Benjamin Cardin

Mr. CARDIN

Mr. CARDIN. Madam President, I rise to discuss the FDA Safety and Innovation Act, the bill now under consideration here in the Senate. I applaud Chairman Harkin and Ranking Member Enzi for their leadership in moving this critical legislation through the HELP committee, and now to the Senate floor. As an agency of the Department of Health and Human Services, the FDA has as part of its broad mission to protect Americans' health by assuring the safety of drugs, biologics, medical devices, our Nation's food supply, vaccines, tobacco, cosmetics, and animal food and drugs. Every single day, every single American depends on the vital work of FDA's employees. There is a second key element to the FDA's work--helping to speed innovations to the marketplace through the drug, biologic, and medical device approval process. It's that component of the FDA's mission that we are addressing this week--reauthorizing the user fees that help fund the approval process. I'm proud of the FDA's workers--the majority of the agency's more than 11,000 employees are based at its headquarters in Silver Spring, MD. It's there that the process of medical innovation, which begins at NIH with basic research, is completed as lifesaving drugs and medical devices are approved for use. A recent report from the IMS Institute for Healthcare Informatics found that in 2011 ``medicines with new mechanisms of action were launched in greater numbers than in prior years, with many representing significant breakthroughs and first-time therapies became available to treat several types of cancer, multiple sclerosis, hepatitis C, and cardiovascular conditions.'' At the same time, we know that greater resources are needed for the agency to be able to fulfill its mission in a timely and effective manner. For all of our Nation's investment in health care research, additional new medicines will not reach patients promptly unless the FDA has the necessary funds to perform its regulatory duties. That's why the user fee amendments are so important. This 5-year reauthorization bill is Congress' opportunity to improve and update the regulatory process, and augment appropriations so that the agency can achieve its goals. The purpose of the user fee program is to reduce the time in which FDA can review and make decisions on marketing applications. Lengthy review times affect drug and medical device manufacturers, who face delays in bringing their products to market, and more importantly they affect patients, who face delays in receiving needed treatments and cures. The bill reported out of committee will move us forward. It will reauthorize the prescription drug user fee program, PDUFA, through October 1, 2017. This is necessary so that the Federal Goverment can continue to collect application, establishment, and product fees from drug companies to support the review process for the next five years. It will also reauthorize the medical device user fee program, MDUFA, through 2017 as well, and in an effort to ensure that the FDA's personnel needs are met, it would authorize a streamlined hiring of employees. Additionally, the Critical Path Public-Private partnerships, which are so important in encouraging medical product innovation, are reauthorized through 2017. Two new user fee programs are established in the bill for generics and one for biosimilars. It's estimated that the monies generated from the generic user fee program will enable the FDA approval time for generics to be shortened from the current time frame of 30 months to 10, speeding savings to patients and to all taxpayers, as Medicare, Medicaid, and CHIP programs will reap considerable cost savings. The base bill takes key first steps toward resolving the vexing issue of drug shortages. I want to acknowledge Senator Klobuchar's work in this area. All of us have heard from our community hospitals and physicians about the anguish they feel when they cannot secure medicines necessary to treat the patients in their care. I certainly have, and I have also heard from patients themselves who cannot fathom how such shortages could occur. Carey Fitzmaurice of Bethesda, who is undergoing treatment for ovarian cancer, wrote to me: My doctor put me on Doxil and carboplatin to try to get rid of some tumors. Doxil was chosen because of recent research showing that it works especially well in those patients with the BRCA gene, like me. I had four treatments with both drugs and was responding very, very well. I have now missed three doses of Doxil due to the shortage. I am ``treading water'' with the Carbo but am frustrated that I am no longer making progress towards remission. Then there is all of the stress involved with the shortage--not knowing if there is anything I can do, or what will happen next or how long I will be in treatment. I am trying to continue to be a wife and mother and to hold down a job. This shortage is adding insult to injury. I wonder why we are being asked to raise money to find cures when we can't even get access to the cures that exist now. Carey is one reason why I am a cosponsor of Senator Klobuchar's bipartisan bill, the Preserving Access to Life Saving Medications Act, and I am pleased that the bill's early notification requirement provisions are included in the PDUFA bill we are considering today. It also requires the Secretary to establish a task force and create a strategic plan to address shortages. This is also an urgent matter because shortages affect the ability to conduct clinical trials. Senator Rockefeller and I worked together some years ago to get Medicare beneficiaries coverage for the routine costs associated with clinical trials. As a result of Senator Brown's work on the Affordable Care Act, insurance companies now must also cover the routine costs of trials. Access to trials often means the difference between life and death for cancer patients, and the availability of trials has enormous implications for the effectiveness of treatments for all patients going forward. There are more than 150 cancer clinical trials being conducted now at the NIH Clinical Center in Bethesda. But the impact of shortages on clinical trials has not received a great deal of attention outside the research world. It is an extremely important issue for Medicare beneficiaries, who have the highest rates of cancer incidence. Cancer trials do not usually use placebos. Rather, they compare standard of care drugs, versus, or in combination with, the experimental drug. Doctors face difficult choices when the standard of care drug is in short supply. They must decide whether to use the limited supply of an existing drug to treat new patients, or use it in clinical trials to help find a cure for those who are seeking new therapies. Cancer trials have been delayed, limited the number of patients enrolled in the trial or stopped the trial entirely because there is simply not enough of the standard of care drug. So I am pleased that the bill contains language requiring the Secretary's strategic plan to considering the impact of drug shortages on research and clinical trials. The Finance Committee held hearings on drug shortages earlier this year as well, and we learned that the majority of shortages are found in the generic drug market. Some are due to a lack of raw materials, while others occur because the drugs yield lower profits than newer generics, and the interest in continuing to market those drugs is no longer there. The notification language in this bill is a good start, but I believe it should be strengthened to better ensure compliance, and so I have cosponsored Senator Blumenthal's amendment establishing civil monetary penalties for manufacturers who knowingly fail to notify the FDA of shortages for essential medicines. I express my appreciation to Senator Pryor for his leadership on nanotechnology. I am pleased to join him in this effort and am hopeful that the language we have sponsored can be included in this bill. Nanotechnology has become increasingly indispensible in our daily lives--everything from cellphones and MP3 players, to packaging of our snack foods, to cancer treatments in development employ the use of nanotechnology. As this burgeoning technology continues to power more of our consumer products and drive job creation in America, it is essential that we fully assess, understand, and address any risks that it may pose to safety, public health and our environment. By soundly assessing the safety of nanotechnology and developing best practices, the Nanotechnology Regulatory Science Act of 2011 will further job creation, public safety and growth in the industry. Our bill would establish a program within the FDA to assess the health and safety implications of using nanotechnology in everyday products, and develop best practices for companies using nanotechnology. This new program would bring more highly-skilled research jobs to Maryland. FDA's laboratories and research facilities at its consolidated headquarters are ideally suited to conduct the scientific studies required under the bill. The USDA's Beltsville Agricultural Research Center, BARC, is similarly equipped to provide innovative scientific technology, training, methods development, and technical expertise to improve public health. Lastly, I urge my colleagues to support language addressing the lack of available information on the benefits and adverse effects of drugs and medical devices for minority populations. Today, warnings and safety precautions are included as part of the initial approval by the FDA. The Agency may also require them post approval--after the drug has been approved and sold for months or years. We know that additional side effects or risks may become known once a product is in the market and a much larger, diverse patient population is using it. Ideally, a detailed conversation between physician and patient about the risks versus the potential benefit of taking a drug would always take place in a timely and informed manner. However, this is not always the case and is especially true if the warning is added after drug is initially prescribed and been on the market for an appreciable time period. The randomized controlled trials used by the FDA when reviewing new drug applications, while the gold standard for examining efficacy, do not necessarily reflect the overall population for a variety of reasons. For example, members of minority groups are generally underrepresented in clinical drug trials even though they are disproportionately affected by diseases such as diabetes, hypertension, colorectal, prostate and cervical cancer, stroke, congestive heart failure, acute coronary disease, and asthma. We know that there are racial and ethnic differences in responses to pharmaceuticals, and they may not become known until the drug is in wide use, certainly beyond the constraints of a controlled clinical trial. In today's world, post-approval surveys and studies are becoming more prevalent, and our ability to discern the effect of a drug over time on a variety of patient types is significantly improving. This information should be made available in a variety of ways to ensure that it reaches physicians, payors and patients, and I have filed an amendment that would greatly improve access to this information. It would build on the current HHS ``Strategic Action Plan to Reduce Racial