Hillary Clinton

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I join Senator Wyden in expressing concern over the process regarding the awarding of reconstruction contracts in Iraq. As Senator Wyden has pointed out, this is an issue that impacts the spending of hundreds of millions of taxpayer dollars. After the magnificent performance of our U.S. military in Iraq, we are now faced with the task of rebuilding Iraq's infrastructure. Huge contracts are being awarded in support of these efforts. However, many of these contracts are being awarded without fair and open competition and with no public oversight. This week, Senator Wyden and I sent a letter to the administrator of the U.S. Agency for International Development, Andrew Natsios, requesting that he make public all documents related to USAID's decision to exempt contracts for reconstruction of Iraq from full and open competition. As the letter points out, sole-source and limited- source contracts seem to be the rule, not the exception, for rebuilding Iraq. However, as the U.S. General Accounting Office has reported, sole- source or limited-source contracts usually are not the best value for the taxpayers. With $100 million in taxpayer funds projected for rebuilding Iraq, it is critical that we ensure that this money is being spent wisely. Certainly, there may be times that contracts need to be awarded outside the normal contract award process. But in those cases, it is particularly important that we ensure that those contracts undergo full disclosure to avoid unnecessary expenses for the taxpayers. As our letter makes clear, both the GAO and the USAID Inspector General have raised questions about the processes used to award reconstruction contracts in Iraq. It is the responsibility of Congress to ensure that the funds we appropriate for reconstruction in Iraq are spent in a fair and open manner. Earlier this year, I joined Senator Wyden, Senator Collins, Senator Byrd and others in introducing the Sunshine in Iraq Reconstruction Contracting Act. The bill provides an element of accountability so that Congress and the American people can have a full understanding of how these contracts are being awarded. It would require that when contracts are awarded without a full and open competition, the awarding agency would have to publicly explain why. We were able to get similar language inserted into the Department of Defense Authorization bill which would require that Iraq reconstruction contracts be subject to these reporting requirements. However, until that provision becomes law, we are calling upon USAID to voluntarily make these documents public. As I have said before, it would be unfortunate if, in our effort to set an example of open government and democratic principles abroad, we undermined those principles here at home. I hope that the rest of my colleagues join me in asking USAID to make these documents public.

Mrs. CLINTON. Mr. President, I ask unanimous consent that reading of the amendments be dispensed with.

Mrs. CLINTON. Mr. President, I ask unanimous consent that the pending amendments be set aside and that I call up amendment No. 1142 and another amendment at the desk by Senator Schumer.

Mrs. CLINTON

Mrs. CLINTON. Madam President, I have long championed a prescription drug benefit that would provide real prescription drug coverage for seniors and individuals with disabilities. Last year and again during this debate, I voted for proposals that provided a comprehensive, reliable benefit without gaps in coverage that force seniors to pay premiums even while they get no benefits in return. S. 1, the Grassley-Baucus bill that passed, however, contains serious shortcomings, including these large benefit gaps. So I must reluctantly oppose this legislation unless it is improved. I am particularly concerned that it poses a strong danger to significant numbers of New Yorkers. It leaves 37 percent of seniors who rely on their retiree drug coverage at risk of losing their employer coverage because of incentives in the bill for employers to drop coverage. It also leaves out 300,000 of New York's nursing home residents who rely on Medicaid and another 230,000 low-income New Yorkers who also rely on Medicaid because Medicare beneficiaries who are also eligible for Medicaid are excluded from receiving the prescription drug benefit that passed last night. These New Yorkers could actually find themselves worse off than they are today if their employers or Medicaid programs drop or reduce coverage. The provisions excluding those beneficiaries who are dually eligible for Medicare and Medicaid also harms New York State's finances. New York State has effectively been subsidizing the Federal Government for years in the absence of a Federal provision for prescription drug benefits, by paying for the drug costs of these Medicare beneficiaries. But by failing to include dually eligible Medicare beneficiaries in the Medicare prescription drug benefit, this bill continues to leave New York, which is in a precarious State budget situation, to subsidize the Federal Government's lack of adequate investment. Finally, the bill includes a Grassley-Baucus amendment that starting in 2009 will allow for government subsidization of private plans at levels much higher than the government funding for beneficiaries in traditional Medicare, and would then allow the private plans to offer benefits not available to the 90 percent of seniors in traditional Medicare, which I believe begins to subordinate the goal of health care for seniors to the goal of privatizing Medicare. While I am pleased that New York's State drug program, EPIC, will still be available under a provision that Senators Corzine, Lautenberg, Schumer and I worked hard to include, the other measures I supported to make sure seniors with other sources of coverage were not harmed by this proposal were unfortunately left out of the bill. For their sake, for the sake of New York's fiscal situation, as well as for the sake of other New York seniors who will be confronted with an unnecessarily complex maze of bureaucracy to navigate in order to access benefits, I felt obliged to oppose the bill. There were some important provisions in the bill, including Senator Schumer's amendment that provides greater market competition for generic drugs so that seniors will have a cheaper alternative and don't have to rely on higher priced name-brand drugs. These positive provisions were not enough, however, for me to vote for the bill unless it is substantially improved. While I believe New York deserves a better bipartisan alternative than the one that passed the Senate yesterday, I hope that those in conference will fight against changes that make the bill even worse for New York, and I will continue fighting this year, as well as in years to come, to correct these deficiencies and actually to deliver on the long-awaited promise of a simple, affordable, comprehensive prescription drug benefit for all seniors. I request that this statement and a separate document, Governor Pataki's letter dated June 12, 2003, be submitted for the Record.

