Kent Conrad

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am pleased to introduce the Kidney Care Quality and Education Act. For the over 400,000 Americans living with kidney disease, the time has come to modernize and improve the Medicare End Stage Renal Disease (ESRD) program. They simply can't wait any longer. When Congress enacted the Medicare ESRD program, we recognized that this disease was unique and deserved special consideration. Unfortunately, since that time, Congress has fallen behind in its commitment, and the program has not kept pace with changes in treatment. My bill would take needed steps to modernize and improve the program to recognize quality and encourage education on kidney disease to better prevent and control ESRD. The Kidney Care Quality and Education Act establishes education programs to assist patients with kidney disease to learn important self-management skills that will help them manage their disease more effectively and improve their quality of life. The bill also seeks to help individuals before they develop irreversible kidney failure by teaching individuals about the factors that lead to chronic kidney disease, the precursor to kidney failure, and how to prevent it, treat it, and, most importantly, avoid it. Additionally, the bill seeks to establish uniform training requirements for dialysis technicians and to identify barriers to accessing the home dialysis benefit. Improving the ESRD program payment system and ensuring continued high quality care is also a critical component of modernizing the ESRD program. Medicare established the first prospective payment system (PPS) in the ESRD program in the early 1980s. Yet, the ESRD program remains the only Medicare PPS that does not receive an annual update. As a result, dialysis facilities have experienced difficulties in hiring qualified health care professionals and purchasing new technology. It is time for the dialysis community to receive annual payment updates; however, it is also critically important that increased payments are tied to high quality. My bill addresses both of these issues by creating a three-year Continuous Quality Improvement Initiative to link payments with quality. First, the three-year initiative would create an annual update mechanism to fairly pay providers. Second, it would ask providers to report on quality measures developed through consultation with key stakeholders. Finally, it would withhold a certain percentage of the annual update to fund a quality bonus pool from which payments would be made to those providers who provide the best quality of care. Congress must reaffirm its commitment to Americans with kidney failure by improving the program through new educational programs, quality initiatives, and payment reform. The Kidney Care Quality and Education Act is a comprehensive bill that moves the program in that direction. I urge my colleagues to join with me in supporting this important legislation.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am pleased to introduce the Kidney Care Quality and Education Act. For the over 400,000 Americans living with kidney disease, the time has come to modernize and improve the Medicare End Stage Renal Disease (ESRD) program. They simply can't wait any longer. When Congress enacted the Medicare ESRD program, we recognized that this disease was unique and deserved special consideration. Unfortunately, since that time, Congress has fallen behind in its commitment, and the program has not kept pace with changes in treatment. My bill would take needed steps to modernize and improve the program to recognize quality and encourage education on kidney disease to better prevent and control ESRD. The Kidney Care Quality and Education Act establishes education programs to assist patients with kidney disease to learn important self-management skills that will help them manage their disease more effectively and improve their quality of life. The bill also seeks to help individuals before they develop irreversible kidney failure by teaching individuals about the factors that lead to chronic kidney disease, the precursor to kidney failure, and how to prevent it, treat it, and, most importantly, avoid it. Additionally, the bill seeks to establish uniform training requirements for dialysis technicians and to identify barriers to accessing the home dialysis benefit. Improving the ESRD program payment system and ensuring continued high quality care is also a critical component of modernizing the ESRD program. Medicare established the first prospective payment system (PPS) in the ESRD program in the early 1980s. Yet, the ESRD program remains the only Medicare PPS that does not receive an annual update. As a result, dialysis facilities have experienced difficulties in hiring qualified health care professionals and purchasing new technology. It is time for the dialysis community to receive annual payment updates; however, it is also critically important that increased payments are tied to high quality. My bill addresses both of these issues by creating a three-year Continuous Quality Improvement Initiative to link payments with quality. First, the three-year initiative would create an annual update mechanism to fairly pay providers. Second, it would ask providers to report on quality measures developed through consultation with key stakeholders. Finally, it would withhold a certain percentage of the annual update to fund a quality bonus pool from which payments would be made to those providers who provide the best quality of care. Congress must reaffirm its commitment to Americans with kidney failure by improving the program through new educational programs, quality initiatives, and payment reform. The Kidney Care Quality and Education Act is a comprehensive bill that moves the program in that direction. I urge my colleagues to join with me in supporting this important legislation.

