Tom Daschle

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I thank the Majority Leader for his comments, and I share the Senator's concern about the concentration of NIH funds. I, too, ask if next year we can't find more than $10 million for this program--$10 million that will be split among researchers in 24 states. I would also like to explain briefly why I believe IDeA ought to be funded at a much higher level. Mr. President, IDeA funds only merit- based, peer reviewed research that meets NIH research objectives. Let me state that another way: IDeA funds only good science, and it is in no way an earmarked program specific to a specific disease or disease- related issue. Researchers from the 24 IDeA states can submit proposals to any one of a number of existing NIH funding mechanisms, and those proposals are then peer-reviewed and funding decisions are made based on merit. Mr. President, I think the statistics the Majority Leader mentioned regarding the extreme geographic concentration of NIH research funds are eye-opening. I think many members of the Senate would be surprised to learn that nearly one-half of NIH extramural funds go to just five states, and that 24 IDeA states combined received just over 5% of NIH extramural funding in FY95. In fact, the Majority leader and I were joined by 24 of our colleagues in the Senate in sending a letter to the Subcommittee Chairman, Senator Specter, supporting $100 million for IDeA in FY99. To put that request in perspective, Mr. President, the final FY99 Labor, Health and Human Services and Education appropriation before us increases NIH funding by $2 billion. In other words, a $100 million IDeA program would have designated five percent of one year's increase for this program which funds competitive, peer-reviewed research in 24 states. The conferees did include $10 million for IDeA--an increase from the FY98 funding level of $5 million--and I thank Senator Specter for his support. Because this program is so important, I will continue to encourage the Chairman to increase IDeA funding next year and in the years that follow.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I rise today to call attention to the outstanding achievements of a Nevadan who has dedicated himself to helping individuals who often lack the means to help themselves. Dana Taschner has achieved national recognition as a champion for victims of domestic violence and civil rights abuses. He is a 38 year-old lawyer from Reno who chooses cases that are relatively small-scale, but representative of many of the problems facing Americans. Time and again, Mr. Taschner has had the courage and initiative to take on cases that more prominent firms are hesitant to handle for political or monetary reasons. Dana Taschner truly brings honor to his profession. Mr. Taschner's devotion to fighting oppression recently earned him the American Bar Association's Lawyer of the Year award. He was chosen from a pool of approximately 245,000 other lawyers in North America, competing with litigators with much higher profiles and greater wealth. In 1993, Mr. Taschner took on the Los Angeles Police Department and succeeded in forcing them to change their policy regarding police officers who commit domestic violence. In this case, he represented 3 orphans whose father, an L.A. police officer, murdered their mother and then took his own life. Taschner was able to overcome his own painful childhood memories of domestic abuse and secure the orphans a settlement. He argued that the department should not have returned the officer's gun after he had beaten his wife and threatened to kill her. He also forced the department to treat these matters as criminal cases, rather than internal affairs. In this era of cynicism and self-promotion, I believe we must take steps to encourage and reward sincerity. Dana Taschner's unwavering dedication to his clients can be seen in his personal relationships with them, relationships that often outlive the outcome of the case. As an attorney myself, I have seen firsthand how much our country needs people in my field who care enough about their clients to commit themselves personally, as well as professionally. Many litigators find it much easier to take the cases that bring financial gain, rather than attempting to help the true victims of injustice. I am proud that his colleagues have lavished accolades upon Mr. Taschner, but I believe it is a much greater sign of his success that his clients put their faith in him. Dana Taschner, whose integrity and selfless devotion to fairness truly embody our American justice system, is a role model for us all.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I am pleased to report that, after years of waiting, families facing the tragedy of alcohol-related birth defects can finally expect a coordinated federal response to their needs. The Fetal Alcohol Syndrome and Fetal Alcohol Effect Prevention and Services Act, which has been included as part of S. 1754, the Health Professions Education Partnerships Act, will establish a national task force to address FAS and FAE, and a competitive grant program to fund prevention and intervention for affected children and their families. The Fetal Alcohol Syndrome and Fetal Alcohol Effect Prevention and Services Act was introduced as S. 1875 earlier this year and, with today's Senate passage, will be cleared for the President's signature. It is a modest measure, but its implications--in terms of children saved, families saved, and dollars saved--are dramatic. Alcohol-related birth defects, commonly known as Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effect (FAE), wreak havoc on the lives of affected children and their families. The neurological damage done by fetal exposure to alcohol is irreversible and extensive, undercutting normal intellectual capacity and emotional development. A child with FAS or FAE may be unable to think clearly, to discern right from wrong, to form relationships, to act responsibly, to live independently. The complicated and debilitating array of mental, physical, and behavioral problems associated with FAS and FAE can lead to continual use of medical, mental health, and social services--as well as difficulty learning basic skills and remaining in school, alarming rates of anti-social behavior and incarceration, and a heightened risk of alcohol and drug abuse. FAS is the leading cause of mental retardation in the United States. And it is 100 percent preventable. FAS is completely preventable, yet, each year in the United States, some 12,000 children are born with FAS. The rate of FAE may be 3 times that. Researchers believe these conditions are often missed--or misdiagnosed--so the actual number of victims is almost certainly higher. The incidence of FAS is nearly double that of Down's syndrome and almost 5 times that of spina bifida. In some Native American communities, one of every 100 children is diagnosed with FAS. It has been more than 30 years since researchers identified a direct link between maternal consumption of alcohol and serious birth defects. Yet, the rate of alcohol use among pregnant women has not declined, nor has the rate of alcohol-related birth defects. In fact, both are increasing over time. The Centers for Disease Control (CDC) reported a sixfold increase in the percentage of babies with FAS born between 1980 and 1995. This increase is consistent with the CDC's finding that rates of alcohol use during pregnancy, especially the rates of ``frequent drinking,'' increased significantly between 1991 and 1995. These findings defy the Surgeon General's warning against drinking while pregnant as well as a strongly worded advisory issued in 1991 by the American Medical Association urging women to abstain from all alcohol during pregnancy. Clearly, we need to do more to discourage women from jeopardizing their children's future by drinking while pregnant. In addition to the tragic consequences for thousands of children and their families, these disturbing trends have a staggering fiscal impact. The Centers for Disease Control and Prevention estimates the lifetime private and public cost of treating an individual with FAS at almost $1.4 million. The total cost in terms of health care and social services to treat all Americans with FAS was estimated at $2.7 billion in 1995. This is an extraordinary and unnecessary expense. We know FAS and FAE are not ``minor'' problems. They are prevalent; they are irreversible; they are devastating to the victim and his or her family; and they are a drain on societal resources. We know the word is not getting out--or maybe it's not getting through--that drinking alcohol during pregnancy is a tremendous and senseless risk. We know children with FAS and FAE and their families are not receiving appropriate services, and we are all paying the consequences. Given what we know about FAS and FAE, our governmental and societal response to date are clearly inadequate. With this legislation, we are finally strengthening that response. To the extent we can prevent FAS and FAE and help parents respond appropriately to the special needs of their children, we can reduce institutionalizations, incarcerations and the repeated use of medical, mental health and social services that otherwise may be inevitable. It makes fiscal sense, but, far more importantly, it is what we need to do for the children and families who suffer its impact. The legislation we are sending to the President will establish a national task force of parents, educators, researchers and representatives from relevant federal, state and local agencies. That task force will tell us how to raise awareness about FAS and FAE--how to prevent it and how to deliver the kinds of services that will enable children and adults with FAS and FAE, and their families, to cope with its devastating effects. A national task force with membership from outside of, as well as within, the federal government is our best bet if we want to take a realistic look at this problem and address it. The true experts on these conditions are the parents and professionals who deal with the cause and effects of these conditions day in and day out. If we want to respond appropriately, parents, teachers, social workers, and researchers should have a place at the table. A national task force will also provide the opportunity for communities to share best practices, preventing states that are newer to this problem from having to ``reinvent the wheel.'' In conjunction with the task force efforts, the Secretary will establish a competitive grants program. This $25 million program will provide the resources necessary to operationalize the task force recommendations by supporting education and public awareness, coordination between agencies that interact with affected individuals and their families, and applied research to identify effective prevention strategies and FAS/FAE services. Mr. President, responding to the tragedy of alcohol-related birth defects is an urgent cause. I'd like to thank the many concerned parents, researchers, educators, advocacy organizations and federal agencies for their invaluable input on this legislation. I am confident this initiative will deliver profound benefits to the Nation, and I am thrilled to see us moving toward its enactment.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I want to congratulate the Presiding Officer for his work in disposing of the conference report on S. 1260, the securities litigation legislation. I appreciate very much that at long last this legislation is now going to become law. This is a bill that is widely supported on both sides of the aisle. A number of Senators have had a lot of opportunities to take some responsibility for the fact that this passed. I want to cite one Senator, in particular, who deserves great credit. That is the Senator from California, Senator Boxer. She has been a persistent advocate and one who has been extraordinarily engaged in this matter now for some time. I talked with her again this morning because she was calling about the status of the legislation. I was able to report that it was my expectation we would be able to finish our consideration of the bill today, and thanks to the agreement we have been able to reach on both sides of the aisle with Senators who have been as involved as the Senator from Wyoming has, we have now reached this point. I congratulate all who have had a part to play in our success, and particularly the Senator from California, for her persistence, for her leadership, and the effort she has made to bring us to this point. I yield the floor and I suggest the absence of a quorum.