Mrs. CLINTON

Mrs. CLINTON. I rise to urge my colleagues to defeat this amendment. In proposing this amendment, Senator sessions argues that the restoration of health benefits to legal immigrants has not been fully reviewed or discussed. he also argues that SCHIP and Medicaid provisions are welfare reform measures and therefore not germane to the prescription drug bill. The amendment also states that Congress deliberately limited benefits available to legal immigrants when it removed these benefits in 1996. I respectfully disagree with all of these three assertions. First of all, the Senate Finance Committee has already extensively reviewed this issue. In 2001, the Finance Committee held a series of hearings on health coverage for the uninsured, including legal immigrants. During the TANF reauthorization mark-up in June 2002, there was a full debate on the restoration of health benefits to legal immigrants, and the Immigrant Children's Health Improvement Act passed as an amendment by a vote of 12 to 9. This year, during Finance Committee mark-up of the prescription drug bill, there was once again full debate on the restoration of health benefits to legal immigrants. Senator Nickles offered an amendment to strike the immigrant children's health provision from the chairman's mark and that amendment failed by a vote of 8 to 13. Second, I disagree with Senator Sessions' argument that Section 605 of the bill is not germane to Medicare prescription drug legislation. Every time this sort of provision comes to a vote, my colleagues on the other side of the aisle question the vehicle. When the immigrant child health provisions came up in committee last year, as part of the TANF reauthorization mark-up, Senator Hatch remarked that, ``If we start playing with health care policy, this bill isn't going to go through.'' This year, Senator Sessions is saying that TANF reauthorization is the appropriate vehicle. I ask my colleagues on the other side of the aisle then--which one is the appropriate vehicle? In fact, the restoration of health benefits to legal immigrants is also a major component of the effort to add a prescription drug benefit under Medicare. Senators Grassley and Baucus realized this when they included this provision in the prescription drug mark as part of a compromise agreement that included both Senator Kyl's undocumented aliens provision to reimburse hospitals for the cost of treating undocumented aliens and Senator Graham's legal immigrants provision. Finally, benefits to legal immigrants were cut in 1996 as a cost- saving measure, not as a matter of welfare reform. Section 605 of the underlying bill is also consistent with other policies approved by President Bush. Last year, the President signed legislation restoring food stamp benefits for legal immigrant children. The immigrant child health provisions would make these same children eligible for Medicaid and SCHIP. In an interview with the Associated Press in May 2002, Tommy Thompson, Secretary of the Department of Health and Human Services, stated that he had no ``philosophical objection'' to lifting the ban on providing health care benefits to legal immigrants. Senator Sessions' amendment also has significant dire consequences for women and children, and could add costs to the Medicaid program, which I am certain that Senator Sessions did not intend. Current restrictions prevent thousands of legal immigrant children and pregnant women from getting the same access to preventive health care services that they would have if they were U.S. citizens. As a result of the restrictions, immigrant children have fewer opportunities to see a pediatrician and receive treatment before minor illnesses become serious and life-threatening. Families who are unable to get basic preventive care for their children have little choice but to turn to emergency rooms--the least cost-effective place to provide care--when their children become sick. Similarly, without prenatal care, a woman may give birth to a baby with low-birth weight, placing the baby at risk and resulting in hundreds of thousands of dollars in neonatal intensive care costs. Frankly, I am saddened that we must fight over a bipartisan, thoughtful and extensively reviewed provision that will protect the health of children who legally came to our country and had no control over the length of time they were legal immigrants. We must ensure that it is defeated.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I ask for the yeas and nays.

Mrs. CLINTON. Madam President, I come to the floor in support of the amendment proposed and then withdrawn by my colleague, Senator Schumer, that would have helped Medicare+Choice programs continue to provide insurance for their beneficiaries. This is a serious problem in New York and, I have reason to believe, in many other parts of the country because, as costs have continued to rise, many health plans are being forced to drop people from their rolls. They are actually withdrawing from large regions of New York and elsewhere in the country, leaving people to scramble for alternatives. Even those who are continuing to provide coverage are raising their premiums drastically. Like the rest of Medicare, Medicare+Choice plans are feeling the squeeze in a system caught between rapidly exploding costs and rapidly imploding finances. Here we are on the floor debating the future of Medicare and the structure of new benefits like prescription drugs, but while we debate the future of Medicare, we need to recognize that there are people right now in our States who depend on these plans today, and the plans, when they withdraw and then reenter from year to year, cause confusion and excess costs that fall directly on the backs of our seniors. So these seniors, who are already facing rising premiums, benefit cuts, and withdrawal of services, should not be forgotten in the context of the debate we are carrying on today which will actually try to encourage more seniors to move in to these kinds of private health insurance choices. I hope that we do something not only about the future, but we start doing something about the present and take care of our seniors who were promised better benefits in these Medicare+Choice plans only to find the rug pulled out from under them, as the plans either raised premiums, sometimes 15, 20 percent, and withdrew from their region, leaving them without the coverage for which they thought they bargained. I fear we are setting up many more of our seniors for this kind of disappointment, confusion, and disruption if we do not heed the lessons of what has already happened. I thank the Chair for this attention, and I yield the floor.

Mrs. CLINTON. This amendment is critical to the functioning of the plan now under consideration. If we are going to move toward creating a marketplace for drugs, then we need information about which drugs work better for the money they cost. Last December, we found out through a study by the National Heart, Lung and Blood Institute that the newer drugs such as calcium channel blockers and ACE inhibitors which cost 30 to 40 percent more than diuretics were not as effective for treating high blood pressure. There is much information about this. My amendment is very simple. It asks NIH to do studies comparing drugs to give that information to physicians and to consumers so they can make good decisions in the marketplace. It also asks that we synthesize the literature out there, make it available over the Internet. If we are going to have a marketplace for drugs, the information about which drugs are more effective should not be the sole property of the great companies. Physicians, clinicians, consumers, and patients need that information. This will help us do that. I hope you will support this amendment. It does not have any cost attached to it. It is about getting information to the people who will make the decisions about which drugs should be used when it comes to making these choices we are trying to provide for people.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I am pleased to join my friend from Utah, Senator Hatch, today in introducing a bill that will commission a study from IOM to identify performance measures and payment incentives that reward high quality providers in Medicare. Currently Medicare pays the same amount for good care as it does for poor quality care. It's easy to assume that the dollars that go to Medicare all yield high quality care, but the evidence is otherwise. Take heart disease, the leading cause of death in the U.S. Cholesterol management after a heart attack can mean the difference between disability and an active lifestyle. Yet we don't have adequate data that show us whether most Medicare beneficiaries are getting this clinically appropriate care. And the only data that we do have, from NCQA, The State of Health Care Quality 2002, tells us that in 2001 almost one-quarter, 23 percent, of Medicare beneficiaries in health plans did not have their cholesterol managed after a heart attack. In New York, between 14 and 22 percent of diabetic beneficiaries in health plans did not get a blood sugar control test in 2001. When Medicare and Medicare enrollees pay the same amount to providers that give excellent care as it does to those who provide mediocre care, that may unintentionally create incentives for providers to skimp or cut corners on quality. We debate endlessly over ways to control costs in Medicare, but we have not taken one of the simple steps that will, almost certainly, drive quality up and assure that we are getting good value for the dollars we spend. Medicare should be a leader in national efforts to improve quality. Medicare, with its $250 billion of purchasing power, 40 million enrollees, programs data, and professional experience can bring more resources to bear on these quality problems than any other purchaser. The study we are proposing today would be the first step down this path. It would cost relatively little but yield great rewards as a guide to how to measure and pay for quality in the future. The study would develop measures to assess quality, including outcome measures. It would tell us what payment incentives have worked in the private sector. And it would identify approaches to use incentives to improve quality that can be implemented across all of Medicare. So I am pleased that we are making this effort today, and hope that it is just the first step of many more that we will take down the path of improving Medicare for patients and consumers.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I ask the clerk to report amendment No. 954, which is at the desk.

