Hillary Clinton

Mrs. CLINTON

Mrs. CLINTON. The Senator is absolutely accurate. The problem is made even worse by a phenomenon that has occurred over the last several years where much of the aid that the colleges themselves have provided has gone away from need-based aid to so-called merit-based aid. So students who come from families such as mine are meritorious--and I am very proud of that--but then they are taking those dollars, those very scarce collegiate scholarship dollars, they are taking them, when they don't need them, and thereby depriving other students who do need them from that access. So it is both the Federal and State programs and even the colleges' own programs which, combined, are leaving hundreds of thousands of worthy, meritorious, needy students behind. We are doing it on both ends of the education spectrum. As the Senator so well knows, we are setting ourselves up for a very unfortunate set of circumstances. If you ask the question: How does this country become richer, safer, smarter, and stronger?--any list of answers that has any basis in evidence, fact, or logic will tell you, investing in education. We know investing in education increases the lifelong earnings of college graduates by $600,000. Every year of postsecondary education will provide between 5 to 15 percent more in annual earnings. Yet here we are closing the door to college education, basically telling a lot of kids who depend on loans, depend on grants, depend upon increasing student debt: I am sorry; you are not in our plans for the future. That is a terrible mistake for this country to make.

Mrs. CLINTON

Mrs. CLINTON. The teaching hospitals will certainly help defray some of the increasing costs that are not going to be taken care of otherwise.

Mrs. CLINTON. Pursuant to section 207(C) of H. Con. Res. 68, the concurrent resolution on the budget for fiscal year 2000, I move to waive section 207(B) of that concurrent resolution for purposes of the pending amendment, and I ask for the yeas and nays.

Mrs. CLINTON. Mr. Majority Leader, I was going to move to waive the relevant section of the Budget Act and ask for the yeas and nays, but let me wait until you are finished.

Mrs. CLINTON. Yes, it is the original proposal.

Mrs. CLINTON. Mr. President, I rise in support of my amendment. I urge the Senate to take action now because, in the event we do not freeze the cuts that would go into effect, we will be facing disastrous impacts throughout our Nation with respect to our physicians, our home health agencies, our skilled nursing homes, our Medicare+Choice programs, our teaching hospitals, our community hospitals, our rural hospitals--all of which need to keep up with inflation and increasing costs and demands. If you look across our country you can see specifically the amount of money that our hospitals and all of our other health care providers will lose if we do not take this action now to freeze these cuts before they go into effect on the first of March. This amendment provides for the freeze. It also provides for a 2- percent increase for physicians who otherwise are going to be leaving Medicare. I really appreciate the commitment we have received from the Finance Committee to address this issue. We will all be working diligently to ensure we do address it. But in the meantime, our system is deteriorating. The quality of service is decreasing. The numbers of providers are not there to take care of the increased demand, and I urge the Senate to take this intermediary step to vote this 6-month action while we try to fix the program.

Mrs. CLINTON. Mr. President, I suggest the absence of a quorum.

Mrs. CLINTON. Yes.

Mrs. CLINTON. Mr. President, I ask unanimous consent that the modified amendment be accepted at the desk and be considered.

Mrs. CLINTON. The Senator's question is absolutely pertinent. We worked very hard through the night addressing that point. I have been informed by my staff, in consultation with the Finance Committee staff, that the amount is offset. Clearly, as I have said, I think this is such an emergency that we should spend new money, but we do have such an offset.

Mrs. CLINTON. Yes.

Mrs. CLINTON. Mr. President, I agree with the Senator. As the Senator knows, as often happens around here, we have been working very closely with staff of the Finance Committee. Many of these provisions have been modified, and also we were able to fully offset the costs by extension of the Customs user fee, knowing full well that is a concern of many of my colleagues with respect to how this would be paid for. I will take the position it is such an emergency that we should find new money, if necessary, to give us the time to do this in a deliberative manner. But we do have the offsets, and the modified amendment provides for those offsets.

Mrs. CLINTON. No.

Mrs. CLINTON. The Senator is correct to point that out. That is not in the modified amendment. I apologize; the Senator has not gotten a copy of the modified amendment.

Mrs. CLINTON. Yes.

Mrs. CLINTON. I thank the Senator from North Dakota. Clearly, if we do not act, doctors are going to start pulling out of Medicare in a month. Then we are going to have the rapid unraveling of the system, which we all fear. It is going to be much harder to put it together under the leadership of Senator Grassley and others who are addressing this issue.

