Christopher Dodd

Mr. DODD

Mr. DODD. Mr. President, I am pleased to join the Chairman of the Labor and Human Resources Committee, Senator Jeffords, in introducing the Health Care Personal Information Nondisclosure (PIN) Act of 1998. This legislation is designed to offer Americans the peace of mind that comes with knowing that their most personal and private medical information is protected from misuse and exploitation. Medicine has changed dramatically since the time Norman Rockwell painted the scene of a doctor examining his young patient's doll. The flow of medical information is no longer confined to doctor-patient conversations and hospital charts. Recent technological advances have introduced more efficient methods of organizing data that allow information to be shared instantaneously--helping to contain costs--and even save lives. The national database of medical information provides a prime example of the benefits of these advances. Through the use of a simple computer, emergency room doctors are now equipped with a quick and inexpensive means of accessing the medical records needed to properly treat unconscious patients. Unfortunately, as we saw all too clearly just a few months ago, our laws have not kept pace with technology. In February the Washington Post exposed the activities of two pharmacies that were sharing personal medical information about prescription drug use with unauthorized third parties. And, most disturbingly, these actions were perfectly legal. Clearly, the existing patchwork of state laws protecting medical records are proving to be inadequate to address the public's concerns. These concerns are so strong that in some cases they threaten to actually negate the benefits of advances in medicine and technology. The fear of discrimination and exploitation has led some ethnic communities with susceptibility to certain conditions to urge their members to avoid genetic testing. The fear that sensitive medical information might be released without authorization has led patients to avoid full disclosure of mental health concerns to their physicians and to unnecessarily forego opportunities for treatment. I believe that the Health Care PIN Act offers the privacy protections that the public demands. This legislation sets clear guidelines for the use and disclosure of medical information by health care providers, researchers, insurers, employers and others. The Health Care PIN Act provides individuals with control over their most personal information, yet promotes the efficient exchange of health data for the purposes of treatment, payment, research and oversight. To ensure the accountability of entities and individuals with access to personal medical information, the legislation imposes stiff penalties for unauthorized disclosures. The Health Care PIN Act provides consumers with a strong, nationally uniform set of privacy protections. However, in areas of privacy law in which states have been the most active--namely in the confidentiality of sensitive mental health and public health records--states could continue to establish additional protections. I would also like to indicate my intent to work with Senator Jeffords to incorporate into this legislation protections against genetic discrimination in both employment and health insurance. Although we were unable to resolve this issue before introduction of this legislation, I am confident that we can reach consensus on this critical and timely issue. This legislation represents common-sense middle ground in the range of proposals that have been offered both this and the previous Congress. I look forward to working with Senator Jeffords, as well as with Senators Bennett, Leahy, and Kennedy, who have contributed so much to this debate, to move forward quickly to enact comprehensive, bipartisan legislation.

