Susan Collins

Ms. COLLINS

Ms. COLLINS. Mr. President, to continue the colloquy with the distinguished chairman, I again thank him very much for his support. I would like to point out the research conducted at the University of Maine is particularly vital because of the 104 USDA-ARS labs across the country, the laboratory located in Orono, ME, is the only one in New England. The facility is thus able to conduct research on the unique challenges that face our New England farmers. Specifically, the lab at Orono has conducted research into raised bed techniques that allow potatoes to be grown in the short New England growing season, as well as into disease and pest management. The potato industry in New England, 95 percent of which is located in northern Maine where I grew up, is suffering through a difficult period. Underpriced subsidized imports and several consecutive years of disease, drought and pest problems have resulted in a steady decline in the amount of acreage planted in potatoes. The additional $300,000 included in the managers' amendment will allow the lab to hire a new pathologist and microbiologist to help New England farmers to overcome many of the challenges they face. I look forward to working with my colleague to enact this significant legislation and, again, I commend and thank him for acceding to our request in this regard.

Ms. COLLINS. I thank the Senator for his very kind comments. It has been a great honor to be able to work with the Senator on the issue of improving the safety of imported fruit and vegetables and all imported food. As we have learned from the two hearings that we held to date, this is a very complex issue that does not lend itself to a simple solution. It is my hope that continuing to work with the Senator from Mississippi, we will be able to complete our investigation this fall and develop a series of recommendations that will get to the heart of the problem and help to continue to ensure that our food safety is the best in the world. I thank the chairman for his cooperation and participation in this conversation, and I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent that the Subcommittee on Near Eastern and South Asian Affairs be authorized to meet during the session of the Senate on Monday, July 13, 1998 at 3:00 pm to hold a hearing.

Ms. COLLINS

Ms. COLLINS. Mr. President, diabetes is a serious and potentially life-threatening disease affecting more than 16 million Americans at a cost of more than $137 billion annually. That is more than the cost of treating any other disease. Moreover, since 3 million elderly Medicare beneficiaries have been diagnosed with diabetes, and another 3 million are likely to have it but not realize it at this point, nowhere is the economic impact of diabetes felt more strongly than in our Medicare Program. Treating seniors for the often devastating complications associated with diabetes accounts for more than one-quarter of all Medicare expenses. Therefore, helping diabetic seniors avoid the complications of their disease will not only greatly improve the quality of their lives, but also help reduce the economic burden that diabetes places on the Medicare Program. This, Mr. President, is essential to the long- term economic viability of Medicare. While there is no known cure, diabetes is largely a treatable disease. Many people who have diabetes can lead completely normal, active lives as long as they stick to a proper diet, carefully monitor the amount of their blood sugar or glucose, and take their medicine, which may or may not include insulin. However, Mr. President, unfortunately, if a person with diabetes does not follow this rather strict regimen, they put themselves at risk of blindness, loss of limbs and an increased chance of heart disease, kidney failure, and stroke. Therefore, appropriate preventive services for diabetes have the potential to save a great deal of money that otherwise would go for hospitalization or other acute care costs--not to mention a great deal of unnecessary pain and suffering. Mr. President, Congress recently took a number of important steps to improve Medicare coverage of preventive care for individuals with diabetes. Prior to enactment of the Balanced Budget Act of 1997, Medicare covered diabetes self-maintenance education services in inpatient or hospital-based settings and in limited outpatient settings, specifically hospital outpatient departments or rural health clinics. Medicare did not, however, cover education services if they were given in any other outpatient setting, such as a physician's office. Moreover, while Medicare did cover the cost of blood-testing strips used to monitor the sugar in the blood, it did so only for type I diabetics who required insulin to control their disease. Last year's Balanced Budget Act rightly expanded Medicare to cover all outpatient self-management training services as well as providing uniform coverage of blood-testing strips for all people with diabetes. With the enactment of the Balanced Budget Act, we made significant progress toward improving care for Medicare beneficiaries with diabetes. However, Mr. President, there is more that we can do. External insulin infusion pumps have proven to be more effective at controlling blood glucose levels than conventional injection therapy for many insulin-dependent diabetics. This helps them to avoid the expensive complications and the suffering resulting from uncontrolled diabetes. However, Mr. President, Medicare currently does not cover these pumps, even in cases where they have been prescribed as medically necessary by the Medicare beneficiary's physician. I am, therefore, today pleased to introduce legislation, the Medicare Insulin Pump Coverage Act of 1998, that would expand Medicare coverage to cover insulin infusion pumps for certain type I diabetics. External insulin pumps are neither investigational nor experimental. They are widely accepted by health care professionals involved in treating patients with diabetes. Moreover, studies such as the Diabetes Control and Complications Trial sponsored by NIH have established that maintaining blood glucose levels as close to normal as possible is the key to preventing the devastating complications of diabetes. For many patients, Mr. President, the use of an infusion pump is the only way that optimal blood glucose control can be achieved safely and effectively. That is why virtually all other third-party payers-- including most State Medicaid programs and CHAMPUS--cover the device. Moreover, there is precedent under the Medicare Program itself for covering the pump. Medicare currently covers infusion pumps for numerous cancer drugs as well as for pain control medications. Mr. President, I first became interested in this problem because of the experience of one of my constituents, Nona Frederich of Raymond, ME. She is an example of the kind of Medicare patient who would benefit from the pump. She is currently, unfortunately, being denied what is for her the most effective form of glucose control. Nona has been an insulin-dependent diabetic since 1962. Because of her extremely volatile insulin sensitivity, her diabetic specialist placed her on an insulin infusion pump in January of 1982. Until she reached age 65, the cost of the pump and operating supplies was underwritten in large part by her insurer, Colorado Blue-Cross-Blue Shield, and later by Blue Cross-Blue Shield of Maine. In March of 1995, it became necessary for Nona to purchase a new infusion pump. By now, however, she was older and on Medicare. Much to her surprise, Medicare refused to cover the pump, even though her doctor had prescribed it as clearly being medically necessary to help control her diabetes. Since then, with the help of my Portland office staff, the Frederichs have worked their way through the Health Care Financing Administration's system of appeals. Unfortunately, in January of this year, they received final notification of a negative decision by the Department of Health and Human Services. Their only option now is to file a civil suit, which they are simply not in a position to pursue. The Frederichs literally have notebooks filled with documentation of the procedures they have followed and the evidence they have submitted. Moreover, they have personally paid close to $5,000 in original pump costs and supplies for which they have received no reimbursement under the Medicare Program. For a Medicare beneficiary with limited income, these kinds of costs can be devastating. They can place the pump completely out of reach, even though the pump is medically necessary. In such a case, such patients would be forced to return to or continue with conventional insulin therapy which simply may not be as effective in controlling their blood sugar. As a consequence, these patients are admitted to the hospital with complications over and over again. The irony is that then Medicare will pick up the bill, and a far higher bill it will be than if Medicare had paid for the pump in the first place. While potentially devastating for an individual, the financial cost to Medicare of expanding coverage to include the insulin-infusion pump would be relatively minor. Under my bill, the pump would have to be prescribed by a physician and the beneficiary would have to be a Type-I diabetic, ``experiencing severe swings of high and low blood glucose levels.'' Of the estimated 3 million Medicare beneficiaries with diabetes, only about 5 percent are Type-I, or insulin-dependent. Of these, it is estimated the pump would be appropriate for only about 4 percent. But what a difference it would make in the lives of those 4 percent. The American Diabetes Association, the American Association of Clinical Endocrinologists and the American Association of Diabetes Educators, as well as officials at the Centers for Disease Control, have all advocated expanding Medicare to cover insulin pumps for Type-I diabetics who would otherwise have great difficulty in controlling their blood sugar. I am very pleased to be introducing this legislation today to do just that. I urge my colleagues to join me as cosponsors. I ask that the text of the bill be entered into the record.

