Michael Enzi

Mr. ENZI

Mr. ENZI. Mr. President, I want to quickly refresh the memory of the Senator from North Carolina. I would not have entered into the time agreement had I known he wasn't listening when I debated the Snowe-DeWine arrangement where I clearly pointed out that it is not considered thereunder. I think this is a sticking point that the President would see as being very difficult. We are talking about companies such as Hewlett-Packard, Firestone, Motorola, Caterpillar, Pitney Bowes--big companies that are providing this. I have checked on the costs. Their costs will go up from $40 million to $70 million if the Snowe-DeWine amendment is the only defense they have. I yield the remaining time to the Senator from Texas.

Mr. ENZI

Mr. ENZI. Among the handful of principles that are fundamental to any true protection for health care consumers, probably the most important is allowing States to continue in their role as the primary regulator of health insurance. It is because of my commitment to preserving existing consumer protections that I am glad to be a cosponsor of the Collins-Nelson amendment. Their amendment recognizes a principle that has been recognized and respected for more than 50 years. In 1945, Congress passed the McCarran-Ferguson Act, a clear acknowledgment by the Federal Government that States are indeed the most appropriate regulators of health insurance. It was acknowledged that States are better able to understand their consumers' needs and concerns. It was determined that States are more responsive, more effective enforcers of consumer protections. As recently as last year, this fact was reaffirmed by the General Accounting Office. GAO testified before the Health, Education, Labor, and Pensions Committee saying: In brief, we found that many states have responded to managed care consumers' concerns about access to health care and information disclosure. However, they often differ in their specific approaches, in scope and in form. Wyoming has its own unique set of health care needs and concerns. Every State does. For example, despite our elevation, we don't need the mandate regarding skin cancer that Florida has on the books. My favorite illustration of just how crazy a nationalized system of health care mandates would be comes from my own time in the Wyoming Legislature. It is about a mandate I voted for and still support today. Unlike Massachusetts or California, for example, in Wyoming we have few health care providers, and their numbers virtually dry up as you head out of town. We don't have a single city with competing hospitals. So we passed an ``any willing provider'' law that requires health plans to contract with any provider in Wyoming who is willing to do so. While that may sound strange to my ears in any other context, it was the right thing for Wyoming to do. But I know it is not the right thing for Massachusetts or California. I wouldn't dream of asking them to shoulder the same kind of mandate for our sake when we can simply, responsibly apply it within our borders. That is what States have been doing with the 1,100 laws they have passed dealing with patients' bills of rights. What is even more alarming to me is that Wyoming has opted not to enact health care laws that specifically relate to HMOs. But that is because there are ostensibly no HMOs in Wyoming. There is one which is very small. It is operated by a group of doctors who live in town, not a nameless, faceless insurance company. Yet the sponsors of the underlying bill insist they know what is best for everybody. So they want to require the State of Wyoming to enact and actively enforce-- that is what the opposing amendment does, enact and actively enforce-- what they say is the right thing for our State. They want to regulate under 15 new laws a style of health insurance that doesn't even exist in our State. It requires States to forsake laws that they have already passed dealing with patient protections included in the bill, if they are not the same as the new Federal standard. The technical language in the bill reads ``substantially equivalent,'' ``does not prevent the application of,'' and under the process of certifying these facts with the Secretary of Health and Human Services, the State will have to prove that their laws are ``substantially equivalent'' or some other variation of words. There are a whole bunch of words that could be used there. There could be a whole series of amendments to undermine the Collins amendment. This is one of them. The proponents of this language--whichever version you care to look at, except for Collins--say that it won't undo existing State laws that are essentially comparable, but that isn't what their bill requires. Under either amendment--the bill or the Breaux-Jeffords amendment--they are going to force States to change laws that they have already reviewed, that they believe already work in their States. Is it that the proponents aren't overly concerned with the implementation of the law versus being able to say that their bill meets the political test of covering all Americans, regardless of existing, meaningful protections that State legislatures have enacted? If the laws just have to be comparable, why don't they use that phrase? I will get into this issue in more detail as the debate proceeds. I believe we can compromise. I don't think this is the compromise. I like the language of the Collins amendment. The only hard proof that we have right now is that States are, by and large, good regulators, while the Federal Government has done a lousy job. The General Accounting Office has been reporting to us that since we passed the Health Insurance Portability and Accountability Act in 1996. And that is the ``consumer protection enforcement'' mechanism around which the bill before us is written. Wyoming currently requires that the plans provide information to patients about coverage, copays and so on, much as we would do in this bill; a ban on gag clauses between doctors and patients; and an internal appeals process to dispute denied claims. I am hopeful that the State will soon enact an external appeals process, too. This is a list of patient protections that a person in any kind of health plan needs, which is why the State has acted. But requiring Wyoming to enact a series of additional laws that don't have any bearing on consumers in our State is an unbelievable waste of the citizens' legislature's time and resources. As consumers, we should be downright angry at how some of our elected officials are responding to our concerns about the quality of our health care and the alarming problem of the uninsured in this country. We are talking about driving up the price of insurance and driving people out of the insurance market. I keep mentioning that insurance in this country is provided on a voluntary basis. We have had amendments that dealt with small businesses to see if they could get any kind of relief. Most of them are strained to the maximum. The smaller your business, the higher your potential risk, so the higher the rates you pay. Insurance is risk protection. We discriminate against the smaller businesses on rates because it is actuarially more difficult to calculate that. Under this bill, we have had some opportunities to provide some relief to those small businessmen. It hasn't happened. They have been ignored. I will be bringing an amendment that will deal with the large businesses. I almost exclusively work with small businesses. Tomorrow, I will be bringing one that deals with the big self-insured, self- administered companies to see if there is going to be any hope of relief for those people who provide the best insurance in this country. Mr. President, we will be committing two fouls against consumers if we do not adopt the Collins-Nelson amendment. The first would be to eliminate all meaningful patient protections that are not exactly like the Federal law. Second would be to put in enforcement responsibilities with the agency that has already said it can't do the job. Add to that the third foul that the rest of the bill prices millions of people out of health insurance and we have done anything but hit a home run for patients. I urge my colleagues to consider the valuable experience and wisdom of the amendment sponsors, as well as the urging of the National Council of State Legislatures. Think about the divergence of philosophy. Do you want your health care to be one size fits all in Washington, determined by HIPAA and HCFA, or do you still want your States to be involved? Do you want your States to have the control? Do you want your States to be able to continue the kind of service they have been providing through your State legislatures that can make decisions based on your State and your needs? I yield the floor. Exhibit 1 National Conference of State Legislatures, Washington, DC, June 27, 2001. Hon. Susan Collins, U.S. Senate, Washington, DC. Hon. Ben Nelson, U.S. Senate, Washington, DC. Dear Senator Collins and Senator Nelson: On behalf of the National Conference of State Legislatures, I would like to take this opportunity to commend you for authoring an amendment to S. 1052, the pending Patients' Bill of Rights legislation. Your amendment recognizes the important work states have done regarding the regulation of managed care entities and supports the continued role of states in the regulation of health insurance. The amendment substantially addresses concerns we expressed in our recent letter to you and your colleagues. In that letter we urged you to: (1) grandfather existing state patient and provider protection laws; and (2) provide a transition period between the enactment of federal legislation and the effective date of the Act to provide each state an opportunity to preserve their authority to regulate managed care entities. This amendment also addresses our concerns regarding the adequacy of the federal infrastructure to enforce the patient and provider protections established in the bill. Finally, it is important to emphasize that the proposed amendment recognizes that insurance markets differ among the states and a ``one size fits all'' approach may have adverse results among states and within regions of a state. This amendment permits a state to certify adverse impact and head off disruption in its insurance market. NCSL supports this amendment. States are best situated to provide oversight and enforcement of the patient and provider protections established in the legislation. The record of the states is strong. We are looking for an approach that supports the traditional role of states in the regulation of insurance and that recognizes the differences in state insurance markets and provides a mechanism for states to protect those markets. NCSL supports passage of Patients' Bill of Rights legislation that makes a promise that can be fulfilled. We believe state oversight and enforcement is an integral part of ensuring fulfillment of the promise and we look forward to continuing to work with you to develop legislation that will improve the quality of health care without adversely affecting access to care. Sincerely, Garnet Coleman, Texas House of Representatives, Chairman, NCSL Health Committee.

Mr. ENZI. Will the Senator yield 4 minutes?