Mr. CONRAD

Mr. CONRAD. Madam President, I rise to offer for the Record the Budget Committee's official scoring of H.J. Res. 20, making revised continuing appropriations for fiscal year 2007. The pending long-term continuing resolution appropriations bill for fiscal year 2007, as passed by the House, provides discretionary budget authority for fiscal year 2007 of $463.5 billion. When combined with discretionary budget authority levels included in the 2007 Defense and Department of Homeland Security conference reports, total 2007 nonemergency budget authority is $872.7 billion. This level is $60 million below both the Appropriations Committee's 302(a) allocation pursuant to the deeming resolution (Sec. 7035 of P.L 109-234) and the President's requested level. When funding levels contained in the bill are combined with nonemergency budget authority levels included in previously enacted bills, all subcommittees are at their 302(b) allocation with the exception of the Homeland Security Subcommittee, which is $60 million below its allocation. No points of order lie against the bill as passed by the House. I commend the distinguished chairman of the Appropriations Committee for bringing this legislation before the Senate. 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, today I am introducing the Midwifery Care Access and Reimbursement Equity (M-CARE) Act of 2007. For too many years, certified nurse midwives (CNMs) have not received adequate reimbursement under the Medicare program. My legislation takes steps to improve reimbursement for these important healthcare providers. Since 1988, CNMs have been authorized to provide maternity-related services to Medicare-eligible women of child-bearing age. There are approximately three million disabled women of child-bearing age on Medicare; however, if they choose to utilize a CNM for ``well women'' services, the CNM is only reimbursed at 65 percent of the physician fee schedule. This is not right and does not come close to offsetting the costs incurred by these professionals. At this incredibly low rate of reimbursement, the Medicare Payment Advisory Committee (MedPAC) agrees that a CNM simply cannot afford to provide services to Medicare patients and has supported increasing reimbursement for CNMs. In fact, the Commission recommended in 2002 that CNMs' reimbursement be increased and acknowledged that the care provided by these individuals is at least comparable to similar providers. My legislation would make several changes to improve the ability of CNMs and certified midwives (CMs) to effectively serve the Medicare- eligible population. First, and most importantly, my bill recognizes the need to increase Medicare reimbursement for CNMs by raising the reimbursement level from 65 percent to 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. Several states have recognized this in their Medicaid programs--approximately 29 States reimburse at 100 percent of the physician fee schedule for out-of- hospital services. In addition, the M-CARE Act would establish recognition for a certified midwife (CM) 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. My bill would change this. This bill will enhance access to ``well woman'' care for thousands of women in underserved communities and make several needed changes to improve access to midwives. I urge my colleagues to support this legislation.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am introducing the Midwifery Care Access and Reimbursement Equity (M-CARE) Act of 2007. For too many years, certified nurse midwives (CNMs) have not received adequate reimbursement under the Medicare program. My legislation takes steps to improve reimbursement for these important healthcare providers. Since 1988, CNMs have been authorized to provide maternity-related services to Medicare-eligible women of child-bearing age. There are approximately three million disabled women of child-bearing age on Medicare; however, if they choose to utilize a CNM for ``well women'' services, the CNM is only reimbursed at 65 percent of the physician fee schedule. This is not right and does not come close to offsetting the costs incurred by these professionals. At this incredibly low rate of reimbursement, the Medicare Payment Advisory Committee (MedPAC) agrees that a CNM simply cannot afford to provide services to Medicare patients and has supported increasing reimbursement for CNMs. In fact, the Commission recommended in 2002 that CNMs' reimbursement be increased and acknowledged that the care provided by these individuals is at least comparable to similar providers. My legislation would make several changes to improve the ability of CNMs and certified midwives (CMs) to effectively serve the Medicare- eligible population. First, and most importantly, my bill recognizes the need to increase Medicare reimbursement for CNMs by raising the reimbursement level from 65 percent to 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. Several states have recognized this in their Medicaid programs--approximately 29 States reimburse at 100 percent of the physician fee schedule for out-of- hospital services. In addition, the M-CARE Act would establish recognition for a certified midwife (CM) 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. My bill would change this. This bill will enhance access to ``well woman'' care for thousands of women in underserved communities and make several needed changes to improve access to midwives. I urge my colleagues to support this legislation.

Mr. CONRAD

Mr. CONRAD. Mr. President, 5 years ago, I formed the bipartisan Task Force on Tribal Colleges and Universities to raise awareness of the important role that the tribal colleges and universities play in their respective communities as educational, economic, and cultural centers. The Task Force seeks to advance initiatives that help improve the quality education the colleges provide. For more than 3 decades, tribal colleges have been providing a quality education to help Native Americans of all ages reach their fullest potential. More than 30,000 students from 250 tribes nationwide attend tribal colleges. Tribal colleges serve young people preparing to enter the job market, dislocated workers learning new skills, and people seeking to move off welfare. I am a strong supporter of our Nation's tribal colleges because, more than any other factor, they are bringing hope and opportunity to America's Indian communities. Over the years, I have met with many tribal college students, and I am always impressed by their commitment to their education, their families and their communities. Tribal colleges and universities have been highly successful in helping Native Americans obtain a higher education. Congress has recognized the importance of these institutions and the significant gains they have achieved in helping more individuals obtain their education. While Congress has steadily increased its financial support of these institutions, many challenges still remain. One of the challenges that the tribal college presidents have expressed to me is the frustration and difficulty they have in attracting qualified individuals to teach at the colleges. Recruitment and retention are difficult for many of the colleges because of their geographic isolation and low faculty salaries. To help tackle the challenges of recruiting and retaining qualified faculty, I am introducing the Tribal Colleges and Universities Faculty Loan Forgiveness Act. This legislation will provide student loan forgiveness to individuals who commit to teach for up to five years in one of the tribal colleges nationwide. Individuals who have Perkins, Direct, or Guaranteed loans may qualify to receive up to $15,000 in loan forgiveness. This will provide these institutions with extra help in attracting qualified faculty, and thus help ensure that deserving students receive a quality education. Finally, the bill also includes loan forgiveness for nursing instructors at the few tribal colleges with accredited nursing programs. Nursing instructors currently receive loans through the Department of Health and Human Services for their training. As a result, without the added provision in this bill, they would not qualify for assistance. I would be remiss if I did not recognize that former Senator Daschle was responsible for spearheading this initiative for a number of years. The tribal colleges lost a true champion, but I am pleased to carry forward his vision and support for the colleges. I am pleased that Senators Domenici, Dorgan, McCain, Bingaman, Kohl and Thune are original cosponsors of this bill, and I look forward to working with my colleagues to pass this important legislation.

Mr. CONRAD

Mr. CONRAD. Mr. President, 5 years ago, I formed the bipartisan Task Force on Tribal Colleges and Universities to raise awareness of the important role that the tribal colleges and universities play in their respective communities as educational, economic, and cultural centers. The Task Force seeks to advance initiatives that help improve the quality education the colleges provide. For more than 3 decades, tribal colleges have been providing a quality education to help Native Americans of all ages reach their fullest potential. More than 30,000 students from 250 tribes nationwide attend tribal colleges. Tribal colleges serve young people preparing to enter the job market, dislocated workers learning new skills, and people seeking to move off welfare. I am a strong supporter of our Nation's tribal colleges because, more than any other factor, they are bringing hope and opportunity to America's Indian communities. Over the years, I have met with many tribal college students, and I am always impressed by their commitment to their education, their families and their communities. Tribal colleges and universities have been highly successful in helping Native Americans obtain a higher education. Congress has recognized the importance of these institutions and the significant gains they have achieved in helping more individuals obtain their education. While Congress has steadily increased its financial support of these institutions, many challenges still remain. One of the challenges that the tribal college presidents have expressed to me is the frustration and difficulty they have in attracting qualified individuals to teach at the colleges. Recruitment and retention are difficult for many of the colleges because of their geographic isolation and low faculty salaries. To help tackle the challenges of recruiting and retaining qualified faculty, I am introducing the Tribal Colleges and Universities Faculty Loan Forgiveness Act. This legislation will provide student loan forgiveness to individuals who commit to teach for up to five years in one of the tribal colleges nationwide. Individuals who have Perkins, Direct, or Guaranteed loans may qualify to receive up to $15,000 in loan forgiveness. This will provide these institutions with extra help in attracting qualified faculty, and thus help ensure that deserving students receive a quality education. Finally, the bill also includes loan forgiveness for nursing instructors at the few tribal colleges with accredited nursing programs. Nursing instructors currently receive loans through the Department of Health and Human Services for their training. As a result, without the added provision in this bill, they would not qualify for assistance. I would be remiss if I did not recognize that former Senator Daschle was responsible for spearheading this initiative for a number of years. The tribal colleges lost a true champion, but I am pleased to carry forward his vision and support for the colleges. I am pleased that Senators Domenici, Dorgan, McCain, Bingaman, Kohl and Thune are original cosponsors of this bill, and I look forward to working with my colleagues to pass this important legislation.

