Kent Conrad

Mr. CONRAD

Mr. CONRAD. Mr. President, some of the most pivotal events in U.S. history that have helped eliminate the barriers between white and black Americans have been simple acts that occurred in very common, everyday settings; on a bus, in a diner, and in a school. Today marks the 50th anniversary of one of those events, and it also occurred in a common and unlikely setting--at a baseball game. On April 15, 1947, the Brooklyn Dodgers debuted their new infielder, Jackie Robinson, in a game against the Boston Braves. And by his very presence on that field, American society was changed forever. Until that day, professional baseball had been segregated for over 50 years, and no African-American in the 20th century had worn a major league uniform. Segregation had denied many fine black players from competing side by side with their white counterparts. It was the dream of many Negro League stars like Satchel Paige, Josh Gibson, and Cool Papa Bell to take the field in a major league park and have the chance to claim their rightful place in the record books alongside Babe Ruth and Ty Cobb. They knew they were good enough, and so did many white baseball executives who saw them play. But until Jackie Robinson, black Americans were kept out of the majors and many of these great players never got the chance to play there. In 1947, Dodgers' manager Branch Rickey ignored the color line and gave Jackie Robinson a chance to play. Not because he was black, not because he could be a symbol for a change in American society, but because he was a dazzling player who could help the Dodgers win. And he did. In that very first year, Robinson became the National League's Rookie of the Year. In 1949, he would be named the Most Valuable Player. In 10 years, he helped Brooklyn capture six National League championships and one World Series title. He retired with a lifetime batting average of .311 and was named to the Hall of Fame in his first year of eligibility. After his rookie season, he was listed second only to Bing Crosby as the most popular man in America. That is a very interesting fact, for even though he clearly captured the hearts and minds of many Americans, and no doubt changed the thinking of many others, there were also those who hated him and let him know it with vicious insults, jeers, and threats of physical violence. On the field opposing ballplayers tried to spike him on the base paths, and pitchers regularly threw fast balls near his head. Even some of his own teammates asked to be traded when they learned he was being called up from the minors. Off the field he sometimes could not join the rest of the Dodgers in the same hotels or restaurants. Jackie Robinson had to endure it all, because he knew if he fought back, if his confidence and calm were rattled, and if he did not perform to the highest athletic level, it could be years before another minority player would be given the same chance. But he used his courage and ability to succeed on every level, proving himself to be much, much more than just a talented baseball player. How far we have come in terms of racial equality in the half-century since Jackie Robinson's debut is debatable. Black athletes are now commonplace in professional sports, and some, such as basketball star Michael Jordan, are among the most successful and instantly recognizable figures in the world. Over the weekend, an amazingly- gifted and congenial young man named Tiger Woods became both the first African-American and first Asian-American to win the Masters golf tournament, breaking down another long-held color barrier. But outside of sports, there are still subtle but daunting barriers that prevent African-Americans, as well as other minorities, from achieving equal status in many facets of our culture. Shortly before his death in 1972, Robinson himself was quoted as saying, I can't believe that I have it made while so many of my black brothers and sisters are hungry, inadequately housed, insufficiently clothed, denied their dignity, live in slums or barely exist on welfare. If he were still alive today, it is likely his opinion would be unchanged. But America is a work in progress and there may always be barriers, large and small, which create inequity in our society. Jackie Robinson was one of the best athletes in the world, and the barrier he broke was one that prevented him and other black athletes from using their talents for their fullest gain. Jackie Robinson faced that barrier with courage, faith, and dignity. He broke it for himself, but even more significantly for all those who have followed. That is why he is a hero and why we celebrate his memory today. Perhaps the lesson we can learn from Jackie Robinson's example is that we must face those areas of discrimination we encounter in our lives, no matter what our racial heritage, with the same courage, faith, and dignity. We may never fully end discrimination but we can continue working together to eliminate the barriers that remain.

Mr. CONRAD

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

Mr. CONRAD

Mr. CONRAD. Mr. President, just for the information of my colleague, Senator Breaux is here. I have 20 minutes allocated. I will not take 20 minutes. I hope to be closer to 10 minutes. So the Senator from Louisiana will have an opportunity as well. Mr. President, I have just returned from another trip to my home State of North Dakota to see firsthand the developing slow-motion disaster that is occurring there. I call it a slow-motion disaster, Mr. President, because it is not one of those things that happens and then is over with. We have a slow-motion disaster. We have had the worst winter on record in North Dakota. Then we were hit at the end by the most powerful winter storm in 50 years, on top of the greatest flood threat in 150 years. Mr. President, you can imagine, people of my State are beginning to wonder what happened, what could have led to a series of events as extreme as these. I don't think anyone has the answer at this point. We are truly coping with an unprecedented series of disasters. We have just had a visit from the Vice President of the United States, Vice President Gore, the Secretary of Transportation, Rodney Slater, and the head of FEMA, James Lee Witt, all in the State of North Dakota last Thursday and Friday. We deeply appreciated the Federal response. We got a Presidentially declared major disaster and we got it in very short order. We have also received unprecedented assistance from the Corps of Engineers, in terms of advanced measures, to hold down the catastrophe that could have occurred without the really heroic efforts by the Corps of Engineers, by FEMA, and by local agencies, local leadership and, of course, the extraordinary efforts of volunteers. We had people go 300 miles, from western North Dakota to eastern North Dakota, to help sandbag because they knew we were faced with an imminent disaster in eastern North Dakota. My own cousin, a professor at the University of Wisconsin, heard that Fargo, ND, was about to flood and they needed sandbaggers. He drove all night from Madison and arrived at 3 in the morning and sandbagged from the time he got there all day and into the next evening. That is the kind of attitude North Dakota has brought to this disaster. I tell you, out of all this, the thing I am most proud of is the response of the people of our State, which has truly been extraordinary. Not only have all of the Federal agencies and State agencies pulled together, along with the volunteers, literally thousands of them across the State that helped out, but we also want to thank the Red Cross for their outstanding assistance across North Dakota. We should also thank all of the other agencies. The mental health hotline tells me they are taking a dramatically increased level of calls. I have been asked, ``What did you see out there, Senator Conrad?'' This picture shows the power lines that are down. You can see that power pole after power pole snapped. They went down like tinker toys. We had this massive ice storm, after we already had 100 inches of snow in North Dakota, the heaviest snowfall we have ever experienced. Then we get this storm that dumped another 2 feet in parts of North Dakota. It was combined with ice. Ice formed on the lines, and there were 70- mile-an-hour winds that came through. Those winds just took down these structures all across North Dakota. Over 4,000 power poles were taken down. Mr. President, it didn't end there. This is a picture of one of the most stunning events that occurred during this disaster. This is one of the largest structures in North America. This is a 2,000-foot television tower for KXJB television; it all went down, all 2,000 feet. You can see that this structure is laid out just as if somebody came and knocked it over and laid it out perfectly across the snow. That, of course, took a lot of television stations and radio stations off the air in the midst of this crisis. So not only did you have horrible weather, you also had a communications problem. Mr. President, this picture shows a farmer on his tractor. As you can see, these are his silos in the back. His tractor is up to its wheel rims in water. He is just getting across the farm trying to move into a position to rescue grain that would otherwise be destroyed by the rising flood waters. Mr. President, we have another chart that tells the extent of this disaster. We had 80,000 homes without power. From a week ago Saturday, on into the week, many homes were not restored until last Friday. This is in the midst of zero temperatures with 40-degree-below-zero wind chill factors, people without heat--80,000 people without power. There were over 600 people at emergency shelters, and that is as of Friday. Many more than that were in shelters during the peak. And 4,000 power poles were destroyed. Over 9\1/2\ feet of snow fell since November. That really is an extraordinary set of circumstances, with not only the most snowfall we have ever experienced, but they had the most powerful winter storm in 50 years on top of the greatest flood threat in 150 years. The Red River to the north--I hear some of the national news media talking about it as though it flows south. Of course, anyone that knows geography knows the Red River flows north. The Red River has exceeded the highest flood levels ever in four different locations. In the northern part of the State, it is still rising. We have had the crest in the southern part of the State, although we expect the second crest to come later when this snow that has just fallen melts. Nonetheless, the peak crest has now hit the southern part of the State and is moving north. In the north, the river is still rising. The livestock losses were running 60 percent above normal before this latest storm hit. Because of the very severe weather conditions we have had, we have had tens of thousands of cattle killed across the State of North Dakota. In fact, this shows losses of more than 70,000. As of this morning, I have been notified that cattle losses, they now believe, are running well over 100,000 in the State of North Dakota. The occupant of the chair, who is from the neighboring State of Wyoming, understands what cattle losses mean in a State like ours. I think even the occupant of the chair would find it hard to fully appreciate the loss of 100,000 head. That is a tremendous economic blow to the State of North Dakota. As the occupant of the Chair knows well, we have been hurt by very low cattle prices as it is, and that industry is certainly struggling. To have piled on top a 100,000 loss of cattle across the State--in fact, they tell us 112,000 head is perhaps the best estimate. But that is an enormous economic blow to the State of North Dakota. Mr. President, I have come here this morning in order to share these circumstances with my colleagues so that they can appreciate and understand what is happening across the State. I can tell you that resilient North Dakotans continue to battle their disaster. In many places it is an uphill battle. But North Dakota has a can do attitude, and--as I saw in town after town as I traveled across the State on Thursday and Friday, the people are recovering. They understand what is at stake. Mr. President, we very much appreciate the Federal assistance that the President has called for with his disaster declaration. Again, we want to thank the North Dakota National Guard, the Federal Emergency Management Agency, and the U.S. Army Corps of Engineers. Let me just say that the Corps of Engineers is being praised from one end of the State to the other by local officials who are saying this was the best prepared they have ever been for flooding disaster. That is a good thing because this is the worst flooding that we have seen in the history of North Dakota. I also again would like to thank the Red Cross, the Salvation Army, the church organizations, and volunteer organizations that have pitched in. The response, as one of the disaster coordinators told me, has just been superb. It has been everything you could possibly ask for. So we extend our appreciation to all of those who pitched in. I also want to conclude by saying that I very much appreciate what my colleagues have told me--that they will stand up and be supportive during this time of need. We certainly have attempted to do that when they were in a disaster situation. And I very much appreciate the words of support that we have received from literally dozens of our colleagues. With that, Mr. President, I yield the floor. Mr. BREAUX addressed the Chair.

