Kent Conrad

Mr. CONRAD

Mr. CONRAD. Mr. President, section 401(c)(4) of S. Con. Res. 13, the 2010 budget resolution, permits the chairman of the Senate Budget Committee to adjust the section 401(b) discretionary spending limits, allocations pursuant to section 302(a) of the Congressional Budget Act of 1974, and aggregates for legislation making appropriations for fiscal years 2009 and 2010 for overseas deployments and other activities by the amounts provided in such legislation for those purposes and so designated pursuant to section 401(c)(4). The adjustment is limited to the total amount of budget authority specified in section 104(21) of S. Con. Res. 13. For 2009, that limitation is $90.745 billion, and for 2010, it is $130 billion. On June 25, 2009, the Senate Appropriations Committee reported H.R. 2847, the Commerce, Justice, Science, and Related Agencies Appropriations Act, 2010, with an amendment in the nature of a substitute. The reported legislation contains $126 million in funding that has been designated for overseas deployments and other activities pursuant to section 401(c)(4). The Congressional Budget Office estimates that the $126 million in budget authority will result in $104 million in new outlays in 2010. As a result, I am revising both the discretionary spending limits and the allocation to the Senate Committee on Appropriations for discretionary budget authority and outlays by those amounts in 2010. When combined with previous adjustments made pursuant to section 401(c)(4), $379 million has been designated so far for overseas deployments and other activities for 2010. In addition, section 401(c)(2)(B) of the 2010 budget resolution permits the chairman to adjust the section 401(b) discretionary spending limits, allocations pursuant to section 302(a) of the Congressional Budget Act of 1974 and aggregates for legislation making appropriations for fiscal year 2010 that both appropriates $7.1 billion and provides an additional appropriation of up to $890 million to the Internal Revenue Service for enhanced tax enforcement to address the tax gap, the difference between the amount of taxes owed and the amount of taxes paid. On July 9, 2009, the Senate Appropriations Committee reported S. 1432, the financial services and general government appropriations Bill, 2010. The reported bill contains $890 million in funding that satisfies the conditions of section 401(c)(2)(B). The Congressional Budget Office estimates that the $890 million in budget authority will result in $837 million in new outlays in 2010. As a result, I am revising both the discretionary spending limits and the allocation to the Senate Committee on Appropriations for discretionary budget authority and outlays by those amounts in 2010. When combining the effects of the two adjustments, I am revising today both the discretionary spending limits and the allocation to the Senate Committee on Appropriations by a total of $1,016 million for budget authority and $941 million for outlays. I ask unanimous consent to have the following revisions to S. Con. Res. 13 printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise to offer for the Record the Budget Committee's official scoring of S. 1436, Energy and Water Development and Related Agencies Appropriations Act for fiscal year 2010. The bill, as reported by the Senate Committee on Appropriations, provides $33.8 billion in discretionary budget authority for fiscal year 2010, which will result in new outlays of $19.8 billion. When outlays from prior-year budget authority are taken into account, discretionary outlays for the bill will total $43.2 billion. The Senate-reported bill matches its section 302(b) allocation for budget authority and for outlays. The Senate-reported bill includes several provisions that make changes in mandatory programs that result in an increase in direct spending in years following the budget year, 2011 to 2019. Each of these provisions is subject to a point of order established by section 314 of the 2009 budget resolution. The bill is not subject to any other budget points of order. I ask unanimous consent to have the table displaying the Budget Committee scoring of the bill printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I would like to speak today about an amendment I have offered to the National Defense Authorization Act, No. 1759, to provide $16.8 million in funding for the research and development of a program called ``1760 in the Bay,'' which will allow for our B-52 fleet to carry GPS-guided ``smart weapons'' internally in the bomb bay. Currently, the B-52 can only carry these important weapons externally, on its wing pylons. Giving the B-52 this expanded capability would allow for an increase in the aircraft's overall bomb- load capacity, or for an increase in its fuel efficiency and range by using an internal-only weapons load. As early as 1993, the Air Force documented the requirement for internal carriage of precision-guided munitions in its B-52H Conventional Upgrade Operational Requirements Document. The Air Force reaffirmed its belief in the need for this requirement in 2005, and Congress continued to fund the program in 2006 and 2007. The program is on the Air Force's fiscal year 2010 unfunded priorities list. My amendment would provide $16.8 million in R&D funding to complete required hardware and software development and testing for an electrical upgrade to ``military standard 1760,'' which provides a common electrical and digital interface between weapons and aircraft. The MIL-STD-1760 connecter is used to transfer guidance information to weapons including the GBU-32 JDAM, the AGM-154, and the CBU-103, CBU- 104, and CBU-105. This technology upgrade will also make it easier to add WCMD, JSOW, and JASSM weapons to the B-52 in the future. This is exactly the kind of investment we need to be making in the B- 52, an aircraft that is indispensable to maintaining an effective bomber force. It is unmatched in its range and payload ability. It is the most cost-effective and reliable component of our Nation's bomber force. It is a plane that we are going to be using more than 30 years from now. It is truly the ``best bomb truck for the buck.'' Particularly in light of the decision by the President and Secretary Gates to delay procurement of the next-generation bomber, it is critical that we continue to outfit each B-52 with new technology like the ``1760 in the Bay'' program. amendment no. 1656 Mr. President, I want to take a moment to talk about an amendment I have offered to the National Defense Authorization Act, No. 1656, that would require a study and report on the recruitment and retention of members of the Air Force in nuclear career fields. One of the key lessons learned from the nuclear incidents that occurred a couple of years ago is that we need to be able to keep our best and brightest in the nuclear force. Working with America's nuclear arsenal is one of the most demanding jobs in the Air Force. It takes special people with unique skills to maintain and safeguard our nation's most powerful weapons. That is why the Air Force has stated that one of its biggest priorities is reinvigorating the nuclear mission. In recent months, I have heard from a number of senior Air Force leaders working in the nuclear mission that interest among airmen in the nuclear career field is very high, in part due to sustained leadership attention to the nuclear force. Right now, the best and the brightest are flocking to this career field. However, I remain concerned about the long-term outlook of this important area of work. I want to be sure that interest in the field will not wane if the Air Force's top priority shifts to other issues. There is absolutely no doubt that leadership at every level of the Air Force understands that our nuclear weapons are one of our Nation's most critical assets. By deterring America's enemies, assuring our allies, and dissuading potential future adversaries, our nuclear personnel are at war every single day. This is the message of Air Force and Department of Defense leadership, and it is the message of the Senate and the Congress. But it is not enough for our airmen to simply hear that message. They must be given evidence to demonstrate that it is more than words. Few needs are more critical than the ongoing effort to determine the best ways to make the systemic change necessary to ensure that every airman working on the nuclear mission believes each and every day that his job is critical to the strength and security of the United States. The standup of the Strategic Deterrence and Nuclear Integration Office on the Air Staff and the new Global Strike Command major command are important steps. But steps must also be taken to make sure that the message is understood at every level, even to the youngest cadet. I believe it is necessary to examine what incentives could or should be built into the system in order to ensure that we continue to be able to recruit, retain, and develop highly trained and motivated nuclear personnel. That is why I have introduced this amendment to ask the Air Force to provide a report on the steps it has taken to improve recruiting and retention and to gauge the potential impact that new retention bonuses or assignment incentive pay could have on the attractiveness of serving in the nuclear mission, and, in turn, on the effectiveness of the force. amendment no. 1780

