Susan Collins

Ms. COLLINS

Ms. COLLINS. I do not wish to yield at this point. I would like to conclude my statement. We do need strong remedies to prevent HMOs from denying needed care. There is no dispute over that point. All of us are deeply troubled by cases in which an HMO has acted in a way that was not in the best interest of the patient. That is not what this debate is about. The debate is about the best way to solve those problems, to ensure that every patient gets the care that he or she needs when they need it. That is what the debate is about. That is why a strong, independent, and binding appeals process is critical to ensure that patients get the care they need when they need it; that they get the care they were promised. They should not have to hire an attorney and file a lawsuit to get the health care they need. They just can't sue their way to quality care. That is why the key is to make sure that we have an appeals process that is binding, that is independent, and that will force the HMO to provide the care that has been promised. I am particularly concerned that the liability provisions in the McCain-Kennedy bill, as currently drafted, could well discourage employers that currently voluntarily provide health insurance to 172 million employees and their families from continuing to offer coverage. While the McCain-Kennedy bill claims to protect employers, the fact is, as I read the bill, they would be subject to both new Federal and State lawsuits authorized under the bill. Under the McCain-Kennedy bill, a trial lawyer just needs to allege that an employer directly participated in a medically reviewable decision to force that employer to court. The direct participation standard in S. 1052 does not shield employers from being sued. It simply gives them a defense that they can raise in court. Being subject to such lawsuits will be particularly hard, potentially ruinous for small business owners who cannot afford the tens of thousands of dollars they would have to spend on attorney's fees to fight these kinds of cases in court. Many Maine employers have expressed their serious concerns about the liability and scope provisions of the McCain-Kennedy bill. I met, for example, with the assistant director of human resources at Bowdoin College who talked about how moving to a self-funded ERISA plan enabled the college to continue to offer affordable coverage to Bowdoin employees when premiums for their fully insured plan skyrocketed in the late 1980s. Since they were self-funded, they were actually able to lower their premiums for their employees and at the same time enhance their benefit package with such features as well-baby care, free annual physicals, and prescription drug cards with low copayments. They told me that a proposal such as the one before us today could seriously jeopardize their ability to offer affordable coverage for their employees. Similar concerns have been expressed by the Maine Municipal Association, L.L. Bean, Bath Iron Works, and many other very responsible Maine employers that care deeply about providing the best possible health insurance for their employees. Even though S. 1052 is certain to drive up health insurance costs, it also does nothing to expand access to affordable health insurance. In fact, by driving up costs, it jeopardizes health insurance coverage for people who already have it and puts the cost further out of reach for those who lack it now. As we proceed with our consideration of legislation to protect patients' rights, we should also be considering ways to expand access to coverage for millions more Americans by making health insurance more affordable. As the Presidential Advisory Commission on Consumer Protection and Quality noted in its report which was done for President Clinton, I note: Costs matter. Health coverage is the best consumer protection. As we proceed in this very important debate, I hope we can continue to work to improve S. 1052 so that it truly protects patients without jeopardizing their insurance coverage and without wiping out the good work of the States. I was encouraged today by a conversation with Senator McCain in which he indicated that he is very open to resolving some of the problems I have raised in my statement. I hope that we can work together, and at the end of the day I hope we can approve, by an overwhelming vote, a responsible Patients' Bill of Rights that will help ensure that patients receive the care they need, when they need it, without having to resort to hiring an expensive lawyer and filing a lawsuit. That should be a goal that should unite us all. I look forward to the upcoming debate. I think it is an important one. I hope we can come together on a bipartisan bill that the President will sign, that will make a real difference in the health care for America's patients.

Ms. COLLINS. I am happy to yield to my friend from Massachusetts.

Ms. COLLINS. Mr. President, I have worked very closely with the Maine Medical Association on a variety of issues. I know that while they do want to see liability provisions similar to those of the Senator, they are very concerned about the issue I raised about the preemption of Maine's law. Maine has been very active in passing a number of laws to provide consumer protections. They are carefully balanced laws. On this chart, there is a check mark all the way across. I know the Maine Medical Association was very involved with the legislature in negotiating those provisions. They are concerned about the preemption of Maine's laws which they helped to draft.

Ms. COLLINS. My friend from Massachusetts may not have heard me when I said earlier--and I don't expect him to be on the edge of his chair through every moment, but I made very clear that my hope is that we can come together on this important issue. It is important, and I think it is unfortunate that we didn't get through a conference on the Patients' Bill of Rights last year. Then we would have had these protections already in place. It is a shame that last year when we had agreement on 90 percent of the bill, we didn't enact it. Senator Breaux of Louisiana and I suggested just that approach. So I look forward to continuing to work with my colleagues on both sides of the aisle. Just at noontime today, I had a discussion with Senator McCain and he indicated an openness to solving some of the problems I have outlined in my statement. The Senator from Massachusetts knows I always enjoy working very closely with him. So I look forward to that because my goal is that we can pass a bill that does the job on which we all agree, and yet that would not preempt States' laws when States are doing a good job, and that would not cause health insurance costs to rise to the point where we jeopardize coverage altogether. I know those are goals we share, and I hope we can indeed work closely together.

Ms. COLLINS

Ms. COLLINS. Mr. President, reserving the right to object, I will not object. I wonder if we could add ``or their designee.''

