John Ensign

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I ask unanimous consent that the substitute amendment at the desk be agreed to, the committee amendment, as amended, be agreed to, the bill, as amended, be read the third time and passed, the motion to reconsider be laid upon the table, and that any statements relating to the bill be printed in the Record.

Mr. ENSIGN. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar item No. 236, S. 610.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I ask unanimous consent that the bill be read three times and passed; that the motion to reconsider be laid upon the table, with no intervening action or debate; and that any statements relating to this measure be printed in the Record.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I ask unanimous consent that it be in order for the Senate to proceed en bloc to the consideration of the following calendar items: Calendar No. 41, S. 425; Calendar No. 255, S. 391; Calendar No. 256, S. 434; Calendar No. 257, S. 435; Calendar No. 258, S. 452; Calendar No. 259, S. 714; Calendar No. 260, S. 1003; Calendar No. 261, H.R. 622; and Calendar No. 262, H.R. 1012.

Mr. ENSIGN. I ask unanimous consent that any amendments, where applicable, be agreed to, the bills, as amended, if amended, be read three times, passed, and the motions to reconsider be laid upon the table en bloc; the consideration of these items appear separately in the Record and that any statements related thereto be printed in the Record, without intervening action or debate.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, reserving the right to object, I want to make a couple of points. Point one is that we have seen that the economy is recovering. We are at about a 6 percent unemployment rate nationwide. Back in 1993, the Democrats controlled the House of Representatives, they controlled the Senate and they controlled the White House. Extensions of unemployment benefits had been going on for a period of time because of the recession. And with the Democrats in control of both Houses and the Presidency, they terminated the program when the national unemployment rate was at 6.4 percent. The national unemployment rate was .4 of a percent higher than it is today. The current extension of unemployment benefits does not end until the end of December. In December, individuals currently receiving extended benefits will still maintain those benefits. And based on all the projections, the national unemployment rate should be lower at the end of December than it is today. There are a couple other points that need to be made in this debate. First, when the unemployed are about to exhaust their unemployment benefits, over half of those unemployed individuals get a job in those last 2 weeks. And we have seen that a lot of people lately have been exhausting the full time on their unemployment. Why is that? Well, for one reason: The States have been reducing the amount of job searching required by each individual. Basically, they are making it easier to stay on unemployment insurance and taking away the incentives to go out there and get a job. The welfare reform bill, signed into law by President Clinton, characterized Republicans as throwing women and children out into the streets, that we were cruel, heartless, hard-hearted people. But we knew something about human behavior. We knew that if we gave some assistance, some temporary assistance, and gave individuals an incentive to be employed, in other words that it was better to get a job than it was to be on welfare--we knew that a lot of people would go out and get jobs. What we didn't know was the staggering number of them who did. Unemployment insurance is the same way. The more generous the benefit, the easier you make it to stay on unemployment insurance, and the less incentive there is for people to actually go out and do what it takes to get a job. So this is not about being cruel and heartless. It is recognizing the fact that our unemployment rate is less today than it was in 1993, when the Democrats were in control and every single Democratic Senator and House Member voted to end the program when the unemployment rate was higher than it is today. Every single Democrat voted to end the program. With that, I appreciate the work they are trying to do. I know their hearts are in the right place. But on policy grounds, I object.