Mr. ENZI. Thank you, Mr. President. I appreciate the other side allowing us this opportunity to state our case at the beginning because of some important considerations we have. I particularly congratulate the Senator from Maine, Susan Collins, for her tremendous efforts on this entire Patients' Bill of Rights. On any issue in which she gets involved, you will find that she studies it to a greater depth than anyone. She does additional research; she gets all of the help she can; she gets to the point where she understands what she is doing; and then she works with others to make it better. It does not happen a lot around here. But she is one dedicated Senator who is always willing to look at a better idea. She has teamed up, in this particular instance, with Senator Nelson, a neighbor of mine, from Nebraska. One of the reasons this is an interesting team is that they have both been State insurance commissioners. They both understand the State side of this. They both understand what is in the bill. I would not want to imply that everybody does not, but these are two people who absolutely understand what is going on in the bill. They have teamed up and said there is a way that we can provide the protections, that we can get the States involved, and that we can enlarge the scope. They put it together. I congratulate them for their tremendous efforts. For 2 weeks, I have been saying that on 80 percent of this bill both sides agree. On eighty percent of it we agree. It is that other 20 percent where there are some philosophical differences. I have seen--both in legislating that I did before I got to the Senate and since I have arrived--that one of the keys to passing legislation is to put a good title on the bill. That is something we agree on 100 percent: The Patients' Bill of Rights is a great title. What you do with that can be an abuse of the title. And on 20 percent of this bill, there is an abuse of that title. There are some substantial changes that need to be made. One of those is, who is going to administer it? There are two very different philosophies involved in the administration of this bill. One side says: Washington knows best. Bring it back to Washington. If the bureaucracy isn't big enough now, we will make it big enough. And we will put enough dollars in it that we will be able to solve it. For anybody in America who has ever had to work with the Washington bureaucracy, picture the difference between Washington and your local and State governments. When you call Washington, have you ever gotten to talk to the same person twice? That means that when you call in today with a problem that you have to explain, and then when they do not take care of it-- because they really do not have the involvement that they do if they know you--you have to call them back. Well, you would not know by tomorrow; you would not know by next week. You would be lucky to know by next month. But next month, when you are sure Washington has not solved your problem, you have to call again. And I guarantee you, you will talk to a different person who will say: What is your problem? And after you have gone through all of the explanation again, they will say: We will get back to you on it. And you are going to spend another month getting back to them on it. Contrast that with State and local calls that you have had to make. You can almost always talk to the same person again, so the problem that you discussed yesterday they still remember today. And you do not have to wait a month for the decision because they are doing the job efficiently. There are various ranges of bureaucracies and efficiencies in Washington, also. This bill has chosen to give the jurisdiction to that agency that is doing the poorest job. Don't believe me. Don't believe the debate. What I ask you to do is call your doctor and ask them what they think of HCFA. Call it HCFA; it is the Health Care Financing Administration. But they call it HCFA because that is a four-letter cuss word to them. You will find that your doctor thinks HCFA is a cuss word. That is how impressed they are with the administration of this agency, the one to which we are about to turn over all of the jurisdiction for the problems you have worked with your State on before. We are going to take what the States have been doing, and doing well for over 50 years, where there are people you can talk to every day, and we are going to say, no, you are not doing a good enough job because there is some bureaucrat in Washington who decided that they know better and they want to handle your problem. Find out how efficient HCFA is. I am certain under the new administration that it will be more effective, but it will be a long time recovering from the problems it has right now. Yes, we can throw more money at it. Is that where you want your tax money to go? Right now, your States are paying for that. We are going to duplicate and supersede, without saving you a dime and in fact costing you more. Does the Federal Government do a better job? One of the things I have been working on since I have been here is OSHA. OSHA allows two different processes. One is State plan States. That is where the States do the work. The other is the Federal plan. That is where the Federal Government takes care. I can tell you that the accidents are less in the State plan States for just the reasons I mentioned before. A bureaucracy operating out of Washington, trying to handle the whole country as a one-size-fits-all problem can't do the same job as the people at home in your State. What are some of the things they have to handle? I will tell you, the new reason that HCFA is going to become a bigger cuss word is called HIPAA. This has to do with portability of insurance. The change in some of my phone calls this week has been calls from doctors and hospitals. They weren't concerned about a Patients' Bill of Rights yet. They were concerned about the HIPAA privacy rules. Ask your doctors and your hospitals what they think about that. Privacy is important to all of us, but they have managed to muff that one. The same agency that people are calling me and complaining about right now is related to where we are going to turn over, under the opposing amendment, all of the workload. This week and last week you heard about a number of amendments. One of the things I am very proud of is that all of those amendments were different solutions that needed to be done on this 20 percent of the bill where there is a problem, different approaches. It was not the same amendment time after time after time, which we have seen here before. It was different approaches to different problems in the bill. There are about six problems that we have to get solved, that we have to get some consensus on in order to have a good bill, one that matches up to the title of Patients' Bill of Rights. What you are seeing here, of course, is us trying to solve in the committee of the whole what could have been done in committee. You are seeing more amendments here than what you might see on the floor with the bill. But that is because normally we have the committee meetings where we get to put forward lots of amendments in a smaller group and, therefore, be able to get them decided with less discussion because there are fewer people. I mentioned some phone calls. I have to add that I am starting to get some other phone calls now which are from my school districts, wondering how this bill is going to affect them. They know we just finished the education bill and that there might be some more money under the education bill for them. They are asking: But we provide insurance to our employees; is this going to suck up all that money, and how liable will we be? Again, I congratulate the Senator from Maine and the Senator from Nebraska for the tremendous work they have done in coming up with a solution--one we talked about last year--on which there was a lot of consensus. There was a lot more give, a lot more understanding, and even people supporting this one who seem to think HCFA is a better solution now. One of the groups supporting the Collins amendment that I want to point out is the National Conference of State Legislatures. They recognize the value of the State handling these insurance problems. I ask unanimous consent that there be printed in the Record after my remarks a letter from the National Conference of State Legislatures.

Mr. ENZI. Madam President, I thank the Senator from Nebraska for the care and concern that has gone into this amendment. I support it along with him. I know how important it is for businesses to be able to nail down the prices so they can provide this voluntary insurance to people. If they don't know how much it will cost, if it is going to rise astronomically, I guarantee the small businesses will bail out. That is what the discussion has been about this week and last week--how to continue to have insurance for people. I am an accountant, the only accountant in the Senate. I like dealing with numbers. The people who really deal with numbers are the actuaries. They are the ones who have to figure out what the odds are that something is going to happen to people. The smaller the plan, the tougher it is to figure the odds. But those odds have to be calculated in order to figure out the price. If the actuary said figure the whole universe of things that could happen, normally we exclude the ones that are difficult to calculate, but you don't get to exclude those anymore. You have to figure it as though those could happen to the person, and some reviewer will charge your plan with that. So we cannot tell you what you are going to have to pay. We guarantee it will have to be a higher number because of the uncertainty. It is extremely important we avoid the Russia syndrome or the China syndrome, where they don't have contracts worth anything. In this country we maintain the sanctity of contracts. It is time to do that again. It is time to do that, particularly to protect the people working for small businesses in this country so they will continue to have insurance. This amendment is particularly important because it does several things. First, it allows both the employer and the employee to be certain about what benefits are covered under the health plan. If they can't know that, then what's the point of the contract. Second, the amendment will virtually guarantee that all health plan contracts will now have a great definition of medical necessity, which is the clause in a contract that's used to make many decisions on claims for benefits. If a health plan or employer chooses not to adopt a strong definition, as defined in this amendment, then they forgo their right to rely on that definition in making decisions on claims for benefits. That's achieved by allowing the independent reviewer in the external appeals process to ignore that definition if it's not among those listed in the amendment. This amendment brings to bear two important consequence that go a long way helping this bill become law. Again, the contract, upon which not just the breadth of benefits is determined, but also the cost of health coverage to both the employer and employee is based, is made whole. And, the quality of health care in this country is set at a standard that will assure patients receive medically necessary care as determined by the standards in the best programs, namely the Federal Office of Personnel Management's definition for fee-for-service plans. Mr. President, I again commend my colleagues for their work. Enacting this amendment is as important to preserving the employer sponsored health care system as anything else we may do on this bill. There's simply no reason why Members would vote to undo a health plan contract or against requiring that health plans adopt a strong definition of medical necessity.

