William Cohen

Mr. COHEN

Mr. COHEN. Mr. President, I would like to engage the distinguished chairman of the Appropriations Subcommittee on Veterans' Affairs, Housing and Urban Development, and Independent Agencies, Senator Christopher Bond, in a colloquy regarding processing veterans' claims and the reduction of the claims backlog due to the efforts of the Board of Veterans' Appeals [BVA]. The Board of Veterans' Appeals [BVA] is responsible for the final decision in each of the many thousands of claims for entitlement to veterans benefits that are presented annually for appellate review. The Board's mission is to issue quality decisions in a timely manner. The timeliness of BVA's decision-making has come under intense scrutiny as unprecedented appellate backlogs have developed in recent years, primarily as a result of the process of adapting to a judicial review environment. However, beginning in 1995, BVA has done much to reverse this trend and is making progress in reducing the time veterans must wait for decisions on appeals. Mr. President, in 1994 our veterans had to wait 781 days, over 2 years, for an appelant decision on their benefits and medical claims. This response time was reduced to 763 days in 1995. This reduction was still possible even with an increase of approximately 4,500 cases. Thus far in 1996 the response time has been reduced even further to 623 days. The anticipated appeals response time will be reduced to 545 days upon implementation of the BVA's staff increase by 50 attorneys in 1997. While this time is still too long for America's veterans to wait, it represents a substantial reduction from 1994 in the waiting time for appeals. I believe two factors are responsible for the improvements in the BVA decision output and timeliness: First, productivity has increased at all levels, primarily as a result of the Board's successful implementation of its organizational realignment at the outset of 1996 and second, additional staffing resources made available in fiscal year 1996 have enabled the Board to add additional attorneys to the mission critical tasks of reviewing and drafting decisions on appeals. The Board's principal indicator of productivity is the number of appeals decided per full time employee [FTE]. As of may 31, 1996, BVA appeals decided per FTE had risen over 20 percent to a level of 80.1 from the fiscal year 1995 level of 65.1 appeals per FTE. This compares with fiscal year 1994's productivity of 49.9 appeals per FTE. As the distinguished chairman is aware the other body approved the $4 million to fund the additional 50 positions on the Board. The bill before us specifically removes that funding. While the funding adding the 50 positions will decrease the processing time and lead to long term reduction, what is just as important is the impact of not adding those 50 positions. The processing time will not only increase in the near future, but will continue to increase and that is why I'm so concerned over the $4 million reduction. I ask the chairman of the VA/HUD Subcommittee on Appropriations to support the $4 million request to the Board of Veterans' Appeals for an additional 50 staff so that we may continue to reduce the veterans' appeals response time.