Mr. CONRAD

Mr. CONRAD. Mr. President, a family in northeastern North Dakota--two parents and their 7-year-old--has been without power since Saturday with snowdrifts trapping them in their home. They had to sleep huddled in the hallway to keep warm. Seventy-five people have been stuck in the basement of the Hebron city hall because their cars were pulled off of the major highway going by as that road became impassable. Those 75 people have been stuck there since Saturday. Officials in Cass County, the most populous county of our State, are having difficulty responding to emergency calls because the water surrounding many homes is frozen. So they can't get there by wheel vehicles and they can't get there by boat. There is no way to get to people in order to extricate them. Mr. President, there has been a tremendous response, not only by volunteers in our State but also by the agencies attempting to cope with this disaster. I want today to thank the President for responding so quickly in declaring our State a Presidentially declared disaster. This is our second Presidentially declared disaster of this year. We are only in the fourth month of this year. We already had a Presidentially declared disaster because of the record amounts of snowfall. Now on top of that we are anticipating a record flood. These are truly difficult times for our State. Many homes are still without power. We need generators and fuel to heat homes, make certain that essential services are up and operating. My State needs special heavy equipment to clear snow and ice from roads to allow for emergency access. This is a snowfall that is unlike any we have seen because it happened with a freezing rain and then snowfall, and so the snowpack that is there is like concrete. That is what the people who are out there trying to fight this mess are telling us. They have never seen a snowpack like this. We had rain on top of snow, it froze, and it is like concrete trying to break through these incredible snowdrifts. I also want to recognize FEMA and the capable administrator there, James Lee Witt, who is coming to my State tomorrow. FEMA has responded marvelously to the needs in North Dakota. I also wish to thank the Corps of Engineers that is involved in a really heroic effort. Some of these people have been working around the clock with no sleep for days attempting to build these dikes higher as the flood crest forecasts keep increasing. I just want to say on behalf of the people of my State how much we appreciate the extraordinary response of the Corps of Engineers and of the Federal Emergency Management Agency. I would also like to thank the president of Manitoba Hydro, Bob Brennan. We were alerted by the Governor; they were having trouble getting people across our border. We got the Immigration and Naturalization Service to provide an immediate 2-week waiver on all of their requirements at the border. We talked to Manitoba Hydro and they committed to sending 100 people to our State to help rebuild the transmission facilities. Now, that is real neighborliness, and we appreciate very much that our neighbor to the north has responded in this most generous way of sending 100 people to help us rebuild the transmission facilities in our State. I would also like to thank the Internal Revenue Service. This is something we rarely do. They have indicated that they would practice forbearance on our individual income tax payers in the State of North Dakota by allowing them to file by May 30 without late payment penalties. They will be asked to pay interest on the money during the period that they would have paid, but they are being given until May 30. If they file and if they pay by that date, they will not be hit by any late-payment penalties. I am told that they are applying this same standard to every State and every county that receives a Presidentially declared disaster in the face of what is happening in many parts of the country. We struggle to find good news in all of this, hopeful news. But I can tell you there is good news and there is hopeful news, and that is the spirit of the people. In North Dakota, we say we have a yes, we can attitude, and that is exactly what we have seen in coping with these disasters. As one emergency official said to me, Senator, I have seen blizzards; I have seen floods; I have seen power outages, but I have never seen all three together at the same time. That is what we are coping with in North Dakota. I must say that can- do spirit has served us well. Not only do North Dakotans show that spirit, but I must say these Federal agencies that have come to help are also showing that spirit, and we deeply appreciate it. I thank the Chair and yield back the remainder of my time. I yield the floor. I note the absence of a quorum.

Mr. CONRAD. Mr. President, I rise again today to report to my colleagues on the developing disaster in the State of North Dakota. As I reported to my colleagues yesterday, we were hit last weekend with the most powerful winter storm in over 50 years. We are a State that is accustomed to tough storms. But, frankly, we have never seen one quite like this. Mr. President, this storm came on top of the worst flooding threat in 150 years. So we have a double whammy of a powerful winter storm, dumping record amounts of snowfall, in addition to an underlying threat of massive flooding, because before this storm hit North Dakota, we were faced with a record snowfall in the State of North Dakota, over 100 inches of snow, before we got dumped on with another anywhere from 17 to 24 inches in the eastern part of our State. As the paper of my hometown reported, ``A Doozy of a Record''--record snowfall they are talking about. It is maybe hard to see on the chart here. But what they are showing is a major shopping center. These are cars, or I guess more accurately they are the tops of cars. That is how deep the snow was in my hometown. That is not the only place that has been hit. It is across the State of North Dakota. This is from the largest city in our State, Fargo, ND. The headline there is ``The Worst of Two Seasons.'' They are talking about the blizzard on top of the flood. Mr. President, this is a truly staggering set of circumstances that the people of my State are having to cope with. Just this morning I was called by the head of the Corps of Engineers for our district, who informed me that although all of the predictions were dire, they have now become even worse. As of this morning the National Weather Service is telling us that the forecasted crest, instead of being 37\1/2\ feet in the city of Fargo, our major town in North Dakota, it has now been raised to 39 to 39\1/2\. Already we are faced with the worst flood in 150 years. We were told this morning that this is the 500-year flood level. Of course, the dikes were built to accommodate the earlier projections at 37\1/2\ feet. So the dikes were built to 39\1/2\ feet. Now we are told the forecasted crest is 39 to 39\1/2\ feet. Mr. President, this could be a calamitous situation. They are telling us that the crest will be reached late tomorrow or perhaps early Friday. I have talked to the Corps of Engineers. They are working feverishly to add to the dikes that have already been constructed not only in Fargo but right up the Red River Valley--in Harwood and Grand Forks, ND--to try in a race against the clock to build these dikes high enough to protect the people and the property that is around this river. Mr. President, this is the most heavily populated part of my State. The disaster that is unfolding is truly staggering in proportion. Early Saturday 80,000 people were without power, with wind chills of 40 below zero. Can you imagine being an elderly person in a home being faced with the most powerful winter storm in 50 years without heat? That is what is happening in my State. Although great progress is being made because of a really heroic effort by people to respond, still today 20,000 people are without power and without heat, most of them since Saturday. Today temperatures outside are hovering near zero in North Dakota, and even more threatening, temperatures inside these homes that are without heat ranging between 30 and 40 degrees. Not only is the human condition being put under great stress but also livestock has been put under grave stress in our State. Thousands of cattle are dead. I was told yesterday of a ranching family that brought 10 of their calves into their home to try to give them protection, and allow them to live. All 10 of them died. The cattle were dying because the wind was so ferocious that it blew the snow up into their nostrils and they suffocated. They can't get to many cattle to feed them because of the snowdrifts that are everywhere. Mr. President, I thought I would share with my colleagues just some of the individual stories that tell the depths of this tragedy. A young man froze to death in his pickup when it became stranded only 1 mile from the small town of Lankin, ND. One family that is stranded in its farmhouse due to overland flooding is burning its fence posts to keep warm. The water around their house was iced over, so neither emergency vehicles nor boats were able to rescue them. Another family was forced to snag logs that drifted by in flood waters to heat their home. The Turtle Mountain band of Chippewas has snowdrifts of up to 15 feet. Can you imagine a snowdrift of 15 feet that is blocking transportation? In fact, emergency crews needed 4 hours to get to a man who had a heart attack. A man from Wilton, ND, went on the radio in search of hip-length waders so that he could wade out to rescue 120 sheep that are caught up in the flood waters. An elderly couple was trapped inside their home due to a 6-inch layer of ice that had formed over their doors and windows; trapped in their own home because ice had formed around the doors and windows and they could not get out. An emergency rescue team was sent in to rescue them.

Mr. CONRAD. I thank the Chair for informing me. If we could now go on with leader time, I would appreciate that.

Mr. CONRAD

Mr. CONRAD. I thank the Chair.

Mr. CONRAD. Mr. President, I would like to start by using my own 5 minutes and at the end of that time go into leader time. If the Presiding Officer will indicate to me when I have consumed the 5 minutes, I will be grateful for that.

