John Chafee

Mr. CHAFEE

Mr. CHAFEE. It can be done by unanimous consent tomorrow, I see. Division II--Amendment No. 440

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

Mr. CHAFEE. Mr. President, I would like to briefly review the bidding here, if I might. Part B is a program that provides for payments to physicians; it is an insurance program. Nobody who is in Medicare has to take out this insurance program. Those that do pay a $45-per-month premium currently, over 99 percent of all Social Security beneficiaries, take the part B insurance. That is what it is-- insurance. What is this premium that they pay the $45? That is calculated to cover 25 percent of the costs of the program, of the entire part B cost. Twenty-five percent is what an individual pays. So where is the other 75 percent coming from? The other 75 percent comes from the General Treasury. So you get this anomalous situation of a very low-income individual that might be the person that cleans the streets, if you will, or cleans up our offices early in the morning; that individual's income taxes go into the General Treasury, and then part of them come out to pay some millionaire retiree's doctor bills-- 75 percent of them. Now, something is wrong here. Why should those people be paying 75 percent of Warren Buffet's doctor bills? So what we have proposed here is that there be what we call a means test. The wealthier individuals will pay more for that premium instead of having it come out of the General Treasury. So did we start with low-income people? Hardly. Before anybody has to start paying more than the 25 percent premium, that individual, if he is an individual, as opposed to a married couple, that individual has to have an income of over $50,000 a year as a retiree. And it gradually comes in a greater portion, until finally that individual, if he is making $100,000 per year, is paying 100 percent of the premium. He doesn't have to take it if he doesn't want it. If he can go out and find a better deal somewhere, so be it. But I suspect he will find that this is a very, very good insurance program and he is delighted to pay the 100 percent, and he surely can afford it. It will only be $135 a month more, if he is paying the total premium, than if he were just paying the 25 percent. What about the married couple? There is talk here about how onerous this is. It doesn't even start with a married couple to pay more than the 25 percent until that couple is filing an income tax return showing that a $75,000 income. They don't pay the entire amount of the premium until their income is $125,000 a year. Where I come from that is a pretty good income. So, Mr. President, what we are trying to do is overcome this, I think, shocking situation where a very wealthy person is only paying 25 percent of the cost of a program with the taxpayers of the Nation. That cleaning woman, her taxes are going into that general fund to come out and pay some wealthy person's doctor bill--75 percent of them. That, Mr. President, just plain isn't fair. The question is whether we should debate it longer. I don't know how long it takes to understand the particular program we are proposing here this evening. Now, there are going to be savings. As the distinguished Senator from Louisiana pointed out, the savings are nearly $4 billion over 5 years. You can say, oh, that's not much. Boy, that is getting pretty inured to Washington spending if you say $4 billion isn't much. All that savings goes into the Medicare Program, the part A program, the hospital insurance, which is about to go under. Is it me that says that? No. We previously, this evening, quoted from the report of the trustees of the Medicare fund. Those trustees have used the most alarming words. I have here the little booklet that they put out in which they use terms of the part A trust fund, namely the Hospital Insurance. They use terms like--these are the trustees, and four of the six trustees are Cabinet officers, all Democrats. This is what they say: Further delay in implementing changes makes the problem harder to solve. We urge the earliest possible enactment of legislation to extend the HI trust fund. The Medicare trust fund, the HI, will be exhausted in 4 years without legislation to address it. It seems to me, Mr. President, that this is a very worthwhile undertaking. It is the right thing to do. It is not hurting anybody. If people at a $125,000-a-year income can't pay their entire insurance bill, then they are not doing their budgeting very well. So, Mr. President, I strongly support this measure, which was reported from the Finance Committee.