Ms. COLLINS. Mr. President, I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am pleased to join my good friend and colleague from Wisconsin, Senator Russ Feingold, in introducing legislation to improve access to oral health care by strengthening the dental workforce in our Nation's rural and underserved communities. Oral and general health are inseparable, and good dental care is critical to our overall physical health and well-being. Dental health encompasses far more than cavities and gum disease. The recent U.S. Surgeon General report Oral Health in America states that ``the mouth acts as a mirror of health and disease'' that can help diagnose disorders such as diabetes, leukemia, heart disease, or anemia. While oral health in America has improved dramatically over the last 50 years, these improvements have not occurred evenly across all sectors of our population, particularly among low-income individuals and families. Too many Americans today lack access to dental care. While there are clinically proven techniques to prevent or delay the progression of dental health problems, an estimated 25 million Americans live in areas lacking adequate dental services. As a consequence, these effective treatment and prevention programs are not being implemented in many of our communities. Astoundingly, as many as eleven percent of our Nation's rural population has never been to the dentist. This situation is exacerbated by the fact that our dental workforce is graying and the overall ratio of dentists to population is declining. In Maine, there currently are 393 active dentists, 241 of whom are 45 or older. More than 20 percent of dentists nationwide will retire in the next ten years and the number of dental graduates by 2015 may not be enough to replace these retirees. As a consequence, Maine, like many States, is currently facing a serious shortage of dentists, particularly in rural areas. While there is one general practice dentist for every 2,286 people in the Portland area, the numbers drop off dramatically in western and northern Maine. In Aroostook County, where I'm from, there's only one dentist for every 5,507 people. Moreover, at a time when tooth decay is the most prevalent childhood disease in America, Maine has fewer than ten specialists in pediatric dentistry, and most of these are located in the southern part of the State. This dental workforce shortage is exacerbated by the fact that Maine currently does not have a dental school or even a dental residency program. Dental schools can provide a critical safety net for the oral health needs of a state, and dental education clinics can provide the surrounding communities with care that otherwise would be unavailable to disadvantaged and underinsured populations. Maine is just one of a number of predominantly rural States that lacks this important component of a dental safety net. Maine, like many States, is exploring a number of innovative ideas for increasing access to dental care in underserved areas. In an effort to supplement and encourage these efforts, we are introducing legislation today to establish a new State grant program designed to improve access to oral health services in rural and underserved areas. The legislation authorizes $50 million over five years for grants to States to help them develop innovative dental workforce development programs specific to their individual needs. States could use these grants to fund a wide variety of programs. For example, they could use the funds for loan forgiveness and repayment programs for dentists practicing in underserved ares. They could also use them to provide grants and low- or no-interest loans to help practitioners to establish or expand practices in these underserved areas. States, like Maine, that do not have a dental school could use the funds to establish a dental residency program. Other States might want to use the grant funding to establish or expand community or school-based dental facilities or to set up mobile or portable dental clinics. To assist in their recruitment and retention efforts, States could also use the funds for placement and support of dental students, residents, and advanced dentistry trainees. Or, they could use the grant funds for continuing dental education, including distance-based education, and practice support through teledentistry. Other programs that could be funded through the grants include: community-based prevention services such as water fluoridation and dental sealant programs; school programs to encourage children to go into oral health or science professions; the establishment or expansion of a State dental office to coordinate oral health and access issues; and any other activities that are determined to be appropriate by the Secretary of Health and Human Services. The National Health Service Corps is helping to meet the oral health needs of underserved communities by placing dentists and dental hygienists in some of America's most difficult-to-place inner city, rural, and frontier areas. Unfortunately, however, the number of dentists and dental hygienists with obligations to serve in the National Health Service Corps falls far short of meeting the total identified need. According to the Surgeon General, only about 6 percent of the dental need in America's rural and underserved communities is currently being met by the National Health Service Corps. In my state, approximately 173,000 Mainers live in designated dental health professional shortage areas. While the National Health Service Corps estimates that it will take 33 dental clinicians to meet this need, it currently has only three serving in my State. The bill we are introducing today would make some needed improvements in this critically important program so that it can better respond to our nation's oral health needs. First, it would direct the Secretary of Health and Human Services to develop and implement a plan for increasing the participation of dentists and dental hygienists in the National Health Service Corps scholarship and loan repayment programs. It would also allow National Health Service Corps scholarship and loan repayment program recipients to fulfill their commitment on a part-time basis. Many small rural communities may not have sufficient populations to support a full-time dentist or dental hygienist. This would give the National Health Service Corps additional flexibility to meet the needs of these communities. Moreover, some practitioners may find part-time service more attractive, which in turn could improve both recruitment and retention in these communities. Last year, after a six-year hiatus, the National Health Service Corps began a two-year pilot program to award scholarships to dental students. While this is a step in the right direction, these scholarships are only being awarded to students attending certain dental schools, none of which are in New England. Moreover, the pilot project requires the participating dental schools to encourage Corps dental scholars to practice in communities near their educational institutions. As a consequence, this program will do nothing to help relieve the dental shortage in Maine and other areas of New England. The bill we are introducing today would address this problem by expanding the National Health Service Corps Pilot Scholarship Program so that dental students attending any of the 55 U.S. dental schools can apply and require that placements for these scholars be based strictly on community need. It would also improve the process for designating dental health professional shortage areas and ensure that the criteria for making such designations provides a more accurate reflection of oral health need, particularly in rural areas. Mr. President, the Dental Health Improvement Act will make critically important oral health care services more accessible in our Nation's rural and underserved communities, and I urge all of my colleagues to sign on as cosponsors. I also ask unanimous consent that letters endorsing the bill from the American Dental Association and the American Dental Education Association be printed in the Record.

