Susan Collins

Ms. COLLINS

Ms. COLLINS. Thank you, Mr. President.

Ms. COLLINS. Mr. President, I ask unanimous consent that I be permitted to proceed as if in morning business for up to 12 minutes

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise to discuss the legislation before the Senate that will result in the most significant reorganization of the executive branch in more than 50 years. The creation of a Cabinet- level Department of Homeland Security is of fundamental importance to our national security. I believe it is one of the most important pieces of legislation we will consider during this Congress. In the year since the terrorist attacks on our Nation, much has been done to make our country more secure. Congress has approved billions of dollars to secure our borders, protect critical infrastructure, train and equip first responders, and better detect and respond to a bioterrorism attack. Our brave men and women in uniform have been fighting valiantly in Afghanistan and have succeeded in many of the goals in the war against terrorism. The creation of the Department of Homeland Security is another important step in our efforts to secure our Nation against another terrorist attack. This sweeping reorganization dwarfs any corporate merger that you can think of. It involves some 200,000 employees and nearly $40 billion in budget. The task before the Senate is truly daunting, and it is important we get the job done right. Currently, as many as 100 Federal agencies are responsible for homeland security. But not one of them has homeland security as its principal mission. That is the problem with our current organizational structure. With that many entities responsible, nobody is accountable and turf battles and bureaucratic disputes are virtually inevitable. If we are to overcome these problems and create a national security structure that can defend our Nation, we must unite the current patchwork of agencies into a single new Department of Homeland Security. This agency would work to secure our borders, help protect our ports, our transportation sector, and protect our critical infrastructure. It would synthesize and analyze homeland security intelligence from multiple sources, thus lessening the possibility of intelligence breakdowns or lack of communication. Furthermore, the new domestic security structure would coordinate Federal communications regarding threats and preparedness with State and local governments, as well as with the private sector. Our efforts to create a new Department of Homeland Security will help to remedy many of the current weaknesses of the past and thus help to protect us against future terrorist attacks. As a member of the Senate Governmental Affairs Committee, which held extensive hearings on the reorganization legislation, I have had the opportunity to consider a multitude of ideas and concepts regarding the creation of the new Department. We heard excellent testimony from Governor Ridge, from the Directors of the FBI and the CIA, and from a host of other experts. They all shed light on the problems that are created by our current disorganization in the area of homeland security. They all shed light on the problems that have impaired our ability to defend our homeland and on the threats that we now face and inevitably will face in the future. During the committee's consideration of this bill, I expressed concerns that in our effort to create a new Department, we must be careful to protect the traditional missions, the very important missions of the agencies that are being assembled into this giant new department. In particular, I believe the Coast Guard's traditional functions, such as search and rescue and marine resource protection, must be protected and maintained. Since the tragic events of September 11, the Coast Guard's focus has shifted dramatically to homeland security. I talked with Coast Guard officers in Portland, ME, who told me the amount of time they are now spending on port security operations and inspecting foreign vessels coming into the harbor in Portland. I have no doubt these are very important missions and that the Coast Guard plays an essential role in homeland security. And I believe it should play a leading role in the new Department. However, we know the Coast Guard cannot continue to focus on homeland security missions without jeopardizing its traditional focus. I am concerned that if the current resource allocation is maintained and the Coast Guard continues to perform these new homeland security responsibilities, its traditional missions will be sacrificed. The President's budget goes a long way to try to remedy this problem by allocating significant new funds for the Coast Guard. But we also need to make sure the organizational structure in the new Department also safeguards the Coast Guard's traditional mission. For example, prior to September 11, port security missions accounted for approximately 2 percent of the Coast Guard's resources. Immediately following the terrorist attacks, the Coast Guard deployed 59 percent of its resources to port security and safety missions. As a result, many of the aircraft and vessels traditionally used for search and rescue were far removed from their optimal locations for that function. Even after the immediate impact of the September 11 attacks subsided, its impact on the resources of the Coast Guard remained. Indeed, from April through June of this year, the Coast Guard devoted 9 percent fewer hours on search and rescue missions than it did in the year before. Because of the Coast Guard's importance to coastal areas throughout our Nation, any reduction in its traditional functions is cause for great concern. Those of us who represent coastal States know how absolutely vital the mission of the Coast Guard is. Last year alone, the Coast Guard performed over 39,000 search and rescue missions and saved more than 4,000 lives. On a typical day, the Coast Guard interdicts and rescues 14 illegal immigrants, inspects and repairs 135 buoys, helps over 2,500 commercial ships navigate in and out of U.S. ports, and saves 10 lives. That is on a typical day. In short, the Coast Guard's traditional missions are of vital importance and they simply must be preserved. Let me take a moment to talk about the Coast Guard's impact and its importance in my home State of Maine. Each year, the Coast Guard performs about 300 search and rescue missions in my State. These missions are literally a matter of life and death. Since October of 1999, 14 commercial fishermen have lost their lives at sea. Commercial fishing is one of the most dangerous of occupations, and the Coast Guard every year saves fishermen who get into trouble. How many more would have died or been injured if the nearest Coast Guard cutter had not been in port? How many more fishermen or recreational boaters will lose their lives if the local Coast Guard stations must devote the vast majority of their time to homeland security functions? I agree that the Coast Guard must perform homeland security functions. The role the Coast Guard is playing in securing our ports is vitally important. But it is also vitally important that it not do so at the expense of its traditional missions. To respond to this challenge, Senator Stevens of Alaska and I teamed up to offer an amendment during the Governmental Affairs Committee markup of this legislation. We offered a successful amendment to preserve the traditional functions of the Coast Guard, even as the agency is moved into the new Department of Homeland Security. I want to recognize Senator Stevens and thank him for his leadership on this issue, as well as recognize the support of our colleagues who voted for our amendment in committee. Our amendment establishes the right balance between homeland security functions and the traditional missions of the Coast Guard. It ensures that the Coast Guard's non-homeland-security functions shall be maintained after its transfer into the new Department but also provides for flexibility in the event of a national emergency or an attack on our Nation. The amendment also has the Commandant of the Coast Guard report directly to the Secretary. In the chairman's draft, he would not have done so. Thus, his role would have been devalued or demoted. Our amendment, the Stevens-Collins amendment, remedies that problem. Our amendment will help to protect our coastal communities' economies, their way of life, and their loved ones, while Americans, wherever they live, can rest assured that the Coast Guard will perform its necessary and vital homeland security functions. I believe our language strikes the right balance. As we craft this bill, it is also important that we never forget who is on the front lines in the event of a national emergency. We learned on September 11 who responds. It is not the response of people in Washington. The people who are on the front lines are our police officers, our firefighters, and our emergency medical personnel. That is why we need to make sure the new Department coordinates its activities and supports the activities of the local first responders. I thank Senator Feingold for his leadership in ensuring that the interests of the first responders are ever in our mind. I worked with him as well as with Senator Carper on an amendment in committee that strengthens the role of first responders in homeland security, that recognizes their contributions. We offered an amendment to enhance the cooperation and coordination among State and local first responders. The new Department will be required to designate an employee to be based in each and every 1 of the 50 States to be a liaison to State and local governments. I think that is so important. And it recognizes that this is a joint effort. Similarly, an amendment Senator Carnahan and I offered will help our community fire departments by expanding the current grant program known as the FIRE Program. As I am sure the Presiding Officer knows, because he represents a rural State, as I do, the FIRE Program has been so important in helping a lot of our small, rural fire departments upgrade their equipment and their training. The amendment the Senator from Missouri and I offered in committee would expand the FIRE Program and provide fire departments with the ability over 3 years to receive maximum grants of $100,000 to hire personnel. When I talk to my fire chiefs at home, they tell me that not only do they need help with equipment and training but they need more firefighters. For those of us who went to New York City, one of the memories I will carry with me forever was talking with the fire commissioner and learning how many firefighters lost their lives on September 11. I will never forget his telling me that more firefighters died on that day than in the previous 70 years of the New York City Fire Department. It is the firefighters, the police officers, the emergency medical personnel who are always first on the scene. We cannot forget that these brave individuals will be the first to be called upon if and when a terrorist attack again occurs. The New Department of Homeland Security is an essential component of our response to current and future threats. As the brutal attacks of September 11 demonstrated, distance from our enemies and the barriers of oceans no longer guarantee the security of our homeland. The bill we are considering today is another important step in preserving and strengthening our homeland security. I believe this legislation will help to make our Nation more secure, and I am hopeful that we will pass it quickly after due consideration. I yield the floor.