Mrs. CLINTON. Mr. President, I will also be talking about amendment No. 953, which is at the desk.

Mrs. CLINTON. Thank you, Mr. President. Amendment No. 1000 Mr. President, amendment 1000, offered on behalf of myself and Senators Tim Johnson and Jeff Bingaman, is being offered to ensure our seniors have information they need to make informed consumer choices about their drugs, and also to ensure practitioners have the information needed to choose the right drug for a patient, and, further, that the private plans this bill would create have the information they need to make formulary and benefit design choices based on sound science. This amendment ensures that various Government agencies--NIH, FDA, CMS, and the others involved in this effort--conduct research comparing the efficacy and, if applicable, the comparative safety of the top drugs used by Medicare and Medicaid beneficiaries who are Medicare eligible. Now often there are a number of competing drugs to treat the same condition. But which is more effective? Oftentimes we just do not know. While the FDA is responsible for determining safety and effectiveness of prescription drugs compared to a placebo, there is no Government entity responsible for examining whether drug A is more effective at treating a particular condition than drug B. Meanwhile, drug companies do not always have an incentive to do head-to-head trials of the drugs they put out versus those of their competitors. But this information is critical to all decisionmakers, to patients and consumers, to practitioners, and to the private plans that are being created. Now clinicians have told me they are frequently trying to decide whether to switch a patient from an old drug to a new drug. They are not deciding between the old drug and a placebo; they are deciding between a drug they have used for a particular patient and then one which has come to their attention because it is now on the market, and they are trying to decide: Which is best for my patient? They wish they had more information that would enable them, besides trial and error and possible adverse consequences, to make that determination. Clearly, consumers will also benefit from more sources of information. Right now advertising is a source available to consumers, but this amendment will help us provide an unbiased, scientific source of information that consumers can compare side by side rather than just a beautiful advertisement of people running through a field or twirling their grandchildren and then being told: This is the drug for the condition you have. They will be able to say: Well, wait a minute. Here is the drug I have been prescribed, here is a drug I have heard about. Let me look on the Internet to see what the differences might be. Now we have all heard of ``me too'' drugs, and there is nothing wrong with ``me too'' drugs. Sometimes a ``me too'' drug will work incrementally better than a previous drug or it may be better tolerated. Even if a ``me too'' drug does not have those characteristics, it might be superior for a certain portion of the population but not for others. The problem is, we do not have that kind of comparative data. My amendment directs NIH to do comparative efficacy trials for the top Medicare drugs--the ones that are primarily prescribed for the Medicare population--for the kinds of conditions the Medicare population primarily suffers from. No single study will settle that question once and for all, so my amendment then directs the Agency for Health Research and Quality, AHRQ, to do what it does best, which is to synthesize the literature that is out there as well as the NIH data to report information on the comparative efficacy of these medical interventions that we are subsidizing now in this bill for our seniors. HHS will then make this comparative information available to clinicians, to Congress, to relevant Federal agencies. And it will, most particularly and importantly, make that available to seniors so they can make informed choices for themselves. Under this amendment, we would put this information on the Internet. FDA would look at whether this information needs to be included in drug labels, and drug ads would also contain this information so that they do not mislead seniors. One indicator of the rarity of these studies is that completion of a comparative efficacy study can make national news. For example, many of us read last December when the National Heart, Lung, and Blood Institute published a study and discovered that it corrected the assumption that newer drugs, such as calcium channel blockers and ACE inhibitors, which cost 30 to 40 times more than diuretics, were not more effective than those long-time treatments for high blood pressure. This is information we have needed for years. We have one of the most advanced health care systems, if not the most advanced, in the world. If the information stream our doctors count is such a tiny trickle that the daily news can keep track of all major developments, then this amendment must be passed in order to give us a sound scientific basis for the decisions that are going to be made with the $400 billion that we are allocating. When the research is done, as we learned about in the calcium channel blockers and ACE inhibitors versus old-fashioned diuretics, it is important and its benefits are immediately obvious. In January 2003, the American Journal of Ophthalmology published an article comparing the efficacy of two glaucoma drugs. One is latanoprost and the other bimatoprost. These were compared in an NIH- sponsored randomized clinical trial. Despite the fact that the Latanoprost is currently the most popular medication, the study found that Bimatoprost was more effective. This is critically important because if we are going to be putting money into drugs and we are going to be holding out the promise to our seniors that finally help is on the way, then let's make sure these tax dollars are used to fund the drugs that are most effective. In 1999, an NIH-sponsored study showed that a well-known, safe, cheap generic drug, Metoprolol, was just as effective for treating patients with heart failure as a more expensive drug which had come on to the market just a few years earlier. Some may say these studies could promote a one-size-fits-all approach to prescribing, but to the contrary, these studies can actually help make prescribing more nuanced and appropriate to each subpopulation. For instance, in March 2003, the American Journal of Cardiology reviewed numerous clinical trials of medications used to treat what is called atrial fibrillation, a type of heart arrhythmia, and came up with recommendations about what are the most effective drugs for use for this condition based on what the underlying cause of the condition was in each case. As someone who is fast approaching the age of Medicare eligibility, I want, both for my pocketbook and my health, to know that my doctor and I have the best information available about which drug is appropriate for me. And I certainly think that we can, through this amendment, begin to provide that information to ensure that seniors and their physicians have good, solid data on which to make their decisions. This amendment is supported by a number of groups that are aware of the significance of trying to put into this bill some scientifically based data on which to make these decisions. The RxHealth Value Coalition is supporting the amendment. I have a letter from them. They consist of not only large employers--Verizon, General Motors, Ford, et cetera--but Blue Cross, Blue Shield, Kaiser, AARP, and many others. I ask unanimous consent to print the RxHealth Value letter of June 24, 2003, supporting this amendment, in the Record.