Ms. COLLINS

Ms. COLLINS. Mr. President, the Senator from Connecticut is such a strong advocate for our Nation's children. I have enjoyed working with him on so many issues. But as much as I admire him and share his commitment, I do rise in opposition to the amendment of Senator Dodd. This amendment, although it is very well intentioned, is contrary to the goal of this education reform bill which is to give more flexibility to local schools and to States while holding them accountable for what really counts, and that is student achievement, ensuring that every child is learning, that no child is left behind. Comparability of services is a concept that was created to make sure that title I schools get services comparable to those received in nontitle I schools. But the amendment of the Senator from Connecticut simply goes too far. It would, for example, require States to ensure comparability among schools in class size, in qualifications of teachers by category of assignments such as regular education, special education, bilingual education. It would mandate the same courses be offered, the range of courses, and how rigorous they are. It is extraordinarily prescriptive. It really turns on its head the whole idea of leaving to States and local communities the issues of curriculum design and teacher qualifications. For example, we know very well the needs of schools vary from community to community. My brother, Sam Collins, is chair of the school board in Caribou, ME, my hometown. Through his efforts and efforts of other local leaders, the school system has established a bilingual education program in the elementary schools. It is a wonderful program. But under the Dodd amendment, that program would have to exist in every school in Maine. That is just not practical. Similarly, in Portland, ME, we have a large number of students with limited English proficiency. That means there is a great need for ESL teachers and bilingual teachers in that school system. But in other more rural parts of Maine that need simply doesn't exist. This amendment simply is impractical. It is just not workable, in addition to being contrary to the concept of allowing those who know our students best--our local school boards, our teachers, our parents, our principals, our superintendents of schools--to design the curriculum and provide the courses and other needs for a local school. Schools differ. One school may need a gifted and talented program; another may need to improve its library; still another may need to establish an ESL program. In short, one size does not fit all. Yet that is the implication and the premise of the amendment of the Senator from Connecticut. This amendment would shift the power away from local communities and local school boards to Washington. We want to, instead, empower local communities to make the right decisions and then, very importantly, hold them accountable for results. We want to change the focus from paperwork and process and regulation and, instead, focus on what really matters, and that is ensuring that every child in America gets the very best education possible. We want to do that by holding schools and States accountable, not by telling them what courses they need to have, not by prescribing every rule, every regulation. Let's trust our teachers and our local school board members. Let's trust the local teachers and superintendents. They know best what is needed. I urge opposition to the amendment of my colleague, Senator Dodd. Again, he is a strong advocate for our Nation's schools, and I have enjoyed working with him, but I believe his amendment goes too far and is misguided. I retain the remainder of our time for our side, and I yield the floor.