Mr. COHEN

Mr. COHEN. Mr. President, in the spring of 1995, the Medicare trustees, on a bipartisan basis, issued an urgent warning that the Medicare hospital trust fund will go broke by the year 2002, unless major changes are made to protect the system. Since that alarm was sounded, the Congress has been wrestling with ways to bring Medicare spending under control, in order to forestall impending bankruptcy and to strengthen Medicare for both current and future beneficiaries. This year the situation is even more critical. The 1996 trustees' report projects bankruptcy for the trust fund by the year 2001. I stated at the time of the trustees warning that, at a minimum, we should pass legislation to crack down on the fraud and abuse that drives up the costs of health care for senior citizens and taxpayers. Estimates are that Medicare loses over $18 billion each year to fraud and abuse, and that fraudulent schemes cost the entire health care system and our economy as much as $100 billion each year. Today, we are reaching a historic milestone by passing one of the most comprehensive and tough anti-fraud packages ever contemplated by Congress. It has been a long road--over 3 years to be exact--but as the author of the antifraud and abuse provisions I am proud that this Congress, in a bipartisan way, did the right thing. Specifically, my proposal creates tough new criminal statutes to help prosecutors pursue health care fraud more swiftly and efficiently, increases fines and penalties for billing Medicare and Medicaid for unnecessary services, over billing, and for other frauds against these and all Federal health care programs, and makes it easier to kick fraudulent providers out of the Medicare and Medicaid program, so they do not continue to rip off the system. Most importantly, the bill establishes an antifraud and abuse program to coordinate Federal and State efforts against health care fraud, and substantially increases funding for investigative efforts, auditors, and prosecutors. In early 1993, I first embarked upon writing an antifraud bill. This was based on the recommendations of a health care fraud task force set up by the Bush administration and on an investigation by the Senate Special Committee on Aging, which I chair. That legislation became the basis for the fraud and abuse section of all the Republican health care reform bills proposed in 1993 and 1994 as well as for the administration's proposal. It was one of the few truly bipartisan issues contemplated during that contentious debate. In late 1993, the criminal provisions of my bill passed the Senate unanimously as part of the crime bill but were deleted during conference. Last year, my proposal passed Congress as part of the budget reconciliation bill and were also used as framework by the administration in its budget reconciliation proposal. As we all know, the President vetoed that bill. Today, it stands as an integral part of the Kassebaum-Kennedy health insurance reform proposal, finally on its way to the President for signature. Health care fraud is an equal opportunity employer that does not discriminate against any part of the system. All Government health care programs--Medicare, Medicaid, CHAMPUS, and other Federal and State health plans, as well as private sector health plans, are ravaged by fraud and abuse. Similarly, no one type of health care provider or provider group corners the market on health care fraud. Scams against the system run the gamut from small companies or practitioners who occasionally pad their Medicare billings because they know they'll never get caught, to large criminal organizations that systematically steal millions of dollars from Medicare, Medicaid, and other insurers. According to the FBI, health care fraud is growing much faster than law enforcement ever anticipated, and even cocaine distributors are switching from drug dealing to health care fraud schemes because the chances of being caught are so small--and the profits so big. The inspector general of the Department of Health and Human Services, for example, has cited problems in home health care, nursing home, and medical supplier industries as significant trends in Medicare and Medicaid fraud and abuse. Padding claims and cost reports, charging the Government and patients outrageous prices for unbundled services, and billing Medicare for costs that have nothing to do with patient care are just a few of the schemes that are occurring in these industries. It is time that we crack down--and shut down--these schemes that are bilking billions of dollars from Medicare and other health care programs. If we have asked honest health care providers to take cuts in reimbursement and asked Medicare and Medicaid recipients to pay more out-of-pocket costs to bring spending under control, we have an absolute duty to ensure the American public that their health care dollars are not lining the pockets of criminals and greedy providers who are manipulating the system through fraud and abuse. The proponents of strong anti-fraud proposals responded to a mandate from beneficiaries that we need to control spending and ease the burden on taxpayers. The anti-fraud provisions in the Kassebaum-Kennedy bill did precisely that in a reasonable, measured manner that did not infringe on personal liberties nor penalize innocent mistakes. The fraud provisions substantially mirror existing fraud statutes and are designed to give enforcement more precise tools to protect consumers against fraud and abuse. The proposal simply provides adequate resources for prosecutors and investigators, long strapped by budget cuts and under staffing, to go after serious patterns and cases of abuse. The bill closes loopholes in current law and provides criminal penalties for a defined set of serious and egregious violations, such as embezzlement and misappropriation of assets. Prosecutors would continue to have an extremely high burden to prove that the violations were committed knowingly and willfully. Despite such a reasoned approach, we were inundated at the last moment by scare tactics and blatant mischaracterizations. There were full page ads depicting a doctor shackled in stocks claiming that doctors