Ms. COLLINS

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

Ms. COLLINS. Mr. President, I ask unanimous consent that I be permitted to proceed for not to exceed 12 minutes.

Ms. COLLINS

Ms. COLLINS. Mr. President, diabetes is a serious and potentially life-threatening disease affecting more than 16 million Americans at a cost of more than $137 billion annually. That is more than the cost of treating any other disease. Moreover, since 3 million elderly Medicare beneficiaries have been diagnosed with diabetes, and another 3 million are likely to have it but not realize it at this point, nowhere is the economic impact of diabetes felt more strongly than in our Medicare Program. Treating seniors for the often devastating complications associated with diabetes accounts for more than one-quarter of all Medicare expenses. Therefore, helping diabetic seniors avoid the complications of their disease will not only greatly improve the quality of their lives, but also help reduce the economic burden that diabetes places on the Medicare Program. This, Mr. President, is essential to the long- term economic viability of Medicare. While there is no known cure, diabetes is largely a treatable disease. Many people who have diabetes can lead completely normal, active lives as long as they stick to a proper diet, carefully monitor the amount of their blood sugar or glucose, and take their medicine, which may or may not include insulin. However, Mr. President, unfortunately, if a person with diabetes does not follow this rather strict regimen, they put themselves at risk of blindness, loss of limbs and an increased chance of heart disease, kidney failure, and stroke. Therefore, appropriate preventive services for diabetes have the potential to save a great deal of money that otherwise would go for hospitalization or other acute care costs--not to mention a great deal of unnecessary pain and suffering. Mr. President, Congress recently took a number of important steps to improve Medicare coverage of preventive care for individuals with diabetes. Prior to enactment of the Balanced Budget Act of 1997, Medicare covered diabetes self-maintenance education services in inpatient or hospital-based settings and in limited outpatient settings, specifically hospital outpatient departments or rural health clinics. Medicare did not, however, cover education services if they were given in any other outpatient setting, such as a physician's office. Moreover, while Medicare did cover the cost of blood-testing strips used to monitor the sugar in the blood, it did so only for type I diabetics who required insulin to control their disease. Last year's Balanced Budget Act rightly expanded Medicare to cover all outpatient self-management training services as well as providing uniform coverage of blood-testing strips for all people with diabetes. With the enactment of the Balanced Budget Act, we made significant progress toward improving care for Medicare beneficiaries with diabetes. However, Mr. President, there is more that we can do. External insulin infusion pumps have proven to be more effective at controlling blood glucose levels than conventional injection therapy for many insulin-dependent diabetics. This helps them to avoid the expensive complications and the suffering resulting from uncontrolled diabetes. However, Mr. President, Medicare currently does not cover these pumps, even in cases where they have been prescribed as medically necessary by the Medicare beneficiary's physician. I am, therefore, today pleased to introduce legislation, the Medicare Insulin Pump Coverage Act of 1998, that would expand Medicare coverage to cover insulin infusion pumps for certain type I diabetics. External insulin pumps are neither investigational nor experimental. They are widely accepted by health care professionals involved in treating patients with diabetes. Moreover, studies such as the Diabetes Control and Complications Trial sponsored by NIH have established that maintaining blood glucose levels as close to normal as possible is the key to preventing the devastating complications of diabetes. For many patients, Mr. President, the use of an infusion pump is the only way that optimal blood glucose control can be achieved safely and effectively. That is why virtually all other third-party payers-- including most State Medicaid programs and CHAMPUS--cover the device. Moreover, there is precedent under the Medicare Program itself for covering the pump. Medicare currently covers infusion pumps for numerous cancer drugs as well as for pain control medications. Mr. President, I first became interested in this problem because of the experience of one of my constituents, Nona Frederich of Raymond, ME. She is an example of the kind of Medicare patient who would benefit from the pump. She is currently, unfortunately, being denied what is for her the most effective form of glucose control. Nona has been an insulin-dependent diabetic since 1962. Because of her extremely volatile insulin sensitivity, her diabetic specialist placed her on an insulin infusion pump in January of 1982. Until she reached age 65, the cost of the pump and operating supplies was underwritten in large part by her insurer, Colorado Blue-Cross-Blue Shield, and later by Blue Cross-Blue Shield of Maine. In March of 1995, it became necessary for Nona to purchase a new infusion pump. By now, however, she was older and on Medicare. Much to her surprise, Medicare refused to cover the pump, even though her doctor had prescribed it as clearly being medically necessary to help control her diabetes. Since then, with the help of my Portland office staff, the Frederichs have worked their way through the Health Care Financing Administration's system of appeals. Unfortunately, in January of this year, they received final notification of a negative decision by the Department of Health and Human Services. Their only option now is to file a civil suit, which they are simply not in a position to pursue. The Frederichs literally have notebooks filled with documentation of the procedures they have followed and the evidence they have submitted. Moreover, they have personally paid close to $5,000 in original pump costs and supplies for which they have received no reimbursement under the Medicare Program. For a Medicare beneficiary with limited income, these kinds of costs can be devastating. They can place the pump completely out of reach, even though the pump is medically necessary. In such a case, such patients would be forced to return to or continue with conventional insulin therapy which simply may not be as effective in controlling their blood sugar. As a consequence, these patients are admitted to the hospital with complications over and over again. The irony is that then Medicare will pick up the bill, and a far higher bill it will be than if Medicare had paid for the pump in the first place. While potentially devastating for an individual, the financial cost to Medicare of expanding coverage to include the insulin-infusion pump would be relatively minor. Under my bill, the pump would have to be prescribed by a physician and the beneficiary would have to be a Type-I diabetic, ``experiencing severe swings of high and low blood glucose levels.'' Of the estimated 3 million Medicare beneficiaries with diabetes, only about 5 percent are Type-I, or insulin-dependent. Of these, it is estimated the pump would be appropriate for only about 4 percent. But what a difference it would make in the lives of those 4 percent. The American Diabetes Association, the American Association of Clinical Endocrinologists and the American Association of Diabetes Educators, as well as officials at the Centers for Disease Control, have all advocated expanding Medicare to cover insulin pumps for Type-I diabetics who would otherwise have great difficulty in controlling their blood sugar. I am very pleased to be introducing this legislation today to do just that. I urge my colleagues to join me as cosponsors. I ask that the text of the bill be entered into the record.

