Kent Conrad

Mr. CONRAD

Mr. CONRAD. Mr. President, I further ask unanimous consent that we come in at 10 a.m. and go to the budget resolution, with Senator Patty Murray being recognized for 15 minutes; at the conclusion of her remarks, that Senator Gregg or his designee be recognized for the purpose of offering an amendment with 1 hour equally divided; that at the conclusion of that debate, Senator Boxer be recognized to offer an amendment in relationship to the Thune amendment and that there be 1 hour equally divided; also, at the end of that period, that I be recognized, or my designee, for a possible side-by-side to the Johanns amendment. We may not need that, but we may, and so I ask unanimous consent that that time be reserved as well.

Mr. CONRAD. With that, we are ready to stand in recess for the day. I think we are ready to go to closing.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise on a matter of personal privilege to talk about what is going on in my State. I was just there this past Friday morning and through the weekend. As the country knows, we are facing record floods across the entire State of North Dakota. These are crests we have never seen before on river after river in North Dakota. The great Missouri was bogged down with ice dams and nearly flooded the capital city last week, but that was prevented by a demolition team that came in and set charges and blew a channel in the ice. I was in Fargo, ND, on Friday and Saturday and Sunday--which everyone has been watching--and it is truly inspirational to see what is happening there. It is a town of 90,000, and the mayor told us yesterday that of those 90,000 people, they have 80,000 volunteers because everybody knows that everything is on the line. You go into the FARGODOME, which is a giant sports facility where NDSU plays its games, and they have thousands of volunteers, with rock music blaring. They made 3 million sandbags in 7 days. Think about that--3 million sandbags in 7 days, working 24 hours a day, around the clock. They are fully staffed around the clock, and they are doing everything that is humanly possible to save that city. This was the headline yesterday in the Fargo Forum: ``Holding Steady.'' It shows a picture of National Guardsmen and the Coast Guard rescuing people, and you can see these massive ice chunks and the flood. Today, we got the news that we can now anticipate another major winter storm beginning tonight, with 6, 7, or 8 inches of snow. Of greater concern, however, are the higher winds because we have miles and miles of dike--at least 38 miles of main dike. These dikes, of course, for the most part are clay dikes, and in many places those are topped over with sandbags to raise the level. Because the weather service raised the forecast level right at the end on us, we had to build the dikes up even further. While the good news is that the river is dropping slightly--from just under 41 feet to now just over 39 feet--we know there is a wall of water headed for that river. There is a most incredible snow wall--three times normal--out in the watershed, and all that water is headed for this river. So while we are cautiously optimistic, we all know the dikes can breach. That happened the night before last in the early hours, and we lost an entire high school campus in the middle of the night. The good thing is the contingency dikes that have been built right behind the main dikes held--and I can tell you it is an impressive site. Remember, this river is 22 feet above flood stage. So these massive dikes that have been built all along the river, and then these contingency dikes behind them, are in preparation for a breach. I attended early morning meetings with the city leadership. They have this organized. They have rapid strike teams, rapid response teams, they have 24-hour patrols trying to make certain the dikes don't breach, that they are not seeping. If they get a report, the report goes in, and they have four different types of rapid response teams ready to go to fill the breach. If there were ever a case of an extraordinary outpouring, this is it. This is a picture of what I was talking about in the FARGODOME. Look at this. This is thousands and thousands of people with sand, filling bags. This is what you see throughout that facility. This is just a small part of it. It is an absolute beehive of human activity working to defend that town and to save their homes. So far we have been remarkably successful. There has been tragedy--2 deaths, 50 injuries as of yesterday. But this has so far averted a much bigger crisis. This is a picture of a home out in the county. You can see they have diking around that home, and you can see there is not much freeboard