Mr. CONRAD. Mr. President, I rise to engage in a colloquy with my esteemed colleague Senator Enzi, the cochairman of the Senate ICBM Coalition, about an amendment the coalition has offered to express the sense of Congress on the strategic importance of the intercontinental ballistic missile. I am happy to offer this amendment on behalf of the members of the Senate ICBM Coalition, including my cochairman Senator Enzi, as well as Senators Hatch, Tester, Bennett, Baucus, Barrasso, and Dorgan. This amendment, No. 1682, expresses the sense of the Congress that we must maintain the long-term vitality of the triad, that the land-based nuclear force is the most stabilizing portion of our nuclear arsenal, and that our robust ICBM force must be retained to advance our Nation's strategy of deterrence, assurance, and dissuasion. I strongly believe that all three legs of the triad must be maintained in order to retain a highly reliable and credible nuclear force, and we particularly believe that our ICBM force takes on even greater importance as we draw down our nuclear force. As GEN Larry Welch and others have argued, our land-based nuclear force is the most stabilizing portion of our nuclear arsenal, and it becomes even more so as total warhead numbers shrink. The readiness, broad dispersion, numbers, and low warhead loading of the ICBM force make a successful disarming attack nearly impossible. That deters attack from near-peer competitors and dissuades future adversaries from building their nuclear forces. It also eliminates the pressure to maintain a launch-on-warning posture. While almost everyone agrees with us that the ICBM is an essential part of the triad, some believe that the size of the force can or should be reduced. I strongly oppose cutting the ICBM force below its current force structure of 3 wings of 150 missiles each. A reduction in the size of the force below 3 wings would make it increasingly difficult to recruit, retain, and develop highly trained and motivated people. That would have a tremendous impact on the effectiveness of the force. Finally, in light of the serious fiscal challenges facing our Nation, it is worth noting that ICBMs are by far the most cost-effective leg of the nuclear triad, coming in at about one-fifth the annual operating cost of the submarine-launched leg. What is more, ICBM costs will be stable for many years to come, while an extremely expensive replacement program for the Ohio-class submarine is just about to begin. I support President Obama's efforts to negotiate a new arms control treaty with Russia to replace the expiring Strategic Arms Reduction Treaty. However, we must be very careful that reductions to our nuclear forces are conducted in a way that avoids creating unnecessary risks. Our ICBM force dramatically decreases the risk of nuclear war by providing a stabilizing constant in our nuclear posture, and it ought to be maintained at its current levels as an essential part of our nation's nuclear force. I thank my colleague Senator Enzi for his work as cochair of the ICBM Coalition.

Mr. CONRAD. Mr. President, I thank my friend Senator Enzi and each member of the ICBM Coalition for their support for this amendment. national guard--state partnership program

Mr. CONRAD

Mr. CONRAD. Mr. President, I am pleased today to recognize a community in North Dakota that is celebrating its 125th anniversary. On July 23-26, the residents of Northwood will gather to celebrate their community's history and founding. Founded in 1884, Northwood is located in Northeastern ND, and was named after Northwood, IA, a common starting point for pioneers settling in the Dakota Territory. In its early years, the town grew rapidly, and continued to expand over the next century. It was honored in 1993 by the North Dakota League of Cities as City of the Year. In 2007, Northwood was devastated by an EF4 tornado. Not a single building was left untouched by this monstrous storm that wreaked havoc on everything in its path. Homes and businesses were destroyed, yet amidst all of the destruction, this community banded together, and with the assistance of the federal government, it has successfully rebuilt. Today, Northwood is a friendly and welcoming community that includes a nine-hole golf course, a swimming pool, a strong business community, and a high quality education system. Additionally, the town remains true to its agricultural roots through its farming population. The central point of Northwood's 125th anniversary celebration will be the dedication of the new Northwood Public School and the Veteran's Memorial. Other activities, to name a few, include a community picnic, a tractor pull, a teen dance, karaoke, a 5K walk and run, a craft show, a kiddie parade, and a 3-on-3 basketball tournament. I ask the Senate to join me in congratulating Northwood, ND, and its residents on their first 125 years and in wishing them well in the future. By honoring Northwood and all other historic small towns of North Dakota, we keep the great pioneering frontier spirit alive for future generations. It is places such as Northwood that have helped shape this country into what it is today, which is why this fine community is deserving of our recognition. Northwood has a proud past and a bright future.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I honor the North Dakota Wheat Commission. On July 8, the North Dakota Wheat Commission celebrated its 50th year marketing and promoting wheat on behalf of my State's farm families. As the top spring wheat and durum wheat producing State in the Nation, I am proud of what the North Dakota Wheat Commission has been able to achieve for our State's producers. The commission, created by the North Dakota Legislature in 1959, has allowed my State's farmers to become more actively engaged in the export and market promotion of our wheat crop because the commission is funded and directed by producers. During its 50 years of existence, North Dakota's average wheat production has increased from 100 million bushels to 300 million bushels annually. In that same time period, total U.S. exports have increased from 500 million bushels to 1.3 billion bushels. Thanks in part to the work of the North Dakota Wheat Commission, U.S. hard red spring and durum wheat are exported to more than 80 countries around the world. These exports account for 50 percent of hard red spring wheat and one-third of durum wheat. The North Dakota Wheat Commission's customer base includes markets across the globe, including Asia, Latin America and Europe. While our wheat output and exports have increased, one thing has remained the same: My State's wheat producers have a solid reputation around the world for having a premium product. This is, in part, thanks to the hard work of the North Dakota Wheat Commission. In closing, I again want to recognize the North Dakota Wheat Commission for a successful first 50 years and wish them continued success in the future.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise to offer for the record, the Budget Committee's official scoring of S. 1298, the Department of Homeland Security Appropriations Act for fiscal year 2010. The bill, as reported by the Senate Committee on Appropriations, provides $42.9 billion in discretionary budget authority for fiscal year 2010, which will result in new outlays of $25.5 billion. When outlays from prior-year budget authority are taken into account, discretionary outlays for the bill will total $46.7 billion. The bill includes $242 million in budget authority designated as being for overseas deployment and other activities for the Coast Guard. Pursuant to section 401(c)(4) of S. Con. Res. 13, the 2010, budget resolution, an adjustment to the 2010 discretionary spending limits and the Appropriations Committee's 302(a) allocation has been made for this amount in budget authority and for the outlays flowing therefrom. The Senate-reported bill matches its section 302(b) allocation for budget authority and is $1 million below its allocation for outlays. No points of order lie against the committee-reported bill. I ask unanimous consent that the table displaying the Budget Committee scoring of the bill be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise to offer for the record, the Budget Committee's official scoring of S. 1294, the Legislative Branch Appropriations Act for fiscal year 2010. The bill, as reported by the Senate Committee on Appropriations, provides $3.1 billion in discretionary budget authority for fiscal year 2010, which will result in new outlays of $2.6 billion. When outlays from prior-year budget authority are taken into account, discretionary outlays for the bill will total $3.3 billion. The Senate-reported bill is below its section 302(b) allocation for budget authority by $1.5 billion and below its allocation for outlays by $1.3 billion. The Senate-reported bill does not include funding for House-only items. Funding for these items will be included in the conference agreement. No points of order lie against the committee- reported bill. I ask unanimous consent that the table displaying the Budget Committee scoring of the bill be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise to submit to the Senate the first budget scorekeeping reports for the 2010 budget resolution. The reports, which cover fiscal years 2009 and 2010, were prepared by the Congressional Budget Office pursuant to section 308(b) and in aid of section 311 of the Congressional Budget Act of 1974, as amended. The reports show the effects of congressional action through June 23, 2009, and include the effects of P.L. 111-22, the Helping Families Save Their Homes Act of 2009; P.L. 111-31, the Family Smoking Prevention and Tobacco Control Act; H.R. 1777, an act to make technical corrections to the Higher Education Act of 1965, and for other purposes, pending Presidential action; and H.R. 2346, the Supplemental Appropriations Act, 2009, pending Presidential action. The estimates of budget authority, outlays, and revenues are consistent with the technical and economic assumptions of S. Con. Res. 13, the 2010 budget resolution. For 2009, the estimates show that current level spending is $942 million below the level provided for in the budget resolution for budget authority and $3.9 billion above it for outlays while current level revenues match the budget resolution level. For 2010, the estimates show that current level spending is $1,205.9 billion below the level provided for in the budget resolution for budget authority and $715.9 billion below it for outlays while current level revenues are $12.3 billion above the budget resolution level. I ask unanimous consent to have the letters and accompanying tables from CBO printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, section 401(c)(4) of S. Con. Res. 13, the 2010 budget resolution, permits the chairman of the Senate Budget Committee to adjust the section 401(b) discretionary spending limits, allocations pursuant to section 302(a) of the Congressional Budget Act of 1974, and aggregates for legislation making appropriations for fiscal years 2009 and 2010 for overseas deployments and other activities by the amounts provided in such legislation for those purposes and so designated pursuant to section 401(c)(4). The adjustment is limited to the total amount of budget authority specified in section 104(21) of S. Con. Res. 13. For 2009, that limitation is $90.745 billion, and for 2010, it is $130 billion. On June 18, 2009, the Senate Appropriations Committee reported S. 1298, the Department of Homeland Security Appropriations Bill, 2010. The reported bill contains $242 million in funding that has been designated for overseas deployments and other activities pursuant to section 401(c)(4). The Congressional Budget Office estimates that the $242 million in designated funding will result in $194 million in new outlays in 2010. As a result, I am revising both the discretionary spending limits and the allocation to the Senate Committee on Appropriations for discretionary budget authority and outlays by those amounts in 2010. In addition, I am also revising part of the adjustment I made last week to the budgetary aggregates pursuant to section 401(c)(4) of S. Con. Res. 13 for the conference report to H.R. 2346, a bill making supplemental appropriations for the fiscal year ending September 30, 2009. Specifically, I am reducing the amount of the adjustment in budget authority and outlays by $11 million each in 2010. I ask unanimous consent that the following revisions to S. Con. Res. 13 be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, section 303 of S. Con. Res. 13, the 2010 Budget Resolution, permits the Chairman of the Senate Budget Committee to adjust the allocations of a committee or committees, the aggregates, and other appropriate levels and limits in the resolution for legislation that makes higher education more accessible and affordable, including expanding and strengthening student aid, such as Pell grants. These adjustments to S. Con. Res. 13 are contingent on the legislation not increasing the deficit over either the period of the total of fiscal years 2009 through 2014 or the period of the total of fiscal years 2009 through 2019. I find that the amendment in the nature of a substitute to H.R. 1777, a bill to make technical corrections to the Higher Education Act of 1965, and for other purposes, fulfills the conditions of the deficit- neutral reserve fund for higher education. Therefore, pursuant to section 303, I am adjusting the aggregates in the 2010 budget resolution, as well as the allocation to the Senate Health, Education, Labor, and Pensions Committee. I ask unanimous consent that the following revisions to S. Con. Res. 13 be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I wish today to recognize a community in North Dakota that will be celebrating its 125th anniversary. On July 2-5, 2009, the residents of Park River will gather to celebrate their community's history and founding. The town of Park River was founded in 1884. It was named for its location on the Park River. The river itself was named by pioneer fur trader Alexander Henry, to note the corrals or parks that the Assiniboine Indians had built by the river to herd wild animals. Park River's town motto, ``Park River, The Town with a Heart,'' truly captures the essence of the community where people are always willing to lend a helping hand. The town's all volunteer ambulance service, the Walsh County EMS, operates 24 hours a day and demonstrates the town's willingness to help each other out. Today, the town's economy is mostly agricultural based, but also does focus on incorporating businesses in the technology and health care sector. Park River's health care industry is epitomized by its state- of-the-art hospital, First Care Health Center. This center has been providing quality medical care for the past 55 years to the residents of Park River and those in surrounding communities. To celebrate their 125th anniversary, the people of Park River have planned a number of events including a polka fest, talent show, fireworks, road rally, an all class reunion, an American Legion baseball reunion game, and a parade that will be held on July 4th. Mr. President, I ask the Senate to join me in congratulating Park River, ND, and its residents on their first 125 years and in wishing them well through the next century. By honoring Park River and all the other historic small towns of North Dakota, we keep the great pioneering frontier spirit alive for future generations. It is places such as Park River that have helped to shape this country into what it is today, which is why this fine community is deserving of our recognition. Park River has a proud past and a bright future.