would land in jail for committing honest mistakes. There were editorials that grossly distorted the intent and scope of the provisions in a fashion that minimized the very real threat that fraud poses to our health care system and, indeed, to the solvency of Medicare. I am sympathetic to the concerns of physicians and other health care providers that the practice of medicine has become excessively regulated. I also believe that physicians raise legitimate concerns that too often managed care plans manage costs alone at the expense of quality of care for patients and unduly limit physicians' decisions on how to best treat their patients. To blame all of these trends on the health care fraud provisions, particularly at the last stage in the negotiation process, was misguided and inaccurate. I am proud that my Republican and Democratic colleagues were not intimidated by these falsehoods and proceeded on a straight path to passing strong legislation. As the author of these provisions, and as someone who has been involved in the negotiations of these provisions over a 3-year span, there are a couple of issues I wish to clarify as we debate final passage of the conference report. First, the fraud and abuse control program established in the bill contemplates increased collaboration between the Department of Justice and the Office of the Inspector General [OIG] in health care law enforcement. It was not my intention, however, to expand the legal responsibility of the Office of Inspector General to private health plans. The jurisdiction of the OIG remains as it exists today, with only those augmentations of its authority specifically authorized in the bill. Second, it was my intention that the costs covered by the funds appropriated to the Federal Bureau of Investigation provided for in the mandatory appropriation section include those associated with the hiring of additional agents and support resources as supplemental funding to address the burgeoning health care fraud problem. Third, the moneys from the control account which are directed to the Office of the Inspector General are primarily intended to increase the ability of that office to investigate health care fraud and ensure that Medicare funds are properly spent. If the Office of the Inspector General is assigned the duty of preparing the advisory opinions, I would expect the Secretary and the Attorney General to consider a specific grant of funds for this purpose from any discretionary moneys in the control account as an addition to the amounts already available to the OIG. We would not want to see a reduction in the effort to investigate fraud, in order to provide staff for the advisory opinion function. Finally, as the author of the original enhanced guidance to providers section, I would like to make some affirmative and declarative statements on the actual advisory opinion language. Although advisory opinions are an appropriate means of giving guidance to the industry on some issues, it is clearly unwise to have the agencies in the position of opining on the intent of the person requesting the opinion. To have a Government agency make an independent determination of what is in someone's head, based solely upon what that person chooses to tell the agency, is a highly questionable Government function. That is why I want it clearly stated for the record of debate what has been stated during conference and indeed what has been stated by advisory opinion proponents for the last 3 years that this issue has been debated. Advisory opinion advocates have stated definitively and consistently in conference and during many lengthy negotiations that the advisory opinion provision does not require a finding of intent. Not only do I adhere to that view, I will do everything possible to ensure while I am still here, and while this provision will be reviewed prior to implementation by the agencies, that such an expectation is followed. I will also ensure that after I am gone those who have oversight authority here in Congress, and those who are in the leadership, make sure that such an expectation is followed. I know that the Attorney General has spoken to the Speaker of the House, the Senate Majority Leader, the chairmen of the House and Senate Judiciary Committees as well as numerous members of the Ways and Means Committee and Finance Committee about her concerns relating to the issuance of advisory opinions. None of the existing advisory opinion mechanisms available to the Federal Government require an independent determination of intent. To reiterate, statements were made by the conferees that this was the expectation here as well. I, therefore, expect the agencies to design a process for advisory opinions which does not require such a determination. I also expect that this advisory opinion process will sunset 4 years after the date of enactment of this bill as is required by the bill. Mr. President, in conclusion, I would like to applaud members for this major antifraud victory. According to the Congressional Budget Office, these provisions will yield billions in scorable savings. I am convinced that the long-term savings are much greater, and that billions more will be saved once dishonest providers realize that we are cracking down on fraud, and that they can no longer get away with illegally padding their bills to pad their own pockets. For years, I have been saying that Federal law enforcement often feel like the mouse has outsmarted the mousetrap, because they lack adequate tools and resources to penalize egregious cases of fraud. While I know that this bill does not solve this enormous and complicated problem, I can state today that the mousetrap has sprung. I would like to thank Senators Roth and Dole, for all of their steadfast support and assistance over the years; Alec Vachon of the Finance Committee and Harry Damelin of the Permanent Subcommittee on Investigations, for all their hard work and perseverance; Sue Nestor, formerly of the Finance Committee, for all her hard work before she left the Senate; and Helen Albert, Mary Gerwin, and Priscilla Hanley, of my staff, for their dedication to passage of this important legislation. mental health parity