Mr. CHAFEE. As I said, 47 years ago, in 1950, there were 16 workers for every retiree. Today, there are 3 workers for every retiree--not 16, but 3. Twenty-eight years from now, in the year 2025, the ratio will fall to two workers for every retiree. So something has to be done if this Medicare trust fund is going to survive. What we have proposed is increasing the Medicare eligibility age to conform with that of Social Security. In 1983, we raised the age of Social Security eligibility gradually. It comes into full force in the year 2025. By the year 2025, the retirement age will be 67, not the 65 that it is today. We have proposed that the Medicare Program step up in similar fashion. The key thing, Mr. President, is to take these actions now; don't wait until the baby boomers are all there collecting and we can't do anything about it. Now, if we act, we can take these very gradual steps. For example, the first step will be in 2003, 6 years from now, when the eligibility age for Social Security and Medicare will go from 65 to 65 and 2 months. Then it goes up to 65 and 10 months by the year 2007. Then we take a break for 11 years--excuse me. In 2008, it will be at age 66, and then gradually it goes up by 2 months and 4 months and 6 months until the year 2025, when the retirement age for Social Security----

Mr. CHAFEE. Let me try 10 minutes.

Mr. CHAFEE. I ask unanimous consent that I may have 2 more minutes.

Mr. CHAFEE. I will.

Mr. CHAFEE. Social Security is already set. That goes to 67. We did that in 1983. That goes to age 67 in 2025. What we do in this program is to have Medicare conform to that. Mr. President, unless we take these actions, there isn't going to be any Medicare for the future. A lot of people say, ``Do nothing.'' Well, I think that is totally reckless. Other people can say, ``Well, just increase the tax.'' That would mean increasing the tax on Medicare by 250 percent. That is what would be required to increase the payroll tax. It would have to be increased from the current amount of 1.45 percent of payroll to 3.6 percent, which is nearly a threefold increase. So, Mr. President, this is a very wise provision that we did, in a bipartisan manner, in the Finance Committee, and I certainly hope that it will withstand any attacks. I thank the Chair and I thank the distinguished chairman of our committee.

Mr. CHAFEE. Mr. President, there is an organization set up to report to the Congress every year on the status of Social Security and the status of Medicare. This group is a very distinguished group. It consists of the Secretary of the Treasury; the Secretary of Health and Human Services; the Secretary of Labor, or Acting Secretary of Labor; and the Commissioner of Social Security, or the Acting Commissioner of Social Security. These are the people, plus two members of the public. I might say, of the first four--and there are six in all--four of these are Democrats. They are not Republicans; they are Democrats. They submitted a report to us in the Congress in April of this year. What did they say? As we have reported for the last several years, one of the Medicare trust funds, the Hospital Insurance-- The HI, the so called part A. will be exhausted in 4 years without legislation that addresses its fiscal imbalance. This isn't a bunch of right wing Republicans saying there is trouble ahead. These are the very prestigious, qualified Cabinet Members of the President of the United States--every single one of them a Democrat. It goes on to say: We are urging the earliest possible enactment of legislation to further control Hospital Insurance program costs because of the nearness of the Hospital Insurance Trust Fund exhaustion date. Mr. President, these are serious matters. They go on to explain why this is happening. On page 6 of its report it says: Why do costs rise faster than income? The primary reason for these costs of Social Security and the Hospital Insurance costs are because of the baby boom generation retirees, while the number of workers paying payroll taxes grows more slowly. Mr. President, we are facing an emergency here. This legislation, which came from the Finance Committee, proposes to do something about it. What is the situation? In 1950, which is 47 years ago, there were 16 workers for every retiree--16 workers in the United States paying into the Hospital Insurance Fund and paying into Social Security.

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

Mr. CHAFEE. Mr. President, I would like to ask the majority leader a question. As I understand it, suppose somebody has an amendment this afternoon and is prepared to go to a vote this afternoon; would there be a vote this afternoon?

Mr. CHAFEE. Mr. President, I would like to address the matter before us, and I believe the time is running anyway, is it not?

Mr. CHAFEE. I ask that I might have 5 minutes on Senator Roth's time on this matter.