Ms. COLLINS

Ms. COLLINS. Mr. President, I am pleased to be a cosponsor of this important legislation, and I want to commend the Senator from Vermont, the chairman of the committee, for his work in bringing this very important legislation to the floor. Mr. President, today we continue a historic commitment which began 40 years ago when Congress enacted the National Defense Education Act. In 1958, the NDEA provided that: ``The security of the Nation requires the fullest development of the mental resources and technical skills of its young men and women.'' At that time, Congress was thinking of security in terms of the cold war and was reacting to the Soviet Union's stunning achievement in launching Sputnik. Although the cold war is behind us now, the sentiments expressed in 1958 remain valid today. The threat may no longer be as dramatic as the threat posed by the technological advancements of a hostile superpower; instead, the threat that we face today is a quiet threat of lost opportunity--economically, culturally, and socially--a threat that will be realized if we fail to provide educational opportunities to our citizens. As a Senator from a State with a very high rate of high school completion but a very low rate of participation in higher education, I am particularly concerned about the threat that the lack of access to higher education poses to the future well-being of many of our lower- income citizens. We know, Mr. President, that fewer people from lower-income families enroll in postsecondary education. The problems caused by the lack of access, however, do not stop once we get students to campus. Another challenge is keeping them there and encouraging them to graduate. The disturbing truth, Mr. President, is that students who find college least affordable are much less likely to complete college than their financially more secure counterparts. As the Educational Testing Service's Policy Information Center has reported, ``The education staircase . . . is getting steeper and harder to climb, particularly for those in lower income groups.'' The center has reported the alarming fact that students from lower- income backgrounds, in addition to having much lower rates of entrance into college, have much higher dropout rates than those from higher- income families. In 1979, a student in the top quartile of family income was four times more likely to obtain a baccalaureate degree by age 24 than a student from the bottom quartile. By 1994, Mr. President, this problem, this gap, had gotten much worse. Individuals from the top quartile were 10 times more likely to attain a 4-year degree by age 24. When you couple this statistic with the well-established relationship between educational attainment and lifetime earnings, the consequences of the education gap are obvious. We keep reading about the gap between the rich and the poor in this country and that that gap is growing. That gap is, by and large, an education gap. If we are able to provide educational opportunities to lower-income families, we will help close that gap, because the differences in the lifetime earnings of people who complete only high school versus those who go on to postsecondary education are enormous. We are at risk of creating a permanent underclass of people without the skills that open the gateways to economic opportunity, the skills that allow entry into a job market demanding a higher-educated and better-trained workforce. In fact, Mr. President, it is estimated that in the State of Maine more than 80 percent of the new jobs being created require some sort of postsecondary education. Unless steps are taken to close this educational gap, a gap rooted in economics rather than in intelligence or ability, we are locking the children of America's lower-income families into a self-perpetuating cycle of inadequate education and low-income status. Without educational opportunities, a significant part of American society will never have the chance to participate fairly in America's bright technology-based future. Mr. President, the legislation before us, the Higher Education Act reauthorization, will help provide these educational opportunities. I would like to highlight some specific provisions in this legislation that I worked on and believe are critical. These provisions increase access to education by focusing on two components--first, helping families afford education; and, second, increasing the aspirations of our young people, particularly those who come from families where higher education is not a tradition. Mr. President, the Pell Grant Program has been one of the Federal Government's greatest contributions to the success of higher education. Over the last 25 years, this program has provided invaluable assistance to tens of millions of our neediest students. The Pell Grant Program has, however, had some flaws. Most notably, under its current formula, the program creates a disincentive to work. This was brought home to me when I talked to a young person who had decided to take a year off between high school and college in order to earn more money for her education. She worked at McDonald's and lived at home, saved every penny. The consequence was that she lost her Pell grant when she went to school the next year. We have created, in the current formula, a disincentive, because we have a very low cap on allowable earnings which penalizes students who are trying to pay for their education through work rather than relying solely on loans. Earlier this year, I introduced the Working Students Income Protection Act to address this problem. I am very pleased that the Labor and Human Resources Committee has incorporated my bill into the final version of the legislation before us today. It will increase by $1,000 the earnings allowance for students who receive Pell grants. Another important provision improving the Pell grant that is included in this legislation is the elimination of the dependent care cap that had been included in the formula in the past. Again, I introduced legislation to make this change because I was concerned that as we increase the maximum level of aid, we end up limiting Pell grant awards to some of the most needy students, those who have child care expenses. Often these are single parents who are balancing raising children, going to work, and attending college. The changes that are included in this bill will make it a little bit easier for these students. Another provision of this bill includes legislation that Senator Reed of Rhode Island and I have authored to strengthen the State Student Incentive Grant Program. This program provides assistance to 12,000 Maine students who come from families whose average income is under $12,000. Mr. President, as important as all this financial assistance is--and I know from my experience working in a Maine college that it is critical--there is another significant barrier to higher education for a lot of our young people. If students come from a disadvantaged social or economic background, and come from families where there is no experience with higher education, they may look at college as being beyond their reach. It may be a frightening experience for them or something they simply do not consider, despite having the ability to succeed. In reauthorizing the Higher Education Act, we are continuing one of the Federal Government's most successful efforts, and that is the TRIO Programs. In my home State, TRIO Programs such as Talent Search and Upward Bound have identified and reached out to promising young people who otherwise never would have considered postsecondary education but for these terrific programs. Two-thirds of the students benefiting from the TRIO Programs come from families where neither parent has any higher education and whose families' incomes are below $24,000. One such student, Mr. President, recently visited me. She was a young woman from Greene, ME, who talked with such excitement about the benefit of the Talent Search Program to her aspirations. She said that the program had convinced her that she wants to go to college. This young woman comes from a low-income family. Neither of her parents went to college. In fact, her mother was a teenage mother who dropped out of high school to raise her children. This young woman put it very well. She said, ``But for this program, but for the Talent Search Program, I would have been too frightened to go to college. I would have just assumed that it wasn't for me.'' This program, by exposing her to a college environment, by giving her the counseling, the mentoring, and the encouragement that she needed, has convinced her that higher education will be part of her future. I am convinced that it will be a bright future indeed. It is difficult for me to think of a more worthwhile investment of Federal funds than these important programs. The Federal Government cannot guarantee equal educational attainment for every student, but we can certainly take steps that will guarantee equality of access for every student. We can help eliminate the barriers of cost and inadequate aspirations that prevent students from lower- and middle- income families from pursuing postsecondary education. We can give them equal opportunity by providing the access through the important programs in this legislation. The Higher Education Act that is before the Senate today will help our citizens overcome economic and social barriers, take advantage of education, and reach their full potential. That not only benefits them as individuals, it benefits our Nation as a society, as well. Today I encourage my colleagues to join in affirming and extending the commitment for access to education that we began 40 years ago. I thank the President for the time, and I thank the chairman for his efforts, as well. I yield the floor.