Ms. COLLINS. Mr. President, first, I commend the Senator from Texas for her superior work on this issue. She and I have been working on it for a very long time. I am delighted to see the bipartisan compromise amendment reached today. This action is long overdue and would correct a misinterpretation of title IX of the education amendments of 1972 that clearly was never intended. Our amendment would ensure that local school districts can establish single-sex classrooms. I would like to share with my colleagues a wonderful example from Presque Isle High School in northern Maine of what can be accomplished with a single-sex classroom. A gifted math teacher in Presque Isle by the name of Donna Lisnik believed that an all-girls advanced mathematics class would result in higher levels of achievement by women. She was absolutely right. Donna established an all-girls math class, and the results were absolutely outstanding. Both the achievement of the girls, whether measured on SAT scores or by other tests, and the results, the number of girls participating in the class, soared. Everything was a plus. I had the privilege of visiting Mrs. Lisnik's class. I saw firsthand the enthusiasm the girls had for mathematics, how comfortable they felt, and how they were accelerating. However, unfortunately, in the previous administration, the Department of Education concluded that this very worthwhile and effective course did not correct historical inequities and, thus, deemed it to be a violation of title IX requirements. As a result, Presque Isle had to open the course to both boys and girls. It was unfortunate that the school was prevented from pursuing a strategy that was resulting in very high achievement levels for the girls attending those classes. Senator Hutchison's bipartisan compromise amendment will ensure that schools with innovative education programs, designed to meet gender- specific needs, will not face needless obstacles. This amendment is a great example of our working across party lines to do what is best for our children and for educational reform. It will give schools the flexibility to design and the ability to offer single- gender classes when the school determines that these classrooms will provide students with a better opportunity to achieve higher standards. That is a goal we all share. I see the Senator from Delaware is also seeking to speak on this issue, so I yield back to the Senator from Texas the remainder of my time. Again, I commend her for her hard work on this issue. It has been a pleasure to be her partner in this regard.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am pleased to join my good friend and colleague from Wisconsin, Senator Russ Feingold, in introducing legislation to improve access to oral health care by strengthening the dental workforce in our Nation's rural and underserved communities. Oral and general health are inseparable, and good dental care is critical to our overall physical health and well-being. Dental health encompasses far more than cavities and gum disease. The recent U.S. Surgeon General report Oral Health in America states that ``the mouth acts as a mirror of health and disease'' that can help diagnose disorders such as diabetes, leukemia, heart disease, or anemia. While oral health in America has improved dramatically over the last 50 years, these improvements have not occurred evenly across all sectors of our population, particularly among low-income individuals and families. Too many Americans today lack access to dental care. While there are clinically proven techniques to prevent or delay the progression of dental health problems, an estimated 25 million Americans live in areas lacking adequate dental services. As a consequence, these effective treatment and prevention programs are not being implemented in many of our communities. Astoundingly, as many as eleven percent of our Nation's rural population has never been to the dentist. This situation is exacerbated by the fact that our dental workforce is graying and the overall ratio of dentists to population is declining. In Maine, there currently are 393 active dentists, 241 of whom are 45 or older. More than 20 percent of dentists nationwide will retire in the next ten years and the number of dental graduates by 2015 may not be enough to replace these retirees. As a consequence, Maine, like many States, is currently facing a serious shortage of dentists, particularly in rural areas. While there is one general practice dentist for every 2,286 people in the Portland area, the numbers drop off dramatically in western and northern Maine. In Aroostook County, where I'm from, there's only one dentist for every 5,507 people. Moreover, at a time when tooth decay is the most prevalent childhood disease in America, Maine has fewer than ten specialists in pediatric dentistry, and most of these are located in the southern part of the State. This dental workforce shortage is exacerbated by the fact that Maine currently does not have a dental school or even a dental residency program. Dental schools can provide a critical safety net for the oral health needs of a state, and dental education clinics can provide the surrounding communities with care that otherwise would be unavailable to disadvantaged and underinsured populations. Maine is just one of a number of predominantly rural States that lacks this important component of a dental safety net. Maine, like many States, is exploring a number of innovative ideas for increasing access to dental care in underserved areas. In an effort to supplement and encourage these efforts, we are introducing legislation today to establish a new State grant program designed to improve access to oral health services in rural and underserved areas. The legislation authorizes $50 million over five years for grants to States to help them develop innovative dental workforce development programs specific to their individual needs. States could use these grants to fund a wide variety of programs. For example, they could use the funds for loan forgiveness and repayment programs for dentists practicing in underserved ares. They could also use them to provide grants and low- or no-interest loans to help practitioners to establish or expand practices in these underserved areas. States, like Maine, that do not have a dental school could use the funds to establish a dental residency program. Other States might want to use the grant funding to establish or expand community or school-based dental facilities or to set up mobile or portable dental clinics. To assist in their recruitment and retention efforts, States could also use the funds for placement and support of dental students, residents, and advanced dentistry trainees. Or, they could use the grant funds for continuing dental education, including distance-based education, and practice support through teledentistry. Other programs that could be funded through the grants include: community-based prevention services such as water fluoridation and dental sealant programs; school programs to encourage children to go into oral health or science professions; the establishment or expansion of a State dental office to coordinate oral health and access issues; and any other activities that are determined to be appropriate by the Secretary of Health and Human Services. The National Health Service Corps is helping to meet the oral health needs of underserved communities by placing dentists and dental hygienists in some of America's most difficult-to-place inner city, rural, and frontier areas. Unfortunately, however, the number of dentists and dental hygienists with obligations to serve in the National Health Service Corps falls far short of meeting the total identified need. According to the Surgeon General, only about 6 percent of the dental need in America's rural and underserved communities is currently being met by the National Health Service Corps. In my state, approximately 173,000 Mainers live in designated dental health professional shortage areas. While the National Health Service Corps estimates that it will take 33 dental clinicians to meet this need, it currently has only three serving in my State. The bill we are introducing today would make some needed improvements in this critically important program so that it can better respond to our nation's oral health needs. First, it would direct the Secretary of Health and Human Services to develop and implement a plan for increasing the participation of dentists and dental hygienists in the National Health Service Corps scholarship and loan repayment programs. It would also allow National Health Service Corps scholarship and loan repayment program recipients to fulfill their commitment on a part-time basis. Many small rural communities may not have sufficient populations to support a full-time dentist or dental hygienist. This would give the National Health Service Corps additional flexibility to meet the needs of these communities. Moreover, some practitioners may find part-time service more attractive, which in turn could improve both recruitment and retention in these communities. Last year, after a six-year hiatus, the National Health Service Corps began a two-year pilot program to award scholarships to dental students. While this is a step in the right direction, these scholarships are only being awarded to students attending certain dental schools, none of which are in New England. Moreover, the pilot project requires the participating dental schools to encourage Corps dental scholars to practice in communities near their educational institutions. As a consequence, this program will do nothing to help relieve the dental shortage in Maine and other areas of New England. The bill we are introducing today would address this problem by expanding the National Health Service Corps Pilot Scholarship Program so that dental students attending any of the 55 U.S. dental schools can apply and require that placements for these scholars be based strictly on community need. It would also improve the process for designating dental health professional shortage areas and ensure that the criteria for making such designations provides a more accurate reflection of oral health need, particularly in rural areas. Mr. President, the Dental Health Improvement Act will make critically important oral health care services more accessible in our Nation's rural and underserved communities, and I urge all of my colleagues to sign on as cosponsors. I also ask unanimous consent that letters endorsing the bill from the American Dental Association and the American Dental Education Association be printed in the Record.

Ms. COLLINS

Ms. COLLINS. Madam President, I ask unanimous consent that the reading of the amendment be dispensed with.

Ms. COLLINS. I thank the Presiding Officer, and I thank the Senator from Massachusetts. On behalf of myself and the Senator from North Dakota, Mr. Conrad, as well as the Senator from Nebraska, Mr. Hagel, I send a modification of amendment No. 509 to the desk.

Ms. COLLINS. Madam President, I ask for the yeas and nays on the amendment.