Mr. ENZI

Mr. ENZI. Mr. President, I rise to announce the introduction of a bill that would help preserve the identity of American communities that have struggled with the United States Postal Service to acquire their own, individual zip codes. The bill would do this by prohibiting the Postal Service from extending zip codes across State boundaries. This bill was introduced in response to concerns raised by the community of Alta, WY. Alta is a small, rural town situated next to the Wyoming-Idaho border at the western base of the Grand Teton Mountains. Because of treacherous travel conditions to the east of Alta, the Postal Service made the decision to serve Alta residents out of the post office in neighboring Driggs, ID. Alta is isolated from other parts of Wyoming and it simply would be too dangerous to require the Postal Service to cross the Teton mountain range in the winter to deliver mail to Alta. In providing this service, however, the post office has not provided Alta residents their own zip code at the Driggs post office, but has required them to use the Driggs zip code even though Alta residents live in an entirely different State. While this may not seem like a big deal on its face, there are a number of technical complications that arise in the lives of Alta residents because the Postal Service has not been willing to extend the courtesy of an Alta zip code. By requiring Alta residents to use the Driggs zip code, the Postal Service has created a lot of confusion for Alta residents who attempt to conduct business with mail order companies. What sales tax do they pay? Idaho or Wyoming? Although the Postal Service maintains that zip codes are not used to identify specific locations, other companies use zip codes as an important location code that is necessary to adequately conduct their business. Sales tax is often programmed by zip code, so are car insurance rates, life insurance, homeowner's insurance, even our Federal and State income taxes use zip codes as an indicator of when and where to pay taxes. The requirements of this bill will not be onerous for the Postal Service to implement. It will not require the service to build new facilities or even to change its method of operations. All it will do is require the Postal Service to identify those communities whose mail service crosses State boundaries and to assign them the necessary identification number that they need to provide the rest of the world a clear and concise description of where they live and who they are. I urge my colleagues to support this most important legislation.

Mr. ENZI

Mr. ENZI. Mr. President, I rise to announce the introduction of a bill that would help preserve the identity of American communities that have struggled with the United States Postal Service to acquire their own, individual zip codes. The bill would do this by prohibiting the Postal Service from extending zip codes across State boundaries. This bill was introduced in response to concerns raised by the community of Alta, WY. Alta is a small, rural town situated next to the Wyoming-Idaho border at the western base of the Grand Teton Mountains. Because of treacherous travel conditions to the east of Alta, the Postal Service made the decision to serve Alta residents out of the post office in neighboring Driggs, ID. Alta is isolated from other parts of Wyoming and it simply would be too dangerous to require the Postal Service to cross the Teton mountain range in the winter to deliver mail to Alta. In providing this service, however, the post office has not provided Alta residents their own zip code at the Driggs post office, but has required them to use the Driggs zip code even though Alta residents live in an entirely different State. While this may not seem like a big deal on its face, there are a number of technical complications that arise in the lives of Alta residents because the Postal Service has not been willing to extend the courtesy of an Alta zip code. By requiring Alta residents to use the Driggs zip code, the Postal Service has created a lot of confusion for Alta residents who attempt to conduct business with mail order companies. What sales tax do they pay? Idaho or Wyoming? Although the Postal Service maintains that zip codes are not used to identify specific locations, other companies use zip codes as an important location code that is necessary to adequately conduct their business. Sales tax is often programmed by zip code, so are car insurance rates, life insurance, homeowner's insurance, even our Federal and State income taxes use zip codes as an indicator of when and where to pay taxes. The requirements of this bill will not be onerous for the Postal Service to implement. It will not require the service to build new facilities or even to change its method of operations. All it will do is require the Postal Service to identify those communities whose mail service crosses State boundaries and to assign them the necessary identification number that they need to provide the rest of the world a clear and concise description of where they live and who they are. I urge my colleagues to support this most important legislation.