Mr. CHAFEE. Mr. President, I am offering an amendment with Senator Rockefeller and Senator Jeffords to ensure that the children's health insurance block grant, which is what we provided for from the Finance Committee, provides adequate health coverage for children and that it is affordable for most low-income families. Let me say I am very pleased in this package we have $24 billion, $24 billion set aside to provide health insurance coverage for some of the 10 million children in our Nation who are currently uninsured. I thank the chairman of the committee for helping us in many respects in connection with how this health care money is dispensed. There are two areas which remain of concern to me, namely what benefits are we going to provide to these children and how much are we going to require their parents to pay toward health insurance; in other words, deductibles and copayments. Under the Finance Committee bill, it provides that the benefits should be actuarially equivalent to the benefits provided under the Federal Employees Health Benefits Plan. This, of course, is not a single plan. It is a menu of plans that Federal employees may choose from. These plans are designed to meet the needs of adult Federal workers and retirees, not children. Stating that the benefits must be actuarial equivalent, which means the same dollar value, does not spell out what benefits the children will get. Children could be denied critical benefits, such as vision and hearing care. Some may say the States will offer the benefits that children need, but that is not what the record shows. A survey by the National Governors' Association of the 28 non-Medicaid--in other words programs that are not pursuant to Medicaid-- State health programs for children found that they did not cover vision care in 16 of these plans; 16 out of 28 did not cover glasses for these poor children, and 10 didn't cover hearing defects. The amendment I am offering today would require that the benefits be at least the same as those under the standard Blue Cross/Blue Shield benefit package, including hearing and vision services. We are talking about very low-income children here. These are children who live in families of three where the gross income is under $18,000. We are talking about children at 133 percent of the Federal poverty level. They do not have extra money to provide for eyeglasses or hearing aids. What we do is provide that the package be the same as the Blue Cross/Blue Shield package as far as benefits go. This is a standard package and it includes eyeglasses and hearing aids. In addition, we provide deductibles and copayments be eliminated for those who are--not eliminated, but be nominal for those from these very low-income families. So, that is the essence of it. It is a very good amendment. I wish it would be accepted. And I yield now--how much time do I have left?

Mr. CHAFEE

Mr. CHAFEE. Mr. President, I think today, as we go on to further consideration of this Medicare legislation, we are going to really see who is concerned about the future of this program and who is concerned about it being there, not just to the end of this century, which is 3 years from now, but well into the next century. I think everybody who has taken the trouble to read the report of the trustees of Social Security and Medicare has seen the danger this program is in. It is going broke. It isn't something that is just automatically going to be there; we are used to these things. Somehow people think, ``Oh, it can't happen.'' Well, it can happen. So from the Finance Committee has come a series of proposals to do something about the security of the Medicare Program to ensure that it is going to be there, hopefully well into the next century. What is the particular issue before us today, Mr. President? The issue is, is it all right, proper, to have a $5 copayment in some instances--in some instances, Mr. President--for those who are visited by the home health care agents, officials, the nurses and those who come in a home health care visit. First, it is important to stress that after a hospital stay, for the first 100 visits, there is no charge. There is no charge for the first 100 visits after a hospital stay. Subsequent to that, there is a $5 charge. Under part B, for physicians' visits, and so forth, that an individual makes, there is a 20-percent copayment, and if that were applied to the home visits, 20 percent of a $90 visit--and that is the average cost of these visits from the visiting nurses or whoever it might be--20 percent of that is $18. Is the suggestion that there be an $18 copayment, 20 percent? No, there isn't, Mr. President. There is a charge of $5, which is in the neighborhood of 6 percent. Not a 20- percent charge, a 6 percent charge. It seems to me that that is very fair. First of all, it helps reduce the cost to Medicare, obviously. Second, it clearly, to some small extent, affects the behavior of the individual who has asked for the home health care visit. I think this is a fair charge, $5. It is not for everybody. As I say, the first 100 visits go without a charge whatsoever. One hundred visits is a lot of visits. Then it goes to this very modest, not 20-percent payment, but 6-percent payment. Mr. President, I hope that the amendment to remove this provision in the bill will be rejected. I thank the Chair. Mr. KENNEDY addressed the Chair.

Mr. CHAFEE

Mr. CHAFEE. Mr. President, today the Committee on Environment and Public Works is reporting a bill, S. 797, the John F. Kennedy Center Parking Lot Improvement Act, as ordered reported on June 5, 1997. I am also filing a technical amendment to the bill which corrects a potential problem with respect to the funding of any large screen format equipment for an interpretive theater for the Kennedy Center. The purpose of the amendment is to ensure that the Board of Trustees of the Kennedy Center are prohibited from using appropriated funds for acquisition of such equipment.