Ms. COLLINS. Madam President, I rise today with my colleague, Senator Conrad, to offer what I believe is the first bipartisan amendment since we have seen the change in control of the Senate. We are offering an amendment that will help Congress ensure that it provides States with an appropriate level of funding to develop and administer the student assessments that will be required under the BEST Act. As do many of my colleagues, I want to make sure the Federal Government pays for its fair share of the costs associated with the assessment requirements of this important legislation. However, critical though it is that we have a system to determine whether or not our children are really learning, no one really understands or knows the cost of these assessments. We cannot see in the future, but the various experts have their own estimates of the assessment costs, and those estimates vary widely. Cost estimates range by orders of magnitude, and yet no comprehensive examination of these costs has yet been undertaken. Thus, we find ourselves in a dilemma of trying to estimate what the costs will be and figuring out the appropriate Federal share, but we really do not know the costs involved. The amendment which Senator Conrad, Senator Hagel, and I offer requires the General Accounting Office to conduct a study of assessment tests and transmit its report to the chairman and ranking members of the House and Senate Appropriations Committees, the Labor-HHS subcommittees, the HELP Committee, and the education and workforce committee. The report would have to be transmitted to Congress by May 31 of next year. This would provide the opportunity to incorporate GAO's estimates into our planning for the fiscal year 2003 appropriations cycle. I also note that the testing requirements of the bill do not become fully effective until the year 2005. Congress would have a full 3 fiscal years to provide funding based on the estimates provided by the GAO. The GAO study draws upon the best available data, including the cost or pricing data from each State that has already developed and administered statewide student assessments and from the companies that actually develop these tests. For example, the State of Maine has an excellent testing system that is used in three grades. It is well developed; it is of high quality. That will be the kind of information the GAO will gather in determining the cost of these assessments. Other States have taken different approaches to testing and have different costs associated with the tests they are now administering. The GAO will determine the aggregate costs for all States to develop and administer the assessments required by the BEST Act, and the GAO will estimate how much of these costs will be expected to be incurred in each of the fiscal years 2002 through 2008. The study determines assessment development and administrative costs for each State. In addition to looking at the aggregate, we want to look at what the experience has been and will be in each State. We have also asked the GAO to examine the factors that help explain the wide variations in the test costs that are now administered by States. This information will help Congress determine whether it is apportioning funds among the States in an equitable manner. The General Accounting Office is particularly well suited to conduct this study. My staff has had extensive discussions with GAO to determine whether or not they will be able to conduct this important assignment. The GAO has broad experience in estimating the costs of governmental programs and analyzing the Federal Government's role in elementary and secondary education. Indeed, just last year the GAO completed a 50-State study of the title I program, which included an analysis of the efforts of the States to ensure compliance with key title I requirements and to hold local districts and schools accountable for educational outcomes. The GAO, therefore, is the right agency to conduct an impartial, thorough study of assessment costs. The assessment provisions in the BEST Act are intended to help reach the goal of leaving no child behind. Yesterday, a bipartisan group talked with the President about the education bill. He, once again, very eloquently stated the premise of the bill of making sure that schools are held accountable for the education of each child, of making sure that no child, no matter what the family income or country of origin, is left behind. We want to make sure every child is learning. That is the inspiring goal of this legislation. That is why the President has proposed this assessment process--so we can assess whether or not each child from grades 3 through 8 is learning in the areas of reading and math. The education blueprint we are drafting will work only through a concerted, cooperative effort, where the Federal Government, States, and communities all share responsibility. Senator Jeffords offered an amendment that passed overwhelmingly last month to provide a guaranteed stream of funding to States, beginning in the year 2002, in order to assess the performance of their students. Unless the Federal Government provides the States with $370 million in the year 2002 and an increasing amount in each of the succeeding 6 fiscal years, the assessment requirements in the bill will be delayed. In other words, we are making sure we are matching the requirements with the resources necessary for the Federal Government to help States and local school districts fulfill the requirements of this new legislation. The BEST Act requires a great deal from our schools and from our States. For the first time, we are requiring accountability in a meaningful way. We are requiring that all students, and in particular our disadvantaged and low-income students, show improvement in their academic achievement from year to year. We need to provide adequate funding to help States develop high-quality assessment tools. At the same time, we just don't want to write a blank check to the testing companies. Such an approach would sap the incentive of companies to develop student assessments efficiently and cost effectively. The solution is information. We need to have solid, well-researched data to make the best decisions possible when determining funding levels to support the States' testing systems over the next several years. Now is the ideal time to authorize a thorough study by the GAO to gather the information we need. Since States and local school districts will be in the first year of assessment development and implementation next year, it is the perfect time to gather the critical information on which to base future funding decisions. The GAO report will provide the information we need to make the right decisions based on actual State experience and the best available data and informed projections. I urge my colleagues to support this reasonable addition to the education reform bill. I urge my colleagues to support the Collins- Conrad amendment.

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

Ms. COLLINS. Mr. President, I ask unanimous consent that the order for the yeas and nays on the Collins-Conrad amendment be vitiated, and that the amendment be agreed to by a voice vote.

Ms. COLLINS. I urge adoption of the amendment.

