Kent Conrad

Mr. CONRAD

Mr. CONRAD. Mr. President, I am very pleased to join my distinguished colleague from North Dakota, in introducing legislation to authorize $1.7 billion in emergency funding for FY 2000 Veterans Health Administration programs. Since the release of the Administration's FY 2000 budget for the Department of Veterans Affairs, I have been deeply concerned by the level of funding--$17.3 billion--for the Veterans Health Administration. This concerned was heightened by comments in an internal memo by Dr. Kenneth Kizer, VA Undersecretary for Health, in February, regarding the FY 2000 veterans health care budget. In that memo, Dr. Kizer warned VA Secretary Togo West that the Administration budget for FY 2000 ``poses very serious challenges which can only be met if decisive and timely actions are taken.'' Dr. Kizer went on the say that unless the VA acts soon, ``* * * we face the very real prospect of far more problematic decisions, e.g. mandatory employee furloughs, severe curtailment of services or elimination of programs and possible unnecessary facility closures'' Indeed, Mr. President, I can confirm, that concern over VA health care funding in FY 2000, and the possibility of severe curtailment of services, and the furlough VA employees is a very real concern for North Dakota veterans and DVA officials at the Fargo VA Medical Center in North Dakota. Veterans health care funding in FY 2000, and the hope that funding can be authorized this year to under take critical environmental improvements at the Fargo DVA Medical Center are high priorities for North Dakota veterans. These key priorities were discussed during a visit to the Fargo DVA Medical Center earlier this year, at my request, by Deputy Secretary Hershel Gober. In fact, so concerned are members of the Disabled American Veterans nationwide, including North Dakota members, about funding for VA medical programs, that a rally has been scheduled on May 30th at the Fargo DVA Medical Center to heighten public awareness of the FY 2000 budget for veterans medical care and to press for additional funds. Mr. President, over the past few months, Members of the Senate Committee on Veterans' Affairs and many of my colleagues have been working hard to increase funding for veterans medical care in FY 2000. I have strongly supported these efforts. During consideration of the FY 2000 budget resolution in committee, and when the resolution was reported to the Senate for consideration, I voted to increase funding for VA medical care by $3 billion, the figure recommended in the FY 2000 Independent Budget supported by the AMVETS, Disabled American Veterans, the Veterans of Foreign Wars, and the Paralyzed Veterans of America. House and Senate conferees eventually agreed to increase veterans health care funding by $1.66 billion in FY 2000. Most recently, I cosigned a letter to Members of the Senate Appropriations Committee urging the committee to provide $1.7 billion above the administration's request for the Veterans Health Administration. Although Senate appropriators have not made a decision on how much to increase funding for veterans medical care, initial reports for a significant increase are not encouraging. Because of concerns that the FY 2000 appropriations for veterans health are not expected to be adequate, and may result in unnecessary furloughs and disruptions of health care services for veterans, Senator Dorgan and I are introducing legislation to provide an emergency authorization of $1.7 billion in funding above the administration's request for $17.3 billion for the Veterans Health Administration. This figure also represents the level of additional health care funding recommended for the VA to Senate appropriators by Senate Veterans' Committee Chairman Arlen Specter and Ranking Member John D. Rockefeller. We must make every effort to find these emergency FY 2000 funds for veterans medical care, and to include them in appropriate legislation to avoid disruptions in critical health care. We can do no less for our veterans. Mr. President, I ask unanimous consent that additional material be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise today to again talk about the continuing agriculture crisis that is facing America's farmers. I spent this weekend in North Dakota. I spoke at the annual graduation of the North Dakota State School of Science and then at North Dakota State University's graduation on Saturday morning. On Friday, I went to an event we call Marketplace For Kids, which we hold every year, in which children from a large part of North Dakota come in and show the things they have been working on--inventions, creative ideas that they have had. In these three sets of events I ran into literally hundreds of North Dakota farm families. Without exception they told me, Senator, unless there is a Federal response and unless it comes quickly, literally thousands of us are going to be forced off the land this spring. This is a crisis as deep and as serious as any I have seen in my 13 years now representing North Dakota in the Senate. We have had quite a string of crises: in 1988-1989, the worst drought since the 1930s; in 1997, the worst flood in 500 years that devastated the town of Grand Forks, ND; and now this continuing agriculture crisis, as a result of, really, three factors. One is the collapse of farm prices. The second is incredibly bad weather over the last 5 years--overly wet conditions. In fact, as I flew over North Dakota, it looked like Lake Agassiz, which existed thousands of years ago, was reforming, because everywhere I looked, as I flew in a light plane over half of North Dakota, flying from east to west, all I saw was water everywhere. It was really stunning to see it. Then, of course, we have been hit by bad policy: A farm bill that has reductions in support from Government no matter what happens to farm prices, very steep reductions that are included in that policy; and, of course, a trade policy that left us vulnerable to incredible increases in imports from Canada traded on an unfair basis. This stew that is being cooked is increasingly hard to choke down for our farmers. This is a recent headline, April 4, in the Bismarck Tribune, my hometown newspaper. The headline is: ``Farm Families Forced To Cancel Health Insurance.'' In the story they talk about Clint Jacobs, a 30-year-old farmer, who raises 200 head of cattle near Amidon, ND. That is out in western North Dakota. He and his wife and their 1\1/2\-year-old daughter were paying $550 every 3 months for health insurance and they had $1,000 deductible. They had to drop their health insurance. This is a story that is repeated every day across North Dakota, and I am sure in other farm belt States as well, as we cope with the lowest prices in 52 years--the lowest prices in 52 years. These farm families, with incredibly hard-working, decent, honest people, are having to dump their health insurance in a bid to survive financially. This really is not right. As I traveled across my State this weekend, farm families came to me, bankers came to me with a very consistent message: You have to respond and you have to respond quickly, because this is a set of facts that is going to suck thousands of us down. This article I was referring to says that 26 out of 82 farmers and ranchers who were surveyed had dropped health insurance to make ends meet. The survey was done by the Lutheran Disaster Response of Lutheran Social Services in North Dakota. As one person said, if you have four or five bad years and you tighten the belt every time, health insurance gets to be one of the things that is cut. That is what is happening today in my State. Patients are skipping preventive care, such as checkups and mammograms. Some doctors and other health care providers are not getting paid. In a sidebar story by the Associated Press, their farm writer says: Facing a dim agriculture forecast this year, farmers can now prepare for financial cutbacks. A Purdue University extension specialist who offers financial advice to struggling farmers in Indiana said families must determine what they can do without. That is exactly what is happening in North Dakota. Maybe there are some who are listening and saying that we have had to do that in our life, we have had to cut back when times are tough, we have had to consider what you can do without; so what. This is not a typical downturn. This goes far beyond what somebody can fairly plan for--the lowest prices in 52 years; 5 years of the worst weather on record; as a result, an outbreak of disease unprecedented in our State's history. In over 100 years, we have never seen an outbreak of disease like we are coping with now. Scab, a fungus that breaks out when there are overly wet conditions, dramatically reduced production, with prices, as I indicated, the lowest they have been in 52 years. What a double whammy. On top of it, to have a farm bill passed--and it does not matter what farm prices are--that is slashing Government support for producers at the very time our chief competitors are spending more. The Europeans, who are our chief competitors and who we were supposed to be convincing to cut their subsidies by cutting ours, did they decide to follow suit? Absolutely not. They have decided to spend more, and they are already spending $50 billion a year to support their farmers. We are spending $5 billion. That is not a fair fight. Our farmers are ready to take on anybody anytime anywhere. They are ready to compete. They are ready to take on the farmers of France and Germany and England, and all the rest, but they are not prepared to take on, in addition to the farmers from those countries, the governments of those countries. They are not prepared to take on the French Government, the German Government, and the British Government, as well as the farmers from those countries. That is not a fair fight. Yet, that is what we have said to our farmers: You go out there and you take on the French farmers and, while you are at it, take on the French Government as well. You go out there and compete against the German farmer, and while you are at it, take on the German Government as well. That is not a fair fight. We have to put tools in the hands of our farmers so they have a chance to fight back. If we do not, we will wake up sometime soon and find that tens of thousands of farm families have been forced off the land and have been destroyed financially. That is what is happening in my State each and every day. Good people, honest people are being destroyed. The question is, Are we going to stand and help them or are we going to stand by and do nothing? That is the choice that is before us. I hope we respond, and I hope we respond quickly. We need to immediately pass the emergency supplemental that is in the conference committee between the House and the Senate tomorrow. We need to pass that legislation because it provides an expansion of credit to get farmers into the fields, and we need to add to that package. We need to add $1.5 billion to keep the promise that we made last year in the disaster bill. We now know the farmers have signed up for the program that we have promised. We found we are $1.5 billion short of funding what we promised. We ought to keep the promise, and we ought to do it in this bill. In addition, we ought to provide the same supplemental benefit we provided last year to offset this dramatic decline in prices. That would be an AMTA supplemental, transition payments that were provided for in the last farm bill that are going down each and every year. Last year, because of the crisis, we provided a 50-percent supplement. We need to do that again this year. It will cost $2.8 billion. That is a total package approaching $5 billion. Last year, we passed a package of $6 billion. I would like to have that amount again this year, but the reality is that we are going to have to make do with the package like the one I have described, at least for now. But it needs to happen now. We should not wait because while we are waiting, literally thousands of people are being forced off the land and being financially destroyed, through no fault of their own, by being caught up in a circumstance of bad weather, bad prices, and bad policy. There is not much we can do about the prices, there is not much we can do about the weather, but we can do something about the policy. That is our responsibility. I hope we meet that responsibility and meet it this week. I want to show, before I leave this subject, some charts that appeared in the newspapers back home while I was there. It showed the net return per acre of wheat in North Dakota going back to 1986. You can see the kinds of returns that farmers were seeing per acre for planting wheat. Our State is a major wheat State, really one of the key breadbasket States in the Nation. As you can see, there were positive returns of over $30 an acre in 1986 and 1987. Then we saw pretty tough times in 1988, 1989, and 1990, the drought years. We saw a substantial improvement in 1991, 1992, and 1993. In 1994, we saw a steep slide; 1995, further erosion; 1996 was about the same as 1995, and then the bottom fell out in 1997, negative returns per acre approaching a $20 loss per acre. The more you planted, the worse off you were, and the same pattern was repeated in 1998. If we do not act, 1999 is going to be a whole lot worse and, literally, as I have indicated, thousands of farm families are going to be facing auction. I showed a cartoon that was in the biggest paper in my State several weeks ago. It showed a pole, and it had auction signs, 9 or 10 different auction signs all pointing in different directions. Sitting on top of the pole was a buzzard. That is kind of the feeling in my State right now. The buzzards are swooping overhead waiting for another farm failure, waiting for another auction, waiting to see another farm family sold out, because that is what is happening all too frequently in my State these days. If it was not enough to have the dominant crop in negative return territory the last year, this is the pattern of raising cattle. You can see very much a similar pattern, only returns went negative earlier for cattle. In 1995 and 1996, they were negative, and they were barely in the black for 1997 and 1998. Two-thirds of the income in my State is crop income. So when crops are giving negative returns, and then you face on top of that livestock giving negative returns, it is impossible to make money--impossible to make money--again, not through any fault of these farm families. These are the hardest working, most honest people I know, but they are being devastated by events beyond their control. The financial collapse in Asia cost them their biggest customer. The financial collapse in Russia cost them a very big customer. Those events, working together, have created a nightmare for these farm families. Then on top of that, after you stack these natural disasters, you put the final coup de grace--the bad policy coming out of Washington--and it is pretty hard for a farm family to make it. It is pretty hard for them to take on the Europeans when those countries have decided that they are going to spend $50 billion a year to support their producers and we are spending $5 billion. We are being outspent, outgunned, 10-to-1. And why? Because the Europeans decided some time ago that it made sense to their countries to have people out across the land. They did not want to see everybody forced into the city. They did not think that made sense for their society. I hope very soon we will come to a similar conclusion in this country and will decide that it makes sense to have people out across the land, because if we do not respond, there will be precious few people out there; they will all be headed to the cities. The last thing we need in the Washington metroplex is more people: More crowding, more pollution, more hassle. That is exactly what is going to happen unless we respond. This is a good country, a generous country, and one that responds when people are in crisis. We are going to respond to the disasters in Oklahoma, in Kansas, in Tennessee, and the other States that have been affected. I believe we are going to respond in this crisis, as well, in the farm States of America, because they are on the brink of a total financial collapse. That is the seriousness of what is happening. Now is the time; this week is the time; on this supplemental is the time to respond, and to respond strongly, to give people the help they desperately need. I thank the Chair and yield the floor.

