John Chafee

Mr. CHAFEE

Mr. CHAFEE. Mr. President, I send a substitute to the desk and ask for its immediate consideration.

Mr. CHAFEE. I did say ``phase out,'' that it was to end it. That is the way I read it. Perhaps others may read it differently. My point is, we have a real problem on our hands. We need a little time to examine this, to give attention to the report, to consider it, and make our recommendations. In our committee, we are fortunate to have the chairman of the subcommittee of jurisdiction, Senator Inhofe. I am sure he has some comments in connection with this whole problem.

Mr. CHAFEE. Mr. President, this is a very complicated subject. It is not only the pronunciation of MTBE that is complicated. The whole area of oxygenates as additives to gasoline adds to the complication that we face. There have been several references, and aptly so, to the blue-ribbon panel that EPA established to look into MTBE and decide to the best of its ability what ought to be done. This blue-ribbon panel has just reported, so we have hardly had a chance to see it. I think it was a report in the last 2 weeks. So we have hardly had a chance to see it. I would point this out: The report looked to a reduction in the use of MTBE, whereas, if you note from the sense-of-the-Senate resolution that the Senator from California has, she looks to a complete phaseout--phaseout meaning end the production of, use of, MTBE, in order, she says, to address the threats posed by it. As I said in my opening remarks, this is a complicated issue. We have had two hearings on it in the Committee on Environment and Public Works which has jurisdiction over this matter, and we have been waiting for the report which now has just come in. In September, I can promise everyone here that, indeed--the Senator from California is a member of our committee--we will have further hearings on it and decide what recommendations we will make to the full Congress. As has been pointed out, to just ban MTBE is not the way to go, recognizing that even though the corn growers are anxious to fill the gap, they would themselves recognize there is just plain not enough ethanol to take care of our Nation at this time. I greatly urge my colleague, the Senator from California, to withdraw her amendment. We are going to have a hearing on it. She is going to have an opportunity to have her views expressed come September, which is very close. Secondly, I urge my colleagues, absent the Senator from California withdrawing the amendment, to vote to table it and give us a chance within the committee to study not only the report itself but just to make up our minds in a bipartisan fashion what we think is the best route to go.

Mr. CHAFEE. Yes.

Mr. CHAFEE

Mr. CHAFEE. Mr. President, I ask unanimous consent that I be added as a cosponsor of the Ashcroft amendment.

Mr. CHAFEE

Mr. CHAFEE. The legislation Senator Hatch and I have drafted would address the problem that currently prevents these fuels and vehicles from competing on their own in the market. Incentives to make them less costly will stimulate demand and permit the economies of scale that are needed in order for them to gain more widespread use. Our proposal has been endorsed by a diverse group of stakeholders including the Natural Resources Defense council, the Union of Concerned Scientists, virtually all the major automobile manufacturers, and the American Gas Association. There is growing bipartisan support in the Senate for many of these concepts; on the Finance Committee, Senators Rockefeller, Bryan, and Robb have all expressed support. I would ask Senator Roth whether there might be an opportunity to consider this legislation and whether he would work with us toward its inclusion in a future tax package. Senator ROTH. I thank my colleagues from Rhode Island and Utah for their hard work on this legislation. The bipartisan support for this proposal is impressive. This is legislation that could make an important contribution to the environment. I look forward to working with my colleagues on this effort.

Mr. CHAFEE. I would like to engage the Chairman of the Finance Committee, Senator Roth, and the Senator from Utah, Senator Hatch, in a colloquy regarding alternative fuel vehicles. As the chairman knows, Senator Hatch and I presented an amendment during the finance Committee's markup of the tax bill, to provide incentives for the sale and use of clean alternative motor fuels and alternative fuel vehicles. Although the amendment has not been included in the legislation we are considering today, I continue to believe that a tax bill should ultimately include these provisions. As the Chairman and Senator Hatch know, the increased use of these fuels and vehicles will provide substantial environmental and energy efficiency benefits. The vehicles targeted for credits by our amendment are far less polluting than conventional cars and trucks. So, one result of our amendment would be improved air quality. One study of the effect of our proposal estimates that the number of natural gas vehicles in operation could more than triple by 2004, exceeding 250,000 vehicles. That number would continue to grow exponentially. These cars are so much cleaner than gasoline and diesel vehicles that our proposal could eliminate 58,000 tons of smog-forming emissions by 2004. That number would more than double by 2009. In order to accomplish that without alternative fuel vehicles, we would have to remove 1.5 million conventionally-fueled vehicles from the road. Furthermore, each gallon of alternative fuel used in such a vehicle represents one less gallon of gasoline that we need to obtain from imported oil. The Department of Energy estimates that nearly three billion gallons of gasoline would be displaced, thus reducing our foreign oil dependence.