Mr. CONRAD

Mr. CONRAD. Mr. President, my State has been hit by a massive disaster over this last weekend. North Dakota has been hit with the strongest storm in over 50 years. This is a storm of staggering proportions. Mr. President, North Dakota this last weekend got hit by a combination of an ice storm and blizzard that is unprecedented in the last 50 years. In North Dakota, we are used to harsh winters, but, frankly, we have never seen anything quite like this one. This most recent storm not only involved ice, it involved 70-mile-an-hour winds. That combination has knocked down power poles all across the eastern part of our State. As of yesterday, we had 80,000 people still without power in the State of North Dakota, many of them with no power since Saturday morning. The temperatures have been 40 degrees below zero wind chill since the heat went out. Mr. President, we have story after story of people who are huddled in homes around stoves trying to keep warm. My scheduling director, who is from the small town of Warsaw, ND, has talked to her mother, who is over 80 years old. She has had no heat since Saturday. Mr. President, this is a disaster of truly staggering proportions. In this storm, there were whiteout conditions for 10 hours straight--10 hours straight--where the snow was so heavy and the wind so strong, you literally could not see 5 inches in front of your vehicle. As I have indicated, all of this led to, first of all, a massive snowfall. In some parts of our State, it was as much as 24 inches. In much of the State, it was 17 and 18 inches. That is on top of record snowfall that we had already received. This is a headline from before this most recent disaster: ``106 Inches of Snow and Rising.'' This is the Fargo Forum newspaper, the biggest newspaper in the State of North Dakota, and this was before the most recent disaster. Now we can put another 17 inches on top of that in the Fargo area. This was a record at 106 inches. Mr. President, we have extreme hardship now across the State of North Dakota--no power, extremely cold temperatures, and facing us is the worst flooding in 150 years. The National Weather Service has now told us that we can anticipate the worst flooding in 150 years. That is on the heels of the most powerful winter storm in 50 years. It makes you wonder precisely what is happening with these weather patterns. We have had an entire community ask to be moved to an emergency shelter--1,500 people. In one of the small towns in North Dakota, they asked to have the whole town put in an emergency shelter because there is no heat and has not been any heat since Saturday. We had a local rancher call in to the radio station, and he said, ``My entire herd is out because the fences went down with this incredible ice storm and these extraordinary winds.'' He asked people who were listening to the radio, ``If you see my herd roaming around, give me a call.'' I had another rancher call in from a town out in the western part of North Dakota, and he had a hundred cows and he had a calve crop coming in. Understand, this is the part of the season when you are calving. The calves are being born and being born in these disastrous conditions. They had a hundred cows, and they had a calve crop coming in, and they believe all of them are dead. They brought 10 into their own home--10 calves into their home to try to save them. All of them died. What was happening was, as the calves were being born, the wind is so strong, the snow is being forced up into their nostrils and the cows were suffocating. Now, if they didn't suffocate, they froze to death. Now, that is the extraordinarily brutal conditions that we are facing. Mr. President, we had a disaster supplemental sent up by the White House before we had this 2-week break. I hope very much that the first order of business here will be that disaster supplemental. We ought to move that legislation and move it now. There is assistance in that legislation for some areas that have already been hard hit. There is further assistance for those that have been hard hit since that disaster bill was sent up here. So I would ask respectfully of the leadership to get that disaster supplemental to the floor as quickly as possible. These are situations that cannot wait. These people need help. They need it now. North Dakota has been first in line to help out others when they faced disasters, and we have been happy to do so. Mr. President, we are now faced with a staggering disaster and we need help. We are asking for it now. Mr. President, I see there are other Senators wishing to speak. Will we be able to continue?

Mr. CONRAD. Mr. President, in addition to the disaster supplemental, I think we should also ask, ``Where is the budget?'' Because the budget contains items that are going to be critically important to dealing with these disasters as well. The budget was supposed to have come out of the Budget Committee by April 1. That deadline has been missed. The full Senate is supposed to act by April 15. I hope we don't miss that deadline as well, because this Congress is developing a reputation of failing to act. Mr. President, finally, there is a third matter. That is the chemical weapons treaty. We have a deadline of April 29. That is when it goes into effect. Where is that piece of legislation? Mr. President, I say to my colleagues that there are three pieces of business that we ought to do and do quickly. The disaster supplemental ought to be first in line. Second, the budget: We have a deadline of April 15. Third, the chemical weapons treaty: We have a deadline of April 29. All three of those ought to be taken up, taken up quickly, and passed so the people of this country know that this Congress is doing its business. I thank the Chair. I yield the floor. Mr. JOHNSON addressed the Chair.

Mr. CONRAD. Mr. President, I ask for 1 minute more.

Mr. CONRAD

Mr. CONRAD. Mr. President, I want to thank the Senator from Vermont for his observations on the ranking member of the Finance Committee, who is really an American legend. I also want to just say to my colleague, Senator Bumpers, who is coming on the floor, that I will be brief so that Senator Bumpers can have his time. And I look forward to hearing his remarks.