Mr. CONRAD

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

Mr. CONRAD

Mr. CONRAD. Mr. President, today, I am pleased to join Senator Baucus, Senator Daschle, and other Senators to introduce the Promoting Health in Rural Areas Act of 1999 (PHIRA). This legislation will improve access, increase choice and improve the quality of health care in rural America. As you know, Mr. President, the Balanced Budget Act (BBA) of 1997 produced real savings for the Medicare program and helped to extend solvency of the program. However, since passing the BBA, we have heard concerns from many rural health care providers that they are facing serious financial pressures due in large part to reductions that were enacted as part of the BBA. During the BBA debate, I was very concerned that across-the-board cuts in Medicare would have a disproportionate impact on rural health care. Rural hospitals rely heavily on Medicare and in my state of North Dakota, Medicare accounts for 70 percent of hospital revenue. This means that Medicare reimbursement reductions have a bigger direct impact on rural hospitals than on other hospitals. It also means that rural hospitals have fewer other sources of revenues where they can increase margins to make up for losses in Medicare revenue. To help protect access to health care in rural areas, I and a coalition of other Senators, worked hard to fight for provisions in the BBA to protect our rural areas. We made positive steps toward ensuring that health care in rural areas is affordable and accessible. Our victories included, for the first time, requiring Medicare reimbursement for telehealth. Also included was the creation of the Critical Access Hospital program. The BBA also helped to reform managed care reimbursement to make it more equitable to rural areas and added Graduate Medical Education language to protect rural residency programs. Despite our efforts, BBA reductions are having an unfair and disproportionate impact on rural health care systems--these cuts have caused real pain for providers and threaten to reduce access to health care for seniors, particularly in rural areas. To help address these concerns, we have worked hard to develop legislation that will ensure our rural areas have access to quality care. The Promoting Health in Rural Areas Act of 1999 will improve Medicaid and Medicare reimbursement to rural providers, strengthen health professional recruitment programs, and encourage the development of telehealth. One problem that rural areas face is reimbursement systems that favor urban areas, or that do not take the special needs of rural providers into account. Medicare payments to hospitals are currently based on formulas that are biased toward urban areas. The first element of PHIRA would correct these formulas and pay hospitals more fairly. In the BBA, Medicaid funding for Community Health Clinics (CHCs) and Rural Health Clinics (RHCs) was changed, leaving no guarantee that states will adequately fund these facilities. This bill would create a new payment system for CHCs and RHCs that will help ensure continued support for these essential facilities. The bill would also guarantee that Medicare+Choice plans in rural counties get the increased reimbursement promised in the BBA. This provision is important to ensure that beneficiaries in rural areas have at least some of the health plan choices that are available to urban seniors. The second element of our bill includes provisions to attract and bring more health care providers into our communities. Rural communities face difficulties in recruiting and retaining health care providers. In my state, over 85% of counties are designated as either a partial or full health shortage profession area (HPSA). Nationwide, 22 million rural Americans live in HPSAs. We must do more to attract qualified health care providers into our rural areas. Currently, communities must actually lose a physician before they qualify for recruitment assistance to replace that provider. This bill would let communities get assistance for up to 12 months in advance when they know someone is going to retire. In addition, this bill will take positive steps to ensure that our future health care providers choose to serve in HPSAs. Currently, students in our National Health Service Corps program, a program helps students pay for their medical education or re-pay their medical student loans in return for serving in HPSAs, are facing undue hardship due to the fact that they are being taxed on scholarships they receive to participate in the NHSC. This bill will reward students for their commitment to working in HPSAs by exempting them from being taxed on their NHSC scholarships. The third element of PHIRA will go even further to ensure that the most important medical services are available in our communities by expanding access to telehealth services. The promise of telehealth is becoming increasingly apparent. Throughout the country, providers are experimenting with a variety of telehealth approaches in an effort to improve access to quality medical and other health-related services. Those programs are demonstrating that telecommunications technology can alleviate the constraints of time and distance, as well as the cost and inconvenience of transporting patients to medical providers. Many approaches show promising results in reducing health care costs and bringing adequate care to all Americans. For the first time, technological advances and the development of a national information infrastructure give telehealth the potential to overcome barriers to health care services for rural Americans and afford them the access that most Americans take for granted. But it is clear that our nation must do more to integrate telehealth into our overall health care delivery infrastructure. This bill would expand Medicare reimbursement for telemedicine to all rural areas, and to all Medicare services. Medicare reimbursement policy is an essential component of helping to integrate telehealth into the health care infrastructure and is particularly important in rural areas, where many hospitals do as much as 80% of their business with Medicare patients. Because the Secretary defined reimbursable services so narrowly in the BBA, this legislation clarifies that all services that are covered under Medicare Part B will be covered if they are instead delivered vial telehealth. In particular, it clarifies that the technology called ``store and forward'', which is a cost-effective method of transferring information, is included in this reimbursement policy. This bill will also help communities build home-grown telehealth networks. It will help to build telehealth infrastructure and foster rural economic development, and it incorporates many of the most important lessons learned from other grant projects and studies on telehealth from across the Federal government. Because so many rural and underserved communities lack the ability to attract and support a wide variety of health care professionals and services, it is important to find a way to bring the most important medical services into those communities. Telehealth provides an important part of the answer. It helps bring services to remote areas in a quick, cost-effective manner, and can enable patients to avoid traveling long distances in order to receive health care treatment. Mr. President, I am confident that the Promoting Health in Rural Areas Act will take important steps toward ensuring those in our rural and underserved communities have access to quality, affordable health care. I urge my colleagues to support this legislation.