Ms. COLLINS. Mr. President, I yield myself as much time as I may consume from the time of Senator Thompson.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am pleased to be joining my colleague from West Virginia, Senator Rockefeller, in introducing the Advance Planning and Compassionate Care Act, which is intended to improve the way we care for people at the end of their lives. Noted health economist, Uwe Reinhardt, once observed that ``Americans are the only people on earth who believe that death is negotiable.'' Advancements in medicine, public health, and technology have enabled more and more of us to live longer and healthier lives. However, when medical treatment can no longer promise a continuation of life, patients and their families should not have to fear that the process of dying will be marked by preventable pain, avoidable distress, or care that is inconsistent with their values or wishes. The fact is, dying is a universal experience, and it is time to re- examine how we approach death and dying and how we care for people at the end of their lives. Clearly, there is more that we can do to relieve suffering, respect personal choice and dignity, and provide opportunities for people to find meaning and comfort at life's conclusion. Unfortunately, most Medicare patients and their physicians do not currently discuss death or routinely make advance plans for end-of-life care. As a result, about one-fourth of Medicare funds are now spent on care at the end of life that is geared toward expensive, high- technology interventions and ``rescue'' care. While most Americans say they would prefer to die at home, studies show that almost 80 percent die in institutions where they may be in pain, and where they are subjected to high-tech treatments that merely prolong suffering. Moreover, according to a Dartmouth study conducted by Dr. Jack Wennberg, where a patient lives has a direct impact on how that patient dies. The study found that the amount of medical treatment Americans receive in their final months varies tremendously in the different parts of the country, and it concluded that the determination of whether or not an older patient dies in the hospital probably has more to do with the supply of hospital beds than the patient's needs or preference. The Advance Planning and Compassionate Care Act is intended to help us improve the way our health care system serves patients at the end of their lives. Among other provisions, the bill makes a number of changes to the Patient Self-Determination Act of 1990 to facilitate appropriate discussions and individual autonomy in making difficult discussions about end-of-life care. For instance, the legislation requires that every Medicare beneficiary receiving care in a hospital or nursing facility be given the opportunity to discuss end-of-life care and the preparation of an advanced directive with an appropriately trained professional within the institution. The legislation also requires that if a patient has an advanced directive, it must be displayed in a prominent place in the medical record so that all the doctors and nurses can clearly see it. In addition, the legislation authorizes the Department of Health and Human Services to study end-of-life issues and also to develop demonstration projects to develop models for end-of-life care for Medicare, Medicaid, and State Child Health Insurance Program, S-CHIP, patients. The Institute of Medicine recently released a report that concluded that we need to improve palliative and end-of-life care for children with terminal illnesses. According to the report, far too often children with fatal or potentially fatal conditions and their families fail to receive competent, compassionate, and consistent care that meets their physical, emotional, and spiritual needs. Our legislation therefore requires that at least one of these demonstrations focus particularly on pediatric end-of-life care. Finally, the legislation establishes a telephone hotline to provide consumer information and advice concerning advance directives, end-of- life issues, and medical decisionmaking and also establishes an End-of- Life Care Advisory Board to assist the Secretary of Health and Human Services in developing outcome standards and measures to evaluate end- of-life care programs and projects. The legislation we are introducing today is particularly important in light of the debate on physician-assisted suicide. The desire for assisted suicide is generally driven by concerns about the quality of care for the terminally ill; by the fear of prolonged pain, loss of dignity and emotional strain on family members. Such worries would recede and support for assisted suicide would evaporate if better palliative care and more effective pain management were widely available. Patients and their families should be able to trust that the care they receive at the end of their lives is not only of high quality, but also that it respects their desires for peace, autonomy, and dignity. The Advanced Planning and Compassionate Care Act that Senator Rockefeller and I are introducing today will give us some of the tools that we need to improve care of the dying in this country, and I urge all of my colleagues to join us as cosponsors.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am pleased to join with Senators Cleland, Hutchinson, Kerry, Snowe and Miller in introducing the David Jayne Medicare Homebound Modernization Act of 2002 to modernize Medicare's outdated ``homebound'' requirement that has impeded access to needed home health services for many of our nation's elderly and disabled Medicare beneficiaries. Health care in American has gone full circle. People are spending less time in institutions, and recovery and care for patients with chronic diseases and conditions has increasingly been taking place in the home. The highly skilled and often technically complex care that our home health agencies provide have enabled millions of our most vulnerable older and disabled individuals to avoid hospitals and nursing homes and stay just where they belong, in the comfort and security of their own homes. Under current law, a Medicare patient must be considered ``homebound'' if he or she is to be eligible for home health services. While an individual is not actually required to be bedridden to qualify for benefits, his or her conditions must be such that ``there exists a normal inability to leave home.'' The statute does allow for absences from the home of ``infrequent'' or ``relatively short duration.'' Unfortunately, however, it does not define precisely what this means. It leaves it to the fiscal intermediaries to interpret just how many absences qualify as ``frequent'' and just how short those absences must be. Interpretations of this definition have therefore varied widely. As a consequence, there have been far too many instances where an overzealous or arbitrary interpretation of the definition has turned elderly or disabled Medicare beneficiaries, who are dependent upon Medicare home health services and medical equipment for survival, into virtual prisoners in their own home. We have heard disturbing accounts of individuals on Medicare who have had their home health benefits terminated for leaving their homes to visit a hospitalized spouse or to attend a family gathering, including, in one case, to attend the funeral of their own child. Under current law, a Medicare patient must be considered ``homebound'' if he or she is to be eligible for home health services. While an individual is not actually required to be bedridden to quality for benefits, his or her condition must be such that ``there exists a normal inability to leave home.'' The statute does allow for absences from the home that are ``infrequent and of short duration.'' It also gives specific permission for the individual to leave home to attend medical appointments, adult day care or religious services. Otherwise, it leaves it to the fiscal intermediaries to interpret just how many absences qualify as ``frequent'' and just how short those absences must be. Interpretations of this definition have therefore varied widely. As a consequence, there have been far too many instances where an overzealous or arbitrary interpretation of the definition has turned elderly or disabled Medicare recipients, who are dependent upon Medicare home health services and medical equipment for survival, into virtual prisoners in their own homes. The current homebound requirement is particularly hard on younger, disabled Medicare patients. For example, I recently met with David Jayne, a 40-year old man with Lou Gehrig's disease, who is confined to a wheelchair and cannot swallow, speak or even breathe on his own. Mr. Jayne needs several skilled nursing visits per week to enable him to remain independent and out of an inpatient facility. Despite his disability, Mr. Jayne meets frequently with youth and church groups. Speaking through a computerized voice synthesizer, he gives inspirational talks about how the human spirit can endure and even overcome great hardship. The Atlanta Journal