Mrs. CLINTON. Similarly, I have a letter from Consumers Union, dated June 24, 2003, which also supports amendment No. 1000, and I ask unanimous consent that letter, too, be printed in the Record.

Mrs. CLINTON. Finally, I have a letter from Families USA, dated June 24, 2003, that similarly supports the amendment. I will read the following paragraph from it: It would be unfortunate if Congress decides to spend $400 billion on pharmaceuticals over the next decade, without providing a few dollars to ensure that what we are buying is indeed worth buying. I ask unanimous consent that letter be printed in the Record as well.

Mrs. CLINTON. Mr. President, if we are serious about making changes that will improve the health of our seniors on Medicare, I hope that we look to establish in this bill the proposition that good information, solid science that can be made available to seniors, to clinicians, to plans, be part of what we are establishing with the proposition that this money needs to be well spent, well spent not only to safeguard the taxpayers' dollars but well spent to ensure that our doctors and patients get the best possible treatment. I also am offering amendment No. 999 that is intended to ensure that Medicare plans compete to improve rather than cut corners on quality. This bill already includes a measure that I have supported, along with Senator Hatch and others, to commission the Institute of Medicine to ensure the Medicare Program pays plans for providing higher quality care. Unfortunately, even for the many common diagnoses and treatments that are part of a senior's medical history, we lack the quality standards that the Medicaid Program would use to help consumers make informed comparisons and choices among health plans. For some diseases, the National Commission for Quality Assurance does collect information about health plans by providing data, for example, on how well HMOs screen for breast cancer or provide flu shots for older adults. For many other diseases, however, we do not know which plans make sure that their diabetic patients get their eyes examined for retinal damage, what percent of asthmatics receive adequate therapy to control their asthma, or many other issues that go to the heart of the quality of health care that is being provided to our seniors. The data tells us that Medicare beneficiaries are often not receiving the care they need to maintain their health. In 2001, for example, 23 percent of Medicare beneficiaries in private health plans did not have their cholesterol managed after a heart attack. Now, my amendment is based on recommendations made by the Institute of Medicine. It authorizes a collaborative effort among the relevant Government agencies to develop quality indicators in the 20 most important areas identified in this Institute of Medicine report entitled ``Priority Areas for National Action.'' It authorizes the Quality Interagency Coordination Task Force--that is a task force that brings together all the Federal agencies that are needed to collect health quality data--to implement these indicators so that they are all collecting quality information in the same way. The Secretary of Health and Human Services would then develop demonstration programs for communities to engage in community-wide reporting, according to these quality indicators. This amendment also has the potential to lower the cost of the Medicare Program. Because plans will provide quality measures that consumers will use, health plans will want to implement those quality improvement measures that have also been proven to lower health care costs. One such program, as an example, is a diabetes intervention program implemented by Group Health Cooperative, a group model health plan in Washington State. This intervention program improved diabetic blood sugar control and saved between $685 and $950 annually from reduced hospital admissions, emergency department visits, and physician consultations. This is the kind of emphasis on quality that I think we need to put into this bill. Otherwise, as we try to make sense of the variety of options and choices that are available, we are not going to know what improved quality or what decreases costs. That should be one of our goals, and this amendment holds out the promise that the Medicare Program, with proper implementation of quality indicators, can do both--improve health and quality control and decrease costs. Amendment No. 953

Mrs. CLINTON. Mr. President, amendment No. 953 would empower Medicare beneficiaries and their families in making decisions about nursing homes and home health services. Data on nursing home quality is publicly available through a project strongly supported by Administrator Scully, and I am very appreciative of that because that information is imperative. However, I know from talking with people throughout New York that there are still many problems in nursing homes with respect to errors and mishaps that undermine the quality of care, the quality of life and, in some respects, even the health of the nursing home residents. Many people still don't know about this existing quality data and about the existing ombudsman program within the administration on aging that is intended to help families navigate nursing home decisions. This amendment would establish a national long-term care ombudsman resource center, which will help to develop and train ombudsmen. The amendment would establish pilot programs, including grants to create ombudsman offices in 10 States. These are the people--it should really be ``ombudspeople,'' I guess--who are uniquely positioned to know about the facilities they serve. They visit the facilities regularly. They are often located at agencies in the local communities. They have firsthand knowledge. They are very valuable resources. However, their knowledge, if it doesn't actually get to the users, the nursing home residents and, more importantly, their family members or advocates, doesn't help anyone. This pilot project would fund specific ombudsman programs to provide comprehensive outreach, public education, and individual consultation that integrate quality information into health care decisionmaking. Through this pilot project, the ombudsman center would be able to identify the resources needed to actually provide consumer education on long-term care and home health, as well as best practices and collaborative models that could then be replicated around the country. I ask my colleagues also to support this amendment because, again, I think information is critical. We talk about trying to create more of a market for these health care resources. Markets exist on information. A market without good information is not really a market at all. So if we are going to move toward the private market and provide these private health plans as competition to the existing Medicare delivery system, then I think we have to do more than just talk about the market. We need to empower the consumers within the marketplace. Information is that basis for empowerment. Amendment No. 954