Mr. COHEN

Mr. COHEN. Mr. President, about 11 months ago, the Senate passed a welfare reform bill by an overwhelming 87 to 12 margin. That vote demonstrated that there was strong, bipartisan agreement that the current welfare system needs a dramatic overhaul. After almost a year of discussion relating to the best way to reform the current system, it is satisfying that the same bipartisan spirit will be present when we vote on a welfare reform plan for third time. The current system, with its trademark entitlement programs, has been only marginally successful in providing for the most basic needs of low-income people, and has been a dismal failure in encouraging recipients to become independent. While we supported changes in 1988 to emphasize work in our welfare system--those reforms included so many exemptions that the incentives to work were seriously undermined. Those reforms did not do enough to help us distinguish those who had fallen on hard times and needed a helping hand from those who simply refused to act in a disciplined and responsible manner. When welfare is a Federal entitlement, it is very difficult to make that distinction. The legislation before us today will put welfare recipients on notice that their time on the system is limited. We are offering them assistance with child care, health care, and training to become self- sufficient. In return, recipients are expected to put in time improving their education, participating in training, and getting a job to get off the system permanently. As recipients increase their efforts to comply with these new requirements, States must understand the responsibility they are accepting with the flexibility gained from the block grant. The Federal Government is ending the 60-year philosophy that anyone at anytime is entitled to cash assistance. The philosophy has changed to: we will help someone get a job and keep a job by providing child care and health care for a specified period of time. This shift in philosophy means that the culture of State welfare offices must evolve into the culture of a job placement service where the focus is getting jobs, not mailing checks. This legislation also takes a big step forward to reinforce the importance of families in society. Regrettably, too many of our young people are growing up without two parents involved in their lives; 92 percent of AFDC families have no father in the home. This bill recognizes that reducing out-of-wedlock births is an important goal, but does not prescribe Federal solutions that would hamstring the ability of States to try different approaches. One of the most essential ingredients for self-sufficiency is the availability of child care. By funding child care activities at almost $22 billion, States will have the resources they need to design successful return-to-work programs. With this enhanced funding, parents will have some assurance that their children will be cared for in safe settings. As the President indicated yesterday, this bill is not perfect. One of my principle concerns is the impact of cuts in food stamps on the working poor. Food stamp benefits do not extend just to families on AFDC. The Food Stamp Program plays an important role in helping poor, working families make ends meet. Food stamps are the front-line defense against poverty, providing a minimum safety net of 1 out of every 10 people in Maine. This program has proven vital in improving the health of our children and the elderly, and protecting people with disabilities. We need to ensure that this program retains its vital mission: to ensure that families have enough resources to buy food. One of the most important provisions in this bill is the emphasis on the collection of child support and establishing paternity for children born out-of-wedlock. Child support collections continue to increase across the Nation. The Republican bill includes provision which will encourage even greater increases in child support collections. By taking a tougher stand to establish and then enforce child support orders, some of the families currently tied to the welfare system may be able to get loose. It is obvious that no one likes the current system. Governors don't like it, welfare recipients don't like it, and the public believes that welfare programs serve only those people who want to take advantage of the system. As a result, support for antipoverty programs has eroded drastically in recent years. By injecting a work ethic into our welfare system and emphasizing self-sufficiency, which this bill does--we are on the right track. This bill comes very close to providing resources and incentives that will improve our anti-poverty programs, but I also hope we will continue to work to ensure that our most vulnerable populations are protected.

Mr. COHEN

Mr. COHEN. Mr. President, this is an amendment that pertains to the States of Maine and New Hampshire, dealing with weight limit for trucks. We have worked in close conjunction with the Senator from New Jersey, the Senator from Montana, and the Senator from Rhode Island. They have agreed that the amendment should be adopted. It would defer imposition of penalties or the use of funds to impose penalties prior to September 1, 1997. That is acceptable to both sides.