Ms. COLLINS

Ms. COLLINS. Mr. President, I rise to add my voice to those who have already spoken in support of the defense authorization bill. Providing for the common defense is the single most important responsibility of a national government. If we fail in this regard, all the other aspects of our public policy become irrelevant. I am particularly pleased with the significant role that my own State of Maine plays in our national defense. The legislation brought to us by the Armed Services Committee--and I commend the leaders of the committee for their tremendous efforts-- recognizes Maine's contributions in a number of ways. Perhaps none is more significant than the contribution of the State of Maine in the field of naval shipbuilding. This is where the skill and the dedication of Maine workers at Bath Iron Works provide the U.S. Navy with state- of-the-art Arleigh Burke class destroyers, the backbone of our destroyer fleet. Fortunately, this bill ensures this will be true for years to come, because the legislation continues the Navy's multiyear procurement program for the Arleigh Burke class. The bill also provides funding for the new LPD-17 amphibious ship which will be built in Bath and will help the Marine Corps maintain its local reach for years to come. Moreover, this bill provides continued funding for the Navy's next generation of destroyers, the DD-21. With the DD-21, Mainers will continue to play a pivotal role on the cutting edge of American sea power through Bath's participation in the ``shipbuilding alliance'' that will construct this powerful and innovative new ship for our 21st-century Navy. Other provisions of importance to my State increase funding to modernize and reconfigure the Navy's P-3 maritime patrol aircraft. This should permit these tried-and-true workhorses of naval aviation, operating out of bases such as the Brunswick Naval Air Station in Maine, to continue protecting our security for years to come. This bill also recognizes and supports the contributions of a number of very important defense contractors in Maine, including Saco Defense, Pratt & Whitney and Fiber Materials International of Biddeford. Furthermore, having learned a great deal about the extraordinary high-tech chemical and biological sensor laboratory at the University of Maine, I am also proud of the groundbreaking role Maine is playing in this crucial field. Recent events in Iraq and elsewhere illustrate the grave threats posed by the proliferation of chemical and biological weapons, the so-called poor man's atomic bomb. If we are to protect Americans against such threats, our troops in the field and our citizens at home need access to small, portable, state-of-the-art sensors capable of detecting such threats quickly and efficiently. I am proud that the University of Maine and Maine companies, such as Sensor Research & Development, are playing such an important role in preparing to meet this need and that this legislation supports funding for this important research program and other very significant defense projects at the University of Maine. Maine will also contribute to our national defense in the development of advanced composite materials--a field in which Fiber Materials International, of Biddeford, Maine, is a world leader. From structural skin elements of advanced NASA spacecraft to the nose tips and other components for a whole generation of high-tech missile systems, FMI provides this country with the very best in fiber composite materials. Another world leader from Maine is the Pratt & Whitney plant in South Berwick, Maine, which produces engine components for the F-15 Eagle. I should also note that this bill also aims to help ensure that the Defense Finance and Accounting Service meets its cost-cutting goals in a responsible manner--by requiring a careful study of how best to balance DFAS infrastructure reductions before the Department of Defense undertakes any such cuts. This ought to help Maine, and other states, avoid any unfair burden from cuts in facilities such as the award- winning DFAS center in Limestone, Maine. I commend my colleague, the senior Senator from Maine, for her amendment requiring this study. As a state with one of the highest per-capita populations of veterans in the country, Maine will also gain from this bill's provision for three demonstration projects designed to help the Department of Defense determine the best way to provide health care to Medicare-eligible veterans over the age of 65. Among the demonstration projects this language would authorize is an effort to extend FEHBP benefits to Medicare-eligible veterans. This provision is itself modeled upon a bill introduced by Senator Bond which I have cosponsored. Through such demonstration projects, we hope to be able to fill a significant gap in the health care our country provides to military retirees. As a final observation, I would like to point out that this defense authorization bill also includes language I introduced that will release federal interests in the Kennebec Arsenal in Augusta, Maine. The national government actually transferred this property to Maine nearly a century ago, but this conveyance had a number of strings attached--among them the requirement that the land only be used for a mental hospital. Today, these conditions are wholly obsolete, and this historic site is in great need of repair and historical preservation. The language I introduced which has been incorporated into the defense authorization bill will finally release the Kennebec Arsenal, without conditions, to the people of Maine. Augusta, ME, has very exciting plans for renovating this historic structure. All in all, this defense authorization bill represents far-sighted thinking about the challenges of U.S. defense policy in the years ahead. For this alone, it deserves our support. I am however, particularly pleased that this bill recognizes Maine's role in our defense preparedness and our state's pivotal position on the forefront of defense research and development, and that it builds upon them in order to ensure our security in the 21st Century. Mr. President, I urge my colleagues to support this legislation, and I, again, salute the leaders of the Armed Services Committee for their impressive efforts. Thank you, Mr. President. I yield the floor. Mr. BROWNBACK addressed the Chair.