Ms. COLLINS. Mr. President, I thank the Senator from Massachusetts and the Senator from New Hampshire for their kind comments. I appreciate their support for the amendment. I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, I yield the floor and, seeing no one seeking recognition, I suggest the absence of a quorum.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am pleased to introduce legislation to honor one of the great contributors to our national postal system, Horatio King, by naming after him the Paris Hill Post Office in Paris, ME, the town of his birth. My colleague from Maine, Senator Snowe, joins me in this effort. Horatio King had a long career serving the public as a newspaper publisher and postal employee, eventually working his way through the ranks to become Postmaster General under President Buchanan. All told, he served under three Presidents. His career with the Postal Service began in 1839, when he was appointed by then Postmaster General Kendall to a postal position that required him to leave Maine and reside in Washington, DC. In 1850, he became affiliated with the foreign mail service and was instrumental in developing this aspect of our postal system. His efforts were recognized in 1854 when he was appointed first assistant Postmaster General, a post he would hold until becoming Postmaster General in 1861, shortly before the outbreak of the Civil War. Horatio King did not end his service, however, after reaching this pinnacle. In 1863, President Lincoln recognized his steadfast devotion to the Union and, although King was of the opposite political party, named him to a commission charged with carrying out the Emancipation Proclamation in the District of Columbia. King was also a man of letters, and was well known for his literary evenings which did much to elevate the culture in Washington at a time when it was a much smaller and less diverse town than the one of today. He would frequently publish newspaper and magazine articles and lectures, and even published a book of travel sketches upon returning from a tour of Europe. Today, the birthplace of Horatio King remains well preserved and cared for by my constituents, Janice and Glenn Davis, as the lovely King's Hill Inn. Horatio King served Maine well by serving America well. It is appropriate that Congress recognize his contributions by naming the Post Office in the town of his birth for him and, along with Senator Snowe, I am delighted to have the opportunity to introduce legislation to accomplish this.

Ms. COLLINS

Ms. COLLINS. Finally, Mr. President, I thank my principal cosponsor of this legislation, Senator Feingold of Wisconsin, for his contributions to this bill. We found that Maine and Wisconsin have many similar problems in ensuring that there is an adequate supply of dentists in our more rural parts of our State. It is our hope that this legislation will be considered and enacted this year.

Ms. COLLINS. Mr. President, I am pleased to join my good friend and colleague from Wisconsin, Senator Russ Feingold, in introducing legislation to improve access to oral health care by strengthening the dental workforce in our nation's rural and underserved communities. Oral and general health are inseparable, and good dental care is critical to our overall physical health and well-being. Dental health encompasses far more than cavities and gum disease. The recent U.S. Surgeon General report Oral Health in America states that ``the mouth acts as a mirror of health and disease'' that can help diagnose disorders such as diabetes, leukemia, heart disease, or anemia. While oral health in America has improved dramatically over the last 50 years, these improvements have not occurred evenly across all sectors of our population, particularly among low-income individuals and families. Too many Americans today lack access to dental care. While there are clinically proven techniques to prevent or delay the progression of dental health problems, an estimated 25 million Americans live in areas lacking adequate dental services. As a consequence, these effective treatment and prevention programs are not available in too many of our communities. Astoundingly, as many as eleven percent of our nation's rural population has never been to a dentist. This situation is exacerbated by the fact that our dental workforce is graying and the overall ratio of dentists to population is declining. In Maine, for example, there currently are 393 active dentists, 241 of whom are 45 or older. More than 20 percent of dentists nationwide will retire in the next ten years, and the number of dental graduates by 2015 may not be enough to replace these retirees. As a consequence, Maine, like many States, is currently facing a serious shortage of dentists, particularly in rural areas. While there is one general practice dentist for every 2,286 people in the Portland area, the numbers drop off dramatically in western and northern Maine. In Aroostook County, where I am from, there's only one dentist for every 5,507 people. Moreover, at a time when tooth decay is the most prevalent childhood disease in America, Maine has fewer than ten specialists in pediatric dentistry, and most of these are located in the southern part of the state. This dental workforce shortage is exacerbated by the fact that Maine currently does not have a dental school or even a dental residency program. Dental schools can provide a critical safety net for the oral health needs of a state, and dental education clinics can provide the surrounding communities with care that otherwise would be unavailable to disadvantaged and underinsured populations. Maine is just one of a number of predominantly rural states that lacks this important component of a dental safety net. Maine, like many States, is exploring a number of innovative ideas for increasing access to dental care in underserved areas. In an effort to supplement and encourage these efforts, we are introducing legislation today to establish a new