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

Mr. DASCHLE

Mr. DASCHLE. Mr. President, the closing hours of the 105th Congress are fast approaching. I could not let this Congress end without coming to the Senate floor to address the tragedy in Kosovo. It is a human crisis of immense proportion, and it poses an increasing threat to the United States and the global community. The last several years have been marked by Yugoslavian President Milosevic's steady escalation of political repression and violence against the people of Kosovo. Acting at Milosevic's behest, Yugoslav forces have driven nearly 400,000 Kosovar Albanians from their homes. Fourteen thousand homes and 400 villages have been razed. Over 700 Kosovar Albanian men, women, and children have been killed. Within the last several weeks our newspapers have been filled with accounts of atrocities committed by Milosevic's units against scores of unarmed civilians. Among the list of crimes documented by international observers are politically motivated killings; massacres of women, children and elderly persons; torture; arbitrary arrest; detention without cause; denial of fair, public trial; and destruction of private homes. Further exacerbating this man-made crisis is the fact that winter is fast approaching, placing at peril the health and well being of tens of thousands of displaced persons who have managed to survive Milosevic's cruelties. After watching this recent string of atrocities, the international community was compelled to respond. On September 23, the United Nations Security Council adopted a resolution condemning the excessive use of force by Milosevic's thugs and demanding that he cease military actions against civilians, withdraw his security units, facilitate the safe return of refugees and displaced persons to their homes, permit unimpeded access of humanitarian organizations to the people of Kosovo, and engage in meaningful negotiations on Kosovo's final status. Diplomacy has been and should continue to be a major component of our response to this situation. But we must also acknowledge reality. The reality is that meaningful negotiations toward a settlement of Kosovo's status cannot take place in the current environment. Furthermore, words alone have never been enough to slow Milosevic and his henchmen. This was demonstrated to the world all too painfully in Bosnia. Despite numerous appeals from the international community to end his support for the war in Bosnia, Milosevic repeatedly turned a deaf ear, and the hostilities continued unabated. It was only after NATO carried out a series of airstrikes against military forces supported by Milosevic that a cease-fire became possible. The circumstances appear to be similar in Kosovo. And, if Milosevic fails to fully and immediately comply with the terms of the U.N. resolution, I believe the time has come for NATO to respond similarly. The United States and our NATO allies must be prepared to carry out airstrikes against the Federal Republic of Yugoslavia if such action is determined to be the only means of enforcing the U.N. resolution. I say this for three reasons. First and foremost, continued repression, violence, and instability in Kosovo directly threaten the national security interests of the United States. Kosovo is a tinderbox in the heart of one of the most unstable and critical regions of the world. Balkan history has clearly demonstrated that a spark in this region can rapidly spread into a blaze that engulfs the world. We have already seen refugee outflows into Albania and Macedonia. Two NATO allies, Greece and Turkey, with their competing regional interests, could easily and quickly get enmeshed in this crisis if it continues and widens. Second, the credibility of NATO, still our most important alliance, hangs in the balance. For nearly 50 years, NATO has been the organization most responsible for keeping the peace in Europe. NATO had great success in the years after World War II and the Cold War. Its post-Cold War utility was proven earlier this decade in Bosnia. What NATO does in Kosovo will go a long way toward determining this crucial alliance's role in the 21st century. A strong, unified NATO is still the best insurance policy we have against large-scale conflict in Europe. Third, as the west's history with Milosevic in Bosnia proves, if words are to have the desired effect on his behavior, they must be backed up with a credible threat to use force. Indeed, our recent experience in Kosovo itself bears this out. In the past week or two, Milosevic has launched an effort to convince the world that he is fully complying with the requirements of the September 23 U.N. resolution. Not surprisingly, this behavior occurred precisely as the specter of NATO military action began to loom over him. In fact, there may only be one way to achieve peace in Kosovo without the use of force. NATO must demonstrate to Milosevic that it is prepared to use force to compel his compliance. This is precisely the policy toward which this Administration and our NATO allies appear to be moving. Mr. President, in offering my endorsement for this approach, let me be clear. If air operations and missile strikes against the Federal Republic of Yugoslavia are necessary to force Milosevic to the negotiating table, the United States and our NATO allies should demonstrate that we are prepared to pursue that option. Certainly we should not give the Administration a blank check, but we must accept our responsibility as a world leader and acknowledge that stronger measures may be required. The Administration should continue to consult closely with Congress every step of the way as events unfold. Milosevic's atrocities have gone on too long. It's time for the United States to defend its national interests and help restore peace to this troubled region. It's time for the world to say no to the torture and slaughter of innocent civilians in Kosovo.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, on Saturday, I had a chance to talk about our good friend, Dale Bumpers. I'd like to take a few minutes to talk about four other friends who will be leaving us at the end of this Congress. Shortly after he left the White House, Calvin Coolidge was called on to fill out a standard form. After filling in his name and address, he came to a line marked ``occupation.'' He wrote ``retired.'' When he came to the next line, labeled ``remarks,'' he wrote ``Glad of it.'' I suspect that our colleagues who are retiring at the end of this Congress are also ``glad of it''--at least in some small measure. But, in addition to relief, I hope they also feel a sense of pride--both for what they have accomplished here, and the dignity with which they have served. In a short time here, Dirk Kempthorne has made all of our lives a little better. Thanks in large part to him, the Safe Drinking Water Act is now the law. Senator Kempthorne has also reminded us of the importance of state and local involvement in our decisions. We will all miss him. I had the good fortune to travel with Senator Kempthorne to the Far East. As most of our colleagues know, as we travel we get to know one another even better. I know him and I admire him and I wish him well in his life after the Senate. I also applaud him for the nature with which he has continued to work with all of us. He has a very conciliatory, very thoughtful, a very civil way with which to deal with colleagues on issues. If we would all follow Dirk Kempthorne's example, in my view, we would be a lot better off in this body. His manner, his leadership, his character, his personality is one that we are going to miss greatly here in the U.S. Senate. We will also miss Dan Coats. With his thoughtful approach and uncompromising principles, Senator Coats has followed his heart above all else. And, as a result of his support of the Family and Medical Leave Act, millions of Americans are able to follow their hearts, too, and spend more time with their families when they need them most. When Senator Coats announced his retirement in 1996, he