Mr. ENSIGN. Mr. President, I now want to take my time and talk about the Medicare reform and prescription drug bill that we have before us today. I rise to explain how and why I am going to vote on this bill. From the day I was sworn into office in 1995 as a Congressman, I have spent as much time on strengthening the Medicare program as I have any other single issue considered by Congress. On the Health subcommittee of the House Ways and Means Committee, I learned the details of how this comprehensive healthcare system works for our seniors and the disabled. I have tried to keep true to the principle of making Medicare more oriented to keeping seniors healthy, not just waiting until they become ill to treat them. With the growth of Medicare costs and the baby boom population, I also believe just as strongly that the structural security of Medicare must be kept healthy and reforms must not wait until the program is ill. As a Senator, I have continued to pursue my passion for healthcare policy. I campaigned on and introduced my own Medicare prescription drug bill, along with Senator Chuck Hagel. I was proud that our bill received the votes of a majority of the Senate when it was considered last year, although not adopted as the final bill. Aside from the prescription drug benefit in the bill, I strongly believe that for Medicare to remain healthy, structural reforms must take place that control unnecessary costs through market forces and allow the program to operate more efficiently and more preventatively. This bill contains a number of provisions that I hope will help drive down the increasing costs of health care, not just for our seniors, but throughout the entire healthcare market place. Health Savings Accounts will give patients control over their care, to include who patients go to for care, as well as control over their individual expenditures. If shown to be successful, this would be the most sweeping healthcare reform since the managed care model over a decade ago. Likewise, income-relating of the Medicare Part B premium, the disease management demonstration project, and the prescription drug card with a private account--by the way, that was a component of the bill Senator Hagel and I introduced--are all positive aspects of this legislation. I am pleased that in the bill are two other critical reforms that I spearheaded in the House and now in the Senate. Placing a 2-year moratorium on the outpatient therapy cap is a win for our oldest and sickest Medicare seniors. Those who suffer from life-threatening ailments such as Parkinson's disease and stroke should not have to pay every dollar out of pocket just because they require additional care. The bill also includes a provision that eliminates the late penalty military retirees pay for joining Medicare. Our military retirees, who gave so much of their lives to our country, deserve access to the best healthcare benefits available without being penalized for changes in the system. They thought they were going to get lifetime Health Care. Then, when they were put into the Medicare system they were not informed, or at least many of them were not aware that if they did not sign up right away, later they would have to pay extra penalty costs. Joining me in helping to get these passed was Senator Lincoln, and I would like to thank her for all of her efforts. The reason I have struggled so fervently over the merits of this legislation is the substantial financial burden this bill places, not only on the Medicare program, but on the country. The benefits in this bill will assist seniors and disabled Americans only to the degree that our Nation is fiscally able to sustain paying for it. That is why I drafted a bill that was responsible to the next generation of workers who will bear the burden of paying the price tag on Medicare prescription drugs. I want to put up a couple of charts that help us understand what we are dealing with for the next generation. Until 1970, we had about 20 million seniors in our Medicare Program. Today we have a little over 40 million seniors, 30 years later. Thirty years from now we will have close to 80 million seniors, equaling another doubling of the number of seniors. This chart shows the problem. These are the number of workers per senior, per retiree, per person over 65 who we have in this country. In 1970, for every one retiree we had a little over seven people, on average. In 2000, that had slipped to 3.9. When that huge expanse of the baby boomers is in full bloom in 2030, we will have 2.4 workers for every one retiree. I remember Senator Phil Gramm telling us that means there are a lot more people riding in the cart and a lot fewer people pulling the cart. I believe this bill threatens the fiscal security of the Medicare Program and compromises the continued growth of our economy by lacking the necessary cost controls to keep it from consuming our domestic budget. I personally believe the cost of this bill is grossly underestimated. By the time the drug benefit goes into effect in 2006, we will have a better understanding of the enormous cost of this bill but at that time it will be too late to do anything about it. Without measures to contain overutilization, the Government or the private sector plans will be forced to ration prescription drugs for our seniors, similar to the way care is rationed in Canada. While all major legislation requires legislative corrections after becoming law, I believe that before the ink is dry on this new benefit, a campaign will be underway to expand this program by closing the coverage gap that exists in the bill. I believe there will also be efforts also to reduce deductibles and reduce premiums as well, further transferring costs onto the next generation. While providing seniors with a prescription drug benefit is so very important to all of us, it must be done in a way that does not bankrupt Medicare and threaten future access to care in our country for our seniors. It also needs to be fiscally responsible to the next generation. I believe the Congressmen and Senators who put this bill together labored so intensively, and they did it for the right reasons. They had pure motives. I also appreciate the leadership the President has shown on this issue. In fact, if we would have adhered more to the principles that he laid out at the beginning of the year, I believe we would have a much better bill before us today--perhaps a bill I could support. I am very disappointed in the debate these last few days in how people have politicized this bill. Unfortunately, I believe many have done so for their own political benefit. There have been many things said about this bill. You could say many negative things about this bill, and you could say many positive things as well. However, what we ought to do in this Chamber is at least talk about what is in the bill and what is not in the bill. To mischaracterize the bill, I believe, is patently unfair, and it is just wrong to scare senior citizens into thinking that Medicare is somehow going to go away. We must remember that most of the private sector reforms in this legislation do not even kick in for several years. So to scare seniors I just, frankly, believe is wrong. I have anguished deeply over this bill. There really are some positive things in it, things that I like. But, overall, I just believe the negative things in it outweigh the positive. That is why I, unfortunately, am going to have to vote against this conference report. I look at the chairman of the Finance Committee who is on the floor right now, and there is just no finer person in the Senate than Senator Grassley. So it is with a heavy heart that I announce that I am going to vote against final passage of this bill because I know that he did his best to put together a bill with all the different people he had to work with in the House and the Senate, the various interest groups and the like. But I believe this bill does not rise up to the level where I think the positives will outweigh the negatives in the future. I think the costs are going to be too great. Looking at the first 10 years, it is estimated to be around $400 billion. For the second 10 years, I know of estimates as high as $1.7 trillion. Do we really want to shoulder our children and our grandchildren with this burden? That is a question each of us has to least ask ourselves, and go into this with our eyes wide open. Twenty years from now when we look back on this debate and on our entire careers, will we be able to say we really did what was right for the future of our country? I hope that in fact we can. I yield the floor.