Mr. CONRAD

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

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am introducing the Water Infrastructure Revitalization Act, which authorizes $60 million through the U.S. Army Corps of Engineers to assist communities in North Dakota with water supply and treatment projects. Imagine if you went to turn on your kitchen faucet one day and no water came out. This scenario became true for thousands in the communities of Fort Yates, Cannonball, and Porcupine just days before Thanksgiving in 2003. The loss of drinking water forced the closure of schools, the hospital and tribal offices for days. About 170 miles upstream, the community of Parshall faces similar water supply challenges as the water level on Lake Sakakawea continues to drop, leaving its intake high and dry. These and other communities in the State have faced significant expenditures in extending their intakes to ensure a continued supply of water. In addition, the city of Mandan faces the prospect of constructing a new horizontal well intake because changes in sediment load and flow as a result of the backwater effects of the Oahe Reservoir have caused significant siltation problems that restrict flow into the intake. These examples barely scratch the surface of the problems faced by many North Dakota communities in maintaining a safe, reliable water supply. Since 1999, the Corps of Engineers has been authorized to design and construct water-related infrastructure projects in several different States including Wisconsin, Minnesota and Montana. The State of North Dakota confronts water infrastructure challenges that are just as difficult as those in these other States. In fact, many of these challenges are caused directly by the Corps of Engineers's operations of the Missouri River dams. As a result, it is only appropriate that the Corps be part of the solution to North Dakota's water needs. The Water Infrastructure Revitalization Act would provide important supplemental funding to assist North Dakota communities with water- related infrastructure repairs. Under the act, communities could use the funding for wastewater treatment, water supply facilities, environmental restoration and surface water resource protection. Projects would be cost shared, with 75 percent Federal funding and 25 percent non-Federal in most instances. However, the bill reduces the financial burden on local communities if necessary to ensure that water rates do not exceed the national affordability criteria developed by the Environmental Protection Agency. This bill is not intended to compete with or take away funds for the construction of rural water projects under the Dakota Water Resources Act. Instead, it is meant to provide important supplemental funding for communities that are not able to receive funding from the Dakota Water Resources Act. It is my hope that this authorization will be included as part of the Water Resources Development Act. I ask my colleagues to support this legislation to address an important issue in North Dakota.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am introducing legislation to authorize the U.S. Army Corps of Engineers to construct a new municipal water supply system for the city of Devils Lake, ND. This project is very important to the reliability of the water supply for the residents of Devils Lake and is needed to mitigate long-term consequences from the rising flood waters of Devils Lake. As many of my colleagues know, the Devils Lake region has been plagued by a flooding disaster since 1993. During that time, Devils Lake, a closed basin lake, has risen more than 25 feet, consuming land, destroying homes, and impacting vital infrastructure. As a result of this disaster, the city of Devils Lake faces a significant risk of losing its water supply. Currently, 6 miles or approximately one-third of the city's 40-year-old water transmission line is covered by the rising waters of Devils Lake. The submerged section of the water line includes numerous gate valves, air relief valves, and blow-off discharges. All of the water for the city's residents and businesses must flow through this single transmission line. It is also the only link between the water source and the city's water distribution system. Since the transmission line is operated under relatively low pressures and is under considerable depths of water, a minor leak could cause significant problems. If a failure in the line were to occur, it would be almost impossible to identify the leak and make necessary repairs, and the city would be left without a water supply. The city is in the process of accessing a new water source due both to the threat of a transmission line failure and the fact that its current water source exceeds the new arsenic standard. The city has worked closely with the North Dakota State Water Commission in identifying a new water source that will not be affected by the rising flood waters and will provide the city with adequate water to meet its current and future needs. The bill will authorize the Corps to construct a new water supply system for the city. Mr. President, I believe the Federal Government has a responsibility to address the unintended consequences of this flood and mitigate its long-term consequences. This bill will help the Federal Government live up to its responsibility and ensure that the residents of Devils Lake have a safe and reliable water supply. It is my hope that this authorization will be included as part of the Water Resources Development Act. I ask my colleagues to support this legislation to address an important issue for the city of Devils Lake.