said, ``I want to leave (politics) when I am young enough to contribute somewhere else * * * I want to leave when there is still a chance to follow God's leading to something new.'' Wherever Senator Coats and Senator Kempthorne are led, we wish them both the best. I am confident that they will continue to contribute much to their country and to their fellow citizens. And we will surely miss our own 3 departing Senators. Dale Bumpers, Wendell Ford and John Glenn are 3 of the sturdiest pillars in this institution. They have much in common. They came here-- all 3 of them--in 1974. For nearly a quarter-century, they have worked to restore Americans' faith in their government. Their names have been called with the roll of every important question of our time. And they have answered that call with integrity and dignity. They are sons of small town America who still believe in the values they learned back in Charlestown, Arkansas; Owensboro, Kentucky; and New Concord, Ohio. They are also modest men. Perhaps because they had already accomplished so much before they came to the Senate, they have never worried about grabbing headlines here. Instead, they have been content to work quietly, but diligently-- often with colleagues from across the aisle--to solve problems as comprehensively as they can. They have been willing to take on the ``nuts and bolts'' work of the Senate--what John Glenn once called ``the grunt work'' of making the government run more efficiently. They were all elected to the Senate by wide margins, and re-elected by even wider margins. And they all would have been re-elected this year, I have no doubt, had they chosen to run again. What I will remember most about each of them, though, is not how much they are like each other they are, but how unlike anyone else they are. Each of them is an American original. As I said, I've already shared my thoughts about Dale Bumpers. No Senator has ever had more courage than Dale Bumpers. And no Senate Leader has ever had the benefit of a better teacher than Wendell Ford. No Leader has ever enjoyed such a loyal partnership as I have. No Leader has ever had a better friend and counselor. For the past 4 years, Senator Ford has been my right hand and much more. He is as skilled a political mind, and as warm a human being, as this Senate has ever known. Carved inside the drawer of the desk in which Wendell sits is the name of another Kentucky Senator, ``the Great Compromisor,'' Henry Clay. It is a fitting match. Like Henry Clay, Wendell Ford believes that compromise is honorable and necessary in a democracy. But he also understands that compromise is, as Clay said, ``negotiated hurt.'' I suspect that is why he has always preferred to try to work out disagreements behind the scenes. It allows both sides to bend, and still keep their dignity. In 1991, Wendell's quiet, bipartisan style convinced a Senator from across the aisle, Mark Hatfield, to join him in sponsoring the ``Motor Voter'' bill. Working together, they convinced the Senate to pass that legislation. To this day, it remains the most ambitious effort Congress has made since the Voting Rights Act to open up the voting booth to more Americans. Wendell Ford has served the Bluegrass State as a state senator, lieutenant governor, governor and United States Senator. His love for his fellow Kentuckians is obvious, and it is reciprocated. In his 1980 Senate race, Wendell Ford became the first opposed candidate in Kentucky history to carry all 120 counties. In 1992, he received the highest number of votes ever cast for any candidate in his state. Throughout his years in the Senate, Senator Ford has also been a tenacious fighter for the people of Kentucky. He has also been a leader on aviation issues, a determined foe of government waste and duplication, a champion of campaign finance reform, and--something we are especially grateful for on this side of the aisle--a tireless leader for the Democratic Party. He chaired the Democratic Senate Campaign Committee for three Congresses, from 1976 through 1982. And, in 1990, Democratic Senators elected him unanimously to be our party whip, our second-in-command, in the Senate--a position he still holds today. We will miss his raspy and unmistakable voice, his good humor and wise counsel. Finally, there is John Glenn. What can one say about John Glenn that has not already been said? In all these 24 years, as hard as he tried to blend in with the rest of us, as hard as he tried to be just a colleague among colleagues, it never quite worked, did it? I used to think that maybe I was the only one here who still felt awed in his presence. Two years ago, on a flight from China with John and a handful of other Senators and our spouses, I learned that wasn't so. During the flight, we were able to persuade John to recollect that incredible mission aboard Friendship 7, when he became the first American to orbit the Earth. He told us about losing all radio communication during re-entry, about having to guide his spacecraft manually during the most critical point in re-entry, about seeing pieces of his fiberglass heat panel bursting into flames and flying off his space capsule, knowing that at any moment, he could be incinerated. We all huddled around him with our eyes wide open. No one moved. No one said a word. Listening to him, I felt the same awe I had felt when I was 14 years old, sitting in a classroom in Aberdeen, South Dakota, watching TV accounts of that flight. Then I looked around me, and realized everyone else there was feeling the same thing. I saw that same sense of awe in other Senators' faces in June, when we had a dinner for John at the National Air and Space Museum. Before dinner, we were invited to have our photographs taken with John in front of the Friendship 7 capsule. I don't think I've ever seen so many Senators waiting so patiently for anything as we did for that one picture. A lot of people tend to think of two John Glenns: Colonel John Glenn, the astronaut-hero; and Senator John Glenn. The truth is, there is only John Glenn--the patriot. Love for his country is what sent John into space. It's what brought him to Washington, and compelled him to work so diligently all these years in the Senate. People who have been there say you see the world differently from space. You see the ``big picture.'' You see how small and interconnected our planet is. Perhaps it's because he came to the Senate with that perspective that John has fought so hard against nuclear proliferation and other weapons of mass destruction. Maybe because he'd had enough glamour and tickertape parades by the time he came here, John chose to immerse himself in some decidedly unglamorous causes. He immersed himself in the scientific and the technical. He looked at government with the eyes of an engineer, and tried to imagine ways it could work better and more efficiently. As early as 1978, he called for Congress to live by the same workplace rules it sets for everyone else. More recently, he spearheaded the overhaul of the federal government procurement system, enabling the government to buy products faster, and save money at the same time. In 1974, the year he was elected to the Senate, John Glenn carried all 88 counties in Ohio. In 1980, he was re-elected with the largest margin in his state's history. The last time he ran, in 1992, he became the first Ohio Senator ever to win 4 terms. As I said, I'm sure he would have been re-elected had he chosen to run again. But, as we all know, he has other plans. For 36 years, John Glenn has wanted to go back into space. On October 29, he will finally get his chance. At 77 years old, he will become the oldest human being ever to orbit the earth--by 16 years. Many of us will be in Houston to see John and his Discovery crew mates blast off. If history is any indication, I suspect we will be wide-eyed once again. In closing, let me say, Godspeed, John Glenn and Dale Bumpers, Wendell Ford, Dirk Kempthorne and Dan Coats. You have served this Senate well. You are all ``Senators' Senators,'' and we will miss you dearly.