Mr. CONRAD

Mr. CONRAD. Mr. President, I am pleased today to recognize a community in North Dakota that is celebrating its 125th anniversary. On July 2-5, the residents of Cando will gather to celebrate their community's history and founding. Founded in 1884, Cando was designated the county seat for Towner County and named for the ``Can Do'' spirit of the pioneers. That spirit is still visible in this active community, where hunting, fishing, camping, and bird-watching are all popular activities. In fact, ducks are so common to the area that Cando is known as the duck capital of North Dakota. This active community, located in north-central North Dakota, is home to two museums, a golf course, bowling alley, and many thriving businesses. In honor of Cando's 125th anniversary, town officials have organized activities including a golf tournament, street dance, folk dance, parade, potluck, tractor pull, and variety show. Mr. President, I ask the Senate to join me in congratulating Cando, ND, and its residents on their first 125 years and in wishing them well in the future. By honoring Cando and all other historic small towns of North Dakota, we keep the great pioneering frontier spirit alive for future generations. It is places such as Cando that have helped shape this country into what it is today, which is why this fine community is deserving of our recognition. Cando has a proud past and a bright future.

Mr. CONRAD

Mr. CONRAD. Mr. President, I am pleased to be joined by my friend and Finance Committee colleague, Senator Pat Roberts from Kansas, in introducing legislation that can help Americans enjoy a more secure retirement. In these economically challenging times, financial security--especially during retirement--can be a frustrating and elusive goal. In retirement, the chief anxiety for most people is protecting the savings they have accumulated while working and deciding how best to manage those assets. In 21st century America, there is another crucial challenge for retirees. The good news is that Americans are living longer, but it also means that people have to plan for a longer period of retirement. A successful long-term retirement income plan is difficult even in a bullish market. How much more difficult is this task in today's market--particularly for the millions of Americans with limited investment experience? We believe in encouraging people to save for retirement. Through the tax code, we encourage asset-building through home ownership. We provide significant tax incentives for employer-based pension plans and for retirement savings programs by individuals, such as IRAs and 401(k) plans. One of the biggest threats to retirement income security for baby boomers is their own longevity. It will not be easy to manage their accumulated assets so that they will last a lifetime. Unprecedented numbers of Americans are now living into their 90s and even past 100. Consequently, people are going to spend more time in retirement than previous generations. Now our society is witnessing the beginning of the retirement wave we knew was already building. Before it recedes, 77 million baby boomers will have entered their retirement years. Many of them will not have the guaranteed monthly retirement checks that many of their parents enjoyed as a result of employer-based pension plans. Traditional defined benefit pension plans have given way to defined contribution plans, which have shifted the retirement income security risk from the employer to the individual. Of course, there are still many Americans who have no access at all to employer-provided pension plans. Some have never been in the traditional workforce; others work in seasonal jobs or part time. In my state of North Dakota, as well as in rural and farming communities across America, there is an acute need for retirement vehicles that will provide a secure lifetime payout. Others who could face difficulty in securing retirement income are widowed individuals--both men and women--who suddenly find themselves having to make a life insurance benefit or proceeds from the sale of a business or family home last a lifetime. The proposal we are introducing today will provide a valuable tool for helping people avoid the risk of outliving their assets. Specifically, we are proposing a tax incentive to encourage Americans to annuitize a portion of their assets available for retirement. If they annuitize--in other words, elect to receive their money from an annuity in a series of payments for the rest of their lives, no matter how long that may be--they would be able to exclude from income 50 percent of the annuity benefit that represents the accumulation in the annuity above and beyond the original investment. The exclusion would be capped at $20,000, indexed, to ensure that tax sheltering activity is not encouraged and that the incentive will be effective for people who would benefit most from securing a lifetime income stream. This proposal we offer today would apply only to life-contingent, non-qualified annuities. A life-contingent annuity that is subsequently modified to a fixed-term payout would be subject to a recapture tax. Baby boomers represent an unprecedented challenge to our retirement security policies. They should have a wide range of options available for responsible retirement planning. Our proposal focuses on non- qualified annuities because it is important to have this option considered as part of the larger retirement income security debate that Congress should have before baby boomers begin retiring in large numbers. Options for making qualified plans more secure should be part of that debate as well. I hope that Congress will tackle this matter promptly because over the last few years too many people have seen their retirement savings severely eroded. This legislation will provide an important incentive to help them preserve what they have. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I am pleased to be joined by my friend and Finance Committee colleague, Senator Pat Roberts from Kansas, in introducing legislation that can help Americans enjoy a more secure retirement. In these economically challenging times, financial security--especially during retirement--can be a frustrating and elusive goal. In retirement, the chief anxiety for most people is protecting the savings they have accumulated while working and deciding how best to manage those assets. In 21st century America, there is another crucial challenge for retirees. The good news is that Americans are living longer, but it also means that people have to plan for a longer period of retirement. A successful long-term retirement income plan is difficult even in a bullish market. How much more difficult is this task in today's market--particularly for the millions of Americans with limited investment experience? We believe in encouraging people to save for retirement. Through the tax code, we encourage asset-building through home ownership. We provide significant tax incentives for employer-based pension plans and for retirement savings programs by individuals, such as IRAs and 401(k) plans. One of the biggest threats to retirement income security for baby boomers is their own longevity. It will not be easy to manage their accumulated assets so that they will last a lifetime. Unprecedented numbers of Americans are now living into their 90s and even past 100. Consequently, people are going to spend more time in retirement than previous generations. Now our society is witnessing the beginning of the retirement wave we knew was already building. Before it recedes, 77 million baby boomers will have entered their retirement years. Many of them will not have the guaranteed monthly retirement checks that many of their parents enjoyed as a result of employer-based pension plans. Traditional defined benefit pension plans have given way to defined contribution plans, which have shifted the retirement income security risk from the employer to the individual. Of course, there are still many Americans who have no access at all to employer-provided pension plans. Some have never been in the traditional workforce; others work in seasonal jobs or part time. In my state of North Dakota, as well as in rural and farming communities across America, there is an acute need for retirement vehicles that will provide a secure lifetime payout. Others who could face difficulty in securing retirement income are widowed individuals--both men and women--who suddenly find themselves having to make a life insurance benefit or proceeds from the sale of a business or family home last a lifetime. The proposal we are introducing today will provide a valuable tool for helping people avoid the risk of outliving their assets. Specifically, we are proposing a tax incentive to encourage Americans to annuitize a portion of their assets available for retirement. If they annuitize--in other words, elect to receive their money from an annuity in a series of payments for the rest of their lives, no matter how long that may be--they would be able to exclude from income 50 percent of the annuity benefit that represents the accumulation in the annuity above and beyond the original investment. The exclusion would be capped at $20,000, indexed, to ensure that tax sheltering activity is not encouraged and that the incentive will be effective for people who would benefit most from securing a lifetime income stream. This proposal we offer today would apply only to life-contingent, non-qualified annuities. A life-contingent annuity that is subsequently modified to a fixed-term payout would be subject to a recapture tax. Baby boomers represent an unprecedented challenge to our retirement security policies. They should have a wide range of options available for responsible retirement planning. Our proposal focuses on non- qualified annuities because it is important to have this option considered as part of the larger retirement income security debate that Congress should have before baby boomers begin retiring in large numbers. Options for making qualified plans more secure should be part of that debate as well. I hope that Congress will tackle this matter promptly because over the last few years too many people have seen their retirement savings severely eroded. This legislation will provide an important incentive to help them preserve what they have. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise to offer for the Record the Budget Committee's official scoring of the conference report to accompany H.R. 2346, the Supplemental Appropriations Act, 2009. The conference report includes $105.9 billion in discretionary budget authority for fiscal year 2009, which will result in outlays in 2009 of $30.5 billion. Of this budget authority, $90.7 billion is designated as being for overseas deployments and other activities pursuant to S. Con. Res. 13, the concurrent resolution on the budget for fiscal year 2010. This results in new outlays of $27 billion in 2009. The conference report also includes $16.2 billion in emergency discretionary budget authority, which results in outlays of $3.5 billion in 2009. Finally, the conference report includes rescissions of existing budget authority and other changes that result in -$1 billion in regular budget authority and -$37 million in 2009 outlays. The conference report includes several emergency designations each of which is subject to a point of order established by section 403 of the 2010 budget resolution. In addition, the conference report includes language relating to credit scoring that is within the jurisdiction of the Budget Committee and as a result is subject to a point of order under section 306 of the Congressional Budget Act. Finally, the conference report includes several provisions that make changes in a mandatory program--CHIMPS--that result in an increase in direct spending over the 9-year period, 2011-2019. Each of these provisions is subject to a point of order established by section 314 of the 2009 budget resolution. I ask unanimous consent that the table displaying the Budget Committee scoring of the conference report be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, section 401(c)(4) of S. Con. Res. 13, the 2010 budget resolution, permits the chairman of the Senate Budget Committee to adjust the section 401(b) discretionary spending limits, allocations pursuant to section 302(a) of the Congressional Budget Act of 1974, and aggregates for legislation making appropriations for fiscal years 2009 and 2010 for overseas deployments and other activities by the amounts provided in such legislation for those purposes and so designated pursuant to section 401(c)(4). The adjustment is limited to the total amount of budget authority specified in section 104(21) of S. Con. Res. 13. For 2009, that limitation is $90.745 billion, and for 2010, it is $130 billion. On May 19, I made two adjustments pursuant to section 401(c)(4) for H.R. 2346, a bill making supplemental appropriations for the fiscal year ending September 30, 2009, and for other purposes. H.R. 2346 passed the Senate on May 21. I find that the conference report for H.R. 2346, which was filed on June 12, 2009, also fulfills the conditions of section 401(c)(4). As a result, for fiscal years 2009 and 2010, I am further revising the adjustments made on May 19 to the discretionary spending limits and the allocation to the Senate Committee on Appropriations for discretionary budget authority and outlays. When combined with those previous revisions, the total amount of the adjustment pursuant to section 401(c)(4) for 2009 is $90.73 billion in discretionary budget authority and $27.029 billion in outlays, and the total amount of the adjustment for 2010 is $11 million in discretionary budget authority and $34.239 billion in outlays. In addition, I am also further revising the aggregates consistent with section 401(c)(4). I ask unanimous consent to have the following revisions to S. Con. Res. 13 printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, section 311(a) of S. Con. Res. 13, the 2010 budget resolution, permits the chairman of the Senate Budget Committee to adjust the allocations of a committee or committees, the aggregates, and other appropriate levels in the resolution for legislation that authorizes the Food and Drug Administration to regulate products and assess user fees on manufacturers and importers of those products to cover the cost of the regulatory activities. Additionally, section 307 of S. Con. Res. 13 permits the chairman to adjust the allocations of a committee or committees, aggregates, and other appropriate levels in the resolution for legislation that, among other things, reduces or eliminates the offset between the Survivor Benefit Plan annuities and veterans' dependency and indemnity compensation. The adjustments under both reserve funds are contingent on the legislation not increasing the deficit over either the period of the total of fiscal years 2009 through 2014 or the period of the total of fiscal years 2009 through 2019. On June 3, I made revisions to S. Con. Res. 13 pursuant to sections 311(a) and 307 for an amendment in the nature of a complete substitute to H.R. 1256, the Family Smoking Prevention and Tobacco Control Act. The complete substitute to the House-passed bill was passed by the Senate on June 11 and by the House on June 12, clearing it for the signature of the President. The adjustment on June 3 was based on information provided by the Congressional Budget Office. Since that time, CBO has revised its estimate of the cost of H.R. 1256 to reflect an earlier date of enactment. Even with the changed date of enactment and revised estimate, H.R. 1256 still qualifies for reserve fund adjustments pursuant to sections 311(a) and 307. As a consequence, I am revising the adjustments I made on June 3 to reflect CBO's updated estimate. These revisions affect the aggregates in the 2010 budget resolution, as well as the allocation to the Senate Health, Education, Labor, and Pensions Committee. I ask unanimous consent to have the following revisions to S. Con. Res. 13 printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I am pleased today to recognize a community in North Dakota that is celebrating its 125th anniversary. On June 18 to 21, the residents of Bottineau will gather to celebrate their community's history and founding. Originally founded in 1883 as Oak Creek, the town was designated the county seat in 1884. It changed its name to Bottineau, taking its new name from Pierre Bottineau, a pioneer, hunter, and frontiersman. 3 years later, the town relocated 1\1/2\ miles so that it would be along the newly installed railroad tracks. The town lies in north-central North Dakota and is now home to over 2,000 residents. Today, Bottineau has many things to be proud of. The Bottineau County Fair is North Dakota's oldest county fair. The county also houses Bottineau Winter Park, often called the Jewel Above the Prairie, which remains a perennial attraction. And the town of Bottineau is known for ``Tommy Turtle,'' the world's largest turtle, which stands 30 feet tall and is said to have been built as a symbol of the Turtle Mountains. The citizens of Bottineau clearly value education, as their town is home to Minot State University's Bottineau Campus. Apart from its academic success, the campus has also seen athletic success in recent years, with the Lumberjacks hockey team claiming three consecutive national championships in the last 3 years. Both the Lumberjacks and the Ladyjacks have had accomplished seasons in the past several years. Additionally, the campus has added new sports teams in recent years-- something that bodes well for the future of the school. In honor of the city and county's 125th anniversary, officials have organized a vibrant celebration that includes basketball and golf tournaments, art and quilt shows, class and city gatherings, games for the young and old, a dance, and a centennial parade. Mr. President, I ask the Senate to join me in congratulating Bottineau, ND, and its residents on their first 125 years and in wishing them well in the future. By honoring Bottineau and all other historic small towns of North Dakota, we keep the great pioneering frontier spirit alive for future generations. It is places such as Bottineau that have helped shape this country into what it is today, which is why this fine community is deserving of our recognition. Bottineau has a proud past and a bright future.