Mr. CONRAD

Mr. CONRAD. Mr. President, let me just say that Senator Domenici, the chairman of the Budget Committee, has come to the floor this afternoon and presented two possible budgets. One is the President's budget, but without the trigger mechanism the President provided to assure balance even if the Congressional Budget Office projections are the ones that are used. The President's budget, of course, reaches unified balance by the estimates of the Office of Management and Budget, but it does not reach balance by the estimates of the Congressional Budget Office. And I want to emphasize, ``unified balance.'' All of us need to understand that is not real balance. Nobody should be fooled anywhere about any of these budgets that talk about balancing on a so-called unified basis, because when they use that big word, what they are talking about is putting all of the trust funds into the pot to claim balance. So I think it is important to understand I do not believe any of these budgets that claim unified balance are really balanced budgets at all. But, with that said, I think it is also important to understand when you hear these differences between Office of Management and Budget projections and Congressional Budget Office projections, the fact is both of them over the last 4 years have been overly pessimistic. They have overestimated what the deficit would be. And I think that is also important to keep in mind. As I understand it, the Senator from New Mexico, the chairman of the Budget Committee, offered the President's budget but without his trigger mechanism. Why did the President not balance according to CBO's projections? Well, very simply, when he did his budget he did not have available to him the CBO baseline. He did not have available the CBO projections. Although he asked for them, and asked for them repeatedly, they were not prepared in time. So in order to fulfill his responsibility to present a budget, he used his Office of Management and Budget projections, which, again, I emphasize have been overly pessimistic, not a rosy scenario, overly pessimistic over the last 4 years in order to present a budget. He provided a trigger mechanism so that if, in fact, CBO's projections were different, were even more pessimistic than his own Office of Management and Budget's, that he could still be in unified balance by the year 2002. I also understand the Senator from New Mexico has offered a second budget that has no tax cuts or no net tax cuts and also has very deep cuts in domestic discretionary spending. When we use the term ``domestic discretionary spending,'' what we are talking about is that category of spending that includes education, roads, bridges, airports, parks. Those are the categories of spending that are included in so- called domestic discretionary spending. Mr. President, if I could, the reason I came to the floor this afternoon was to try to put this all in some perspective. Because I think unless people have an idea of what we are talking about in terms of the estimated expenditures of the Federal Government over the next 5 years and the estimated revenues and where the money goes, it is very hard to understand the nuances of these budget discussions. This chart shows over the next 5 years what we are anticipating spending from the Federal Government: $9.3 trillion. The revenue that is forecasted for the Federal Government over the next 5 years is here in this block: $8.5 trillion. So it is readily apparent that we are faced with a circumstance that, without change, we are going to be adding $800 billion to the national debt. Unfortunately, our friends on the other side of the aisle in Senate bill 2, which means clearly that is one of their highest priorities, says the first thing to do is to cut the revenue anticipated by $200 billion. So they take this sliver off to start with. They reduce our revenue from $8.5 trillion down to $8.3 trillion as the initial step in addressing this gap between expenditure and revenue. It makes no sense to me why you would dig the hole deeper before you start filling it in. That is what our friends on the other side of the aisle have been talking about. Instead of addressing this $9.3 trillion worth of expenditures with $8.5 trillion of revenue, they say cut it to $8.3 trillion of revenue to begin with. So now we have $1 trillion that will be added to the national debt. Mr. President, this chart shows where the money is going to be going over the next 5 years. This is where the money is scheduled to be spent, and I think this is what our friends across the way are struggling with as they struggle to come up with a budget resolution. Where are you going to cut? If we can see we are faced with adding $1 trillion to the national debt based on scheduled spending and scheduled revenues, and they start out by first taking $200 billion of revenue away, so you create a $1 trillion hole to fill in, where are you going to cut? Here is where the money is scheduled to go: Social Security, $2.1 trillion of the $9.3 trillion that we are scheduled to spend over the next 5 years. Interest on the debt, $1.3 trillion. Clearly you cannot cut interest on the debt. Everybody is against cutting Social Security. Those two alone are 37 percent of the scheduled expenditures. Defense, $1.4 trillion, another 15 percent. We do not hear much of anybody talking about cutting defense. So you start adding it up, defense is 15 percent, Social Security is 23 percent, which is 38 percent, and interest on the debt is 14 percent. That is 52 percent of the scheduled expenditures which nobody is talking about cutting. That takes us to Medicare, $1.3 trillion, or another 14 percent of Federal expenditures. Medicaid, $600 billion, about 7 percent of Federal expenditures over the next 5 years. Other entitlements. We use that terminology and it refers to things like retirement, nutrition for children, welfare. Those are things that are in the categories of ``other entitlements.'' Then there is nondefense discretionary spending, which I referred to earlier and which Senator Domenici, in the second budget that he laid down here, would cut very deeply. He would cut from an unconstrained baseline $263 billion out of this category. That is a tremendous amount of money out of defense and nondefense. Those two are called discretionary spending. From the nondefense discretionary side, the budget he just presented would cut $183 billion out of a total that we are scheduled to spend over the next 5 years of $1.5 trillion. Again, what we are talking about there is education, roads, bridges, airports, parks, law enforcement. Do we really want to be cutting those areas in the magnitude of the budget that the chairman of the Budget Committee has laid down? I do not think so. I do not think Senator Domenici thinks so. In fact, I am quite confident he does not think so. He is just making a point with the second budget he laid down of what it would take even with no tax cuts to achieve unified balance. Remember, unified balance is not balance at all. That is when you take all the money from all the trust funds and throw those into the pot to claim that you are balancing the budget. I hope this puts in some perspective what it is that we face this year. This is not going to be easy. That is, hopefully, the message that I have communicated here. When you look at what the scheduled revenue is of the Federal Government--maybe we could show that chart again--$9.3 trillion are the expenditures, and we are scheduled to have $8.5 trillion of revenue. If the first thing you do is take $200 billion out of the revenue column, now you are at $8.3 trillion, and you have $9.3 trillion of expenditures, you have $1 trillion added to the national debt. Is that what we want to do? To have the kind of massive tax cut that some have talked about, you have to borrow it all. Does that make sense? Should we borrow money to have a tax cut? Does that make sense to people? We already have a $5 trillion national debt. How deep in the hole are we going to go around here before we respond? Mr. President, these are the major categories of Federal spending. I think one can see that if we are going to be serious about balancing the budget and doing it in an honest way, we have a tall order in front of us. Talking about tax cuts of $200 billion over the next 5 years, which our friends on the other side of the aisle have put up as their Senate bill No. 2, really makes no sense to me. It especially makes no sense when you look at what happens to that tax cut proposal in the second 5 years. This is not just a matter of reaching some kind of balance in the year 2002. We have to be looking over the horizon here, because the real challenge is, where is this all going? The real challenge is we have the baby boom generation coming along, and they are going to start retiring in the year 2012, and they will double the number of people almost overnight eligible for our major programs. We are headed for a circumstance in which, if we fail to change course, we are going to either have an 80 percent tax rate--yes, 80 percent; does anybody believe we will do that?--or a one-third cut in all benefits. Cut Social Security one-third, cut Medicare one-third, cut all veterans benefits one-third. Those are the kind of draconian options that will be presented to this Congress and a future President if we fail to act. We have a responsibility to respond. I submit that having tax cuts of $200 billion over the next 5 years that explode to $500 billion over the next 10 years is not rational, is not responsible, is not the way to begin to fill in the hole. I have never seen anybody that went out to fill in a hole and the first thing they did was dig it deeper. It makes very little sense to me. I hope that Senator Domenici, by presenting these budget options this afternoon, sobers up people on both sides of the aisle here, sobers up those who think that we can have massive tax cuts. That is not in the cards. That is not serious if people are going to be honest with the long-term fiscal imbalances this country faces. That is not facing it head on or squarely. Also, I hope it stands as a message to people on my side of the aisle, some who are opposed, for example, to correcting the Consumer Price Index that we use to adjust for the cost of living. The evidence is overwhelming that we are making an overcorrection for the cost of living by as much as perhaps 1 percent a year. It sounds like a small amount, but it makes a big difference over time. That 1 percent mistake will cost the U.S. Government $1 trillion over the next 12 years. Some on my side say we cannot touch that. If we can't touch that, and the other side says we have to have a big tax break, you begin to wonder what can we do around here? Goodness knows, if we can't correct a mistake, which I believe the CPI is in terms of adjusting for the cost of living based on the best evidence that we have, what can we do? If our friends on the other side want to have dessert before we start eating our vegetables in the face of this enormous challenge of these long-term fiscal imbalances, then how serious are they really about addressing the challenges facing America's future? We have an opportunity here to do something great for America, because this isn't just some dry discussion about making columns of numbers add up. That isn't what this is about. This is not a counting exercise. This is about the future economic strength of America. This is about what kind of jobs are going to be available for our kids. This is about what kind of life future Americans are going to enjoy. This is about the competitive position of America. That is what is at stake. It is not just some dull, lifeless debate about balancing a budget. This discussion is about what we can do to strengthen America for the future and the difference that we can make in the lives of the people of our country by being responsible now, because what we have been told is, if we balance this budget in this window of opportunity we have before the baby boomers start to retire, our economy in the future will be 30 percent larger than if we fail to act. Some may be listening to this saying, ``Wait a minute. I am lost. What is the connection between balancing the budget now and having a bigger economy later?'' It is very simple, but it is very real. If we are going to grow the economy, if we are going to make it bigger, if we are going to have more jobs, we need investment. To have investment you have to have savings. The biggest threat to savings in this country is the deficits that the Federal Government runs, because those deficits take money out of the pool of savings of our society. That is why this debate matters. It is perhaps the single most important debate we will have in this Congress this year. If we all do it seriously and honestly and face our responsibilities squarely, we can do something great for our country. I thank the Chair. I yield the floor. Mr. DURBIN addressed the Chair.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise today in support of Senate Joint Resolution 18, the campaign finance reform constitutional amendment sponsored by Senators Hollings and Specter. This constitutional amendment gives Congress and the States the power to limit campaign spending. Although I've supported similar constitutional amendments in the past, this is the first time I've cosponsored such an amendment. Amending the Constitution is not something I take lightly. The Constitution is the basic law of our land, and the guarantor of our country's most precious rights and liberties. The Constitution has only been changed 27 times--only 17 times since the first 10 amendments, the Bill of Rights, were adopted in 1789. Voting to amend the Constitution is perhaps the most important vote I can cast as a U.S. Senator. However, it seems to me we have reached a crisis point with our current campaign finance system. To put it simply, campaign spending is out of control. It is my belief that this constitutional amendment will help us address in a fair and reasonable manner the chronic problems plaguing our current campaign finance system. In 1974, 23 years ago, Congress passed the Federal Election Campaign Practices Act in response to the controversy surrounding the Watergate scandal. The Federal Election Campaign Practices Act required greater disclosure by candidates and parties, restricted cash contributions, and limited campaign expenditures. In 1976, the Supreme Court reviewed the constitutionality of the act in Buckley versus Valeo. In reviewing the case, the Court struck down the limits on campaign expenditures as an unconstitutional restriction on freedom of speech. The effect of this decision is that it equated the unlimited expenditure of campaign money with the exercise of free speech. In my view, this decision was a mistake. Since that time, Congress has made numerous attempts at addressing this decision, particularly during the last 10 years, by putting forth various comprehensive campaign finance reform initiatives. Most of these bills attempted to address the campaign expenditure problem either by providing a system of public financing or providing inducements for voluntary spending limits. During my 10 years in the Senate, I have supported most of these proposals. Unfortunately, all of these initiatives were defeated. The campaign spending problem was further exacerbated by the Supreme Court's decision last June in the Colorado Republican Party versus FEC. In that decision, the Court struck down the spending limits of political parties in congressional campaigns. This decision virtually wiped out the remaining Federal campaign spending limits. Last year, we saw record amounts of money spent on campaigns. Republican and Democratic committees alone spent $881 million and it has been estimated that more than $4 billion was spent on campaigns at all levels during the last election cycle. There is every indication to believe that the costs of campaigns will continue to skyrocket. Some argue that the amount of money spent on campaigns is insignificant when compared with the amount we spend on other facets of our economy. I think this is a specious comparison. The current campaign finance system is out of control and it threatens to push average Americans out of the process. Voter cynicism and apathy are on the increase. In the last election, voter turnout fell below 50 percent. Most people understand the corrosive effect the current campaign finance system has on our democracy. The time has come for us to fix this system by placing reasonable limits on the amount of money that can be spent on campaigns. We must restore confidence in our political system. Voting for this constitutional amendment will allow us to do just that. I urge my colleagues to vote in favor of Senate Joint Resolution 18.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise to briefly address two questions: No. 1, the question of a waiver for Ambassador Barshefsky; and, No. 2, the approval of Ambassador Barshefsky as our trade representative. Mr. President, I represent the State of North Dakota. We are right next to Canada. The question of a waiver for Ambassador Barshefsky relates to the question of her previous representation of Canada on trade issues, and that requires a waiver if she is to become our trade representative. Mr. President, anyone who has worked with Ambassador Barshefsky understands her full commitment and dedication to the trade interests of the United States. My State has been involved in a longstanding dispute with Canada with respect to unfairly traded Canadian grain coming into this country at below their cost and having a devastating effect on the farmers of my State, not only the producers in North Dakota but farmers in Montana, farmers in South Dakota, Minnesota, Kansas, Nebraska. Charlene Barshefsky has stood with us shoulder to shoulder to get a fair result. Mr. President, this issue first came up when she was approved as the Deputy USTR 4 years ago. She has done a superb job in her position at the trade representative's office. I think anybody who has followed her career and watched the job she did in negotiating to open up Pacific rim countries to our trade, the job that she has done fighting for U.S. interests in trade disputes with Canada, that she represented for a brief time on limited issues when she was in the private sector, would understand there is no reason--none--to deny a waiver to allow Charlene Barshefsky to become our trade representative. Mr. President, Charlene Barshefsky is superb. I have dealt with many trade representatives. Rarely does one find someone of her background, her intelligence, her talent and her commitment. Those are qualities that we want working for the United States in these very difficult trade negotiations. And she has shown her mettle over and over and over. I urge my colleagues to vote for the waiver and to vote for Charlene Barshefsky to be our next trade representative. I thank the Chair and yield the floor.

Mr. CONRAD

Mr. CONRAD. Mr. President, I thank the Senator from Vermont. I especially thank my colleague from West Virginia for his courtesy. Mr. President, we are going to vote in just a very few hours on one of the most critical issues facing this country. Mr. President, I believe deeply that we must balance the Federal budget. I believe we must do it because we are faced with a demographic time bomb that puts this Nation's future in jeopardy if we fail to act. Just as deeply as I feel about balancing the budget, I feel opposition to the balanced budget amendment that is before this body. I call it the so-called balanced budget amendment, because the most important question that we need to ask and answer today is, What budget is being balanced by this amendment? When you pierce the veil, what you find is this isn't a balanced budget amendment at all. It does not balance the budget. It loots and raids every trust fund that this Government has in order to claim balance. That is what this amendment does. Mr. President, as I have pointed out before on the floor of this body, if any private company sought to take the retirement funds of their employees and throw those into the pot to claim they had balanced the budget, they would be in violation of Federal law. Yet we are about to enshrine that principle in the Constitution of the United States? The greatest document in human history is our Constitution. It has made this country the greatest country in human history. Mr. President, this amendment that is before us would take the Social Security trust fund surpluses--just over the next 5 years, $465 billion--and raid and loot every penny in order to claim balance. The American people are for this amendment by about 80 percent until they find out how it works. When they find out it only balances by raiding and looting trust funds, then 80 percent of them are opposed to it. Part of our responsibility is to make certain that people know how this so-called balanced budget amendment to the Constitution works. This is what it does. It raids and loots every penny of Social Security trust fund surpluses in order to claim balance. This chart I think discloses just how fraudulent the proposal we are about to vote on is. It shows the deficits and debt in the year 2002. If this is a balanced budget amendment, then in the year 2002, in which it is fully effected, one would expect the debt would not be increasing, that it would stop deficit spending. That is not what it does. On a unified basis, they claim balance. That is by using every penny of every trust fund of the Federal Government. But if you look at excluding the Social Security trust funds and Postal Service funds, you will find that in the year 2002 we would have a $103 billion deficit. If you look more broadly at all of the funds, all of the trust funds, you find out that the debt would increase $110 billion in the year it is effected. Mr. President, this is not a balanced budget amendment at all. Second, there is no provision for a national economic emergency. We know that right now the right policy is to cut spending and balance the budget. That was exactly the wrong policy in the midst of the Great Depression. We ought to have provision for a national economic emergency. Third and finally, we ought not to have a circumstance that would permit unelected judges to write the budget for the United States. That would be a profound mistake. The judges know nothing about the defense needs of America. They know nothing about the budget considerations for this country. The last thing we ought to have happen is to have unelected Federal judges sitting around the table writing the budget for the United States. For those reasons, I am opposed to the balanced budget amendment that we will vote on in just a few hours. It would be a mistake for the country. It would not stand the test of time. I thank the Chair and yield the floor.