Mr. DASCHLE

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

Mr. DASCHLE

Mr. DASCHLE. Mr. President, as we near the end of the 105th Congress, I would again like to voice my frustration about the fact that the United States Senate failed to consider and pass important legislation this year that could have greatly benefited the American people. Unfortunately, the highway leading to adjournment is littered with legislation that should have been considered, passed and enacted long ago, including efforts to prevent teen smoking, modernize our public schools, and increase the minimum wage. I am particularly disappointed that my colleagues on the other side of the aisle prevented the United States Senate from considering managed care reform legislation. Yesterday, Senate Republicans even prevented us from proceeding to their own HMO reform bill. Time and again, the American people have said they want a comprehensive, enforceable Patients' Bill of Rights. Toward that goal, several of my Democratic colleagues and I introduced the Patients' Bill of Rights Act of 1998. That legislation addressed a growing concern among the American people about the quality of care delivered by health maintenance organizations. Despite enormous public support for HMO reform, Democratic efforts to consider the Patients' Bill of Rights were stymied at every turn. For months, it has been my intention to offer an amendment to the HMO reform legislation regarding a serious deficiency in veterans' access to emergency health care. I was prepared to do so yesterday. Since the Senate was again precluded from debating managed care reform, however, I would like to call attention to this matter before the 105th Congress adjourns by introducing the Veterans' Access to Emergency Health Care Act of 1998 as a separate bill. I hope my colleagues will support this legislation when I introduce it again in the 106th Congress, when I am confident the United States Senate will finally have the opportunity to consider meaningful HMO reform legislation. The problem addressed in this bill stems from the fact that veterans who rely on the Department of Veterans Affairs (VA) for health care often do not receive reimbursement for emergency medical care they receive at non-VA facilities. According to the VA, veterans may only be reimbursed by the VA for emergency care at a non-VA facility that was not pre-authorized if all of the following criteria are met: First, care must have been rendered for a medical emergency of such nature that any delay would have been life-threatening; second, the VA or other federal facilities must not have been feasibly available; and, third, the treatment must have been rendered for a service-connected disability, a condition associated with a service-connected disability, or for any disability of a veteran who has a 100-percent service- connected disability. Many veterans who receive emergency health care at non-VA facilities are able to meet the first two criteria. Unless they are 100-percent disabled, however, they generally fail to meet the third criterion because they have suffered heart attacks or other medical emergencies that were unrelated to their service-connected disabilities. Considering the enormous costs associated with emergency health care, current law has been financially and emotionally devastating to countless veterans with limited income and no other health insurance. The bottom line is that veterans are forced to pay for emergency care out of their own pockets until they can be stabilized and transferred to VA facilities. During medical emergencies, veterans often do not have a say about whether they should be taken to a VA or non-VA medical center. Even when they specifically ask to be taken to a VA facility, emergency medical personnel often transport them to a nearby hospital instead because it is the closest facility. In many emergencies, that is the only sound medical decision to make. It is simply unfair to penalize veterans for receiving emergency medical care at non-VA facilities. Veterans were asked to make enormous sacrifices for this county, and we should not turn our backs on them during their time of need. There should be no misunderstanding. This is a widespread problem that affects countless veterans in South Dakota and throughout the country. I would like to cite just three examples of veterans being denied reimbursement for emergency care at non-VA facilities in western South Dakota. The first involves Edward Sanders, who is a World War II veteran from Custer, South Dakota. On March 6, 1994, Edward was taken to the hospital in Custer because he was suffering chest pains. He was monitored for several hours before a doctor at the hospital called the VA Medical Center in Hot Springs and indicated that Edward was in need of emergency services. Although Edward asked repeatedly to be taken to a VA facility, he was transported by ambulance to Rapid City Regional Hospital, where he underwent a cardiac catheterization and coronary artery bypass grafting. Because the emergency did not meet the criteria I mentioned previously, the VA did not reimburse Edward for the care he received at Rapid City Regional. His medical bills totaled more than $50,000. On May 17, 1997, John Lind suffered a heart attack while he was at work. John is a Vietnam veteran exposed to Agent Orange who served his country for 14 years until he was discharged in 1981. John lives in Rapid City, South Dakota, and he points out that he would have asked to be taken to the VA Medical Center in Fort Meade for care, but he was semi-unconscious, and emergency medical personnel transported him to Rapid City Regional. After 4 days in the non-VA facility, John incurred nearly $20,000 in medical bills. Although he filed a claim with the VA for reimbursement, he was turned down because the emergency was not related to his service-connected disability. Just over one month later, Delmer Paulson, a veteran from Quinn, South Dakota, suffered a heart attack on June 26, 1997. Since he had no other health care insurance, he asked to be taken to the VA Medical Center in Fort Meade. Again, despite his request, the emergency medical personnel transported him to Rapid City Regional. Even though Delmer was there for just over a day before being transferred to Fort Meade, he was charged with almost a $20,000 medical bill. Again, the VA refused to reimburse Delmer for the unauthorized medical care because the emergency did not meet VA criteria. The Veterans' Access to Emergency Health Care Act of 1998, which I am introducing today, would address this serious problem. It would authorize the VA to reimburse veterans enrolled in the VA health care system for the cost of emergency care or services received in non-VA facilities when there is ``a serious threat to the life or health of a veteran.'' Rep. Lane Evans has introduced identical legislation in House of Representatives. Although I am extremely disappointed that the United States Senate did not debate meaningful managed care reform legislation this year, I am hopeful the American people will continue to urge their elected representatives to pass a comprehensive, enforceable Patients' Bill of Rights early next year. I am equally hopeful that any meaningful HMO reform legislation will address this serious deficiency in veterans' access to emergency health care. I look forward to continuing to work with my colleagues on both sides of the aisle to ensure that veterans receive the health care they deserve. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, as we near the end of the 105th Congress, I would again like to voice my frustration about the fact that the United States Senate failed to consider and pass important legislation this year that could have greatly benefited the American people. Unfortunately, the highway leading to adjournment is littered with legislation that should have been considered, passed and enacted long ago, including efforts to prevent teen smoking, modernize our public schools, and increase the minimum wage. I am particularly disappointed that my colleagues on the other side of the aisle prevented the United States Senate from considering managed care reform legislation. Yesterday, Senate Republicans even prevented us from proceeding to their own HMO reform bill. Time and again, the American people have said they want a comprehensive, enforceable Patients' Bill of Rights. Toward that goal, several of my Democratic colleagues and I introduced the Patients' Bill of Rights Act of 1998. That legislation addressed a growing concern among the American people about the quality of care delivered by health maintenance organizations. Despite enormous public support for HMO reform, Democratic efforts to consider the Patients' Bill of Rights were stymied at every turn. For months, it has been my intention to offer an amendment to the HMO reform legislation regarding a serious deficiency in veterans' access to emergency health care. I was prepared to do so yesterday. Since the Senate was again precluded from debating managed care reform, however, I would like to call attention to this matter before the 105th Congress adjourns by introducing the Veterans' Access to Emergency Health Care Act of 1998 as a separate bill. I hope my colleagues will support this legislation when I introduce it again in the 106th Congress, when I am confident the United States Senate will finally have the opportunity to consider meaningful HMO reform legislation. The problem addressed in this bill stems from the fact that veterans who rely on the Department of Veterans Affairs (VA) for health care often do not receive reimbursement for emergency medical care they receive at non-VA facilities. According to the VA, veterans may only be reimbursed by the VA for emergency care at a non-VA facility that was not pre-authorized if all of the following criteria are met: First, care must have been rendered for a medical emergency of such nature that any delay would have been life-threatening; second, the VA or other federal facilities must not have been feasibly available; and, third, the treatment must have been rendered for a service-connected disability, a condition associated with a service-connected disability, or for any disability of a veteran who has a 100-percent service- connected disability. Many veterans who receive emergency health care at non-VA facilities are able to meet the first two criteria. Unless they are 100-percent disabled, however, they generally fail to meet the third criterion because they have suffered heart attacks or other medical emergencies that were unrelated to their service-connected disabilities. Considering the enormous costs associated with emergency health care, current law has been financially and emotionally devastating to countless veterans with limited income and no other health insurance. The bottom line is that veterans are forced to pay for emergency care out of their own pockets until they can be stabilized and transferred to VA facilities. During medical emergencies, veterans often do not have a say about whether they should be taken to a VA or non-VA medical center. Even when they specifically ask to be taken to a VA facility, emergency medical personnel often transport them to a nearby hospital instead because it is the closest facility. In many emergencies, that is the only sound medical decision to make. It is simply unfair to penalize veterans for receiving emergency medical care at non-VA facilities. Veterans were asked to make enormous sacrifices for this county, and we should not turn