Mr. CONRAD

Mr. CONRAD. Mr. President, today, I am pleased to join Senator Baucus, Senator Daschle, and other Senators to introduce the Promoting Health in Rural Areas Act of 1999 (PHIRA). This legislation will improve access, increase choice and improve the quality of health care in rural America. As you know, Mr. President, the Balanced Budget Act (BBA) of 1997 produced real savings for the Medicare program and helped to extend solvency of the program. However, since passing the BBA, we have heard concerns from many rural health care providers that they are facing serious financial pressures due in large part to reductions that were enacted as part of the BBA. During the BBA debate, I was very concerned that across-the-board cuts in Medicare would have a disproportionate impact on rural health care. Rural hospitals rely heavily on Medicare and in my state of North Dakota, Medicare accounts for 70 percent of hospital revenue. This means that Medicare reimbursement reductions have a bigger direct impact on rural hospitals than on other hospitals. It also means that rural hospitals have fewer other sources of revenues where they can increase margins to make up for losses in Medicare revenue. To help protect access to health care in rural areas, I and a coalition of other Senators, worked hard to fight for provisions in the BBA to protect our rural areas. We made positive steps toward ensuring that health care in rural areas is affordable and accessible. Our victories included, for the first time, requiring Medicare reimbursement for telehealth. Also included was the creation of the Critical Access Hospital program. The BBA also helped to reform managed care reimbursement to make it more equitable to rural areas and added Graduate Medical Education language to protect rural residency programs. Despite our efforts, BBA reductions are having an unfair and disproportionate impact on rural health care systems--these cuts have caused real pain for providers and threaten to reduce access to health care for seniors, particularly in rural areas. To help address these concerns, we have worked hard to develop legislation that will ensure our rural areas have access to quality care. The Promoting Health in Rural Areas Act of 1999 will improve Medicaid and Medicare reimbursement to rural providers, strengthen health professional recruitment programs, and encourage the development of telehealth. One problem that rural areas face is reimbursement systems that favor urban areas, or that do not take the special needs of rural providers into account. Medicare payments to hospitals are currently based on formulas that are biased toward urban areas. The first element of PHIRA would correct these formulas and pay hospitals more fairly. In the BBA, Medicaid funding for Community Health Clinics (CHCs) and Rural Health Clinics (RHCs) was changed, leaving no guarantee that states will adequately fund these facilities. This bill would create a new payment system for CHCs and RHCs that will help ensure continued support for these essential facilities. The bill would also guarantee that Medicare+Choice plans in rural counties get the increased reimbursement promised in the BBA. This provision is important to ensure that beneficiaries in rural areas have at least some of the health plan choices that are available to urban seniors. The second element of our bill includes provisions to attract and bring more health care providers into our communities. Rural communities face difficulties in recruiting and retaining health care providers. In my state, over 85% of counties are designated as either a partial or full health shortage profession area (HPSA). Nationwide, 22 million rural Americans live in HPSAs. We must do more to attract qualified health care providers into our rural areas. Currently, communities must actually lose a physician before they qualify for recruitment assistance to replace that provider. This bill would let communities get assistance for up to 12 months in advance when they know someone is going to retire. In addition, this bill will take positive steps to ensure that our future health care providers choose to serve in HPSAs. Currently, students in our National Health Service Corps program, a program helps students pay for their medical education or re-pay their medical student loans in return for serving in HPSAs, are facing undue hardship due to the fact that they are being taxed on scholarships they receive to participate in the NHSC. This bill will reward students for their commitment to working in HPSAs by exempting them from being taxed on their NHSC scholarships. The third element of PHIRA will go even further to ensure that the most important medical services are available in our communities by expanding access to telehealth services. The promise of telehealth is becoming increasingly apparent. Throughout the country, providers are experimenting with a variety of telehealth approaches in an effort to improve access to quality medical and other health-related services. Those programs are demonstrating that telecommunications technology can alleviate the constraints of time and distance, as well as the cost and inconvenience of transporting patients to medical providers. Many approaches show promising results in reducing health care costs and bringing adequate care to all Americans. For the first time, technological advances and the development of a national information infrastructure give telehealth the potential to overcome barriers to health care services for rural Americans and afford them the access that most Americans take for granted. But it is clear that our nation must do more to integrate telehealth into our overall health care delivery infrastructure. This bill would expand Medicare reimbursement for telemedicine to all rural areas, and to all Medicare services. Medicare reimbursement policy is an essential component of helping to integrate telehealth into the health care infrastructure and is particularly important in rural areas, where many hospitals do as much as 80% of their business with Medicare patients. Because the Secretary defined reimbursable services so narrowly in the BBA, this legislation clarifies that all services that are covered under Medicare Part B will be covered if they are instead delivered vial telehealth. In particular, it clarifies that the technology called ``store and forward'', which is a cost-effective method of transferring information, is included in this reimbursement policy. This bill will also help communities build home-grown telehealth networks. It will help to build telehealth infrastructure and foster rural economic development, and it incorporates many of the most important lessons learned from other grant projects and studies on telehealth from across the Federal government. Because so many rural and underserved communities lack the ability to attract and support a wide variety of health care professionals and services, it is important to find a way to bring the most important medical services into those communities. Telehealth provides an important part of the answer. It helps bring services to remote areas in a quick, cost-effective manner, and can enable patients to avoid traveling long distances in order to receive health care treatment. Mr. President, I am confident that the Promoting Health in Rural Areas Act will take important steps toward ensuring those in our rural and underserved communities have access to quality, affordable health care. I urge my colleagues to support this legislation.

Mr. CONRAD

Mr. CONRAD. Mr. President, I ask unanimous consent we get 4 additional minutes on this side as well.

Mr. CONRAD. Reserving the right to object, and I will not object.

Mr. CONRAD. Mr. President, I also want to comment on the National Teacher Appreciation Week, because I think all of us can look back in our own backgrounds and remember what a difference teachers made in our lives. I can remember very well the teachers who made a contribution to my life, to my growing up: Mrs. Goplin, who taught American history and who really shared a great love for understanding the Constitution of the United States, always told us that this is one of the greatest documents in human history. I will never forget those words of Mrs. Goplin. She was exactly right. Our Constitution is one of the greatest documents in human history, and how lucky we are to live in a country that has constitutional guarantees of freedom for the American people and says to each and every American, you have certain rights, rights that protect you from the overreach of government, because our forefathers had known in Europe that government can become oppressive and that government can make demands on its citizenry that are not fair, that are not reasonable. We are so lucky to have these protections. I remember other teachers: My third grade teacher, Mrs. Offerdahl, who is still alive in a nursing home in North Dakota, what a great woman. She came every morning to that class with a sparkle in her eye and a love for learning and a love for teaching. She made a difference not only in my life but in the lives of hundreds and hundreds of students whom she taught over a very long career in the Bismarck, ND, school system--Mrs. Offerdahl. And Mrs. Senzek, who was my fifth grade teacher, a highly intelligent woman, somebody who was absolutely committed to improving the educational standards of the kids in Bismarck, ND. My sixth grade teacher, Miss Barbie, who was a very sophisticated woman, somebody who loved reading and imparted that love to students. I think back to how fortunate we were to have people of that quality and that caring who provided education to us and at great sacrifice to themselves. I can say every one of these women whom I have mentioned could have made much more money doing something else, but they were dedicated to teaching young people, and they made enormous financial sacrifices to do it. There are so many other teachers along the way whom I remember. Mrs. Hook was my second grade teacher. She was a woman of real majesty, really almost a regal person, very tall, very erect, very dignified, somebody who commanded respect. These are people who made an impression that has lasted a lifetime, lasted a lifetime for me, but I know lasted a lifetime for other students in the Bismarck public school system as well. Mr. President, I add our words of praise to all the teachers across this country who make a difference in the lives of kids. Other than family members, other than parents, perhaps there is no more important relationship than what teachers do in terms of training our kids. So, today, we say thank you, thank you for everything you have done. You have made a difference.

Mr. CONRAD

Mr. CONRAD. I just ask my colleague from the State of Montana if he would like that additional 5 minutes. I would be happy to yield to him at this point.

Mr. CONRAD. Mr. President, I want to talk about another crisis that is occurring in this country. It is not receiving the attention as are the storms in Oklahoma, the tornadoes, and the tremendous damage that has been wreaked in those States by this set of storms, but it is a crisis nonetheless. It is almost a stealth crisis. It is a crisis in American agriculture, and I can tell you, it is causing trauma, too. In my State, we have just seen a series of headlines in the major newspapers that tell the story. I thought I would bring them to the attention of my colleagues today so hopefully we can reflect not only on the tragedy in Oklahoma and Kansas, but we can reflect on the tragedy that is happening in central America, and I mean the central America of North Dakota and South Dakota, Montana, Nebraska, and Kansas--States that have been hard hit by a virtual depression in agriculture. It is causing real trauma, Mr. President. These headlines tell the story. This headline sums it up: ``The rural depression.'' There is a real depression in the heartland of America. Prices, the lowest we have seen in 50 years, are causing literally thousands of farmers to exit agriculture. Here is another headline which recently ran in papers back home: ``Farm prices, farm numbers both fall.'' And this headline that says: ``Another farm dies; does Washington really care?'' That is the question we are going to be asking today and we are going to continue to ask as we see this crisis grow and develop affecting more and more farm families and starting to affect the small towns of our State as well. In fact, this headline says it well: ``AG Crisis Is Bigger Than N.D.'' This is an editorial from the largest paper in our State pointing out that not only is North Dakota affected but other farm States as well. This is a headline which ran recently: ``State Loses Farmers.'' And one headline which ran, again, in the biggest paper in our State: ``Crop Prices Are the Problem.'' And indeed they are. ``Crop Prices Are the Problem.'' This article says, ``Crop prices, that's the big thing wrong with the region's farm picture this year.'' And they are exactly right. When I mentioned the crisis has moved from the farmstead to the streets of North Dakota, this headline tells that story: ``Farm Downturn Leaves Main Street Reeling. Three family-run businesses in Michigan, North Dakota closed, with little hope of reopening.'' There is the crisis that is receiving enormous attention in Oklahoma and Kansas--and it should have enormous attention. Those people deserve for others to understand what is happening and the suffering they are experiencing. There is another crisis as well, and that is the crisis in farm country. Those people are suffering. And they deserve attention as well. Let me just show another chart which goes right to the heart of the problem we are facing. This shows what has happened to farm prices from 1946 to 1998 for wheat and barley. You can see from the prices--this is 1998--it has even gotten worse. We go out to 1999, and these prices continue to decline in real terms. We have the lowest prices now for these commodities in 52 years. This is a crisis by any definition. I just want to conclude by going back to what one of the articles said in the papers back home. This says: ``Banks' Survey Shows Farm Income Dwindling.'' In this article they say, ``The vice is tightening on farm borrowers in the Upper Great Plains. The outlook for farm income is grim unless commodity prices increase.'' Mr. President, that is exactly the case. We face a tightening noose around the necks of literally thousands of farm families, and it is time for a response from the Federal Government. We need to pass the disaster supplemental. We need to make the last disaster program we passed whole, because we now know it will cost $1.5 billion more to keep the promise which was made in that disaster program. We need to once again shore up the transition payments that are promised farmers under the new farm bill at this time of price collapse. Those are steps we can take, we need to take, we must take. In addition, we should reform crop insurance, because we know that program does not work when you have multiple years of disaster. I just close by saying once again, I hope America is listening and understands that there are tragedies occurring across the United States. We have a tragedy in Oklahoma, a tragedy in Kansas, and we ought to respond. There are also tragedies that are occurring below the radar screen. They are not getting the attention of the national press. They are a crisis nonetheless, and we ought to respond to them as well. I thank the Chair and yield the floor. Mr. President, I know my colleague from Montana is waiting to speak. I inquire of the Parliamentarian, how much time do we have remaining on our side?