Mr. CONRAD. Mr. President, today I am introducing the Water Infrastructure Revitalization Act, which authorizes $60 million through the U.S. Army Corps of Engineers to assist communities in North Dakota with water supply and treatment projects. Imagine if you went to turn on your kitchen faucet one day and no water came out. This scenario became true for thousands in the communities of Fort Yates, Cannonball, and Porcupine just days before Thanksgiving in 2003. The loss of drinking water forced the closure of schools, the hospital and tribal offices for days. About 170 miles upstream, the community of Parshall faces similar water supply challenges as the water level on Lake Sakakawea continues to drop, leaving its intake high and dry. These and other communities in the State have faced significant expenditures in extending their intakes to ensure a continued supply of water. In addition, the city of Mandan faces the prospect of constructing a new horizontal well intake because changes in sediment load and flow as a result of the backwater effects of the Oahe Reservoir have caused significant siltation problems that restrict flow into the intake. These examples barely scratch the surface of the problems faced by many North Dakota communities in maintaining a safe, reliable water supply. Since 1999, the Corps of Engineers has been authorized to design and construct water-related infrastructure projects in several different States including Wisconsin, Minnesota and Montana. The State of North Dakota confronts water infrastructure challenges that are just as difficult as those in these other States. In fact, many of these challenges are caused directly by the Corps of Engineers's operations of the Missouri River dams. As a result, it is only appropriate that the Corps be part of the solution to North Dakota's water needs. The Water Infrastructure Revitalization Act would provide important supplemental funding to assist North Dakota communities with water- related infrastructure repairs. Under the act, communities could use the funding for wastewater treatment, water supply facilities, environmental restoration and surface water resource protection. Projects would be cost shared, with 75 percent Federal funding and 25 percent non-Federal in most instances. However, the bill reduces the financial burden on local communities if necessary to ensure that water rates do not exceed the national affordability criteria developed by the Environmental Protection Agency. This bill is not intended to compete with or take away funds for the construction of rural water projects under the Dakota Water Resources Act. Instead, it is meant to provide important supplemental funding for communities that are not able to receive funding from the Dakota Water Resources Act. It is my hope that this authorization will be included as part of the Water Resources Development Act. I ask my colleagues to support this legislation to address an important issue in North Dakota.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am introducing legislation to authorize the U.S. Army Corps of Engineers to construct a new municipal water supply system for the city of Devils Lake, ND. This project is very important to the reliability of the water supply for the residents of Devils Lake and is needed to mitigate long-term consequences from the rising flood waters of Devils Lake. As many of my colleagues know, the Devils Lake region has been plagued by a flooding disaster since 1993. During that time, Devils Lake, a closed basin lake, has risen more than 25 feet, consuming land, destroying homes, and impacting vital infrastructure. As a result of this disaster, the city of Devils Lake faces a significant risk of losing its water supply. Currently, 6 miles or approximately one-third of the city's 40-year-old water transmission line is covered by the rising waters of Devils Lake. The submerged section of the water line includes numerous gate valves, air relief valves, and blow-off discharges. All of the water for the city's residents and businesses must flow through this single transmission line. It is also the only link between the water source and the city's water distribution system. Since the transmission line is operated under relatively low pressures and is under considerable depths of water, a minor leak could cause significant problems. If a failure in the line were to occur, it would be almost impossible to identify the leak and make necessary repairs, and the city would be left without a water supply. The city is in the process of accessing a new water source due both to the threat of a transmission line failure and the fact that its current water source exceeds the new arsenic standard. The city has worked closely with the North Dakota State Water Commission in identifying a new water source that will not be affected by the rising flood waters and will provide the city with adequate water to meet its current and future needs. The bill will authorize the Corps to construct a new water supply system for the city. Mr. President, I believe the Federal Government has a responsibility to address the unintended consequences of this flood and mitigate its long-term consequences. This bill will help the Federal Government live up to its responsibility and ensure that the residents of Devils Lake have a safe and reliable water supply. It is my hope that this authorization will be included as part of the Water Resources Development Act. I ask my colleagues to support this legislation to address an important issue for the city of Devils Lake.

Mr. CONRAD

Mr. CONRAD. Mr. President, I urge my colleagues to oppose cloture on this matter. I think this is a well-intentioned amendment, but it does virtually nothing about the deficit. What it does do is transfer power from the Congress of the United States to the White House. What it will set up, I say to my colleagues, with this President perhaps, and with some future President for certain, is a circumstance in which the President will be able to leverage Members of this body on completely unrelated issues because of his unchecked power to line-item veto provisions in appropriations bills. That is a profound mistake for this body. The Founding Fathers set up this separation of power very carefully. They put the power of the purse in the Congress. They did that because they were concerned about the extraordinary power that the Kings had in Europe. They never wanted to replicate that here. Mr. President, that is exactly the formula that has helped America be the preeminent power in the world--the strongest economic power and the strongest military power. We should not alter that relationship by granting this increased power to this President or any future President. I urge my colleagues to oppose cloture.

Mr. CONRAD. Would the Senator from Massachusetts like to go first?