Mrs. CLINTON. Mr. President, this amendment is intended to improve the safety of the prescription drug program. As our seniors are using a growing number of medications to stay out of the hospital, to live healthier and longer lives, we are inadvertently, but inevitably, creating a burden on our seniors to understand and know how to use all of these prescription drugs. There are interactions, there are other issues, there are many problems with trying to sort out for our seniors how drugs work, how they interact with one another. This is a very important issue that I think, again, we need to address at the beginning of this process, not after some additional problems have been discovered. In a recent study of adverse drug events published in the Journal of the American Medical Association, 21 percent of preventable adverse drug events were caused by patients not following drug prescription instructions. That is just human nature. People make mistakes and, as you get older, it is harder to read all that little writing on the prescription bottles. That is something that just kind of comes with the process. Of course, we have many people for whom English is not their first language. We have others who have challenges with eyesight and literacy. So, clearly, our seniors, like the rest of us, could make mistakes. Studies have found that one-third of patients often don't take the prescription the way they are supposed to because they don't understand it. Now, if you have a dose of a three-times-a-day antibiotic, and you also have other prescription drugs to be taken five, six, seven times a day, or whatever the combination is, there are all kinds of opportunities for confusion because many seniors take complex drugs with multiple dangerous side effects, often much more serious than those from antibiotics. They are more likely to suffer injuries and hospitalizations as a result. As many as 60 percent of the elderly have these problems about understanding and following the directions. This is a very critical statistic. Twenty-three percent of nursing home admissions in our country result from the inability of older Americans to manage their medication at home. That is why I am offering this amendment to ensure that the Secretary of HHS works to ensure the use of health literacy standards and information that will minimize adverse drug events, to ensure that we develop drug informational materials for non-English-speaking people and the functionally illiterate patients that can be made available to pharmacists who can access them electronically for easy use. So, Mr. President, these amendments can be summed up in a very few words: enhanced quality, lower cost. If we enhance quality, we avoid a lot of the problems that exist in our system today. We learn more about quality. We empower patients, as well as clinicians, with information that can better determine quality outcomes, and we save money. We do not have people being admitted to the hospital because they mix up their drugs. We do not have people trying to figure out how they can get good information about quality standards in nursing homes. We have all kinds of issues that cost money, as well as put the health and well-being of our seniors at risk. I ask that my colleagues favorably consider these amendments. There is no cost attached to these amendments, but they will do what we hope to achieve by this significant legislation: improve quality for our seniors and lower costs in the long run by making prescription drugs readily available and understanding appropriately their use. Mr. President, I thank you for your kind attention, and I yield the floor. Amendment No. 1000

Mrs. CLINTON. Mr. President, I ask unanimous consent that further reading of the amendment be dispensed with.

Mrs. CLINTON. Mr. President, I ask unanimous consent that further reading of the amendment be dispensed with.

Mrs. CLINTON. Mr. President, I rise today to speak of four amendments I have filed. And I would like to discuss each in turn, starting with amendment No. 1000, offered on behalf of myself, Senator Tim Johnson, and Senator----

Mrs. CLINTON. Mr. President, I join with my colleague from North Dakota in thanking the Senator from Washington for championing this cause for so long because it is clearly long overdue. And I thank both Senators for presenting it to us in this context. I look forward to supporting it. Mr. President, I ask unanimous consent that the pending amendments be temporarily set aside so I may offer several amendments.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I ask unanimous consent that Dr. Leonardo Trasande and Dr. Murali Raju, legislative fellows in my office, be granted floor privileges for the duration of this debate.