our backs on them during their time of need. There should be no misunderstanding. This is a widespread problem that affects countless veterans in South Dakota and throughout the country. I would like to cite just three examples of veterans being denied reimbursement for emergency care at non-VA facilities in western South Dakota. The first involves Edward Sanders, who is a World War II veteran from Custer, South Dakota. On March 6, 1994, Edward was taken to the hospital in Custer because he was suffering chest pains. He was monitored for several hours before a doctor at the hospital called the VA Medical Center in Hot Springs and indicated that Edward was in need of emergency services. Although Edward asked repeatedly to be taken to a VA facility, he was transported by ambulance to Rapid City Regional Hospital, where he underwent a cardiac catheterization and coronary artery bypass grafting. Because the emergency did not meet the criteria I mentioned previously, the VA did not reimburse Edward for the care he received at Rapid City Regional. His medical bills totaled more than $50,000. On May 17, 1997, John Lind suffered a heart attack while he was at work. John is a Vietnam veteran exposed to Agent Orange who served his country for 14 years until he was discharged in 1981. John lives in Rapid City, South Dakota, and he points out that he would have asked to be taken to the VA Medical Center in Fort Meade for care, but he was semi-unconscious, and emergency medical personnel transported him to Rapid City Regional. After 4 days in the non-VA facility, John incurred nearly $20,000 in medical bills. Although he filed a claim with the VA for reimbursement, he was turned down because the emergency was not related to his service-connected disability. Just over one month later, Delmer Paulson, a veteran from Quinn, South Dakota, suffered a heart attack on June 26, 1997. Since he had no other health care insurance, he asked to be taken to the VA Medical Center in Fort Meade. Again, despite his request, the emergency medical personnel transported him to Rapid City Regional. Even though Delmer was there for just over a day before being transferred to Fort Meade, he was charged with almost a $20,000 medical bill. Again, the VA refused to reimburse Delmer for the unauthorized medical care because the emergency did not meet VA criteria. The Veterans' Access to Emergency Health Care Act of 1998, which I am introducing today, would address this serious problem. It would authorize the VA to reimburse veterans enrolled in the VA health care system for the cost of emergency care or services received in non-VA facilities when there is ``a serious threat to the life or health of a veteran.'' Rep. Lane Evans has introduced identical legislation in House of Representatives. Although I am extremely disappointed that the United States Senate did not debate meaningful managed care reform legislation this year, I am hopeful the American people will continue to urge their elected representatives to pass a comprehensive, enforceable Patients' Bill of Rights early next year. I am equally hopeful that any meaningful HMO reform legislation will address this serious deficiency in veterans' access to emergency health care. I look forward to continuing to work with my colleagues on both sides of the aisle to ensure that veterans receive the health care they deserve. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I don't think anyone could say it any better than that, and I appreciate the Presiding Officer's comments. They are certainly well spoken and very appropriate. I join my colleague from New Jersey in expressing feelings that are very hard to express in public. Senator Bumpers and I have some things in common. I am not as eloquent as he is, but I feel at times such as this probably as emotional. I love his sense of humor. I have used more Bumpers material in my public career than anybody else in this Chamber. I don't think this is his story, but I might as well start with it. There was a time when Senator Bumpers was at a dinner. We all go to these banquets over and over and over. We all drag our wives along. And they are so good to come with us so often. Betty was at this particular dinner with Senator Bumpers, sitting, as she always does, at his side supportive and smiling. The emcee introduced Senator Bumpers as one who is a model legislator, a model politician, a model spokesperson for Arkansas, just a model person all the way around. On the way home, Dale commented to Betty about what a wonderful introduction that was. They got home; Betty brought the dictionary to Dale, sitting now in his own study, and read to him the word ``model,'' as it is defined in Webster's. There it is defined as ``a small replica of the real thing.'' Senator Bumpers is a model in the truest sense of the word. In many respects I call him my model, for how he speaks, for what he stands for, for how he interacts with his colleagues, for how he represents his State, for all of the courageous positions he has taken. I don't know how you do better than that. I don't know who it was who once said, ``If we are to see farther into the future, we must stand on the shoulders of giants.'' Dale Bumpers is a giant. And it is upon his shoulders that we have stood many, many, many times to see into the future, as I have seen. He persuades us, he cajoles us, he humors us, he always enlightens us. As I heard Senator Domenici, the senior Senator from New Mexico, say earlier: ``He does it in a way that is not in fashion perhaps, not in keeping with what the normal rules of the body are.'' The normal rules are, you are supposed to stay at your desk. Not Senator Bumpers. Senator Bumpers has the longest cord in Senate history. I joked the other night, when we finally see Senator Bumpers depart, we are going to cut up his cord and give 10 feet to every Senator and save 10 more for the next. He goes up and down that aisle. Since, as we are prone to do in this body, we name things after our colleagues--I happen to be fortunate enough to reside in the Byrd suite--I am going to start referring to that as the Bumpers corridor. And I am pointing, for the record, to my left. For anybody who has served with Dale, I don't have to point at all. We all know what the Bumpers corridor is. So it is a bittersweet moment. We recognize the time comes for all of us to depart, to say goodbye. As others have noted, and I am sure more will note before the end of the session, we say goodbye not only to our dear, wonderful friend Dale, but to his wife Betty as well. There is no question, as we all know, he over-married. There is no question who the real force in the family is. There is no question who the visionary and the giant is. As Senator Bumpers so capably noted, there is no question who is beloved in the State of Arkansas. We will miss Betty Bumpers and her vision and her humor and all of her contributions. I asked my staff to put some thoughts together and I really want to share some of them because I think, for the record and for our colleagues and for those who may be watching, it is important to remember who it was we just have heard from. We heard from a Marine. We heard from a man who volunteered to serve during World War II. We heard from a person who grew up in a small town, Charleston, AR--I don't have a clue where it is--where he worked as a smalltown lawyer and taught Sunday school. He may not have been a Methodist preacher, but he was a Sunday school teacher. He told us about his decision, in 1970, to run for Governor. What he did not say is that he was one of eight candidates vying for the Democratic nomination. He did indicate that polls taken at the start of the race gave him a 1-percent approval rating. That is half of what it is right now. He sold a herd of Angus cattle for $95,000 to finance his TV ad campaign. You couldn't get that much for Angus cattle today. He finished the primary in second place, behind someone whose name we all know, Orville Faubus, whose race-baiting brand of politics still dominated much of Arkansas Democratic politics. He beat Orville Faubus in a runoff and went on to beat the incumbent Republican, Governor Winthrop Rockefeller, in a general election by a margin of 2 to 1. After being elected Governor, Dale Bumpers was asked by Tom Wicker, then a reporter for the New York Times, to explain how a man would come from obscurity to beat two living legends. He answered simply, ``I tried to appeal to the best in people in my campaign.'' And that is what he has done his entire public career; he has appealed to the best of people. As Governor, he worked aggressively and successfully to modernize the State government. He put a tremendous emphasis on improving education and expanding health services. Then, in 1973, with 1 year remaining in his term, he made the decision to challenge another living legend, William J. Fulbright, for the Democratic nomination for the U.S. Senate. Senator Fulbright was, at that time, a 30-year incumbent Senator. It probably did not come as any surprise to people in Arkansas, but it must have to the Nation, because when all the votes were counted, Dale won that race too, 2 to 1. In the Senate, there is not a colleague in this Chamber who has not been affected by his eloquence and his reasoning on everything from arms control to the environment. He has been a champion for rural America. He has been a consistent advocate for fiscal discipline. In the 1980s he voted against the tax cuts, arguing that they would explode the Federal deficit. In the 1990s he took the tough votes needed to eliminate those deficits. He has been a tireless defender of the U.S. Constitution and the separation of powers it guarantees. He did not mention this, but he should have. In 1982 he was the only Senator from the Deep South to vote against a proposal stripping the Federal courts of their right to order school busing. He said at the time, while he opposed the use of busing to achieve racial balance, he opposed even more ``this sinister and devious attack on the Constitution . . . [this] erosion of the only document that stands between the people and tyranny.'' This past July, shortly before launching the last of his annual attempts to kill the international space station, Senator Bumpers told a reporter that he expected to lose again but he would try anyway because he thought it was the right thing to do. Then he added, ``I probably lost as many battles as anybody who ever served in the U.S. Senate.'' I want to tell my friend as he prepares to end his Senate career, if you did in fact lose more battles than someone else who may have served here, it is only because you chose tougher and more important battles. Even more than the outcome of your battles, you have earned your place in history for the dignity and the courage and the eloquence with which you have waged those battles. I remember, having just arrived--I was elected in 1986, sworn in in 1987--by the end of the year, in 1987, I had already decided who my man for President was. I remember the conversation as if it took place yesterday. I was reminded again, as our colleague spoke on the Senate floor, about his ambition. That was the ambition for many of us as well. He would have been the same kind of outstanding President that he has been the outstanding Governor and Senator we know today. That was not to be. But in the eyes of all of us, Dale Bumpers will always stand as the giant we knew, as the respected legislator we trust, and as the friend we love. I yield the floor. Mr. NICKLES addressed the Chair.