Mr. CONRAD. I thank the Chair. I ask the Chair to inform me when I have consumed 10 minutes. Mr. President, I thank my colleague from Texas for his remarks about Senator Gregg and me and our proposal to try to work on the overall major challenges facing us, which are long-term fiscal imbalances that are especially affected by the entitlement programs and the baby boom generation and the existing structural deficit we confront. We are engaged in a good-faith effort to try to address these long-term challenges. We were at breakfast together yesterday discussing those. I appreciate the Senator from Texas mentioning that. With respect to this specific proposal, I don't think it merits our support. In fact, it is a very serious mistake to go in this direction. This amendment is actually dangerous. I say that with great respect to the former chairman of the Budget Committee who has offered the amendment. I believe it is dangerous because this transfers power in a way the Founding Fathers did not envision and would not have supported. The power of the purse resides in the Congress of the United States because the Founding Fathers recognized that putting too much power in the hands of one person was a dangerous matter. Here are the things that are wrong with this line-item veto proposal. I will go on to address the big differences between the Daschle proposal and this one, but here is what is wrong with this line-item veto proposal: It represents an abdication of congressional responsibility; it shifts too much power to the executive branch, with very little impact on the deficit; it provides the President up to a year to submit rescission requests; requires Congress to vote within 10 days; provides no opportunity for extended debate; and allows the President to cancel new mandatory spending passed by Congress, such as those dealing with Social Security, Medicare, veterans, and agriculture. That is breathtaking power. In fact, we could have this negotiation that the Senator from Texas was referencing between Democrats and Republicans on what has to be done to the long-term circumstance with Social Security and Medicare, we could reach a bipartisan conclusion, and then the President would have the unilateral power to come back and cherry-pick those provisions he didn't like. No President should be given that power. Let's talk about the line-item veto. This is what USA Today said in an editorial last year: It is a convenient distraction. The vast bulk of the deficit is not the result of self- aggrandizing line items, infuriating as they are. The deficit is primarily caused by unwillingness to make hard choices on benefit programs or to levy the taxes to pay for the true costs of government. This is an article from the Roanoke Times last year: [T]he President already has the only tool he needs: The veto. He has veto power. He can veto any one of these spending bills. He has chosen not to veto a single one. That Bush has declined to challenge Congress in five-plus years is his choice. The White House no doubt sees reviving this debate as a means of distracting people from the missteps, miscalculations, mistruths and mistakes that have dogged Bush and sent his approval rating south. The current problems are not systemic; they are ideological. A line-item veto will not magically grant lawmakers fiscal discipline and economic sense. On the question of whether this has any effect on the deficit, this is the Acting CBO Director last year before the Congress, his testimony: Such tools, however, cannot establish fiscal discipline unless there is political consensus to do so . . . In the absence of that consensus, the proposed changes to the rescission process . . . are unlikely to greatly affect the budget's bottom line. This is from CQ, Congressional Quarterly, again of last year: Passage of [the line item veto] legislation would be ``a political victory that would not address long-term problems posed by growing entitlement programs,'' Gregg said. Senator Gregg himself said this would be ``a political victory that would not address long-term problems posed by growing entitlement programs.'' He also said this last year in a separate publication: Senator Gregg said it would have ``very little impact on the budget deficit.'' He is right. The impact it would have is to transfer enormous power to the President. I am not just talking about this President, I am talking about any future President. This is what George Will, a conservative commentator, said: It would aggravate an imbalance in our constitutional system that has been growing for seven decades: The expansion of executive power at the expense of the legislature. Here is what an American Enterprise Institute scholar said about the line-item veto last year: The larger reality is that this proposal gives the President a great additional mischief making capability, to pluck out items to punish lawmakers he doesn't like, or to threaten individual lawmakers to get votes on other things, without having any noticeable impact on budget growth or restraint. He went on to say: More broadly, it simply shows the lack of institutional integrity and patriotism by the majority in Congress. They have lots of ways to put the responsibility on budget restraint where it belongs--on themselves. Instead, they willingly, even eagerly, try to turn their most basic power over to the President. Shameful, just shameful. On the question of the previous Daschle proposal, the suggestion that they are the same is not true. They are fundamentally different. The context is totally different as well. The Daschle amendment was offered in juxtaposition to another line-item veto proposal that was clearly unconstitutional--in fact, was judged to be so by the U.S. Supreme Court. So the Daschle proposal was an attempt to defeat a proposal which was clearly unconstitutional and which has been subsequently judged unconstitutional. But the further claim that the Gregg proposal before us now and the Daschle proposal are the same is clearly not correct. Let me ask three questions and give answers with respect to how the two differ. Can the President propose to rescind new mandatory items such as Social Security and Medicare reforms? Under the Gregg proposal, yes; under the Daschle proposal, no. That is a profound difference. Can you imagine if we were to reach an accommodation and agreement on long-term differences on these mandatory programs--Medicare, Social Security, agriculture, veterans--and then the President has the unilateral ability to go change it? I don't think so. That is not a direction we should take if we are going to have good-faith negotiation. No. 2, can the President propose rescissions from multiple bills in one rescissions package? Under the Gregg proposal, the answer to that question is yes. Under the Daschle proposal, the answer was no. Why does that matter? The President could take something that was very unpopular--for example, the bridge to nowhere--remember that? We had the debate last year about the bridge to nowhere. A handful of us voted against that bridge to nowhere, by the way. I voted against it. The President could have taken that proposal and combined it with a proposal that was important to an individual Member and that might have great merit, and he could combine the two and kill the one with the other. Let's be blunt. The President would have the ability to call a Member or have his staff call a Member and say: Look, I have a very controversial judge up there. I need your vote. And by the way, I am considering a project in your State that is critically important to you. I am going to have to line-item veto that. But I might be persuaded not to if I could have your support on this other matter. That is exactly what the Founding Fathers were concerned about--handing that kind of power to a President, that kind of power over an individual Member. That is a dangerous notion. It has been ruled unconstitutional in the past. I believe this would be ruled unconstitutional. I thank the Chair and yield the floor.

Mr. CONRAD. Mr. President, will the Chair inform me how much time is left on the Republican side?

Mr. CONRAD. How much time remains on either side?