Ms. COLLINS

Ms. COLLINS. Mr. President, today I introduce the Graduate Medical Education Technical Amendments Act of 1998, which is intended to address some of the problems that small family practice residency programs in Maine and elsewhere are experiencing as a result of provisions in the Balanced Budget Act (BBA) of 1997 that were intended to control the growth in Medicare graduate medical education spending. Of specific concern are the provisions in the BBA that cap the total number of residents in a program at the level included in the 1996 Medicare cost reports. Congress' goal in reforming Medicare's graduate medical education program was to slow down our nation's overall production of physicians, while still protecting the training of physicians who are in short supply and needed to meet local and national health care demands. While it is true that the BBA's provisions will curb growth in the overall physician supply, they do so indiscriminately and are thwarting efforts in Maine and elsewhere to increase the supply of primary care physicians in underserved rural areas. Because Maine has only one medical school--the University of New England, which trains osteopathic physicians--we depend on a number of small family practice residency programs to introduce physicians to the practice opportunities in the state. Most of the graduates of these residency programs go on to establish practices in Maine, many in rural and underserved areas of the state. The new caps on residency slots included in the BBA penalize these programs in a number of ways. For instance, the current cap is based on the number of interns and residents who were ``in the hospital'' in FY 1996. Having a cap that is institution-specific rather than program-specific has caused several problems. For instance, the Maine-Dartmouth Family Practice Residency Program had two residents out on leave in 1996--one on sick leave for chemotherapy treatments and one on maternity leave. Therefore, the program's cap was reduced by two, because it was based on the number of actual residents in the hospital in 1996 as opposed to the number of residents in the program. Moreover, residents in this program have spent one to two months training in obstetrics at Dartmouth's Mary Hitchcock's Medical Center in Lebanon, New Hampshire. Because the cap is based on a hospital's cost report, these residents are counted toward Dartmouth Medical School's cap instead of the Maine-Dartmouth Family Practice Residency Program's. Last year, the Maine program was informed that Dartmouth would be cutting back the amount of time their residents are there. But the Maine-Dartmouth Family Practice Residency Program has no way of recouping the resident count from them in order to have the funds to support obstetrical training for their residents elsewhere. Moreover, the cap does not include residents who continue to be part of the residency program, but who have been sent outside of the hospital for training. This penalizes all primary care specialties, but especially family medicine, where ambulatory training has historically been the hallmark of the specialty. This is particularly ironic since other specialty programs that now begin training in settings outside the hospital will, under the new rules, have those costs included in their Medicare graduate medical education funding. All told, the Maine Dartmouth Family Practice Residency Program will see its graduate medical education funding reduced by over half a million dollars a year as a result of the cap established by the BBA. The example I have just used is from Maine, but the problems created by the BBA's graduate medical education changes are national in scope. It has created disproportionately harmful effects on family practice residencies from Maine to Alaska. A recent survey of all family practice residency program directors has found that: 56 percent of respondents who were in the process of developing new rural training sites have indicated that they will either not implement those plans or are unsure about their sponsoring institutions' continued support. 21 percent of respondents report planning to decrease their family practice residency slots in the immediate future. The majority of those who are planning to decrease their slots are the sole residency program in a teaching hospital. This means that, under current law, they have no alternative way of achieving growth, such as through a reduction of other specialty slots in order to stay within the cap. And finally, the vast majority of family practice residencies did not have their full residency FTEs captured in the 1996 cost reports upon which the cap is based. In addition to this survey, we have anecdotal information from residencies across the country detailing how they have lost funding either because of where they trained their residents or because their residents had been extended sick or maternity leave. For example, one family practice residency in Washington State last year had an equivalent of 14 residents training outside of the hospital and four in the hospital. Under the BBA, their cap would be four. By contrast, had all of their residents been trained in the hospital up to this point, their payment base would have been capped at 18, even if they trained residents in non-hospital settings in the future. The Medicare Graduate Medical Education Technical Amendments Act, which I am introducing today, will address these problems by basing the cap on the number of residents ``who were appointed by the approved medical residency training programs for the hospital'' in 1996, rather than on the number of residents who were ``in the hospital.'' I am also concerned that the Balanced Budget Act and its accompanying regulations will severely hamper primary care residency programs that are expanding to meet local needs. Specifically, a new residency program that had not met its full complement of accredited residency positions until after the cutoff date of August 5, 1997, is precluded from increasing its number of residents unless the hospital decreases the number of residents in one of its other specialty programs. However, over forty percent of the nation's family practice residency programs are the only program sponsored by the hospital. This provision therefore completely precludes such a hospital from expanding its residency program to meet emerging primary care needs. To address this problem, the legislation I am introducing today would exempt the small number of programs at hospitals that sponsor just one residency program from the cap. In addition, to enable a number of family practice residency programs that are already in the pipeline to get accredited and grow to completion, the bill extends the cutoff date to September 1999. And finally, the Balanced Budget Act gave the Secretary of Health and Human Services the authority to give ``special consideration'' to new facilities that ``meet the needs of underserved rural areas.'' The Health Care Financing Administration has interpreted this to mean facilities that are actually in underserved rural areas. There have been several recent expansions in family practice residency programs that include a rural training track, with residents located in outlying hospitals, or with satellite programs designed specifically to train residents to work with underserved populations. Even though these new programs or satellites required accrediting body approval, they are still part of the ``mother'' residencies, which may not be physically located in an underserved rural area. While these are not technically new programs, I believe that the definition should be expanded to include such endeavors, given the value of these programs in addressing the needs of underserved populations. Therefore, the Medicare Graduate Medical Education Technical Amendments Act would expand the definition to include ``facilities which are not located in an underserved rural area, but which have established separately accredited rural training tracks.'' Mr. PRESIDENT, while the changes I am proposing today are relatively minor and technical in nature, they are critical to the survival of the small family practice residency programs that are so important to our ability to meet health manpower needs in rural and underserved areas. I urge all of my colleagues to join me in cosponsoring the Medicare Graduate Medical Education Technical Amendments and ask unanimous consent that the text of the bill be printed in the Record.