Mr. CONRAD

Mr. CONRAD. Mr. President, I add my words to those who talked about the tragedy in Oklahoma this morning. I remember watching television last night and seeing the power and the destructive might of those storms that swept across Oklahoma and parts of Kansas as well. I have a feeling for what the people are going through, as a result of the disasters that hit North Dakota in 1997. We had the worst flood in 500 years in Grand Forks, ND, and we had 95 percent of the town evacuated, the largest mass evacuation of a city in the United States since the Civil War. I know the trauma those people are facing, and I know the difficulty of recovery. Our hearts go out to the people in Oklahoma and Kansas who have been so affected. I hope they know that we are prepared to respond and to help. We in North Dakota remember very well how people reached out a helping hand to our State, so many people from around the country who actually came to North Dakota to help us rebuild--the Red Cross, the other organizations, the Salvation Army. We had a woman from California who came to town and gave $2,000 to every family that had been affected, a gift of tens of millions of dollars. We remember very well the Federal Government's rapid response, the agencies of the Federal Government that moved to assist the people who were affected. FEMA did an absolutely superb job under the leadership of James Lee Witt. We will never forget it. The Department of Housing and Urban Development, under the leadership of Secretary Cuomo, did a superb job, and we will never forget their help. The SBA was quick to move in to help businesses. We know all of those agencies will be ready to respond in Oklahoma and Kansas as well. I hope that we see the Congress respond. I believe the people in Oklahoma and Kansas deserve the same kind of rapid and full response that we received in North Dakota. Frankly, I hope they don't face some of the delays we faced in trying to get a congressional response, because when people are devastated, they should not have to wait for help. This Government is big enough and strong enough and this country is generous enough to move to help immediately. Mr. President, again, our hearts go out to the people in Oklahoma and Kansas who have lived through this trauma; and to those who have lost relatives and loved ones, we share their deep sorrow.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise today as an original cosponsor of the bipartisan Flag Protection Act of 1999. I salute its author, Senator McConnell of Kentucky. I believe every Member of this body abhors acts of desecration against the flag. Burning a flag, or otherwise dishonoring this symbol of freedom, is repugnant to me, to my colleagues, and to the vast majority of American citizens. I believe we should protect the flag from the acts of those few who would dishonor it. But the question is, How do we do it? Mr. President, we have previously passed a statute to protect the flag but that was overturned by the U.S. Supreme Court as unconstitutional. Some now say the only alternative is to pass a constitutional amendment. After considerable study and review, I have concluded that is not the case. There is an alternative, and the alternative is the legislation that we offer today, the Flag Protection Act of 1999. It is a statute. It is not a constitutional amendment. It will protect the flag, and I believe it will be upheld as constitutional. We have a clear responsibility to exhaust all other options before we take the very serious step of amending the Constitution of the United States. Every one of us in the Senate pledges on our first day in this Chamber to uphold, protect, and defend the Constitution of the United States. Amending that time-honored, time-tested document is among the most serious of our duties--a step we have taken only rarely in the long history of our country. The Constitution is the foundation of our Government. I believe it is one of the greatest documents in human history. Its freedoms are the source of our strength as a nation--and a model of freedom to the world. Mr. President, the Founding Fathers wisely made it very difficult to amend the Constitution. They knew that a process that would allow for easy amendment of the Constitution could destabilize our country, that it could undermine the stability we have enjoyed through our long history. The Constitution has been amended only 27 times in 200 years, although many more attempts have been made. Those 27 amendments, beginning with the Bill of Rights, were the result of fundamental debates about the nature of our society, and who we would be as a nation. Freedom of religion, freedom of the press, freedom to assemble peacefully, the right to a trial by jury, the right to vote--these amendments address rights so basic we almost take them for granted today. Yet, some of them at the time of adoption provoked serious debate and division, division so deep they threatened to split the country. Mr. President, I hesitate to launch this Nation on an undertaking of such magnitude and divisiveness. When there is an alternative--and there is an alternative--I believe we can protect the flag without amending the Constitution. I believe we can propose and pass a statute that will protect the flag against burning and other acts of desecration, and I believe that statute will be upheld as constitutional. That is why today I am joining this bipartisan effort with my colleagues, Senator McConnell of Kentucky, Senator Dorgan of North Dakota, and Senator Bennett of Utah, to introduce the Flag Protection Act of 1999. This statute provides for maximum protection for the flag while respecting the liberties it symbolizes. We have been assured by experts at the Congressional Research Service and by constitutional scholars that it will be upheld by the courts. When it comes to amending the Constitution, I am conservative. I feel strongly that the flag can and should be protected. But before we take the step of amending the Constitution of the United States, we should exhaust every other remedy. Today we have introduced a statutory remedy. I ask my colleagues to join me in approving this law to protect the flag and the Constitution. Mr. President, I ask unanimous consent to have printed in the Record a letter from the AMVETS of North Dakota. The AMVETS, in a letter to me, dated September 29, 1998, have endorsed this approach. I also ask unanimous consent to have printed in the Record the specific provision that they adopted at their convention supporting the approach that we are taking today.

Mr. CONRAD. Mr. President, I would also like to read briefly from a letter I received from a constituent in North Dakota. He wrote to me the following: As a third generation military officer, I cannot support an amendment to the Constitution with respect to the flag. I have many compelling reasons to ask that you not support this amendment. My sworn duty as an officer in the United States Air Force to uphold and defend the Constitution of the United States lies at the heart of my opposition. This amendment will weaken the Constitution and open the door for more frivolous amendments in the future. I cannot stand by and let this happen without raising my voice. He went on to say: Of the gallant Americans who fought and died in the service of our country within the last 200 years, I tell you this: They did not die defending the flag. They died defending our freedom and the ideals upon which our country was founded. Don't cheapen their sacrifice by supporting this misguided amendment. Mr. President, a third letter that I received was from a man also from North Dakota. He wrote me this: On my mother's side, my great-grandfather came to the United States from Bohemia and fought in the Union Army. On my father's side, my great-grandmother lost her two oldest sons, Iowa soldiers, at the Siege of Vicksburg. And members of my family have represented the United States in every war since. I am a Korean War combat veteran. He went on to say: The flag is strong enough to take care of itself. But if these flag protectors are sincere about its protection, then strong legislation is the safest way to go. Mr. President, that is what we are offering today on a bipartisan basis--four Senators; two Democrats, two Republicans--offering the Flag Protection Act of 1999. We believe this is the appropriate way to protect the flag. Mr. President, I yield the floor. Mr. DORGAN addressed the Chair.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise today as an original cosponsor of the bipartisan Flag Protection Act of 1999. I salute its author, Senator McConnell of Kentucky. I believe every Member of this body abhors acts of desecration against the flag. Burning a flag, or otherwise dishonoring this symbol of freedom, is repugnant to me, to my colleagues, and to the vast majority of American citizens. I believe we should protect the flag from the acts of those few who would dishonor it. But the question is, How do we do it? Mr. President, we have previously passed a statute to protect the flag but that was overturned by the U.S. Supreme Court as unconstitutional. Some now say the only alternative is to pass a constitutional amendment. After considerable study and review, I have concluded that is not the case. There is an alternative, and the alternative is the legislation that we offer today, the Flag Protection Act of 1999. It is a statute. It is not a constitutional amendment. It will protect the flag, and I believe it will be upheld as constitutional. We have a clear responsibility to exhaust all other options before we take the very serious step of amending the Constitution of the United States. Every one of us in the Senate pledges on our first day in this Chamber to uphold, protect, and defend the Constitution of the United States. Amending that time-honored, time-tested document is among the most serious of our duties--a step we have taken only rarely in the long history of our country. The Constitution is the foundation of our Government. I believe it is one of the greatest documents in human history. Its freedoms are the source of our strength as a nation--and a model of freedom to the world. Mr. President, the Founding Fathers wisely made it very difficult to amend the Constitution. They knew that a process that would allow for easy amendment of the Constitution could destabilize our country, that it could undermine the stability we have enjoyed through our long history. The Constitution has been amended only 27 times in 200 years, although many more attempts have been made. Those 27 amendments, beginning with the Bill of Rights, were the result of fundamental debates about the nature of our society, and who we would be as a nation. Freedom of religion, freedom of the press, freedom to assemble peacefully, the right to a trial by jury, the right to vote--these amendments address rights so basic we almost take them for granted today. Yet, some of them at the time of adoption provoked serious debate and division, division so deep they threatened to split the country. Mr. President, I hesitate to launch this Nation on an undertaking of such magnitude and divisiveness. When there is an alternative--and there is an alternative--I believe we can protect the flag without amending the Constitution. I believe we can propose and pass a statute that will protect the flag against burning and other acts of desecration, and I believe that statute will be upheld as constitutional. That is why today I am joining this bipartisan effort with my colleagues, Senator McConnell of Kentucky, Senator Dorgan of North Dakota, and Senator Bennett of Utah, to introduce the Flag Protection Act of 1999. This statute provides for maximum protection for the flag while respecting the liberties it symbolizes. We have been assured by experts at the Congressional Research Service and by constitutional scholars that it will be upheld by the courts. When it comes to amending the Constitution, I am conservative. I feel strongly that the flag can and should be protected. But before we take the step of amending the Constitution of the United States, we should exhaust every other remedy. Today we have introduced a statutory remedy. I ask my colleagues to join me in approving this law to protect the flag and the Constitution. Mr. President, I ask unanimous consent to have printed in the Record a letter from the AMVETS of North Dakota. The AMVETS, in a letter to me, dated September 29, 1998, have endorsed this approach. I also ask unanimous consent to have printed in the Record the specific provision that they adopted at their convention supporting the approach that we are taking today.