Mr. DODD

Mr. DODD. Mr. President, today I rise to express my opposition to Senator Kyl's sense of the Senate Amendment to the Budget Resolution. While this amendment raises important concerns about the scope of seniors' choices in determining their personal health care needs, this proposal may actually restrict the health care options available to our nation's senior citizens and undermine the quality of care afforded all Medicare beneficiaries. Initially, Senator Kyl's amendment simply seems to endorse the important role of choice for seniors when making critical decisions about their personal health. I strongly support efforts to increase the health care options available to Medicare beneficiaries and improve the quality of health care that seniors receive. However, this amendment would move us in the wrong direction. With approximately 96 percent of physicians treating Medicare patients presently, choice of physicians does not appear to be a problem for Medicare beneficiaries. In reality, Medicare allows seniors to choose the doctor of their choice along with providing protections that shield Medicare beneficiaries from unnecessarily high out-of-pocket costs. Ironically, in many ways, Senator Kyl's amendment is a problem in search of a solution. Senator Kyl's legislation specifically supports private contracting between physicians and patients for services traditionally covered by Medicare. By allowing doctor's to privately contract for these services, this amendment could effectively remove consumer protections designed to protect seniors' from excessive out-of-pocket costs. These protections are critically important to the elderly who rely on the affordable and high-quality care that Medicare provides. Private- contracting for Medicare-covered services would cause seniors to pay 100 percent of any given health care service or benefit. Few seniors can afford or have any desire to pay, such exorbitantly high-rates. It is also important to note that seniors' are perfectly free to contract privately with their doctor on health care benefits not covered by Medicare such as routine physical exams, eye care, and prescription drugs. However, by permitting doctors to charge their Medicare patients whatever they wish for Medicare-covered health care services, we would be subjecting seniors' to unnecessarily high-out of pocket costs and would compromise the quality of care afforded to all Medicare beneficiaries. I am also deeply concerned that this initiative would create a two- tiered health care system for the elderly, threatening the quality of care afforded all Medicare beneficiaries. Private contracting could create an incentive for wealthier and healthier beneficiaries to opt out of the Medicare program. This could lead to a health care system that provides high-quality coverage to those seniors' who could afford the high out-of-pocket costs associated with private-contracting, while leaving the majority of Medicare beneficiaries with substandard care. Almost 70 percent of Medicare beneficiaries have an annual income under $25,000. It is simply unconscionable for these seniors of modest means to be subject to paying 100 percent of their health care bill to services that are normally covered under the Medicare program. Additionally, the implementation of a private-contracting system would provide an incentive for doctor's to give priority to those Medicare beneficiaries who can afford to pay for it at the expense of providing quality and affordable care to the majority of Medicare beneficiaries. Additionally, the Kyl amendment would offer the potential for increased fraud and abuse within the Medicare program. The Medicare system is already fraught with staggering levels of fraud and abuse. According to the Inspector General of the U.S. Department of Health and Human Services, $23.2 billion annually is wasted on fraud and abuse in the Medicare program. Given the financial challenges that face the Medicare program in the near future, this level of abuse in unacceptable. Allowing physicians to set their own payment rates for certain patients, while simultaneously permitting them to submit claims to Medicare for the treatment of traditional Medicare beneficiaries for the very same procedures, would create the opportunity for double billing, a serious form of fraud and abuse. While we should be moving to prevent fraud and abuse in the Medicare system, private contracting would offer the potential for increased fraud in the Medicare system. Mr. LAUTENBERG addressed the Chair.

Mr. DODD

Mr. DODD. If I could. I appreciate, Mr. President, the chance to, if I could, take just a couple minutes to rebut.

Mr. DODD. We anticipated that this might be one of the arguments that would be raised, and asked the Department of Health and Human Services to tell us exactly what the status of child care spending by the States is. I think this graph here states it well. My colleague from New Mexico just pointed out that 98.8 percent of child care funds have been obligated, but in addition, by January of this year 90.6 percent of funds had actually been spent. So the notion somehow that states are not spending the available child care money is not valid. I appreciate the Senator raising this point, but according to our latest data, the States have already spent pretty much 90 percent of available child care dollars. And they have obligated, of course, virtually 100 percent of it, which demonstrates, I think, a clear need out there.

Mr. DODD. I appreciated that.

Mr. DODD. The Senator from New Hampshire, Senator Gregg, had an amendment. I see the manager is here.

Mr. DODD. The debate on that is over?

Mr. DODD. Parliamentary inquiry. Will the Senator allow me to make that amendment?

Mr. DODD. I call up my amendment for immediate consideration.

Mr. DODD. I ask unanimous consent reading of the amendment be dispensed with.

Mr. DODD. Mr. President, I ask unanimous consent a member of my staff, Dr. Caryn Blitz, be given floor privileges during consideration of the budget resolution.

Mr. DODD. I have some comments to make on my own amendment, but several of my colleagues have other matters to attend to, and I will yield, if I may, whatever time she may consume to the distinguished colleague from California and then to my colleague from Minnesota. I yield first to my colleague from California.