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

Mr. COHEN. Mr. President, on behalf of myself, Senator Snowe, Senator Smith, and Senator Gregg, I send an amendment to the desk and ask for its immediate consideration.

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

Mr. COHEN

Mr. COHEN. Mr. President, I ask unanimous consent that the Special Committee on Aging be authorized to meet during the session of the Senate on Tuesday, July 30 at 9:30 a.m. to hold a hearing to discuss suicide among the elderly.

Mr. COHEN

Mr. COHEN. I move to reconsider the vote.

Mr. COHEN. It is not the intention of this legislation to compel U.S. persons to breach or repudiate pre-sanctions contracts or commitments.

Mr. COHEN. I believe there is one other. Mr. President, I yield 5 minutes to the Senator from California.

Mr. COHEN. Mr. President, I yield 2 minutes to the Senator from Idaho.

Mr. COHEN. Can we add, with respect to the Cohen amendment, there be no second-degree amendments?

Mr. COHEN. Mr. President, as my friend from Kentucky has indicated, we have to set aside ideology on this particular vote, that and labels. He would have you believe that those who support the Cohen-Feinstein- Chafee amendment are for repression, for dictators, for brutality, for house arrests, against sanctions, against morality, against protecting Aung San Suu Kyi, against democracy. My friends, it is not nearly so simple. And perhaps I have overstated the statements of my friend from Kentucky, but when we have allegations made that this is a profound moral choice, that this measure that I offer would, in fact, negate the impact of sanctions upon this particular regime, that it would lend support to the military junta-- and we have heard statements made by our colleague from New York that adoption of the Cohen amendment would, in fact, aid and comfort the enemies of democracy--I must speak out with some vigor on such suggestions, or even implication. We heard talk about the European Parliament boycotting Burma. Well, the European Union said no. As a matter of fact, there is a report in papers as of yesterday: ``A Danish proposal for sanctions against Burma was toned down last week to one condemning the Government of SLORC.'' So they toned it down from sanctions to simply condemning, and we condemn them. It was said that Mickey Kantor favors the subcommittee's approach, our Trade Representative favors it. I do not understand that. We have a letter introduced on behalf of the administration that the White House supports the approach that I and Senators Feinstein and Chafee and others have taken. No one has fought harder, if we talk about ideals, than our colleague from Arizona, Senator McCain. He spent more than 6 years in prison keeping that flame of idealism alive, representing this country in a way that few of us can even begin to contemplate, and yet he is supporting the approach that I am suggesting. Those of us who are urging the support of this amendment are, in fact, calling for sanctions. We are calling upon our administration to impose sanctions, to not issue visas--except those required by treaty-- to any government official from Burma. We are insisting that we cast a vote of ``no'' on any international lending organization loans to Burma. We are saying that if they make any attempt to imprison or harass Aung San Suu Kyi, sanctions go into effect immediately, that no further business can enter that particular country. We are for sanctions. We are for, however, limited exemptions in the field of human rights, certainly for humanitarian assistance. Does anyone here want to cut off an attempt to feed starving people? On counternarcotics: We have heard by just the last vote, an overwhelming vote, of our concern about narcotics coming into this country. Over two-thirds of all the heroin production in the world is coming out of Burma, are we saying let us walk away? Do we not want to engage in any way, even if it is certified by the administration that the SLORC is cooperating to try to reduce the flow of narcotics coming into our country? Is that what we want to go on record in favor of? Do we want to deny funding for the National Endowment for Democracy, organizations that people like Senator McCain are actively involved in, that actively promote change by the Burmese junta? My amendment tries to carve out a narrow exemption to give some flexibility to this administration or the next administration, not simply to look to the past and punish this junta for past deeds, but rather to see if there is any way we can use whatever leverage we have, and it is very small, to encourage this junta to come into the 21st century of pro-democratic activity. It has been suggested that we have commercial interests in mind. I do not represent any oil companies. I do not have any business interests in mind. What I am asking is, what is the most effective way to produce change? Do sanctions work? Yes and no. They worked in South Africa because the world supported it. The frontline countries in Africa supported it. The frontline countries in Asia do not support this action by the subcommittee. Iran is another exception where sanctions can and do work. It is a terrorist-sponsoring nation, destabilizing its region, and so there is world condemnation of Iran. And China, let me just mention China. Mr. President, I was looking through my desk here while the debate was going on, and I came across some interesting remarks made by my former colleague from Maine, Senator Mitchell, some years ago in 1991-92, when debating China. He said something at that time that I think may bear some relevance here today. He said: The year-long renewal of most-favored-nation trade status for China has brought the world precisely nothing in the way of reform in the Chinese regime. It has not encouraged the Chinese regime to respect the human rights of any Chinese citizen. It has not emboldened the Chinese Government to broaden its experiments with a market economy beyond one province. That was said back in 1991, and then again in 1992. He may have been right at that time as far as his perception, but things have changed in China. They are now, in fact, making changes in Shanghai. They are now providing a legal system based upon ours, they are giving an accused individual a right to an attorney before he can be arrested and apprehended. They are making vast changes. It comes about more slowly there, not nearly as fast as we would like, but change has occurred. Yes, we are standing up to our ideals on the issue of democracy in Asia, but when you talk to the Chinese they say, you talk about ideals. For 200 years you enslaved people. You put people in chains. You treated them like subhumans. You robbed them of their families and their dignity and their lives, and it was not until about 30 years ago you finally decided to change. Give us an opportunity to bring about change in this region. Do not lecture us that you achieved your ideals all in one period of time. So it took time for us to change over here. What we are saying with our amendment is that we can make more change in Burma from within than from without, and we can bring Burma out from the dark ages of repression into the sunlight of the 21st century and prodemocratic activity. We can do this not by trying to turn away, and trying to isolate them--because we cannot do it effectively--but by having some limited contact from within. Mr. President, I suggest that the passage of my amendment will accomplish the goals that we all want to change the military dictatorship's activity.