Constitution ran a feature article on Mr. Jayne and his activities, including a report about how he had, with the help of family and friends, attended a football game to root for the University of Georgia Bulldogs. A few days later, at the direction of the fiscal intermediary, his home health agency, which had been sending a health care worker to his home for two hours, four mornings a week, notified him that he could no longer be considered homebound, and that his benefits were being cut off. While his benefits were subsequently reinstated due to the media attention given the case, this experience motivated him to launch a crusade to modernize the homebound definition and led him to found the National Coalition to Amend the Medicare Homebound Restriction. The current homebound requirement is particularly hard on younger, disabled individuals who are on Medicare. The fact is that the current requirement reflects an outmoded view of life for persons who live with serious disabilities. The homebound criteria may have made sense thirty years ago, when an elderly or disabled person might expect to live in the confines of their home, perhaps cared for by an extended family. The current definition, however, fails to reflect the technological and medical advances that have been made in supporting individuals with significant disabilities and mobility challenges. It also fails to reflect advances in treatment for seriously ill individuals, like Mr. Jayne, which allow them brief periods of relative wellness. It also fails to recognize that an individual's mental acuity an physical stamina can only be maintained by use, and that the use of the body and mind is encouraged by social interactions outside the four walls of a home. The David Jayne Medicare Homebound Modernization Act of 2002 will amend the homebound definition to base eligibility for the home health benefit on the patient's functional limitations and clinical condition, rather than on an arbitrary limitation on absences from the home. It will provide a specific, limited exception to the homebound rule for individuals who: One, have been certified by a physician has having a permanent and severe condition that will not improve; Two, who need assistance from another person with 3 or more of the 5 activities of daily living and require technological and/or personal assistance with the act of leaving home; Three, who have received Medicare home health services during the previous 12 month period; and Four, who are only able to leave home because the services provided through the home health benefit makes it possible for them to do so. We believe that our legislation is budget neutral because it is specifically limited to individuals who are already eligible for Medicare and whose conditions require the assistance of a skilled nurse, therapist or home health aide to make it functionally possible for them to leave the home. Our legislation does not expand Medicare eligibility--it simply gives people who are already eligible for the benefit their freedom. This issue was first brought to my attention by former Senator Robert Dole, who has long been a vigorous advocate for people with disabilities. Our proposal is also supported by the Consortium of Citizens with Disabilities, the Visiting Nurse Associations of America, the National Association for Home Care, Advancing Independence: Modernizing Medicare and Medicaid, AIMM, and the National Coalition to Amend the Medicare Homebound Restriction. Moreover, the David Jayne Medicare Homebound Modernization Act of 2002 is consistent with President Bush's ``New Freedom Initiative'' which has, as its goal, the removal of barriers that impede opportunities for those with disabilities to integrate more fully into the community. By allowing reasonable absences from the home, our amendment will bring the Medicare home health benefit into the 21st Century, and I look forward to working with my colleagues to getting it done.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am pleased to be joining my colleague from West Virginia, Senator Rockefeller, in introducing the Advance Planning and Compassionate Care Act, which is intended to improve the way we care for people at the end of their lives. Noted health economist, Uwe Reinhardt, once observed that ``Americans are the only people on earth who believe that death is negotiable.'' Advancements in medicine, public health, and technology have enabled more and more of us to live longer and healthier lives. However, when medical treatment can no longer promise a continuation of life, patients and their families should not have to fear that the process of dying will be marked by preventable pain, avoidable distress, or care that is inconsistent with their values or wishes. The fact is, dying is a universal experience, and it is time to re- examine how we approach death and dying and how we care for people at the end of their lives. Clearly, there is more that we can do to relieve suffering, respect personal choice and dignity, and provide opportunities for people to find meaning and comfort at life's conclusion. Unfortunately, most Medicare patients and their physicians do not currently discuss death or routinely make advance plans for end-of-life care. As a result, about one-fourth of Medicare funds are now spent on care at the end of life that is geared toward expensive, high- technology interventions and ``rescue'' care. While most Americans say they would prefer to die at home, studies show that almost 80 percent die in institutions where they may be in pain, and where they are subjected to high-tech treatments that merely prolong suffering. Moreover, according to a Dartmouth study conducted by Dr. Jack Wennberg, where a patient lives has a direct impact on how that patient dies. The study found that the amount of medical treatment Americans receive in their final months varies tremendously in the different parts of the country, and it concluded that the determination of whether or not an older patient dies in the hospital probably has more to do with the supply of hospital beds than the patient's needs or preference. The Advance Planning and Compassionate Care Act is intended to help us improve the way our health care system serves patients at the end of their lives. Among other provisions, the bill makes a number of changes to the Patient Self-Determination Act of 1990 to facilitate appropriate discussions and individual autonomy in making difficult discussions about end-of-life care. For instance, the legislation requires that every Medicare beneficiary receiving care in a hospital or nursing facility be given the opportunity to discuss end-of-life care and the preparation of an advanced directive with an appropriately trained professional within the institution. The legislation also requires that if a patient has an advanced directive, it must be displayed in a prominent place in the medical record so that all the doctors and nurses can clearly see it. In addition, the legislation authorizes the Department of Health and Human Services to study end-of-life issues and also to develop demonstration projects to develop models for end-of-life care for Medicare, Medicaid, and State Child Health Insurance Program, S-CHIP, patients. The Institute of Medicine recently released a report that concluded that we need to improve palliative and end-of-life care for children with terminal illnesses. According to the report, far too often children with fatal or potentially fatal conditions and their families fail to receive competent, compassionate, and consistent care that meets their physical, emotional, and spiritual needs. Our legislation therefore requires that at least one of these demonstrations focus particularly on pediatric end-of-life care. Finally, the legislation establishes a telephone hotline to provide consumer information and advice concerning advance directives, end-of- life issues, and medical decisionmaking and also establishes an End-of- Life Care Advisory Board to assist the Secretary of Health and Human Services in developing outcome standards and measures to evaluate end- of-life care programs and projects. The legislation we are introducing today is particularly important in light of the debate on physician-assisted suicide. The desire for assisted suicide is generally driven by concerns about the quality of care for the terminally ill; by the fear of prolonged pain, loss of dignity and emotional strain on family members. Such worries would recede and support for assisted suicide would evaporate if better palliative care and more effective pain management were widely available. Patients and their families should be able to trust that the care they receive at the end of their lives is not only of high quality, but also that it respects their desires for peace, autonomy, and dignity. The Advanced Planning and Compassionate Care Act that Senator Rockefeller and I are introducing today will give us some of the tools that we need to improve care of the dying in this country, and I urge all of my colleagues to join us as cosponsors.