Mr. DASCHLE

Mr. DASCHLE. I thank the Chair.

Mr. DASCHLE

Mr. DASCHLE. Parliamentary inquiry; could the Chair inform our colleagues as to the order that has been agreed to as a result of the unanimous consent request.

Mr. DASCHLE. I ask unanimous consent I be recognized for the purpose of morning business following the two Senators who have already been identified through the unanimous consent.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, today, with Senator Baucus, I introduce a bill intended to improve health care for Americans living in rural communities. The Promoting Health in Rural Areas Act of 1998 would help rural communities attract and retain health care providers and health plans, improve the viability of sole community hospitals, and make optimal use of the advances in medical technology available today. Delivering health care in rural America presents unique challenges-- issues related to geography, lack of transportation, and reimbursement. With a relatively small population spread over a large area, and health care professionals in short supply, patients often must travel long distances to see a physician or get to a hospital. While these rural communities strive to improve access through telemedicine and recruitment efforts, they must also struggle to maintain what they have, to ensure that providers who leave their area are replaced, and to keep their hospitals' doors open. Rural communities have long had great difficulty recruiting and retaining health care providers to serve their needs. Despite great increases in the number of providers trained in this country over the past 30 years, rural communities have not shared equitably in the benefits of this expansion. Even though 20 percent of Americans live in non-metropolitan counties, only 11 percent of physicians practice in those counties, and that percentage has been falling for the last 25 years. Currently, 30 towns in South Dakota are looking for family physicians. Telemedicine is a promising tool to provide medical expertise to rural communities. Through telemedicine technology, rural patients can have access to specialists they would otherwise never encounter. The benefits of telemedicine extend to rural health professionals as well, providing them with technical expertise and interaction with peers that can make practicing in a rural area more attractive. Yet the potential of telemedicine has been limited by reimbursement issues and a number of other obstacles. In addition to problems with provider recruitment and limitations facing telemedicine, seniors in rural areas do not have the array of health plan options available in more urban areas due in part to a disparity in reimbursement. Although the Balanced Budget Act began to address the issue of low payment levels in rural areas, and has been successful to some degree, budgetary constraints have prevented the expected increase in rural areas. The Promoting Health in Rural Areas Act of 1998 is intended to address some of the basic challenges facing rural health care. It will not address every health problem facing rural America. It is, however, intended to take important steps to improve access, increase choice, and improve the quality of care provided in more isolated parts of the country. The bill addresses obstacles in current law to the recruitment and training of providers in rural areas. One provision in the bill ensures that new rules enacted as part of the Balanced Budget Act, regarding reimbursement for medical residents, do not discriminate against areas that train residents in rural health clinics or other settings outside a hospital. The bill also helps medically underserved communities plan and be ready for the retirement of a physician. Current law effectively requires communities to actually lose a physician before they qualify for recruitment assistance to replace that doctor. Because recruitment is rarely less than a 6-month-long process, current policy places a community at risk of potentially having no physician available to them for long periods of time. This bill would provide communities with 12 months of lead time to secure recruitment assistance when they know a retirement or resignation is pending. The bill would enhance the economic viability of Sole Community Hospitals, often the only source of inpatient services that are reasonably available in a geographic area, by updating the base cost reporting period. The bill would ensure that health plans for Medicare beneficiaries who want to develop in rural counties get the increased reimbursement promised in the Balanced Budget Act, while maintaining budget neutrality. This provision is important to ensure that beneficiaries in rural areas begin to have some of the health plan choices available to urban seniors. The bill also places significant focus on the promise of telemedicine for rural areas and attempts to overcome some of the barriers that have limited its potential. The bill would expand reimbursement for telemedicine to all rural areas, not just those designated as health professional shortage areas. The bill also would allow reimbursement for services currently covered by Medicare in face-to-face interactions with health professionals. It also would make telemedicine more convenient, by allowing any health care practitioner to present a patient to a specialist on the other side of the video connection. Mr. President, providing health care in rural communities raises unique challenges that require targeted responses. Rural America deserves appropriate access to health care--access to providers, access to hospitals, access to quality care, and greater choice. The bill we introduce today takes important steps to achieve these ends.