Mr. DODD. I would say to our colleague from California I am aware of this figure. It is 200,000. The reason I know that number is because in 1996 I asked the General Accounting Office to do an assessment to determine the extent to which the child care needs of working families were being met, including whether there were waiting lists for child care. California was one of the States that was surveyed. The report found that California presently has some 200,000 families who are waiting for a quality, affordable, accessible child care slot to open up so they may leave their child in a safe place.

Mr. DODD. I thank both of our colleagues from California, Senator Feinstein and Senator Boxer. To our colleague from Minnesota, I yield such time as he may desire. Privilege of the Floor

Mr. DODD. I thank my colleague from Minnesota for his eloquent remarks. Let me turn to my colleague from the State of Washington who has been a leader long before she arrived in the Senate on the child care issue as a member of the legislature in Washington.

Mr. DODD. I thank our colleague from Washington as well. As I mentioned, her experience goes back to her years of public service and her years as a parent. I was looking at the clock as she spoke. It is almost 3 o'clock. This would not apply to all parts of the country, but certainly on the east coast right now there are as many as 5 million children who have no safe place to go after leaving school. We know that for parents who have no choice but to be in the workplace, when school lets out, and before they get home from work at 5 o'clock or 6 o'clock, there is a great sense of anxiety about where their child is? They worry: Who is watching my child? What is my child doing? We know from police chiefs all over the country, that juvenile delinquency rises, not after 11 p.m. at night, but between 3 o'clock and 8 o'clock in the evening. My hope is to raise some legislative ideas which would allow us to at least deal with after-school care, with infant care, with the quality of child care. But, I am being told by the budget resolution I cannot do that; I cannot bring up my idea on after-school care on child care in this Congress because it is subject to a point of order. I don't think it is fair. I don't think it is right. I think it is harmful to children and working families. My colleague from Massachusetts cares about this issue very, very much. I know he has some comments he would like to share as well.

Mr. DODD. Mr. President, I thank my colleague from Massachusetts. And I'd like to recognize him for his significant contribution to the issue of child care, particularly to early child development. We've all learned a great deal over the past year about brain development and the critical period in children's growth from the ages of zero to 3. My colleague from Massachusetts has been instrumental in focusing attention on the needs of children during the earliest years. I am particularly grateful that he is here today to comment on this amendment. I ask unanimous consent that Senators Murray, Kerry of Massachusetts, Daschle, Kennedy, Lautenberg, Landrieu, Durbin, Wellstone, Kohl and Harkin be listed as cosponsors of this amendment.