Mr. CONRAD. Mr. President, I would also like to read briefly from a letter I received from a constituent in North Dakota. He wrote to me the following: As a third generation military officer, I cannot support an amendment to the Constitution with respect to the flag. I have many compelling reasons to ask that you not support this amendment. My sworn duty as an officer in the United States Air Force to uphold and defend the Constitution of the United States lies at the heart of my opposition. This amendment will weaken the Constitution and open the door for more frivolous amendments in the future. I cannot stand by and let this happen without raising my voice. He went on to say: Of the gallant Americans who fought and died in the service of our country within the last 200 years, I tell you this: They did not die defending the flag. They died defending our freedom and the ideals upon which our country was founded. Don't cheapen their sacrifice by supporting this misguided amendment. Mr. President, a third letter that I received was from a man also from North Dakota. He wrote me this: On my mother's side, my great-grandfather came to the United States from Bohemia and fought in the Union Army. On my father's side, my great-grandmother lost her two oldest sons, Iowa soldiers, at the Siege of Vicksburg. And members of my family have represented the United States in every war since. I am a Korean War combat veteran. He went on to say: The flag is strong enough to take care of itself. But if these flag protectors are sincere about its protection, then strong legislation is the safest way to go. Mr. President, that is what we are offering today on a bipartisan basis--four Senators; two Democrats, two Republicans--offering the Flag Protection Act of 1999. We believe this is the appropriate way to protect the flag. Mr. President, I yield the floor. Mr. DORGAN addressed the Chair.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am pleased to be joined by Senators Nickles, Rockefeller, Inouye, and Harkin to introduce legislation that directs the Office of Personnel Management (OPM) to develop a classification standard appropriate to the occupation of physician assistant. Physician assistants are a part of a growing field of health care professionals that make quality health care available and affordable in underserved areas throughout our country. Because the physician assistant profession was very young when OPM first developed employment criteria in 1970, the agency adapted the nursing classification system for physician assistants. Today, this is no longer appropriate. Physician assistants have different education and training requirements than nurses and they are licensed and evaluated according to different criteria. The inaccurate classification of physician assistants had led to recruitment and retention problems of physician assistants in federal agencies, usually caused by low starting salaries and low salary caps. Because it is recognized that physician assistants provide cost- effective health care, this is an important problem to resolve. This legislation mandates that OPM review this classification in consultation with physician assistants and the organizations that represent physician assistants. The bill specifically states that OPM should consider the educational and practice qualifications of the position as well as the treatment of physician assistants in the private sector in this review. Mr. President, I believe that this legislation will make an important correction that will help federal agencies make better use of these providers of cost-effective, high quality health care.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am pleased to be joined by Senators Nickles, Rockefeller, Inouye, and Harkin to introduce legislation that directs the Office of Personnel Management (OPM) to develop a classification standard appropriate to the occupation of physician assistant. Physician assistants are a part of a growing field of health care professionals that make quality health care available and affordable in underserved areas throughout our country. Because the physician assistant profession was very young when OPM first developed employment criteria in 1970, the agency adapted the nursing classification system for physician assistants. Today, this is no longer appropriate. Physician assistants have different education and training requirements than nurses and they are licensed and evaluated according to different criteria. The inaccurate classification of physician assistants had led to recruitment and retention problems of physician assistants in federal agencies, usually caused by low starting salaries and low salary caps. Because it is recognized that physician assistants provide cost- effective health care, this is an important problem to resolve. This legislation mandates that OPM review this classification in consultation with physician assistants and the organizations that represent physician assistants. The bill specifically states that OPM should consider the educational and practice qualifications of the position as well as the treatment of physician assistants in the private sector in this review. Mr. President, I believe that this legislation will make an important correction that will help federal agencies make better use of these providers of cost-effective, high quality health care.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise to speak today about the continuing crisis in agriculture. Last night I was watching CNN. They had the first of a series of programs on the crisis in agriculture. They interviewed a cotton farmer from the Deep South who has a 2,500-acre farm, which is not a small farm but certainly not one of the largest. He was telling the interviewer that he lost $500,000 last year. I tell that story because that was a farmer from the Deep South. I represent North Dakota, the opposite end of the country. We are having exactly the same experience in our part of the country, a farm depression. This is a cartoon that ran in the major newspaper back home. It is a picture of vultures sitting on signs of farm auctions, pointing the way to farm auctions. There are one, two, three, four, five, six, seven different signs pointing towards farm auctions with the buzzard sitting on top of the sign. The cartoon says, ``Tis spring! Tis spring! Tis spring!'' That is how an awful lot of us are feeling because in most of the country we are celebrating spring. Certainly here in the Nation's Capital we see beautiful flowers in bloom and we are enjoying absolutely gorgeous weather. We are celebrating a rebirth, a renewal. But we are not celebrating in farm country because spring has brought us up against hard reality. The hard reality is that our operations are not going to make it. They are not cash-flowing. Many farmers are not getting the credit they need to get into the field this spring. That is why the now stalled emergency supplemental is important. It provides emergency disaster funding for farm credit to assure that those who are credit worthy can get into the field to plant this year's crop. Too many feel that agriculture has turned against them, that policy here has turned against them, that trade policy has turned against them, and, yes, that market forces have turned against them. Look at the very tough facts that our producers face. This chart shows wheat prices. The red line on the chart shows the cost of production across the country. Producing a bushel of wheat costs about $5. This jagged line shows what has happened to wheat prices. Wheat prices are now $2.40 a bushel, and it costs over $5 to produce it. This is the pattern going back to 1996. The last time we were at the cost of production was back in 1996. Since that time, wheat prices have plunged. Why? It is a complicated series of factors, starting with the Asian financial collapse that cost us some of our best markets, followed by the financial collapse in Russia that did further damage to our farmers because, of course, Russia was a big customer of ours. Yet now they cannot pay because they are out of hard currency. We have had that double whammy. On top of that, we have had good production weather around most of the world, so production has been up, yet because of the financial problems in Asia and Russia, demand is down. That has led to a dramatic price weakening. In the midst of that, we passed a new farm bill. The new farm bill, unfortunately, doesn't work well when prices collapse because there is no adjustment for price collapses. Under the old farm policy, when prices went down, support went up. Under this new policy, support goes down year by year no matter what happens to prices. The combination is leaving our farmers in the ditch, literally and figuratively. Our prices are so bad, so ruinously low, that literally tens of thousands of farm families face foreclosure. This is not just true in our part of the country. The distinguished Chair is from a nearby State. They are experiencing the effect of these very low prices, not only in terms of row crops, not only in terms of wheat, barley, and other commodities, but in terms of beef, in terms of hogs. We see hog prices as low as 8.5 cents a pound. It costs 40 cents a pound to produce a hog. If farmers only get 8.5 cents a pound when they go to sell, they are in deep trouble. We are down to only 800 hog producers in my State. We anticipate losing as many as three-quarters of them this year; 600 of the 800 are going to go out of business. The story is not much different in terms of beef because we see cattle prices at very, very low levels. The combination--whether it is in our part of the country, the northern plains, or as I started these remarks talking about this cotton farmer in the Deep South losing $500,000 last year on only 2,500 acres--is a calamity. What is especially ironic is it is in the midst of a great economic boom across the country. We have probably never had better economic times in the larger economy, yet when we look at agriculture, we see the worst of times. It is really a result of a triple whammy: bad prices, bad policy, and bad weather. To top it all off, in addition to the bad prices, these are the lowest prices in 52 years; on top of that, the bad policy-- trade policy and farm policy--that has left farmers without much help in a time of this financial collapse; on top of that, we have had bad weather. In my State, 5 years of overly wet conditions have led to the biggest outbreak of a disease called scab that has also dramatically reduced production. Talk about a bad set of facts, that is it: bad prices, bad weather, and bad policy. We have a chance to do something on the policy front. It won't solve the problem, but it will help. It is urgently needed. That is the disaster supplemental that is before the Senate. I ask my colleagues, can't we move on that disaster supplemental? Can't we move on that legislation now? Can't we pass it? If we wait, it will be too late. If we wait, it is simply going to be too late. Farmers need to be in the field now. This is the end of April. Time waits for no man. Time does not wait when you are planting a crop. I hope my colleagues will respond to this plea that we pass the urgent supplemental directly. I hope we do it this week and get that money out there where it can do some good and help these farmers through what is the worst crisis they have faced since the 1930s. The time to act is now. I urge my colleagues to participate in that effort. We passed it here the end of March, and now here we are at the end of April. There is something dysfunctional when we have disaster emergency legislation before us and we passed it in this Chamber a month ago and it still is not out there; it is still not implemented. Mr. President, I ask our colleagues to act on that disaster supplemental and to do it now. I thank the Chair. I yield the floor and suggest the absence of a quorum.