Mr. CONRAD

Mr. CONRAD. Mr. President, today, I am pleased to be joined by Senator Kerrey, Senator Harkin, Senator Wellstone, Senator Baucus, Senator Cochran, and Senator Inouye to introduce legislation to help improve health care delivery in rural and underserved communities throughout America through the use of telecommunications and telehealth technology. Telehealth encompasses a wide variety of technologies, ranging from the telephone to high-technology equipment that enables a surgeon to perform surgery from thousands of miles away. It includes interactive video equipment, fax machines and computers along with satellites and fiber optics. These technologies can be used to diagnose patients, deliver care, transfer health data, read x-rays, provide consultation, and educate health professionals. Telehealth also includes the electronic storage and transmission of personally identifiable health information, such as medical records, test results, and insurance claims. 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. Because I believe telehealth holds incredible promise for rural America, I formed the Ad Hoc Steering Committee on Telemedicine and Health Care Informatics to explore telehealth and related issues in 1994. The purpose of the steering committee, which includes telehealth experts from government, private industry, and the health care professions, is to evaluate Federal policies on telehealth and how to use telecommunications technology more effectively to increase access to health care throughout America. Throughout the last few years, as the steering committee held meetings and policy forums, it became increasingly apparent that there is enormous energy and financial effort being devoted to telehealth today, both by government and private industry. 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. Telehealth is already making a difference in my State. The University of North Dakota has a fiber optic two-way audio and video interactive network that has been used to train students in areas like social work and medical technology. Recently, I had the opportunity to spend some time with two of the premier telehealth systems in the State of North Dakota. I was amazed at the capabilities of these systems. They currently supply speciality care to rural North Dakota clinics, manage chronic disease, lower administrative costs, and reduce the isolation felt by rural and frontier practitioners. Because telehealth is in many respects an emerging health care application, it is particularly important to constructively capitalize on efforts like these. My proposal attempts to facilitate this in a number of ways. The first element of my proposal builds on current demonstration projects to require the Health Care Financing Administration to put in place a reimbursement system for telehealth activities under Medicare. Medicare reimbursement policy is an essential component of helping to integrate telehealth into the health care infrastructure, and must be explored. It is particularly important in rural areas, where many hospitals do as much as 80 percent of their business with Medicare patients. While rural areas are the most in need of telehealth services, I also realize there are other groups that would greatly benefit from an expansion of this service. That is why I am also asking the Secretary of Health and Human Services to submit a report that will examine the impact of expanding telehealth reimbursement for nonrural Medicare beneficiaries who are home-bound or nursing home-bound and for whom being transferred for health care services imposes a serious hardship. The second element of this proposal asks the Secretary of Health and Human Services to submit a report to the Congress on the status of efforts to ease licensing burdens on practitioners who cross State lines in the course of supplying telehealth services. Currently, consultation by almost any licensed health professional in this situation requires that the practitioner be licensed in both States. In talking with telehealth providers in my State, and with experts on the ad hoc committee, I have been told repeatedly that this is one of the most significant barriers to developing broad integrated telehealth systems. More importantly, they tell me States have actively been using licensure to close their borders to innovative telehealth practice. In the past 2\1/2\ years, 11 States have taken legislative action to ensure that out-of-State practitioners must be fully licensed in their State in order to provide telehealth services, even if they are fully licensed in their own State. During a recent discussion with a telehealth practitioner from my home State of North Dakota, I was told about a group of telehealth specialists who, among their small group practice, were licensed in more than 30 different States. That means they pay 30 different fees, are responsible for 30 different continuing education requirements, and are overseen by 30 different regulatory bodies. This is a costly and burdensome procedure for many practitioners, but the burden falls particularly heavily on rural practitioners, who face long travel times to acquire continuing education, and who frequently run on lower profit margins than urban practitioners. While I am not prepared at this time to propose that the Federal Government get involved with professional licensure, I have asked the Secretary to study the issue and report to Congress yearly on the status of efforts by States and other interested organizations to address this issue. This will allow us to reach out to the States and work together to find solutions to cross-State licensure concerns. As part of this report, I have asked the Secretary to make recommendations to Congress, if appropriate, about possible Federal action to lower the licensure barrier. A third element of my proposal involves coordination of the Federal telehealth effort. Vice President Gore has been making outstanding contributions in the area of the information super- highway. The Department of Health and Human Services, in large part at the urging of the Vice President, has created an informal interagency task force that is examining our Federal agency telehealth efforts. This group recently completed a report on telehealth that highlights current Federal activities and also provides a thorough examination of many of the important issues in telehealth. My bill attempts to use that task force to inventory Federal activity on telehealth and related technology, determine what applications have been found successful, and recommend an overall Federal policy approach to telehealth. Many departments and agencies of the Federal Government are engaged in telehealth activity, including the Veterans' Administration, Department of Defense, Department of Agriculture, Office of Rural Health Policy, and many others. The more these agencies work together to coordinate the Federal effort and consolidate Federal resources, the more effective the Federal Government will be in contributing to telehealth in a positive way. I believe this is especially important in light of the recent GAO report calling for an expanded role for this group and more coordination of telehealth issues across the Federal agencies. The efforts of this group, along with the ongoing activities of the congressional ad hoc steering committee, will provide a renewed focus for telehealth across the Federal Government. Such coordination will also help protect the American taxpayer from unnecessary duplication of effort. The fourth part of my proposal helps communities build homegrown telehealth networks. It attempts both to build a telehealth infrastructure and foster rural economic development and incorporates many of the most important lessons learned from other grant projects and studies on telehealth from across the Federal Government. Clearly, the scarcity of resources in many rural communities requires that the coordination and use of those resources be maximized. My bill encourages cooperation by various local entities in an effort to help build sustainable telehealth programs in rural communities. It plants seed money to encourage health care providers to join with other segments of the community to jointly use telecommunications resources. Using a unique loan forgiveness program, it rewards telehealth systems that supply appropriate, high-quality care while reducing overall health care costs. Most importantly, it does not create a system where various technological approaches are imposed upon communities. Rather it enables potential grantees to determine user-friendly approaches that work best for them. This homegrown approach to developing user-friendly telehealth systems, as well as the preference for coordinating resources within communities, will help ensure the long-term viability of such programs after the grant expires. Mr. President, my proposal is a sound first step in our national efforts to integrate telecommunications technology into the rapidly evolving health care delivery system. This bill is very similar to legislation, S. 2171 I introduced late in the 104th Congress. I am very encouraged by the positive feedback I have received from telehealth networks across the country. Over the past few months, I have attempted to reach out to different groups and incorporate their ideas into this proposal. As a result, I have made several changes in the bill that I believe will make this a stronger proposal. But, as with any complex issue, I understand that some may prefer different approaches. By introducing this legislation early in the 105th Congress, I hope to send a message to all interested parties that now is the time to come forward with creative solutions to these important issues. It is my hope that comprehensive telehealth legislation can be attached to any Medicare reform legislation enacted in this Congress so we can improve access to needed health care services for rural and underserved populations. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, today, I am pleased to be joined by Senator Kerrey, Senator Harkin, Senator Wellstone, Senator Baucus, Senator Cochran, and Senator Inouye to introduce legislation to help improve health care delivery in rural and underserved communities throughout America through the use of telecommunications and telehealth technology. Telehealth encompasses a wide variety of technologies, ranging from the telephone to high-technology equipment that enables a surgeon to perform surgery from thousands of miles away. It includes interactive video equipment, fax machines and computers along with satellites and fiber optics. These technologies can be used to diagnose patients, deliver care, transfer health data, read x-rays, provide consultation, and educate health professionals. Telehealth also includes the electronic storage and transmission of personally identifiable health information, such as medical records, test results, and insurance claims. 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. Because I believe telehealth holds incredible promise for rural America, I formed the Ad Hoc Steering Committee on Telemedicine and Health Care Informatics to explore telehealth and related issues in 1994. The purpose of the steering committee, which includes telehealth experts from government, private industry, and the health care professions, is to evaluate Federal policies on telehealth and how to use telecommunications technology more effectively to increase access to health care throughout America. Throughout the last few years, as the steering committee held meetings and policy forums, it became increasingly apparent that there is enormous energy and financial effort being devoted to telehealth today, both by government and private industry. 