Ms. COLLINS. Mr. President, I am pleased to join with Senators Cleland, Hutchinson, Kerry, Snowe and Miller in introducing the David Jayne Medicare Homebound Modernization Act of 2002 to modernize Medicare's outdated ``homebound'' requirement that has impeded access to needed home health services for many of our nation's elderly and disabled Medicare beneficiaries. Health care in American has gone full circle. People are spending less time in institutions, and recovery and care for patients with chronic diseases and conditions has increasingly been taking place in the home. The highly skilled and often technically complex care that our home health agencies provide have enabled millions of our most vulnerable older and disabled individuals to avoid hospitals and nursing homes and stay just where they belong, in the comfort and security of their own homes. Under current law, a Medicare patient must be considered ``homebound'' if he or she is to be eligible for home health services. While an individual is not actually required to be bedridden to qualify for benefits, his or her conditions must be such that ``there exists a normal inability to leave home.'' The statute does allow for absences from the home of ``infrequent'' or ``relatively short duration.'' Unfortunately, however, it does not define precisely what this means. It leaves it to the fiscal intermediaries to interpret just how many absences qualify as ``frequent'' and just how short those absences must be. Interpretations of this definition have therefore varied widely. As a consequence, there have been far too many instances where an overzealous or arbitrary interpretation of the definition has turned elderly or disabled Medicare beneficiaries, who are dependent upon Medicare home health services and medical equipment for survival, into virtual prisoners in their own home. We have heard disturbing accounts of individuals on Medicare who have had their home health benefits terminated for leaving their homes to visit a hospitalized spouse or to attend a family gathering, including, in one case, to attend the funeral of their own child. Under current law, a Medicare patient must be considered ``homebound'' if he or she is to be eligible for home health services. While an individual is not actually required to be bedridden to quality for benefits, his or her condition must be such that ``there exists a normal inability to leave home.'' The statute does allow for absences from the home that are ``infrequent and of short duration.'' It also gives specific permission for the individual to leave home to attend medical appointments, adult day care or religious services. Otherwise, it leaves it to the fiscal intermediaries to interpret just how many absences qualify as ``frequent'' and just how short those absences must be. Interpretations of this definition have therefore varied widely. As a consequence, there have been far too many instances where an overzealous or arbitrary interpretation of the definition has turned elderly or disabled Medicare recipients, who are dependent upon Medicare home health services and medical equipment for survival, into virtual prisoners in their own homes. The current homebound requirement is particularly hard on younger, disabled Medicare patients. For example, I recently met with David Jayne, a 40-year old man with Lou Gehrig's disease, who is confined to a wheelchair and cannot swallow, speak or even breathe on his own. Mr. Jayne needs several skilled nursing visits per week to enable him to remain independent and out of an inpatient facility. Despite his disability, Mr. Jayne meets frequently with youth and church groups. Speaking through a computerized voice synthesizer, he gives inspirational talks about how the human spirit can endure and even overcome great hardship. The Atlanta Journal Constitution ran a feature article on Mr. Jayne and his activities, including a report about how he had, with the help of family and friends, attended a football game to root for the University of Georgia Bulldogs. A few days later, at the direction of the fiscal intermediary, his home health agency, which had been sending a health care worker to his home for two hours, four mornings a week, notified him that he could no longer be considered homebound, and that his benefits were being cut off. While his benefits were subsequently reinstated due to the media attention given the case, this experience motivated him to launch a crusade to modernize the homebound definition and led him to found the National Coalition to Amend the Medicare Homebound Restriction. The current homebound requirement is particularly hard on younger, disabled individuals who are on Medicare. The fact is that the current requirement reflects an outmoded view of life for persons who live with serious disabilities. The homebound criteria may have made sense thirty years ago, when an elderly or disabled person might expect to live in the confines of their home, perhaps cared for by an extended family. The current definition, however, fails to reflect the technological and medical advances that have been made in supporting individuals with significant disabilities and mobility challenges. It also fails to reflect advances in treatment for seriously ill individuals, like Mr. Jayne, which allow them brief periods of relative wellness. It also fails to recognize that an individual's mental acuity an physical stamina can only be maintained by use, and that the use of the body and mind is encouraged by social interactions outside the four walls of a home. The David Jayne Medicare Homebound Modernization Act of 2002 will amend the homebound definition to base eligibility for the home health benefit on the patient's functional limitations and clinical condition, rather than on an arbitrary limitation on absences from the home. It will provide a specific, limited exception to the homebound rule for individuals who: One, have been certified by a physician has having a permanent and severe condition that will not improve; Two, who need assistance from another person with 3 or more of the 5 activities of daily living and require technological and/or personal assistance with the act of leaving home; Three, who have received Medicare home health services during the previous 12 month period; and Four, who are only able to leave home because the services provided through the home health benefit makes it possible for them to do so. We believe that our legislation is budget neutral because it is specifically limited to individuals who are already eligible for Medicare and whose conditions require the assistance of a skilled nurse, therapist or home health aide to make it functionally possible for them to leave the home. Our legislation does not expand Medicare eligibility--it simply gives people who are already eligible for the benefit their freedom. This issue was first brought to my attention by former Senator Robert Dole, who has long been a vigorous advocate for people with disabilities. Our proposal is also supported by the Consortium of Citizens with Disabilities, the Visiting Nurse Associations of America, the National Association for Home Care, Advancing Independence: Modernizing Medicare and Medicaid, AIMM, and the National Coalition to Amend the Medicare Homebound Restriction. Moreover, the David Jayne Medicare Homebound Modernization Act of 2002 is consistent with President Bush's ``New Freedom Initiative'' which has, as its goal, the removal of barriers that impede opportunities for those with disabilities to integrate more fully into the community. By allowing reasonable absences from the home, our amendment will bring the Medicare home health benefit into the 21st Century, and I look forward to working with my colleagues to getting it done.