Mr. CONRAD

Mr. CONRAD. Mr. President, I wish to recognize a community in North Dakota that is celebrating its 125th anniversary. On June 11 to 14, the residents of Napoleon gathered to celebrate their community's history and founding. Founded in 1884, Geo H. Cook from Steele, ND, first surveyed and platted the Napoleon town site. The city was named after the president of the Napoleon Townsite Company, Napoleon Goodsill. This company constructed the first building in Napoleon. It soon became the county seat, a title the city still holds today despite numerous challenges over the years. In 1914, Napoleon became incorporated as a village and later was recognized as a city in 1947. Located in south central North Dakota, Napoleon's beautiful parks and recreation provide its residents with great enjoyment. Napoleon Country Club is a picturesque nine-hole golf course located just 1 mile outside of the city. The Napoleon City Park has 12 campsites along with basketball, tennis, and volleyball courts. Beaver Lake State Park is also nearby which provides fantastic hunting, fishing, and boating. Today, Napoleon is a rural agricultural community that is excited to celebrate its quasquicentennial. Currently, Napoleon is building an elevator which will provide improved service to a unit train for grain hauling, and wind farm projects are beginning in the city. To celebrate its 125th anniversary, Napoleon held a number of exciting events. The Opening Ceremony included music, city hall dignitaries, and a fly over. The festivities continued all weekend with entertainment such as a softball tournament, 4-H and Future Farmers of America livestock show, craft vendor show, 3 on 3 basketball tournament and a magician, followed by street dances at night. The events concluded on Sunday with a demolition derby. Mr. President, I ask the Senate to join me in congratulating Napoleon, ND, and its residents on their first 125 years and in wishing them well in the future. By honoring Napoleon and all the other historic small towns of North Dakota, we keep the great tradition of the pioneering frontier spirit alive for future generations. It is places such as Napoleon that have helped to shape this country into what it is today, which is why the community of Napoleon is deserving of our recognition. Napoleon has a proud past and a bright future.

Mr. CONRAD

Mr. CONRAD. Mr. President, I am pleased today to recognize a community in North Dakota that is celebrating its 125th anniversary. On June 25 to 28, the residents of Braddock will gather to celebrate their community's history and founding. Settlers first came to the area in 1883 and founded Braddock shortly thereafter, making it the oldest existing town in Emmons County. Located in south-central North Dakota, Braddock was established as the first railroad town in the county. Frederick Underwood, president of the Soo Railroad, named the town in honor of his good friend, County Auditor Edward Braddock. Today, Braddock remains a close-knit community. Though small, Braddock is known across the State for the popular Johnny Holm concerts it hosts every year, as well as for the excellent hunting grounds in the area. The citizens of Braddock are very involved in their community and have many active organizations, including Saint Katherine's Altar Society, the Lions Club, the Senior Citizens Organization, and the South Central Threshers Association. The people of Braddock have planned a lively celebration in honor of the town's 125th anniversary. Activities include a beard-judging contest, duck race, tractor trek, fashion show, outdoor concerts, and a parade. Mr. President, I ask the Senate to join me in congratulating Braddock, ND, and its residents on their first 125 years and in wishing them well in the future. By honoring Braddock and all other historic small towns of North Dakota, we keep the great pioneering frontier spirit alive for future generations. It is places such as Braddock that have helped shape this country into what it is today, which is why this fine community is deserving of our recognition. Braddock has a proud past and a bright future.