Mr. CHAFEE

Mr. CHAFEE. Mr. President, I am pleased to announce the 50th anniversary of Salve Regina University, in Newport, RI. Salve Regina University is a private coeducational university of the arts and sciences, administered by the Sisters of Mercy. In commemoration of this milestone, the U.S. flag will be flown over the Capitol Building on September 2, 1997. As part of its 50th anniversary celebration, Salve Regina will host year-long activities, open to all, centered around the theme ``The Enduring Power of Vision: Tradition, Achievement, Challenge.'' These activities, including a conference on cultural and historical preservation, will take place on the university's 60-acre campus, bordering on the famed Cliff Walk in Newport. Mr. President, you may be interested to know that since the enrollment of its first class on September 24, 1947, the university has expanded to offer 29 undergraduate majors in the arts and sciences and 16 graduate programs, including a Ph.D. in Humanities. I am particularly pleased that the continued success and achievement of Salve Regina will be celebrated this year. And I am very proud to congratulate Salve Regina University for its 50 years of dedication and excellence in education.

Mr. CHAFEE

Mr. CHAFEE. Mr. President, I commend the Senators from North Carolina and Delaware for bringing this very important piece of legislation to the Senate floor. It has been many years since Congress has passed and the President signed a State Department Authorization bill. U.S. interests will be very well served if we are able to accomplish this very difficult but important task. I would like to address a key provision within S. 903, that being the U.N. reform plan. I have long had a deep interest in the world body, and this legislation offers the Senate an opportunity to better understand the many complex issues surrounding U.S. membership in the United Nations. There have been a number of what I consider to be unfortunate misconceptions raised about the United Nations in recent years that, in the context of this legislation, ought to be addressed in a forthright manner. American taxpayers deserve to know what benefits does the United States derives from its participation in the United Nations? A misconception one hears repeatedly is that the United States pays billions of dollars in U.N. dues, but gets little or nothing to show for it in return. I think it is important to rebut this allegation in order to more effectively make a case for full payment of our arrearages. The United Nations advances U.S. foreign policy goals in a number of ways, including isolation of nations that support terrorism, conflict resolution through diplomacy, the provision of humanitarian aid, and the promotion of democracy and human rights. These many successful ventures are too often overlooked as the more headline-grabbing failures of the U.N. seem to receive more attention by the news media. For example, U.N. economic sanctions serve to isolate and weaken regimes of nations such as Iraq, Libya, and others that routinely challenge United States interests abroad. Although these outlaw regimes remain in power, their ability to influence world events and undermine our interests are greatly reduced. I note the now-lifted U.N. sanctions on Serbia, which were instrumental in bringing that nation to the negotiations that eventually resulted in the Dayton peace accords. And we should also recall that Operation Desert Storm was conducted under the authority of a U.N.-passed resolution. The United Nations has also been instrumental in a number of peacemaking endeavors, including the brokering and implementation of peace agreements in the nearby, formerly war-ravaged nations of El Salvador and Guatemala. While I recognize and acknowledge the imperfect record of U.N. peacekeeping missions, particularly in Somalia and Bosnia, there have been successes in a number of lesser known parts of the world that are infrequently publicized. In any event, it should also be understood that the number of troops involved in U.N. peacekeeping operations has been reduced two-thirds over the past 2 years. What's more, the United Nations has been a forum in which international norms and standards of conduct are debated and established. These standards put the weight of international unity behind efforts to encourage good conduct on the part of all member states, particularly those that seek to do otherwise. During the 51st U.N. General Assembly alone, a number of important resolutions were adopted, with U.S. support, that promoted our national security interests. These resolutions sought to combat international crime, promote respect for human rights, and deplore the conduct of the repressive Burmese Government. I also note the work of the U.N. Human Rights Commission in Geneva, an important organization which, among other things, puts needed pressure on many nations to fully respect the fundamental rights of its citizens. Mr. President, these are just some