there. We are hoping it holds. This is another picture that shows response of our National Guard. This is one of the rapid response teams that moved to fill a place where the levee needed to be built up. There was some seepage. So this is one of the rapid response teams that has moved in to try to prevent that dike from breaching. These guys have been absolutely heroic. One of the things that has been interesting, there is a great rivalry between the University of North Dakota and North Dakota State. North Dakota State is in Fargo; UND is in Grand Forks. In 1997, the great flood hit Grand Forks. So this year all the sports teams from UND are down at NDSU with their rivals working together to defend these dikes. This is a picture from yesterday. That is a 1-ton sandbag being lifted by a helicopter. They are going to put it in place to try to divert the flow of the river. The river has tremendous force behind it. Of course that force is hitting the dikes. In order to divert at a vulnerable position, yesterday they dropped about a dozen of these 1- ton sandbags to change the direction of the river. This is a picture of what you can see all throughout Fargo, ND. They have Neighborhood Watch groups to patrol to make sure there is no seepage. If there is a place that needs to be built up, they put out a call and people turn up just like this. You can see hundreds of people here working to sandbag to try to defend their homes and defend their neighborhoods. The thing that has kind of escaped the attention of the national media but which is so striking is, this flood threat is all across North Dakota, from the far western part of the State all across to eastern North Dakota and the Red River Valley. The Red River Valley gets most of the attention, but we landed in Valley City on Friday and in Valley City--no, this was on Saturday--the snow around the airport was 10 feet high. That is the Cheyenne River Valley. The Cheyenne River Valley will crest later than the Red. But they are anticipating record crest levels. Again, we went to a place where they have the Winter Show, in Valley City, ND. It is a big structure. There are hundreds of volunteers there working around the clock. This is from my hometown, the Bismarck Tribune, Bismarck, ND, with the headline, simply ``Battered,'' ``Area Hit Hard by a 1-2 Punch.'' That was flooding and a blizzard; 12 to 18 inches of snow hit my hometown last week. Last night we got another major winter storm. I am told more than 10 inches of snow hit last night. We were faced with an immediate threat of flooding. Here you can see two guys wading. This is ice. They have broken through the ice in their hip waders, and this is all water. They are going to check on the home of a couple to make sure they are safe. This is the kind of flooding that was in my hometown. Here is a canoe, people going from one house to another in a canoe. It is hard to fully appreciate the magnitude of this. We have had massive snowfall in places in the State, three times average, of course leading to these record floods. We have never seen the Red River at this height before in recorded history. Never before in recorded history has it been this high. I want to say to people who are watching, it is inspirational to see these communities come together, to work together in an all-out effort to save their homes, to save their communities. I could not be more proud of the people of North Dakota. Boy, faced with threat, they have absolutely demonstrated what I think are heroic qualities. I was pleased the President acknowledged this in his weekend address and talked about what this demonstrates about the human spirit. Honestly, you have to be there to fully appreciate what I am talking about. We are thinking about our friends and neighbors and families back home, wishing them the very best as this flood fight continues. The great news is the river is going down, at least the Red is going down. But we have to contend with this major winter storm that is going to hit tonight, and we also have to contend with something nobody can predict--how fast things will warm up. If it warms up too fast that water out there is going to head for the river. We know we ought to keep up our guard, and that is what everybody intends to do. I also want to acknowledge the local leadership: Mayor Walaker, Deputy Mayor Tim Mahoney--what outstanding leadership they are providing in that community. These guys are not working any 8-hour days. It is round the clock and it could not be better. They are out there urging their citizenry on. They have said: If we go down, we are going to go down swinging. I tell you, I don't think they are going to go down. I think they are going to win.