Mr. ENSIGN. Will the Senator yield for a unanimous consent request? I ask unanimous consent that I be recognized following the Senator from Iowa.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of S. 1947, which was introduced earlier today.

Mr. ENSIGN

Mr. ENSIGN. I ask unanimous consent that the Inhofe amendment at the desk be adopted, the bill, as amended, be read the third time and passed, the motions to reconsider be laid upon the table en bloc, and that nay statements relating to the bill be printed in the Record.

Mr. ENSIGN. Mr. President, I ask unanimous consent that the Senate now proceed to the immediate consideration of H.R. 1006, which is at the desk.

Mr. ENSIGN

Mr. ENSIGN. I ask that the Chair now lay before the Senate the House message to accompany S. 1768. The Presiding Officer laid before the Senate the following message: Resolved, That the bill from the Senate (S. 1768) entitled ``An Act to extend the national flood insurance program'', do pass with the following amendment: Strike out all after the enacting clause and insert:

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I ask unanimous consent that the bill be read three times and passed, the motion to reconsider be laid upon the table, and that any statements relating to the bill be printed in the Record.

Mr. ENSIGN. Mr. President, this is legislation that I authored and was very proud to have authored. This is the bill that is going to help protect large cats from being owned in a place such as New York and kept in apartments.

Mr. ENSIGN. Mr. President, I ask unanimous consent that the Agriculture Committee be discharged from further consideration of H.R. 1367 and that the Senate proceed to its immediate consideration.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I ask unanimous consent that the bill be read three times and passed; that the motion to reconsider be laid upon the table, with no intervening action or debate; and that any statements relating to this measure be printed in the Record.

Mr. ENSIGN. Mr. President, I ask unanimous consent that the Committee on Agriculture be discharged from further consideration of S. 33 and that the Senate proceed to its immediate consideration.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I ask unanimous consent that the bill be read three times and passed; that the motion to reconsider be laid upon the table; and that any statements relating to the bill be printed in the Record.

Mr. ENSIGN. Mr. President, I ask unanimous consent that the Agriculture Committee be discharged from further consideration of S. 1499 and that the Senate proceed to its immediate consideration.