Ms. COLLINS

Ms. COLLINS. Again, I thank the ranking member for his forthrightness, his knowledge and his determination to keep America strong. I also thank him for his continued leadership on defense and defense related issues. I believe that the Appropriations Committee deserves the thanks of the American people for the leadership the committee has shown in defending our nation from the threat of chemical and biological weapons. The chairman and ranking member are dedicated to America's defense and the committee staff have done outstanding work on this bill. Enterprize Architecture

Ms. COLLINS. I thank the Senator for his illuminating words. If the distinguished ranking member would indulge me further, I would like to call to his attention a research initiative regarding food safety and security that is on the Committee's list of projects eligible for funding. This initiative is one that holds great potential to protect our military from a chemical or biological threat. Does the Senator from Alaska share my view that this kind of a program ought to be a priority for the chemical and biological defense initiative fund?

Ms. COLLINS. I thank the distinguished Ranking Member for his leadership on Defense issues. And I am very pleased to see that the Defense Appropriations bill places a high priority on addressing the chemical and biological weapons threat that we face and provides additional funding beyond the President's request for a number of high priority research programs. As the Senator knows, I have been actively supporting vigorous research efforts in this area since my first days in the Senate because the threat from these weapons is serious and it is growing day by day. I am pleased to see that the Committee is recommending to the Senate that a chem-bio defense initiatives fund be established with an initial funding increment of $25 million. The Committee has listed a number of technology initiatives for consideration, but is providing the Secretary of Defense with the discretion to allocate the funds. It seems logical to ensure that the most promising, maturing technologies are seen through to their completion, particularly if the technology shows a high potential to yield benefits in defending our troops, Nation, and our global interests. Is it the Committee's intent to ensure that such on-going programs that are nearing completion receive a priority for consideration of these funds?

Ms. COLLINS. Mr. President, I rise today to discuss the very important issue of chemical and biological research. The threat of a chemical and biological attack is no longer an emerging threat: it is very real, and it affects not only our nation, but our allies as well. The risks associated with chemical and biological weapons are growing, and our capacity to assess, counter, and deter these threats needs to be addressed. That is why it is critical to see continued investments made in diagnostic tools for biowarfare-inflicted agents, chemical and biological detection devices, and sensors to ensure the safety of food and water supply.