Mr. COHEN. Mr. President, I ask unanimous consent that Senator Thomas be added as a cosponsor to the Cohen amendment.

Mr. COHEN. How much time is remaining?

Mr. COHEN. At what point?

Mr. COHEN

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

Mr. COHEN. Could I just indicate for the record, during the course of the debate this morning the question of the administration's position was raised. I have since been apprised that the administration does lend its support to the Cohen amendment, which prior to the beginning of the discussion of this matter it did not. So perhaps they have been watching C-SPAN and have tuned in to see the better part of wisdom in supporting the Cohen amendment. Mr. President, I ask unanimous consent that the letter, signed by Barbara Larkin, Assistant Secretary of State for Legislative Affairs be printed in the Record.

Mr. COHEN. Mr. President, I understand there are a number of Senators who would like to speak on this measure who cannot come to the floor at this time. So I am going to suggest the absence of a quorum in a moment, but then agree to lay aside this amendment so that other amendments that may be pending can be considered. Mr. McCONNELL addressed the Chair.

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

Mr. COHEN. It gives the administration some flexibility. They would like more. Mine does not give them quite as much as they like.

Mr. COHEN. If the Senator will yield, I don't believe he does. He does not express support for this amendment.

Mr. COHEN

Mr. COHEN. Finally, Mr. President, action to clarify section 907 is in the U.S. national security interest. On a strategic level, section 907 may force Azerbaijan back under the Russian yoke. A number of other ex-Soviet republics have been coerced into compromised relationships with Moscow, because they have been unable to build strong national institutions. Azerbaijan has so far resisted Russian and Iranian pressure and is striving to maintain its sovereignty by developing its large oil reserves. The suffering and privation aggravated by section 907, however, make the Azerbaijan's quest for sovereignty more difficult. Mr. President, I know that the Azeri-Armenian conflict evokes deep passion in many of my colleagues, but the easing of the suffering of displaced civilians, children and refugees is not a political statement, it is a moral imperative. The war in the Caucasus is now winding to a close on terms favorable to Armenia and the Armenian population of Nagorno-Karabakh. While a peace treaty has not yet been signed, both sides in the war have shown a desire to negotiate and turn their embattled countries to the task of rebuilding and recovery. Clarifying section 907 is essential to speed that process. Mr. President, this issue presents us with a simple question: Does the United States want to act now to speed the process of recovery, rebuilding, and democratization, or do we want to stand by and allow want and isolation to doom Azerbaijan and the Caucasus as a whole to a future of instability, authoritarianism, conflict and subjugation to reactionaries in Moscow? I commend Senator Byrd for his initiative in seeking to clarify the section 907 ban. Exhibit 1 Subject: A Generation Lost: Alarming News About The Health of IDP Children First, summary: The 900,000 refugees and internally displaced persons [IDPS] remain the world's forgotten tradegy. The tragedy must end now. According to the preliminary results of a CDC/UN health survey on the IDPS-- they have health problems that are significantly worse than CDC anticipated. That the IDPS suffer from poor nutrition, lack of access to health care and chronic diarrhea among children was predictable. However, much more shocking were the CDC's findings of stunted growth in children, a high incidence of goiter