Mr. ENSIGN

Mr. ENSIGN. Second is the means testing idea of Part B, the affluence testing, as it is being called. I think it is wrong. This is not a part of Medicare where people are paid in their taxes over the year. Part B is something that younger generations--such as the pages we have here-- people paying taxes out there are paying for seniors, and we should, at least for those wealthy seniors, have them pay for that benefit they are getting, instead of shifting the benefit on to middle-class taxpayers. That is also very good. Another part that is good in the bill is this idea of a disease management pilot project. Right now in Medicare, you go to one doctor and Medicare pays, and maybe you have diabetes and you have to go to several specialists, internists, or whatever; there is nothing really coordinating care. So you get different prescriptions and different doctors. There is no real coordination of care and also not a lot is being done preventively. So we end up with poor-quality care, poor outcomes, and we spend more money. We have a great demonstration project, a pilot project that Republicans and Democrats actually should like in this bill on the disease management part of it. In the future, I believe it will improve outcomes for seniors healthwise, and it will also save costs. As to some of the negative parts of the bill, first of all, it does not kick in right away. A bill that I introduced would have kicked in as soon as the drug discount card kicks in. That is the only thing that really kicks in, in the next 5 or 6 months--the drug discount card. The legislation I had introduced actually would have fully kicked in. The Democrat bill and Republican bill we had debated, none of those kicked in right away, and neither does this bill. The other problem with this bill is there is a cliff at 150 percent of poverty. After that, you kind of drop right off the cliff. So for those below 150 percent of poverty, this is too generous. With a $1 and $3 copay, we are going to incentivize people to overutilize drugs, pure and simple. You are going to see overutilization of drugs. We see it in Medicaid today because of the low copays and we are going to see it here. That was a huge mistake that we didn't once again have people receiving the drugs having anything financial at stake. And $1 and $3 copays will not change behavior in any way whatsoever. The other thing that actually we have to consider--and we should at least go into this with open eyes--this is the largest wealth transfer since Medicare was first put into effect. We just have to know that. The $400 billion is being taken from younger people and given to older people. The older people didn't pay for it. We are giving that. So we have to go into this with open eyes. The other thing I believe is a problem with the drug benefit we have in Medicare is that it is giving it to the wealthy. I don't believe we should be. We should be helping and putting almost all the benefit into the people who are literally having to choose between prescription drugs and rent and maybe whether they are going to eat that month or what kind of food they are going to eat that month. Instead, this bill gives coverage for everybody on Medicare. I don't believe that is right. When Bill Gates turns 65, I don't believe he should be getting a prescription drug benefit that is paid for by some union worker who worked hard all of their life and paid taxes. I don't believe that is right. So I believe the prescription drug benefit should be means tested. That is another negative in this particular piece of legislation. Just mentioning a couple of the things, there are some really good pieces of this bill, but there are some major negatives in this bill. When we are going through all of the rhetoric, I think all of us have to be honest. The supporters of the bill should be honest that there are some problems with it, but the people who are against the bill should also be honest. This does not end Medicare as we know it. This is a bill incredibly generous to low-income seniors. Even if I vote against this bill, I have to say this is incredibly generous to low- income seniors. That is just being honest. All seniors pay out of pocket is a $1 copay for generics and a $3 copay for brand name prescription drugs. That is an incredibly generous benefit. In conclusion, as I go through this next 24 to 48 hours--whenever we are going to vote on final passage of the bill--it is a 700-page document we got a couple of days ago. I think we have to take our time to go through the bill.

Mr. ENSIGN. Mr. President, I want to talk about one Senator's journey through this bill, trying to make a decision based on the facts and trying to get through the rhetoric, because there is a lot of that going on in any piece of legislation. So I am trying to write down the pros and the cons of this legislation and go through them in a systematic fashion and try to make a decision based on policy and not based on politics, a decision based on what is in the bill, not on what people are saying is in the bill. As I have gone through this, I have a whole list of general principles that I believe are good. I have still not made up my mind on this final piece of legislation because it is really a balancing act. There are good things and there are things that are not so good. Just to mention a few of the things that I believe are good in this bill, probably the best thing is something called the health savings account, which has nothing to do with Medicare today. It has to do with reforming the overall insurance system in our country for health care. It is something I have been fighting for, for many years and introduced legislation on when I was in the House of Representatives on the Ways and Means Committee. We passed it several times, but unfortunately, when we passed the final version, we had to water it down so much that we enacted a piece of legislation that did not work. So the health savings accounts in this piece of legislation, I believe, are going to be one of the most significant reforms we can possibly enact for the future of bringing the patient back into the accountability loop. When you have a third-party payer system--what I mean by that is the person receiving the care doesn't directly pay for the care; it is a third-party payer system. So when you walk into a doctor and the doctor says we need to run this test and that test, the person doesn't even say how much do those tests cost or is there a cheaper place to go get an MRI, for instance, or is one place better or cheaper or is a certain specialist better than others or is one cheaper than others, and maybe of the same quality--none of those kinds of discussions happens because they are not paying the bill. The health savings account allows them to put money into an account tax free. It builds up in the account tax free, and when it is taken out for health care expenses, it is taken out tax free. Then that person directly pays the doctor. Now, why is that significant? It is significant because in our current system, whether it is traditional Medicare fee for service, or even the HMOs or the PPOs, all the payments go through some kind of bureaucracy, whether it is a Government bureaucracy or a private one. Anybody that has experienced our health care system today knows that maybe companies are not trying to deny payment but it certainly seems like that in a lot of cases. My in-laws are dealing with this right now. My father-in-law had cancer last year. They have been battling for almost a year now on whether the insurance company should pay for a large part of their coverage or not. That takes a lot of time for people to process, to answer phones, go through the whole process. If somebody is paying out of their own pocket to the doctor, none of these conversations has to take place, and that money that is saved through the bureaucratic process can go directly to health care. I believe health savings accounts are one of the most positive things in this bill. Mr. President, will the Chair please notify me when there is 1 minute remaining?

