected in its early states, the survival rate is 90 percent, but only 10 percent if found when it is most advanced. Our seniors are at particular risk for cancer. The greatest single risk factor for colorectal cancer is being over the age of 50, when more than 90 percent of cases are diagnosed. In addition to increasing survival rates, identifying diseases early reduces Medicare costs. In the case of colorectal cancer, Medicare will pay $207 for a screening colonoscopy in a medical facility, but if the patient is not diagnosed until the disease has metastasized, the cost of care can exceed $60,000 over the patient's lifetime. Medicare pays $98 for a mammogram, but if breast cancer is not detected early, treatment can cost tens of thousands of dollars more, depending on when the cancer is found and the course of treatment used. One drug used to treat late stage breast cancer can cost as much as $40,000 a year. There can be no doubt that these services are both life saving and cost saving. But if seniors cannot afford the copayments for these services, they may delay getting them. In addition to cancer, diabetes is another prevalent disease among seniors. The statistics associated with diabetes are staggering. Nearly 20 million Americans are estimated to have diabetes. Approximately half know they have diabetes and another half have diabetes but do not know it. But once diagnosed, the co-morbidities associated with diabetes can be avoided. It is estimated that 90 percent of diabetes-related blindness is preventable, 50 percent of kidney disease requiring dialysis is preventable, 50 percent of diabetic-related amputations are preventable and 50 percent of diabetic-related hospitalizations are preventable. Diabetes and its complications are not only disabling, but costly to Medicare as well. The cost of medical care of people with diabetes is about $150 billion a year, according to data from the Department of Health and Human Services. In its direct costs, diabetes was the most costly of the 39 diseases reported. Despite the fact that 9 percent of the Medicare population is diagnosed with diabetes, about 27 percent of the Medicare budget is used to treat their diabetes. Most of the cost for medical care of people with diabetes is for the treatment of the complications, which are largely preventable with modern treatment including blood sugar control. Clearly, prevention of the complications of diabetes would reduce the costs of diabetes in lives and in dollars. Numerous studies have found that once diabetes management training is provided, populations see a nearly 50 percent reduction in emergency room visits. In addition, the number of outpatient visits, doctor office visits, and other medical expenses all decline. Diabetes can lead to amputations, blindness, heart disease, and stroke, all of which can be prevented with training and management. This bill also gives the Secretary of Health and Human Services the authority to add new preventive services based on the recommendations of the U.S. Preventive Services Task Force. As we have seen, it can take a very long time for Congress to change health policy in this country. In order to add new preventive services to Medicare, it now requires legislative action. Under current law, as our researchers discover new, more efficient, and more accurate screening methods to detect disease, Congress would have to pass new legislation authorizing coverage for each one. This provision would enable Medicare to provide coverage for new types of screenings based on up-to-date scientific evidence. The Preventive Services Task Force has a long and distinguished record. It dates back to 1984, when the U.S. Public Health Service convened a panel of primary and preventive health care specialists to develop guidelines for preventive services. From this panel, the U.S. Preventive Services Task Force's Guide to Clinical Preventive Services was born. While many other respected professional and research organizations have issued their own recommendations, the Task Force's publication is regarded as the ``gold standard'' reference on preventive services. In December of 1995, a new Task Force released an updated and expanded second edition of the Guide which includes findings on 200 preventive interventions for more than 70 diseases and conditions. The Task Force employed a rigorous methodology to review the evidence for and against hundreds of preventive services, assessing more than 6,000 studies. The Task Force recommended specific screening tests, immunizations, or counseling interventions only when strong evidence demonstrated the effectiveness of preventive services. My bill will give the Secretary the authority to use this gold standard to expand Medicare's basic benefit package to include the tests that studies have shown to be effective. The newest benefit is the Welcome to Medicare Visit, an initial physical examination for new beneficiaries. We know that large numbers of people in the 55 to 64 age group lack health insurance, so it is particularly important for them to get a baseline examination and screenings for diseases that affect elderly people But as of July 2006, only 2 percent of all new beneficiaries, or about 8,000 people, have received this physical exam. Uptake has been slow for a number of reasons. You must get the exam within 6 months of enrolling in Medicare Part B. But many seniors don't learn about the benefit until they have been enrolled for a while, and even then it can take several months to schedule a physical examination with a doctor. So the vast majority of our seniors are missing out on this important benefit. My bill extends eligibility from 6 months after enrolling in Part B to 1 year. Finally, I want to address the matter of cost, and that is the appropriate thing to do under our budget scoring principles. The elimination of cost sharing for preventive services has been scored by the Congressional Budget Office at $1.1 billion over 5 years. Based on CBO estimates from the 2003 Medicare law, extending the eligibility period for the Welcome to Medicare Visit from six months to one year will cost approximately $1.2 billion over years. But I believe that the members of this body also understand that, although dynamic scoring is not used by CBO, preventive health care will save money. If we detect diseases earlier, the overall cost to our society will be less. Our seniors will save out of pocket costs and all taxpayers will save money. This bill is supported by the American Cancer Society's Cancer Action Network, the American Federation of State, County and Municipal Employees, the Center for Medicare Advocacy, the Colorectal Cancer Coalition, C3, and the Society of Vascular Surgeons. I urge my colleagues to join me in this effort to get improve seniors' access to lifesaving preventive services.