and Ethnic Health Disparities'' by directing the Secretary to develop a communications plan to ``address the best strategy for communicating safety alerts, changes to the label or labeling of drugs, including black box warnings, biological products or devices, health advisories, any information identifying particular subpopulations, and any other relevant information as determined appropriate to enhance communication, including varied means of electronic communication.'' This amendment has the support of the chairman and the ranking member, as well as the FDA and BIO, and I urge the Senate to adopt it. Mr. President, PDUFA reauthorization is essential to furthering the Nation's health, bringing the medical innovations conceived by researchers and entrepreneurs into practice, and creating jobs. I look forward to working through the process to improve this bipartisan legislation. Again, I thank and congratulate Senator Harkin and Senator Enzi for their incredible work in bringing forward this bill that is so important to the public health of our Nation. We are dealing with the safety of drugs, biologics, medical devices, our Nation's food supply, vaccines, cosmetics, and the list goes on and on. It is critically important that we have the proper authorization so that the FDA has the resources it needs to advance innovation into the marketplace, products that fall within the jurisdiction of the FDA. We know that the basic research has gone on at NIH. To get products to market, it is important that the FDA have the resources in order to move the process forward. I am proud of the 11,000-member workforce headquartered in Silver Spring, MD, for the FDA. They work very hard. This reauthorization legislation of the user fees will give them the tools in order to get the job done. I am particularly impressed that this is a 5-year reauthorization bill that will give them predictability, which is needed in order to get the job done. I applaud Senator Harkin and Senator Enzi. We don't see enough of these bills moving forward with the type of process our leaders have brought forward. They have resolved a lot of the issues, and we thank them for that. They have brought us a bill that enjoys broad bipartisan support and is in the best interest of our Nation. I am proud to support this legislation, and I thank them for the manner in which they have proceeded in committee and now on the floor. Also, I point out that this bill deals with the drug shortage issues. I applaud the occupant of the chair, Senator Klobuchar, and her efforts in dealing with those issues. We need more effective notification of potential shortages so that we can take appropriate action to make sure the people of this Nation have an adequate supply of medicines. Let me share with my colleagues a letter I received from Carey Fitzmaurice of Bethesda, MD, who is undergoing treatment for ovarian cancer. She wrote: My doctor put me on Doxil and carboplatin to try to get rid of some tumors. Doxil was chosen because of recent research showing that it works especially well in those patients with the BRCA gene, like me. I had four treatments with both drugs and was responding very, very well. I have now missed three doses of Doxil due to the shortage. I am ``treading water'' with the Carbo but am frustrated that I am no longer making progress towards remission. Then there is all of the stress involved with the shortage--not knowing if there is anything I can do, or what will happen next, or how long I will be in treatment. I am trying to continue to be a wife and mother and to hold down a job. This shortage is adding insult to injury. I wonder why we are being asked to raise money to find cures when we can't even get access to the cures that exist now. That is a frustration that is out there on drug shortages. I am very pleased that this legislation will move us in the right direction in answering that question. It doesn't only affect those under active treatment, it also affects a number of clinical trials. There are currently about 150 clinical trials at NIH involving cancer and trying to find answers and cures for cancer. The problem is that on these clinical trials they don't use placebos, they use the current drug therapy that is known for the treatment against an experimental process. If there are not enough drugs available to treat people for the current protocols, how can those drugs be used in a clinical trial. As a result, we are finding it very challenging to move forward with the clinical trials that are needed. This legislation recognizes that concern and specifically deals with it. I congratulate the committee leadership for addressing that issue. I also will mention one other issue: nanotechnology. I congratulate Senator Pryor for his leadership in this area. Programs at FDA to access health safety facts and using nanotechnology in everyday products is something we need to do. This legislation advances that. I point out that I am proud that the lab facilities at the FDA are fully capable of dealing with the challenges presented by nanotechnology. This legislation acknowledges that. We also, in Maryland, are proud of the Beltsville Agricultural Research Center, which will advance nanotechnology and the impact it has on everyday products and safety. Those issues will be addressed also by the underlying bill. We very much appreciate the leadership of the committee. Let me talk for a moment about the two amendments I have brought forward. Amendment No. 2125 deals with safety warnings, particularly as they affect the minority community. Clinical trials don't always represent the diversity of our community. We know there is underrepresentation of minorities within clinical trials. Quite frankly, when the FDA gives approval, they give approval to the known risks, as I am sure you are all aware, but it doesn't always represent the impact on all communities. We also know there are racial and ethnic differences in response to pharmaceuticals, and they may not become known until the drug is in wide use, certainly beyond the constraints of a controlled clinical trial. So we do have the initial approval of FDA that includes the known risks, but we also have the capacity under FDA to do postapproval warnings. My amendment deals with that aspect. Health and Human Services has a strategy to deal with minority health and health disparities. It is called the Strategic Action Plan to Reduce Racial and Ethnic Health Disparities. We also now have an institute at the National Institutes of Health that deals solely with minority health and health disparities. We have a commitment to do a better job as a nation in dealing with minority health disparities. This amendment would help us move forward in that regard. One particular drug that is used to treat an inflammatory disorder has been determined by several studies to have a mortality risk that is three times higher for African-Americans than the general public. However, it is still widely prescribed, and ads for the product on the Internet and on television prominently feature African-American actors. This is an area in which the National Medical Association and many other groups concerned about the quality of minority health have focused on for years. Beyond the black box warning, which is the most serious warning that can be issued about the side effects of approved drugs, there are other concerns about products that are marketed for the overall population that may have side effects, but the specific data has not been developed yet to warrant a black box warning. The amendment I have offered directs the FDA to develop communication plans to address the best strategy for communicating benefits and risks, safety alerts, changes to the label or labeling of drugs, including black box warnings, biological products or devices, health advisories, any information identifying particular subpopulations, and any other relevant information as determined appropriate to enhance communication, including a variety of means of electronic communication. I might point out this amendment has the support of the FDA and BIO, and it is budget neutral. So I would urge my colleagues to support this amendment to advance the commitment we all have made to deal with reducing and hopefully one day eliminating minority health disparities in our health care system. It is totally consistent with the Strategic Action Plan to Reduce Racial and Ethnic Health Disparities at the Department of Health and Human Services. The second amendment I have brought forward, amendment No. 2141, deals with small businesses. This is a very appropriate amendment, as it is being considered during Small Business Week. We all acknowledge the importance of small business in the growth of our economy. Two out of every three new jobs are created through small business. We get more innovation through our small businesses on a per-employee basis than we do through larger companies. It is critically important small businesses be energized if our economy is going to rebound, as we know it needs to. This is particularly true as we deal with innovation in drug development or medical devices. My amendment deals with the issues of coordinating the work between the FDA and small business. It provides a listing of the staffing levels at the small business offices of the FDA so that we know the capacity we have and we can evaluate that. It is our responsibility to do that. It provides an overview of the status of partnership efforts between the FDA and the SBA. We want the two agencies, the Food and Drug Administration and the Small Business Administration, to be working in concert to advance the cause for small businesses as well as the mission of the FDA. My amendment provides a summary of all outreach efforts to small businesses and small business associations. It details the number of small businesses receiving protocol assistance. It shows the number of unsolicited and solicited grant applications to small businesses, again, so we can evaluate that. Most importantly, it calls for the examination of existing barriers, particularly as it relates to the generic drug shortages. It is interesting that with regard to the fee schedule, the FDA has the authority to do waivers as it relates to brand names. We know a lot of the generics are where we have our shortages because of the economics of the circumstances. But the SBA has limited ability to waive the fee structure as it relates to the general development of generic drugs. My amendment would ask the SBA to report back to Congress on what impact that has on small businesses being innovative in developing generic drugs to help us generally with less costly drugs that are available for treatment, but also to make sure we deal with the drug shortage issue, which I alluded to earlier. This amendment is also supported by Senator Landrieu, the chairman of the Small Business Committee, on which I have the pleasure of serving. I urge my colleagues to support both amendments I have brought forward. I believe they only enhance the strength of the bill before us and are totally consistent with the work of the chairman and the ranking member of the committee. With that, Madam President, I would again urge my colleagues to support both amendments and to support the underlying bill. I yield the floor, and I suggest the absence of a quorum.