Mr. CONRAD

Mr. CONRAD. Mr. President, I ask unanimous consent that the Senate proceed to a period of morning business, with Senators permitted to speak for up to 10 minutes each.

Mr. CONRAD

Mr. CONRAD. Mr. President, I wish to say on behalf of the people I represent that we, too, send our condolences to the family of the soldier who was lost. My State has suffered many losses in Iraq and Afghanistan, and we understand the extraordinary sacrifice these families make. We wish to say to the people of New Hampshire, and especially the family of the soldier, that our thoughts and prayers are with them as well.

Mr. CONRAD

Mr. CONRAD. Mr. President, I ask unanimous consent that the bill be read a third time and passed, a motion to reconsider be laid upon the table, and any statements relating to the measure be printed in the Record.

Mr. CONRAD. Mr. President, I ask unanimous consent that the HELP Committee be discharged from further consideration of S. 681 and the Senate proceed to its immediate consideration.

Mr. CONRAD

Mr. CONRAD. Mr. President, I ask unanimous consent that Michael Feldman, a congressional fellow on the Budget Committee, be granted the privilege of the floor for the duration of the consideration of S. Con. Res. 13.

Mr. CONRAD. Mr. President, I ask unanimous consent that Democratic Budget Committee staff members John Righter, Steve Posner, Joel Friedman, and Republican Budget Committee staff members Jim Hearn, David Fisher, and Jim Carter be granted floor privileges and floor passes during the consideration of S. Con. Res. 13.

Mr. CONRAD

Mr. CONRAD. Mr. President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 10 a.m. tomorrow, Tuesday, March 31; that following the prayer and the pledge, the Journal of the proceedings be approved to date, the morning hour be deemed to have expired, the time for the two leaders be reserved for their use later in the day, and the Senate resume consideration of S. Con. Res. 13, the concurrent resolution on the budget, under the previous order.