Mrs. CLINTON

Mrs. CLINTON. I rise today to address the matter we are debating in the Senate. I believe this legislation to provide a Medicare prescription drug benefit holds tremendous promise and also tremendous peril. I applaud the leaders of this effort, Chairman Grassley and ranking member Baucus, for bringing this bill to the floor and working in a collegial, bipartisan manner to present it to the Senate and to the American people. It is absolutely essential we finally deliver on the promise many have made for years that we will pass a prescription drug benefit and make it available and absolutely secure to our seniors. However, 3 weeks ago this Chamber learned a very important lesson. We learned about the importance of details and how a very small change in a very large piece of legislation in a conference report can mean 12 million children would be left out of a child tax credit. Therefore, I think it is imperative we spend the time to ask the hard questions about this legislation and that we exercise caution. So much is at stake for the people we represent. For example, right now this bill excludes the lowest income seniors who are eligible for both Medicare and Medicaid. In my own State, 219,000 seniors and New Yorkers with disabilities fall into that category. We leave them at risk of a State's decision to curtail or limit or even eliminate certain Medicaid drug coverage and long-term care coverage. Now we are all in a rush to try to do this to help our seniors, but we do not want to rush through this legislation at the expense of getting it tragically wrong. We have to go over this bill line by line and word by word. The details are changing every minute. The Congressional Budget Office says one thing, committee staff say another thing. We do not know how much it is going to cost. We do not know exactly what all of the elements will end up being, particularly when we look at what the House has passed. Speaking for New York, that is totally unacceptable. Then we read today in the newspaper the President has a very different idea about two central features of this Senate proposal. Let's address the real problems and not gloss over them and not rush to some judgment because we are going out on recess in a week. My constituents, from the 80-year-old widow in Utica to the 85-year-old man living in a nursing home in the Bronx, are counting on me to go over this process with care and to cast my vote in a way that will help them, not hurt them. As I have been talking with my colleagues and certainly as I have been reading the commentary in the press, there is a lot of confusion about this bill. The question is, what exactly does this bill do? How does it work for our seniors? I bet we would get many different answers if I were to ask that on the floor of the Senate. My constituents and people all over America are trusting us to examine this bill carefully and to gauge the consequences. If we do not take the time to do it, how will we know we are doing what is right? I am deeply concerned in this case that old saying about haste making waste could certainly come true. For starters, why is this plan so complicated? Why would we purposefully create what I call a new Medicare maze instead of establishing a solid, straightforward foundation for generations to come? We have to look at how this would actually work for the people we say we are trying to help. I have tried to map it out. Here is the question: How do you get prescription drugs under this plan? I have tried to put myself in the position of a senior, a person with a disability. It quickly became clear this will be a very confusing and in some instances a discouraging process for the vast majority of our seniors. Here is where we should start in looking at how to answer this question. How do you get your prescription drug benefits under this plan? Let's start with the fact that if you are a senior or a person with disabilities, you are out of this process--no Medicare benefit for nursing home residents, for seniors. Who needs a Medicare benefit more than people in our nursing homes? They are the ones frailest, most at risk; they need more help in order to keep alive and have some quality of life, but they are gone. They are not in this program. If you are in a nursing home and you are getting support through Medicaid right now, you are not eligible. Instead, they would have to rely on what they do now, which is Medicaid. But they would be in an entirely different system, totally at the mercy of the individual States. I don't know about other States, but in New York we have certainly made an effort to keep faith with these frailest people, seniors in nursing homes, people with chronic and life-threatening and debilitating disabilities, but we are not taking care of them in this plan. They drop out of the Medicaid maze before they even get started. This plan is really for a senior who has to choose between traditional fee for service with a private drug plan or Medicare Advantage, the private PPOs. We have created a new Government agency. I don't think a lot of people recognize that. This new Medicare Advantage will be administered by a new agency, the Center for what is called Medicare Choices, created under this bill. So we have ourselves a new bureaucracy. We are going to be spending money on bureaucrats and administrators, instead of on drugs, instead of taking care of our poorest seniors in nursing homes. Even before any benefit is available, this new bureaucracy gets built up and drains scarce resources out of what we can spend for our seniors. To go back to our seniors here, our seniors have to choose between multiple plans. As you can see, they might have a PPO, with a $45-a- month premium, or an HMO, with a $32-a-month premium. They may have private plans that are available to them. They have to make these choices. Certainly I am all for choice, but we know, from what drug companies themselves have said, there will be many regions of our country where there will not be a lot of choice. So before seniors make that choice, they will need to register how the prescription drug benefits differ under each of these various proposals and whether the drug they need--this is a very personal consideration--whether the drug they need will be covered under the plan they are analyzing. If a senior looked for the lowest premium--and I can guarantee most seniors will look for the lowest premium because most of our seniors are hard pressed, on fixed incomes, and they are going to be trying to save their dollars, so they will look for the lowest premium--the senior would choose the HMO at $32 a month. But suppose this HMO doesn't cover the senior's doctor, someone the senior has relied on and trusted for years, but that doctor is not in the HMO? So the senior turns to the plan with the next lowest premium. On here, that would be private plan 2, where the premium is $37. But suppose the formulary used in this private plan doesn't cover the drug the senior needs. Let's assume the senior is on a drug for high cholesterol, and assuming the senior read the fine print, assuming the senior has informed help--which I think is a leap of faith in many parts of our country--the senior may sign up for this plan and not really know it does not cover the drug that has been prescribed for his or her condition. So what does the senior do? She is in the plan. She finds out it doesn't provide the drug. She has a grievance procedure she can go to. Imagine, we have an 80- or 85-year-old widow. She is trying to understand this. She is in the plan. She gets to keep her doctor, but she doesn't get the drug the doctor wants her to take. The doctor says: In my professional judgment, this is the best drug for you, but I am sorry, the plan you are in doesn't include it on the formulary--the list of drugs that are permitted. So what can the senior do? The senior can take a drug off the formulary, whether or not the doctor thinks