State grant program designed to improve access to oral health services in rural and underserved areas. The legislation authorizes $50 million over 5 years for grants to States to help them develop innovative dental workforce development programs specific to their individual needs. States could use these grants to fund a wide variety of programs. For example, they could use the funds for loan forgiveness and repayment programs for dentists practicing in underserved areas. They could also use them to provide grants and low- or no-interest loans to help practitioners to establish or expand practices in these underserved areas. States, like Maine, that do not have a dental school could use the funds to establish a dental residency program. Other States might want to use the grant funding to establish or expand community or school-based dental facilities or to set up mobile or portable dental clinics. To assist in their recruitment and retention efforts, States could also use the funds for placement and support of dental students, residents, and advanced dentistry trainees. Or, they could use the grant funds for continuing dental education, including distance-based education, and practice support through teledentistry. Other programs that could be funded through the grants include: community-based prevention services such as water fluoridation and dental sealant programs; school programs to encourage children to go into oral health or science professions; the establishment or expansion of a State dental office to coordinate oral health and access issues; and any other activities that are determined to be appropriate by the Secretary of Health and Human Services. The National Health Service Corps is helping to meet the oral health needs of underserved communities by placing dentists and dental hygienists in some of America's most difficult-to-place inner city, rural, and frontier areas. Unfortunately, however, the number of dentists and dental hygienists with obligations to serve in the National Health Service Corps falls far short of meeting the total identified need. According to the Surgeon General, only about 6 percent of the dental need in America's rural and underserved communities is currently being met by the National Health Service Corps. In my State, approximately 173,000 Mainers live in designated dental health professional shortage areas. While the National Health Service Corps estimates that it will take 33 dental clinicians to meet this need, it currently has only three serving in my State. The bill we are introducing today would make some needed improvements in this critically important program so that it can better respond to our nation's oral health needs. First, it would direct the Secretary of Health and Human Services to develop and implement a plan for increasing the participation of dentists and dental hygienists in the National Health Service Corps scholarship and loan repayment programs. It would also allow National Health Service Corps scholarship and loan repayment program recipients to fulfill their commitment on a part-time basis. Some small rural communities may not have sufficient populations to support a full-time dentist or dental hygienist. This would give the National Health Service Corps additional flexibility to meet the needs of these communities. Moreover, some practitioners may find part-time service more attractive to them. This particularly may be the case for a retired dentist who may want to practice only part- time, allowing this feasibility could in turn improve both recruitment and retention in these communities. Last year, after a 6-year hiatus, the National Health Service Corps began a two-year pilot program to award scholarships to dental students. This is a step in the right direction, however, these scholarships are only being awarded to students attending certain dental schools, not one of which is located in New England. Moreover, the pilot project requires the participating dental schools to encourage Corps dental scholars to practice in communities near their educational institutions. The problem is obvious. If none of these programs are in New England, and yet there is a requirement that the dentists participating in these programs practice in the surrounding communities, this is of no benefit to a State such as Maine that does not have a dental school and does not have a qualifying program. As a consequence, this program will do nothing at all to help relieve the dental shortage in Maine and other areas of New England. The legislation we are introducing today would address this problem by expanding the National Health Service Corps Pilot Scholarship Program so that dental students attending any of the 55 American dental schools can apply and require that placements for these scholars be based strictly on community need, not on whether or not they surround the dental school. It would also improve the process for designating dental health professional shortage areas and ensure that the criteria for making such designations provide a more accurate reflection of oral health needs, particularly in our rural areas where the problem is most acute. And finally, taxing the scholarships and stipends of students adversely affects their financial incentive to participate in the National Health Service Corps and to provide health care services in underserved communities. Our legislation would, therefore, exclude from Federal income tax the fees and related educational expenses to individuals who are participating in the National Health Service Corps scholarship and loan repayment programs. The Dental Health Improvement Act will make critically important oral health care services more accessible in our Nation's rural and underserved communities. I urge all of my colleagues to join me in supportin this legislation. I ask unanimous consent that letters endorsing my bill from the American Dental Association and the American Dental Education Association be printed in the Record.