Mrs. CLINTON. Yes, I will yield.

Mrs. CLINTON. The Senator is absolutely correct. Health care is a primary provider of jobs in every State that I know of and certainly in the cities across the country. Our hospitals, nursing homes, home health programs, physicians offices are all providing employment. That is why it was so important that we tried to address this last year. We could not get past the procedural roadblocks, despite the best efforts of Senator Grassley and Senator Baucus. I supported their proposals. Now we have to act because we are on the brink of an emergency. I want to make sure that the modified version of the amendment with the offsets we have found is at the desk because there seems to have been some confusion.

Mrs. CLINTON. Yes.

Mrs. CLINTON. Mr. President, I rise to offer the 6-month Medicare and Medicaid extenders amendment No. 89 to H.J. Res. 2. The modified version of the amendment is at the desk. The modification assures that the cost of this amendment is fully offset by extension of the Customs user fee. The current appropriations bill, like the extension of unemployment insurance we passed earlier, represents unfinished business from last year. We are dedicating so much time to deliberating this bill because we recognize our obligation to take care of issues we left unresolved in the last Congress. I stand before you today to discuss another obligation that we left unfinished. That is Medicare. Virtually every Senator on both sides of the aisle has in the past expressed deep concern about the shortfalls of the Medicare system, particularly the lack of a long overdue prescription drug benefit. Now, regardless of the many DSH solutions that have been proposed and debated, I think it is fair to say that all of us stand united in saying Medicare needs fixing. Now, does this amendment provide that long-awaited fix? No. But what it does do is effectively freeze Medicare in its 2002 state. As badly as we all believe that Medicare was functioning last year because of the fiscal pressures, without action Medicare will be in even worse shape this year. Many of the Medicare and Medicaid provisions enacted in the Balanced Budget Act of 1999 or the Beneficiary Improvement and Protection Act of 2001 either expired at the end of fiscal year 2002 or will be expiring soon. Last year, there was bipartisan interest, led by Senators Grassley and Baucus, in addressing many of these ill-conceived cuts. But that effort was caught up and procedurally tangled at the end of last year, and many of the cuts we were trying to avert will now go into effect. I believe a number of these cuts, once implemented, will be very difficult to reverse. Yet because of procedural roadblocks, we won't be able to address them, despite the overwhelming bipartisan majorities in this body to fix these cuts and their impact. This is policy by default and by neglect, not by deliberative democracy. My bill provides a 6-month moratorium on this Medicare cliff to prevent irreversible deterioration of services for beneficiaries while Congress completes the unfinished debate from last year over a more comprehensive Medicare reform package. The measures in this amendment--with the exception of the physician payment update, which lasts from March 1 to September 30--are scheduled to be implemented from April 1 to September 30, 2003, the exact same time period as the other rural hospital provision that is already included in the omnibus. The specific measures of this amendment include an inflationary update for hospitals and a continuation of the workforce add-on for nursing facilities that are trying to maintain nurses in a time of shortage. It also delays the automatic 15-percent home health cut. It prevents cuts in dialysis services, and it helps stroke victims by continuing a moratorium on the $1,500 cap for therapy services. This amendment would also assure that hospitals serving a disproportionate share of Medicaid and Medicare beneficiaries, including teaching hospitals, are not crippled or even have services basically shut down while Congress debates this issue. It assures that doctors who have suffered a 5.4-percent cut last year, and are frozen at last year's rate by this omnibus bill, would get a 2-percent increase from last year's unacceptably low levels. It also extends the QI Program, which I know my colleague Senator Bingaman is very interested in; that provides support for low-income seniors who would otherwise be unable to afford Medicare premiums. These seniors will be kicked off Medicare on April 1. Once they are kicked off, it will be hard to identify and reinstate them unless Congress extends their eligibility. Medicare+Choice plans are also increasing their premiums, cutting benefits, and withdrawing services. I believe beneficiaries need protections against these health plan deductions and we should debate and pass these protections in the coming year. In the meantime, I am troubled by reports of plans pulling out of markets and leaving beneficiaries stranded. As you can tell from this chart, until we can act to help beneficiaries, this amendment provides for a 3-percent increase, increasing the 2 percent already scheduled, which will hopefully prevent further pull-outs and the disruption they cause to the continuity of care. So what would happen if we didn't do anything? Well, as this chart shows, hospitals are already struggling to keep up with rising health care demands while trying to invest in the latest lifesaving technology. They would lose roughly $1 billion, including over $100 million in New York alone. Medicaid DSH hospitals, which take care of a disproportionately high number of uninsured patients, would lose an additional $100 million. Meanwhile, this chart shows the increasing amount of uncompensated care that hospitals are forced to provide. Let me say a word about physicians, many of whom were forced to limit their Medicare practice due to last year's cut. This will--if we don't act, if we only implement what is in the omnibus bill--continue to bring about limitations in practice and decrease the numbers of patients who are served. Skilled nursing facilities already facing worsening nursing shortages would lose $700 million. That amounts to about $32 per day per resident. And for the average nursing facility, this amendment amounts to about a $117,000 annual cut. That is enough to pay for two registered nurses, three licensed practical nurses, or five certified nursing assistants. Home health agencies, which are so critical in allowing patients to be taken care of at home rather than in expensive inpatient facilities, would lose $500 million. These are just a few of the providers who form the fabric of our seniors' health care system. If we allow the fabric to fray, it will be much harder to weave it together again. As this chart shows, the fabric is already framed. Over the past year, I have talked to numerous providers from New York and from other States who are just on the brink of halting services, not only to Medicare patients but actually going out of business altogether. The common refrain I hear is that once these providers leave the Medicare system, they are not coming back, even if an eventual long-term solution is found. In other words, it is far easier, and I argue far cheaper, to preserve our current system and then strengthen it later than to allow the current system to be destroyed with the hope of rebuilding it in the future. When a critically ill patient comes into the emergency room, he is first seen in the ER, stabilized, then sent to surgery, if required. Why? Well, we all know from watching television that the ER physician knows that surgery will take a while. If immediate measures are not taken, the patient could die before the surgeon can even begin operating. What we have with Medicare right now is a critically ill system, one which I know requires major surgery in the very near future to transplant the dying patient into once again a live and vigorous one. But until we are ready to do that operation, we need to take immediate action to stabilize the system and prevent it from collapsing before we are able to act. This amendment will act as that stabilizer, will give us time to undertake the long-term task. I therefore urge my colleagues to support the amendment. Continued inaction will leave Medicare so irreversibly damaged that even the best healers among us will be unable to revitalize it. I look forward to stabilizing our patients and getting on to debating the right cure.