Ms. COLLINS

Ms. COLLINS. Mr. President, I would like to announce for the information of the Senate and the public that the Permanent Subcommittee on Investigations of the Committee on Governmental Affairs, will hold a hearing entitled ``The Safety of Food Imports: From the Farm to the Table--A Case Study of Tainted Imported Fruit.'' This hearing is the second in a series of hearings the Subcommittee has scheduled as part of an in-depth investigation into the safety of food imports. The hearing will be a case study of an outbreak of Cyclospora associated with fresh raspberries imported into the United States from Central America. The outbreak of Cyclospora occurred in over 20 states across the country in 1996 and in 1997. This hearing will take place on Thursday, July 9, 1998, at 9:30 a.m., in room 342 of the Dirksen Senate Office Building. For further information, please contact Timothy J. Shea of the Subcommittee staff at 224-3721.

Ms. COLLINS

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

Ms. COLLINS. I thank the Chair. I yield the floor.

Ms. COLLINS. I thank the Chair. (The remarks of Ms. Collins pertaining to the introduction of S. 2167 are located in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Ms. COLLINS

Ms. COLLINS. Mr. President, since coming to the Senate and assuming the Chairmanship of the Permanent Subcommittee on Investigations, one of my top priorities has been the seemingly never-ending fight to ferret out and eliminate waste, fraud and abuse in federal government programs. We've all heard the horror stories of $500 hammers and roads built to nowhere. The waste of scarce federal resources not only picks the pockets of the taxpayers but also places severe financial pressures on already overburdened programs, forcing cutbacks in the delivery of vital government services. Over the past year, I have seen this waste first-hand as the Subcommittee put a spotlight on massive fraud in the Medicare program. To cite just one example, the Subcommittee's investigation revealed that the federal government had been sending Medicare checks to 14 health care companies whose address, if they had existed, was in the middle of the runway of the Miami International Airport. That fraud cost the taxpayers millions of dollars, diverting scarce resources from the elderly and legitimate health care providers. This example and others like it were uncovered by my Subcommittee working hand-in-hand with the Inspector General's Office, whose mission is to identify the eliminate waste, fraud and abuse in federal programs. In many ways, the Inspectors General are the eyes and ears of the Permanent Subcommittee on Investigations, in particular, and the Congress, in general, as we strive to detect and prevent waste, fraud, abuse, and mismanagement in federal programs. Mr. President, this year marks the 20th anniversary of the Inspector General Act, the law that the Congress passed to create these guardians of the public purse. As we recognize this anniversary, it is important for Congress to take a close look at the IG system. During the past 20 years, the Inspector General community has grown from 12 in 1978 to 57 Inspectors General today. These offices receive more than $1 billion in annual funding and employ over 10,000 auditors, criminal investigators, and support personnel. The Office of Inspector General is charged with tremendous responsibilities and is given considerable authority to uncover waste and abuse within the government. By and large, the IG community has done an outstanding job. They have made thousands of recommendations to Congress, ultimately saving taxpayers literally billions of dollars. Investigations by Inspectors General have also resulted in the recovery of billions of dollars from companies and individuals who defrauded the federal government. These investigations have been the basis for thousands of criminal prosecutions, debarments, exclusions and suspensions. The Inspectors General have a demonstrated record of success over the past 20 years, but as with any government program, we must be vigilant to ensure that the program is well managed, accountable, and effective. With this goal in mind and drawing on my work with the Inspectors General over the past year and a half, I am introducing the ``Inspector General Act Amendments of 1998,'' a bill to improve the accountability and efficiency of the Inspectors General program. I am pleased to have my colleague from Iowa, Senator Grassley, as a cosponsor. The bill is designed to increase the accountability and independence of Inspectors General. It establishes a renewable nine-year term of office for each of the 26 Inspectors General who are appointed by the President and confirmed by the Senate. This provision will also encourage Inspectors General to serve for longer periods of time so that their experience and judgment can be used to fight waste, fraud and abuse. This bill also takes steps to streamline the IG Offices themselves-- making them more efficient and flexible--by consolidating existing offices and by reducing the volume of the inspectors general reporting requirements. The number of OIGs has increased more than four-fold in twenty years, and many of these are small offices with just a handful of employees. These small OIGs can be made far more efficient and effective by transferring their functions to larger, department-wide IG offices. For example, my bill consolidates the current stand-alone office of the Peace Corps, with just 15 employees, into the State Department-- eliminating unnecessary overhead and bureaucracy but continuing thorough audit and oversight of the Peace Corps. Under this proposal, seven existing small IG offices are consolidated into the IG offices of major departments. Currently, Offices of Inspectors General are required by law to provide semi-annual reports to Congress. My bill would increase the value of the report process by reducing the requirement to a single annual report and streamlining the information required for each report. For example, the new reporting requirement would require the IGs to identify areas within their jurisdiction which are at highest risk for waste, fraud and abuse. In that way, the Congress can attack those weak areas before they get worse and before the problems become more difficult to solve. The Inspectors General have made valuable contributions to the efficient operation of the federal government, but their record is not without blemish. For example, this successful record was recently tarnished by the activities of the Treasury Department's Office of Inspector General. After an extensive investigation, my Subcommittee found that this office violated federal laws in the award of two sole- source contracts, which wasted thousands of dollars. It was disturbing to find that this one Inspector General's Office was itself guilty of wasting resources--the very office charged with preventing fraud and abuse. At the conclusion of that investigation, the Subcommittee asked the question: who is watching the watchdogs? Let me stress that, in my view, problems like the ones in the Treasury Inspector General's office are not widespread in the Inspector General community. However, an Inspector General is not like any other government manager. Inspectors General are the very officials in government responsible for combating waste, fraud and abuse in Federal programs. And as such, Inspectors General should be held to a higher standard. To do their job effectively, Inspectors General must be above reproach, must set an example for other government managers to follow, and must not create situations where there is even the appearance of impropriety. Credibility and effectiveness are lost when the office charged with combating waste and abuse engages in the kind of activity that the Inspector General is responsible for deterring. To increase accountability, my bill requires independent external reviews of the Inspector General offices every three years. It gives each office the flexibility to choose the most efficient method of review, but it does require that the watchdogs themselves submit to oversight by a qualified third party. This provision will help ensure public confidence in the management and efficiency of the IG offices. Finally, Mr. President, one provision that is not included in this bill, but that deserves careful consideration, is the grant of statutory law enforcement authority for the Inspector General of the Department of Health and Human Services. The Medicare fraud investigation conducted by my Subcommittee revealed the dangers faced by HHS-IG Special Agents when they work with the FBI and others to investigate some cases of health care fraud. These agents work side by side with other federal law enforcement professionals, and the Congress should carefully examine the best way to provide them with tools necessary for them to do their jobs effectively. Mr. President, the bill I introduce today represents the first step in the process to improve the effectiveness, efficiency and accountability of the Inspector General program. These offices provide valuable assistance to the Congress so that we can exercise our duty to oversee the operation of the federal government and to make sure that the taxpayer's money is well spent and not wasted. I urge my colleagues to join me in this effort to strengthen and improve the Inspectors General program into the next century.