that is the right thing, or the senior can file a grievance and can go through this grievance process, with a hearing, to try to get the drug that the senior's doctor tells her she should be taking for her high cholesterol. If we do that, we know we have consumed valuable time. We have created yet another bureaucracy. Not only have we created this new Government agency to run this program, now we have created a whole grievance process, putting lawyers to work, putting advocates to work, to try to figure out how to get the drug the woman wants or get the doctor the senior wants. So we have used up a lot of paper, used up a lot of time, and unfortunately taken hard-to-have, scarce resources out of doing what we all want them to do; namely, get the drugs paid for that our seniors require. Let's suppose we go from year 1--because this doesn't go into effect until 2006, so we are not quite sure how it is all going to work, but suppose we go from year 1 to year 3. I could not get everything on the chart, so we will skip 2007; we will go to 2008. These private plans are new. They have not refined all their business models. We know when the State of Nevada tried something similar, drug companies said: Wait a minute, there is no money in this for me. I don't want to provide drugs to the sickest, oldest people in America. I can't make anything on that. So they dropped out. I think it is fair to assume that at the end of those first 2 years when a plan's contract expires, it may decide to drop out, just as Medicare HMOs have dropped out. As I am sure all of us have heard from our constituents, the number of Medicare+Choice plans has decreased by over half in the last 5 years, leaving thousands of seniors in the lurch when they pull out of the markets where the seniors live. Those who did not pull out, they stayed but at a huge increase in price. They cut back benefits and raised premiums--15.5 percent last year alone. So all of a sudden, now, we have what used to be a $32 plan being a $47 plan. This is a monthly premium. Let's say our senior waited it out, finally got the prescription drug she needed through a grievance hearing, but then after 2 years the plan she was in with the drug she needed did not find the market profitable and chose to pull out. The Government would have to be sure there was a Federal fallback in place, so our senior might then go into the Federal fallback. The Federal fallback would guarantee, for a limited period of time, that the senior would get the drug and the doctor of her choice. But this would only be for a limited time, only until this new Government agency could negotiate with private plans--and they can potentially subsidize up to 99.9 percent of their risks--in order to get two plans back into the marketplace. Our senior would then have a plan at a higher price, with the Government basically subsidizing--some might argue, bribing--the private plan to come back into the marketplace. But by year 4, our senior might again have to change plans for the very same reasons, about coverage, including doctors, including drugs, and as you can tell, this is the most streamlined version I could put on one chart of what it is we are debating. I think it is important to recognize that this new Government agency is giving a huge gift in a subsidy to these private plans, but it is giving another very large gift because it is basically saying you come into our plan and we will waive all State insurance regulation. I don't know about you, but people who have dealt with insurance companies of all kinds sometimes have problems with them, and they go to their State insurance commissioner who is close to the problem, and they try to get it worked out and get some support. That will be gone. You will not have the right to go to your State insurance commissioner because this new Government agency up here will have said: All bets are off. We beg you to come into the market. We will pay you to come into the market. And guess what the sweetener is. We are not going to hold you to any of the regulations with which you would otherwise have to comply. Last year, we passed in this body a prescription drug benefit known as Graham-Miller. It was simple, had the same premiums, deductibles, and copays, and there were no dropoffs. It was over 50 percent more generous than the bill before us today. I know many of my colleagues prefer this Medicaid maze because they are such strong supporters of competition. So am I. Goodness gracious, competition, the free market, we all know that is one of the pillars of American success. But I don't champion competition for the sake of championing it when it comes to health care and when it comes to the elderly and the frail and people who use the bulk of prescription drugs in our country. I champion it when it actually produces a good result. Competition on a skewed playing field that excludes certain plans from staying in the market and creates inefficient administrative and transaction costs could actually leave customers less informed, less well off, and spend these scarce health care dollars on creating a new bureaucracy whose primary purpose is to somehow subsidize insurance companies. I think drug plans should not compete for profits by attracting only the healthiest of people and dumping seniors they consider bad risks. They should not compete by cutting corners in quality. They should compete with each other on quality and price. Of course, the way to do that is to set some uniform benefit package to try to have a uniform premium so you can compare apples to apples and not apples to oranges to kumquats or bananas or whatever else is in the fruit basket. The Senate bill has taken some steps to try to rationalize its system. The House of Representatives' bill lacks even the basic protection for seniors. It lacks what we call a Federal fallback; that is, when your HMOs or PPOs or drug insurance programs pull out on you and don't give you the drug you need or won't let you see your doctors, then you can go into what is called the Federal fallback. The House doesn't even have that. They somehow magically assume--although we have seen no evidence of it and it defies common sense--that there are going to be all of these drug companies and all of these insurance plans competing to take care of that elderly woman or that elderly man with all of these drug costs. As I mentioned, New York State has 219,000 low-income seniors who qualify for both Medicare and Medicaid. They are excluded. I fear they are being put at risk because they are going to have to rely on State programs in these times of big budget problems. There are also some other people I worry about when I look at this Medicaid maze. For example, retirees who bargain for and obtain health care benefits for their retirement. The Congressional Budget Office says a third of Medicare retirees with drug benefits would lose coverage under this bill. In our State, that is 365,000 people. Then we have another. New York has put into place its own prescription drug plan to help people who have incomes up to $50,000. If you go to New York and you have friends or families in New York, you know we have a higher cost of living. In our State, middle-class people with big drug costs pay for those costs. There are 317,000 who are enrolled in the State's EPIC prescription drug program, and nearly 900,000 are excluded because they are in nursing homes or they have disabilities and under the calculations may have their retiree benefits put at risk, or who are going to have their State prescription guarantee also put at risk-- one in three Medicare recipients in New York. Never in the history of the Medicare program has a Medicare beneficiary been denied access to a covered benefit. I am just so troubled that we are excluding our lowest income seniors. I don't know how we justify that. I have a letter from our Republican Governor which I ask unanimous consent to have printed in the Record.