Mr. CARDIN

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

Mr. CARDIN. Madam President, I ask unanimous consent to speak as in morning business.

Mr. CARDIN. I ask unanimous consent for an additional 5 minutes.

Mr. CARDIN. Madam President, I take this time to bring to the attention of my colleagues that we are celebrating National Small Business Week, which is a very important occasion because, as the Senator from New Hampshire understands, the growth engine for America is our small businesses. When we are looking at job growth, which we all know we need in order to get our economy moving again, we know there will be more jobs created from small companies than from large companies. About two out of every three jobs created in America will come from small companies. We also know when we are looking at innovation, it is the small businesses that file the patents and come up with the creative new ideas for America to become as competitive as we need to be. There are an incredibly larger number of patents per employee from small companies than from large companies. So the growth engine for America's economy rests with our small businesses. I am proud to serve on the Small Business Committee under the leadership of Chairman Landrieu. We have brought forward many initiatives that help small businesses, and I think it has made a huge difference as our economy is starting to recover. We are now looking at 25 consecutive months of continuous private sector job growth where we have turned around the economy and we are now growing. In large measure I think it is because of the attention we have paid to the small business community. We are proud of what it has meant for our entire country. Let me speak a little bit about my State of Maryland. We have over 500,000 small businesses in Maryland that employ over 1 million people. So it is by far a huge part of the Maryland economy. Our strategy over the last several years during the Obama administration has been to concentrate on small businesses and, in particular, to help them recover from this economic recession. The first effort was to increase the capacity of the Small Business Administration. I was proud of the Obama budget that put more money back into the Small Business Administration. I was proud of the initiative we had in the Senate to add funds to the Small Business Administration so that the SBA could indeed be the advocate for the small business community; so that small businesses have an agency in the government that is fighting for their issues. It has made a huge difference. When I speak with the small businesses in Maryland, they tell me they now have a much greater capacity for help through counselors and advocates at the Small Business Administration. We then dealt with the No. 1 issue that was brought to our attention--and I am sure the Presiding Officer has heard the same stories in New Hampshire I have heard in Maryland--that small businesses have had a hard time getting access to capital; that we need to do a better job of providing capital, particularly during a tough economic period where small businesses don't have the same deep pockets as the larger companies. So we increased the SBA loan limits, increased the amount of the Federal loan guarantee in order to make it more attractive for banks to lend money to small businesses, knowing full well the government was standing behind those loans. That made some monies available. We looked for creative new programs to help our small businesses, including one in the Treasury Department. We also looked at helping our States by initiating partnerships with our States. The additional funds we made available in Washington to help build the State programs has made many more loans available to small companies in Maryland. All of that has helped in providing opportunities for our small businesses. The reauthorization of the SBIR Program and the STTR Program has made a huge difference. Since 1983, in my State of Maryland, $1.5 billion of funding has come from the SBIR Program. For those who are listening who may not know what this program is about, it is about innovation. It is small companies that are involved in biotech and cybertech areas where they use innovation to create jobs. In my State and in the Presiding Officer's State, they are using these funds to create opportunities for America to be competitive internationally. We can state chapter and verse for our national defense research or for clean energy technology where small businesses are taking advantage of these innovative research grants and have been able to build jobs in our communities and make America more competitive for the future. The reauthorization and thus predictability of funding under the SBIR Program and the increased amounts that are available will create, and has already created, more job opportunities. We got that done, and that was certainly a major step forward. We passed bills providing tax breaks to small businesses, including the expensing of their equipment, so they can go out and buy equipment and keep things moving.