Mr. ENZI

Mr. ENZI. Mr. President, listening to this debate it probably sounds like the Democrats have coined a good phrase, the Patients' Bill of Rights, and they are the only ones in favor of it. It is a good phrase. What we are doing is legislating. Legislating means fixing the bill so that it does what the title says. We want to have a Patients' Bill of Rights. Both sides want a Patients' Bill of Rights. That is the fundamental issue before the Senate. The fundamental issue is getting patients the care they need when they need it. The lawsuits are peripheral. They are not the main issue. I have listened to my Republican colleagues discuss this matter for 2 days; likewise, my Democratic colleagues continue to raise specific examples of patients whose care was not appropriately delivered. They have cited the need for their version of a Patients' Bill of Rights to curb such abuses by HMOs. The Democrats know full well it is not a new right to sue that will address the cases they keep raising. They know it is the immediate medical review of the claim for benefits that will get people care and prevent more horrible injuries from occurring. Here is the interesting part. We all agree on this point. Eighty percent of what is being talked about in the Patients' Bill of Rights we agree on. Eighty percent of it will take care of the patients. That is the part on which we agree. It has been reflected in every version of the bill that has ever been introduced. Speaking on specific examples of HMO wrongdoing is certainly relevant to this debate and likely reinforces what the American people need for a bill. However, the message the Democrats are trumpeting is misleading. I hear them saying they are the only ones who want a bill. I say again for the fourth day and for the fourth year, I want to pass a Patients' Bill of Rights and see it signed into law by the President. Patients are foremost in this debate. That should remain our focus. In our effort to meet that, we do need to make a number of modifications to the underlying bill. The other 20 percent of the bill needs to be fixed. I believe we can do that and subsequently enact into law a strong bill. I don't know that it is universal that everybody wants a bill. I think some people want an issue. I was involved in the Patients' Bill of Rights conference committee last year. Some of my more senior colleagues tell me Members spent more time working that bill than any bill they can ever remember. We came that close to a solution. In fact, I know everybody realized we could have the solution, and we were about to get agreement on the entire package. Some decided that an issue was better than a solution, that the issue would resonate during the elections. So we don't have a Patients' Bill of Rights today. People bailed out of that conference committee, came out to this floor and introduced a package that was clear back at the beginning of the negotiations. It didn't contain a single issue we had resolved. They wanted an issue, not a solution. We are all trying to get a Patients' Bill of Rights. We are all concerned. Right now what we are doing is writing laws. Laws have to have the right wording. I congratulate the Senators from Texas for providing wording that is extremely important in this debate. I ask that they make me a cosponsor on this amendment. This is going to be extremely important to everybody who gets insurance. It will be more important, of course, to the businesses that participate in providing that insurance. I watch out for the little guy. I was a small businessman. My wife and I started a family shoe store in Gillette, WY. We saw what government regulation does to people's job. Most of that government regulation is not bad for big business because they can afford the specialist to do it. The small businesses, who have to be experts in all of these areas we see as grand solutions for everybody, don't have the experts. They have to handle all of these things on their own. I have been there and done that and I will watch out for those small businesses. One thing I will say about small business, those small business employees recognize how tenuous the business is and consequently how tenuous their jobs are. They understand it is not a gold mine out there, that it is a lot of hard work that provides people with services, and consequently, people with jobs. They do understand, also, that insurance is voluntary. They know their employer does not have to give them insurance. The businesses want to provide the insurance. They recognize it is a benefit that helps them keep the employee, but it is not clear cut how that is provided. As the insurance prices have gone up, more and more businesses have dropped insurance. As the price has gone up, more and more businesses have shared the cost. They have said this is all we can afford, we will have to share on the cost. Some businesses do not provide insurance and individuals have to buy it themselves. If costs go up, fewer and fewer of those businesses that are voluntarily providing that, or are at least providing a portion of the insurance, will continue. They are going to get out. One of the things that will cause that to happen is the employer liability contained in this bill. We are told there is no liability. I spent about 20 minutes yesterday discussing that there is liability here. On page 148 is the beginning of the exclusions for physicians and other health care professionals. It is very straightforward. It covers one page of the text. It says they can't be sued. Now, that is not an outright exclusion. It is pretty close to an outright exclusion. There are other ways to be sued other than what is in the bill. This is found on page 148, with the title at the bottom, but technically, the details are on the next page, one page, double-spaced. Page 150, exclusion of hospitals: Same deal, very straightforward. It takes a page and a half for hospitals. Physicians only take one page for exclusion, and hospitals take a page and a half. There are still ways hospitals can be sued, as there are ways physicians can be sued. I explained yesterday how the employer liability works. Page 144 says causes of action against employers and plan sponsors precluded. It sounds about as straightforward as the others, doesn't it? The way I counted, there are two dozen pages providing exceptions. It is not just like you can begin reading at the beginning and see what the exceptions are. I mentioned yesterday, you better have a bushel basket of bread crumbs to follow the trail as you go backwards and forwards looking at the exceptions in the bill. Remember, this applies to small businesses. They have to be able to understand this. The easy way out for them, if they don't understand it, is to drop it and say, I am not going to be sued. If I don't carry the insurance, I can't be sued. It is that easy. So they say, here is money I used to put into your insurance. I know you participated in it and had to put some in, too. I know that is not deductible. That is another sore point that ought to be cleared up while we are doing the bill. We had that opportunity the other night to allow deductibility for the insurance premiums for the self-employed. That is another one of those small business issues that ought to be cleared up in this bill. The big corporations get deductibility for their insurance. The self-employed don't. Is that fair? I guess they do not have good lobbyists. It is something we could get cleared up in this bill, but we have already chosen not to do that. How did we choose not to do that? Not by saying we are not going to allow the deductibility by the small employer. None would have voted for that. Instead, we said there is this little parliamentary tactic that we can use. We can say that, since the House didn't send us this tax provision, we can confuse everybody and vote against it and keep those self-employed people from getting their insurance and never have to say that is really what we are doing. Fifty-two Members--two more than needed--said they weren't going to give the self-employed the same right to deduct insurance that we give to the big corporations. Small businesses come under the self-employed category--the single proprietor that hires four or five people. That is the small businesses about which we are talking. We wonder why they do not provide insurance. We wonder why those in that group that do are a little bit concerned about the liability that is involved in this bill. If they really intended to include employers and plan sponsors, why didn't they do it like they did for physicians? Why didn't they do it like they did for hospitals? The wording can be just as easy. That is what this amendment is about. The bill is purported to follow the Texas plan. I congratulate the Texas Senators for kind of making them put their writing where their mouth is. The amendment we have here is the Texas version. It is a Texas version that says the employer can't be sued. With physicians and just as with hospitals, it isn't quite as straightforward as that. They can still be sued, but not specifically because of the way this bill is written. Bad drafting produces bad legislation. I hope it was just written this way as a result of speed, but I have to tell you I think it was intentional. I sat through all of those discussions about liability before and all of the unusual cases that can happen from it and all of the strange exceptions. Those will affect a few people in this country. But most of them who will be losing their health insurance will never come into a single exception that applies to the employer, to the physician, or to the hospital. They just want to be well. When you are sick, that is what you want. When you are sick, you are not trying to figure out who to sue and how to sue. When you are well, that can be taken care of. I congratulate them on coming up with this amendment that will clear it up. I have to tell you I was a little disappointed when we spent a couple of days talking about problems in this bill, and problems that would make this bill acceptable. We have talked about those before, negotiated them, and have had some success on that. I was really disappointed when the first amendment by the proponents of this bill was a sense of the Senate. I hope everybody understands what a sense of the Senate is. A sense of the Senate is