examples of how the United Nations and its affiliated organizations serve U.S. national security interests around the world. There are many more. It's vitally important that every Member of Congress understand exactly what we are receiving in return for our substantial investment at the United Nations in order to make the best judgment about how to proceed in addressing our unpaid dues. Another important misconception about the United Nations is the characterization of it as a bloated, uncontrolled bureaucracy that is unresponsive to calls for restraint. It is true that the United Nations and its administrative activities had seen enormous growth during its first several decades of existence. This growth and associated bureaucracy led to justified calls for reform and reduction. We must keep in mind that the United Nations has already undergone several reforms in the past decade, often at the urging of the U.S. Congress. Well before Secretary-General Kofi Annan assumed office, the United Nations had established an inspector general, reduced the number of high level posts, and cut both its peacekeeping and general budgets. And in the relatively short time since Annan has been Secretary-General, he has announced additional far-reaching reforms. On March 17, Annan specified a series of 10 reform benchmarks involving further budget cuts and restructuring. Included among these are a transfer of resources from administration to programs, establishment of a code of conduct for U.N. staff, and streamlining of his own office. Annan has done a great deal with the authority he has, while proposing additional measures that must be negotiated with member states. So no one should be left with the understanding that the United Nations is somehow immune from accountability and unresponsive to criticism. The world body, especially through its new Secretary- General, has heard the call for reform. Its leadership recognizes that it must be responsive to the concerns of member states, particularly its biggest donor, the United States. This brings us to today's debate. It has been my longstanding view that the United States absolutely must remain a full and active member of the United Nations. The many constructive activities of the United Nations. I have discussed, and the many U.S. interests that are served by our participation in the world body warrant a continued and strengthened U.S. role. Indeed, the 20th century has seen the tremendous consequences that result when the United States shrinks from its inevitable leading role in world affairs. In fact, I would argue that the increasing complexity of the challenges confronting the United States today make it more important than ever that we remain engaged internationally by, among other things, fully participating in the United Nations. And we certainly cannot adequately participate in the United Nations by continuing to carry an arrearage of around $1 billion. Because of this arrearage, our respect and credibility there has diminished, thereby limiting United States ability to influence positively the United Nations' deliberations and activities. As the sole remaining superpower in an increasingly complex world, the United States simply must play a leading and unimpeded role at the United Nations. While I am extremely pleased about the willingness of the Senator from North Carolina to engage in negotiations to clear up our arrearage, I believe that paying our back dues in full without the onerous conditions of title 22 is the appropriate course of action. It appears unlikely that the United Nations will, in fact, agree to this package as a whole, particularly given the lukewarm initial reaction of its leadership. This reaction is certainly understandable. Could you imagine if every member state made demands such as this in return for full payment of dues? What would best serve U.S. interests is to pay off our arrearage now and encourage our diplomats to undertake a very serious effort to negotiate further reforms with a Secretary-General who appears strongly committed to genuine change. I am greatly concerned that the substantial progress we have already made in working with Kofi Annan could be jeopardized by enactment of these mandates. It is no surprise that many member states of the U.N. have said that these conditions are a mere starting point for further negotiations. Such an interpretation, if accepted by the body as a whole, would simply put us back at square one with a $1 billion arrearage. Rather than debating how best to pay our back dues, we should instead focus on the more fundamental question of whether or not the United States ought to be a member of the United Nations at all. If we do decide that it's in our interests to remain there, then we should simply pay our dues and move on. It is imperative that the United States remain engaged, rather than withdraw, from world affairs and institutions such as the United Nations. I urge my colleagues to support the Lugar/Sarbanes amendment.