and widespread anemia. Some of this could result in mental retardation for the worst affected children in the camps. This is not 1992. The authors of FSA 907 did not intend that the U.S. Government not respond to such suffering of little kids. On humanitarian grounds, the United States must act--even if it means some contact with the government public health service--to meet this long-ignored crisis. End summary. Second, Ibrahim Parvanta of the Centers for Disease Control [CDC] met with the Ambassador on April 19 to discuss the preliminary results of CDC's aid-funded medical survey of IDPS in Azerbaijan. From March 27 through April 19, the World Health Organization [WHO], the Centers for Disease Control and Prevention [CDC] and UNICEF, in collaboration with Relief International [RI] and Medicines Sans Frontieres/Holland [MSF/H] conducted a nation-wide health and nutrition survey in Azerbaijan. The survey covered 55 districts with an estimated population of 620,000 IDPS and the non-IDP population of the country for comparison purposes. Because of section 907 of the Freedom Support Act, CDC's part of the survey could only focus on the IDP population, using PVO support. WHO/UNICEF focused on the general population with government of Azerbiajan support. Parvanta highlighted the following preliminary findings of the survey. food insecurity Forty-nine percent of all IDP families and 29 percent of resident families surveyed, skipped meals during the week before the survey. Members of 46 percent of IDP households and of 31 percent of resident households had not eaten meat during the preceding 2 weeks. stunted growth in children Children in Azerbaijan suffer fromn chronic health and nutrition problems that lead to stunted growth. The long term functional implications on physical work capacity, intellectual development and overall health may be significant. Recurrent clinical and sub-clinical infections, as well as nutritional deficiencies (particularly micronutrients) may be responsible for this condition. Parvanta stressed that stunted growth was higher among IDP children aged 6-11 months (30.7%) than the same age group in resident population (21.3%). health care: out of reach Poor access to health care is currently a serious problem, particularly for IDPS in Azerbaijan. Most often, ill people who want treatment cannot afford it. (Despite a public health system which supposedly provides free medical care, Azeris must pay to obtain medical treatment.) Thirty-seven percent of people surveyed said that they did not seek medical treatment the last time someone in their family was sick. The main reason, specified in 68 percent of cases, was an inability to pay. Twenty-four percent of IDP children and 16 percent of the resident children (ages 0 to 59 months) were reported to suffer from diarrhea. Seventeen percent of the surveyed population were discovered to have iodine deficiency disorders (goiter). The prevalence of goiter varies considerably by region. Seventy percent of IDP children 12 to 23 months old were reported to suffer from anemia. Parvanta said that this figure is far higher than they expected to find here. If iron deficiency is the main cause of anemia in Azerbaijan, then many children risk significant and potentially irreversible consequences to their mental development. Anemia is also a wide-spread problem for adults. Third, Parvanta cautioned that CDC would have to further analyze the data before reaching final conclusions. The Ambassador asked whether the survey work had uncovered evidence of the WHO-reported malaria among IDPS. He said that they had not although this was yet not mosquito season. Noting that he has previously worked in Armenia, Parvanta added that living conditions are considerably worse for the IDPS in Azerbaijan than refugees in Armenia.