Mr. DODD. Mr. President, let me take a few minutes and describe what we are trying to do. This amendment is a procedural one. I am not really debating the issue of how we should resolve the child care crisis--although there are certainly no shortage of opinions on how we ought to do that. All I am trying to do here with this amendment is to say, at some point later this year, if the funds are available, can I bring up a child care amendment without being subjected to a point of order? That is all I want to do. We can get to the merits of various child care proposals at some point later. But under this budget resolution, I am precluded from bringing up such proposals, unless I can override a point of order that requires a supermajority. I don't think that is right or fair. I don't disagree with those who might say we want to provide a tax cut as a result of having additional revenues, either because the economy is doing tremendously well or if we are able to come up with a tobacco settlement. But what I don't understand is, if it's OK to bring up those issues, why can't I bring up child care, which is a staggering problem? Five million children at this hour, as they finish school for the day, are home alone, unattended. Thirteen million children, every day need some kind of child care setting. And their parents need the ability to pay for that care. But, as you can see from this graph, due to inadequate funding, only 1 in 10 eligible children are receiving assistance from the Child Care and Development Block Grant. Many other families are left to cope with skyrocketing costs. As you can see from this second chart the cost of child care in various cities across America is truly astonishing. In Boston, child care for an infant is $11,860 a year. For a 3-year-old, it's $8,840. For 6-year-olds, it's $6,600. Costs of child care in other states--Florida, Minnesota, Texas, Colorado--range from $4,000 to $9,000. These figures are all the more astonishing when you realize that half of all the parents with young children earn less than $35,000. Can you imagine how difficult it must be for a family in the city of Boston that earns $35,000 a year to afford $11,000 in child care for an infant? Your family is making $35,000 a year and you may have to spend a third of your budget on child care. How do you make ends meet? I am not suggesting that the federal government should pick up the whole tab here. But I have some ideas about how we can leverage funds from states, from communities, and from businesses. But I can't even offer these ideas without overcoming a point of order. Whatever else you may agree or disagree with when it comes to child care, isn't it at least fundamentally fair on an issue this important that we be allowed in this body to debate our options? The budget resolution is about making decisions on how to spend the money of the American people. Now not all of my constituents may agree that child care is important, but a lot of people do. I am going to have to say to them: I am sorry, I can't even bring up your ideas about what we should do to make sure that your child has a safe place to be when you can't be with them. I am not allowed to raise your concerns under this budget resolution. We are allowed to have, on page 27 of this bill, title II, budgetary restraints and rulemaking, line 3, a tax cut reserve fund. That is allowed. So we are allowed to have a reserve fund for tax cuts, but we're not allowed to have a reserve fund for child care. All I want to do is to create a reserve fund to leave open the possibility of dealing with the issue of child care. Vote against me later if you want. Stand up and say you're sorry, but you don't like my ideas. I will accept it if you disagree with me. But, I can't imagine anybody here, regardless of ideology or party, would say I should not be allowed, in a budget resolution --to address a priority we all agree is pretty high on the list. I ask my colleagues here, 50 plus 1, to say we agree with you, we think that ought to be a priority and we are going to support you. As it stands right now, if it tries to raise concerns or offer solutions to this problem then I have to produce a supermajority to overcome a point of order--which everybody around here knows is virtually impossible to do. Mr. President, this is a very real issue, one that I think is important. I only have half an hour and to even debate this issue and to tell people why I feel so strongly about it. We have to move along. I will say from the outset that I have great respect for the chairman of the Budget committee. He has a thankless job, as does my colleague from New Jersey. It is difficult work. I sat on his committee for a number of years. I realize it is not easy to put a budget resolution together. But I believe I ought to have a chance--I believe I deserve a chance--to speak to the needs of children in this nation. There are millions of children, Mr. President--who don't have access to high quality care. Only 17 States have child care standards that meet even minimal standards of quality. In most States, if give manicures, if you work on someone's nails, you have to meet tough standards. But only 17 States require any training at all for somebody who is going to hold a child's life in their hands. Where is the logic in that? What I would like to see is debate on how we can improve the quality of child care, through training, and by improving provider-child ratios. I want to debate tax cuts to assist businesses that want to provide child care to their employees. I know my colleague from Wisconsin, Senator Kohl, would like the chance to present this very good idea. There is something fundamentally wrong with a process that would preclude debate on those ideas. I see my colleague from Louisiana, Senator Landrieu, is here. Let me, if I can, yield a few minutes to her. I turn to my colleague from Louisiana, who has worked for many years on children's issues in her state and has brought great energy to these matters since her arrival in the U.S. Senate.