Ms. COLLINS

Ms. COLLINS. I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise in strong support of the Greater Access to Affordable Pharmaceuticals Act, which will make prescription drugs more affordable by promoting more competition in the pharmaceutical industry and increasing access to lower priced generic drugs. I was very pleased to have the opportunity to work with my colleague, the Senator from North Carolina, in offering this compromise in the Health, Education, Labor, and Pensions Committee, where it was approved by a strong bipartisan vote. I also recognize the leadership and hard work of the Senators from New York and Arizona on this critical issue. Prescription drug spending in the United States has increased by 92 percent over the past 5 years to almost $120 billion. These soaring costs are a particular burden for the millions of uninsured Americans, as well as for those seniors on Medicare who lack prescription drug coverage. Many of these individuals are simply priced out of the market or forced to choose between paying the bills or buying the pills they need to remain healthy. Skyrocketing prescription drug costs are also putting the squeeze on our Nation's employers who are struggling in the face of double-digit increases in their insurance premiums. They are finding it increasingly difficult to continue to provide health care coverage for their employees. Soaring costs are also exacerbating the Medicaid funding crisis that all of us are hearing about from our Governors back home who are struggling to bridge shortfalls in the States' budgets. In 1984, the Hatch-Waxman Act made significant changes in our patent laws that were intended to encourage pharmaceutical companies to make the investments necessary to develop new drug products while simultaneously enabling their competitors to bring lower cost, generic equivalents to the market. We should acknowledge that, to a large extent, the original Hatch-Waxman Act succeeded. The law has speeded access to generic drugs in the market. As a consequence, consumers are saving anywhere between $8 and $10 billion a year by purchasing lower priced generic drugs. Moreover, there are even greater potential savings on the horizon. Within the next 4 years, the patents on brand name drugs with combined sales of $20 billion are set to expire. If Hatch-Waxman were to work as it was intended, consumers could expect to save between 50 and 60 percent on these drugs as lower-cost generic alternatives becomes available after these patents expire. But despite the past successes of this law, it has become increasingly evident that the Hatch-Waxman Act has been subject to abuse. While many pharmaceutical companies have acted in good faith, there is mounting evidence that others have attempted to game the system by exploiting legal loopholes in the current law. The result is, too many pharmaceutical companies have maximized their profits at the expense of consumers by filing frivolous lawsuits that have delayed access to lower priced generic drugs. Just yesterday, the Federal Trade Commission released its long- awaited study that found that brand name drug manufacturers have, indeed, misused the law to delay the entry of lower cost generics into the market. The FTC found that these tactics have led to delays of between 4 and 40 months--over and above the first 30-month stay provided under Hatch-Waxman--for generic competitors of at least eight drugs--eight very popular drugs--since 1992. Moreover, six of these eight delays have occurred since 1998. The FTC report identifies two specific provisions of the current law--the automatic 30-month stay and the 180-day market exclusivity provision--as being susceptible to challenges and strategies that delay the entry of lower cost generic alternatives into the market. According to the FTC report, these loopholes ``continue to have the potential for abuse'' and, if left unchanged, ``may have [even] more significance [for consumers] in the future.'' I am pleased to say that these are the very loopholes that our bill would close. The Congressional Budget Office estimates that our legislation would cut our Nation's drug costs by an astounding $60 billion over the next 10 years. It is no wonder that our proposal is supported by coalitions representing the Governors, employers, insurers, organized labor, seniors groups, and individual consumers who are footing the bill for these expensive drugs and whose costs for many popular drugs could be cut in half if generic alternatives were more readily available. I would like to pause for a moment to discuss some of the details of the underlying Edwards-Collins bill. Some of my colleagues have argued that certain provisions of the bill are unconstitutional or that the bill will lead to more litigation. But no amendments have been offered to change any of the provisions of the Edwards-Collins bill. Moreover, the bill itself is the product of months of work and represents a broad, bipartisan compromise that incorporates the views and concerns of a wide spectrum of interests. I worked particularly hard on carefully wording the cause of action created by the bill, and believe that criticisms of it spurring increased litigation are not well-founded. Our bill creates a new civil action that offers a remedy if companies incorrectly or frivolously listed patents in the Orange Book, so that these patents do not delay the ability of a generic drug to come to market. The bottom line is, the cause of action will help to reduce both the cost of prescription drugs and the cost of prescription drug litigation. It does so by allowing generic drug makers, for the first time, to directly challenge a patent that has been frivolously or incorrectly listed. I understand the concerns of some of my colleagues who are leery of creating new causes of action. But I would reply that, in many cases, litigating through narrowly-targeted suits can be quicker and less expensive than aggregating a number of claims in one, massive proceeding. Moreover, I have worked to target the new provision as carefully as possible. In Committee, I offered a common sense amendment to tailor the new cause of action in a way that will help minimize unintended consequences while, at the same time, ensuring that it still serves its intended purpose of policing frivolous or incorrectly listed patents. My amendment made it clear that the delisting cause of action is for injunctive relief only and cannot result in monetary damages. It also limited the new cause of actions to patents listed in the Orange Book up to 30 days after a New Drug Application's approval. In doing so, my amendment harmonized the 30-month stay provision and the cause of action, as it should be. The original Hatch-Waxman Act was a carefully constructed compromise that balanced an expedited FDA approval process to speed the entry of lower cost generic drugs into the market with additional patent protections to ensure continuing innovation that brings us these wonderful lifesaving and life-enhancing drugs. The bipartisan compromise bill before us restores that balance by closing the loopholes that have reduced the original law's intent and its effectiveness in bringing lower cost generic drugs to market more quickly. I am very pleased we are going to pass this legislation. It really will make a difference for millions of Americans who are struggling to afford the high cost of prescription drugs. Mr. President, I ask unanimous consent that letters from various groups that are supporting this legislation and worked very closely with us in drafting it be printed in the Record.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am pleased to be introducing America's National Maritime Museums Act of 2002. This legislation would designate an additional 19 maritime museums as ``American National Maritime Museums'' nationwide. Maritime Museums are dedicated to advancing maritime and nautical science by fostering the exchange of maritime information and experience and by promoting advances in nautical education. The America National Maritime Museum designation would include a commitment on the part of each institution toward accomplishing a coordinated education initiative, resources management program, awareness campaign, and heritage grants program. Maritime museums in America will be dedicated to illuminating humankind's experience with the sea and the events that shaped the course and progress of civilization. Museum collections are composed of hundreds of thousands of maritime items, including ship models, scrimshaw, maritime paintings, decorative arts, intricately carved figureheads, working steam engines, and much more. Maritime museums offer a variety of learning experiences for children and adults through hands-on workshops and programs that focus on maritime history. Maritime lecture series presentations offer an opportunity to learn about the history and lore of the sea from some of the nation's leading maritime experts. Visitors learn the broad concept of sea power, the historic and modern importance of the sea in matters commercial, military, economic, political, artistic, and social. The legislation that I am proposing would help museums better interpret maritime and social history to the public using their extensive collections of artifacts, exhibits and expertise. These programs and facilities are used by schools, civic organizations, genealogists, maritime scholars, and the visiting public, thus, serving students of all ages. I urge all members of the Senate to join me in support of the America's National Maritime Museums Act of 2002.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am pleased to be introducing America's National Maritime Museums Act of 2002. This legislation would designate an additional 19 maritime museums as ``American National Maritime Museums'' nationwide. Maritime Museums are dedicated to advancing maritime and nautical science by fostering the exchange of maritime information and experience and by promoting advances in nautical education. The America National Maritime Museum designation would include a commitment on the part of each institution toward accomplishing a coordinated education initiative, resources management program, awareness campaign, and heritage grants program. Maritime museums in America will be dedicated to illuminating humankind's experience with the sea and the events that shaped the course and progress of civilization. Museum collections are composed of hundreds of thousands of maritime items, including ship models, scrimshaw, maritime paintings, decorative arts, intricately carved figureheads, working steam engines, and much more. Maritime museums offer a variety of learning experiences for children and adults through hands-on workshops and programs that focus on maritime history. Maritime lecture series presentations offer an opportunity to learn about the history and lore of the sea from some of the nation's leading maritime experts. Visitors learn the broad concept of sea power, the historic and modern importance of the sea in matters commercial, military, economic, political, artistic, and social. The legislation that I am proposing would help museums better interpret maritime and social history to the public using their extensive collections of artifacts, exhibits and expertise. These programs and facilities are used by schools, civic organizations, genealogists, maritime scholars, and the visiting public, thus, serving students of all ages. I urge all members of the Senate to join me in support of the America's National Maritime Museums Act of 2002.