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. Telehealth is already making a difference in my State. The University of North Dakota has a fiber optic two-way audio and video interactive network that has been used to train students in areas like social work and medical technology. Recently, I had the opportunity to spend some time with two of the premier telehealth systems in the State of North Dakota. I was amazed at the capabilities of these systems. They currently supply speciality care to rural North Dakota clinics, manage chronic disease, lower administrative costs, and reduce the isolation felt by rural and frontier practitioners. Because telehealth is in many respects an emerging health care application, it is particularly important to constructively capitalize on efforts like these. My proposal attempts to facilitate this in a number of ways. The first element of my proposal builds on current demonstration projects to require the Health Care Financing Administration to put in place a reimbursement system for telehealth activities under Medicare. Medicare reimbursement policy is an essential component of helping to integrate telehealth into the health care infrastructure, and must be explored. It is particularly important in rural areas, where many hospitals do as much as 80 percent of their business with Medicare patients. While rural areas are the most in need of telehealth services, I also realize there are other groups that would greatly benefit from an expansion of this service. That is why I am also asking the Secretary of Health and Human Services to submit a report that will examine the impact of expanding telehealth reimbursement for nonrural Medicare beneficiaries who are home-bound or nursing home-bound and for whom being transferred for health care services imposes a serious hardship. The second element of this proposal asks the Secretary of Health and Human Services to submit a report to the Congress on the status of efforts to ease licensing burdens on practitioners who cross State lines in the course of supplying telehealth services. Currently, consultation by almost any licensed health professional in this situation requires that the practitioner be licensed in both States. In talking with telehealth providers in my State, and with experts on the ad hoc committee, I have been told repeatedly that this is one of the most significant barriers to developing broad integrated telehealth systems. More importantly, they tell me States have actively been using licensure to close their borders to innovative telehealth practice. In the past 2\1/2\ years, 11 States have taken legislative action to ensure that out-of-State practitioners must be fully licensed in their State in order to provide telehealth services, even if they are fully licensed in their own State. During a recent discussion with a telehealth practitioner from my home State of North Dakota, I was told about a group of telehealth specialists who, among their small group practice, were licensed in more than 30 different States. That means they pay 30 different fees, are responsible for 30 different continuing education requirements, and are overseen by 30 different regulatory bodies. This is a costly and burdensome procedure for many practitioners, but the burden falls particularly heavily on rural practitioners, who face long travel times to acquire continuing education, and who frequently run on lower profit margins than urban practitioners. While I am not prepared at this time to propose that the Federal Government get involved with professional licensure, I have asked the Secretary to study the issue and report to Congress yearly on the status of efforts by States and other interested organizations to address this issue. This will allow us to reach out to the States and work together to find solutions to cross-State licensure concerns. As part of this report, I have asked the Secretary to make recommendations to Congress, if appropriate, about possible Federal action to lower the licensure barrier. A third element of my proposal involves coordination of the Federal telehealth effort. Vice President Gore has been making outstanding contributions in the area of the information super- highway. The Department of Health and Human Services, in large part at the urging of the Vice President, has created an informal interagency task force that is examining our Federal agency telehealth efforts. This group recently completed a report on telehealth that highlights current Federal activities and also provides a thorough examination of many of the important issues in telehealth. My bill attempts to use that task force to inventory Federal activity on telehealth and related technology, determine what applications have been found successful, and recommend an overall Federal policy approach to telehealth. Many departments and agencies of the Federal Government are engaged in telehealth activity, including the Veterans' Administration, Department of Defense, Department of Agriculture, Office of Rural Health Policy, and many others. The more these agencies work together to coordinate the Federal effort and consolidate Federal resources, the more effective the Federal Government will be in contributing to telehealth in a positive way. I believe this is especially important in light of the recent GAO report calling for an expanded role for this group and more coordination of telehealth issues across the Federal agencies. The efforts of this group, along with the ongoing activities of the congressional ad hoc steering committee, will provide a renewed focus for telehealth across the Federal Government. Such coordination will also help protect the American taxpayer from unnecessary duplication of effort. The fourth part of my proposal helps communities build homegrown telehealth networks. It attempts both to build a telehealth infrastructure and foster rural economic development and incorporates many of the most important lessons learned from other grant projects and studies on telehealth from across the Federal Government. Clearly, the scarcity of resources in many rural communities requires that the coordination and use of those resources be maximized. My bill encourages cooperation by various local entities in an effort to help build sustainable telehealth programs in rural communities. It plants seed money to encourage health care providers to join with other segments of the community to jointly use telecommunications resources. Using a unique loan forgiveness program, it rewards telehealth systems that supply appropriate, high-quality care while reducing overall health care costs. Most importantly, it does not create a system where various technological approaches are imposed upon communities. Rather it enables potential grantees to determine user-friendly approaches that work best for them. This homegrown approach to developing user-friendly telehealth systems, as well as the preference for coordinating resources within communities, will help ensure the long-term viability of such programs after the grant expires. Mr. President, my proposal is a sound first step in our national efforts to integrate telecommunications technology into the rapidly evolving health care delivery system. This bill is very similar to legislation, S. 2171 I introduced late in the 104th Congress. I am very encouraged by the positive feedback I have received from telehealth networks across the country. Over the past few months, I have attempted to reach out to different groups and incorporate their ideas into this proposal. As a result, I have made several changes in the bill that I believe will make this a stronger proposal. But, as with any complex issue, I understand that some may prefer different approaches. By introducing this legislation early in the 105th Congress, I hope to send a message to all interested parties that now is the time to come forward with creative solutions to these important issues. It is my hope that comprehensive telehealth legislation can be attached to any Medicare reform legislation enacted in this Congress so we can improve access to needed health care services for rural and underserved populations. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, the great State of North Dakota has brought forth many sons and daughters who have made tremendous contributions to our Nation and our world. Throughout its history, our State has given rise to individuals of great character, strong perseverance, and expansive vision. Today, I ask my colleagues to join me in recognizing two such individuals of whom North Dakota is very proud: Vonnie and Dale Brown. A native of Columbus, ND, Vonnie Ness was the daughter of Martha and Clifford Ness and the granddaughter of Norwegian homesteaders, who came to the United States in the 1800's to settle in North Dakota. Possessed with both a great love and talent for dance, Vonnie graduated with a degree from Minot State University. When she and Dale married and later moved to Baton Rouge, LA, she combined a career as an instructor at Louisiana State University with the responsibilities of full-time motherhood to their daughter, Robyn. For many years, Vonnie taught a variety of dance courses at LSU where she was a much-loved and highly popular instructor. Since leaving LSU, she has continued her internationally acclaimed research in ethnic and folk dance and maintains an extensive schedule of travel throughout eastern Europe as a preeminent scholar in this field. Born in Minot, ND, 61 years ago, Dale grew up in the most challenging of circumstances. He was raised in a single-parent home by a mother, Agnes Brown, whose strength of character and persistence in the face of great poverty kept the family together. Dale's life is a testament to overcoming hardship through optimism and hard work. Indeed, he has never not worked, having held a job throughout his childhood and young adulthood to support his family and help pay for his college education at Minot State, of which he is also a proud alumnus. In turn, North Dakota and Minot State University are extremely proud of him. When he arrived at LSU, charged with reestablishing a once-powerful basketball program that had fallen on hard times, Dale took to the task with his usual blend of tenaciousness and God-given ability. It was not long before the Fighting Tigers were living up to their name, and LSU was once again on the map as a basketball powerhouse. The statistics are in the record books and speak for themselves. Since he arrived at LSU in 1972, Dale's teams have gone on to secure four Southeastern Conference titles, made 13 NCAA tournament appearances, including two trips to the Final Four, and provided thousands of hours of enjoyment to spectators who appreciated seeing skill and sportsmanship in college basketball. Over 25 years he has recruited, coached, and mentored a long list of players who have had significant careers in the NBA. But the record books don't even begin to tell the full story of what Dale Brown has done at LSU and contributed to our society. Ask any of the players he has coached what it is that they most value about their experience at LSU and they will tell you, clearly and simply, ``It's been an honor playing for him.'' A current team member recently said in an article in the Washington Post about Dale's upcoming retirement, ``He just teaches you more than basketball. He teaches you how to be successful in life. Every day it's always more than basketball. It's how to have an interview, how to hold a job. He's always bringing in motivational speakers to talk to us.'' Too often in college sports, the goal of developing mature young women and men is forgotten to the all-consuming need to win, to show more skill on the playing field takes precedence overall else. To be sure, Dale Brown has compiled a record of great success on the basketball court; his players have benefited from his technical skill and coaching ability and have played very, very well. But his greatest legacy will be the players who have matured, through exposure to his character and example, into fine human beings. Our society needs more of these people and we need more teachers like Dale and like Vonnie to help our young people aim high and grow. As Dale prepares to leave his position at LSU, coaching his last game this Saturday, we would like to recognize him and Vonnie for their contributions and wish them well as they enter this exciting new period of their lives together. Many new experiences await them, but some things will remain; undoutedbly, they will continue to leave their own special marks on the people they encounter and the lives they touch evey day. Mr. President, North Dakota is a State of achievers, of people who overcome adversity and who embody the most noble characteristics of our pioneer ancestors and try their hardest, sometimes failing, but never quitting. Such is the example set for us by Vonnie and Dale Brown. Vonnie and Dale live in Louisiana now, but they will forever be North Dakotans, carrying forth their fellowman that make our State strong and all of us proud. I ask my fellow Senators to join me in saluting them today.