Ms. COLLINS

Ms. COLLINS. Mr. President, since coming to the Senate and assuming the Chairmanship of the Permanent Subcommittee on Investigations, one of my top priorities has been the seemingly never-ending fight to ferret out and eliminate waste, fraud and abuse in federal government programs. We've all heard the horror stories of $500 hammers and roads built to nowhere. The waste of scarce federal resources not only picks the pockets of the taxpayers but also places severe financial pressures on already overburdened programs, forcing cutbacks in the delivery of vital government services. Over the past year, I have seen this waste first-hand as the Subcommittee put a spotlight on massive fraud in the Medicare program. To cite just one example, the Subcommittee's investigation revealed that the federal government had been sending Medicare checks to 14 health care companies whose address, if they had existed, was in the middle of the runway of the Miami International Airport. That fraud cost the taxpayers millions of dollars, diverting scarce resources from the elderly and legitimate health care providers. This example and others like it were uncovered by my Subcommittee working hand-in-hand with the Inspector General's Office, whose mission is to identify the eliminate waste, fraud and abuse in federal programs. In many ways, the Inspectors General are the eyes and ears of the Permanent Subcommittee on Investigations, in particular, and the Congress, in general, as we strive to detect and prevent waste, fraud, abuse, and mismanagement in federal programs. Mr. President, this year marks the 20th anniversary of the Inspector General Act, the law that the Congress passed to create these guardians of the public purse. As we recognize this anniversary, it is important for Congress to take a close look at the IG system. During the past 20 years, the Inspector General community has grown from 12 in 1978 to 57 Inspectors General today. These offices receive more than $1 billion in annual funding and employ over 10,000 auditors, criminal investigators, and support personnel. The Office of Inspector General is charged with tremendous responsibilities and is given considerable authority to uncover waste and abuse within the government. By and large, the IG community has done an outstanding job. They have made thousands of recommendations to Congress, ultimately saving taxpayers literally billions of dollars. Investigations by Inspectors General have also resulted in the recovery of billions of dollars from companies and individuals who defrauded the federal government. These investigations have been the basis for thousands of criminal prosecutions, debarments, exclusions and suspensions. The Inspectors General have a demonstrated record of success over the past 20 years, but as with any government program, we must be vigilant to ensure that the program is well managed, accountable, and effective. With this goal in mind and drawing on my work with the Inspectors General over the past year and a half, I am introducing the ``Inspector General Act Amendments of 1998,'' a bill to improve the accountability and efficiency of the Inspectors General program. I am pleased to have my colleague from Iowa, Senator Grassley, as a cosponsor. The bill is designed to increase the accountability and independence of Inspectors General. It establishes a renewable nine-year term of office for each of the 26 Inspectors General who are appointed by the President and confirmed by the Senate. This provision will also encourage Inspectors General to serve for longer periods of time so that their experience and judgment can be used to fight waste, fraud and abuse. This bill also takes steps to streamline the IG Offices themselves-- making them more efficient and flexible--by consolidating existing offices and by reducing the volume of the inspectors general reporting requirements. The number of OIGs has increased more than four-fold in twenty years, and many of these are small offices with just a handful of employees. These small OIGs can be made far more efficient and effective by transferring their functions to larger, department-wide IG offices. For example, my bill consolidates the current stand-alone office of the Peace Corps, with just 15 employees, into the State Department-- eliminating unnecessary overhead and bureaucracy but continuing thorough audit and oversight of the Peace Corps. Under this proposal, seven existing small IG offices are consolidated into the IG offices of major departments. Currently, Offices of Inspectors General are required by law to provide semi-annual reports to Congress. My bill would increase the value of the report process by reducing the requirement to a single annual report and streamlining the information required for each report. For example, the new reporting requirement would require the IGs to identify areas within their jurisdiction which are at highest risk for waste, fraud and abuse. In that way, the Congress can attack those weak areas before they get worse and before the problems become more difficult to solve. The Inspectors General have made valuable contributions to the efficient operation of the federal