Mr. CONRAD

Mr. CONRAD. Mr. President, I want to take a moment to honor a North Dakota family filled with heroes. Even in a State where sacrifice is more than a slogan and service is a way of life, the Lothspeich family stands out. When their nation needed them, every single one of the nine Lothspeich brothers rose to answer the call to duty. Today we recognize the service of the three brothers who are still with us, and honor the memory of those who are not. In times of crisis, it is our best and bravest that step forward, risking it all, to come to the defense of our Nation. The honorable service of each of these nine brothers epitomizes the story of our Nation's veterans. Eugene was a machine gunner in Italy in the Second World War, where he was awarded the Purple Heart. Harold served in the Philippines, where he earned two battle stars. Edward served in the Pacific with the Navy, Donald served in Germany at the peak of the Cold War, Gerald worked with the atomic bomb program here in the U.S. Lyle was a rifle instructor helping to train the next generation of our Nation's servicemembers, and Spike served in the Air Force Medical Service Corps in Japan. From World War II through the Korean conflict and the Cold War, for 15 years running, at least one of these nine men could be found in uniform, serving their country in the Army, in the Navy, and in the Air Force. It is truly a remarkable story. We owe a deep debt of gratitude to them and to all of our veterans. Years ago our forefathers founded this country with a vision of freedom for all. It was that vision that inspired the Lothspeich brothers to leave Park River, ND, to travel to Italy, Germany, Japan and the Philippines in defense of this great land. We honor them, and we honor all of our brave veterans and all of those who serve our country in uniform today. Without selfless service by those like the Lothspeichs, we simply would not have the freedoms we hold most dear.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I join my good friend and colleague, Senator Baucus, in introducing the Patient-Centered Outcomes Research Act of 2009. This proposal builds on the legislation we introduced during the last Congress. Our legislation is the product of months of careful deliberations regarding the best way to expand the quality and quantity of evidence available to patients, physicians, and other health care decision-makers about the comparative clinical effectiveness of health care services and treatments. We have met with dozens of key stakeholders and thought leaders to discuss various aspects of this legislation. People have come to us with many constructive suggestions, many of which are reflected in the bill that we are introducing today. I am proud of the result. This legislation lays the groundwork for improving health care quality and patient outcomes, enhancing patient safety, and reducing overall health care costs in the long run. As Chairman of the Senate Budget Committee, I am acutely aware of the long-term budget challenges facing our Nation. Health care spending is growing at an unsustainable rate. Although demographic changes associated with the retirement of the baby boom generation contribute to this spending growth, the most significant factor is growth in health care costs in excess of per capita GDP growth. According to Congressional Budget Office projections, by 2050, Medicare and Medicaid spending alone will consume 12 percent of our Nation's gross domestic product. But excess growth in per capita health care costs is not just a challenge for Federal health spending and the Federal budget. If we continue on the current trajectory, the private sector will also be overwhelmed by rising health care costs. In fact, total health care spending is projected to grow from about 17.6 percent of GDP in 2009-- which is far higher than in other industrialized countries--to more than 37 percent of GDP in 2050. Clearly, we need to address the underlying causes of rising health care costs, not just in the Medicare and Medicaid programs, but in the overall health care system. Simply cutting Medicare and Medicaid without making other changes will do little to solve the larger problem we face. Skyrocketing health care costs are hurting families, businesses, and State and Federal budgets. In a speech before the Business Roundtable on March 12th, President Obama emphasized this point: ``Medicare costs are consuming our Federal budget. Medicaid is overwhelming our State budgets. At the fiscal summit we held in the White House a few weeks ago, the one thing on which everyone agreed was that the greatest threat to America's fiscal health is not the investments we've made to rescue our economy. It is the skyrocketing cost of our health care system.'' Health care reform is about achieving three important goals: choice, quality, and affordability. To achieve these three goals, we must confront the fact that our health care system does not deliver care as effectively or efficiently as it should. There is widespread agreement that Americans are not getting good value for the money we are already spending on health care. According to work by the Dartmouth Atlas Project, nearly 30 percent of total spending in our health care system, or $700 billion per year, is wasteful and does nothing to improve health outcomes. Despite our high level of health care spending, health outcomes in the United States are no better than health outcomes in the other OECD countries. Indeed, the U.S. spends twice as much as other OECD nations on health care, yet Americans have shorter average life expectancies and higher average mortality rates than residents of other OECD countries. OECD data show that the U.S. has one of the highest rates of medical errors among industrialized nations and that U.S. patients are more likely to receive duplicate tests and more likely to visit an emergency room for a condition that could have been treated in a regular office visit than most other nations in the comparison. Similarly, a 2008 Commonwealth Fund report found that the U.S. is last among 19 industrialized nations in preventable mortality, or deaths that could have been prevented if individuals had access to timely and effective care. We can and must find ways to deliver health care more efficiently, reduce ineffective or unnecessary care, and get better health outcomes without harming patients. One solution is to generate better information about the relative clinical effectiveness of alternative health strategies--and encourage patients and providers to use that information to make better choices about their health. Many health care services and treatments are absorbed quickly into routine medical care--yet there is little evidence that these services and treatments are any more clinically effective than existing treatments and services. Generating more comparative clinical effectiveness research is one of the keys to transforming our health care system away from a system based on volume toward a system that focuses on evidence-based medicine and improving patient outcomes. The Federal Government currently funds some comparative effectiveness research through the Agency for Healthcare Research and Quality, AHRQ, the National Institutes of Health, NIH, and the Veterans Health Administration. For example, the Effective Health Care Program at AHRQ has been a successful initiative. But comparative effectiveness research is not the primary focus of any Federal agency--nor is this Federal funding occurring permanently on a large scale. Provisions included in the American Recovery and Reinvestment Act, ARRA, temporarily expanded existing Federal efforts by providing $1.1 billion to AHRQ, NIH, and the Secretary of Health and Human Services, HHS, for such research through 2010. Important work is currently underway to develop recommendations for how best to utilize some of these resources. In particular, I would like to commend the work being done by the Institutes of Medicine, IOM, to convene a panel of experts that is tasked with making recommendations on how to spend the $400 million provided to the HHS Secretary through ARRA. The IOM panel has been doing extraordinary work in gathering ideas and input from a very broad group of stakeholders under a very tight timeline. I look forward to seeing the results of its work at the end of the month. It is this model of allowing for input from a broad set of stakeholders and of conducting priority-setting activities in a transparent way that we are hoping to advance in the legislation we are introducing today. The Congressional Budget Office, CBO, the Medicare Payment Advisory Commission, MedPAC, and the IOM have all discussed the positive impact of creating a new entity charged solely with conducting research on the comparative effectiveness of health interventions, including pharmaceuticals, medical devices, medical procedures, diagnostic tools, medical services and other therapies. In its June 2007 report to Congress, MedPAC issued a unanimous recommendation that ``Congress should charge an independent entity to sponsor credible research on comparative effectiveness of health care services and disseminate this information to patients, providers, and public and private payers.'' And the Congressional Budget Office agrees. In a report, entitled, ``Research on the Comparative Effectiveness of Medical Treatments: Issues and Options for an Expanded Federal Role,'' former CBO Director Peter Orszag wrote that, ``generating better information about the costs and benefits of different treatment options--through research on the comparative effectiveness of those options--could help reduce health care spending without adversely affecting health overall.'' The IOM also supports getting better information into the hands of patients and providers. As part of its report, ``Learning What Works Best: The Nation's Need for Evidence on Comparative Effectiveness in Health Care,'' the Institute concluded that, ``[a] substantially increased capacity to conduct and evaluate research on clinical effectiveness of interventions brings many potential opportunities for improvement across a wide spectrum of healthcare needs.'' This bill that Senator Baucus and I are introducing today represents an important step in creating a long-term vision for expanding comparative clinical effectiveness research. The bill would significantly expand the conduct of comparative clinical effectiveness research to get better information into the hands of patients and providers in the hopes of improving health outcomes and reducing unnecessary or ineffective care. The purpose of this bill is to provide patients and physicians with objective and credible evidence about which health care treatments and services are most clinically effective for particular patient populations. The research conducted under our bill would evaluate and compare the clinical effectiveness of two or more health care interventions, protocols for treatment, care management, and delivery, procedures, medical devices, diagnostic tools, and pharmaceutical, including biologicals Access to better evidence about what works best will help patients and health care providers make better-informed decisions about how best to treat particular diseases and conditions. Our hope is that the evidence generated by this research could lead to savings in the overall health care system over the long-term by empowering patients and doctors with information about treatments and services that may be clinically ineffective, while at the same time improving health care outcomes and quality. Specifically, our bill creates a private, nonprofit corporation, known as the Patient-Centered Outcomes Research Institute, which would be responsible setting national research priorities and carrying out a comparative clinical effectiveness