Mr. CARDIN. Madam President, I thank my friend from Arizona for his courtesy. I will try not to use the entire 5 minutes. There are other areas where we have also moved forward to help our small businesses, including credits for their health insurance so they can cover their employees. In my own State of Maryland, we have set up an African Trade Office which has provided opportunities in international trade--an area where we think we can still make progress. I could talk about many of the success stories of Maryland small businesses that have used the SBIR Program, including one to develop new treatment for smallpox vaccines to make them more efficient. We have had examples of where we are now developing a vaccine to deal with the common cold. I was at an SBA event where we honored the leading entrepreneurs in our State, and I can cite an example of a small businessperson, Janet Amirault, who was the small businessperson of the year--the CEO of a software development company. She has had some personal issues with her health, but despite that, for the last 3 years she has had 90 percent growth in her revenues. This is the innovation we have in Maryland that comes out of the small business community. Taylor Made Transportation Services, which first qualified under the 8(a) program, has now graduated from that. They started with a small transportation company that provided transportation for people with special needs and is now providing for diverse transportation needs in our communities. All of that has developed through small business programs that we helped develop. So I come to the floor today to announce a new initiative that I will be filing today, the Small Business Goaling Act, to deal with another problem we have with small businesses that I hope we will be able to take up on the floor of the Senate in the very near future. It would increase the prime goals for small businesses in government procurement from 23 percent to 25 percent and increase the subcontracting goals to 40 percent, adding transparency to how government provides procurement opportunities for government contracts to small businesses. We have also taken some action in dealing with bundling and trying to prevent the bundling of small contracts into large contracts that makes it more difficult for small businesses to get prime contracts. I believe this legislation will improve transparency and visibility so we can, in fact, provide more opportunities; so the government leads by example, by using small companies more to help them grow. It will help a variety of small businesses, including disabled veteran companies, women-owned companies, and minority-owned companies so that all will benefit from these opportunities. I wish to thank the chairperson of the Small Business Committee, Senator Landrieu, for her extraordinary help in getting this bill together. It will help small businesses by allowing them to grow and create jobs, thereby helping our country in recovery. Once again, I thank my friend from Arizona for giving me these extra few minutes. The best way to help celebrate National Small Business Week is for us to pay more attention to helping small businesses grow. With that, I yield the floor.

Mr. CARDIN

Mr. CARDIN. Mr. President, I ask unanimous consent that the Subcommittee on Emerging Threats and Capabilities of the Committee on Armed Services be authorized to meet during the session of the Senate on May 22, 2012, at 2 p.m.

Mr. CARDIN. Mr. President, I ask unanimous consent that the Subcommittee on Airland of the Committee on Armed Services be authorized to meet during the session of the Senate on May 22, 2012, at 3:30 p.m.

Mr. CARDIN. Mr. President, I ask unanimous consent that the Select Committee on Intelligence be authorized to meet during the session of the Senate on May 22, 2012, at 2:30 p.m.

Mr. CARDIN. Mr. President, I ask unanimous consent that the Committee on Energy and Natural Resources be authorized to meet during the session of the Senate on May 22, 2012, at 10 a.m., in room 366 of the Dirksen Senate Office Building.

Mr. CARDIN. Mr. President, I ask unanimous consent that the Committee on Banking, Housing, and Urban Affairs be authorized to meet during the session of the Senate on May 22, 2012, at 10 a.m., to conduct a committee hearing entitled ``Implementing Derivatives Reform: Reducing Systemic Risk and Improving Market Oversight.''

Mr. CARDIN. Mr. President, I ask unanimous consent that the Subcommittee on Seapower of the Committee on Armed Services be authorized to meet during the session of the Senate on May 22, 2012, at 9:30 a.m.

Mr. CARDIN. Mr. President, I ask unanimous consent that the Subcommittee on Readiness and Management Support of the Committee on Armed Services be authorized to meet during the session of the Senate on May 22, 2012, at 11 a.m.

Mr. CARDIN. Mr. President, I ask unanimous consent that the Subcommittee on Personnel of the Committee on Armed Services be authorized to meet during the session of the Senate on May 22, 2012, at 5 p.m.

Mr. CARDIN

Mr. CARDIN. Mr. President, today I wish to honor the life and legacy of Sister Jeannette Murray, Order of Saint Benedict, who cofounded the Benedictine School in Ridgely, MD. According to Sister Jeannette, it has always been her lifetime dream to provide a complete and total program that will meet the needs of individuals with developmental disabilities. She has more than accomplished that goal. The Sisters of St. Benedict recognized the need for a school that would educate children and young adults with developmental disabilities and established the Benedictine School in 1959 with 19 students. Since that time, the school has provided comprehensive services for more than 1,000 individuals, including those with no meaningful family support. In 2009, the Benedictine School celebrated 50 years as a nationally recognized, accredited, and cost-effective living and learning environment for children and adults with developmental disabilities. Most recently, Sister Jeannette led the charge for the school's therapeutic aquatic center, spearheaded a $10 million campaign for capital projects and endowments, and challenged the community to realize her dream of providing 24/7 care for aging loved ones. In April 2012, the Benedictine School broke ground for Senior Homes, ``universal design'' homes for seniors with disabilities that will offer around- the-clock care. Earlier this year, Sister Jeannette retired as executive director of Benedictine School, and on June 24 she is being honored by the community--donors, students, residents, civic and community leaders-- for her work on behalf of the developmentally disabled. Sister Jeannette has made a tremendous difference in the lives of her students and their families and to all who hear and believe in her work. Her dream has benefitted not only her students and their families but also the larger community. I hope my colleagues will join me in thanking Sister Jeannette Murray--the ``little woman with the huge heart'' as the parents of her students call her--for her vision, dedication, and service and in wishing her well in her retirement as she continues to inspire others to share her vision ``to see people with developmental disabilities living meaningful, personally satisfying and well supported lives in the community of their choice.''

Mr. CARDIN

Mr. CARDIN. Mr. President, I rise today to express my enthusiastic support for our efforts to elevate international food security commitments through the G8, which is being held this weekend in Maryland. I understand that President Obama has invited the Presidents of Benin, Ghana, Ethiopia, and Tanzania to participate in the summit and strategize on ways in which we can all work together to accelerate progress on food security. With over 1 billion poor and hungry people around the world, there is no time to wait. Just 3 years ago, in L-Aquila, Italy, G8 leaders committed to support developing-country plans for agriculture to the tune of $7 billion a year over 3 years. African governments also committed to allocating 10 percent of their budgets to support agriculture, because they recognize that three-fourths of Africans make a living from agriculture. This week we expect the G8 leaders to focus on private sector investment, donor coordination, innovation, and partnership. I see this as a natural next step in which we strive to amplify the truly historic commitments that we have made to ending world hunger. As Secretary Clinton said in 2009, ``We have the resources to give every person in the world the tools they need to feed themselves and their children. So the question is not whether we can end hunger. It's whether we will.'' We must harness the good will of the private sector, do a better job of coordinating among ourselves in the donor community, and show the American people that we are doing development better. With such a limited foreign assistance budget, getting the most out of every dollar that we spend is vital if we are going to beat global hunger and human suffering. To that end, I am very pleased that the U.S. will be following up on not only what the members of the G8 committed but what they actually delivered. In order for our new food security initiative to succeed, all pledges must have clear accountability mechanisms. I believe that our own Feed the Future Program, our global hunger and food security initiative, does just that. Feed the Future focuses on small farmers, particularly women. It helps countries to develop their agriculture sectors to generate opportunities for broad-based economic growth and trade, which in turn support increased incomes and help reduce hunger. It is strengthening strategic coordination to align the efforts of the private sector, civil society, and multilateral institutions. And it is delivering on sustained and accountable commitments through robust monitoring and evaluation systems. I look forward to hearing more about the Feed the Future success stories in the months to come, as USAID officials develop and release their accountability reports. There are a few other elements of the program that I would just like to underscore as someone who cares very deeply about the status of women. First, Feed the Future developed and launched the Women's Empowerment in Agriculture Index, a research method which measures the quantity and quality of gender integrated programs. This is essential is we are to continue designing better development programs. Second, Feed the Future has launched a fund to advance innovative approaches to promote gender equality in agriculture and land use and integrate gender effectively into agricultural development and food security programs. And third, Feed the Future has harnessed the capabilities of other U.S. Government partners such as the Department of Agriculture to develop science-based solutions to many of the problems faced by women farmers. Feed the Future is already working with the private sector in Africa; just recently USAID announced a unique trilateral partnership between PepsiCo, USAID, and the World Food Program. Through this partnership they will provide a nutritionally fortified feeding product while helping to build long-term economic stability for smallholder chickpea farmers in Ethiopia by involving them directly in PepsiCo's product supply chain. Ending global hunger is a monumental task. But when the leaders of France, Germany, Italy, Japan, the United Kingdom, Canada, Russia, and the United States join together with our African partners and the most powerful private sector and civil society organizations in the world, I believe it is one that we can achieve.