Mr. CHAFEE

Mr. CHAFEE. Just briefly, I congratulate my colleague, Senator Breaux, from Louisiana, for his presentation and organization of this whole effort that we have had. I believe there is going to come a time--not tomorrow, not the day after but before long--in which this proposal, which he and I and so many others have worked on, is going to be accepted by this body. I certainly hope so. I thank Senator Moynihan for the kind comments he made about the efforts we have made. I thank the Chair.

Mr. CHAFEE. Mr. President, the time in favor of this amendment will be controlled by Senator Breaux for both Democrats and Republicans. I commend Chairman Roth for his hard work in crafting the Taxpayer Refund Act. I was pleased to support that and defend it in the Finance Committee. It is a carefully balanced, equitable bill that will provide targeted tax relief to all Americans. It has several features that I would like to point out. First, it gives a generous tax deduction to millions of Americans whose employers do not provide health insurance. In other words, those who buy insurance through a company, but the company itself does not pay for the insurance, this helps make that deductible. Second it corrects a flaw in the alternative minimum tax which, if left uncorrected, will result in the application of the alternative minimum tax to millions of American families who currently don't pay it. Third, the bill contains some very important environmental and urban renewal initiatives. Despite all the meritorious provisions in the bill of Senator Roth, I believe $800 billion in tax cuts is too big. What if the budget surpluses needed to pay for these reductions don't materialize? Does any one of us believe that Congress can or should hold discretionary spending to nearly $600 billion below current levels over the next decade? What about the fact that we are now in the middle of, or perhaps at the end of, who knows, the longest burst of economic prosperity in our peacetime history? Is that going to continue unabated? Nobody can tell. Nobody has a crystal ball that will give an accurate answer. So I am simply not comfortable with rebating more than half of the projected non-Social Security surplus in tax cuts. That is why, along with fellow members of the Finance Committee, Senators Breaux, Jeffords and Kerrey, as well as a number of other moderate Senators from both sides of the aisle, I have joined in sponsoring a $500 billion bipartisan alternative tax cut amendment. This bipartisan alternative is a good, solid package. It would provide broad-based tax relief for middle income tax payers and families. It would increase the standard deduction to $4,350 for joint filers, $2,150 for heads of households, and $1,300 for single filers. These increases in the standard deduction would have the effect of simplifying tax preparation for some 9 million households. Our bipartisan alternative contains the historic homeowner credit that I mentioned earlier. That is an outstanding provision and certainly will be of assistance in curbing urban sprawl. If we are serious about passing a tax cut this year, I believe our bipartisan alternative is the right way to go. It would provide carefully targeted, well-deserved tax relief to the American people but for $300 billion less than either the House or Senate bills. There is no doubt in my mind that President Clinton will veto an $800 billion tax cut package, particularly one that resembles the House-passed bill. What is more, his veto will be sustained. All of that puts us right back at square one. All of this maneuvering could be avoided by the acceptance now of this sensible bipartisan alternative that is being proposed. I hope my colleagues will support that bipartisan alternative. I thank the Chair, and I thank Senator Breaux and yield the remainder of my time to Senator Breaux.

Mr. CHAFEE

Mr. CHAFEE. Mr. President, on July 31, friends and colleagues will gather at the U.S. Naval War College to honor Colonel Stephen McCartney, Lieutenant Colonel Jack McMahon, and First Sergeant Thomas Scalavino who are retiring from Marine Corps Reserves. Accordingly, I want to pay tribute to these three distinguished gentlemen from Rhode Island as they embark on the next phase of their private lives. As many know, I had the privilege of commanding a marine rifle company in Korea in the fall of 1951 and winter of 1952. During that time, I came away with tremendous respect for each officer and enlisted man. They were courageous and displayed extraordinary endurance. I have never forgotten the confidence they had in themselves, and their willingness to go into harm's way. If there was dangerous work to be done, they were willing to do it. Colonel McCartney, Lieutenant Colonel McMahon, and First Sergeant Scalavino have displayed that same commitment and valor to our country. After graduating from the Marine Corps Platoon Leader's Course in 1968, Stephen McCartney was commissioned a Second Lieutenant in the Marine Corps in 1969 and assigned as an infantry officer. In this capacity, he served with the 1st Marine Division in the Republic of Vietnam and participated in three major combat operations against Viet Cong and North Vietnamese army units until 1971. In 1973, Colonel McCartney left active duty but remained involved in the Marine Corps Reserve, serving with the 25th Marines. However, his tour did no end there. During Operations Desert Shield and Desert Storm, then Lieutenant Colonel McCartney and his battalion were activated and assigned to the 1st Marine Division. There he participated in direct combat operations against Iraqi forces in Saudi Arabia and Kuwait. In 1992, McCartney was promoted to his present rank. In his nearly thirty years of active and reserve service, Colonel McCartney has served in a variety of other important Marine Corps billets with consistent and meritorious service. Indeed, Colonel McCartney's services have ranged from infantry officer to the Providence Police Department where he retired with the rank of Major, to his most recent appointment as Chief of Police for the Warwick Police Department. Lieutenant Colonel Jack McMahon is retiring from the Marine Corps Reserve after serving our country for over twenty years. During these years, Lieutenant Colonel McMahon's reserve and active duty experience included service as a judge advocate, as well as a commanding officer of Rhode Island's Marine Corps Reserve transportation unit in Fields Point and at the u.S. Naval War College. Throughout his career, Lieutenant Colonel McMahon has been the recipient of numerous commentary letters and awards, including the ``Junior Officer of the Year'' award in 1979. He has been recommended for the Navy Achievement, two Navy Commendations, a Meritorious Service Medal, and the Navy-Marine Corps Medal. Finally, Lieutenant Colonel McMahon has served as a prosecutor in the Rhode Island Attorney General's office for the past nineteen years. A native of Sicily, First Sergeant Thomas Scalavino came to the United States in 1960 and enlisted in the Marine Corps in 1965. Without much time to spare, First Sergeant Scalavino participated in eighteen operations in the Republic of Vietnam from 1966 to 1967 as a rifleman in such military actions as Operations Big Horn and Operation Coyote. In 1971, First Sergeant Scalavino was honorably discharged, but could not stay away for long. He reenlisted in 1981 at Transport Company in Providence, Rhode Island at the rank of Corporal. His responsibilities included: Administrative Chief, Platoon Sergeant, Platoon Commander, and Company First Sergeant. Later, First Sergeant Scalavino was sent to Southwest Asia where he participated in Operation Desert Shield, Operation Desert Storm, and Operation Cease Fire. First Sergeant Scalavino also has received the ``Navy Achievement Medal'' for his efforts as Motor Transport Officer in Ocean Venture 93. Mr. President, I join with all Rhode Islanders in extending to Colonel McCartney, Lieutenant Colonel McMahon, and First Sergeant Scalavino our best wishes. Their contributions certainly will be remembered for generations to come.