Mr. CONRAD

Mr. CONRAD. Mr. President, I believe that the Congress must make permanent the research and development [R&D] tax credit. The R&D credit has proven to be critical to the United States' economic growth and international competitiveness. The credit has led to many successes in U.S. scientific research and innovation, such as extraordinary accomplishments in pure mathematics; unprecedented growth in the power and availability of information technology; and rapid progress in finding cures for life threatening diseases such as AIDS, cancer, and multiple sclerosis. For my State of North Dakota, the new information technologies mean that information industries are creating thousands of jobs. Despite these accomplishments, and the obvious long-term benefits, the R&D credit continuously faces challenges to its existence. Because the R&D credit has never been made permanent, it has had to be extended seven times by Congress since its inception. This transitory treatment of the R&D credit has forced R&D companies to be more hesitant in planning future research projects. Unfortunately Mr. President, this on-again off-again process also led to an unnecessary and disturbing circumstance in 1996. For the first time in the history of its consecutive extensions, last year the R&D credit was not extended retroactively, leaving a gap in the law from July 1, 1995 through July 1, 1996. The gap has, and will continue to, adversely affect our country's R&D efforts. The gap has already contributed to decreased investment in R&D and less planning for future R&D projects by many companies. Currently, the R&D credit is due to expire on May 31, 1997. Mr. President, we must act now to permanently extend the R&D credit and send the right signal to our Nation's innovators. Failure to act will not only jeopardize our Nation's research efforts, but it will also threaten the United States's world leadership in R&D. Our Nation's growth in R&D investment over the past decade has already been slow compared to Japan, Germany, Italy, and France. Budget realities are forcing the United States to further curtail discretionary spending for basic research. In fact, United States non-defense R&D investment has been flat at 1.9 percent of GDP after peaking at 2.0 percent in 1985, while Japan's has continued to grow to 3.0 percent. Although Germany's R&D commitment has been fairly stable at 2.7 percent since 1987, it is significantly higher than in the United States. One of the main reasons the United States lags behind these countries in R&D investment is because these countries offer their innovators generous tax incentives for R&D, including both deductibility of current expenses and special tax credits. Future economic challenges to the United States are also likely to come from developing countries in Asia as they boost R&D investment to catch up to the rest of the world. New realities are being shaped by rapidly growing international R&D capabilities. These new R&D capabilities have created both global options as well as competitive pressures whose dimension are barely understood. Unless Congress decides to adapt to these realities and to enact a permanent R&D credit, the United State's leadership in the global arena may plummet. Such a result will not only adversely impact the United States internationally, but at home as well in lost jobs, diminished economic growth and a decreased standard of living. As we prepare for the 21st century, we must remain committed to providing an environment that fosters technological investment, scientific exploration, and global competitiveness. Future economic growth and the prosperity of all Americans depends on continued R&D. America' well being depends on it. Let's remove the uncertainty surrounding the R&D credit's extension once and for all, and extend the credit permanently.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I introduce legislation to give States and localities the right to regulate, and if they choose, reject, interstate shipments of municipal solid waste. Mr. President, this is not a new issue to this body; we have grappled with the subject of interstate waste for years. The Senate has passed legislation to address this problem in each of the past three Congresses. Unfortunately, similar legislation has not been passed by the House of Representatives. This problem only grows more and more serious as we delay passing this important legislation. An estimated 16 million tons of municipal solid waste travels across State lines each and every year. And the problem will only grow in the future. Last May, New York City Mayor Rudolph Giuliani and New York Gov. George Pataki announced an agreement to close the city's last landfill, the Fresh Kills landfill. Without additional landfill space in New York, an additional 4 million tons of municipal solid waste will be on the interstate market every year after Fresh Kills closes on December 31, 2001. Landfills across the country are filling up, and communities are searching for new places to send their garbage. They are looking at places like North Dakota, where the air, water, and soil have not been spoiled by pollution and where local communities may be willing to take tremendous amounts of money in exchange for landfill space. Whether they want this imported waste or not, States and surrounding communities are almost powerless to stop the flow of garbage across their borders. Further, residents of local communities that agree to accept out-of-State waste often do not have all the information they need to make an informed choice to open their landfill space to imported garbage. Mr. President, out-of-State waste has already come to my State of North Dakota. We have been accepting industrial waste from General Motors plants from all across the country, although GM has recently begun sending their waste to another facility. We also import municipal solid waste incinerator ash from Minnesota. And one waste company tried for many years to open a superdump in North Dakota that would take nearly twice as much municipal solid waste as the entire State of North Dakota produces. My State is not unique in its situation; this is happening all across the country. Mr. President, the residents of my State and citizens across the country are tired of being powerless to regulate interstate waste. In fact, just last year North Dakota's voters approved an initiated measure that was designed to deter imports of other States' waste into North Dakota. That measure was ruled unconstitutional by the U.S. district judge. In the judge's decision, he wrote, ``The reality appears to be that trash is trash, and any law classifying it into home-grown versus foreign will not work.'' Mr. President, unless Congress acts to give States and localities the authority to regulate and reject interstate waste, this situation will continue. The bill I am introducing today is really very simple. First, it gives States the authority to regulate interstate waste. If a State wants to reject new solid waste shipments, my bill would allow that. Second, it requires that affected local governments formally approve of any waste import. This gives the communities the ability to veto proposed shipments of out-of-State waste. Third, it provides an opportunity for the area surrounding the host community to be involved in a decision to accept out-of-State waste. A decision on siting a solid waste landfill, especially one that will take large amounts of imported waste, must be a collective one, and a small community alone should not be able to make a decision that will affect a much larger area. Finally, my bill requires that waste companies publicly release all the relevant information about their proposed landfill before a community makes a decision on it. This information should include estimated environmental impacts and mitigation, economic impacts, planned expansion, financial disclosure, and records of past violations by the owner and operator of the proposed disposal site. Waste companies hold up the promise of jobs and economic incentives, but they do not want to reveal the potential risks involved in their plans. In many cases, they may not even reveal their overall plans until it is too late to stop them. One practice I have seen involves having a local developer purchase a site and get a permit to dispose of modest amounts of solid waste. The big interstate waste company then buys out the local party and aggressively expands the site's permit. The local community doesn't have a chance. This isn't fair and cannot be allowed to continue. Communities must be able to make informed choices. Mr. President, we have been working on the interstate waste problem in the Senate for many years now. The problem has not gone away and it will not go away without congressional action. The trash is still moving, and States and communities are almost powerless to stop it. It is time to enact strong interstate waste legislation into law. Mr. President, I ask unanimous consent that a copy of my bill be included in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I introduce legislation to give States and localities the right to regulate, and if they choose, reject, interstate shipments of municipal solid waste. Mr. President, this is not a new issue to this body; we have grappled with the subject of interstate waste for years. The Senate has passed legislation to address this problem in each of the past three Congresses. Unfortunately, similar legislation has not been passed by the House of Representatives. This problem only grows more and more serious as we delay passing this important legislation. An estimated 16 million tons of municipal solid waste travels across State lines each and every year. And the problem will only grow in the future. Last May, New York City Mayor Rudolph Giuliani and New York Gov. George Pataki announced an agreement to close the city's last landfill, the Fresh Kills landfill. Without additional landfill space in New York, an additional 4 million tons of municipal solid waste will be on the interstate market every year after Fresh Kills closes on December 31, 2001. Landfills across the country are filling up, and communities are searching for new places to send their garbage. They are looking at places like North Dakota, where the air, water, and soil have not been spoiled by pollution and where local communities may be willing to take tremendous amounts of money in exchange for landfill space. Whether they want this imported waste or not, States and surrounding communities are almost powerless to stop the flow of garbage across their borders. Further, residents of local communities that agree to accept out-of-State waste often do not have all the information they need to make an informed choice to open their landfill space to imported garbage. Mr. President, out-of-State waste has already come to my State of North Dakota. We have been accepting industrial waste from General Motors plants from all across the country, although GM has recently begun sending their waste to another facility. We also import municipal solid waste incinerator ash from Minnesota. And one waste company tried for many years to open a superdump in North Dakota that would take nearly twice as much municipal solid waste as the entire State of North Dakota produces. My State is not unique in its situation; this is happening all across the country. Mr. President, the residents of my State and citizens across the country are tired of being powerless to regulate interstate waste. In fact, just last year North Dakota's voters approved an initiated measure that was designed to deter imports of other States' waste into North Dakota. That measure was ruled unconstitutional by the U.S. district judge. In the judge's decision, he wrote, ``The reality appears to be that trash is trash, and any law classifying it into home-grown versus foreign will not work.'' Mr. President, unless Congress acts to give States and localities the authority to regulate and reject interstate waste, this situation will continue. The bill I am introducing today is really very simple. First, it gives States the authority to regulate interstate waste. If a State wants to reject new solid waste shipments, my bill would allow that. Second, it requires that affected local governments formally approve of any waste import. This gives the communities the ability to veto proposed shipments of out-of-State waste. Third, it provides an opportunity for the area surrounding the host community to be involved in a decision to accept out-of-State waste. A decision on siting a solid waste landfill, especially one that will take large amounts of imported waste, must be a collective one, and a small community alone should not be able to make a decision that will affect a much larger area. Finally, my bill requires that waste companies publicly release all the relevant information about their proposed landfill before a community makes a decision on it. This information should include estimated environmental impacts and mitigation, economic impacts, planned expansion, financial disclosure, and records of past violations by the owner and operator of the proposed disposal site. Waste companies hold up the promise of jobs and economic incentives, but they do not want to reveal the potential risks involved in their plans. In many cases, they may not even reveal their overall plans until it is too late to stop them. One practice I have seen involves having a local developer purchase a site and get a permit to dispose of modest amounts of solid waste. The big interstate waste company then buys out the local party and aggressively expands the site's permit. The local community doesn't have a chance. This isn't fair and cannot be allowed to continue. Communities must be able to make informed choices. Mr. President, we have been working on the interstate waste problem in the Senate for many years now. The problem has not gone away and it will not go away without congressional action. The trash is still moving, and States and communities are almost powerless to stop it. It is time to enact strong interstate waste legislation into law. Mr. President, I ask unanimous consent that a copy of my bill be included in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I thank the Senator from Massachusetts. I point out to my colleague on the other side of the aisle that if this balanced budget amendment passes, is implemented, he would have exactly the same problem as represented by that stack of budget documents sitting on his desk today, because the debt would continue to go up. We would not have a balanced budget at all, because this isn't a balanced budget amendment, unfortunately. This is an amendment that decides they are going to claim it's a balanced budget by looting every penny of Social Security surplus over the next 20 years and then claim balance. But on the question of the amendment before us, I think the amendment by the Senator from Massachusetts addresses one of the three principal concerns of the so-called balanced budget amendment which is before this Chamber. It goes to the question of the role of the courts. Mr. President, what a difference a Congress makes--what a difference. The last time we had this measure before the Senate, on a vote of 98 to 2, we addressed the question of whether or not unelected judges would be left writing the budget of the United States; 98 to 2 the Senators decided we could not be silent, we could not be left with a circumstance in which right through those doors in the Supreme Court of the United States, we would have unelected judges sitting around a table writing the budget for the United States. I ask my colleagues, what do the Justices of the Supreme Court, as learned as they are, know about the defense of the United States or the budget for the defense of the United States? Nothing. They have had none of the detailed briefings, none of the hearings on the question of what the defense systems are that are critical to maintaining the security of the United States.