Mr. CONRAD

Mr. CONRAD. Mr. President, if there is no further business to come before the Senate, I ask unanimous consent that it adjourn under the previous order.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am introducing the Midwifery Care Access and Reimbursement Equity, M-CARE, Act of 2009 with my colleague, Senator Collins. For too many years, certified nurse midwives, CNMs, have not received adequate reimbursement under the Medicare program. Our legislation takes steps to improve reimbursement and ensure access to these important providers. There are approximately three million disabled women of child-bearing age on Medicare, and since 1988, midwives have been providing high- quality, low cost maternity services to these women. However, given outdated payment policies, CNMs are only reimbursed at 65 percent of the physician fee schedule. This makes it impossible to make a practice sustainable and is threatening access to CNMs across the country. The Medicare Payment Advisory Commission, MedPAC, agrees. In a 2002 report, MedPAC recommended that CNMs' reimbursement be increased and acknowledged that the care provided by these individuals is comparable to similar providers. That is why we are introducing legislation that would provide payment equity for CNMs by reimbursing them at 100 percent of the physician fee schedule. CNMs provide the same care as physicians; therefore, it is only fair to reimburse CNMs at the same level. In fact, a majority of the states reimburse CNMs at 100 percent of the physician fee schedule for out-of-hospital services provided to Medicaid beneficiaries. The time has come to extend this policy to Medicare. In addition, the M-CARE Act would establish recognition for a certified midwife to provide services under Medicare. Despite the fact that CNMs and CMs provide the same services, Medicare has yet to recognize CMs as eligible providers. Our bill would change this. A variety of national organizations have expressed their support for this legislation in the past. I am pleased to say that the National Rural Health Association, the National Perinatal Association, the American College of Obstetricians and Gynecologists, along with several nursing organizations, have endorsed this legislation. This bill will enhance access to ``well woman'' care for thousands of women in underserved communities. I urge my colleagues to support this legislation and end this inequity once and for all.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am introducing the Midwifery Care Access and Reimbursement Equity, M-CARE, Act of 2009 with my colleague, Senator Collins. For too many years, certified nurse midwives, CNMs, have not received adequate reimbursement under the Medicare program. Our legislation takes steps to improve reimbursement and ensure access to these important providers. There are approximately three million disabled women of child-bearing age on Medicare, and since 1988, midwives have been providing high- quality, low cost maternity services to these women. However, given outdated payment policies, CNMs are only reimbursed at 65 percent of the physician fee schedule. This makes it impossible to make a practice sustainable and is threatening access to CNMs across the country. The Medicare Payment Advisory Commission, MedPAC, agrees. In a 2002 report, MedPAC recommended that CNMs' reimbursement be increased and acknowledged that the care provided by these individuals is comparable to similar providers. That is why we are introducing legislation that would provide payment equity for CNMs by reimbursing them at 100 percent of the physician fee schedule. CNMs provide the same care as physicians; therefore, it is only fair to reimburse CNMs at the same level. In fact, a majority of the states reimburse CNMs at 100 percent of the physician fee schedule for out-of-hospital services provided to Medicaid beneficiaries. The time has come to extend this policy to Medicare. In addition, the M-CARE Act would establish recognition for a certified midwife to provide services under Medicare. Despite the fact that CNMs and CMs provide the same services, Medicare has yet to recognize CMs as eligible providers. Our bill would change this. A variety of national organizations have expressed their support for this legislation in the past. I am pleased to say that the National Rural Health Association, the National Perinatal Association, the American College of Obstetricians and Gynecologists, along with several nursing organizations, have endorsed this legislation. This bill will enhance access to ``well woman'' care for thousands of women in underserved communities. I urge my colleagues to support this legislation and end this inequity once and for all.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am introducing the Conrad State 30 Improvement Act to extend and expand this program's success in bringing doctors to communities that would otherwise not have access to health care services. In the last Congress, a very similar version of this bill had extremely widespread support in the medical community and a diverse group of cosponsors in the Senate. The Conrad State 30 program, which I helped create in 1994, has brought thousands of physicians to underserved communities in all 50 States, across our great country. Under the program, foreign doctors already in the country for medical training are granted a waiver from a visa requirement to return to their home country for 2 years. In exchange for this waiver, the doctors must commit to providing health care to underserved populations in the United States for 3 years. By 2020, some projections show that the United States may have 200,000 fewer doctors than it needs; that is a staggering statistic, and one that cannot be taken lightly. If this shortfall is allowed to materialize, rural areas, like my State of North Dakota, will undoubtedly be among the hardest hit. Given the looming deficit of doctors and an increasingly competitive global marketplace, it is vital that we maintain the incentives for qualified foreign physicians to serve patients in this country. The immigration benefits historically provided by the Conrad 30 program, and enhanced in this bill, provide crucial incentives to foreign doctors. When they do come to our country, it is vital that we make sure that they end up in the places that need them most. This bill makes the Conrad 30 program permanent, something that I believe is long overdue. It also invites a new group of foreign doctors to take part in the program, a change that could dramatically expand the pool of doctors practicing in rural and underserved areas. Further, the bill creates a mechanism by which the current cap of 30 doctors per State can significantly expand, while protecting the interests of those States that have had difficulty recruiting doctors under the program. Finally, the bill creates an important new incentive for doctors to participate in the program by granting them a green card cap exemption when they have completed their service. I strongly believe the Conrad State 30 Improvement Act can be of great benefit to every state in the country and help combat the growing shortage of health care providers in the U.S.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am introducing the Conrad State 30 Improvement Act to extend and expand this program's success in bringing doctors to communities that would otherwise not have access to health care services. In the last Congress, a very similar version of this bill had extremely widespread support in the medical community and a diverse group of cosponsors in the Senate. The Conrad State 30 program, which I helped create in 1994, has brought thousands of physicians to underserved communities in all 50 States, across our great country. Under the program, foreign doctors already in the country for medical training are granted a waiver from a visa requirement to return to their home country for 2 years. In exchange for this waiver, the doctors must commit to providing health care to underserved populations in the United States for 3 years. By 2020, some projections show that the United States may have 200,000 fewer doctors than it needs; that is a staggering statistic, and one that cannot be taken lightly. If this shortfall is allowed to materialize, rural areas, like my State of North Dakota, will undoubtedly be among the hardest hit. Given the looming deficit of doctors and an increasingly competitive global marketplace, it is vital that we maintain the incentives for qualified foreign physicians to serve patients in this country. The immigration benefits historically provided by the Conrad 30 program, and enhanced in this bill, provide crucial incentives to foreign doctors. When they do come to our country, it is vital that we make sure that they end up in the places that need them most. This bill makes the Conrad 30 program permanent, something that I believe is long overdue. It also invites a new group of foreign doctors to take part in the program, a change that could dramatically expand the pool of doctors practicing in rural and underserved areas. Further, the bill creates a mechanism by which the current cap of 30 doctors per State can significantly expand, while protecting the interests of those States that have had difficulty recruiting doctors under the program. Finally, the bill creates an important new incentive for doctors to participate in the program by granting them a green card cap exemption when they have completed their service. I strongly believe the Conrad State 30 Improvement Act can be of great benefit to every state in the country and help combat the growing shortage of health care providers in the U.S.