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise today, joined by my colleagues Mr. Nickles, Mr. Mack, Mr. Robb, and Mr. Baucus, to introduce important legislation to provide for a 10-year depreciation life for leasehold improvements. Leasehold improvements are the alterations to leased space made by a building owner as part of the lease agreement with a tenant. These improvements can include interior walls, partitions, flooring, lighting, wiring and plumbing--essentially any fixture that an owner provides in space leased to a tenant. They keep a building modern, upgraded, and energy efficient. In actual commercial use, leasehold improvements typically last as long as the lease--an average of 5 to 10 years. However, the Internal Revenue Code requires leasehold improvements to be depreciated over 39 years--the life of the building. Economically, this makes no sense. The owner receives taxable income over the life of the lease (i.e., 10 years), yet can only recover the costs of the improvements associated with the lease over 39 years--a rate nearly four times slower. This wild mismatch of income and expenses causes the owner to incur an artificially high tax cost on these improvements. The bill we introduce today will correct this irrational and uneconomic tax treatment by shortening the cost recovery period for certain leasehold improvements from 39 years to a more realistic 10 years. If enacted, this legislation would more closely align the expenses incurred to construct these improvements with the income they generate during the lease term. For example, a building owner who makes a $100,000 leasehold improvement for a 10-year, $1 million lease would be able to recover this entire investment by the end of that lease at a rate of $10,000 per year. Under current law, this $100,000 improvement is recovered at a rate of $2,564 per year over 39 years. By reducing this cost recovery period, the expense of making these improvements would fall more into line with the economics of a commercial lease transaction, and more property owners would be able to adapt their buildings to fit the demanding needs of today's modern business tenant. Small business should find this bill particularly helpful, because small businesses turn over their rental space more frequently than larger businesses. And we cannot forget that over 80 percent of building owners who provide space to small businesses are themselves small businesses. We have an interest in keeping existing buildings commercially viable. When older buildings can serve tenants who need modern, efficient commercial space, there is less pressure for developing greenfields in outlying areas. Americans are concerned about preserving open space, natural resources and a sense of neighborhood. The current law 39-year cost recovery for leasehold improvements is an impediment to reinvesting in existing properties and communities. This legislation has the strong backing of six major real estate organizations, including the National Realty Committee, the national Association of Realtors, the International Council of Shopping Centers, the national Association of Industrial and Office Properties, the national Association of Real Estate Investment Trusts, and the Building and Office Managers Association, International. I urge all Senators to join us in supporting this legislation to provide rational depreciation treatment for leasehold improvements. 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 today, joined by my colleagues Mr. Nickles, Mr. Mack, Mr. Robb, and Mr. Baucus, to introduce important legislation to provide for a 10-year depreciation life for leasehold improvements. Leasehold improvements are the alterations to leased space made by a building owner as part of the lease agreement with a tenant. These improvements can include interior walls, partitions, flooring, lighting, wiring and plumbing--essentially any fixture that an owner provides in space leased to a tenant. They keep a building modern, upgraded, and energy efficient. In actual commercial use, leasehold improvements typically last as long as the lease--an average of 5 to 10 years. However, the Internal Revenue Code requires leasehold improvements to be depreciated over 39 years--the life of the building. Economically, this makes no sense. The owner receives taxable income over the life of the lease (i.e., 10 years), yet can only recover the costs of the improvements associated with the lease over 39 years--a rate nearly four times slower. This wild mismatch of income and expenses causes the owner to incur an artificially high tax cost on these improvements. The bill we introduce today will correct this irrational and uneconomic tax treatment by shortening the cost recovery period for certain leasehold improvements from 39 years to a more realistic 10 years. If enacted, this legislation would more closely align the expenses incurred to construct these improvements with the income they generate during the lease term. For example, a building owner who makes a $100,000 leasehold improvement for a 10-year, $1 million lease would be able to recover this entire investment by the end of that lease at a rate of $10,000 per year. Under current law, this $100,000 improvement is recovered at a rate of $2,564 per year over 39 years. By reducing this cost recovery period, the expense of making these improvements would fall more into line with the economics of a commercial lease transaction, and more property owners would be able to adapt their buildings to fit the demanding needs of today's modern business tenant. Small business should find this bill particularly helpful, because small businesses turn over their rental space more frequently than larger businesses. And we cannot forget that over 80 percent of building owners who provide space to small businesses are themselves small businesses. We have an interest in keeping existing buildings commercially viable. When older buildings can serve tenants who need modern, efficient commercial space, there is less pressure for developing greenfields in outlying areas. Americans are concerned about preserving open space, natural resources and a sense of neighborhood. The current law 39-year cost recovery for leasehold improvements is an impediment to reinvesting in existing properties and communities. This legislation has the strong backing of six major real estate organizations, including the National Realty Committee, the national Association of Realtors, the International Council of Shopping Centers, the national Association of Industrial and Office Properties, the national Association of Real Estate Investment Trusts, and the Building and Office Managers Association, International. I urge all Senators to join us in supporting this legislation to provide rational depreciation treatment for leasehold improvements. 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 today to introduce legislation which would help clarify an issue that relates to Medicare coverage for anesthesia services and its impact on rural health care. As a senator representing a predominantly rural state, I know only too well the difficulties facing rural health care needs. Access to care in rural areas is slowly worsening as more and more rural hospitals close their doors in the face of overwhelming cost pressures. Clearly, one aspect of access to care is access to surgical procedures. And without anesthesia services, general surgery becomes impossible. Certified registered nurse anesthetists (CRNAs) tend to be the predominant anesthesia provider in rural and undeserved urban areas. In fact, CRNAs are the sole anesthesia provider in 65% of rural hospitals and in addition, provide at least 65% of the nation's anesthesia needs. The simple fact is that anesthesiologists have not been moving into rural areas in any significant numbers, and are not expected to do so in the foreseeable future. Given this trend, if rural hospitals are going to stay open, they desperately need CRNAs for their anesthesia and ultimately their surgical needs. That means we have to maintain a healthy supply of CRNAs to maintain access to care for rural Medicare beneficiaries. Unfortunately, current Medicare rules with respect to supervision provide a disincentive for hospitals to use nurse anesthetists. Medicare's regulations require physician supervision of CRNAs as a condition for hospitals or ambulatory surgical centers to receive Medicare reimbursement, despite many state laws that allow nurse anesthetists to practice without such supervision. Although HCFA has issued a proposed rule that would drop this requirement and defer to states on the issue of supervision, this rule has never been finalized. The federal supervision requirement creates several problems for CRNAs. First, some surgeons and hospitals have been dissuaded from working with CRNAs, in the face of arguments that the physicians may be subjecting themselves to liability for engaging in supervision. But the truth is, the attending physician--or the hospital--is no more legally liable for the CRNAs actions than he or she is for the acts of an anesthesiologist. Second, the federal restriction is anti-competitive, acting as a disincentive for CRNAs to be used. Finally, the restriction creates an inaccurate perception among some surgeons that they have an obligation to direct or control the substantive course of the anesthetic process, even though there is no such obligation. The legislation I am introducing today would eliminate the Federal supervision requirement and instead direct Medicare to defer to state law requirements on supervision. By eliminating this prescriptive federal regulation, we can better maximize the use of nurse anesthetists and eliminate the confusion surrounding CRNA supervision. At a time when the Congress is seeking ways to reduce costs for the Medicare program without sacrificing quality or access to care, increasing the use of nurse anesthetists seems particularly appropriate. In terms of quality of care, there are no significant differences between anesthesia provided by CRNAs or that provided by anesthesiologists. Notwithstanding the claims of anesthesiologists, it is clear from a careful reading of the studies that there are no quantifiable differences in outcomes when CRNAs work with anesthesiologists, or when anesthesiologists provide anesthesia alone. CRNAs have been providing anesthesia services for more than a century. They have been the principal anesthesia providers in combat areas in every war the United States has been engaged in since World War I. CRNAs have received medals and accolades for their dedication, commitment and competence. And CRNAs perform the same anesthesia delivery function as anesthesiologists and work in every setting in which anesthesia is delivered: traditional hospital suites, obstetrical delivery rooms, dentist's offices, HMO's ambulatory surgical centers, Veterans Administration facilities and others. Mr. President, the Federal Government is deferring to state judgment on a whole host of issues, so it seems completely consistent to let states decide how best to use nurse anesthetists, particularly in light of CRNA's long track record of success. States, which have the primary responsibility for regulating nurse practice, have generally not seen any need for a physician supervision requirement in non-Medicare settings. Twenty-nine states do not require supervision of CRNAs in nurse practice acts or board of nursing rules. This clearly indicates that many states, as a matter of public policy, do not believe it is necessary to require physician supervision of CRNAs. It is easy to understand why. Anesthesia is provided only when necessary to permit some medical procedure or intervention. Thus, as a practical matter even when supervision is not required as a matter of law, a surgeon, podiatrist, or dentist will be in the room when anesthesia is provided, and would be capable of handling any emergency that might arise. Finally, I would note that when CRNAs were given direct Medicare reimbursement in 1986, there was no statutory requirement that CRNAs be supervised by physicians in order to receive reimbursement. This was not a requirement imposed by Congress then, nor has there been one since. Had Congress believed that such a requirement was appropriate, it would have been imposed as a condition of reimbursement at that time. Moreover, HCFA routinely defers to the states on scope of practice issues as its relates to other health care professionals. This proposed change is supported by the American Hospital Association and the National Rural Health Association. I urge my colleagues to support this legislation and let the states make their own decisions about how to regulate a health care professional's scope of practice. Rural and undeserved urban areas need CRNAs and it's time the federal government removed impediments in regulations so that consumers' access to anesthesia care, particularly in rural areas, will not be jeopardized.