Mr. CHAFEE

Mr. CHAFEE. Mr. President. I rise today to praise and commend the dedication and commitment of Very Reverend Abdulahad Gabriel Doumato who, for the past fifty years, has led the parish of Saint Ephraim's Syrian Orthodox Church in Rhode Island. Approximately 300 friends, family members, clergymen, elected officials, and parishioners will gather on Sunday, August 1st, to honor Father Doumato on this milestone. A native of Syria, we in his adopted state of Rhode Island have benefitted from and been enriched by Father Doumato's selfless service, devotion, compassion and wisdom--attributes which have characterized his long and distinguished tenure. Father Doumato is a compassionate individual who cares profoundly for his community. He is a deeply peaceful and religious man who possesses boundless hope and optimism. He has consistently and successfully worked for the betterment of his community and has always served with faith and devotion. Indeed, he is a man of integrity, flawless character, unquestionable commitment, and one who has earned a sterling reputation as a pillar of his community. The original community of Saint Ephraim's Church in Rhode Island was formed by a group of immigrant families who came to the United States before the turn of the century. This small, industrious community managed to buy a house and use it as a parish center and chapel for worship. The church was subsequently chartered in 1913. Although Saint Ephraim's has only been in existence for 86 years, the Syrian Orthodox Church has its roots in the original Christian Church of Jerusalem. The dean of Apostles, Saint Peter, who personally anointed his successor before his journey to Rome, founded the Church in Antioch. The Church's current supreme leader, His Holiness Mor Ignatius Zakka I, Patriarch of Antioch and all the East, is the 122nd direct successor of Saint Peter. The church claims a wealth of theological, liturgical, and musical traditions. Indeed, to this day the liturgy is conducted in Aramaic, the language spoken by Jesus Christ, and was the lingua franca in the Near East. Mr. President, Father Doumato has enjoyed an interesting and fulfilling career in the ministry of his church. Like many of us, his life has been filled with challenges, hardships and hope. Unlike many of us, however, he has enjoyed some truly unique and rich experiences. He was born in 1918 and raised in the shadow of the Cathedral Church of the Virgin Mary in the city of Homs, Syria. He was educated in Homs, first in his Church's school and later by Jesuit Brothers. His interest in theology and his Church was an early and important part of his life. His father, the late Gabriel Doumato, who immigrated to Rhode Island in 1973, was an ardent supporter of the Church and served his community in many capacities. Upon completing his education, Father Doumato taught in the Church's schools across Syria. At the beginning of World War II, he entered the French-run National Police Academy and graduated with honors in 1939. For the next ten years, he served as a member of the National Police Force. Throughout this period, he continued to serve the Church as a deacon and was constantly urged by His Holiness Patriarch Ephraim, the Church's supreme leader, to join the ministry. In 1949, he resigned his commission and entered the Seminary of the Syrian Orthodox Church in Syria. Father Doumato was ordained into the priesthood in August 1950 by His Holiness Patriarch Ephraim and immediately assigned to serve the church in Central Falls, Rhode Island. Because of visa delays however, he was unable to attend to this position for two years. In the meantime, he remained in Homs and served as personal secretary to His Holiness the Patriarch. Accompanied by his wife, Victoria, and their four young children, Father Doumato arrived in Rhode Island in August 1952 to lead his new congregation. Ever since his arrival, Father Doumato has quietly and faithfully served God, his parish, our State and, indeed, our country. He has also authored numerous publications about the history of the church and its Divine Liturgy. In 1970, his dedication and self- sacrifice was recognized and honored when he was elevated to the position of Cor-Episcopose--the highest distinction of the priesthood. In 1991, he was again honored for his service and was awarded the Holy Cross of the Archdioceses of the United States and Canada. In closing, I would like to extend my very best wishes on this special occasion to Father Doumato, to his family, and to his parishioners at Saint Ephraim's Church. We are all very proud of Father Doumato, and appreciative of his many contributions to his community, and to our state. I would now like to recognize my colleague, Senator Reed, who also wishes to honor Father Doumato.