Mr. CHAFEE

Mr. CHAFEE. Mr. President, I would like to make a few remarks about the nomination of Michael Armstrong to be Associate Director of Mitigation for the Federal Emergency Management Agency. The President nominated Mr. Armstrong for this position on April 28. Last Thursday, June 9, the Committee on Environment and Public Works unanimously reported out Mr. Armstrong's nomination. During Mr. Armstrong's confirmation hearing, Senators Campbell, Allard, Conrad, and Dorgan, as well as Representatives Skaggs and Pomeroy, spoke in support of his nomination. In addition, Senator Daschle, Governor Romer of Colorado, Governor Racicot of Montana, Governor Janklow of South Dakota, and the Association of State Floodplain Managers have written letters of recommendation on Mr. Armstrong's behalf. I am pleased to report that Michael Armstrong has an impressive background that suits him well to the position before him. For the past 3\1/2\ years, he has served as the Director of FEMA Region 8, which includes the States of Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming. Mr. Armstrong has done an excellent job as Region 8 director. He has assumed tremendous leadership during major disasters, such as the recent floods in North Dakota. Moreover, Mr. Armstrong has done a great deal to encourage public outreach and coordination between Federal, State, and local response resources. FEMA is the central agency within the Federal Government responsible for emergency planning, preparedness, mitigation, response, and recovery. The position for which Mr. Armstrong has been nominated, Associate Director of Mitigation, carries out FEMA's policies and programs to eliminate or reduce risks to life and property from natural hazards such as floods, hurricanes, and earthquakes. Federal emergency management has always focused primarily on how to respond to a disaster, after it strikes. We in Congress are no different; almost every year, we pass supplemental emergency appropriations legislation to pay for the additional, unanticipated costs of timely disasters. FEMA is beginning to place greater emphasis on the mitigation or prevention of long-term risks before the disaster strikes. The purpose of this shift in focus is hopefully to reduce liabilities and ultimately to reduce the cost of disaster response. This appears to be a smart move, and we are all eager to see FEMA succeed in carrying out this initiative. If confirmed, Mr. Armstrong will lead FEMA's efforts in mitigating the risks of natural disasters. This task is not an easy one, but I am confident in Mr. Armstrong's ability to face the challenge ahead.

Mr. CHAFEE

Mr. CHAFEE. Mr, President, I would like to make a few remarks about the nomination of Maj. Gen. Robert Bernard Flowers to be member and president of the Mississippi River Commission. Last Thursday, June 5, the Committee on Environment and Public Works unanimously reported out General Flowers' nomination. General Flowers has an impressive background. He has served in the U.S. Army since 1969 and is a registered professional engineer. General Flowers presently is the Army Corps of Engineers Division Commander of the Lower Mississippi Valley, which comprises districts headquartered in St. Louis, Memphis, Vicksburg and New Orleans. In his current position, General Flowers oversees the Corps of Engineers' water resources program in this 156,000 square mile area of the lower Mississippi Valley. General Flowers' experience will serve him well in the position before him. If confirmed as president of the Mississippi River Commission, General Flowers will be responsible for the planning and implementation of a program to control and develop the lower Mississippi Valley. The MRC also is responsible for the management and oversight of the Mississippi Rivers and Tributaries Project. I might add that General Flowers is no stranger to the flooding and issues involved in controlling the Mississippi River. In fact, he was unable to join the Committee at his confirmation hearing this past March because of the urgency of terrible flooding in that area. He is a dedicated individual who will continue to be an asset to the Mississippi River and the Nation alike. Thank you.