Mrs. CLINTON. Mr. President, I call up amendment No. 89 and ask for its consideration.

Mrs. CLINTON. Yes.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I ask unanimous consent that Murali Raju, a fellow from my office, be granted the privilege of the floor for the duration of the debate.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I am extremely disappointed that this bill contains a 15-year reauthorization of the Price-Anderson Act, which indemnifies the commercial nuclear power industry and limits the industry's liability in the event of an accident. This act, which has provided such protections for the nuclear power industry for some 45 years, needs to be revisited and seriously reconsidered--particularly in the wake of the events of September 11, 2001. It is my hope that such consideration will still be given by the Senate Committee on Environment and Public Works, the Committee of jurisdiction of which I am proud to be a member, despite the reauthorization of the Act on page 1027 of this 1052-page bill--a reauthorization which has not been debated at all of the floor or in Committee this Congress. In addition to increased security concerns at nuclear powerplants as a result of the terrorist attacks of September 11, 2001, there are additional issues that warrant further debate before this act is reauthorized. Recently, the General Accounting Office found that liability limits under the Price-Anderson Act are not adequate to provide for compensation of victims in all nuclear accident scenarios-- not to mention the kind of event we experienced in New York on September 11, 2001. Also, questions have been raised as to whether the Price-Anderson Act includes sufficient protections to deal with the currently deregulated energy industry--whether the act would operate as intended and ensure that nuclear powerplant operators are able to provide compensation in the event of an accident up to the act's limits. A recent study has concluded that under the act, limited liability corporations and multi-tiered holding companies that own nuclear powerplants may be able to effectively shield their intermediate and or parent corporations from financial responsibilities under the Price- Anderson Act and thereby walk away from Price-Anderson obligations without jeopardizing other assets. The use of these relatively new corporate structures for ownership of nuclear powerplants raises questions about the respective obligations of subsidiary, intermediate, and parent corporations to make the payments required under the provisions of the Price-Anderson Act--questions that should be resolved before the act is reauthorized for a 15-year period. In addition, there is increasing cause for concern regarding the general safety and security of our Nation's nuclear powerplants. A recent report by the Nuclear Regulatory Commission's (NRC's) Inspector General found that ``NRC appears to have informally established an unreasonably high burden of requiring absolute proof of a safety problem . . . before it will act to shut down a power plant.'' In addition, the NRC recently ruled that the risk of terrorism is too speculative to be considered when making nuclear reactor licensing decisions. And a recent survey of NRC employees shows that a third of employees question the Commission's commitment to safety, and almost half say that they do not feel safe speaking up in the NRC. While almost 90 percent of the agency's executive-level employees answered favorably to questions regarding the Commission's commitment to safety, less than two-thirds of those in the mid-level ranks answered similarly, according to recent press reports about the employee survey. In addition, reports have been issued that show security guards at nuclear powerplants are over-worked and under-trained, that the guards themselves do not feel that they are getting the support they need to do their jobs right. In fact, a January 2002 report commissioned by Entergy, the owner of the Indian Point nuclear power plant in New York, found that only 19 percent of security guards at Indian Point 2 stated that they could ``adequately defend the plant after the terrorist event of September 11th.'' For these and other reasons, I strongly oppose the inclusion of this 15-year reauthorization of the Price-Anderson Act in this legislation. I remain committed to a thoughtful reconsideration and debate of this act as it pertains to the commercial nuclear power industry, and look forward to addressing this and other issues related to nuclear powerplants, including the important issue of nuclear powerplant security, in the Senate Environment and Public Works Committee this Congress.