Mr. CARDIN

Mr. CARDIN. Mr. President, I rise to introduce the Medicare Preventive Services Coverage Act of 2007. It has been ten years since Congress enacted the first comprehensive package of preventive services for Medicare beneficiaries. At the time Medicare was created in 1965, it was modeled closely after the indemnity health insurance policies of the time. As such, Medicare only covered the treatment of illnesses, and it paid for tests only when a symptom was present, but it did not cover preventive services. Over the next 3 decades, the medical community learned a great deal about the importance of preventive care. Although as early as the 1970s, health maintenance organizations had begun to cover cancer screenings and other wellness services, traditional Medicare had not kept pace. The Balanced Budget Act of 1997 changed that. Working across the aisle, I introduced legislation that year to provide coverage for lifesaving screenings to Medicare beneficiaries. With strong bipartisan support, Congress added our language to BBA 1997, ensuring coverage for preventive services, including: an annual screening mammography for women over age 39; screening pap smear and pelvic examination for cervical cancer; prostate cancer screening; colorectal cancer screening; bone mass measurement for osteoporosis; and diabetes testing supplies and self-management training services. Congress expanded this list of benefits in subsequent Medicare legislation. Now traditional Medicare also covers cardiovascular screenings to help prevent heart attacks and strokes; diabetes screenings; flu shots to help prevent influenza, glaucoma screening, medical nutrition therapy services, Hepatitis B vaccine, and ultrasound screening for aortic aneurysm. Medicare also now covers a one-time ``Welcome to Medicare Visit'' within the first 6 months of Part B enrollment. This is an initial physical examination where beneficiaries can receive education and counseling about their medical history and needs, have some preventive screenings performed, and get referrals for other services. Yes, over the past decade, Medicare has indeed made great strides toward helping our seniors get screened for diseases. But we have far to go. The participation rate for Medicare preventive benefits is low. One key obstacle is financial. America's seniors still have the highest out-of-pocket costs of any age group. A 2007 Kaiser Family Foundation study compared out-of-pocket health care spending among age groups. For nonprescription drug expenses, it found that average spending for the over-65 population was nearly twice that for under-65 group. It also showed that on average, seniors in one-person households are spending 12.5 percent of their incomes on health care, versus 2.2 percent of those under 65. This means that excluding prescription drug costs, despite Medicare Part D, seniors will have very high medical bills that stretch their fixed incomes. It is no wonder that preventive services that require cost-sharing will be delayed or not received at all. Over the years, we have also improved the benefits. We have waived the deductible for mammograms and colorectal cancer screenings. But cost sharing is still an obstacle for many seniors. They still must satisfy the deductible before getting reimbursed for the physical exam and most other services, and they must pay coinsurance for all other services except laboratory tests. The bill that I am introducing today will waive the cost sharing for all preventive screenings and the Welcome to Medicare physical examination. It will also grant the Secretary of Health and Human Services the authority to add additional benefits as he or she determines to be ``reasonable and necessary for the prevention or early detection of an illness or disability.'' These determinations would take into account evidence-based recommendations by the U.S. Preventive Services Task Force and other organizations. Finally, my bill would extend eligibility for the Welcome to Medicare Visit from its current time frame of 6 months to 1 year. This bill will mean the difference between early screening and delayed diagnosis and treatment. It will mean the difference between detecting a serious illness and providing hundreds of thousands of dollars of services later. Let me explain why. Preventive services such as mammography and colonoscopy are important tools in the fight against serious disease. The earlier they are detected, the greater the chances of survival. For example, when caught in the first stages, the 5-year survival rate for breast cancer is 98 percent. But if the cancer has spread, that rate declines to 26 percent. Similarly, if colorectal cancer is detected in its early states, the survival rate is 90 percent, but only 10 percent if found when it is most advanced. Our seniors are at particular risk for cancer. The greatest single risk factor for colorectal cancer is being over the age of 50, when more than 90 percent of cases are diagnosed. In addition to increasing survival rates, identifying diseases early reduces Medicare costs. In the case of colorectal cancer, Medicare will pay $207 for a screening colonoscopy in a medical facility, but if the patient is not diagnosed until the disease has metastasized, the cost of care can exceed $60,000 over the patient's lifetime. Medicare pays $98 for a mammogram, but if breast cancer is not detected early, treatment can cost tens of thousands of dollars more, depending on when the cancer is found and the course of treatment used. One drug used to treat late stage breast cancer can cost as much as $40,000 a year. There can be no doubt that these services are both life saving and cost saving. But if seniors cannot afford the copayments for these services, they may delay