Mr. CONRAD

Mr. CONRAD. Mr. President, I hope colleagues have been listening to the Senator from West Virginia, Mr. Byrd. He is a wise man. He is an experienced man. And what he has been warning this body about this amendment is the truth. This is a dangerous amendment. It is offered by somebody with whom I work closely. Senator Gregg is the former chairman of the Budget Committee. As the incoming chairman of the Budget Committee, we work together virtually every day. I respect him. I like him. But I believe this amendment is profoundly dangerous. It is suggested that this amendment will help deal with our budget shortfall. It will not. Virtually everyone who has examined it will say it makes virtually no difference with respect to our deficits and debt. What it will do, without question, is transfer power to the President of the United States. Senator Byrd has made it clear that it is not a question of this President; it is a question of any President. Make no mistake, I believe this measure and any measure like it is unconstitutional. The Founding Fathers had great wisdom. They did not want to repeat the abuses of the King, so they wanted the spending to be in the hands of the bodies closest to the people--the House of Representatives and the U.S. Senate. They did not want any individual, any President, to have the power of the purse because they recognized the inherent dangers in concentrating power in the hands of one person. Anybody who has any doubt about how this would be used--perhaps by this President but certainly by some President--only needs to reflect on what has happened in the past when people had this kind of unchecked power. I was told by a colleague of ours who served in a State legislature about a situation where the Governor had this kind of power. She got legislation passed that was very important to her. She was called to the Governor's office, and the Governor had her legislation on one side of his desk and a bill he wanted on the other side of his desk. He told her: You know, I am probably going to have to line-item veto your legislation. But I have this bill which is important to me, and if you could see your way clear on that, I might be able to help you on your legislation. Anyone who doubts this President or a future President would use that power on Members of this body ought to think again. The problems with this line-item veto proposal--and we know line-item veto proposals in the past have been declared unconstitutional by the Supreme Court. I believe this measure would be declared unconstitutional, but we shouldn't abdicate our responsibility. We shouldn't wait for the Supreme Court to make a judgment. We should make this judgment. This line-item veto proposal represents an abdication of congressional responsibility. It shifts too much power to the executive branch, and with very little impact on the deficit. It provides a President up to 1 year to submit rescission requests. It requires Congress to vote within 10 days. It provides no opportunity to filibuster proposed rescissions. And it allows a President to cancel new mandatory spending proposals passed by Congress, such as those dealing with Social Security, Medicare, veterans, and agriculture. Colleagues, that is an extraordinary grant of power to any President. Just with this final piece on mandatory spending, we know we have big problems in the future with Medicare and Social Security. We might labor for months to come to an agreement with the President on the future of those programs, and then under this amendment, after the difficult compromises had been reached, this President or a future President could go back and cherry-pick the provisions he or she did not like. I hope colleagues are listening. That is truly an extraordinary grant of power to this President or any President. Here is what USA Today said last year in reference to line-item veto. They called it a convenient distraction. The vast bulk of the deficit is not the result of self- aggrandizing line items, infuriating as they are. The deficit is primarily caused by unwillingness to make hard choices on benefit programs or to levy the taxes to pay for the true cost of government. A convenient distraction. This is what the Roanoke Times said last year with respect to this or a similar proposal: The President already has the only tool he needs: the veto. That Bush has declined to challenge Congress in five-plus years is his choice. The White House no doubt sees reviving this debate as a means of distracting people from the missteps, miscalculations, mistruths, and mistakes that have dogged Bush and sent his approval rating south. The current problems are not systemic; they are ideological. A [line-item] veto will not magically grant lawmakers and the President fiscal discipline and economic sense. Here is what the former Acting CBO Director, Mr. Marron, said in testimony before the House last year about line-item veto: Such tools, however, cannot establish fiscal discipline unless there is a political consensus to do so . . . In the absence of that consensus, the proposed changes to the rescission process . . . are unlikely to greatly affect the budget's bottom line. The proponent of this amendment said this last year: Passage of the [line-item veto] legislation would be a ``political victory'' that would not address long-term problems posed by growing entitlement programs. This is the statement of the author of this amendment last year. He went on to say further: It would have ``very little impact'' on the budget deficit. He was telling the truth. Here is what a conservative columnist said about the line-item veto proposal, George Will. It would aggravate an imbalance in our constitutional system that has been growing for seven decades: The expansion of executive power at the expense of the legislature. I hope colleagues are listening. I truly believe this is a dangerous amendment. A scholar at the American Enterprise Institute went even further and called the proposal ``shameful.'' This is what he said: The larger reality is that this [line-item] veto proposal gives the President a great additional mischief-making capability, to pluck out items to punish lawmakers he doesn't like, or to threaten individual lawmakers to get votes on other things, without having any noticeable impact on budget growth or restraint. I hope colleagues are listening. We are going to have a change in President in 2 years. This amendment might live forever and fundamentally erode the basic concept of a House and a Senate and the division of powers between the legislative branch and the executive branch. Mr. Ornstein, from the American Enterprise Institute, went on to say: More broadly, it simply shows the lack of institutional integrity and patriotism by the majority in Congress. They have lots of ways to put the responsibility of budget restraint where it belongs--on themselves. Instead, they willingly, even eagerly, try to turn their most basic power over to the President. Shameful, just shameful. That was last year. Senator Gregg has indicated his proposal closely tracks the proposal of our colleague, Senator Daschle, from 1995. It does not. There are significant differences. Can the President propose to rescind a few mandatory items, such as Social Security and Medicare reforms? The Gregg proposal, yes; Senator Daschle, no. That is a profound difference. Mandatory proposals would be subject to the President's line-item veto under the Gregg amendment, not under the Daschle amendment. That proposal alone is enough to lead anyone who supported the Daschle proposal to oppose this one. Second, can the President propose rescissions from multiple bills in one rescissions package? Under the Gregg measure, yes; under the Daschle proposal, no. What difference does that make? Let me give an example. Remember the bridge to nowhere? That was something that people responded to, depending on its merits. A lot of people thought it was a waste of money. The President could couple that measure, which many would have supported in terms of elimination, with something that was less well- known that really had merit. Under the Gregg proposal, you could jackpot unpopular things with popular things and get them eliminated, giving the President an extraordinary power to leverage individual Members of Congress to get votes from them on completely unrelated matters. For example, maybe the President puts up a controversial judge and then uses this power to leverage a Senator to vote for a judge that he might not otherwise support in exchange for allowing that Senator's spending proposal to go forward. That is a dangerous power. Finally, how long does the President have to propose rescissions? Under the Daschle proposal, 20 days, or in the next budget; under the Gregg proposal, 1 year. I truly believe this is an extraordinarily dangerous amendment. It is dangerous to the balance of powers between the executive branch and the legislative branch of Government. It is an extraordinary granting of power to a President. Remember, the next President might be of a different party. I would make this same speech if a Democrat were advancing it. I would make this same speech if a Democrat were the President of the United States. This is a dangerous amendment. It will do virtually nothing about our deficit, but it will transfer power to a President who already has too much power. I hope my colleagues pay very close attention to this debate. I hope they reject the Gregg amendment. I thank the chairman and ranking member for their extraordinary courtesy today to allow this discussion to go forward before they have even given their opening remarks. That is truly extraordinary in terms of their graciousness. And we appreciate Senator Kennedy and Senator Enzi.

Mr. CONRAD. Yes.

Mr. CONRAD

Mr. CONRAD. Mr. President, I ask unanimous consent that S. Res. 32 be discharged from the Rules Committee and referred to the Committee on Small Business and Entrepreneurship.

Mr. CONRAD. I thank the Chair. I yield the floor and note the absence of a quorum.