Mr. CONRAD

Mr. CONRAD. Madam President, I wish to offer for the record the Budget Committee's official scoring of H.R. 1105, the Omnibus Appropriations Act for fiscal year 2009. The bill, as passed by the House, provides $407.6 billion in nonemergency discretionary budget authority, BA, for fiscal year 2009, which will result in new outlays of $244.5 billion. When outlays from prior-year budget authority are taken into account, discretionary outlays for the bill will total $468.1 billion. The bill also includes $100 million in emergency discretionary BA for 2009 resulting in $85 million in new outlays for the Secret Service. When the nonemergency funding in H.R. 1105 is combined with the funding included in H.R 2638, the Consolidated Security, Disaster Assistance, and Continuing Appropriations Act for fiscal year 2009, the overall level equals the Appropriations Committee's 302(a) allocation for budget authority and is $2.5 billion below the committee's allocation for outlays. Each appropriations subcommittee included in H.R. 1105 is at its respective 302(b) suballocation for budget authority and outlays. The bill would cause the 2009 budget resolution spending aggregates to be exceeded and would therefore be subject to a point of order under Section 311(a)(2)(A) of the Congressional Budget Act. In addition, several provisions in the bill make changes in mandatory programs-- CHIMPs--that are subject to a point of order under section 314 of S. Con. Res. 70, the concurrent budget resolution for fiscal year 2009. Finally, the bill includes an emergency designation pursuant to section 204 of S. Con. Res. 21, the concurrent resolution on the budget for fiscal year 2008. No other points of order lie against the bill as passed by the House. I ask unanimous consent that the table displaying the Budget Committee scoring of the bill be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I ask unanimous consent to have printed in the Record a copy of the Committee on the Budget Rules of Procedure.

Mr. CONRAD

Mr. CONRAD. I thank the chairman for his extraordinary effort and the effort of the chairman of the Appropriations Committee. Maybe now is the time we need to have calm reflection on where we are and where we are headed. All of us know this economy is in desperately serious trouble. We had a report this morning. Nearly 600,000 jobs were lost in the previous month. That means in the last 4 months we have lost more than 2 million jobs. All indications are that we will lose millions more jobs in this economy. What must be done? Clearly, we need an economic recovery package. There would be virtually unanimous agreement on that fundamental point. What works? Allen Sinai of Decision Economics ran models with his well-regarded econometric model that showed the things that work the best. The fastest is government purchases of goods and services. The second thing that worked the best was transfer payments to States because States are otherwise going to cut their budgets. Why do those things work the best? Because they inject money into the economy the most rapidly and in a way that there is the greatest assurance that the money is spent. That is what is the key to a short- term stimulus. Why? Because if we think about it, demand in the economy is falling. That is why GDP is dropping. That is why joblessness is increasing. What do we do about it? We can't expect consumers to change course because they are worried about losing their jobs. We can't expect corporations to increase demand because their orders are falling. The only place to look for an increase in aggregate demand is to the Federal Government. That then raises the question: What is the most effective way for the Federal Government to deploy its precious taxpayer dollars to give short-term lift to the economy but not to burden us with increased debt looking ahead? That is why the first tests that were applied to this package were that it be timely--that is, that it go into effect quickly--that it be targeted on things that have the most bang for the buck, and that it be temporary so it does not create a bow wave going forward that increases deficits and debt when the economy, we hope, will be in recovery. With that said, we also need to remember the lessons of the past. In the Great Depression, Roosevelt took action in the 1930s to provide stimulus to the economy. Unemployment was at 25 percent. By 1937, unemployment was down to 12 percent. The stimulus was working. Then they tried to balance the budget in 1937, and unemployment went back up to 19 percent. So we have to be very careful about when we pivot and move back to reducing the deficit and the debt. There is nobody who is more acutely aware of how important it is we address those long-term fiscal issues than I am. I think anybody who has followed my career for 22 years here would know I am very concerned about long-term debt. Let's analyze this package. This package--now approximately $925 billion--79.3 percent of it spends out in the first 2 years. Now, that is before we added a few things on the floor. So the numbers might change a little bit, but that is roughly right: about 80 percent in the first 2 years. That means 20 percent is not in the first 2 years. So I submit to my colleagues, the first kind of test, the first kind of screen we should apply is that one. But that is not dispositive because there are certain investments we are going to make that have long-term payoffs for the American people, such as computerizing the health records of the American people, such as--and I would put this at the top of the list--improving the electrical grid for America.