Ms. COLLINS

Ms. COLLINS. Finally, Mr. President, I thank my principal cosponsor of this legislation, Senator Feingold of Wisconsin, for his contributions to this bill. We found that Maine and Wisconsin have many similar problems in ensuring that there is an adequate supply of dentists in our more rural parts of our State. It is our hope that this legislation will be considered and enacted this year.

Ms. COLLINS. Mr. President, I am pleased to join my good friend and colleague from Wisconsin, Senator Russ Feingold, in introducing legislation to improve access to oral health care by strengthening the dental workforce in our nation's rural and underserved communities. Oral and general health are inseparable, and good dental care is critical to our overall physical health and well-being. Dental health encompasses far more than cavities and gum disease. The recent U.S. Surgeon General report Oral Health in America states that ``the mouth acts as a mirror of health and disease'' that can help diagnose disorders such as diabetes, leukemia, heart disease, or anemia. While oral health in America has improved dramatically over the last 50 years, these improvements have not occurred evenly across all sectors of our population, particularly among low-income individuals and families. Too many Americans today lack access to dental care. While there are clinically proven techniques to prevent or delay the progression of dental health problems, an estimated 25 million Americans live in areas lacking adequate dental services. As a consequence, these effective treatment and prevention programs are not available in too many of our communities. Astoundingly, as many as eleven percent of our nation's rural population has never been to a dentist. This situation is exacerbated by the fact that our dental workforce is graying and the overall ratio of dentists to population is declining. In Maine, for example, there currently are 393 active dentists, 241 of whom are 45 or older. More than 20 percent of dentists nationwide will retire in the next ten years, and the number of dental graduates by 2015 may not be enough to replace these retirees. As a consequence, Maine, like many States, is currently facing a serious shortage of dentists, particularly in rural areas. While there is one general practice dentist for every 2,286 people in the Portland area, the numbers drop off dramatically in western and northern Maine. In Aroostook County, where I am from, there's only one dentist for every 5,507 people. Moreover, at a time when tooth decay is the most prevalent childhood disease in America, Maine has fewer than ten specialists in pediatric dentistry, and most of these are located in the southern part of the state. This dental workforce shortage is exacerbated by the fact that Maine currently does not have a dental school or even a dental residency program. Dental schools can provide a critical safety net for the oral health needs of a state, and dental education clinics can provide the surrounding communities with care that otherwise would be unavailable to disadvantaged and underinsured populations. Maine is just one of a number of predominantly rural states that lacks this important component of a dental safety net. Maine, like many States, is exploring a number of innovative ideas for increasing access to dental care in underserved areas. In an effort to supplement and encourage these efforts, we are introducing legislation today to establish a new State grant program designed to improve access to oral health services in rural and underserved areas. The legislation authorizes $50 million over 5 years for grants to States to help them develop innovative dental workforce development programs specific to their individual needs. States could use these grants to fund a wide variety of programs. For example, they could use the funds for loan forgiveness and repayment programs for dentists practicing in underserved areas. They could also use them to provide grants and low- or no-interest loans to help practitioners to establish or expand practices in these underserved areas. States, like Maine, that do not have a dental school could use the funds to establish a dental residency program. Other States might want to use the grant funding to establish or expand community or school-based dental facilities or to set up mobile or portable dental clinics. To assist in their recruitment and retention efforts, States could also use the funds for placement and support of dental students, residents, and advanced dentistry trainees. Or, they could use the grant funds for continuing dental education, including distance-based education, and practice support through teledentistry. Other programs that could be funded through the grants include: community-based prevention services such as water fluoridation and dental sealant programs; school programs to encourage children to go into oral health or science professions; the establishment or expansion of a State dental office to coordinate oral health and access issues; and any other activities that are determined to be appropriate by the Secretary of Health and Human Services. The National Health Service Corps is helping to meet the oral health needs of underserved communities by placing dentists and dental hygienists in some of America's most difficult-to-place inner city, rural, and frontier areas. Unfortunately, however, the number of dentists and dental hygienists with obligations to serve in the National Health Service Corps falls far short of meeting the total identified need. According to the Surgeon General, only about 6 percent of the dental need in America's rural and underserved communities is currently being met by the National Health Service Corps. In my State, approximately 173,000 Mainers live in designated dental health professional shortage areas. While the National Health Service Corps estimates that it will take 33 dental clinicians to meet this need, it currently has only three serving in my State. The bill we are introducing today would make some needed improvements in this critically important program so that it can better respond to our nation's oral health needs. First, it would direct the Secretary of Health and Human Services to develop and implement a plan for increasing the participation of dentists and dental hygienists in the National Health Service Corps scholarship and loan repayment programs. It would also allow National Health Service Corps scholarship and loan repayment program recipients to fulfill their commitment on a part-time basis. Some small rural communities may not have sufficient populations to support a full-time dentist or dental hygienist. This would give the National Health Service Corps additional flexibility to meet the needs of these communities. Moreover, some practitioners may find part-time service more attractive to them. This particularly may be the case for a retired dentist who may want to practice only part- time, allowing this feasibility could in turn improve both recruitment and retention in these communities. Last year, after a 6-year hiatus, the National Health Service Corps began a two-year pilot program to award scholarships to dental students. This is a step in the right direction, however, these scholarships are only being awarded to students attending certain dental schools, not one of which is located in New England. Moreover, the pilot project requires the participating dental schools to encourage Corps dental scholars to practice in communities near their educational institutions. The problem is obvious. If none of these programs are in New England, and yet there is a requirement that the dentists participating in these programs practice in the surrounding communities, this is of no benefit to a State such as Maine that does not have a dental school and does not have a qualifying program. As a consequence, this program will do nothing at all to help relieve the dental shortage in Maine and other areas of New England. The legislation we are introducing today would address this problem by expanding the National Health Service Corps Pilot Scholarship Program so that dental students attending any of the 55 American dental schools can apply and require that placements for these scholars be based strictly on community need, not on whether or not they surround the dental school. It would also improve the process for designating dental health professional shortage areas and ensure that the criteria for making such designations provide a more accurate reflection of oral health needs, particularly in our rural areas where the problem is most acute. And finally, taxing the scholarships and stipends of students adversely affects their financial incentive to participate in the National Health Service Corps and to provide health care services in underserved communities. Our legislation would, therefore, exclude from Federal income tax the fees and related educational expenses to individuals who are participating in the National Health Service Corps scholarship and loan repayment programs. The Dental Health Improvement Act will make critically important oral health care services more accessible in our Nation's rural and underserved communities. I urge all of my colleagues to join me in supportin this legislation. I ask unanimous consent that letters endorsing my bill from the American Dental Association and the American Dental Education Association be printed in the Record.

Ms. COLLINS. Mr. President, I am pleased to introduce legislation to honor one of the great contributors to our national postal system, Horatio King, by naming after him the Paris Hill Post Office in Paris, ME, the town of his birth. My colleague from Maine, Senator Snowe, joins me in this effort. Horatio King had a long career serving the public as a newspaper publisher and postal employee, eventually working his way through the ranks to become Postmaster General under President Buchanan. All told, he served under three Presidents. His career with the Postal Service began in 1839, when he was appointed by then Postmaster General Kendall to a postal position that required him to leave Maine and reside in Washington, DC. In 1850, he became affiliated with the foreign mail service and was instrumental in developing this aspect of our postal system. His efforts were recognized in 1854 when he was appointed first assistant Postmaster General, a post he would hold until becoming Postmaster General in 1861, shortly before the outbreak of the Civil War. Horatio King did not end his service, however, after reaching this pinnacle. In 1863, President Lincoln recognized his steadfast devotion to the Union and, although King was of the opposite political party, named him to a commission charged with carrying out the Emancipation Proclamation in the District of Columbia. King was also a man of letters, and was well known for his literary evenings which did much to elevate the culture in Washington at a time when it was a much smaller and less diverse town than the one of today. He would frequently publish newspaper and magazine articles and lectures, and even published a book of travel sketches upon returning from a tour of Europe. Today, the birthplace of Horatio King remains well preserved and cared for by my constituents, Janice and Glenn Davis, as the lovely King's Hill Inn. Horatio King served Maine well by serving America well. It is appropriate that Congress recognize his contributions by naming the Post Office in the town of his birth for him and, along with Senator Snowe, I am delighted to have the opportunity to introduce legislation to accomplish this.