Mr. CHAFEE

Mr. CHAFEE. Mr. President, I am pleased today to introduce The Medicaid Managed Care Act of 1997. This legislation meets two very important objectives in the Medicaid Program. First, it gives States the additional flexibility they need to administer the Medicaid Program by allowing them to enroll Medicaid beneficiaries into managed care Programs. Second, the bill sets Federal standards for managed care to ensure that Medicaid patients receive the same quality of care as those patients who are enrolled in private managed care plans. Under our legislation, States could require Medicaid patients to enroll in managed care plans without going through the lengthy and cumbersome process of applying to the Secretary of Health and Human Services for a waiver of current Medicaid regulations. In exchange for this important flexibility, States will have to meet a set of minimum Federal standards to ensure that Medicaid patients continue to receive quality care. For example, States would be required to offer patients a choice of at least two health plans. Plans would be required to meet certain standards of access to care, quality, and solvency. These standards are especially important given recent problems in States that have set up Medicaid managed care programs under the waiver process. In some instances, plans have failed to contract with enough providers to serve the Medicaid population. Some have been permitted to operate under standards that are lower than commercial insurers are required to meet, and others have used fraudulent marketing practices to entice Medicaid patients to sign up with their plans. These actions have resulted in patients being denied medically necessary services, and have resulted in States and the Federal Government paying for care that was never given. Considering these abuses, why should we allow Medicaid managed care at all? Because managed care, if implemented correctly, can vastly improve the quality of health care provided to low-income families. In today's fee-for-service program, patients face myriad problems. Some are forced to get care in hospital emergency rooms because they cannot find a private physician willing or able to accept Medicaid's low payment rates. Those who do have access to providers often must wait for hours in clinics which are overcrowded and understaffed. And, sadly, they often do not have access to primary and preventive care services which would have prevented them from becoming ill to begin with. Medicaid managed care, if done well, provides regular prenatal care to assure that children are born healthy. These plans provide coverage for check-ups and immunizations to prevent serious illnesses. And they give patients a medical home--a provider they know they can go to if they are sick, or a number to call if they have questions. Medicaid managed care also has the potential of benefiting our overall health care system by providing access to primary care providers rather than forcing patients to make costly and unnecessary visits to hospital emergency rooms. It gives providers the opportunity to catch and treat, or prevent, costly health problems. Mr. President, we have worked very hard to ensure that this legislation strikes an appropriate balance between the needs of Medicaid beneficiaries and the managed care companies. I want to thank Senators Breaux and Kerrey who helped craft this legislation and are original cosponsors. I also want to thank the many advocacy organizations for their input and support. And I also want to thank some of the managed care organizations who worked with us. I am especially pleased that some of these organizations, such as the HMO Group which is an alliance of health maintenance organizations have endorsed this legislation. Their support is critical to the success of Medicaid managed care. I ask unanimous consent that the text of the legislation be included in the Record.

Mr. CHAFEE

Mr. CHAFEE. Mr. President, I am pleased today to introduce The Medicaid Managed Care Act of 1997. This legislation meets two very important objectives in the Medicaid Program. First, it gives States the additional flexibility they need to administer the Medicaid Program by allowing them to enroll Medicaid beneficiaries into managed care Programs. Second, the bill sets Federal standards for managed care to ensure that Medicaid patients receive the same quality of care as those patients who are enrolled in private managed care plans. Under our legislation, States could require Medicaid patients to enroll in managed care plans without going through the lengthy and cumbersome process of applying to the Secretary of Health and Human Services for a waiver of current Medicaid regulations. In exchange for this important flexibility, States will have to meet a set of minimum Federal standards to ensure that Medicaid patients continue to receive quality care. For example, States would be required to offer patients a choice of at least two health plans. Plans would be required to meet certain standards of access to care, quality, and solvency. These standards are especially important given recent problems in States that have set up Medicaid managed care programs under the waiver process. In some instances, plans have failed to contract with enough providers to serve the Medicaid population. Some have been permitted to operate under standards that are lower than commercial insurers are required to meet, and others have used fraudulent marketing practices to entice Medicaid patients to sign up with their plans. These actions have resulted in patients being denied medically necessary services, and have resulted in States and the Federal Government paying for care that was never given. Considering these abuses, why should we allow Medicaid managed care at all? Because managed care, if implemented correctly, can vastly improve the quality of health care provided to low-income families. In today's fee-for-service program, patients face myriad problems. Some are forced to get care in hospital emergency rooms because they cannot find a private physician willing or able to accept Medicaid's low payment rates. Those who do have access to providers often must wait for hours in clinics which are overcrowded and understaffed. And, sadly, they often do not have access to primary and preventive care services which would have prevented them from becoming ill to begin with. Medicaid managed care, if done well, provides regular prenatal care to assure that children are born healthy. These plans provide coverage for check-ups and immunizations to prevent serious illnesses. And they give patients a medical home--a provider they know they can go to if they are sick, or a number to call if they have questions. Medicaid managed care also has the potential of benefiting our overall health care system by providing access to primary care providers rather than forcing patients to make costly and unnecessary visits to hospital emergency rooms. It gives providers the opportunity to catch and treat, or prevent, costly health problems. Mr. President, we have worked very hard to ensure that this legislation strikes an appropriate balance between the needs of Medicaid beneficiaries and the managed care companies. I want to thank Senators Breaux and Kerrey who helped craft this legislation and are original cosponsors. I also want to thank the many advocacy organizations for their input and support. And I also want to thank some of the managed care organizations who worked with us. I am especially pleased that some of these organizations, such as the HMO Group which is an alliance of health maintenance organizations have endorsed this legislation. Their support is critical to the success of Medicaid managed care. I ask unanimous consent that the text of the legislation be included in the Record.