Mr. CONRAD

Mr. CONRAD. I have ended my presentation. I will be happy to respond to a question.

Mr. CONRAD. Mr. President, today the Senate is debating the so-called Social Security lockbox. This is legislation that was intended to protect the Social Security surpluses. Unfortunately, it failed. Throughout my tenure in the Senate, as a member of the Senate Budget Committee and the Senate Finance Committee, I have done my level best to support balancing the budget without counting Social Security surpluses and to protect those surpluses. That is why I was looking forward to this debate. I was hoping we were going to have a chance to really engage in a discussion about how to protect Social Security--to go through the normal legislative process, to offer amendments, to have votes and to let Senators decide the outcome. Unfortunately, the advocates of this particular approach apparently are so insecure about their approach that they won't permit any amendments. They don't want a debate. They do not want votes to decide the outcome. That is unfortunate. But I think it speaks volumes about the weakness of their position. It seems incredibly ironic to this Senator that a bill whose sponsors say is designed to protect Social Security actually puts Social Security benefit payments at risk. Let me repeat that. This bill which is advertised to protect Social Security actually puts Social Security benefit payments at risk. That is not just the view of this Senator. That is the view of the Secretary of the Treasury, who has the responsibility for making Social Security payments. The Secretary of the Treasury, Mr. Rubin, in a letter dated yesterday, wrote in part: Our analysis indicates that this provision could preclude the United States from meeting its financial obligations to repay maturing debt and to make benefit payments--including Social Security checks--and could also worsen a future economic downturn. The Secretary of the Treasury says this bill is the wrong way to protect Social Security. Interestingly enough, it is not just the Secretary of the Treasury who says that and has reached that conclusion. We also have a letter from the Chairman of the Ways and Means Committee in the House of Representatives, Chairman Archer. Chairman Archer in a letter to the Chairman of the Budget Committee in the House of Representatives, dated April 9, says: One has only to read the arguments presented in the March 17, 1999, letter from Secretary Rubin to appreciate the dire consequences always presented during a debt limit crisis-- disruption of Treasury bond management and worldwide financial markets, doubts about making government payments including Social Security benefits, and raising borrowing costs to the taxpayers--and why Congress always votes to raise the limit. Chairman Archer, the Republican Chairman of the Ways and Means Committee in the House of Representatives that has jurisdiction over this issue, says in conclusion in his letter: I see no need to enact limits, even if merely advisory, that do not directly protect the Social Security surplus and re-ignite the debt limit controversy that proved so bitter and futile for everyone four years ago. That is the Chairman of the Ways and Means Committee in the House of Representatives warning that this legislation is not the way to protect Social Security. Instead, he says: In my view, strict budget enforcement measures are the most effective way to control spending. To reduce debt, the President and the Congress, like every American household, must commit themselves to spending constraint. The Chairman of the Ways and Means Committee is exactly right. The Secretary of the Treasury is exactly right. We are pursuing an illusion here. It is an attractive illusion. It is an illusion that suggests if we just will adopt it, that it is going to save Social Security. Unfortunately, it will not. I would really like to know what the sponsors of this legislation are so afraid of. Why have they, through a contorted plan, blocked anybody from offering an amendment? Why do they want to prevent Senators from voting on alternatives? Why? Because they are afraid of the results. They are afraid they would lose in the cold, hard light of day. They fear that if we have a real debate out here about options and alternatives that their alternative wouldn't hold up. What is there to fear by having votes right here on the floor of the Senate, and deciding this issue the way we decide all others? Why have they gone through their contorted legislative process, this legislative scheme, to prevent people from voting their conscience? I think it is because they know they have a plan that does not hold up. I think you really have to wonder. Are they really interested in protecting Social Security, including its trust funds and benefit payments? Or do they just want a quick vote on a bill whose provisions can't withstand scrutiny? Mr. President, I think we should subject this legislation to scrutiny just as we do other legislation. If we do, we will see that instead of protecting Social Security, this legislation endangers Social Security, while risking more Government shutdowns and default on our obligations. Mr. President, the lockbox that has been offered here today creates limits on publicly-held debt that are supposedly enforceable with 60- vote points of order. I strongly support the goal of paying down publicly-held debt. But creating supermajority points of order against raising the debt limit won't accomplish that goal. The ability of the Federal Government to pay down publicly-held debt is created through tough fiscal decisions, decisions to control spending, decisions not to squander the surpluses that are projected to occur over the next 10 years. If Congress fails to make those tough decisions and spends the surpluses, debt will rise. Creating a debt crisis at that point in time is too late. At that point, the Federal Government has obligations it simply must meet. Interestingly enough, Chairman Archer agrees with me on this point as well. He says: . . . debt limits have a long history of failure in preventing spending and deficits. Hitting a debt limit, like a credit card limit, merely represents the consequences of government spending already approved by the President and Congress. So these new limits on debt could preclude the United States from meeting its future financial obligations to repay debt and to honor its commitments. They would produce permanent damage to our credit standing. The debt obligations of the United States are currently recognized as the most creditworthy of any investment in the world. It is in our interest to maintain that standard. Even the appearance of risk would impose significant additional costs on American taxpayers. I think we all remember November of 1995. A debt crisis was precipitated when Government borrowing reached the debt limit; two months later, in January, Moody's, the credit-rating firm, placed Treasury securities on review for possible downgrade. It is absurd to put us back in that position--endangering the credit rating of the United States to supposedly protect us against rising debt, when this legislation doesn't do that. In addition to the damage that can be done to the U.S. credit rating, this lockbox also puts Social Security benefit payments at risk, as I have indicated before. Again, that is not just my opinion, it is the opinion of the Secretary of the Treasury who has the responsibility to make those payments. It is the opinion of the Chairman of the Ways and Means Committee in the House of Representatives who has jurisdiction over these issues. The point is simple: during a debt crisis, the Treasury Department has no ability to prioritize the payment of Government benefits that are coming due. If Congress cannot raise the debt limit, Social Security benefits cannot be made. The sponsors of this lockbox claim they have addressed this problem in their legislation. They say they have directed Treasury to give priority to Social Security payments. Unfortunately, the Treasury Department has no ability to do that now. If the Treasury Department runs out of borrowing authority and has no cash coming in, prioritization of payments won't help anyway. The Treasury would have no ability to pay Social Security benefits that are due. Using the debt limit as a fiscal policy tool is bad policy. It directly places at risk the benefit payments to Social Security recipients. These are not the only shortcomings of this legislation. Another of the serious problems with the legislation before the Senate is that it risks creating longer and deeper recessions than our economy might otherwise experience. I am concerned about the economic and fiscal impact these debt limit targets could have on the economy during a time of recession. I believe these limits would require the Federal Government to take the wrong actions during recessionary periods, making recessions more severe and negating the stabilizing counter-cyclical tools the Federal Government can use during times of recession. Sometimes I wonder if we learn from the past. Sometimes I wonder if we are not condemned to repeat the unfortunate experiences of the past because we don't learn those lessons. We suffered depression after depression in this country before we finally figured out how to counter the cycle of recession and depression. What this legislation could do is take away those tools at the very time they are most needed. This lockbox legislation requires the Federal Government to hit a debt limit target on May 1 of each year. Throughout the year, the debt target could not be exceeded. During years when we are heading towards the trough of the business cycle, revenues grow more slowly because more people are unemployed and expenditures for programs like unemployment insurance and food stamps rise. When those two things happen, the deficit gets larger and the Treasury has to issue more debt. Under this proposal, the Treasury couldn't issue more debt. At that point, the lockbox would become a noose on this economy, making the recession worse, requiring the Congress to either raise taxes or cut spending at precisely the wrong time. That is economic folly. It is at that very time that the counter- cyclical tools ought to be used to lessen the recession, to prevent depression. That is what our economic history teaches. We should not forget the lessons so bitterly learned. Our friends advocating this legislation say they have included an exception for recession in their lockbox. The problem is, it won't work. The exception allows the debt limit targets in the lockbox to turn off if the U.S. economy experiences two quarters of real GDP growth that is less than 1 percent. This chart shows a few examples of recessions over the last 20 years to see what would have happened had this legislation been in place. For example, the recession of 1981-1982 lasted from July of 1981 to November of 1982. The chart shows what was happening with economic growth during that period. The recession began back in July of 1981. But the trigger under this lockbox legislation would come nine months after the recession had already begun. It chokes off the counter- cyclical tools needed for the first nine months, guaranteeing a deeper recession and perhaps even plunging this economy into depression. This is truly dangerous legislation. It should not be passed. We have the Secretary of the Treasury warning, ``Do not pass this legislation;'' we have the Republican chairman of the House Ways and Means Committee warning, ``Do not pass this legislation.'' What is wrong with those who continue to advocate, in the face of those warnings, legislation that will not protect Social Security, that will endanger it, that further endangers plunging this economy into a worse recession or perhaps even a depression in a time of economic downturn-- especially when we have alternatives that we know will work. Those alternatives can't be considered because the advocates of this legislation have engaged in a legislative scheme to prevent amendments, to prevent the consideration of alternatives. What a way to legislate. If we look at another example, the recession of 1973-1975, we see the quarterly economic growth fluctuated greatly. That recession lasted from November of 1973 to March of 1975. The lockbox provided for in this legislation would not have kicked in until January of 1975, when the recession had been going on for more than a year. We can see on the chart why that is the case. The recession started back in 1973. We can see economic growth fluctuated back and forth--growing, falling; growing, falling. It would have only been late in the recession that this lockbox legislation would have allowed the counter- cyclical policies of the Government to come into play. This legislation simply does not work. This data shows that a recession in the U.S. economy will very likely precipitate a debt crisis, despite the exemption provided in the lockbox. These are not the only defects of this legislation. There is another major problem with the lockbox that is before us, because there is something not included in the lockbox. Medicare is not included in this lockbox. Not one penny of non-Social Security surpluses is included in this lockbox, not one penny. Medicare is under more severe fiscal pressure than Social Security, but Medicare has been left out. Why? Because our friends who are the advocates of this proposal prefer to use the surplus for a tax break scheme. They prefer a tax break scheme, so they do not guarantee one penny of the non-Social Security surplus for Medicare. We have an important decision to make. Do we use the non-Social Security surplus in a tax cut scheme that will provide the greatest relief for the wealthiest among us? Or do we save the Social Security surpluses for Social Security, extend the solvency of Medicare, and still provide room for targeted tax relief and high-priority domestic needs like education, agriculture, health care, and defense? To me, the choice is absolutely clear; we must honor our commitments to the seniors of America. That does not mean we do not need to reform Medicare; obviously we do. I think everybody understands we need to take action to put Medicare on a more sound financial footing, and I have voted consistently in the Finance Committee to do that. But we must also ensure that whatever we do to put Medicare on a more sound financial footing also preserves affordable access to high-quality health care for our senior citizens. Responsible Medicare reform will be much more difficult if we do not provide additional resources to Medicare during this time of severe pressure, because of the demographic changes in this country. The very real pain the balanced budget act of 1997 is already causing suggests to me that making additional cuts of hundreds of billions of dollars over the next 10 years in Medicare, without providing additional resources, would be irresponsible. That is why the lockbox I have supported protects Social Security and Medicare. Senator Lautenberg and I have an alternative lockbox that really does protect Social Security, that does protect Medicare, that does pay down the Federal debt even more aggressively than what our friends on the other side of the aisle are proposing, that does provide room for targeted tax relief and for high-priority domestic needs like education, agriculture, health care, and defense. Our Social Security and Medicare lockbox creates supermajority points of order against any legislation that does not save the entire Social Security surplus in each year and does not save at least 40 percent of the non-Social Security surplus for Medicare. Our lockbox is enforced with points of order and sequestration. It is not enforced through the debt limit. It follows the advice of the Secretary of the Treasury, Mr. Rubin. It follows the advice of the Chairman of the Ways and Means Committee in the House of Representatives. Our amendment provides a remedy if Social Security surpluses are spent--across-the-board cuts in other programs. That is a real defense of Social Security. That is something we know works. Our amendment also adds a new supermajority point of order against a budget resolution that violates the off-budget treatment of Social Security. Our amendment reserves $65 billion for Medicare over the next 5 years, and $376 billion over the next 10 years. After passage of comprehensive Social Security and Medicare reform, our alternative provides $385 billion over the next 10 years for targeted tax relief and for high- priority needs like education, agriculture, health care, and defense. And our amendment reduces publicly-held debt by $300 billion more than the Republican lockbox. It protects Social Security, the surpluses and the benefit payments, and it provides additional resources for Medicare. That is the type of lockbox the Senate should approve. I hope we have an opportunity to consider this alternative. But under the current legislative structure we will not, because the advocates of the legislation before us do not want an alternative considered. They do not want any amendments. They do not want any alternatives. They do not want to give Senators a chance to choose. They want it their way or no way.