Mr. CONRAD

Mr. CONRAD. Madam President, I join with my colleagues who were part of the delegation to Bolivia, Ecuador, and Peru. I also salute the majority leader, Senator Reid, for making as his first trip as majority leader one to these countries in our hemisphere. I think it sent a very important signal to those countries that America is interested in them, that America cares about them, and that we want to improve relations with them. It did make an impression. In country after country, people told us they could not remember the last time a Senate delegation from the United States had come. They could not recall a delegation of this size and this significance coming. You could tell it made an impression. Now, why was it important to go? I believe it was important to go because, first, we see Mr. Chavez, the head of Venezuela, attempting to put together an anti-American bloc in our Southern Hemisphere. Even a casual observer can see that is being attempted. After going to these countries and meeting with the Presidents of each--President Morales, President Correa, President Garcia, and their cabinets--meeting with our Ambassadors in each of the countries--our outstanding Ambassador to Bolivia, Philip Goldberg, our Ambassador to Ecuador, Linda Jewell, who impressed us all with her professionalism, and our Ambassador to Peru, James Struble, deeply knowledgeable, someone who has had wide-ranging experience all around the world--I can tell my colleagues that one of my impressions from this trip was the absolute excellence of our Foreign Service people in each of these countries. They were superb. But I was also deeply impressed by how serious Mr. Chavez is about putting together an anti-American block. In one country, he is buying 30 radio stations, putting up 30 radio stations to influence public opinion. In other countries, he had interceded in the elections--some directly, others indirectly--in order to try to achieve a result. In fact, in Peru, he went so far as to openly endorse the candidate who lost to Mr. Garcia. It is very clear, if one goes country to country--Bolivia, Peru, and Ecuador--that Mr. Chavez is working actively and, I might say, hand in glove with the Cubans, to try to influence outcomes there. We see, and have seen in recent weeks, Mr. Chavez take a series of steps, in terms of expropriation, that I think ought to send a message about his intentions. This delegation consisted of the majority leader, Senator Reid, Senator Durbin, the majority whip, Senator Bennett, at the time of the trip the chairman of the Joint Economic Committee, Senator Gregg, at the time of the trip chairman of the Budget Committee, and Senator Salazar, who really did light up the faces of people in these countries as he speaks such perfect Spanish. One could tell what a difference that makes. My wife speaks some Spanish as well. Of course, Senator Salazar's wife is very fluent in Spanish. One could see how it lit up people's faces when those three members of our delegation spoke Spanish. In addition to the question of Mr. Chavez and his plans to create an anti-American bloc there were other important reasons for this trip. On trade, we have the Andean Trade Preferences Act that will expire. It was only extended for 6 months in the last Congress. Make no mistake, that Trade Preferences Act is critically important to the economies of these three countries. Literally, hundreds of thousands of jobs in those countries are at stake if the Andean Trade Preferences Act is not extended. I know there is some controversy attached to it, but if one sees the potential outcomes of a failure to extend the Andean Trade Preferences Act, one can see that the pressure for more people to come to this country will intensify and intensify dramatically. That is not in our interest. We already have millions of people from these three countries who are in our country, many of them illegally. That is a fact. If we want millions more to come, one way to assure that is to turn a blind eye to what is needed for those countries to have a chance to suceed. In country after country--these three countries--we learned that half the people are living on less than $2 a day. We are talking millions of people living on less than $2 a day. We saw poverty that was akin to walking back into time. People are living at a level of subsistence that is almost unimaginable, certainly unimaginable in our country. We have areas of great poverty, but to see people living literally in hovels and huts without electricity, without a clean water supply, other than a river flowing by, without sewage, without anything other than the most meager subsistence kind of life is jolting. A dramatic proportion of their populations being in that condition sends a very sobering signal about the challenge facing this hemisphere. So I think it was very important that Senator Reid chose as his first trip to go to countries such as Bolivia. Bolivia is the second poorest country in our hemisphere. Only Haiti is poorer. One of the reasons we learned that delegations are not necessarily eager to go to these countries is because they are at 13,000 feet, 11,000 feet, and it takes a little adjustment to get used to it. One spends part of the time walking around with a headache. These are not places that are the first on most people's list of where they want to go. The fact that Senator Reid chose this as the first place that he would take a delegation sent an important message. Not only do we have this challenge of Mr. Chavez in Venezuela and the question of the Andean Trade Preferences Act that runs out because it was only extended 6 months in the last Congress, we also have the free- trade agreement with Peru pending. That is a controversial matter. We understand that. In the House and the Senate, that is a controversial matter. We have been assured by the trade ambassador's office that they will seek to negotiate some of the labor provisions of that agreement in order to make it more acceptable and have a greater chance of passage. I welcome that indication from the trade ambassador's office, and I hope they pursue it aggressively. Still another important reason for this delegation going to Bolivia, Ecuador, and Peru is, of course, most of the illicit drug traffic comes out of the Andean region. Bolivia is increasingly a factor. Most of their product has not come to the United States, as Senator Gregg indicated, but we all know that the drug trade, once it rears its ugly head, has spillover effects everywhere. Peru, obviously, is an important drug-trafficking location, and President Garcia assured us of his absolute commitment to fight the drug trade. In fact, they told us of a commitment they had made in their budget to spend their money combating illicit drug trade in their country because they recognize the toxic and corrosive effect it will have in their society. We should salute President Garcia for stepping to the plate and committing funds in a place that is very hard pressed for money, as we are in a different way, that they are committing their own money to combating the illicit drug trade and at some substantial risk to themselves. Let's be clear, those drug cartels are vicious, they are murderous, and they are not averse to taking lives from those who oppose them. I want to indicate one exchange we had that I believe gives an example of why it is important to do this kind of outreach. In Bolivia, we heard rumors, discussions that the Government there believed there was a plot by the United States to destabilize the Morales Government. When we met with President Morales, I raised that issue with him. I said: We have heard repeatedly you have concerns that there is a move by our Government to destabilize yours. I was able to tell him that our delegation had quizzed all aspects of our Government very closely on that question before we went into the meeting with him, and we were assured in significant detail that there is no such plan by our Government to destabilize the Morales Government, that, in fact, there has been no discussion of any move to destabilize his Government. He became very animated at that point and went through a series of examples of events that told him or at least that gave him concern that perhaps there is a plot by our Government to destabilize them. He was very specific. He talked about an American who went into the country and set off bombs in La Paz last year. He gave as a second example of American students who had taken his picture when he was with President Hugo Chavez of Venezuela. He believed that was perhaps part of an American Government enterprise to spy on him. He cited the example of his Vice President being denied boarding rights to an American airliner. He felt all of these events were indicators--at least indicators to him--that perhaps the United States was seeking to destabilize his Government. Ambassador Goldberg was able to go through each of these examples with him and give him answers as to why these events had nothing to do with the United States. In the case of the American who set off bombs in La Paz, this is somebody traveling on a world federalist passport, illegal documents, had nothing to do with the United States--in fact, was an unstable person and recognized as such by our Government. On the question of the pictures being taken of President Chavez and President Morales, our Ambassador indicated that these were people who were fans of the two and were simply tourists taking pictures. On the question of boarding being denied the Vice President on an American airline, the Ambassador was able to point out that our Government then moved to make it right by providing our aircraft so that the Vice President of Bolivia could make the trip to the United States. I believe this trip was important in sending a signal. It was an important chance to communicate clearly and directly our interest in the region and our desire to improve relations. I am not naive. I don't think one trip is going to change the course of history. We know that there are serious challenges on our Southern border, but reaching out, talking with people, indicating that we have an interest in improving relations, sending a signal that the majority leader of the Senate, in his first foreign trip, is coming to these countries--impoverished countries, countries that are not exactly on the list of countries that people might visit--I think was important and productive. I thank the majority leader for leading this delegation. I thank the other Members. My wife and I found it an exceptional group of people. The people who were on this delegation--Senator Reid, Senator Durbin, Senator Bennett, Senator Gregg, and Senator Salazar--did an exceptional job of representing this country. I thank the Chair and yield the floor.