research agenda. In conducting the research, the Institute would contract with AHRQ, the VA, and other appropriate public and private entities and could use a variety of research methods, including clinical trials, observational studies and systematic reviews of existing evidence. Many leading experts on this issue, such as MedPAC, have concerns that a large entity within the Federal government would be vulnerable to political interference that could hamper the Institute's credibility, and, therefore, limit the usefulness of its research. As a result, we chose a model outside of the Federal government, but subject to government oversight. In order to ensure that the information developed is credible and unbiased, our bill establishes a 21-Member Board of Governors to oversee the Institute's activities. Permanent board members would include the HHS Secretary and the Directors of AHRQ and NIH. The remaining 18 board members would be appointed by the Comptroller General of the U.S. and would include a balanced mix of patients, physicians, public and private payers, academic researchers, philanthropic organizations, quality improvement entities, and medical technology manufacturers. To ensure further credibility, the Institute is also required to appoint expert advisory panels of patients, clinicians, researchers and other stakeholders that would assist in the development and carrying out of the research agenda; establish a methodology committee that would help create methodological standards by which all research commissioned by the Institute must be conducted; create a peer review process through which all primary research findings must be assessed; and develop protocols to help translate and disseminate the evidence in the most effective, user-friendly way. Moreover, Senator Baucus and I want to ensure that the operations of the Institute are transparent and focused on the needs of patients. Therefore, we built in a strong role for public comment prior to all key decisions made by the Institute. For example, the bill requires public comment periods prior to the approval of research priorities and individual study designs. In addition, the bill calls for public forums to seek input, requires that all proceedings of the Institute be made public at least seven days in advance and be made available through annual reports, and requires that any conflicts of interest be made public and that board members recuse themselves from matters in which they have a financial or personal interest. Because all health care users will benefit from this research, our legislation funds the Institute with contributions from both public and private payers. These contributions will include mandatory general revenues from the Federal Government, amounts from the Medicare Trust Funds equal to $2 per beneficiary annually, and amounts from a $2 fee per-covered life assessed annually on insured and self-insured health plans. Funding will ramp up over a series of years. By the 5th year, we expect the Institute's total annual funding to reach nearly $600 million per year and continue to grow thereafter. The concept of an all-payer approach for comparative effectiveness research has been embraced by a number of health care experts. For example, on the subject of comparative effectiveness information in its June 2008 report, MedPAC stated: ``The Commission supports funding from federal and private sources as the research findings will benefit all users--patients, providers, private health plans, and federal health programs. The Commission also supports a dedicated funding mechanism to help ensure the entity's independence and stability. Dedicated broadly based financing would reduce the likelihood of outside influence and would best ensure the entity's stability . . .'' To ensure accountability for these funds and to the Institute's mission, our bill requires an annual financial audit of the Institute. In addition, the bill requires GAO to report to Congress every five years on the processes developed by the Institute and its overall effectiveness, including how the research findings are used by health care consumers and what impact the research is having on the health economy. Finally, the bill requires a review of the adequacy of the Institute's funding, which will include a review of the appropriateness and adequacy of each funding source. Let me take a moment to address some of the criticisms that might be levied against this proposal. Some may say this Institute will impede access to care and will deny coverage for high-cost health care services. That is simply not the case. Our proposal explicitly prohibits the Institute from making coverage decisions or setting practice guidelines. It will be up to medical societies and patient groups to use the research findings as they see fit. Moreover, to the extent that high-cost health care services or new technologies are studied by the Institute and found to be clinically ineffective compared to other services and technologies, such evidence will be made public to consumers and providers so that they can make informed choices. We have been working with colleagues on the other side of the aisle who have concerns about the impact this research could have on patient safety and access to health care treatments and services. For several months, we have been engaged in an active dialogue to address these concerns. While I am disappointed that those discussions did not result in co-sponsorships for this legislation at this time, I look forward to continuing that dialogue in a constructive manner as we work to include a long-term vision for comparative effectiveness research in a comprehensive health reform bill. In the meantime, we have made a number of meaningful changes to our legislation that address the concerns voiced by our colleagues. For example, we have placed a greater focus on aspects of personalized medicine and included new patient safeguards to ensure that when CMS uses this research it does so through a process that is transparent, allows for public comment, and takes into account the benefits to particular subpopulations. This bill is a balanced, carefully crafted proposal that has taken into consideration the recommendations of a broad range of stakeholders and thought-leaders. We welcome further discussion and suggested improvements. But we refuse to allow this proposal to get bogged down in political maneuvering or scare tactics. Our nation needs to immediately ramp up and sustain a major comparative clinical effectiveness research initiative to improve health outcomes and reduce ineffective and inefficient care. Senator Baucus and I will work jointly to push for the expeditious enactment of this bill as part of a comprehensive health reform bill. I urge all of my colleagues to join our effort and cosponsor the Patient- Centered Outcomes Research Act of 2009. There is no time to waste.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I join my good friend and colleague, Senator Baucus, in introducing the Patient-Centered Outcomes Research Act of 2009. This proposal builds on the legislation we introduced during the last Congress. Our legislation is the product of months of careful deliberations regarding the best way to expand the quality and quantity of evidence available to patients, physicians, and other health care decision-makers about the comparative clinical effectiveness of health care services and treatments. We have met with dozens of key stakeholders and thought leaders to discuss various aspects of this legislation. People have come to us with many constructive suggestions, many of which are reflected in the bill that we are introducing today. I am proud of the result. This legislation lays the groundwork for improving health care quality and patient outcomes, enhancing patient safety, and reducing overall health care costs in the long run. As Chairman of the Senate Budget Committee, I am acutely aware of the long-term budget challenges facing our Nation. Health care spending is growing at an unsustainable rate. Although demographic changes associated with the retirement of the baby boom generation contribute to this spending growth, the most significant factor is growth in health care costs in excess of per capita GDP growth. According to Congressional Budget Office projections, by 2050, Medicare and Medicaid spending alone will consume 12 percent of our Nation's gross domestic product. But excess growth in per capita health care costs is not just a challenge for Federal health spending and the Federal budget. If we continue on the current trajectory, the private sector will also be overwhelmed by rising health care costs. In fact, total health care spending is projected to grow from about 17.6 percent of GDP in 2009-- which is far higher than in other industrialized countries--to more than 37 percent of GDP in 2050. Clearly, we need to address the underlying causes of rising health care costs, not just in the Medicare and Medicaid programs, but in the overall health care system. Simply cutting Medicare and Medicaid without making other changes will do little to solve the larger problem we face. Skyrocketing health care costs are hurting families, businesses, and State and Federal budgets. In a speech before the Business Roundtable on March 12th, President Obama emphasized this point: ``Medicare costs are consuming our Federal budget. Medicaid is overwhelming our State budgets. At the fiscal summit we held in the White House a few weeks ago, the one thing on which everyone agreed was that the greatest threat to America's fiscal health is not the investments we've made to rescue our economy. It is the skyrocketing cost of our health care system.'' Health care reform is about achieving three important goals: choice, quality, and affordability. To achieve these three goals, we must confront the fact that our health care system does not deliver care as effectively or efficiently as it should. There is widespread agreement that Americans are not getting good value for the money we are already spending on health care. According to work by the Dartmouth Atlas Project, nearly 30 percent of total spending in our health care system, or $700 billion per year, is wasteful and does nothing to improve health outcomes. Despite our high level of health care spending, health outcomes in the United States are no better than health outcomes in the other OECD countries. Indeed, the U.S. spends twice as much as other OECD nations on health care, yet Americans have shorter average life expectancies and higher average mortality rates than residents of other OECD countries. OECD data show that the U.S. has one of the highest rates of medical errors among industrialized nations and that U.S. patients are more likely to receive duplicate tests and more likely to visit an emergency room for a condition that could have been treated in a regular office visit than most other nations in the comparison. Similarly, a 2008 Commonwealth Fund report found that the U.S. is last among 19 industrialized nations in preventable mortality, or deaths that could have been prevented if individuals had access to timely and effective care. We can and must find ways to deliver health care more efficiently, reduce ineffective or unnecessary care, and get better health outcomes without harming patients. One solution is to generate better information about the relative clinical effectiveness of alternative health strategies--and encourage patients and providers to use that information to make better choices about their health. Many health care services and treatments are absorbed quickly into routine medical care--yet there is little evidence that these services and treatments are any more clinically effective than existing treatments and services. Generating more comparative clinical effectiveness