Mrs. CLINTON. Mr. President, Governor Pataki has written to ask that in this plan Medicare cover the drug costs of these seniors and New Yorkers with disabilities. The Governor's record explains the importance of including these people who are called, in the jargon, ``low-income dual eligibles.'' Furthermore, I believe we should eliminate the penalty against retirees. By refusing to count retiree benefits as out-of-pocket expenses, this bill assures that 365,000 New Yorkers will never make it through the coverage gap. We should also try to support States such as New York that are putting their own money into programs to provide for continuing coverage. The gap in coverage is very disconcerting. I don't even really get to that on this Medicaid maze. I think it is important to recognize there is on average a $275 deductible and at least a $35 monthly premium that could certainly vary widely. As we have seen in these examples, depending upon where you live, and depending upon who is available, there is a 50-percent subsidy until your costs are $4,500. And then you go cold turkey. Some people call that a doughnut hole. That is not my image. There is a brick wall which you run into. Spend your money, and after that you get no help--none at all--until you get to what is called the catastrophic threshold of $5,813 in drug costs. Many of us have heard from our constituents. In fact, we are deluged in my office with phone calls, e-mails, and other contacts from people asking, How is this going to affect me? What does this mean in my life? I think that is the real question. How do I get prescription drugs under this plan? I want to talk about this one story, a woman named Arlene Francis. She lives in the Buffalo area. She was married to a Bethlehem Steel retiree who passed away. At one time, she had the retiree drug coverage that was part of her husband's contract with Bethlehem Steel. As we know, Bethlehem Steel went into bankruptcy and was bought by another company. All retirees and spouses of retirees lost their coverage. Arlene takes Fosamax, a drug for osteoarthritis, which costs $68 a month. She has a hormone replacement patch. She takes antibiotics as needed. She is pretty healthy, when you think about it. That is not a lot for someone to be paying for prescription drugs and getting the coverage she needed. But it is a stretch for her because she has a very limited fixed income. Her drug costs total $998 a year. She relies on our New York program called EPIC, which covers seniors on a sliding scale up to $35,000 for singles, such as Arlene, who is a widow, and $50,000 for a couple. Under EPIC, her annual fee is $36 a year. Her copays are $3. Her share of her yearly $998 drug expense totals $336-- roughly a third of what the cost would be. But what happens under this proposal is very troubling to me. She would pay monthly premiums every month. Let us say we get it at the lowest level of $35 a month. That is $420 a year. She would pay a $276 deductible and a 50-percent copay. How much would she pay to get $998 in drugs? She would pay $1,157. Arlene and many of my constituents aren't going to get anything from this bill. It is voluntary. You argue they don't have to go into it. But we are changing the incentive and the structure of delivering drug coverage for many people in a State such as ours which already tries to help people, which I believe will lead to the limitation or the elimination of the program we already have. Under this program, the Federal Government isn't lifting the States' costly burden of prescription drugs. It even adds some administrative costs on the State Medicaid offices that have to do all of these calculations. Because a State will not receive reimbursement from the Medicare program for the benefits it provides up to the Medicare level, it very well could make a rational decision that it is just not going to continue doing that, and either cut back or end the program, which will be very bad news for the 360,000 seniors in our State, like Arlene, who rely on this very cost-effective way of getting their drugs covered. When we have the Congressional Budget Office stating that seniors with prescription drug costs of $1,115 or less would end up paying more through premiums, deductibles, and cost sharing, they are not getting anything from this bill. On the other end of the income and expenditure level, the bill falls short for patients with high drug costs as well. Even seniors who spend $5,000 will get only $1,700 in benefits. They have to manage 66 percent of the costs on their own. I think we could do more to eliminate the gaps in coverage and to tear down the brick wall that stops people from getting help while they still pay for it until they reach the catastrophic level. I will be introducing a series of amendments. But I think it is important to recognize the fundamental issues I am raising today about the Medicare maze are going to require all of us to work on it. I am very pleased that one of the most important ways we can assure that competition is helpful instead of harmful is to ensure the plans actually do compete on quality. So I appreciate that the bill includes a measure I have supported, along with Senator Hatch and others, to commission the Institute of Medicine to develop ways to think about paying for quality outcomes. I have also filed an amendment to encourage the development of quality standards so that our seniors have some basis of comparison to choose among different plans. I believe it is important to provide information about the efficacy of drugs and their cost-effectiveness so that seniors and others can see for themselves whether we are getting our money's worth for this $400 billion investment. I would like that information on the Internet. I would like it made available through the long-term ombudsmen, the Medicare and Medicaid representatives in every State. I started by saying I think this legislation does hold tremendous promise. But I have tried to outline some--not all but some--of the questions I am having to answer from my constituents who come to me with very specific issues, who ask me how this will affect their lives, whether this will make them better off or worse off financially. I believe it is important for us to be able to really scrub this, understand what it does and what it does not do, and also recognize that on the other end of this Capitol the House has a very different approach. I applaud the work Senators Grassley and Baucus have done. But let's not forget, this body tried to protect lower income working families by giving them the child tax credit--people who pay a higher proportion of their income in taxes than I do, but who were told, at the other end of this building, that because they may not pay income tax, they should not get help for their children. I have to ask, if that is the attitude on the other end of this building, if they have already passed a bill that is not going to help many seniors but provides even more of a giveaway to drug companies to try to get them to offer these plans, how can we trust, at the end of the day, that the more thoughtful debate and version we are working on here in the Senate will be what comes out of this process? I was very disappointed when it was reported in the papers today that the President has weighed in on the side of giving subsidies, increasing benefits to insurance companies--not in the Senate version, but in the House version--and that the President does not want a Federal fallback. This is a huge difference in philosophy, in ideology, and, I believe, in life experience. Medicare has worked. Since 1965, it has removed not only so much of the concern and worry and anxiety about growing older, of facing acute and chronic health care problems, it has removed a lot of burden from the American family. My mother just recently turned 84, and I feel very fortunate that I am in a position to be able to help her. But I know, very well, that a lot of other families trying to save for tuition, for college for their kids, trying to make ends meet, when it comes to mortgages and car payments, they may not be in that position. Therefore, they look to Medicare to really help spread the burden of taking care of our elderly from one generation to the next. It is part of our social contract in America. We have a basic bargain: If you work hard, if you are responsible, we are going to help, through our Government, to make sure you do not fall into poverty, that you are not left without health care. We are going to do that because that is the kind of people we are. Those are the values we have. This could be a giant step back from that commitment. Let's not also forget that this $400 billion, which we are trying to set aside, comes at a time when we are looking at deficits and increasing debt, which will impose even more burdens in the future on middle-class Americans and their families. So I hope we are able to answer the questions and, most fundamentally, explain clearly and unequivocally how someone gets their prescription drug benefits. I do not know that I could take this chart to a senior center, to a nursing home, and explain this. I do not understand why it has to be so complicated, why we have to create a new Government agency, why we have to waive insurance regulations, why we have to cause this level of confusion and uncertainty among people who should have the peace of mind in their later years that they do not have to worry about filing grievances, fighting for their drugs and their doctors. Why are we doing this? Why are we creating these obstacles, this Rube Goldberg system that is going to be extremely hard to explain and very hard to understand? Finally, I do not understand, either, why we are waiting until 2006. Medicare went into effect within a year--a totally new system, with no new agency to administer it. We were able to do it in a year. President Johnson went to Independence, MO, and signed that bill with former President Harry Truman, who had been one of the first of our leaders to say: We need to take care of our seniors. That bill was signed, it has worked well, and it has a very low administrative cost. Two to three cents out of your tax dollars, your contributions that go into Medicare, go into administration, go into any kind of costs that can be compared to the high percentage that these private insurance companies spend. Some of them spend 30 to 40 cents out of your dollar, not on taking care of you but on taking care of themselves. So at the end of the day, Medicare has worked. I am very proud of our country for making that commitment. Yet I worry that what we are about to do is not only difficult to understand, difficult to administer, and confusing but may very well be the beginning of undoing traditional Medicare. The report of the President's letter today certainly gives me pause that we would not even have a Federal fallback. Our people who live in rural States, live in poor urban areas--who are not the most attractive clients for insurance companies because--guess what--they get sicker, they are poorer--where will they get their care if our Government does not have that fallback to provide the safety net? And what do we do as States are making these budget cuts to take care of the hundreds of thousands of our poor residents in nursing homes, our people with disabilities, who depend upon this program? We cannot forget about the larger issue at hand. Our fundamental responsibility and our goal must be, as a nation, to help our seniors by providing a prescription drug benefit that is reliable and comprehensive. And if we are to go down the route of introducing competition, then let's make sure it is competition on cost and quality, not competition to eliminate more and more of the sickest of our elderly or the people with disabilities whom we are trying so hard to take care of. Our goal is not just choice or competition, it is compassion; it is coverage for those who need it. We have a rare bipartisan opportunity to do this. Let's get it right in the Senate, and then let's fight with all of our energy to make sure it is not changed in a conference committee with the House, so that we can, in good conscience, tell our seniors we have done the best we can to make sure they get the benefit we promised. Thank you, Mr. President. I yield the floor.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, Today is Anne Frank's birthday. If she had survived the horror of the Bergen-Belsen concentration camp, then she would have been 74 years old. But she did not survive and because of her moving and thoughtful diary, the world got to know her and understand what it was like living in that apartment during the Nazis' reign of terror. Anne Frank's diary has educated generations around the world about tolerance and dignity. It has left a mark in a way that few books can, and the world is a better place because of Anne Frank's story. That is why I am proud to submit a resolution expressing the sense of the Senate that the United States Postal Service should issue a postage stamp commemorating Anne Frank and the Citizens' Stamp Advisory Committee should recommend to the Postmaster General that such a stamp be issued. Anne Frank was born on June 12, 1929, in Frankfurt, Germany to a German-Jewish family. She and her family fled the Nazi persecution of Jews in Germany and sought safety by moving to Amsterdam, the Netherlands. Following the Nazi occupation of the Netherlands, Anne Frank and her family were forced into hiding in an annex located above her father's office. The family spent 25 months in hiding which Anne Frank described in her diary. The family was betrayed and turned over to the Nazis. Anne Frank was imprisoned in the Bergen-Belsen Nazi concentration camp, where she died in March 1945. She was one of approximately 1,500,000 Jewish children who died at the hands of the Nazis during World War II. In the midst of this unthinkable horror, her diary survived, and was published by her father after the end of the war. It has become one of the most widely read memoirs of the Holocaust experience. It has been translated into more than 67 languages and has touched people around the world. The Diary of Anne Frank holds a special place of honor in the United States. It is the first educational encounter with the Holocaust for many American students. It has been repeatedly dramatized in motion pictures and in the theater. Millions of Americans have come to identify with Anne Frank. She has become an inspiration to children of all faiths and assists young people deal with important issues such as discrimination, bigotry and hate crimes. Anne Frank serves as an enduring symbol of bravery, hope, and tolerance in the face of harsh and brutal conditions. A commemorative postage stamp would be a meaningful way for Americans to honor Anne Frank's inextinguishable courage and dignity. I urge my colleagues to co-sponsor this resolution and assist our efforts to convince the Citizens' Stamp Advisory Committee to recommend the issuance of a postage stamp commemorating Anne Frank.