merely a political statement that takes up a lot of floor time and results in a vote that is almost always unanimous. They just pick something that everybody is going to agree to. And we take time debating it when we could be debating corrections that need to be made to allow people to keep insurance. It is no surprise to anybody that those wind up with a huge vote. I have to tell you that this one was 89-1. Usually they are 99-1. I will also tell you that I am usually the one. I vote against any sense of the Senate that comes here, unless it gives direct instructions to the Senators themselves. That is what the sense of the Senate was designed for. It wasn't designed to tell the House, or the President, or anybody else what to do. It was designed to give very specific instruction to us. But we have gotten away from that tradition. Now if there is something that is peripherally related, we want to make a big deal out of it, such as running an ad to the country. Then we propose a sense of the Senate. There have been some fascinating ones around here--ones that nobody could understand how anybody could vote against. I do not understand how anybody could vote against them either because they don't achieve anything. But they make this great political ad. I thought that during some of this discussion there would have been an amendment that corrected a few things in this bill--maybe not even major things, but at least made a correction. I was disappointed to hear the leader before this discussion say he thought they had compromised as much as they could. That is not how we do legislation around here. You can't have this great smile and talk about bipartisanship and then say you compromised as much as you can before the debate starts. That is not how we do legislation. I told you that we agree on 80 percent of what is in the bill. That is the 80 percent that deals with the patients. Health insurance is voluntary in this country. I know there are a lot of people who prefer that were not the case, but we had that as another tax bill in the bureaucracy to provide inadequate care, as Canada is purported to do. At least I assume they do, since most of their people come down here for care. But we have a system where business pays, or business pays part and the employees pay part, or the individuals buy it on their own, or, in the worst of all worlds, there is no insurance in any combination from anybody. We have to make sure this Patients' Bill of Rights doesn't became a patient bill by driving up the costs, which, of course, will make some others decide that since they have been paying for their own insurance they can no longer afford it, or it will make businesses decide they will have to pass along a bigger share to their employees, or that they won't be able to afford insurance either. That would be a patient's bill--not a Patients' Bill of Rights. One of the great things about this bill, and one of the things we worked hard on in conference, and one of the things that was agreed to was an internal and external review process. If you need the care, there is a way to get it reviewed by doctors. If you do not like the decision, there is a way to get it reviewed by doctors outside of the situation so there isn't a conflict of interest. Those approaches get care to the patient, and can even be expedited, if there is a dramatic health care problem. It can be expedited. There is the internal review and the external review, which will get you the care and which makes the external review the final decisionmaker, as the Senator from Texas said. This bill ought to be written in a straightforward way. I was hoping that the proponents of the bill would see the error, listen to the comments that have been made, and make the changes. But they haven't. Instead, they purported that this is the Texas version, and since the Texas version and President's version is there, we ought to accept it. We are pointing out that is not the Texas version. But we are willing to do the Texas version. Then it makes it just as straightforward for physicians and for hospitals and for employers. It puts them all in the same category. We say: Look, we know mistakes are made sometimes. But we want to have health care, and we want to get everybody on board who is getting health care. I have a few quotes that I want to share with you on this ability to sue and how effective it is of getting health care. Dr. Richard Corlin, who is the president-elect of the American Medical Association, says: We are for medical malpractice reform because we have seen the consequences of what happens when it gets enacted and what happens when it doesn't get enacted. . . . Premiums drive people out of practice, they do not provide anything in the way of added patient safety. . . . It's not just physicians. The costs go up inordinately and they are passed along to everyone. He is talking about the propensity to sue in the United States, which is what we are talking about in the convoluted writing of this first provision which first says we are going to exclude the providers, the businesses, from liability, and then weaves this nasty little web which shows that the intent is to sue them. Another thing on lawsuits by the American Medical Association: The AMA is strongly committed to legislation that would (1) strengthen states' rights to govern the healthcare of their clients, (2) shield employers from frivolous lawsuits, and (3) not open the courts to a wide array of new lawsuits. A member of the AMA board of trustees says: Some opponents of patient protection legislation have spuriously alleged that employers will be held liable for simply selecting the plans, under this scenario. We therefore believe that the bill should explicitly state that employers and other plan sponsors cannot be held liable for fulfilling their traditional roles as employers and plan sponsors. That is from a member of the American Medical Association board of trustees. Another quote by the American Medical Association: Although patients, physicians, and health care providers are most directly harmed by the present liability system, society as a whole is harmed. The spiraling costs generated by our nation's dysfunctional liability system are borne by everyone. Remember, these are quotes from the people who are specifically excluded in the bill, not the ones on the macrame string trail of not being excluded. And they still feel that strongly. Another one from the American Medical Association: In the testimony, the AMA indicated its concerns about ``enterprise liability,'' a proposed policy change included in the Clinton Administration's health reform, that would have made health plans liable for physicians' malpractice. At the time, the AMA stated, ``Enterprise liability may also increase the frequency and magnitude of medical liability claims as individuals become more willing to sue an anonymous ``deep pocket.'' Everything isn't from the American Medical Association, and should not be. I have a quote from the vice president of government affairs of the Associated Builders and Contractors, Inc. He says: Many of ABC's-- That is the Associated Builders and Contractors-- member companies are small businesses and thus the prospect of facing a $5 million liability cap on ``civil assessments'' is daunting. The financial reality is that if faced with such a large claim, many of our members could be forced to drop employee health insurance coverage rather than face the potential liability or possibly even shut their business down. The Corporate Health Care Coalition says: Enactment of this bill (McCain-Kennedy) would unleash a flood of state court cases aimed at pushing the limits on coverage of tested and often questionable medical treatments. Cases that have been brought in state courts against state employee plans have produced huge punitive damage awards ($120 million in a recent California case) that have reshaped health plan coverage in the plans. . . . Uncapped liability exposure driven by aggressive personal injury lawyers will raise health care costs for employees and make health insurance increasingly unaffordable to individuals. Patient rights begin with coverage. Once again, we are trying to give people a Patients' Bill of Rights, not a patient's bill. I have to also quote the American Association of Health Plans: Employers who voluntarily provide health care benefits to their employees can be pulled into lawsuits under the Kennedy-McCain bill. Under Kennedy-McCain, businesses could be forced to pay unlimited economic and non-economic damages, plus unlimited damages under state law and up to $5 million of unprecedented punitive damages under federal law. One lawsuit could easily bankrupt a small business. The cost of pursuing it alone could undoubtedly bankrupt some of the small businesses with which I am familiar. Also the American Association of Health Plans says: According to a recent survey of 600 national employers by Hewitt Associates, 46 percent of employers would be likely to drop health care coverage for their workers if they are exposed to new health care lawsuits. Finally, from the American Health Care Partnership, the founder and chief medical officer says: Employers, especially small and medium sized ones, operating under tight profit margins, cannot afford to place themselves at the risk imposed by onerous punitive damages. . . . Companies will mitigate the risk by either dropping health coverage altogether, or make health care a defined contribution, which, due to adverse risk selection, will make health care insurance unaffordable for most of the sick. Again, yesterday, we passed up the opportunity to help small businesses. We used a parliamentary procedure, technique, to remove some of the liability for Members of this body, so they could vote against having deductibility for insurance for the self-employed; that is, for the self-employed and their employees. Now we are saying it is OK if we have good, clear, concise language in this bill that exempts physicians from lawsuits, and it is OK if we have clear, concise language in here that exempts hospitals, but it is not OK to exempt the people paying the bill, the people providing voluntary health insurance in this country. So I ask that my colleagues pay careful attention to this, make a correction in the bill, so it will make sense. I yield the floor.