Mr. CONRAD. Mr. President, if I could have an additional 30 seconds to close.

Mr. CONRAD. I thank the chairman. Let me say it is critically important we take action. It has to be on a rational basis. It has to have criteria that apply to this package, that will stand the light of day. But at the end of the day, we must act. I thank the Chair and yield the floor.

Mr. CONRAD. I thank Senator Enzi for his support of these principles. Comparative clinical effectiveness research needs to be a permanent part of our health system. It is one of the ways we will improve health care for all Americans. I look forward to working with him on this effort.

Mr. CONRAD. I ask my colleague, Senator Graham, how much time would he need?

Mr. CONRAD. Ten minutes each?

Mr. CONRAD. Mr. President, I think we had 10 minutes each.

Mr. CONRAD. I thank Senator Graham from South Carolina for teaming up on this amendment. I think it is critically important that this amendment be adopted, because it goes right to the heart of the financial crisis we are facing. Housing is right at the center of the economic meltdown that is occurring, and precious little is being done in this economic recovery bill to address it. I salute Senator Isakson for his amendment the other night, because that is the other half of a package I think makes sense for housing. The Isakson amendment broadens the credit, an amendment that I offered in the Finance Committee that was adopted. Now we have the second piece of the puzzle, that is, to address foreclosures. Some will say, we will wait. We will do this in the TARP. Well, No. 1, there is not sufficient funding in TARP to deal with housing and the financial sector. In fact, the testimony before the Budget Committee-- Senator Graham heard it, I heard it--said we are going to need $300 to $500 billion more in the TARP for the financial sector, without addressing at all the housing crisis. I say to my colleagues, I urge my colleagues to think very carefully about this prospect. We know this economy cannot recover without housing being healthier, and without the financial sector being healthier. This amendment addresses housing, and it does it by reallocating funding, not adding more money to this package, but reallocating money within the package. It is fully paid for, $22.8 billion that is needed to have the FDIC go forward with its plan to reduce foreclosures in America. The Senator from South Carolina said it well. The letter from Sheila Bair makes it clear. This amendment, under her estimate, would avert 1.5 million home foreclosures in this country. I do not think we should wait. I do not think we should count on a TARP plan that is already underfunded to deal with the financial crisis as the basis for funding this approach. I think we should do it here. I think we should do it now. And I think we should do it in a way that is paid for. There is a certain level of expectation that occurs when a package comes over from the House, and various allocations are made. The problem is, that is not going to be the final bill leaving this Chamber. That is clear. So adjustments are going to have to be made. Priorities are going to have to be determined. I assert to my colleagues, housing ought to be certainly one of the highest priorities to be addressed in any economic recovery package. There are other things in this legislation that may be meritorious, may be good, some of them stimulative, some of them less so. We have tried to focus on those things that are of questionable value in terms of stimulus. We started with the so-called stabilization fund. Now Governors are going to get several hundred billion dollars under this plan. But one part of it, the economic stabilization fund, constitutes a slush fund if ever there was one. There are absolutely no strings attached. Governors can use it for any purpose. We have reduced that by some 70 percent. That is the biggest pay-for here. Then we have taken other items that have become the object of ridicule, $400 million for sexually transmitted diseases, $75 million for smoking cessation, and on it goes, things that are of questionable value with respect to stimulus, things that, some of them, have very slow spend-out rates. In one of them, only 17 percent of the money is spent in the first 2 years, so 83 percent is beyond 2 years. We have tried to be careful and judicious with respect to the pay- fors to fund what I think has to be a critical priority. Mr. President, how much time have I consumed?