Mr. CHAFEE

Mr. CHAFEE. Mr. President. I strongly support S. Res. 160, and urge my colleagues to vote for this important measure. If this resolution is approved, it will restore Rule XVI of the Standing Rules of the Senate--a rule which, in one form or another, has served the Senate well since 1850. By restoring Rule XVI, Senators will again have at their disposal a procedural tool--a point of order--which can be raised against legislative amendments to appropriations measures. Though this point of order can be waived by a simple majority, it nonetheless reinstates an important procedural safeguard to discourage this harmful practice of legislating on appropriations bills. Since 1995, when the Senate voted in effect to overturn Rule XVI, we have witnessed a proliferation of so-called ``legislative riders'' on appropriations bills. Regrettably, much of this activity has been aimed at undermining our environmental laws. However, no authorizing committee's turf is safe without firm dividing lines clearly to differentiate the functions performed by these two types of committees. Authorizing committees are responsible for developing and overseeing the laws and programs which fall within their respective jurisdictions. The Appropriations Committee is then tasked with establishing appropriate funding levels on an annual basis for each of these programs, based upon the availability of discretionary resources. Shortly, the Senate is scheduled to consider the Fiscal 2000 Interior and Related Agencies Appropriation Bill. Unfortunately, this measure is laden with legislative riders. By singling these provisions out, I do not mean to suggest that they are not deserving of our consideration. To the contrary, these provisions should be thoroughly examined--but not in the context of the appropriations process. The authorizing committees, which have the substantive expertise, are the proper fora within which to consider and evaluate these provisions. However, as most of us know, by attaching a rider to an appropriations bill, one avoids having to defend it from the public scrutiny that comes with the authorizing committee process. Moreover, as part of must-pass annual funding bills, these often objectionable provisions are virtually assured of being signed into law, despite any misgivings a President might have. In addition to miring the appropriations process in controversy, the ability to attach legislative riders to annual spending bills also undermines the power of the authorizing committees to advance authorizing legislation. In fact, appropriations riders have, in some cases, made it difficult to reauthorize some government programs. Thus, Mr. President, the public interest is not well-served by the practice of including legislative provisions in appropriations bills. Unfortunately, reinstatement of Rule XVI will not fully address this problem because the point of order--this is important to note--only applies to legislative amendments which are offered on the floor, and not to legislative provisions added during committee action. In the days when the Senate Appropriations Committee took up and amended House-passed appropriations measures, all of the Committee's changes were considered amendments. Today, as a general matter, the Senate Appropriations Committee develops its own original bills. Thus, the Rule XVI point of order does not apply to legislation added during the committee process--rather only to legislative amendments that are offered on the floor. In other words, in a bill coming from the Appropriations Committee you can have, in effect, a legislative rider. That is there. As we are proposing it, as I understand it, the reinvigoration of rule XVI only applies to those legislative measures that are added on the floor. Thus, while S. Res. 160 is an important first step, it does not go far enough. In order to fully protect the interests of the authorizing committees, the Rule XVI point of order should be made applicable to legislative provisions which have been added to appropriations bills during committee action. For this reason, we should not only restore Rule XVI, but also strengthen it, as Senators Stevens and Byrd have proposed in S. Res. 8, which they introduced earlier this year. As the Chairman and Ranking Member of the Senate Appropriations Committee, these Senators know better than most of us that legislative riders have hindered their ability to secure timely passage of the 13 annual spending bills. Their proposal would subject all legislation contained in appropriations measures--regardless of whether added on the floor or in committee--to the Rule XVI point of order. Thus, while I will vote for S. Res. 160, I will continue to press my colleagues to further strengthen Rule XVI by adopting S. Res. 8. I thank the Chair. I suggest the absence of a quorum.

Mr. CHAFEE

Mr. CHAFEE. I wholeheartedly thank my colleagues from New Hampshire and South Carolina. It is always a pleasure working with them, especially on a worthwhile endeavor such as this. arms control treaty verification

Mr. CHAFEE. I would like to request that the distinguished manager of the bill provide some funding for the program for FY 2000, so that it can continue to build on its past success. Numerous groups, in particular the National Fish and Wildlife Foundation and the FishAmerica Foundation, rely on grants from the program for their restoration efforts, and they would be hardpressed to continue these efforts if the program were not funded. As it is, about 145 projects in 1999 alone are going unfunded due to lack of funds, of which seven are in my own state of Rhode Island.