Mr. CARDIN

Mr. CARDIN. Mr. President, the budget document is a very important document. It speaks to the priorities of our Nation, and it gives instructions to our committees to report out legislation consistent with that of the budget resolution. It gives instructions to the Appropriations Committee to pass appropriations bills and to other committees as it may affect revenues or mandatory spending. We have that budget document for the fiscal year that begins October 1 of this year. That was included in the Budget Control Act which passed this body by 74 votes. It has the force and effect of law. So our appropriations committees know the numbers for the appropriations bills for the year that begins October 1, and the other committees know what the requirements will be. The question is whether we should have a longer term commitment on dealing with our budget problems. We do need a bipartisan, credible program that involves not only the Democrats and Republicans in the Senate, but also the Democrats and Republicans in the House, and the President of the United States. We need to avoid sequestration, and we need the predictability for our economy and for those who act upon our actions to know what the rules will be. We need to have a responsible plan to deal with the long-term deficit that is balanced and fair, that involves more revenue and spending cuts, that allows our recovery to continue, and is bipartisan. I compliment Senator Conrad for his leadership in giving us an opportunity to move in that direction. I think Senator Conrad showed tremendous leadership on behalf of the Democratic members of the Budget Committee to forgo bringing forward a partisan budget and instead said: Let's take a look at a long-term budget that can get bipartisan support, that has been tested, that has been out there, and that is called Bowles-Simpson. We are talking about the broad outline. A budget document gives broad instructions to the committee. It is the so-called macro numbers. I think the chairman has provided us the leadership on that issue. But do not get confused, we have a budget for the fiscal year that begins October 1. We have it earlier than we have ever had it, and it has the force and effect of law. Each of the four Republican plans that we will be voting on moves us in the wrong direction to accomplishing those goals. They use almost all of the spending cuts that are included in these budgets for additional tax cuts. It benefits primarily those who do not need an additional tax cut. The House Republican budget would provide $1 trillion in tax cuts for the wealthiest among us, giving millionaires an average tax cut of $150,000. At the same time, that budget would ask our college students to pay more by allowing interest rates on their loans to increase, and they would ask our seniors to pay more by paying more for their Medicare benefits. They have it backward. Those who have sacrificed the most during these economic times under Republican budgets would be asked to pay more. Those who have benefited the most during that period of time would get additional tax cuts. That is not what we should be doing. It would hurt our economic recovery. It is irresponsible to make the types of cuts that are in the Republican budget that deal with American innovation. Take a look what it would do for basic research in this country, which I hope we all agree is necessary for America to continue to lead the world in innovation. In my own State of Maryland I look at the jobs we created in the biotech field, through cybersecurity. Basic research is critically important to advance those job opportunities and economic opportunities for America. It would reduce our commitments to building our infrastructure--our transit systems, our roads, our energy grids. If we are going to be competitive, we need to rebuild America to meet the global challenges. It would reduce our commitments in education. An educated workforce is America's future. Investing in our children is what we should be doing. The quality of K 12 would suffer, even pre-K--what they do with Head Start--and I already mentioned the cost of student loans in postsecondary education would go up. For our seniors, they would be thrown into a voucher program in Medicare at the mercy of private insurance companies and asked to pay more when they are already overburdened by the costs of their health care. Under the Toomey budget, they would block-grant Medicaid, throwing that burden onto our States. Our children and families would suffer. Under the Paul budget, Social Security benefits would be reduced on average by 39 percent. Social Security is a vital lifeline for the people of this country. Turning it into a program that becomes a political football is not what we need for this country. For our students, the cost of a college education would be increased. We need to put forward a credible plan to reduce the deficit. We need to do this--and we have done it before. When Bill Clinton was President of the United States and I was serving in the House of Representatives, we passed a plan that balanced our Federal budget and actually created a surplus. How did we do it? We did it through a balanced approach. We did it through cutting spending and raising the revenues so we paid our bills. What were the results? Our economy took off, creating millions of jobs. That is what we need to do again. How do we get this done? Let's get working together. Let's have Democrats and Republicans work together in order to come up with a balanced approach that has spending cuts and those who can afford to pay more should be paying more because it is not fair to future generations for us to spend money today and ask our children and grandchildren to pay for it tomorrow. Let us protect the programs that are important for economic growth, for the dignity of our seniors, and for the welfare of our children. It starts with rejecting the extreme partisan budgets that our Republican colleagues are offering on the floor. I urge my colleagues to reject those budget resolutions. I yield the floor.

Mr. CARDIN

Mr. CARDIN. Mr. President, today I wish to celebrate the 350th anniversary of St. Francis Xavier Catholic Church in Leonardtown, MD. I hope my colleagues will join me in celebrating the centuries of history in marking this anniversary, including the establishment of Catholicism in English America. It was 350 years ago that Leonardtown, which was then known as Newtowne, was founded as the first settlement in the Maryland province after the establishment of St. Mary's City. Its geographic location places it within view of St. Clement's Island where the English colonists first landed in 1634. Prior to its settlement by the colonists, the Piscataway Indians and their forebears had occupied the site for many centuries. Lord Baltimore founded the Maryland colony with the intention of providing his co-religionists with the civil liberty to exercise their religion freely, but it was not until the restoration of Charles II to the throne in England that the political climate in Maryland allowed for the building of a public chapel at Newtowne in 1662. The chapel was built by the local Catholics for the community that continues to the present day as Saint Francis Xavier's Parish, a parish within the Archdiocese of Washington. In 1967, when the Society of Jesus withdrew from Newtowne to work in other areas, St. Francis Xavier Church, Newtowne Manor, and the 7.5 acres surrounding them were conveyed to the Archdiocese of Washington. The Archbishop of Washington at the time, James Cardinal Hickey, realized the religious, historical and archeological significance of these buildings, both of which are on the national Register of Historic Places, and he determined that they must be restored and preserved to maintain a link with the earliest days of the Roman Catholic Church in America. While the site of the current church, a.d. 1731, and the Newtowne Manor House, a.d. 1789, the graveyard, and the site of the original chapel have been excavated by archaeologists, more work remains to be done to tell the full story of what is believed to be the second public Catholic chapel built in the colonies. The first is thought to be in neighboring Charles County, MD. I join Father Brian P. Sanderfoot and the Saint Francis Xavier Catholic Church congregation in encouraging further investigation and exploration of their history. Their work will inform all of us about the colonial history of the Catholic community in Maryland and the early colonial life and freedoms evidenced in the records and archeological findings of St. Francis Xavier Catholic Church.