getting them. In addition to cancer, diabetes is another prevalent disease among seniors. The statistics associated with diabetes are staggering. Nearly 20 million Americans are estimated to have diabetes. Approximately half know they have diabetes and another half have diabetes but do not know it. But once diagnosed, the co-morbidities associated with diabetes can be avoided. It is estimated that 90 percent of diabetes-related blindness is preventable, 50 percent of kidney disease requiring dialysis is preventable, 50 percent of diabetic-related amputations are preventable and 50 percent of diabetic-related hospitalizations are preventable. Diabetes and its complications are not only disabling, but costly to Medicare as well. The cost of medical care of people with diabetes is about $150 billion a year, according to data from the Department of Health and Human Services. In its direct costs, diabetes was the most costly of the 39 diseases reported. Despite the fact that 9 percent of the Medicare population is diagnosed with diabetes, about 27 percent of the Medicare budget is used to treat their diabetes. Most of the cost for medical care of people with diabetes is for the treatment of the complications, which are largely preventable with modern treatment including blood sugar control. Clearly, prevention of the complications of diabetes would reduce the costs of diabetes in lives and in dollars. Numerous studies have found that once diabetes management training is provided, populations see a nearly 50 percent reduction in emergency room visits. In addition, the number of outpatient visits, doctor office visits, and other medical expenses all decline. Diabetes can lead to amputations, blindness, heart disease, and stroke, all of which can be prevented with training and management. This bill also gives the Secretary of Health and Human Services the authority to add new preventive services based on the recommendations of the U.S. Preventive Services Task Force. As we have seen, it can take a very long time for Congress to change health policy in this country. In order to add new preventive services to Medicare, it now requires legislative action. Under current law, as our researchers discover new, more efficient, and more accurate screening methods to detect disease, Congress would have to pass new legislation authorizing coverage for each one. This provision would enable Medicare to provide coverage for new types of screenings based on up-to-date scientific evidence. The Preventive Services Task Force has a long and distinguished record. It dates back to 1984, when the U.S. Public Health Service convened a panel of primary and preventive health care specialists to develop guidelines for preventive services. From this panel, the U.S. Preventive Services Task Force's Guide to Clinical Preventive Services was born. While many other respected professional and research organizations have issued their own recommendations, the Task Force's publication is regarded as the ``gold standard'' reference on preventive services. In December of 1995, a new Task Force released an updated and expanded second edition of the Guide which includes findings on 200 preventive interventions for more than 70 diseases and conditions. The Task Force employed a rigorous methodology to review the evidence for and against hundreds of preventive services, assessing more than 6,000 studies. The Task Force recommended specific screening tests, immunizations, or counseling interventions only when strong evidence demonstrated the effectiveness of preventive services. My bill will give the Secretary the authority to use this gold standard to expand Medicare's basic benefit package to include the tests that studies have shown to be effective. The newest benefit is the Welcome to Medicare Visit, an initial physical examination for new beneficiaries. We know that large numbers of people in the 55 to 64 age group lack health insurance, so it is particularly important for them to get a baseline examination and screenings for diseases that affect elderly people But as of July 2006, only 2 percent of all new beneficiaries, or about 8,000 people, have received this physical exam. Uptake has been slow for a number of reasons. You must get the exam within 6 months of enrolling in Medicare Part B. But many seniors don't learn about the benefit until they have been enrolled for a while, and even then it can take several months to schedule a physical examination with a doctor. So the vast majority of our seniors are missing out on this important benefit. My bill extends eligibility from 6 months after enrolling in Part B to 1 year. Finally, I want to address the matter of cost, and that is the appropriate thing to do under our budget scoring principles. The elimination of cost sharing for preventive services has been scored by the Congressional Budget Office at $1.1 billion over 5 years. Based on CBO estimates from the 2003 Medicare law, extending the eligibility period for the Welcome to Medicare Visit from six months to one year will cost approximately $1.2 billion over years. But I believe that the members of this body also understand that, although dynamic scoring is not used by CBO, preventive health care will save money. If we detect diseases earlier, the overall cost to our society will be less. Our seniors will save out of pocket costs and all taxpayers will save money. This bill is supported by the American Cancer Society's Cancer Action Network, the American Federation of State, County and Municipal Employees, the Center for Medicare Advocacy, the Colorectal Cancer Coalition, C3, and the Society of Vascular Surgeons. I urge my colleagues to join me in this effort to get improve seniors' access to lifesaving preventive services.