Ms. COLLINS

Ms. COLLINS. I thank the Senator from West Virginia. Mr. President, I just want to make a couple points. First of all, an increase in the Federal match under Medicaid was part of the Centrist Coalition's economic recovery package we considered. It was part of virtually every version. It had widespread support. It was supported by the administration. It did not make it into the final package. But this is not a new idea. This is an idea with widespread bipartisan support. The second point I want to make is in response to an argument made by my friend and colleague from Oklahoma. My friend from Oklahoma said Medicaid spending does not get cut in economically good times. In fact, it is countercyclical. In good times, far fewer people qualify for Medicaid. In fact, Federal and State spending on Medicaid declined dramatically during the 1990s, when the economic times were good. So there is a countercyclical aspect of Medicaid. It does go down when times are good and the program is less needed. Now times are not good. There are more people in need of assistance from the Medicaid Program. We know 40 million Americans rely on this program. What we are trying to do is preserve this essential, vital health care program that provides services and care to the most vulnerable and needy in our society. That is the motivation behind our proposal. It is not to bail out the States, it is to help the States, our partners, provide essential services.

Ms. COLLINS

Ms. COLLINS. I thank the Senator from West Virginia. It has been a pleasure to work with him and the Senator from Nebraska, as well as the Senator from Oregon, on this important amendment. The Senator from Nebraska raised a very good point. This amendment has implications for all of our health care providers and that is why it enjoys such strong support of our nursing homes, of our hospitals-- our rural hospitals are struggling with inadequate reimbursements--from disability advocates and the Visiting Nurse Associations. But let's talk about what this means. We have talked about it being necessary to protect the most vulnerable in our society. Let's talk about what it means for some individual States. I mentioned yesterday that this amendment would provide $54 million in much needed relief to my home State of Maine. That would help avoid the necessity for draconian cuts in essential social service programs such as our Medicaid Program. But let's look at a few other States. For Alabama, for example, this would mean $92.6 million; for Alaska, it would be $32.2 million; for Arizona, $144 million; for Arkansas, $80 million. Let me skip down a bit. For Florida, $359 million; for Georgia, $208 million; for Hawaii, $28 million; for Idaho, $28.6 million. Indeed, the Governor of Idaho, our former colleague, Governor Kempthorne, has worked very hard as an advocate for this important legislation. In other words, every single State in the Nation would be by this amendment provided with much needed relief. That is why we need to act. Otherwise, States are going to have no choice but to slash essential programs. We have new figures coming out today that show the fiscal crisis affecting our partners, the States, has widened still further. According to the National Conference of State Legislators, States have used up two-thirds of their cash on hand. The gap between revenues and spending has hit $36 billion and is expected to be $58 billion, affecting 46 States. We must act. I urge my colleagues to reject the point of order.