Mr. DASCHLE

Mr. DASCHLE. I thank the Senator from Vermont. I would clarify my comments by adding that the current Presiding Officer was not in the chair, nor was the current Parliamentarian. So it could have been an accident, and I will accept it as that, but I would hope that the Chair--not this particular Presiding Officer--but the Chair would always recognize the importance of following Senate rules. And Senate rules oblige the Chair to recognize either leader before any other Member. Mr. President, I wanted the opportunity to talk about why we raised HMO reform today and why it was important that we have a vote. We had the vote on almost a partisan basis--there were a couple of our Republican colleagues who joined us, but it was largely on a partisan basis. Once again, our efforts to bring forth a bill and a debate on the Patients' Bill of Rights failed. I am disappointed because this may be the last opportunity we have to consider this issue. We have considered a lot of items over the last couple of weeks. I have reported to the distinguished majority leader that I have heard from many of my Members on a daily basis why it is important to bring up HMO reform if we are going to bring up so many other issues. As the sponsor of the legislation, frankly, I feel much the same with regard to the priority this legislation should have. We have attempted to deal with H.R. 10, and I have supported that effort. We have successfully dealt with Internet tax, and I supported that. We dealt with bankruptcy, and, unfortunately, that bill will be vetoed in large measure because we weren't able to come to some successful conclusion in the negotiations, but I supported that. We had time for all of those measures. That our Senate colleagues do not have the time or are unwilling to provide the priority to this legislation speaks volumes about where their real priorities are. Democrats have said over and over again there is nothing more important than this legislation, that there is nothing more important on our agenda than passing a Patients' Bill of Rights this year. We have held hearings throughout the year. We introduced our bill in March, S. 1890. We attempted over the last 9 months, through myriad parliamentary procedures, to be able to come to some conclusion on this issue. We even proposed working overtime, a second shift, to be able to address a Patients' Bill of Rights in a meaningful way. We even offered the bill as an amendment. We have been thwarted in every single scenario that has presented itself to the Senate to date. Frankly, the priority that this legislation should have is probably as great a dividing line as there is between our Republican colleagues and Democratic Senators. Our Republican colleagues first urged insurers to ``get out their wallets'' and fight protections as though it were a war. In April, they voted against the sense-of-the-Senate resolution regarding patients' rights--a vote against access to specialists, against protection from drive-through mastectomies, against an end to the practice of medicine by insurance company bureaucrats. By July they had read polls and, frankly, I think they were concerned about the political implications of this issue. Then they introduced a bill, strikingly different from ours but using exactly the same title. The fact is there are now two bills entitled a Patients' Bill of Rights--one that is real and one that is not. Their bill is filled with loopholes that benefit the insurance industry. And today, once again, they have refused to debate the real issues and our real differences regarding this legislation. Passage of real patient protections should have been the highest priority of this session of Congress. We should have ended this session celebrating bipartisan cooperation on a bill of this import. Instead, our colleagues have thwarted us at every turn. They have ignored how real people get hurt. Over the past year, we have heard story after story of abuses that should have been addressed. We heard about a 6-month-old by the name of James Adams, who was burning with a 105-degree fever, and his HMO forced his parents to drive to an emergency room over an hour away, even though there was a hospital closer by. Young James suffered cardiac arrest, and lost his hands and feet. We also heard about forty-five-year-old Buddy Kuhl who died after his HMO denied and delayed heart surgery. He left a wife and two young children. We could go on with these tragedies that occur every day outside this chamber. The tragedy within this chamber is, with all of these stories and millions and millions of people abused every year, this Congress has ignored and thwarted every effort to address the problem. There is no explanation, no excuse, no way it can be explained away. One-hundred and eighty different groups, as disparate as they can be--from doctors and nurses organizations, to organizations representing consumers and workers, to the American Cancer Society-- urged the Congress, in as strong terms as they could, to do something, resolve this problem, address it in a comprehensive way. Don't pass a sham bill. Don't say you passed something and falsely raise expectations. Don't talk about how serious the problem is and then not address it. We have lost an opportunity to address this issue. We have lost the opportunity to provide critical protections to those who need emergency care, to those who need access to specialists, and to those who have ongoing illnesses who recognize the abuses by HMOs and are increasingly frustrated with Congress' unwillingness to deal with this issue. These are the people who recognize the importance of access to the prescription drugs a doctor prescribes as necessary. They recognize the importance of access to clinical trials. They recognize that the protection against retaliation for doctors and nurses who advocate for patients is critical. They recognize that protection from insurance companies who interfere with a doctor's best judgment is necessary. With all the recognition of the problems that exist, with all that realization, we had an opportunity to work in a bipartisan way to resolve these matters. To leave the issue on the calendar, to leave that work undone is indeed a tragedy. I acknowledge that our prospects for passing something this year are not good. But I will state as unequivocally as I can that this will continue to be an issue until it is resolved. This will continue to be something we will force on the Senate agenda in whatever way we can--as an amendment, moving to a motion to proceed, finding ways to reach out to the millions of Americans who need our help this year and who will certainly need it next year. We must act responsibly. We must act comprehensively. I hope we do it sooner rather than later. I yield the floor.

Mr. DASCHLE. First, let me say that I would not have required leader time had we been following what I understand is normal procedure on the Senate floor: The majority leader is recognized first, the Democratic leader is recognized second. I was not recognized following the motion that I made, and I am very disappointed--

Mr. DASCHLE

Mr. DASCHLE. Mr. President, as the majority leader noted, this is a bittersweet time for many of us. We bid colleagues farewell and we recall the times we have had together. In some cases, we have worked together and shared friendships for many years. I have been asked to do something somewhat unusual tonight. I have been asked by the staff of our distinguished Senator from Kentucky, my dear friend, Senator Ford, to read a letter they have composed to him for the Congressional Record. I am delighted that Senator Ford is on the floor to hear this personally. So, as requested, I will read the letter, which was written by his staff. I know my own staff shares these feelings for Senator Ford. The letter is dated October 9, 1998. October 9, 1998. Dear Senator Ford: After several weeks of tributes, receptions, dinners and other special events in your honor, we're sure that a man of your humble nature is probably ready to have people quit making a fuss and let you leave town as unnoticed and as low-key as possible. However, these weeks have given us the opportunity to hear others tell you what we've also known all along: your legacy of serving our state, your labor of love on behalf of all Americans, and the unfailing kindness you've shown during your time in the United States Senate will never be forgotten. On top of just being a plain `ole good boss, you've also been a mentor, a teacher, and someone we could always look up to for guidance and support, no matter the situation. But most importantly, you've been a friend to all of us. You've given us the opportunity on a daily basis to personally witness the countless hours of hard work you put in on behalf of Kentuckians. We've seen you stay into the early morning hours here in the Senate during an all-night session, and then rush to catch an early morning plane for a commitment back home. We've seen you toil late into the night working on a conference committee, only to have you beat us into work the next morning with a smile and joke for everyone. These are some of the things your Kentucky constituents may never have known. But at the same time, we know they've benefitted greatly from your accomplishments on their behalf and your never-ending desire to see that all Kentuckians, no matter their station, have the tools and opportunities to lead successful and productive lives. As we've heard you say many times, it's been a good run. And we could not let today pass without letting you know how much it's meant for us to have had the opportunity to work with you, to learn from you, and have you as our favorite Senator. Sincerely, Your Staff. Mr. President, I yield the floor. Mr. FORD addressed the Chair.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, today, with Senator Baucus, I introduce a bill intended to improve health care for Americans living in rural communities. The Promoting Health in Rural Areas Act of 1998 would help rural communities attract and retain health care providers and health plans, improve the viability of sole community hospitals, and make optimal use of the advances in medical technology available today. Delivering health care in rural America presents unique challenges-- issues related to geography, lack of transportation, and reimbursement. With a relatively small population spread over a large area, and health care professionals in short supply, patients often must travel long distances to see a physician or get to a hospital. While these rural communities strive to improve access through telemedicine and recruitment efforts, they must also struggle to maintain what they have, to ensure that providers who leave their area are replaced, and to keep their hospitals' doors open. Rural communities have long had great difficulty recruiting and retaining health care providers to serve their needs. Despite great increases in the number of providers trained in this country over the past 30 years, rural communities have not shared equitably in the benefits of this expansion. Even though 20 percent of Americans live in non-metropolitan counties, only 11 percent of physicians practice in those counties, and that percentage has been falling for the last 25 years. Currently, 30 towns in South Dakota are looking for family physicians. Telemedicine is a promising tool to provide medical expertise to rural communities. Through telemedicine technology, rural patients can have access to specialists they would otherwise never encounter. The benefits of telemedicine extend to rural health professionals as well, providing them with technical expertise and interaction with peers that can make practicing in a rural area more attractive. Yet the potential of telemedicine has been limited by reimbursement issues and a number of other obstacles. In addition to problems with provider recruitment and limitations facing telemedicine, seniors in rural areas do not have the array of health plan options available in more urban areas due in part to a disparity in reimbursement. Although the Balanced Budget Act began to address the issue of low payment levels in rural areas, and has been successful to some degree, budgetary constraints have prevented the expected increase in rural areas. The Promoting Health in Rural Areas Act of 1998 is intended to address some of the basic challenges facing rural health care. It will not address every health problem facing rural America. It is, however, intended to take important steps to improve access, increase choice, and improve the quality of care provided in more isolated parts of the country. The bill addresses obstacles in current law to the recruitment and training of providers in rural areas. One provision in the bill ensures that new rules enacted as part of the Balanced Budget Act, regarding reimbursement for medical residents, do not discriminate against areas that train residents in rural health clinics or other settings outside a hospital. The bill also helps medically underserved communities plan and be ready for the retirement of a physician. Current law effectively requires communities to actually lose a physician before they qualify for recruitment assistance to replace that doctor. Because recruitment is rarely less than a 6-month-long process, current policy places a community at risk of potentially having no physician available to them for long periods of time. This bill would provide communities with 12 months of lead time to secure recruitment assistance when they know a retirement or resignation is pending. The bill would enhance the economic viability of Sole Community Hospitals, often the only source of inpatient services that are reasonably available in a geographic area, by updating the base cost reporting period. The bill would ensure that health plans for Medicare beneficiaries who want to develop in rural counties get the increased reimbursement promised in the Balanced Budget Act, while maintaining budget neutrality. This provision is important to ensure that beneficiaries in rural areas begin to have some of the health plan choices available to urban seniors. The bill also places significant focus on the promise of telemedicine for rural areas and attempts to overcome some of the barriers that have limited its potential. The bill would expand reimbursement for telemedicine to all rural areas, not just those designated as health professional shortage areas. The bill also would allow reimbursement for services currently covered by Medicare in face-to-face interactions with health professionals. It also would make telemedicine more convenient, by allowing any health care practitioner to present a patient to a specialist on the other side of the video connection. Mr. President, providing health care in rural communities raises unique challenges that require targeted responses. Rural America deserves appropriate access to health care--access to providers, access to hospitals, access to quality care, and greater choice. The bill we introduce today takes important steps to achieve these ends.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I have been getting questions about what our intentions are with regard to a new CR. My understanding is that we would be contemplating a CR that would take us at least through Monday.