Mr. CHAFEE. Unfortunately, S. 1217, as approved by the Committee, did not provide any funding for the program for FY 2000.

Mr. CHAFEE. Mr. President, with the indulgence of my distinguished colleagues from New Hampshire and South Carolina, I would like to bring to their attention one of the Federal government's most successful restoration programs for marine and estuarine habitats--the Community- Based Habitat Restoration Program started by the National Marine Fisheries Service in 1995. This program promotes restoration of fisheries habitats around the country through voluntary partnerships among state and local governments, the conservation community, industry and businesses, and the academic community. Since its inception, more than 60 projects have been funded. There is a minimum one-to-one match required, but non-Federal parties typically contribute three dollars, and often as much as ten dollars, for every one spent by NMFS. Indeed, over the life of the program, Federal funding totaled $1.2 million, with $6.1 million raised in non-Federal funds.

Mr. CHAFEE

Mr. CHAFEE. Mr. President, I am a little bit confused over just what we accomplished in the past week. As I understand it--I think it is pretty accurate--the Republican bill will pass. However, the President has indicated that he is going to veto this bill. And there is no question that the veto will be sustained. Then where are we? What have we accomplished in a week? It seems to me that we have let the American people down in a situation such as has been outlined. People can say the President shouldn't veto. He is indicating he is going to do that. That is his privilege, obviously. We have been through that before. So, therefore, it seems to me that we have to ask ourselves: Could we have done a better job? It seems to me that we could have. I greatly regret we are not able to present the legislation which a bipartisan group of us had the privilege of working on. We believe that legislation would have accomplished something that we were not able to accomplish, as I previously outlined. I believe we ought to cover all Americans; that is, all privately insured Americans--164 million. The legislation we will pass will not do that. I believe we ought to have an effective and timely external review process to resolve coverage disputes. I am not sure the legislation we have before us--and that we will shortly pass and having examined it-- accomplishes that. I think we ought to be able to give patients the right to sue in Federal court for economic damages--only in the Federal court, and not in the State courts. I certainly have supported legislation to prevent the suits in the State courts. We have dropped from our bill the controversial provisions codifying the Federal law--the professional standard of medical necessity. Instead, we added language to our external review provisions to ensure that external reviewers have a meaningful standard of review. It is with some regret that I announce that I recognize we are not going to have a chance to present our legislation, and I think it would have been good. I think we would have avoided the problems we currently have before us and that our Nation and our citizens would be better off. I thank the Chair.

Mr. CHAFEE

Mr. CHAFEE. If the Senator will yield, I would point out that in our state, Newport County surpasses the employee requirement but is not contiguous to a pay locality because the President's Pay Agent excluded the towns of Westport and Fall River, Massachusetts from the Boston- Worcester-Lawrence pay locality. As a result, less than four miles separate the 3,700 Federal employees in Newport County from the locality pay provided to employees in the Boston pay locality. Given our State's extremely small size and, as the Senator mentioned, the fact that Rhode Island has no county governments, the Salary Council's use of county data is inappropriate. The total land area of Rhode Island is only about two-thirds the size of Worcester County, Massachusetts, nearly all of which falls inside the Boston pay locality. As long as the Pay Agent applies its criteria on a county-by- county basis, no part of Rhode Island will be eligible for a higher level of locality pay, and existing Federal pay disparities between Rhode Island and its neighbors will continue to degrade Federal services in our state. Simply put, the FEPCA law was intended to resolve a public-private pay disparity. In southern New England, however, it has created a public-public pay disparity.

Mr. CHAFEE. Will the Senator yield?

Mr. CHAFEE. It is no wonder that Federal agencies in Rhode Island have trouble recruiting and retaining qualified employees given the very short travel time to the higher-paying Boston or Hartford locality pay areas. Most Americans know that Rhode Island is the smallest state in the nation, but I think it is worth emphasizing just how small the dimensions are, and the impact that has on commuting patterns in our region. It is only 35 miles from the eastern edge of the Hartford locality pay area in Connecticut to the Boston locality pay area in Dartmouth, Massachusetts. In between, a little more than 30 miles across, is the state of Rhode Island and 3,700 federal employees without locality pay in Newport County. Where is the incentive for a federal employee living in central Rhode Island to continue working for a federal agency in our state when he or she could drive less than 20 miles in any direction and receive a nearly 4% raise?