Ms. COLLINS. Madam President, let's put the budget point of order of the Senator from Texas against our fiscal relief amendment into some context. The Senator's point of order, in essence, claims that the fiscal relief provided by our bipartisan amendment is somehow not emergency spending. Let's look at the facts. Let's look at the situation. The Budget Enforcement Act of 1990 established statutory limits on discretionary spending and a pay-as-you-go requirement for new direct spending and tax legislation. But it also exempted from the caps all discretionary spending designated by the President and the Congress as an emergency requirement. The law does not further define what is an emergency requirement. That is up to us. One place we can look for guidance, however, is to the criteria developed by the Office of Management and Budget for the President to use when determining whether or not a spending provision qualifies for emergency treatment. The Office of Management and Budget determined that an emergency spending provision is ``sudden, urgent, necessary, unforeseen, and not permanent.'' The funds that the amendment allocates to the States is all of those things. They meet the criteria precisely for emergency spending. First, our amendment addresses a sudden and unforeseen problem. That is the unexpected drop in revenues States have experienced. Indeed, 39 States were forced to reduce their already enacted budgets for fiscal year 2002 by reducing essential programs, tapping rainy day funds, furloughing employees, and cutting important services. In short, the budget crisis was clearly a sudden and unexpected development for our partners as States. The second relief our amendment provides is needed to address an urgent situation, another criterion. The latest figures show that 46 States are facing an aggregate budget shortfall exceeding $50 billion. Many have already cut or are considering cutting their Medicaid and social service programs. Finally, the relief provided by our amendment is not permanent, it is short-term relief, narrowly tailored to address a fiscal crisis that the States are experiencing now. In short, our amendment is a textbook example of the definition of ``emergency'' spending. It addresses a sudden, unforeseen, urgent crisis, and provides temporary but much needed relief. Finally, we should not forget as we debate this issue what this is really all about. It is about protecting health care and other essential social services for the neediest and most vulnerable citizens in this country. Medicaid provides health insurance to approximately 40 million low-income Americans, including 21 million children and young adults, 11 million elderly and disabled individuals, and 8.6 million adults in families, most of whom are single women. Without this critical safety net, millions of low-income men and women and their families would be left with no health insurance. That is the bottom line in this debate. We need to help the States so they can continue to provide essential health care to the most vulnerable citizens in our society. We are not taking the States off the hook. They are still going to have to make many tough choices in order to balance their budgets. But we can provide this meaningful relief. We must do so now in order to preserve that critical safety net for the most vulnerable in our society.

Ms. COLLINS

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

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

Ms. COLLINS

Ms. COLLINS. Madam President, the National Partnership for Women and Families has issued a statement today endorsing the amendment I have offered with Senators Rockefeller, Ben Nelson, and Gordon Smith. It includes some very important information that helps us better understand why this debate is so important. The National Partnership cites the National Governors Association's May report that over 40 States are facing budget shortfalls totaling $40 to $50 billion overall. Since Medicaid makes up, on average, 20 percent of State spending, it is often the first place that States look to make cuts. So our amendment would provide $9 billion in total fiscal relief that would help sustain critical State Medicaid Programs and bolster the States' ability to keep providing vital social services to those most in need. Let's look at whom this benefits. Medicaid provides health insurance to approximately 40 million low- income Americans, including 21 million children and young adults, 11 million elderly and disabled individuals, and 8.6 million adults in families, most of whom are single mothers. That is the population that is hurt when Medicaid budgets are slashed. That is the most vulnerable of populations. They need our help. The States need our help in order to maintain vital health care services for those 40 million low-income Americans. Without this critical safety net, millions of women and their families would be left with no health insurance at all. So that is why we must act. And we must act before more time elapses and more States are forced to cut their Medicaid budgets. Time is of the essence. I urge my colleagues to join with us in supporting this absolutely critical bipartisan proposal. Madam President, I yield the floor and suggest the absence of a quorum.

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

Ms. COLLINS. Madam President, I see the Senator from New York is in the Chamber. If he would like to speak on this issue at this point, I would be happy to yield.

Ms. COLLINS. Madam President, I share the concern of the Senator from West Virginia that we should not delay action on this important matter. Support for our proposal is growing with each hour. I am excited about that. This proposal offers real relief to our State governments that are struggling with budget shortfalls. But, most importantly, it offers the promise that low-income families who depend on Medicaid will not face a cutoff of some of their important benefits. The Senator from West Virginia raises a very good point. There are health care providers in my State, as well as his, rural hospitals in particular, that are struggling to make ends meet. The threat of Medicaid cuts imposed by States trying to balance their budgets during this very difficult fiscal time poses a threat to their ability to continue to provide quality care. That is why we have the support of so many health care provider groups. I am going to read from some of letters that we have received that endorse our proposal. In some cases, the letters speak to earlier legislation that I introduced along with my friend and colleague, Senator Ben Nelson of Nebraska. But, as I said earlier, we have pooled our efforts because we want to get relief to the States as fast as possible. Let me tell you what our visiting nurses say about the importance of providing this relief. This is a letter that I will read from the Visiting Nurse Associations of America. It is signed by the president, Carolyn Markey. She writes: On behalf of the Visiting Nurse Associations of America (VNAA), I would like to express our strong support for you and Senator Ben Nelson's proposed legislation that would provide temporary fiscal relief to states for Medicaid- covered health care services. VNAA is the national membership association for non-profit, community-based Visiting Nurse Agencies (VNAs), which collectively care for approximately 50% of all Medicaid home health patients each year. VNAA is concerned that approximately one-half of the states across the nation have had to cut their FY 2002 Medicaid budgets in order to avoid a budget crisis. We fear that the majority of states will implement additional cost-containment measures, including reducing benefits, increasing beneficiary cost-sharing and further reducing Medicaid reimbursement to health care providers. On average, Medicaid already reimburses providers significantly less than the cost of care. That is an important point. There are already reimbursement levels that aren't covering the cost of providing this essential care. The letter goes on to say: VNAA's 2001 data shows that, collectively, VNAs are incurring an average $565 loss per Medicaid patient, with an annual loss of $148,500. VNAs' mission is to provide care to all eligible persons regardless of their condition or ability to pay. Because of this mission, VNAs will attempt to continue to admit all eligible Medicaid beneficiaries, but subsidizing Medicaid will force VNAs to cut other social service programs that are funded through charity contributions, such as Meals on Wheels and preventive health clinics. Your legislation is sorely needed at this time. It would help states maintain eligibility and program levels in order for low-income families, children, seniors and persons with disabilities to continue to receive the health care they need. It will also prevent the exodus of some providers from Medicaid participation, and prevent other providers from having to cut vital community-based social services. Those are the stakes. The stakes are high. I ask unanimous consent to have the full text of the letter from Carolyn Markey, the president of the Visiting Nurse Associations of America, printed in the Record.