Mr. ENZI

Mr. ENZI. Madam President, I am not a lawyer; I am an accountant, and I can tell you that this adds up to employers scaling back, even dropping the coverage they now provide. Is this how we propose to protect patients? The problem, at the end of the day, is that there is no fairy tale for hard-working Americans who currently receive health care from their employer. Instead, they are left with the nightmare of more expensive care, reduced benefits, or, in the worst case, losing access to care altogether. That is unacceptable for insured Americans. The logical question is, How in creation does this address the problem of uninsured working Americans? I leave my colleagues to mull that over. I yield the floor and reserve the remainder of the time.

Mr. ENZI. I yield myself 1 more minute.

Mr. ENZI. I yield myself 15 minutes. Madam President, I rise in support of a Patients' Bill of Rights. We need a Patients' Bill of Rights in this country. I spent most of last year working on a conference committee to get a Patients' Bill of Rights. I am told by more senior colleagues that we spent more time meeting as members than on any other bill they could remember. We got that close to having an agreement. In fact, people could see that we were going to get agreement on a Patients' Bill of Rights. There were some people who chose to have it as an issue instead of a solution. That is why we are back again working on a Patients' Bill of Rights. We do need a Patients' Bill of Rights but not this one, the way it reads. I will give some rebuttal to a McCain-Kennedy factsheet on protecting employers. The sponsors of the bill distributed a white paper to the Democrat caucus, and I can't let that go unrebutted. This is the assertion: Employers are explicitly protected from liability in almost every case. But that is not what the bill says. For the record, let me say that you would need a bushel basket of breadcrumbs to weave your way through this bill without getting lost. I tried at first with string, but it got so interwoven I thought it was macrame. This is going to be extremely hard to follow. It is much easier to give examples, as we just heard of people who have been wronged by the system. We need to clear that up. It is much more difficult, though, to make sure it reads properly in the details. You will be able to see why the average person is not entirely clear on how this bill fails to meet the assertion that employer-sponsored health care is protected. I am not a lawyer so my explanation may go a little more slowly than the compelling presentation made by my colleagues Senators Gregg and Gramm on Tuesday. But I can assure you that I will lead you through the language of the McCain-Kennedy bill and show that it clearly sues employers and, therefore, threatens Americans' access to employer-sponsored health care. I was a small businessman. Small business does not have the experts and specialists to interpret all of this, but they are going to have to abide by this stuff, too. See if you can follow this. Here's what the bill language in S. 1052 actually says. On page 144 line 18, there is a subparagraph entitled, ``Cause of Action Against Employers and Plan Sponsors Precluded.'' Nice title. This is subparagraph (A). It literally begins with, ``Subject to subparagraph (B).'' In other words, the provision whose title implies that employers are protected from lawsuits begins with an exception tot hat protection. As you can probably already guess, subparagraph (B) is entitled, ``Certain Causes of Action Permitted,'' which started out with, ``Notwithstanding subparagraph (A),'' which means, despite the protection from lawsuits they just said they were giving employers in the preceding paragraph, here's how ``a cause of action may arise against an employer.'' We're still on page 145 still under subparagraph (B). On line 7, there is a reference back to page 140, where you're sent to paragraph (1), subparagraph (A), which is all captured under a new subsection of ERISA, entitled ``Cause of Action Relating to Provision of Health Benefits.'' This subparagraph first identifies who would be subject to liability, saying: ``In any case in which a person who is a fiduciary of a group health plan''--meaning an employer under ERISA--a health insurance issuer offering health insurance coverage in connection with the plan, or an agent of the plan, issuer or plan sponsor.'' Then the paragraph goes onto page 140 and lists what actions would make that category of employers and health plans liable, saying, ``upon consideration of a claim for benefits of a participant or beneficiary under section 102 of the Act, or upon review of a denial of such claim, fails to exercise ordinary care in making a decision.'' Section 102 captures any consideration of a claim for benefits--whether its written or oral--and section 103 is the entire internal appeals process. Confusing? Intentional? Then page 140 goes on to list the following actions with respect to making a decision. It reads, ``regarding whether an item or service is covered under the terms and condition of the plan or coverage; regarding whether an individual is a participant or beneficiary who is enrolled under the terms and conditions of the plan or coverage; as to the application of cost sharing requirements or the application of a specific exclusion or express limitation on the amount, duration, or scope of coverage of items or services under the terms and condition of the plan or coverage; or, otherwise fails to exercise ordinary care in the performance of a duty under the terms and conditions of the plan with respect to a participant or beneficiary. Then the employer must prove that none of those actions were the ``proximate cause'' of the patient's personal injury. If they can't, then the employer is liable for economic and non-economic damages, and punitive damages of $5 million will be awarded, see page 153, line 23, for ``bad faith and flagrant disregard for the rights of participants.'' I am told that is a fairly high legal standard to meet. But then I remind myself that there is a band of trial lawyers right now trying to sue health plans under Federal racketeering laws. That is what we use to prosecute mobsters. If I were an employer--particularly a small employer--that kind of zeal by lawyers sure would not make me feel any better, and trying to read this bill would not make me feel any better. I am running a little low on breadcrumbs, but let me skip back for a minute to the ``liable actions'' listed on page 140. In particular, the last one I mentioned, which refers to ``fails to exercise ordinary care in the performance of a duty under the terms and conditions of the plan.'' This phrase, ``terms and conditions of the plan,'' is defined in the bill on page 122, line 14--another page--as ``to include, with respect to a group health plan or health insurance coverage, requirements imposed under this title with respect to the plan or coverage.'' Well, page 122 falls into title I of the bill. Title I of the bill includes a plan's utilization review activities, which cover everything from disease management to quality-of-care decisions to cost-benefit analysis; all claims-related activity, including internal and external review; all of the patient protections, from allowing patients direct access to the nearest emergency room to paying the cost of an employee's participation in a clinical trial, and on, including nine more separate patient protections; five additional rights for health care providers, including a whistleblower protection provision, which I will take issue with later; and a series of broad new definitions of provider categories and plan functions, coverage of limited scope plans, which are the dental and eye care plans, and a blanket inclusion of any and all new regulations--listen to that; pay attention here because, besides all of the stuff actually in print, you are going to be subject to any and all new regulations that the Secretary, who is completely at will to draft anything in relation to the act. I would like to note that also included in title I is the overriding of existing State laws that deal with the standards in this bill. I guess that is now also a part of the health plan contract. Confusing? Intentional? Now, after saying all of that, we need to tie all of these duties, obligations, named functions of the employer which again is voluntarily providing health coverage, back to the original trigger, into the employer liability section of this bill. If you remember, that is back on page 145. You will notice that it skips around. That is the subpart of subparagraph (B) I mentioned before, starting on line 7, which says the employer is liable to the extent there was direct participation by the employer or other plan sponsor in the decision of the plan under section 102 of the act upon consideration of a claim for benefits or under section 103 of such act upon review of a denial of a claim for benefits, or to the extent there was direct participation by the employer or other plan sponsor in the failure described in clause (ii) of paragraph (1)(A)--paragraph (1)(A), of course, being when a plan ``fails to exercise ordinary care in the performance of a duty under the terms and conditions of the plan.'' Heard that before? You heard me read that definition a moment ago from page 122, line 14, as being essentially everything under the Sun with which an employer has to comply. OK, we are almost there. So bear with me. We still have a breadcrumb or two left here. The employer liability provision in the bill goes on to further define direct participation, found on page 145, line 21, as meaning ``in connection with a decision described in clause (i) or a failure described in clause (ii).'' These are the two things I just described to you; remember, it was either the consideration of a claim for benefits or the failure to exercise ordinary care. Direct participation means, ``the actual making of a decision''--we all agree on that--``or the actual exercise of control in making such a decision''--we all agree on that--``or in the conduct constituting the failure.'' We didn't know they were going to increase the decision so much, though. It sounds to me like every activity in this bill legally requires employers to do that which they are already legally bound to do under the fiduciary obligations of ERISA, which under Federal law businesses have to meet, which is now included in this, and it would constitute direct participation and, therefore, exposure to unlimited new liability. Now, the sponsors have tried to define what direct participation is not. There are a whopping four things, all of which--and this is important--are conditioned by the clause found on page 146, line 12 and line 16, which reads: ``conduct that is merely collateral or precedent to the decision or failure.'' In other words, this so-called employer protection only applies if any ``actual'' action by the employer occurred long before or away from the decision. I read that to mean that if an attorney links any employer activity covered in the four exceptions to the lawsuit against the employer, then the ``exceptions'' do not apply. But let me tell you what they are anyway. Starting on page 146 and going to 147, they include, an employer's selection of health plan, or third party administrator; an employer engaging in cost-benefit analysis when choosing or maintaining a plan; the employer creation, modification, or termination of the plan; the employer participation in benefit design, and copayments, or limits on benefits. Show me an employer that probably isn't doing all four of those things and I will show you an employer that doesn't have a health plan. You have to do those things; it is a business requirement. If you are going to pick a plan or a third party administrator, you probably have to have some involvement in that. You have to do some cost-benefit analysis. You have to do at least the creation of the health plan, or you don't have a health plan. It sounds like a lot of upfront paperwork as well. That may be what it is all about, too. All other plan administration by an employer is subject to liability. But then so are these functions if we are to apply the ``collateral or precedent'' limitation on the employer protection I just referenced. I mentioned this to show you that it isn't quite as easy as some might be trying to purport here. This is seriously complicated, and it appears that around every corner in this bill there is an exception that swallows the rule. And the exceptions purported to protect employers are swallowed, too. There is no way anybody is going to convince the American people this bill doesn't sue employers, and for just about anything.