Mr. CARDIN

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

Mr. CARDIN. Mr. President, first, I thank Senator Mikulski for her leadership on the process we have used in Maryland on filling judicial vacancies. I am very proud to work with Senator Mikulski in a process that screens lawyers who are interested in becoming Federal judges in order that we can get the very best to recommend to the President. We think the President has chosen the very best in Judge Russell to fill the district court vacancy for the District of Maryland. But I really wanted to applaud my colleague in the Senate for the seriousness that we both take on filling these vacancies. We understand these are lifetime appointments. We want to make sure we get individuals who have the qualifications, who have the temperament, who have the integrity, and have the commitment to public service to serve our judiciary. I rise today to urge the Senate to confirm Judge George Levi Russell III, of Maryland, to be U.S. District Judge for the District of Maryland. Judge Russell was reported by voice vote out of the Judiciary Committee on February 16. Judge Russell currently sits as a trial judge in the Baltimore City Circuit Court. Judge Russell is an excellent candidate. He received bipartisan support from the Judiciary Committee and is ready to take office upon confirmation of the Senate. Judge Russell brings a wealth of experience to this position in both State and Federal courts. Earlier in his career he served as a Federal prosecutor and as an attorney in private law practice. He now sits as a State court trial judge in Maryland. Judge Russell graduated from Moorehouse College with a B.A. in political science and a J.D. from the Maryland Law School in 1991. He passed the Maryland Bar and was admitted to practice in Maryland in 1991. He then clerked for Chief Judge Robert Bell on the Maryland Court of Appeals, which is our highest State court. He worked as a litigation associate for 2 years at Hazel & Thomas, and then briefly at Whiteford, Taylor. He then served as an assistant U.S. attorney for the District of Maryland from 1994 to 1999, handling civil cases. In that capacity he represented various Federal Government agencies in discrimination, accident, and medical malpractice cases. He then worked as an associate at the Peter Angelos law firm for 2 years. In 2002, he went back to the U.S. Attorney's Office, handling criminal cases until 2007. He represented the United States in the criminal prosecution of violent crimes and narcotic cases during the investigatory stage, at trial, and on appeal. This included the initiation of monitoring of wiretaps to infiltrate and break up violent gangs in Baltimore City. He also served as the Project Safe neighborhood coordinator for the office from 2002 until 2005. He participated in community outreach programs in coordination with the Baltimore City State's Attorney's Office to reduce violent crime in Baltimore communities. In 2007, Governor Ehrlich, a Republican, appointed him to serve as an associate judge of the Baltimore City Circuit Court for a term of 15 years. As a trial judge, Judge Russell has presided over hundreds of trials that have gone to verdict or judgment and he has experience in handling jury trials, bench trials, civil cases, and criminal cases. He has the professional experience which has been recognized by a Republican Governor and a Democratic President. Judge Russell has strong roots, legal experience, and community involvement in the State of Maryland. He was born and raised in Baltimore City and has extended family who live in Baltimore. He served as a director and trustee of the board of the Enoch Pratt Free Library, which serves the disadvantaged throughout the State of Maryland. He served on the board of directors of the Community Law Center, which is an organization designed to help neighborhood organizations improve the quality of life for their residences. He has also served as a board member on several organizations that devote substantial resources to helping the disadvantaged, including the Big Brothers and Big Sisters of Maryland. I know he has often spoken to young people in school about the obligations, duty, and mandate of a judge, and he tries to demystify the role of a judge in a black robe. Judge Russell is particularly concerned with addressing the drug, violence, and mental health problems that plague Baltimore City. Judge Russell comes from a very distinguished family in the legal profession of Maryland. Judge Russell's father, George L. Russell, Jr., was also a groundbreaking African-American lawyer in Maryland. He was the first African-American judge on the Maryland Circuit Court in the 1960s and was later Baltimore's first African-American Solicitor. He was also the first African-American president of the Baltimore City Bar Association. In later years, Judge Russell was named by the Governor to chair the Maryland Museum of African-American History and Cultural Commission and served as chairman of the board of the Maryland African-American Museum Corporation. He was also asked to chair Baltimore's Judicial Nominating Commission. He has received numerous awards from the Maryland Bar Foundation and NAACP. His family is deep in public service, including his wife who serves as a judge on the District Court of Maryland for Baltimore City. I am absolutely convinced that Judge Russell possesses the qualifications, temperament, and passion for justice that will make him an outstanding Federal trial judge. He will serve the people of Maryland very well in this position. I therefore urge my colleagues to vote for the confirmation of Judge Russell to serve as a judge for the U.S. District Court for the District of Maryland. I suggest the absence of a quorum.