Mr. CONRAD. I yield.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise today to introduce legislation which would help clarify an issue that relates to Medicare coverage for anesthesia services and its impact on rural health care. As a senator representing a predominantly rural state, I know only too well the difficulties facing rural health care needs. Access to care in rural areas is slowly worsening as more and more rural hospitals close their doors in the face of overwhelming cost pressures. Clearly, one aspect of access to care is access to surgical procedures. And without anesthesia services, general surgery becomes impossible. Certified registered nurse anesthetists (CRNAs) tend to be the predominant anesthesia provider in rural and undeserved urban areas. In fact, CRNAs are the sole anesthesia provider in 65% of rural hospitals and in addition, provide at least 65% of the nation's anesthesia needs. The simple fact is that anesthesiologists have not been moving into rural areas in any significant numbers, and are not expected to do so in the foreseeable future. Given this trend, if rural hospitals are going to stay open, they desperately need CRNAs for their anesthesia and ultimately their surgical needs. That means we have to maintain a healthy supply of CRNAs to maintain access to care for rural Medicare beneficiaries. Unfortunately, current Medicare rules with respect to supervision provide a disincentive for hospitals to use nurse anesthetists. Medicare's regulations require physician supervision of CRNAs as a condition for hospitals or ambulatory surgical centers to receive Medicare reimbursement, despite many state laws that allow nurse anesthetists to practice without such supervision. Although HCFA has issued a proposed rule that would drop this requirement and defer to states on the issue of supervision, this rule has never been finalized. The federal supervision requirement creates several problems for CRNAs. First, some surgeons and hospitals have been dissuaded from working with CRNAs, in the face of arguments that the physicians may be subjecting themselves to liability for engaging in supervision. But the truth is, the attending physician--or the hospital--is no more legally liable for the CRNAs actions than he or she is for the acts of an anesthesiologist. Second, the federal restriction is anti-competitive, acting as a disincentive for CRNAs to be used. Finally, the restriction creates an inaccurate perception among some surgeons that they have an obligation to direct or control the substantive course of the anesthetic process, even though there is no such obligation. The legislation I am introducing today would eliminate the Federal supervision requirement and instead direct Medicare to defer to state law requirements on supervision. By eliminating this prescriptive federal regulation, we can better maximize the use of nurse anesthetists and eliminate the confusion surrounding CRNA supervision. At a time when the Congress is seeking ways to reduce costs for the Medicare program without sacrificing quality or access to care, increasing the use of nurse anesthetists seems particularly appropriate. In terms of quality of care, there are no significant differences between anesthesia provided by CRNAs or that provided by anesthesiologists. Notwithstanding the claims of anesthesiologists, it is clear from a careful reading of the studies that there are no quantifiable differences in outcomes when CRNAs work with anesthesiologists, or when anesthesiologists provide anesthesia alone. CRNAs have been providing anesthesia services for more than a century. They have been the principal anesthesia providers in combat areas in every war the United States has been engaged in since World War I. CRNAs have received medals and accolades for their dedication, commitment and competence. And CRNAs perform the same anesthesia delivery function as anesthesiologists and work in every setting in which anesthesia is delivered: traditional hospital suites, obstetrical delivery rooms, dentist's offices, HMO's ambulatory surgical centers, Veterans Administration facilities and others. Mr. President, the Federal Government is deferring to state judgment on a whole host of issues, so it seems completely consistent to let states decide how best to use nurse anesthetists, particularly in light of CRNA's long track record of success. States, which have the primary responsibility for regulating nurse practice, have generally not seen any need for a physician supervision requirement in non-Medicare settings. Twenty-nine states do not require supervision of CRNAs in nurse practice acts or board of nursing rules. This clearly indicates that many states, as a matter of public policy, do not believe it is necessary to require physician supervision of CRNAs. It is easy to understand why. Anesthesia is provided only when necessary to permit some medical procedure or intervention. Thus, as a practical matter even when supervision is not required as a matter of law, a surgeon, podiatrist, or dentist will be in the room when anesthesia is provided, and would be capable of handling any emergency that might arise. Finally, I would note that when CRNAs were given direct Medicare reimbursement in 1986, there was no statutory requirement that CRNAs be supervised by physicians in order to receive reimbursement. This was not a requirement imposed by Congress then, nor has there been one since. Had Congress believed that such a requirement was appropriate, it would have been imposed as a condition of reimbursement at that time. Moreover, HCFA routinely defers to the states on scope of practice issues as its relates to other health care professionals. This proposed change is supported by the American Hospital Association and the National Rural Health Association. I urge my colleagues to support this legislation and let the states make their own decisions about how to regulate a health care professional's scope of practice. Rural and undeserved urban areas need CRNAs and it's time the federal government removed impediments in regulations so that consumers' access to anesthesia care, particularly in rural areas, will not be jeopardized.