Mr. CHAFEE

Mr. CHAFEE. I thank the Chair. First of all, it is with deep regret that I find myself on the opposite side of an issue from my good friend, the senior Senator from Vermont. The question before us this afternoon is medical necessity. I believe this medical necessity provision is one of the most widely misunderstood issues in this entire debate. I think what we want to make clear is what we are not talking about this afternoon. We are not talking about erasing the gains managed care has made in bringing down costs. We are not talking about forcing plans to cover unnecessary, outmoded, or harmful practices. We are not talking about forcing plans to pay for any service or treatment which is not already a covered benefit. This is absolutely not about giving doctors a blank check. What we are talking about is making sure that patients get what they pay for with their premium dollars. It is about ensuring that an objective standard of what constitutes prudent medical care is used to guide physicians and insurers in making treatment and coverage decisions. This provision is about making sure that an infant suffering from chronic ear infections gets drainage tubes to ameliorate his or her condition. It is about making sure that a patient with a broken hip is not relegated to a wheelchair in perpetuity but, rather, given the hip replacement surgery that prudent medical practice dictates. Although some would have us believe that ``medical necessity'' would undo managed care by giving doctors the power to dictate what treatments and services insurers must cover, this isn't accurate. The real issue is, how will questions of coverage and treatment be decided? S. 1344--a bipartisan bill that I have had the privilege of introducing earlier this year with Senators Graham, Lieberman, Specter, Baucus, Robb, and Bayh--would codify the professional standard of medical necessity. As defined, medically necessary services are those ``services or benefits which are consistent with generally accepted principles of professional medical practice.'' This means the care that a prudent practitioner would give. The medical necessity standard is a well- settled principle of legal jurisprudence which has been used by the courts to adjudicate health law cases for nearly a century. Many insurance contracts in force today contain some version of this standard. In fact, remarkably similar language is found in contracts written by Prudential and Blue Cross and Blue Shield, to name a few. The contractual definition of medical necessity from a Blue Cross contract is care which is ``. . . consistent with standards of good medical practice in the U.S.'' One of the reasons managed care plans are so adamantly opposed to putting this standard into the law is that some in the industry are beginning to move in a very troubling direction, away from this standard. Here is how an insurance regulator in the State of Missouri explained this very alarming trend: Increasingly, insurance regulators in my State are finding that insurers are writing ``sole discretion'' clauses into their contracts--meaning that it is solely up to the insurer to determine whether treatment is medically necessary. Therefore, without an objective standard of what constitutes medically necessary care, and a requirement that treatment and coverage decisions are supported by credible medical evidence, any external appeals process is meaningless. If an insurance contract gives the plan sole discretion to determine what constitutes medically necessary care, an external review panel's hands are tied; it will have no choice but to enforce the terms of the contract, even if the coverage decision in question is completely irresponsible. Thus, if we don't codify the professional standard, any external review provision we pass in the Senate could be entirely meaningless. I have a chart here. This includes the actual medical necessity provision from an insurance contract in force today. I have eliminated the company's name, but this tells the whole story. If a plan has the sole discretion to determine what is medically necessary care, it can ignore the doctor's recommendations, the patient's medical record, and any other evidence it cares to overlook in making its determination. You will see it here. Here is the name of the company. That company will have the sole discretion to determine whether the care is medically necessary. The fact that the care has been recommended, provided, described, or approved by a physician or other provider will not establish that care is medically necessary. In other words, talk about putting the fox in charge of the chicken coop. This is it. Here we have the company deciding whether care is medically necessary, and they have the final decision. Let me give you a real world example of what can happen when a plan has an imprudent definition of medical necessity. A child named Ethan Bedrick was born with cerebral palsy and needed physical therapy to maintain some degree of mobility. The insurer paid for the physical therapy for a while but one day cut off payment for the services-- which, by the way, were covered as an unlimited benefit under the plan's contract. The child's doctor thought the care was medically necessary to prevent further deterioration in Ethan's condition, and physical therapy is routinely provided to patients with cerebral palsy. When the plan was questioned in court as to why the care had been denied, the response was given that it was not medically necessary because, under the plan's definition, medically necessary care is that which will restore a person to ``full normalcy.'' Well, this child has cerebral palsy and he is not going to be restored to full normalcy. If we do not include an objective standard of medical necessity in this legislation, insurers will be able to bait and switch when it comes to the delivery of services, just as they tried to do with Ethan Bedrick. The professional objective standard--and not an insurer's practice guidelines or opinions--should be used to determine if care is medically necessary. Without the objective standard, what measure would an appeals body use to determine whether a treatment or coverage decision was accurate or appropriate? Let me deal with two arguments used by those against this medical necessity provision. First, they say it will prevent ``best practices'' and will force plans to practice substandard care. I have trouble with that. Since the professional standard of medical necessity has been the standard used by the courts for over a hundred years and it is a feature of many insurance contracts today, why hasn't this already had the effect of preventing ``best practice'' medicine? In other words, I don't get the argument that somehow you are not going to practice the best medicine because you have to use what is medically necessary. The fact is that this standard does not lock in the state of medical practice today. Why do we make these giant strides forward? Because we are not locked in, as has been suggested. Second, it is suggested that adopting this standard is tantamount to giving doctors a blank check and will force plans to cover a whole array of services which are not covered benefits, such as aromatherapy. The plain fact is, if a plan excludes aromatherapy, or any other service, that is the end of the story. It excludes it. It is out. There is no fuss after that. If it is written in there, it is out. A patient would have no basis for an external appeal in a case where a denied service was clearly excluded. In summary, I urge colleagues not to be swayed by the health insurance industry. Both Democrats and Republicans alike acknowledge the need for an external appeals process. But make no mistake about it, without a provision to ensure that plans are held to an objective standard of professional medical practice, legislation giving patients access to the external process will be ineffective. I thank the Chair and the managers of the legislation.