Mrs. CLINTON

Mrs. CLINTON. Mr. President, I would like to express my support of the amendment introduced by my colleague, Mr. Daschle, because it provides emergency disaster relief to farmers. During the past 2 years, Mother Nature has not been kind to farmers and bad weather has devastated their crops and threatened the survival of family farms. New York State experienced statewide drought this past growing season. Farmers across the State have struggled with lower crop yields and higher feed prices for their livestock. Fifty-five counties in the State have been designated as primary disaster counties by the Secretary of Agriculture, which includes all of New York's agricultural counties. But in New York, crop damage has not come solely from drought. Unseasonably high temperatures in the spring followed by frost and hailstorms have devastated specialty crops such as such as apples, peaches, pears, grapes, strawberries, stone fruits, onions, and cherries. And the disasters have not just been limited to the 2002 crop year--many farmers in New York were also hurt because of adverse weather in 2001. The unfortunate result of this disastrous weather is that a large percentage of these farmers, particularly those that produce specialty crops, are bordering on financial ruin. I have met with the farmers and growers of New York, and their stories are heartbreaking as they talk about bankruptcy and selling off their family's farm. For many specialty crops, adequate crop insurance that would cover more than catastrophic losses is not available. Crop disaster relief is truly needed to keep these farms going as well as the rural economies that they support. Time is running short for these hard-working families in New York, and they need our help. The funding that Senator Cochran has proposed would give our farmers in New York and across the Nation the relief they need. While it provides a total of $100 million for specialty crops, these funds are not focused on those who have incurred weather-related losses. In 2002 alone, New York's apple growers sustained damage of over $80 million. The amount provided by Senator Cochran is not enough to address these losses and the tremendous needs of other New York crops--such as Labrusca grapes, peaches, pears, strawberries, stone fruits, onions, and cherries. And this says nothing to the financial needs of specialty crop producers across the entire country. In addition, the amendment by Senator Cochran would not fully replenish section 32 funds that the administration took last year from programs designed to feed impoverished urban, suburban, and rural residents. Without fully replenishing these funds, the ability of nutrition and food aid programs to assist citizens in need may be compromised. New York has many in need of food aid, and I cannot stand by while this form of assistance is in jeopardy. The amendment proposed by Senator Daschle does address these needs, and that is why I ask my colleagues to support this emergency disaster assistance package. I have worked with my colleagues in the past to pass legislation that would provide financial relief to farmers who have suffered losses due to natural disasters in 2001 or 2002. I supported the farm bill last year which included disaster aid. I cosponsored S. 2800, a bill that would provide emergency disaster assistance to agricultural producers. And I cosponsored the crop disaster amendment to the Interior Appropriations that passed with 79 votes. In the 108th Congress, I have cosponsored S. 21, which would again provide emergency disaster assistance to agricultural producers as well as restore section 32 funding. And I support Senator Daschle today, in his continued efforts on behalf of this Nation's farmers who have suffered disaster, our rural communities who depend upon farm incomes, and those in this Nation who are hungry.