Mr. ENZI

Mr. ENZI. Thank you, Mr. President. I thank the Senator from Tennessee for his comments. I thank him for the tremendous job he has done. He is the only doctor in the Senate. He has done a tremendous job of educating us in all of the areas of a Patients' Bill of Rights and medical care and has saved quite a few people along the way. We really appreciate that. I particularly thank him for the education he has given me. Mr. President. I rise today to join all of my colleagues in calling for a Patients' Bill of Rights. The President has clearly stated his desire to sign a bill into law, but has also been very clear on what he won't sign. I support his goal of protecting Americans that have been mistreated by their HMO, and I also support his goal of only enacting a bill that will preserve access to insurance for those that already have it, and increase access for those Americans that are uninsured. The legislative and political history on this matter stretches back a ways. In fact, in three of the four-and-a-half years I have been in the Senate, we have passed a Patients' Bill of Rights. I hope to keep that streak going this year, only I hope what we pass finally gets signed into law to the benefit, not the detriment, of consumers. While there is a lot of consensus between all parties on the need for a number of patient protections, a strong internal and external appeals process, a right to hold health plans accountable in certain instances, and an assurance that all Americans be afforded such protections, there remains some disagreement on key issues. First, the appeals process should be meaningful and required because it gets people the right care, right away. Second, limitless lawsuits help lawyers, not patients. Third, turning state regulation of health care on its head is a losing prospect for consumers whose needs have historically been better served by their own state insurance commissioner. While I would like to spend my time today making a general statement about the need for a Patients' Bill of Rights, I plan to revisit in detail the issues I just mentioned as the debate moves ahead. During both the Floor debate and earlier in the Health, Education, Labor, and Pensions Committee consideration of the Patients' Bill of Rights, I asserted strong positions on several key components of the managed care reform debate. I wish, once again, to reiterate my support for adoption of a bill that protects consumers, improves the system of health care delivery and shrinks the rolls of the uninsured. I will do everything I can to prevent increasing the number of uninsured. I believe that as we consider a bill as important as the Patients' Bill of Rights, we must never lose sight of our shared goal of having a strong bill. The politics should be left at the door in our effort to emerge with the best policy for patients. That was the commitment the principals in the conference made to the public more than a year ago. I really cannot go further without commenting on that conference. I have been told by my more senior colleagues that Members have never logged as many hours in trying to thoroughly understand and work a bill as we did last year. The effort was not in vain. We learned a tremendous amount about the value of enacting a good Patients' Bill of Rights. We also learned that preserving access to quality health care is the most important patient protection we can provide to consumers. Together, Senators Gregg, Frist, Gramm, Jeffords, and Hutchinson, Chairman Nickles, and I demonstrated every day our commitment to doing the right thing for patients. I offer a special thanks to Senator Nickles for being a patient gentleman as he led us through this negotiation process. I do think, as that process went on, some saw the possibility that we would complete it. Most of us thought it would be completed. Some thought it was better as an issue than a solution and jumped out of the processes and started bringing votes back here in this Chamber. We could have had this done last year. All of the bills we have ever considered, including the bill before us today, have offered a series of patient protections to consumers-- direct access to OB/GYN and pediatric providers, a ban on gag clauses, a prudent layperson standard for emergency services, a point-of-service option, continuity of care, and access to specialists--that would provide all consumers many of the same protections already being offered to State-regulated health plan participants. This is a bill for managed care. There are already State protections for State-regulated health plan participants. Additionally, health plans would be required to disclose extensive comparative information about coverage of services and treatment options, networks of participating physicians and other providers, and any cost-sharing responsibilities of the consumer. All of these new protections are crowned by the establishment of a new, binding, independent external appeals process, the linchpin of any successful consumer protection effort. While I still do not believe that suing health plans is the biggest concern of consumers, holding health plans accountable for making medical decisions is a key component of a Patients' Bill of Rights. For the record, I believe the biggest concern of patients is getting the best health care they can get, right when they need it most, not the ability to sue. Most people I know value their health over all else. Money does not buy happiness, but good health can make a nice downpayment. Our success will absolutely be measured by whether we get patients the medical treatment they need right away. Everyone agrees that the essential mechanism is an independent, external appeals process. The last thing we should do is establish a system that would require patients to earn their care through a lawsuit. It is for this very reason that the bill I will support securely places the responsibility for medical decisions in the hands of independent medical reviewers whose standard of review is based on the best available medical evidence and consensus conclusions reached by medical experts. These decisions would be binding on health plans. One of the specific concerns that will be directly addressed by the independent review process is that of the ``medical necessity or appropriateness'' of the care requested by the patient and their physician. Consumers and health care providers have repeatedly requested that there be a prohibition on health plans manipulating the definition of ``medical necessity'' to deny patient care. I think all of the bills have attempted to address this concern. I do have concerns, however, about how the bill before us goes beyond addressing this concern and obviates the health care contract altogether, eliminates the contract altogether. Imagine trying to price the contract if you do not know what the contract contains. That provision will have to be fixed in the final bill. The issue of ensuring that patients receive medically necessary and appropriate care they have been promised in their contract has been addressed by a number of States already through the appeals processes they have established. Many employers and health plans already voluntarily refer disputed claims to an independent medical review. But when it comes to formal Federal action pertaining to the employer plans regulated solely by the Department of Labor, we are just now examining how to proceed. In other words, it works at the State level; it has not worked at the Federal level. Now we are considering a Federal solution. Since its inception in 1974, this is the first major reform effort of ERISA, the Employee Retirement Income Security Act, as it pertains to the regulation of group health plans. The focus of the mission-- regardless of politics--should be to protect patients. Protecting patients means not only improving the quality of care but expanding access to care and allowing consumers and purchasers the flexibility to acquire the care that best fits their needs. This leads me to another concern I have with the bill before us. It requires States to forsake laws they have already passed dealing with patient protections included in the bill if they are not the same as the new Federal standards. The technical language in the bill reads ``substantially equivalent,'' ``does not prevent the application of,'' and under the process of certifying these facts with the Secretary of Health and Human Services, the State will have to prove that their laws are ``substantially equivalent and effective patient protections.'' The proponents of this language say it will not undo any existing State laws that are essentially comparable. But that is not what their bill requires. Instead, when I see the requirement of ``substantially equivalent,'' I read that if there is any difference, then they are obviously not equivalent and do not meet the test. What does ``substantial'' mean? And how does it modify ``equivalent'' at the end of the day? These questions are not being answered. Is it that the proponents aren't overly concerned with the implementation of the law versus being able to say that their bill meets the political test of covering all Americans, regardless of existing meaningful protections that State legislatures have enacted? If the laws just have to be comparable, then why don't we use that phrase? I am very leery of one-size-fits-all legislation. Every State has differences, geographical differences, differences in the mix of people, differences in distance, differences in climate, and, more particularly, differences that affect medical care. In Wyoming we have few doctors, we have few people, and we have lots of miles. We do not have competing hospitals anywhere in the State. And we have a need for doctors--I love this--we have a need for doctors, including veterinarians, in every single county. I will get into this issue in more detail as the debate proceeds. I do believe we can strike a compromise on the matter of scope, but I cannot state strongly enough my objection to wrenching from States their authority to regulate on these matters. The only hard proof we have right now is that States are, by and large, good regulators, while the Federal Government has done a lousy job regulating on behalf of its health care consumers. The General Accounting Office has been reporting that to us since we passed the Health Insurance Portability and Accountability Act, HIPAA, in 1996. And that is the consumer enforcement protection mechanism around which the bill is written. I know I am on the verge of sounding like a broken record, but I would like to sketch out the effect of the bill's scope, as it is currently drafted. It is done best with a story about Wyoming. Wyoming, as I mentioned, has its own unique set of health care needs and concerns. Every State does. For example, despite our elevation, we do not need the mandate regarding skin cancer that Florida has on the books. My favorite illustration of just how crazy a nationalized system of health care mandates would be comes from my own time in the Wyoming Legislature. It is about a mandate for which I voted and still support today. You see, unlike in Massachusetts or California, in Wyoming we have few health care providers, and their numbers virtually dry up as you head out of town. We can see every single town by driving outside of it. They do not run together anywhere. So we passed an ``any willing provider'' law that requires health plans to contract with any provider in Wyoming that is willing to do so. While that idea may sound strange to my ears in any other context, it was the right thing to do for Wyoming. I know it is not the right thing to do for Massachusetts or California. I wouldn't dream of asking them to shoulder that kind of a mandate for our sake, when we can simply responsibly apply it within our borders. What is even more alarming to me is that Wyoming has opted not to enact health care laws that specifically relate to HMOs because there are no HMOs in the State, with one exception, which is very small and is operated by a group of doctors who live in town. They are not a nameless, faceless insurance company. Yet under the proposal the Democrats insist is best for everybody, the State of Wyoming would have to enact and actively enforce at least 15 new laws to regulate a style of health insurance that doesn't exist in the State. What Wyoming does currently require is that plans provide information to patients about coverage, copays, and so on, much as we would in this bill; a ban on gag clauses between doctors and patients; and an internal appeals process to dispute denied claims. I am hopeful the State will soon enact an external appeals process, too. This is a list of patient protections that a person in any kind of health plan needs, which is why the State has acted. But requiring Wyoming to enact a series of additional laws that don't have any bearing on consumers in our State is an unbelievable waste of a citizen legislature's time and resources. Let me explain a citizen legislature. In Wyoming, they meet for 20 days one year and 40 days the next year. They do no special sessions. If you are only employed as a legislator--and I use that term loosely on being employed because they hardly get paid anything--for 20 days one year and 40 days the next year, you have to have a bona fide job. You have to have real work in the real world. And they do. So they meet for 20 days one year--and incidentally, the 20 days is the year that they do the budget work, and they make it balance every time--20 days one year and 40 days the next. You have to live the rest of the year under the laws that you passed, which gives you a different perspective on laws than perhaps in States where the legislature meets for longer periods of time and definitely a different perspective than we have in this body. That is a citizen legislature. Speaking of limited resources, I would be remiss if I didn't touch once more on our most important charge in the debate; that is, to preserve Americans' access to health insurance. If we make it too difficult for employers to voluntarily provide health care to their employees, then it should come as no surprise to any of us that they will simply stop volunteering to do so. Insurance for most businesses is a volunteer effort. I won't support a bill that denies people access to health care. If my colleagues don't believe me now, they can bet their constituents will come calling when they lose their insurance or have it priced forever beyond their reach. Sometimes changes we make in the Senate drive up the cost, as the Senator from Tennessee was explaining earlier. For every 1 percent that costs go up, 300,000 people in this country lose their insurance. I will make a promise to my own constituents right now that I will work hard to enact a Patients' Bill of Rights. I will fight any measure that threatens their access to health care. I will reserve further remarks until we delve into the process of considering the different provisions of the bill. I, again, extend the hand of compromise and the offer to all of my colleagues that we rally around our common position on many of the patient protections and forge ahead on the rest of the bill towards an end that has an eye on what is best for the patients. This bill is about them. If someone else is benefiting from a provision, then I would suggest that our drafting is not quite done. There are some of those provisions. I look forward to my continued role in the process. I thank the Chair and reserve the remainder of any time we have.