Mr. COHEN. Mr. President, in 1992, war in the Caucasus led Congress to approve a ban on direct U.S. aid to the Government of Azerbaijan under what is known as ``section 907.'' Although section 907 was not intended to deny humanitarian aid to the war-ravaged population of Azerbaijan, it has done just that. Mr. President, I rise to support the effort today to clarify section 907, making humanitarian aid to nearly 1 million in Azerbaijan easier to deliver. This effort represents a true humanitarian action, while at the same time aiding the stabilization of the Caucasus, one of the hotspots of the former Soviet Union. Section 907 currently prevent non-governmental organizations [NGOs] receiving U.S. funding from dealing with the Government of Azerbaijan in carrying out humanitarian missions in the country. In formerly Soviet Azerbaijan, the Government controls a large portion of the economy, so this restriction makes it very difficult for aid organizations to efficiently deliver much-needed help to the 900,000 refugees from the war with Armenia. Some examples of the problems section 907 has created for the International Rescue Committee [IRC], Rescue International [RI] and CARE, independent relief agencies, are as follows: International Rescue Committee [IRC] initially stored medical supplies in Azerbaijan under tarps on the street, because section 907 precluded renting Azerbaijan Government-owned warehouse space. When the Government allowed IRC to use the space rent free, IRC still had to store the supplies under tarps inside the warehouse because IRC was not permitted to pay to repair a leaking roof, since that would have been contact with the Government of Azerbaijan. Relief International [RI] was unable to cooperate with a 1994 UNICEF child immunization program in Azerbaijan, despite major need for such a program, because UNICEF was working with Azerbaijan's Ministry of Health on the project. This year, CARE withdrew a proposal to USAID to rehabilitate buildings and railroad cars as shelters for displaced Azerbaijanis, because the structures were government owned. RI has been unable to do equal-value exchanges of pharmaceuticals with other non-American, nongovernmental organizations [NGOs] in Azerbaijan, a common practice in areas with scarce medical resources, because these other NGO's cooperate with the government. Two thousand IRC-built latrines to prevent water-borne diseases among the refugee population cost twice what they should have, because a middleman had to be retained for purchasing supplies so as not to conduct business with the Government. The extreme gravity of the humanitarian situation in the country was best illustrated in a recent cable to the State Department from the current United States Ambassador to Azerbaijan, Richard Kauzlarich. In the cable, the ambassador cited the horrifying preliminary results of a medical survey conducted by the Centers for Disease Control, UNICEF and the World Health Organization in Azerbaijan earlier this year: Seventy percent of displaced children in Azerbaijan between the ages of 12 and 23 months suffer from anemia. This can cause irreversible problems in their mental development. Anemia is also widespread in the adult population. Thirty percent of displaced children in Azerbaijan between the ages of 6 and 11 months suffer stunted growth caused by malnutrition; 11 percent of the elderly also suffer malnutrition. Twenty-four percent of Azerbaijani displaced children suffer from diarrhea. Seventeen percent of the displaced population suffer from iodine deficiency disorders (goiter). The message in the ambassador's cable is clear--The United States must act now to clarify section 907 and try to stem the growing humanitarian crisis in Azerbaijan. I ask unanimous consent that the text of the ambassador's cable and a 1994 report by USAID on the effects of the section 907 ban on Azerbaijan be printed in the Record.