Mr. ENSIGN. Taking our time to go through the bill is very wise to do because my biggest fear--and we see this happen with legislation all the time--when we have this kind of complexity in a document is the law of unintended consequences. We enact bills all the time. When we enacted HIPAA--and the majority leader is on the floor and he knows better than anybody--the HIPAA law is a terrible piece of legislation, and we are suffering consequences today. We are driving up health care costs unnecessarily because of that legislation. That is why I am still trying to go through this legislation to make up my mind. I thank my colleague, the senior Senator from Nevada, Mr. Reid, for yielding me the time to speak tonight. I look forward to hearing the majority leader's comments on this legislation as I am still battling through what I am going to do on it. I thank the Chair. I yield the floor.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I rise today to introduce, with my distinguished colleague from Maryland, Senator Mikulski, the Mammography Quality Standards Reauthorization Act of 2003. The purpose of this legislation is to reauthorize the Mammography Quality Standards Act in order to maintain access to high quality mammography services for every woman in America. Breast cancer is the second leading cause of cancer deaths among American women. An estimated 211,300 new cases of invasive breast cancer are expected to occur among women in the United States in 2003. In my home State of Nevada alone, 1,400 new cases of breast cancer will be diagnosed in women, and an estimated 300 women in Nevada will die of breast cancer next year. The MQSA was originally passed in 1992 to ensure that all women have access to quality mammography for the detection of breast cancer in its earliest, most treatable stages. Congress re-authorized MQSA in 1998, extending the program through 2002. Although MQSA was scheduled for reauthorization last Congress, we unfortunately failed to act. The MQSA has had a positive impact on mammography quality. FDA inspection data continues to show overall facility compliance with the national standards to ensure the quality of x-ray images. Currently, over 98 percent of all mammography facilities pass the phantom image test during their facility inspection. MQSA remains as essential tool for early detection and for combating mortality associated with breast cancer. The legislation I introduce today would reauthorize MQSA for 2 years, signifying Congress' commitment to extending the life of this important program. Reauthorizing the act for a shorter amount of time than previously done will allow Congress the time it needs to examine some serious issues facing the long-term effectiveness of the act while still maintaining vital quality standards in the interim. In addition, this legislation would permit the Secretary of the Department of Health and Human Services to issue two additional and temporary certificates that will allow facilities who offer mammography services to continue to provide uninterrupted care while they go through the process of reaccredidation. This is important as we encourage more and more women to seek screening services each year. With these significant changes, MQSA, I believe, will be more effective than ever. While we are improving the act with this bill, we need to tread carefully as we look to make further changes. Mammography, like every health discipline, is an imperfect science. On average, radiologists estimate that somewhere around 75 percent of cancer can be found through mammography. Thus, until the technology improves, the quality of the reading is limited. We have to remember that in the medical field, human error is unavoidable. Most doctors practicing today are excellent at what they do, and placing additional regulations on them, especially in an already highly-regulated subspecialty, can often times do more harm than good. Congress needs to be increasingly vigilant in making sure that practices below acceptable standards are eliminated. To that end, one of the real benefits of MQSA is its required medical audit procedure which mandates that each FDA-approved facility has a system for following up on mammograms that reveal problems. In other words, each facility performs a self-check on itself, helping to ensure quality care is being given. The impact of medical liability on the radiological profession has been immense, leading to a shortage of quality doctors. As bad as it has been for the profession itself, the adverse effect it has had on patient access to care is intolerable. In places across the country, women are having to wait weeks, even months, to get a mammography screening. In a speech this February in Florida, the president of the American Medical Association stated that in a recent survey of Palm Beach, Miami Dade and Broward Counties, 7 of the 29 radiologists said they had stopped reading mammograms--and 8 others are considering that possibility. In addition, Orlando Regional Hospital reports that the average wait time for women seeking mammography rose from 20 days in 2000--to 150 days in 2002. The cause of all this is that many radiologists can't find or afford the necessary liability insurance. The bottom line is that at a time when the medical liability crisis is hitting the industry harder than ever, the last thing the Federal Government should be doing is creating more avenues for abusive lawsuits. That is why Congress must balance the need to find ways to improve the quality and delivery of women's health, while at the same time preserving a positive and equitable medical environment for well- intentioned professionals to practice. The MQSA has been an important program in increasing the quality of mammography services for women. I thank Senator Mikulski and HELP Committee Chairman Gregg for all of their hard work on this issue, and I look forward to seeing this legislation through to passage by the Senate and ultimately signed into law.