Mr. CONRAD

Mr. CONRAD. Mr. President, Senator Grassley and I are again introducing legislation to improve Medicare reimbursement policy for nurse practitioners, clinical nurse specialists, and physician assistants. The Primary Care Health Practitioner Incentive Act and the Physician Assistant Incentive Act of 1997 are very similar to S. 864 and S. 863, which we introduced in the 104th Congress. This legislation passed both Houses as part of reconciliation in 1995. I am very hopeful that this bipartisan legislation will garner widespread support and be signed into law as part of a Medicare reform bill this year. We believe our legislation will help all Americans by making the best possible use of primary care providers who play a vital role in our health care delivery infrastructure. Throughout the country, nurse practitioners, clinical nurse specialists and physician assistants have the skills to provide needed primary care services. This is particularly important in rural and underserved areas that have shortages of physicians. In recent years, our Nation's health care system has put a renewed emphasis on the use of primary care and wellness. Nurse practitioners, physician assistants, and clinical nurse specialists are uniquely positioned to provide this care. Nurse practitioners are registered nurses with advanced education and clinical training, often in a specialty area such as geriatrics or women's health. Nearly half of the Nation's 25,000 nurse practitioners have master's degrees. Clinical nurse specialists are required to have master's degrees and usually work in teritary care settings such as cardiac care. Many, however, also work in primary care. Physician assistants receive an average of 2 years of physician-supervised clinical training and classroom instruction and work in all setting providing diagnostic, therapeutic, and preventive care services. Each of these providers work with physicians in varying degrees usually in consultation. Within their areas of competence, these health care providers deliver care of exceptional quality. These practitioners play a vital role in communities that cannot support a physician but can afford a nurse practitioner or physician assistant; historically, these providers have been willing to move to both rural and inner-city areas that are underserved by health care providers. In fact, there are 50 communities in North Dakota that are taking advantage of the services provided by these care givers. Unfortunately, unless we make changes in our Federal reimbursement scheme, many areas of the country will not be able to benefit from these needed services. Current Medicare reimbursement rules were developed in an ad hoc fashion; as a result, they are inconsistent, incoherent, and nearly inexplicable. Current law provides reimbursement for advanced practice nurses in rural settings. But if the same patient sees the same nurse practitioner in a satellite clinic in an equally rural community that happens to be within an MSA county, reimbursement becomes subject to the ``incident to'' rule that HCFA has interpreted to require the physical presence of a physician in the building. In rural North Dakota and in rural communities throughout the country, that scenario is often inconsistent with the realities of health care delivery. Doctors in these areas often rotate between several clinics in a region that is staffed on a full-time basis by a physician assistant, nurse practitioner, or other provider. This allows physicians to cover a wider area and affords more rural residents access to basic primary care services. Current Medicare rules work against this, however. If a Medicare patient requires care when a physician is away at another clinic or out on an emergency call, the physician assistant or other provider will not be reimbursed by Medicare for the same care that would have been paid for if a physician was in the next room. Moreover, if the nurse practitioner crosses the street from a free- standing clinic to a hospital-affiliated outpatient clinic, the reimbursement rules change once again. Physician assistants are subject to an equally bewildering set of reimbursement rules that serve to prevent their effective use by the Medicare Program. Other complications also cause problems. State laws are often inconsistent with the Medicare requirements. In North Dakota, care provided by a physician assistant is reimbursed even if a physician is not present. Across the country, there also are a wide variety of payment mechanisms that result in reimbursement variations in different settings and among different providers. The Office of Technology Assessment, the Physician Payment Review Commission, and these providers themselves have all expressed the need for consistency and sensibility in a reimbursement system that acknowledges the reality of today's medical marketplace. Our colleagues shared those sentiments in 1995 by passing this legislation in both Houses. The legislation Senator Grassley and I are introducing today will provide each of these groups with reimbursement at 85 percent of the physician fee schedule. They will also provide a bonus payment to those providers who choose to practice in areas designated as Health Professional Shortage Areas [HPSA's]. The health care access problems faced by residents of these communities could be dramatically improved through the use of this special class of primary care providers. Finally, our legislation will ensure that a nurse practitioner who cares for a patient will get paid directly for that service. This legislation offers an example how Medicare can and should increase access to care by promoting the use of cost-effective providers to a much higher degree without compromising the quality of care that older Americans receive. There was a clear agreement on these issues in the 104th Congress, and we urge our Democratic and Republican colleagues to continue to support this legislation in the 105th Congress.

Mr. CONRAD

Mr. CONRAD. Mr. President, Senator Grassley and I are again introducing legislation to improve Medicare reimbursement policy for nurse practitioners, clinical nurse specialists, and physician assistants. The Primary Care Health Practitioner Incentive Act and the Physician Assistant Incentive Act of 1997 are very similar to S. 864 and S. 863, which we introduced in the 104th Congress. This legislation passed both Houses as part of reconciliation in 1995. I am very hopeful that this bipartisan legislation will garner widespread support and be signed into law as part of a Medicare reform bill this year. We believe our legislation will help all Americans by making the best possible use of primary care providers who play a vital role in our health care delivery infrastructure. Throughout the country, nurse practitioners, clinical nurse specialists and physician assistants have the skills to provide needed primary care services. This is particularly important in rural and underserved areas that have shortages of physicians. In recent years, our Nation's health care system has put a renewed emphasis on the use of primary care and wellness. Nurse practitioners, physician assistants, and clinical nurse specialists are uniquely positioned to provide this care. Nurse practitioners are registered nurses with advanced education and clinical training, often in a specialty area such as geriatrics or women's health. Nearly half of the Nation's 25,000 nurse practitioners have master's degrees. Clinical nurse specialists are required to have master's degrees and usually work in teritary care settings such as cardiac care. Many, however, also work in primary care. Physician assistants receive an average of 2 years of physician-supervised clinical training and classroom instruction and work in all setting providing diagnostic, therapeutic, and preventive care services. Each of these providers work with physicians in varying degrees usually in consultation. Within their areas of competence, these health care providers deliver care of exceptional quality. These practitioners play a vital role in communities that cannot support a physician but can afford a nurse practitioner or physician assistant; historically, these providers have been willing to move to both rural and inner-city areas that are underserved by health care providers. In fact, there are 50 communities in North Dakota that are taking advantage of the services provided by these care givers. Unfortunately, unless we make changes in our Federal reimbursement scheme, many areas of the country will not be able to benefit from these needed services. Current Medicare reimbursement rules were developed in an ad hoc fashion; as a result, they are inconsistent, incoherent, and nearly inexplicable. Current law provides reimbursement for advanced practice nurses in rural settings. But if the same patient sees the same nurse practitioner in a satellite clinic in an equally rural community that happens to be within an MSA county, reimbursement becomes subject to the ``incident to'' rule that HCFA has interpreted to require the physical presence of a physician in the building. In rural North Dakota and in rural communities throughout the country, that scenario is often inconsistent with the realities of health care delivery. Doctors in these areas often rotate between several clinics in a region that is staffed on a full-time basis by a physician assistant, nurse practitioner, or other provider. This allows physicians to cover a wider area and affords more rural residents access to basic primary care services. Current Medicare rules work against this, however. If a Medicare patient requires care when a physician is away at another clinic or out on an emergency call, the physician assistant or other provider will not be reimbursed by Medicare for the same care that would have been paid for if a physician was in the next room. Moreover, if the nurse practitioner crosses the street from a free- standing clinic to a hospital-affiliated outpatient clinic, the reimbursement rules change once again. Physician assistants are subject to an equally bewildering set of reimbursement rules that serve to prevent their effective use by the Medicare Program. Other complications also cause problems. State laws are often inconsistent with the Medicare requirements. In North Dakota, care provided by a physician assistant is reimbursed even if a physician is not present. Across the country, there also are a wide variety of payment mechanisms that result in reimbursement variations in different settings and among different providers. The Office of Technology Assessment, the Physician Payment Review Commission, and these providers themselves have all expressed the need for consistency and sensibility in a reimbursement system that acknowledges the reality of today's medical marketplace. Our colleagues shared those sentiments in 1995 by passing this legislation in both Houses. The legislation Senator Grassley and I are introducing today will provide each of these groups with reimbursement at 85 percent of the physician fee schedule. They will also provide a bonus payment to those providers who choose to practice in areas designated as Health Professional Shortage Areas [HPSA's]. The health care access problems faced by residents of these communities could be dramatically improved through the use of this special class of primary care providers. Finally, our legislation will ensure that a nurse practitioner who cares for a patient will get paid directly for that service. This legislation offers an example how Medicare can and should increase access to care by promoting the use of cost-effective providers to a much higher degree without compromising the quality of care that older Americans receive. There was a clear agreement on these issues in the 104th Congress, and we urge our Democratic and Republican colleagues to continue to support this legislation in the 105th Congress.