Mr. CHAFEE. I wonder if we could have an agreement that on the successive votes the Senator from Oklahoma outlined there be a 10- minute break, or whatever he suggests, in there.

Mr. CHAFEE

Mr. CHAFEE. Mr. President, today I urge my colleagues to join me in supporting meaningful emergency services protection for patients in managed care plans. I am happy to cosponsor this amendment with my good friend, Senator Bob Graham. This is one area where we should have little difficulty in coming to agreement--we have already extended this critical protection to Medicare and Medicaid beneficiaries as part of the Balanced Budget Act of 1997. Now it is time for the federal government to finish the job and provide all Americans with a single and consistent standard for emergency room coverage. What's good for our Medicare and Medicaid patients should be good for patients in private plans; there is no earthly justification for not extending this basic protection to all Americans. If a plan says it covers emergency medical services, then it ought to do just that--cover legitimate emergencies. Simply put, this provision establishes reasonable standards to guarantee that patients will have their emergency services covered by their insurance company--regardless of when or where they happen to be faced with the emergency. This question of where the emergency occurs is an important one--the very nature of an emergency situation suggests that the patient will not always have the luxury of going to an emergency room that is part of the plan's network. It is important for patients who reasonably believe they need emergency medical care to receive it without delay. There are several aspects to this provision that must be included to make it a meaningful protection for patients. I will quickly run through just a few of the most important: First, protection from higher cost-sharing must apply to emergency services received without prior authorization. When time is of the essence, the patient should not be held to prior authorization requirements. Second, if the patient is faced with an emergency, he or she should not be charged higher cost-sharing for going to an out-of-network hospital. Third, the patient must have the assurance that his or her plan will arrange for necessary post-stabilization care--either at the facility where the patient is being treated for the emergency, or at an in- network facility--in a timely fashion. The best way to achieve this is through a reference to the post-stabilization guidelines already established in the Social Security Act. This so-called ``post-stabilization'' requirement has been widely mischaracterized as requiring plans to pay for a whole host of services unrelated to the emergency condition at hand. However, I want to make clear that the requirement is really one for coordination--that is, the plan must simply communicate with the emergency facility in order to coordinate the patient's post-stabilization care. If the plan fails to communicate with the treating emergency facility, then, and only then, could the plan be held responsible for payment of post-stabilization services. Furthermore, the services must be related to the emergency condition. Lest anyone doubt the importance of this coordination requirement-- for patients and plans alike--all we have to do is look at the experience of Kaiser-Permanente, one of our nation's largest and oldest health insurers. They have found the provision easy to implement, and a money-saver. In a letter to Senator Baucus dated June 24, 1999 they write ``Of over two thousand patients transported in this fashion, one third have been discharged to their homes. Without this coordination of care, these patients would have been hospitalized at needless expense.'' All of these features are a part of the current law for Medicare and Medicaid beneficiaries, and have been extended to Federal employees by Executive Order. Patients in private health insurance plans deserve no less protection. In sum, with passage of this provision, patients will no longer be in the unreasonable position of fearing that payment for emergency room visits will be denied even when these emergency conditions appear to both the patient and emergency room personnel to require urgent treatment. Patients will be assured prompt access to emergency care regardless of whether the emergency happens to occur out of range of an in-network provider. I thank the Chair.