Mr. CARDIN

Mr. CARDIN. Mr. President, I take this time to urge my colleagues to allow us to move forward in the consideration of the Stop the Student Loan Interest Rate Hike Act so we can allow the interest rate on student loans to remain at its current level rather than doubling, which will happen on July 1, unless we take action. I come to the floor to express the views of many Marylanders with whom I have talked about the cost of higher education. We cannot allow the interest costs to go up. It will affect 7 million students and their families. We already have too much college debt that families have to incur as a result of the cost of a college education. We are not competitive with the rest of the world. We look at countries with whom we compete and we look at the cost of higher education in their country compared with what our students have to endure, and we start off behind because of the enormous cost to a family to afford a college education for their children. We know how important it is. You need to have a college degree in order to be competitive in many fields today. That number of fields is increasing every day. Let me tell you, we have crossed the $1 trillion mark in debt held by families in order to afford a college education. Two-thirds of that debt is held by people who are under 30 years of age. Here they are, trying to start out in life, trying to have a family, trying to buy a home, and they have this large amount of debt. College debt now exceeds credit card debt in America. It is not unusual for a person graduating from a college to have $20,000, $30,000, $40,000, $50,000, $100,000 in debt, and even higher. If we do not act by July 1, the interest costs will add thousands of dollars to that already burdensome amount. The cost of a college education in America is too expensive. If we want to be competitive, we have to get the cost of a college education down. The President in his State of the Union Address talked about ways in which we can encourage colleges and universities to be more affordable for the American public. But one thing we can do is to make sure that the cost of borrowing is not increased. That is why it is particularly important that we pass this legislation. It is affecting family decisions as to what schools children will attend because of the high cost. We are just turning our economy around, starting to make our recovery, and now families are struggling to figure out how they are going to be able to afford a college education. We need to reduce the costs, not increase the costs, to families. We need a trained workforce. We need to be competitive internationally. Let me tell you what else it is affecting. We have some very talented people who are graduating from college and they want to go into the field where they are gifted, where they can make a real contribution to our communities, to our society, to make a difference, to answer that call of community service. That is what they want to do. But when they are saddled with this much debt and if it becomes more expensive to pay off that debt, they have to make a pragmatic decision about their career path rather than following where they can make the greatest contribution to society. That is how these large debts and the cost of paying off that debt are affecting our country. You might have a great researcher who can find the answer to one of our diseases, how we can keep a healthier society, a person who may want to go into research, but they know what the return of research will be when trying to pay off their college loans. If we do not act by July 1, that will be even larger. That is what we are confronted with. That is why it is so urgent, that is why we need to be considering this legislation rather than be stuck in this filibuster. I urge my colleague to move forward. Let's do what the Senate should do--consider amendments and get this process going. It is absolutely critical to our entire country. Let me talk a little bit about my experiences with Marylanders. I have traveled the State of Maryland. I have talked to a lot of our college students. I will generally talk about a lot of different subjects and then ask what is on their mind. They will talk about the cost of college education. They will talk about the fact that we need more grants. They talk about the fact that we need more affordable loans. They certainly will tell me if you are going to increase the interest costs on their loans, it is going to have a major impact on their ability to stay in college, on their ability to follow the career choices that they want to in life. Let me share with my colleagues the stories of two Marylanders who have contacted my office, who have contacted me in the last few days to tell me that this bill we are hopefully going to be able to consider will have a direct impact on their decisions. Katherine Eames is a 22-year-old single mother, with a 4-year-old son Jayden. Katherine has decided to go back to college to pursue her nursing degree and currently attends Hagerstown Community College in Hagerstown, MD. She is attempting to make a better future for herself and for her son. She is attempting--she is going to be a full-time student. Katherine also works part time at a minimum wage job, all while juggling her responsibilities as a single mother. Student loans are necessary. She needs to take out student loans. That is the only way she is able to afford her college. She has student loans in order to be able to stay afloat and realize her dream of making a better future for herself and her son. If student loan interest rates were to double, Katherine would be in a financial turmoil and her future aspirations in jeopardy. Let me quote from Katherine. This is what she says. I think it is so telling. I want to be able to close my eyes and see a bright future for my family and my son. However, if these interest rates increase, all I see from this point forward is a hole I don't think I'll ever be able to climb out of. I know some of my colleagues say we are talking about another 3- percent interest charge, people will be able to afford it. But let me tell you about the real world, the world of Katherine Eames. That is the real world. That is people making career decisions now as to whether they are going to follow their dream; whether she will become a nurse, be able to help her community, help her family, help herself. If we do not make college affordable or if we add additional costs to it, we are going to add more people to this process. As a society, America's competitiveness will suffer as a result. We need to do better. We need to pass this legislation to help the Katherine Eameses who are out there. Let me talk about another Marylander, Ariana Fisher. She wanted to be a doctor since she was 5 years of age. Through hard work and determination, she has been accepted to Georgetown University's medical school. Attending will require her to take out a significant amount in student loans. That is the fact for most American families, their children will have to take out loans if they are going to be able to reach their dreams. She knows how much these are going to cost, but she says compounding this with increased interest rates hinders her ability to pursue her dream. She has the will and the passion to become an excellent physician and her aspirations should not rest on what we do here in making it more economically difficult for her to be able to afford that education. That will not only benefit her but will benefit our community. We are talking about our children. We are talking about whether our children are going to be able to pursue the American dream, whether they are going to have the education they need to help themselves and help our country. We are talking about America's future. This is about whether this Nation is going to be able to continue to lead the world in economic growth. We need to take up the Stop The Student Loan Rate Hike Act. Let me explain. It is subject to a filibuster. Yes, it is a filibuster. We tried to say let's at least get on the bill, which required 60 votes in order to be able to break this filibuster. We came up short. I hope the majority leader will schedule another vote shortly and I hope my colleagues on both sides of the aisle will remember what this means for the future of this country. The stories I related with regard to Katherine Eames or Ariana Fisher are not unique. I am certain you would find similar examples in New Mexico or any other State in this country. You are going to find similar examples of people who desperately need us to act so college costs do not increase. Then let's work together to bring down the costs of college education. College and postsecondary education are a vital gateway to helping American students around the country to achieve the American dream. We need to stand for our Nation's future. We cannot allow higher education to become unaffordable for millions of Americans who have the desire and ability to learn and succeed. Let's end the filibuster. Let's work together as Democrats and Republicans. Let's keep America's future in mind, let's keep the American dream in mind, let's allow Americans to reach that dream by making college education affordable. Let's pass the legislation that is currently pending that would stop the increase in the interest rates on college loans. Mr. President, I suggest the absence of a quorum.

Mr. CARDIN

Mr. CARDIN. Mr. President, today I wish to recognize the accomplishments of Martha Smith, Ph.D., who is retiring as president of Anne Arundel Community College, AACC, in Anne Arundel County, MD. For 18 years, Dr. Smith has been the visionary and driving force behind many of the accomplishments of AACC. Her tireless dedication and unwavering enthusiasm have been instrumental in bringing extraordinary educational opportunities to the students of AACC. Under her leadership, AACC has grown to meet the needs of students and employers in Anne Arundel County and throughout the State of Maryland. The college has focused on high-growth industries and opportunities presented by the base realignment and closure, BRAC, process. As a result, its enrollment has increased from 40,000 to 53,000 students and the number of degree and certificate programs has nearly doubled. The campus locations have grown to include Glen Burnie and Arundel Mills, as well as nine new buildings. Dr. Smith has led AACC's growth and success by keeping her finger on the pulse of workforce trends, student goals, and employer needs. This year, she announced nine new associate's degree programs in fields such as juvenile justice and early childhood education. Under her leadership, AACC opened the Centers for Cyber and Professional Training and Applied Learning and Technology and introduced a new degree in information systems security, evincing the increased demand for highly trained cyber security professionals. In response to the growing needs of Maryland's health care and tourism industries, Dr. Smith has overseen the expansion of the physician assistant certificate program and she cut the ribbon on AACC's new Hospitality, Culinary Arts and Tourism Institute. Dr. Smith's considerable expertise and leadership in the areas of workforce development and education has enabled her to serve in many leadership roles with local, State, and national organizations. As a passionate advocate for high-quality, affordable education for all students who want to pursue higher education, her role on national community college and workforce investment boards has been instrumental in building partnerships and making changes that have strengthened the community college system and enabled more students to be successful. During Dr. Smith's tenure, AACC has garnered numerous awards and honors, including Community College of the Year from the National Alliance for Business. I ask my colleagues to join me in congratulating Dr. Smith on her 18 years of accomplishments as president of Anne Arundel Community College, in thanking her for her inspired leadership and public service, and in wishing her well in her retirement.