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, today I am introducing legislation that would take steps to protect access to long-term care hospitals while ensuring that these institutions are admitting the appropriate type of patients. I am pleased to be introducing the bill along with my colleague, Senator Hatch, and I urge my colleagues to consider cosponsoring this cost-saving proposal. Long Term Acute Care hospitals, or LTAC hospitals, serve a vital role in the Medicare program by providing care to beneficiaries with clinically complex conditions that need hospital care for extended periods of time. These are patients who are too sick to go home or even to a skilled nursing facility, but are stable enough to be released from an intensive care unit. I am happy to have two of these hospitals in North Dakota, one in Fargo and one in Mandan. Together, these two hospitals employ several hundred people and provide care to thousands of North Dakotans. They are a vital part of the North Dakota continuum of care. While these hospitals provide important health services to very frail individuals, the Centers for Medicare and Medicaid Services (CMS) has become concerned with the growth in these facilities. In 2006, there were 400 LTAC hospitals, compared to 100 in 1996. In addition, the agency has also expressed concern that some LTAC hospitals are admitting patients that may be better served by nursing homes or another level of care. As a result, CMS has begun to arbitrarily cut LTAC hospital payments across-the-board. As Chairman of the Budget Committee, I have a unique appreciation for the enormous fiscal challenges that face our country and respect CMS's efforts to reduce growth in Medicare. However, any cuts in spending should be targeted at waste and abuse. We should address the growth in LTAC hospitals, but we also want to ensure that there is a place for patients who truly need long-term hospital stays. The legislation I'm introducing today is a first step in clarifying Congressional intent and giving CMS clearer definitions of what is and is not a LTAC hospital and what type of patient should be admitted to these facilities. At the heart of this bill is a provision that limits the types of patients who can be admitted to LTAC hospitals to those who truly need the specialized care these facilities provide. LTAC hospitals like those in my state that admit only very sick patients will not be significantly affected. But, by eliminating abuses by those facilities that have been receiving generous payments for patients who do not require this sort of specialized care, this provision of the bill would significantly reduce Medicare spending on LTAC hospitals. It was not easy for the LTAC hospitals in North Dakota and across the country to support legislation that restricts their payments, but I compliment them for working with me to put forward a constructive public policy proposal. In particular, I want to recognize Custer Huseby, Chief Executive Officer of SCCI Hospital in Fargo. He understands that the status quo is no longer defensible and has fought to put forward a workable solution that maintains access to these vital facilities, where they are appropriate. I also want to thank Chip Thomas and Karen Haskins of the North Dakota Healthcare Association, who have partnered with Mr. Huseby to support this legislation. Long-term care hospitals serve a vital role in our health care system, and we must protect access to these facilities for those who truly need it. But, we can also take responsible steps to ensure that our federal tax dollars are well spent and directed to the most appropriate level of care. I believe my legislation achieves this balance and urge my colleagues to support this measure.

Mr. CONRAD

Mr. CONRAD. Mr. President, today I am introducing legislation that would take steps to protect access to long-term care hospitals while ensuring that these institutions are admitting the appropriate type of patients. I am pleased to be introducing the bill along with my colleague, Senator Hatch, and I urge my colleagues to consider cosponsoring this cost-saving proposal. Long Term Acute Care hospitals, or LTAC hospitals, serve a vital role in the Medicare program by providing care to beneficiaries with clinically complex conditions that need hospital care for extended periods of time. These are patients who are too sick to go home or even to a skilled nursing facility, but are stable enough to be released from an intensive care unit. I am happy to have two of these hospitals in North Dakota, one in Fargo and one in Mandan. Together, these two hospitals employ several hundred people and provide care to thousands of North Dakotans. They are a vital part of the North Dakota continuum of care. While these hospitals provide important health services to very frail individuals, the Centers for Medicare and Medicaid Services (CMS) has become concerned with the growth in these facilities. In 2006, there were 400 LTAC hospitals, compared to 100 in 1996. In addition, the agency has also expressed concern that some LTAC hospitals are admitting patients that may be better served by nursing homes or another level of care. As a result, CMS has begun to arbitrarily cut LTAC hospital payments across-the-board. As Chairman of the Budget Committee, I have a unique appreciation for the enormous fiscal challenges that face our country and respect CMS's efforts to reduce growth in Medicare. However, any cuts in spending should be targeted at waste and abuse. We should address the growth in LTAC hospitals, but we also want to ensure that there is a place for patients who truly need long-term hospital stays. The legislation I'm introducing today is a first step in clarifying Congressional intent and giving CMS clearer definitions of what is and is not a LTAC hospital and what type of patient should be admitted to these facilities. At the heart of this bill is a provision that limits the types of patients who can be admitted to LTAC hospitals to those who truly need the specialized care these facilities provide. LTAC hospitals like those in my state that admit only very sick patients will not be significantly affected. But, by eliminating abuses by those facilities that have been receiving generous payments for patients who do not require this sort of specialized care, this provision of the bill would significantly reduce Medicare spending on LTAC hospitals. It was not easy for the LTAC hospitals in North Dakota and across the country to support legislation that restricts their payments, but I compliment them for working with me to put forward a constructive public policy proposal. In particular, I want to recognize Custer Huseby, Chief Executive Officer of SCCI Hospital in Fargo. He understands that the status quo is no longer defensible and has fought to put forward a workable solution that maintains access to these vital facilities, where they are appropriate. I also want to thank Chip Thomas and Karen Haskins of the North Dakota Healthcare Association, who have partnered with Mr. Huseby to support this legislation. Long-term care hospitals serve a vital role in our health care system, and we must protect access to these facilities for those who truly need it. But, we can also take responsible steps to ensure that our federal tax dollars are well spent and directed to the most appropriate level of care. I believe my legislation achieves this balance and urge my colleagues to support this measure.