Mr. CHAFEE

Mr. CHAFEE. Mr. President, I am delighted to join in congratulating Senator Thurmond on attaining the distinction of being the Nation's longest serving U.S. Senator. Since coming to the Senate a little over 20 years ago, I have respected Senator Thurmond's abilities, admired his tenacity, valued his judgment, and treasured his friendship. He is an inspiration to all of us, not only because of the length of his service, but because of the quality of his work and the depth of his commitment. All of us marvel at the sheer duration of Strom Thurmond's tenure in the Senate--42 years. But we congratulate him today not only for his longevity, but for dedicating most of his adult life to public service. As a school teacher and a coach, as an attorney, as a soldier who participated in the D-day landing at Normandy, as a State senator, as a circuit court judge, as Governor of South Carolina, and as U.S. Senator, Strom Thurmond has repeatedly sought out opportunities to serve his community, State, and Nation. And, due to his reputation for hard work and effective leadership, the people of South Carolina have repeatedly demonstrated their confidence in him--a degree of confidence among the voters that all of us aspire to but few achieve. Senator Thurmond's unflagging vigor is evident to anyone who shakes his hand--his handshake is firm and formidable. All of us hope and expect that he will stay in the Senate until he reaches the age of 100 and beyond.

Mr. CHAFEE

Mr. CHAFEE. What comes in this year goes out next year, and that principle is in this budget.

Mr. CHAFEE. Mr. President, I thank the distinguished manager of the bill. I rise in opposition today to the amendment offered by the Senator from Virginia and the Senator from Montana. I might say, these are two Senators for whom I have tremendous respect. I have worked with them. The Senator from Virginia, I think we first started our association in 1969, and the Senator from Montana, I started working with him the first year he came to the Senate, which I think was 1978, 1979, and we have been closely associated ever since. However, this amendment, which would increase outlays for transportation spending above the levels provided in the resolution before us, I find to be inconsistent with the achievement of a balanced budget by the year 2002. The Senator from Virginia just said it went beyond the bill, the so- called NEXTEA bill that goes beyond this, and that is absolutely right, but that was before we had a target from the Budget Committee. I believe strongly in the budgetary process we have set up. I voted for it, and I support it. I think we all can agree that the Nation's roads and bridges are in need of repair. No one argues with that. Transportation plays a critical role in our Nation's economy. We recognize that. In the United States, more than 12 million people, more than 11 percent of the gross national product, is involved in transportation. Earlier this year, I cosponsored a measure to increase, within the context of a unified budget, the level of transportation spending from the highway trust fund. I am pleased that the budget agreement, crafted by the Senator from New Mexico and the Senator from New Jersey, increases the spending levels implicit in that proposal, the so- called Bond-Chafee proposal. It is $13 billion over a freeze baseline. That is pretty good. Would we like more? Sure we would. But I think it is terribly important to recognize that any proposal that boosts highway spending or transportation spending without corresponding offsets is something I personally cannot support. So, I agree with Senators Warner and Baucus that transportation spending should be increased, but not in a manner that would undermine the careful agreement reached by the Budget Committee. Do we like everything in this budget? No, but it is the best we can get. I am supporting that agreement. It seems to me we simply cannot afford to retreat from our efforts to eliminate the Federal deficit. So that, Mr. President, is the reason I cannot support this amendment that is before us today. I thank the Chair and thank the manager and thank the distinguished chairman of the subcommittee that deals with these matters. He has worked on them, and I know his heart is in this. As always, he argues his case with vigor and considerable force.