Mr. CARDIN

Mr. CARDIN. Madam President, I have introduced the Diagnostic Imaging Services Access Protection Act of 2012, joined by my colleague from Louisiana, Senator David Vitter. Our goal is to preserve Medicare beneficiaries' access to life-saving advanced diagnostic imaging services, such as magnetic resonance imaging, MRI, computed tomography, CT, and ultrasound. Let me explain why this legislation is necessary. Medicare reimbursement for radiology services is based on two components: technical and professional. The technical component comprises the cost of equipment, nonphysician personnel, and medical supplies associated with the imaging process. The professional component is calculated by factoring in the radiologist's time, effort, and skill involved in interpreting images, rendering patient diagnoses, and reporting the findings in the patient's medical record. In recent years, the Centers for Medicare and Medicaid Services sought to control imaging growth by cutting reimbursement for the technical component--reducing payment for multiple imaging services administered by the same physician to the same patient during a single office visit. This policy is referred to as the multiple procedure payment reduction, or MPPR. It is designed to take into account the efficiencies achieved by doing same-day procedures on the same patient, and for the technical component of radiology, it makes sense. However this year, CMS decided to apply the MPPR to the professional component as well. The 2012 fee schedule rule, which took effect on January 1, cut the professional component reimbursement for radiologists by 25 percent for additional images. This payment reduction ignores the realities of medical practice. It is not supported by sound data, nor was it developed with meaningful physician input. Because each imaging study produces its own set of images that require individual interpretation, radiologists are ethically and professionally obligated to expend the same amount of time and effort interpreting each one, regardless of the number of images, the section of the body being examined, or the date of service. Further, because radiologists are referral-based physicians who rarely order the studies they interpret, MPPR is an ineffective tool to reduce inappropriate utilization. Beneficiaries receiving multiple imaging studies often represent the sickest and most complex cases. They may have advanced cancer or be recovering from a stroke, serious car accidents, multiple gunshot wounds, or other forms of deadly trauma. Not only will CMS' flawed policy disproportionately affect the most vulnerable patients, it may also create incentives to shift services away from the private practice setting, where the physician fee schedule applies, to the more expensive hospital outpatient setting. Our legislation will ensure that CMS does not arbitrarily undervalue the role of the radiologist within the health care delivery system. It would cancel the MPPR cut to the professional component of radiology services through the end of 2012 and prevent it from taking effect in future years, pending more comprehensive study of the matter. Specifically, the Secretary of Health and Human Services would be prohibited from taking this action unless the reduction is based on the data, analysis, and conclusions of an independent expert panel convened by the Institute of Medicine. A similar bill, HR 3269, has been introduced in the House of Representatives and it enjoys the strong bipartisan support of more than 240 cosponsors. I urge my colleagues to support this bipartisan and budget-neutral approach to preserving patient access to community- based diagnostic imaging services.

Mr. CARDIN

Mr. CARDIN. Madam President, as we consider the many important issues currently before us, I believe it is worthwhile for us also to pause and recall past events that remain relevant to our work today. As a member of the Senate Foreign Relations Committee and a long-time member and Co-Chairman of the Helsinki Commission, I would like to remind my colleagues that it was approximately 20 years ago that the conflict in Bosnia-Herzegovina began. While seeking to find a peaceful path out of the Yugoslavia which was collapsing around it, Bosnia and its people instead became chief victims of the clearly senseless violence associated with that collapse. The ethnic cleansing of villages and the shelling of Sarajevo which we first saw in April 1992 were horrific, and little did we know how much worse things would get in subsequent months and years. It was in July and August of 1992 that we first saw the shocking pictures of the detainees in Omarska and other camps run by nationalist, militant Serbs, in northeastern Bosnia. The next year, we saw Croat militants destroy the famous bridge in Mostar for which the city got its name. In 1995, we saw Srebrenica before and after the genocide in which 8,000 people, mostly men and boys, perished. While the United States and its friends and allies brought the conflict in Bosnia to an end with the Dayton Agreement in 1995, the action we took came too late for those who were ethnically cleansed and displaced, those who were tortured or raped, and those who were injured or killed. It is never too late, however, to provide justice. I am glad that people like Slobodan Milosevic, Ratko Mladic and Radovan Karadzic and all others indicted for war crimes, crimes against humanity and genocide were apprehended and transferred to the International Criminal Tribunal for the former Yugoslavia in The Hague. I am also glad that the United States and some other countries persevered to make this happen despite the resistance to cooperation and the protection afforded these individuals. I want to thank my colleagues who joined me in supporting justice in Bosnia as a matter of U.S. policy. I think it is important not only to remember the victims and culprits of the conflict in Bosnia but also to remember the heroes. There were those who opposed extreme nationalism and aggression against neighbors. I particularly want to note the small group of human rights advocates and democratic forces in Serbia who opposed what Milosevic was doing allegedly in their name, even when he appeared to be getting away with it. I have met some of these courageous individuals over the years, including last July when I visited Belgrade, and they are truly inspiring people. Today, Bosnia has recovered from the more than 3 years of brutal, destructive conflict that started 2 decades ago, and the country aspires to join both NATO and the European Union. I believe it is important that we support the people of Bosnia and their desires for integration by holding firm against the lingering forces of ethnic exclusivity, which remain particularly strong in the entity of Republika Srpska created by the Dayton Agreement, and at the same time encourage practical reforms so that Bosnia can function more effectively as a European partner. When one talks to the young people that represent Bosnia's future, as several of us have, it is clear they do not want to forget the past but they certainly do not want to repeat it. They want a future in Europe, and their political leaders need to give them that future. I hope the United States, which has invested so much in Bosnia thus far, will be there as necessary to help.

Mr. CARDIN

Mr. CARDIN. Mr. President, today I wish to recognize Jerome D. Schnydman who will be retiring on June 30 from Johns Hopkins University. Jerome has spent his adult years at Johns Hopkins, first as a student and All-American lacrosse player, graduating in 1967, then as an assistant lacrosse coach from 1968 until 1978, when he rose from assistant director to become the director of undergraduate admissions for the schools of Arts and Sciences and Engineering. He went on to serve as executive director of the Office of Alumni Relations and, most recently, as the secretary to the board of trustees and executive assistant to the president of Johns Hopkins. If you count Jerome's stint as captain of the 1967 National Championship Lacrosse Team, he has served Johns Hopkins University for 4\1/2\ decades and he has done so with grace, intelligence, compassion, and distinction. He received the Alexander K. Barton Cup for ``strong character, high ideals, and effective moral leadership'' upon graduating. In 1998, he was inducted into the Johns Hopkins Athletic Hall of Fame. In 2003, he was inducted into the National Lacrosse Hall of Fame. There will be 10 different disciplines at the University honoring Jerome Schnydman for his distinguished service. That is no surprise: he has been the ``go-to'' guy for everyone and everything. Generations of Hopkins students, faculty, and staff on any of the University's campuses--from Homewood to East Baltimore; from Bayview to SAIS in Washington, D.C.; from Bologna to Shanghai--all know of Jerome and the fine work he has done on their behalf and on behalf of the University. Whether someone works in the Homewood garage or is a Nobel Laureate exploring the cure for cancer, he or she counts Jerome as a friend. He has great respect for the institution, and especially for those who work each day to create and sustain the ``Hopkins family.'' I am proud to say that Jerome and his wife Tammy, a special education teacher, are personal friends. Their children--Becky and her husband Larry, and Andy and his wife Nancy--and their grandchildren--Sophie, Jason, Tucker, and Cassidy--are an integral part of Baltimore. When Jerome retires from Johns Hopkins University, he is excited about serving as the president of his synagogue, Beth El, and spending more time with his family and friends in Baltimore and Bethany Beach. I ask my colleagues to recognize the enormous contributions that Jerome has made to the Johns Hopkins University and Baltimore communities and to wish him well in his well-deserved retirement.