Mr. ENSIGN

Mr. ENSIGN. Mr. President, I rise today to introduce, with my distinguished colleague from Maryland, Senator Mikulski, the Mammography Quality Standards Reauthorization Act of 2003. The purpose of this legislation is to reauthorize the Mammography Quality Standards Act in order to maintain access to high quality mammography services for every woman in America. Breast cancer is the second leading cause of cancer deaths among American women. An estimated 211,300 new cases of invasive breast cancer are expected to occur among women in the United States in 2003. In my home State of Nevada alone, 1,400 new cases of breast cancer will be diagnosed in women, and an estimated 300 women in Nevada will die of breast cancer next year. The MQSA was originally passed in 1992 to ensure that all women have access to quality mammography for the detection of breast cancer in its earliest, most treatable stages. Congress re-authorized MQSA in 1998, extending the program through 2002. Although MQSA was scheduled for reauthorization last Congress, we unfortunately failed to act. The MQSA has had a positive impact on mammography quality. FDA inspection data continues to show overall facility compliance with the national standards to ensure the quality of x-ray images. Currently, over 98 percent of all mammography facilities pass the phantom image test during their facility inspection. MQSA remains as essential tool for early detection and for combating mortality associated with breast cancer. The legislation I introduce today would reauthorize MQSA for 2 years, signifying Congress' commitment to extending the life of this important program. Reauthorizing the act for a shorter amount of time than previously done will allow Congress the time it needs to examine some serious issues facing the long-term effectiveness of the act while still maintaining vital quality standards in the interim. In addition, this legislation would permit the Secretary of the Department of Health and Human Services to issue two additional and temporary certificates that will allow facilities who offer mammography services to continue to provide uninterrupted care while they go through the process of reaccredidation. This is important as we encourage more and more women to seek screening services each year. With these significant changes, MQSA, I believe, will be more effective than ever. While we are improving the act with this bill, we need to tread carefully as we look to make further changes. Mammography, like every health discipline, is an imperfect science. On average, radiologists estimate that somewhere around 75 percent of cancer can be found through mammography. Thus, until the technology improves, the quality of the reading is limited. We have to remember that in the medical field, human error is unavoidable. Most doctors practicing today are excellent at what they do, and placing additional regulations on them, especially in an already highly-regulated subspecialty, can often times do more harm than good. Congress needs to be increasingly vigilant in making sure that practices below acceptable standards are eliminated. To that end, one of the real benefits of MQSA is its required medical audit procedure which mandates that each FDA-approved facility has a system for following up on mammograms that reveal problems. In other words, each facility performs a self-check on itself, helping to ensure quality care is being given. The impact of medical liability on the radiological profession has been immense, leading to a shortage of quality doctors. As bad as it has been for the profession itself, the adverse effect it has had on patient access to care is intolerable. In places across the country, women are having to wait weeks, even months, to get a mammography screening. In a speech this February in Florida, the president of the American Medical Association stated that in a recent survey of Palm Beach, Miami Dade and Broward Counties, 7 of the 29 radiologists said they had stopped reading mammograms--and 8 others are considering that possibility. In addition, Orlando Regional Hospital reports that the average wait time for women seeking mammography rose from 20 days in 2000--to 150 days in 2002. The cause of all this is that many radiologists can't find or afford the necessary liability insurance. The bottom line is that at a time when the medical liability crisis is hitting the industry harder than ever, the last thing the Federal Government should be doing is creating more avenues for abusive lawsuits. That is why Congress must balance the need to find ways to improve the quality and delivery of women's health, while at the same time preserving a positive and equitable medical environment for well- intentioned professionals to practice. The MQSA has been an important program in increasing the quality of mammography services for women. I thank Senator Mikulski and HELP Committee Chairman Gregg for all of their hard work on this issue, and I look forward to seeing this legislation through to passage by the Senate and ultimately signed into law.

Mr. ENSIGN

Mr. ENSIGN. Reserving the right to object, and I will object, very simply put, when the Democrats were in control of the House of Representatives, the Senate, and the Presidency back in 1993, the unemployment rate, when they terminated the program, was 6.4 percent nationally. It is now 6.0 percent, lower than it was in 1993 when every Democrat voted to terminate the program. So with that, I object.