research is one of the keys to transforming our health care system away from a system based on volume toward a system that focuses on evidence-based medicine and improving patient outcomes. The Federal Government currently funds some comparative effectiveness research through the Agency for Healthcare Research and Quality, AHRQ, the National Institutes of Health, NIH, and the Veterans Health Administration. For example, the Effective Health Care Program at AHRQ has been a successful initiative. But comparative effectiveness research is not the primary focus of any Federal agency--nor is this Federal funding occurring permanently on a large scale. Provisions included in the American Recovery and Reinvestment Act, ARRA, temporarily expanded existing Federal efforts by providing $1.1 billion to AHRQ, NIH, and the Secretary of Health and Human Services, HHS, for such research through 2010. Important work is currently underway to develop recommendations for how best to utilize some of these resources. In particular, I would like to commend the work being done by the Institutes of Medicine, IOM, to convene a panel of experts that is tasked with making recommendations on how to spend the $400 million provided to the HHS Secretary through ARRA. The IOM panel has been doing extraordinary work in gathering ideas and input from a very broad group of stakeholders under a very tight timeline. I look forward to seeing the results of its work at the end of the month. It is this model of allowing for input from a broad set of stakeholders and of conducting priority-setting activities in a transparent way that we are hoping to advance in the legislation we are introducing today. The Congressional Budget Office, CBO, the Medicare Payment Advisory Commission, MedPAC, and the IOM have all discussed the positive impact of creating a new entity charged solely with conducting research on the comparative effectiveness of health interventions, including pharmaceuticals, medical devices, medical procedures, diagnostic tools, medical services and other therapies. In its June 2007 report to Congress, MedPAC issued a unanimous recommendation that ``Congress should charge an independent entity to sponsor credible research on comparative effectiveness of health care services and disseminate this information to patients, providers, and public and private payers.'' And the Congressional Budget Office agrees. In a report, entitled, ``Research on the Comparative Effectiveness of Medical Treatments: Issues and Options for an Expanded Federal Role,'' former CBO Director Peter Orszag wrote that, ``generating better information about the costs and benefits of different treatment options--through research on the comparative effectiveness of those options--could help reduce health care spending without adversely affecting health overall.'' The IOM also supports getting better information into the hands of patients and providers. As part of its report, ``Learning What Works Best: The Nation's Need for Evidence on Comparative Effectiveness in Health Care,'' the Institute concluded that, ``[a] substantially increased capacity to conduct and evaluate research on clinical effectiveness of interventions brings many potential opportunities for improvement across a wide spectrum of healthcare needs.'' This bill that Senator Baucus and I are introducing today represents an important step in creating a long-term vision for expanding comparative clinical effectiveness research. The bill would significantly expand the conduct of comparative clinical effectiveness research to get better information into the hands of patients and providers in the hopes of improving health outcomes and reducing unnecessary or ineffective care. The purpose of this bill is to provide patients and physicians with objective and credible evidence about which health care treatments and services are most clinically effective for particular patient populations. The research conducted under our bill would evaluate and compare the clinical effectiveness of two or more health care interventions, protocols for treatment, care management, and delivery, procedures, medical devices, diagnostic tools, and pharmaceutical, including biologicals Access to better evidence about what works best will help patients and health care providers make better-informed decisions about how best to treat particular diseases and conditions. Our hope is that the evidence generated by this research could lead to savings in the overall health care system over the long-term by empowering patients and doctors with information about treatments and services that may be clinically ineffective, while at the same time improving health care outcomes and quality. Specifically, our bill creates a private, nonprofit corporation, known as the Patient-Centered Outcomes Research Institute, which would be responsible setting national research priorities and carrying out a comparative clinical effectiveness research agenda. In conducting the research, the Institute would contract with AHRQ, the VA, and other appropriate public and private entities and could use a variety of research methods, including clinical trials, observational studies and systematic reviews of existing evidence. Many leading experts on this issue, such as MedPAC, have concerns that a large entity within the Federal government would be vulnerable to political interference that could hamper the Institute's credibility, and, therefore, limit the usefulness of its research. As a result, we chose a model outside of the Federal government, but subject to government oversight. In order to ensure that the information developed is credible and unbiased, our bill establishes a 21-Member Board of Governors to oversee the Institute's activities. Permanent board members would include the HHS Secretary and the Directors of AHRQ and NIH. The remaining 18 board members would be appointed by the Comptroller General of the U.S. and would include a balanced mix of patients, physicians, public and private payers, academic researchers, philanthropic organizations, quality improvement entities, and medical technology manufacturers. To ensure further credibility, the Institute is also required to appoint expert advisory panels of patients, clinicians, researchers and other stakeholders that would assist in the development and carrying out of the research agenda; establish a methodology committee that would help create methodological standards by which all research commissioned by the Institute must be conducted; create a peer review process through which all primary research findings must be assessed; and develop protocols to help translate and disseminate the evidence in the most effective, user-friendly way. Moreover, Senator Baucus and I want to ensure that the operations of the Institute are transparent and focused on the needs of patients. Therefore, we built in a strong role for public comment prior to all key decisions made by the Institute. For example, the bill requires public comment periods prior to the approval of research priorities and individual study designs. In addition, the bill calls for public forums to seek input, requires that all proceedings of the Institute be made public at least seven days in advance and be made available through annual reports, and requires that any conflicts of interest be made public and that board members recuse themselves from matters in which they have a financial or personal interest. Because all health care users will benefit from this research, our legislation funds the Institute with contributions from both public and private payers. These contributions will include mandatory general revenues from the Federal Government, amounts from the Medicare Trust Funds equal to $2 per beneficiary annually, and amounts from a $2 fee per-covered life assessed annually on insured and self-insured health plans. Funding will ramp up over a series of years. By the 5th year, we expect the Institute's total annual funding to reach nearly $600 million per year and continue to grow thereafter. The concept of an all-payer approach for comparative effectiveness research has been embraced by a number of health care experts. For example, on the subject of comparative effectiveness information in its June 2008 report, MedPAC stated: ``The Commission supports funding from federal and private sources as the research findings will benefit all users--patients, providers, private health plans, and federal health programs. The Commission also supports a dedicated funding mechanism to help ensure the entity's independence and stability. Dedicated broadly based financing would reduce the likelihood of outside influence and would best ensure the entity's stability . . .'' To ensure accountability for these funds and to the Institute's mission, our bill requires an annual financial audit of the Institute. In addition, the bill requires GAO to report to Congress every five years on the processes developed by the Institute and its overall effectiveness, including how the research findings are used by health care consumers and what impact the research is having on the health economy. Finally, the bill requires a review of the adequacy of the Institute's funding, which will include a review of the appropriateness and adequacy of each funding source. Let me take a moment to address some of the criticisms that might be levied against this proposal. Some may say this Institute will impede access to care and will deny coverage for high-cost health care services. That is simply not the case. Our proposal explicitly prohibits the Institute from making coverage decisions or setting practice guidelines. It will be up to medical societies and patient groups to use the research findings as they see fit. Moreover, to the extent that high-cost health care services or new technologies are studied by the Institute and found to be clinically ineffective compared to other services and technologies, such evidence will be made public to consumers and providers so that they can make informed choices. We have been working with colleagues on the other side of the aisle who have concerns about the impact this research could have on patient safety and access to health care treatments and services. For several months, we have been engaged in an active dialogue to address these concerns. While I am disappointed that those discussions did not result in co-sponsorships for this legislation at this time, I look forward to continuing that dialogue in a constructive manner as we work to include a long-term vision for comparative effectiveness research in a comprehensive health reform bill. In the meantime, we have made a number of meaningful changes to our legislation that address the concerns voiced by our colleagues. For example, we have placed a greater focus on aspects of personalized medicine and included new patient safeguards to ensure that when CMS uses this research it does so through a process that is transparent, allows for public comment, and takes into account the benefits to particular subpopulations. This bill is a balanced, carefully crafted proposal that has taken into consideration the recommendations of a broad range of stakeholders and thought-leaders. We welcome further discussion and suggested improvements. But we refuse to allow this proposal to get bogged down in political maneuvering or scare tactics. Our nation needs to immediately ramp up and sustain a major comparative clinical effectiveness research initiative to improve health outcomes and reduce ineffective and inefficient care. Senator Baucus and I will work jointly to push for the expeditious enactment of this bill as part of a comprehensive health reform bill. I urge all of my colleagues to join our effort and cosponsor the Patient- Centered Outcomes Research Act of 2009. There is no time to waste.