Mr. DASCHLE. Will the majority leader will yield?

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I move that the Senate proceed to the consideration of Calendar No. 505, H.R. 4250, the House-passed health care reform bill.

Mr. DASCHLE

Mr. DASCHLE. I thank the majority leader.

Mr. DASCHLE

Mr. DASCHLE. I do not know that anything else needs to be said, but I certainly want to join with the majority leader in offering my congratulations and my condolences for all of those hours. As one who has only been presented one Golden Gavel in my time in the Senate, I can appreciate the magnitude of the accomplishment just accomplished by the senior Senator from Washington. On behalf of all of our colleagues, I join in congratulating the Senator. I yield the floor.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I am pleased to introduce, with my friend and colleague from South Dakota, Tim Johnson, legislation to make several common-sense changes to the National Vaccine Injury Compensation Program. This bill removes an unintended and unjustified barrier blocking certain children from qualifying for the compensation program. It also makes the necessary changes to allow new drugs to be incorporated into the program, including the newly-approved rotavirus vaccine. The Vaccine Act dates back to 1986, when Congress determined that a no-fault alternative to the tort system would best accommodate the dual objectives of ensuring proper compensation to victims of vaccine injuries and fostering continued development and broad-scale availability of lifesaving vaccines. Through the Vaccine Act, children seriously injured by a childhood vaccine can receive compensation for medical care, custodial or residential care, lifetime lost earnings, pain and suffering, and emotional distress--benefits comparable to those awarded through the judicial tort system. Tragically, some children have been unfairly denied the right to petition for benefits under the program because they did not incur $1,000 or more in out-of-pocket medical expenses. At first glance, the eligibility requirement of at least $1,000 in out-of-pocket medical expenses may seem like a reasonable way of deterring individuals from petitioning for benefits if they lack a material claim to compensation. In reality, however, the absence of out-of-pocket health care expenses does not mean a child has not been seriously injured, nor does it suggest they have access to other sources for recoupment of the losses their injury has exacted. Many children, including the children of military personnel, Native American children covered by the Indian Health Service, children with Medicaid coverage, and children covered under employer-sponsored health plans with minimal cost-sharing requirements, do not have high out-of- pocket health care costs. While health insurance may remove the burden of high medical bills, it does not replace lost income or cover custodial and residential care. It cannot compensate for the toll these injuries have taken and will take on the lives of these children. Health care costs are just one component of the compensation for which a seriously injured child is eligible. I know of a Native American child in my own state who was profoundly injured after receiving a diptheria-pertussis-tetanus vaccination. Within hours of receiving the shot, this five-month-old child had a seizure and suffered severe brain damage because of the defective pertussis component of the shot. The doctors tell us that his disabilities will, throughout his lifetime, preclude this little boy from having a normal life. He will never live or work independently. But, because he receives health care from the Indian Health Service (IHS), he is not eligible for any benefits under the vaccine compensation program. Not only is this child barred from compensation for lost income and emotional trauma, he is denied financial support for his injury-related assisted living needs. Through legislation intended to foster continued improvements in public health, the federal government has obstructed this child's right to sue vaccine manufacturers. But the program's gate-keeping mechanism is off the mark. What we are saying--however unintentionally--to this particular child and others like him is: ``Fend for yourself.'' To deny this child the benefits available to other injured children is indefensible. The Vaccine Act contains other safeguards to prevent unjustified requests for compensation. For example, no benefits claim is accepted without a thorough review and significant medical proof of severe injury directly related to a childhood vaccination. The $1,000 threshold is unnecessary. Senator Johnson and I certainly are not alone in calling for the repeal of the $1,000 threshold. In fact, we are in very good company. The Advisory Commission on Childhood Vaccines voted unanimously to recommend elimination of the $1,000 threshold. I hope this Congress will seize the opportunity to reconcile the intended and actual standards of fairness by which the National Vaccine Compensation Program fulfills its role in the public health system. In so doing, we will make a tremendous difference in the lives of children in desperate need of our support. There is also a disconnect between the Act's intended consequences and its actual effect in regard to enrollment of new vaccines. Several vaccines that have been approved by the Food and Drug Administration and have met the standards established in the Vaccine Act are still not fully integrated into the program. There are currently several vaccines Congress has approved for taxation and inclusion in the Vaccine Compensation Program that, because of a technical error in the legislation, were not authorized as compensable. This bill will fully integrate those vaccines into the program, and it will ensure that all new vaccines will be automatically compensable once the tax is levied. In addition, it initiates the 75 cents-per-vaccination tax on the rotavirus vaccine, which will ensure compensation for recipients of that vaccine. The rotavirus vaccine was approved by the FDA in August of this year to protect against rotavirus gastroenteritis, which causes about 125 deaths and 50,000 hospitalizations per year among infants in the United States. Initiation of the excise tax will help protect the 4 million children who are expected to receive the vaccine annually. The changes proposed in this bill are not controversial. They are common-sense, and they are overdue. When Congress established the Vaccine Compensation Program, its intent was to protect the rights of victims without jeopardizing an invaluable weapon against childhood illnesses. The underpinning of this program is fairness, a standard that cannot be met until Congress makes these important changes. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.