Mr. CHAFEE. Mr. President, one of the key issues in this debate is the scope of the provisions; that is, should patient protections we are debating apply solely to those 48 million Americans enrolled in the self-insured ERISA plans or should they apply to all privately insured Americans? Obviously, there can be varied views on this subject, as we heard from the Senator from Maine, the Senator from Oklahoma, and otherwise on the floor today. In 1996, through the Kassebaum-Kennedy law, Congress passed reforms to the private health insurance marketplace with respect to portability. In my opinion, we should use the same framework used then with respect to scope and effect on State law. Thus, we should establish, I believe, a minimum floor of Federal protection for all 164 million privately insured Americans, not just those 48 million enrolled in self-insured ERISA plans. I see no reason for narrowing the scope of the patient protections in this next and far more consequential area of reform. Protections as critical to patients as the right to a specialist when needed should apply to all Americans, I believe. Some of my colleagues argue that it is the individuals only in the self-insured plans--those completely out of State reach--who should benefit from these Federal protections. While it is true that States do have the authority to legislate patient protections for these other plans, that alone, I believe, is insufficient reason to deny these basic quality improvements and safeguards to all 164 million Americans in privately insured plans. Such a system would, in my judgment, create many unnecessary and inequitable circumstances for consumers and exacerbate the already unlevel playing field which exists in the health insurance marketplace. Congress has recognized the need for minimal Federal guarantees regarding health insurance in several instances. I think this is very important to note. For example, in addition to the portability protections included in the Kassebaum-Kennedy bill, all Americans have been granted protections for continuation of care under the so-called COBRA, the Consolidated Omnibus Budget Reconciliation Act of 1985. They have been given this protection in mental health parity. They have been given this protection in maternity lengths of stay. They have been given this protection just last fall when we passed the breast reconstructive surgery protections. And we extended that to all Americans; we did not restrict it just to the self-insured under the ERISA plans. Republicans and Democrats alike continue to recognize the need for Federal protections that apply to the entire health insurance market. The generic nondiscrimination provisions of S. 326 would apply to plans beyond the self-insured ERISA plans. Where is the logic in creating Federal protections applying to the entire health insurance market regarding these aspects of health insurance but not patient protections as fundamental as access to external appeal or emergency services? Furthermore, as with many other limited preemption laws on the books, this approach would not preempt equal or stronger patient protections which have been adopted by the States. Look at this list. These are not health matters. These are environmental matters. They are consumer and other statutes. They start with the Clean Air Act. All of these statutes provide a floor of Federal protections that the States can and, in some instances, do go beyond. The Federal Government has come in, in all these instances, and said: This is a floor--Toxic Substances Control Act, Safe Drinking Water Act. If you in the State want to go further, fine, go ahead, but these are the minimals you have to do. That is what we are suggesting presents a real problem in the legislation that has been reported and then discussed by the Senator from Maine and the Senator from Oklahoma. It is critical that the protections we adopt this week in the Senate apply to all Americans, including those with plans regulated by the States because State protection is extremely spotty. One justification for applying privacy protections to the entire health insurance market is that there is not a complete body of State law on privacy. For example, it is likewise true with respect to patient protections. Considering only a few of the most important patient protections, only 15 States have adopted an external review procedure and only 13 States have adopted standing referrals to specialists. It is important to note that by not covering all Americans, many of the most vulnerable insurance customers will be left with no protection. You go out to buy a policy. You do not have employee benefit managers; you do not have somebody to look after you like that; and you are at the mercy of the insurers making decisions based solely or primarily on cost considerations. To summarize, all Americans, I believe, should have these basic protections regardless of whether the plan they are in is regulated at the State or Federal level. In fact, most Americans probably do not know who is responsible for regulating their plan and should not have to worry when they are sick as to who is the regulator and what protections they have as a result. They should have the assurance that however their plan is regulated, it will provide them the care they need according to the most basic and commonsense principles. I thank the Chair. Mr. FRIST addressed the Chair.

Mr. CHAFEE

Mr. CHAFEE. Mr. President, it is a rare opportunity when we can provide assistance to one of our nation's most vulnerable groups: children in the foster care program. Currently, Independent Living Programs for older foster children end at their 18th birthday, abandoning these teens in the middle of a critical transition period from adolescence to adulthood. Sadly, these young people are left to negotiate the rough waters of adulthood without vital health and mental health resources and critical life-skills. That is why I am pleased to join my colleagues Senators Rockefeller, Bond, Moynihan, and others in introducing the Foster Care Independence Act. Many of the 20,000 adolescents who leave the foster care rolls each year to become adults come from particularly troubled backgrounds. Typically, these young people have experienced on average four placements in the past seven years of their lives. As a result, they lack a sense of permanency and the skills essential to becoming self- reliant and productive adults. Our bill will cushion the transition to adulthood by funding Independent Living Programs and ensuring access to the critical health care and mental health services provided by Medicaid through a foster child's 21st birthday. Most importantly, it doubles the money available to state- administered Independent Living Programs, allowing them to provide the day-to-day living needs for 18 to 21-year-olds while they learn valuable life skills. This more comprehensive program with a long transition period will promote the safety, health, and permanency in the lives of these children. It also removes a significant barrier to these children's adoption by ensuring that the families who adopt them have access to the appropriate resources through age 21. In addition, this bill provides them access to the health and mental health services offered through Medicaid. Numerous studies of adolescents who leave foster care have found that this population has a significantly higher-than-normal rate of school drop outs, out-of- wedlock pregnancies, homelessness, health and mental health problems, poverty, and unemployment. They are also more likely to be victims of crime and physical assaults. My more comprehensive program addresses these grave health and safety concerns by allowing adolescents who age out of or are adopted out of foster care to continue to receive crucial health, and mental health care benefits through the age of 21. I am heartened by the broad, bipartisan support that the Independent Living Act of 1999, introduced by my colleague, Representative Nancy Johnson, received last week in the House. I urge my colleagues to join me in supporting this important measure and ask unanimous consent that the full text and summary of the bill printed in the Record.