government, but their record is not without blemish. For example, this successful record was recently tarnished by the activities of the Treasury Department's Office of Inspector General. After an extensive investigation, my Subcommittee found that this office violated federal laws in the award of two sole- source contracts, which wasted thousands of dollars. It was disturbing to find that this one Inspector General's Office was itself guilty of wasting resources--the very office charged with preventing fraud and abuse. At the conclusion of that investigation, the Subcommittee asked the question: who is watching the watchdogs? Let me stress that, in my view, problems like the ones in the Treasury Inspector General's office are not widespread in the Inspector General community. However, an Inspector General is not like any other government manager. Inspectors General are the very officials in government responsible for combating waste, fraud and abuse in Federal programs. And as such, Inspectors General should be held to a higher standard. To do their job effectively, Inspectors General must be above reproach, must set an example for other government managers to follow, and must not create situations where there is even the appearance of impropriety. Credibility and effectiveness are lost when the office charged with combating waste and abuse engages in the kind of activity that the Inspector General is responsible for deterring. To increase accountability, my bill requires independent external reviews of the Inspector General offices every three years. It gives each office the flexibility to choose the most efficient method of review, but it does require that the watchdogs themselves submit to oversight by a qualified third party. This provision will help ensure public confidence in the management and efficiency of the IG offices. Finally, Mr. President, one provision that is not included in this bill, but that deserves careful consideration, is the grant of statutory law enforcement authority for the Inspector General of the Department of Health and Human Services. The Medicare fraud investigation conducted by my Subcommittee revealed the dangers faced by HHS-IG Special Agents when they work with the FBI and others to investigate some cases of health care fraud. These agents work side by side with other federal law enforcement professionals, and the Congress should carefully examine the best way to provide them with tools necessary for them to do their jobs effectively. Mr. President, the bill I introduce today represents the first step in the process to improve the effectiveness, efficiency and accountability of the Inspector General program. These offices provide valuable assistance to the Congress so that we can exercise our duty to oversee the operation of the federal government and to make sure that the taxpayer's money is well spent and not wasted. I urge my colleagues to join me in this effort to strengthen and improve the Inspectors General program into the next century.

Ms. COLLINS

Ms. COLLINS. I further ask consent that following morning business the Senate resume consideration of S. 1415, the tobacco bill. Further, that at noon the Senate proceed to vote on the motion to invoke cloture on the modified committee substitute and the mandatory quorum under rule XXII be waived.

Ms. COLLINS. Mr. President, I ask unanimous consent that when the Senate completes its business today, it stand in adjournment until 9:45 a.m. on Thursday, June 11. I further ask that on Thursday, immediately following the prayer, the routine requests through the morning hour be granted and the Senate then begin a period of morning business until 11:15 a.m., with Senators permitted to speak for up to 5 minutes each, with the following exceptions: Senator Rockefeller, 10 minutes; Senator Torricelli, 15 minutes; Senator Baucus, 30 minutes; Senator Collins, 15 minutes; Senator Kerry, 15 minutes; and Senator Smith of Oregon, 5 minutes.

Ms. COLLINS

Ms. COLLINS. I ask unanimous consent the amendment be considered as read and agreed to.

Ms. COLLINS. Senators Levin and McCain have a substitute amendment at the desk. I ask for its immediate consideration.

Ms. COLLINS. Mr. President, I ask unanimous consent the bill be considered read a third time and passed, as amended, the motion to reconsider be laid upon the table, and any statements relating to the bill appear in the Record.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of S. Res. 246 submitted earlier today by Senators Lott and Daschle.

Ms. COLLINS

Ms. COLLINS. Mr. President, I ask unanimous consent that the committee substitute be agreed to, the resolution be agreed to, the amendment to the preamble be agreed to, the preamble be agreed to, the motion to reconsider be laid upon the table, and that any statements relating to the resolution appear in the Record.

Ms. COLLINS. Mr. President, I ask unanimous consent that the Senate proceed to the consideration of Calendar No. 405, House Concurrent Resolution 131.

Ms. COLLINS

Ms. COLLINS. Mr. President, if there is no further business to come before the Senate, I now ask the Senate stand in adjournment under the previous order.