Mr. DODD. I thank my colleague. Let me reiterate the point of this amendment. What this amendment would do is establish a deficit-neutral reserve fund, similar to the tax reserve fund created by the Chairman on page 27 of the resolution, to improve the availability, affordability, and quality of child care. A reserve fund--for those who may not be aware--is simply a mechanism that allows legislation, in this case child care legislation, to be offered later in the year without the threat of a budget point of order being brought against it. Why is that necessary? The budget resolution before us today forecloses the possibility of other meaningful and comprehensive solutions to child care. It does contain some proposals for child care, but it doesn't allow us to offer our alternatives for meeting the concerns of families in this country. Senator Murray, our colleague from Washington, offered an amendment as a member of the Budget Committee in the markup which would have kept our options open. That amendment and this one would allow the Senate to consider mandatory funding--just consider it, not require it--for child care. This amendment was rejected by the committee along party lines. So, as the budget resolution now stands, future legislative attempts to improve the quality of child care, or to help families afford the skyrocketing costs of care, or to create after- school programs for the 5 million children home alone each day after school, to provide for care for children with special health needs, are all shut out. I would like the opportunity to offer those ideas. To do so, this amendment must be adopted. If not, then I am foreclosed from doing so, and that is the reason I am asking for support.

Mr. DODD. I am happy to yield to my colleague.

Mr. DODD. Certainly.

Mr. DODD. To my good friend and colleague, who is so knowledgeable on these issues, let me state this as I understand it, and you respond, if you will. In order to do what you have suggested, of course, I would have to operate within the existing budget structure--which means I would have to take from one critical program--perhaps Head Start or education, to fund child care. I would have to make families compete against themselves. But if I want to take anticipated tobacco revenues or draw from the additional resources of a growing economy, as I understand it, I am precluded under this budget resolution from doing so. Out of that $300 billion or $500 billion in tobacco funds--whatever amount we ultimately decide here--I believe that $15 billion or $20 over 5 years can be found to commit to child care. But under this budget resolution, I would be subject to a point of order; is that not correct?

Mr. DODD. I thank my colleague. I agree that we should not be creating programs that we can't pay for. That is the purpose of creating a deficit neutral reserve account. Like all reserve funds, including that of my friend and colleague from New Mexico, this reserve fund makes the hypothetical statement that if we somehow find additional revenues we should use them for the purpose stated in the fund. Being deficit neutral means that we would be required to find an offset. We don't know where the funds might come from, obviously. Around here, anything can happen between cup and lip. But we are working on an assumption that there will be some revenues available this year, and we want the opportunity to debate whether those funds can be used for child care. With regard to potential tobacco funds, the majority has made the decision that they must exclusively be used for Medicare. What some of us are saying here is that we don't disagree that certainly part of it ought to be for that purpose. But we think in addition to Medicare there are some other legitimate purposes, and one of them is child care. The fact is that the tobacco industry has, for generations, targeted children--and we all know that to be the case. Certainly their advertising, Joe Camel for example, has been designed to appeal to kids. Why? Because the industry knows that 90 percent of the adults who smoke began as teenagers. We are suggesting if you have some additional resources generated by tobacco company payments, shouldn't some of those funds be targeted to children and families? That is all we are suggesting. I am certainly not asking for the money to go exclusively to child care. I am not asking for a provision which says that money from tobacco can only be used for children. I wouldn't say that, because I respect the fact that there are other activities that need and deserve these dollars--public health programs, smoking cessation and biomedical research, and certainly Medicare. But I think that child care also has merit and that I ought to be allowed to make a case on why it deserves some of these tobacco dollars. Again, we may differ, as we certainly do, about how a child care bill ought to be framed. My colleague, for instance, from Vermont and my colleagues from Kansas, Pat Roberts, Senator Snowe from Maine, Senator Collins from Maine, Senator Specter of Pennsylvania and others--all have had ideas on child care which are ones they would like to have considered. So when I stand here to try to set up a reserve account, it isn't just to protect my proposals, it is to protect ideas they may have as well. But in the absence of the adoption of this amendment, whether it is my colleagues from the Republican side who care about child care, or colleagues from this side, unless we have the reserve account, we are precluded from doing anything meaningful in this area. I see my time has expired, the time of those who are the proponents of this amendment. I will yield the floor.

Mr. DODD. If my colleague will yield on that last point.

Mr. DODD. Mr. President, I move to waive the point of order and I ask for the yeas and nays on my motion.