Mr. ENZI

Mr. ENZI. Boy Scouts has been a part of my education. I am an Eagle Scout. I am pleased to say my son was in Scouts. He is an Eagle Scout. I say it is part of my education because each of the badges that is earned, each of the merit badges that is earned, is an education. I tell schoolkids as I go across my State and across my country that even though at times I took courses or merit badges or programs that I didn't see where I would ever have a use for them, by now I have had a use for them and wish I had paid more attention at the time I was doing it. Boy Scouts is an education. It is an education in possibilities for careers. I can think of no substitution for the 6 million boys in Scouts and the millions who have preceded them. There are dozens on both sides of the aisle who have been Boy Scouts. I always liked a merit badge pamphlet on my desk called ``Entrepreneurship.'' It is the hardest Boy Scout badge to earn. It is one of the most important ones. I believe small business is the future of our country. Boy Scouts promote small business through their internship merit badge. Why would it be the toughest to get? Not only do you have to figure out a plan, devise a business plan, figure how to finance it, but the final requirement for the badge is to start a business. I could go on and on through the list of merit badges required in order to get an Eagle badge. There are millions of boys in this country who are doing that and will be doing that. They do need places to meet. They are being discriminated against. They are being told they cannot use school facilities. It isn't just school facilities; it is Federal facilities. A couple of years ago, we had an opportunity to debate this again on floor, and it had to do with the Smithsonian. Some Boy Scouts requested they be able to do the Eagle Scout Court of Honor at the National Zoo and were denied. Why? The determination by the legal staff of the Smithsonian that Scouts discriminate because of their support for and encouragement for the spiritual life of their members. Specifically, they embrace the concept that the universe was created by a supreme being, although we surely point out Scouts do not endorse or require a single belief or any particular faith's God. The mere fact they asked you to believe in and try to foster a relationship with a supreme being who created the universe was enough to disqualify them. I read that portion of the letter twice. I had just visited the National Archives and read the original document signed by our Founding Fathers. It is a good thing they hadn't asked to sign the Declaration of Independence at the National Zoo. This happens in the schools across the country. Other requests have been denied. They were also told they were not relevant to the National Zoo. That is kind of a fascinating experiment in words. I did look to see what other sorts of things had been done there and found they had a Washington Singers musical concert, and the Washington premiers for both the ``Lion King'' and ``Batman.'' Clearly, relevance was not a determining factor in those decisions. But the Boy Scouts have done some particular things in conservation that are important, in conservation tied in with the zoo. In fact, the founder of the National Zoo was Dr. William Hornaday. He is one of the people who was involved in some of the special conservation movements and has one of the conservation badges of Scouts named after him. If the situations did not arise, this amendment would not come up. But they do arise, as I mentioned with the list of eight incidents already this year. Four of those are on a statewide basis. Last summer the Supreme Court in Boy Scouts of America v. Dale held that the Boy Scouts were entitled to full protection under the first amendment right of expressive association. The High Court held that State laws such as New Jersey's law of public accommodation unconstitutionally violated the first amendment rights of this venerable organization if they were applied to force the Boy Scouts to accept Scoutmasters whose lifestyles violated the Boy Scout oath. The Helms amendment will ensure that public schools that receive public education funds do not force the Boy Scouts to check their first amendment rights at the schoolhouse door. The Helms amendment simply requires that the Boy Scouts are treated fairly, as any other organization, in their efforts to hold meetings on public school property. It does not require public schools to open their doors to any organization for before- or after-school meetings on public school property. It provides if the school is going to provide an open forum for youth or community groups before or after school, that school must allow the Boy Scouts the chance to use school property for their meetings. Unfortunately, many school districts are bending to the pressure of far left interest groups in their attempt to deny the constitutional rights of the Boy Scouts of America. A number of school districts have prohibited the Scouts from meeting on public school property or have pressured local Scouting troops to denounce their very principles on which the organization was founded before they can have meetings there. An example of this discrimination is in Broward County, FL, where the school board voted last November to prohibit the Boy Scouts of America from using public schools to hold meetings and recruitment drives. This is part of a growing trend of local schools, which are imposing viewpoint discrimination against the Boy Scouts because they disapprove of the Scout's message and the way they put this message into practice. Fortunately, the Federal courts have not looked favorably on this viewpoint of discrimination against the Boy Scouts in the early legal challenges to these actions. In March of this year, the U.S. District Court for the Southern District of Florida issued a preliminary injunction against the Broward County School District to block their attempt to keep the Boy Scouts off public school property. The district court found that since the school district allowed numerous other groups to use public school facilities, they had established a limited forum. Accordingly, they were not allowed to discriminate against Boy Scout speech simply because they disagreed with the Scout's viewpoint on homosexuality. In granting this injunction, Judge Middlebrooks wrote: The constitutional rights to freedom of speech or expression are not shed at the school gate. I have to mention, these are examples of where the Scouts were able to use the courts to assure that they were not discriminated against. I am pretty sure everybody in America recognizes if you have to use the courts to get your rights to use school buildings, it costs money. It costs time. This amendment eliminates that cost and eliminates that time, to allow the organizations to have the same rights as the other groups at school. It is unfortunate, sometimes, that we have--the legal system is very important in the country but it has some interesting repercussions. Our system of lawsuits, which sometimes are called the legal lottery of this country, allow people who think they have been harmed to try to point out who harmed them and get money for doing that. It has had some difficulties for the Boy Scouts. I remember when my son was in the Scouts their annual fundraiser was selling Christmas trees. One of the requirements when they were selling Christmas trees was that the boys selling trees at the lot had to be accompanied by two adults not from the same family. I did not understand why we needed all of this adult supervision. It seemed as if one adult helping out at the lot would be sufficient. The answer was, they have been sued because there was only one adult there and that adult was accused of abusing the boys. Two adults provided some assurance that did not happen. The interesting thing is, it was just me and my son at the lot and we still had to have another adult in order to keep the Boy Scouts from being sued. They run into some of the same difficulties with car caravans. So the legal system of this country has put them in the position where they are doing some of the things that they are doing. The legal system of the country has caused some of the discrimination that is done. It is something we need to correct. This discussion of the Helms amendment is timely. On Monday of this week, the Supreme Court held that a public school in New York was not allowed to exclude the Good News Club, which is a private Christian organization for gradeschool children, from using public school facilities for the group's afterschool meetings. In the Good News Club v. Milford Central School, the Court determined that the school violated the club's first amendment free speech rights by discriminating against the group's viewpoint. The Helms amendment would assure that these free speech protections would also apply to the Boy Scouts of America. The Boy Scouts of America is one of the oldest and largest youth organizations in the United States and the world today. The organization teaches its members to do their duty to God, to love their country, and serve their fellow citizens. The Boy Scouts have formed the minds and hearts of millions of Americans and prepared these boys and young men for the challenges they are sure to face the rest of their lives. It is an essential part of Americana. I urge my colleagues to join me in defending the Boy Scouts from constitutional discrimination by supporting the Helms amendment. Exhibit No. 1 examples of boy scouts being discriminated against On May 21, 2001, the Gay, Lesbian and Straight Education Network--an activist homosexual organization--reported that ``After launching a campaign last September [against the Boy Scouts] the Gay, Lesbian and Straight Education Network has tracked a total of 359 school districts which have severed sponsorships with the Scouts since the Supreme Court ruling last June'' [www.glsen.org]. On May 11, 2001, the Associated Press reported that the Iowa City School board voted to prohibit the Boy Scouts of America from distributing any information in schools because of the Scouts membership criteria. Greg Shields, the national spokesman for Boy Scouts of America said, ``We simply ask to be treated the same way as any other private organization . . . [and] that our free speech and right to assemble be respected just as we respect those rights of others. On February 8, 2001, the Ashbury Park Press reported that the State [of New Jersey] is considering a rule change that would bar school districts from renting space to the Boy Scouts of America because of their position on homosexuality. On February 7, 2001, The Arizona Republic reported that the Sunnyside School District, in Tucson [two-sawn], Arizona decided to charge the Boy Scouts of America fees to use school facilities, even though no other groups have to pay fees. The ACLU executive director said that, ``While Boy Scouts, atheists, Nazis, even Satanists have the right to express their views, government should not use public money to promote them.'' On January 28, 2001, the Boston Globe reported that the Acton School Committee in Massachusetts decided to prevent the Boy Scouts from distributing literature at school--even though other groups can do so. In defending its actions, Acton School Committee cited Massachusetts law, which says that schools cannot sponsor the Boy Scouts. On January 14, 2001, the New York Times reported that New York's Chappaqua School District officials were about to coerce two local Boy Scout troops into signing a document that denounced the national policies of the Boy Scouts of America as a condition for allowing these troops access to school property. On January 13, 2001, the Wisconsin State Journal reported that the Madison School Board voted unanimously to post a condemnation against the Boy Scouts of America in all 45 school districts. On January 11, 2001, the News & Observer reported that ``The Chapel Hill-Carroboro school board voted to give Scouts until June to either go against the rule of their organization or lose their sponsorship and meeting places in schools.'' On December 18, 2000, the Seattle Union Record reported that a state coalition of advocates for gay and lesbian students has asked Seattle Public Schools to restrict the Boy Scouts of America's access to students and school buildings. On December 2, 2000, the New York Times reported that the Schools Chancellor barred New York City public schools from: bidding on contracts with city schools, sponsoring Scout troops or allowing the Scouts to recruit members during school hours. On November 20, 2000, the Associate Press reported that in Mount Pleasant, Michigan, School boards in Minneapolis and New York City, as well as other city and state governments and groups nationwide, have recently cut support of the Scouts because of its gay policy. In the Detroit suburb of Plymouth, a teachers union asked its school board to ban groups--including the Boy Scouts--that discriminate against gays. On November 16, 2000 Fla. Today reported that ``Broward County's school board voted unanimously to keep the Boy Scouts of America from using public schools to hold meetings and recruitment drives because of the groups ban on gays.'' [District Court intervened.] On November 15, 2000 the Telegram and Gazzete reported that in Worchester, Ma, ``Superintendent of Schools Alfred Tutela . . . banned the Boy Scouts from holding meetings in the properties of the Wachusett Regional Schools District.''

Mr. ENZI. Madam President, I rise in support of amendment No. 648, the Boy Scouts of America Equal Access Act, offered by my distinguished colleague from North Carolina, Senator Helms. I am certain, with some modifications, any of the inflammatory groups that have been mentioned will be excluded from the amendment. The amendment was intended to be simple and straightforward in its purpose, to ensure the constitutional rights of 6 million Boy Scouts in the United States are not violated by public schools that receive Federal education funds. The Boy Scouts of America is one of the oldest and largest youth organizations in the United States and in the world today. The organization teaches its members to do their duty to God, to love their country, and to serve their fellow citizens. And they do that. The Boy Scouts have formed the minds and hearts of millions of Americans and prepared these boys and young members for the challenges they are sure to face for the rest of their lives. I urge my colleagues to join in defending the Boy Scouts from unconstitutional discrimination by supporting the Helms amendment. It has been said earlier in the discussion that this is an unnecessary amendment. It brings to mind two things. First, when did we stop doing unnecessary amendments around here? And second, this would not be brought up if it were not necessary. I have had a number of opportunities, needs that should never have happened, to defend the Boy Scouts and make sure they have places to meet. I have a list of five times it happened during the year 2000, and eight times already this year. This is a young year. An Iowa city school board voted to prohibit Boy Scouts from distributing any information in schools because of Scouts' membership criteria. Greg Shields, the national spokesman for Boy Scouts of America, said, ``We simply ask to be treated the same way as any other private organization . . . [and] that our free speech and right to assemble be respected just as we respect the rights of others.'' The New York Times reported that New York's Chappaqua School District officials were able to coerce two local Boy Scout troops into signing a document that denounced national policies of the Boy Scouts as a condition to allowing the troops access to school property. I ask unanimous consent this list be printed at the end of my statement.

Mr. ENZI. I rise in opposition to the amendment and point out one of the real values of Boy Scouts is that it isn't designed to be competitive. It isn't designed to see who is the best Boy Scout, who has the most merit badges, who has better merit badges. It is designed to teach young men good values. It is designed to teach young men about the world. It is designed to teach young men about possible careers. That is being thwarted. I will not repeat everything I said this morning. I am sure that is a relief. I hope Members look at the record. I am convinced they did not pay attention when I spoke earlier. An important point: The record of five cases a year ago, where the Boy Scouts had to go to court. We are not talking hypothetical; we are not talking about the possibility that somebody's constitutional rights were violated. We are talking about actual situations. Some of those will be resolved over the years at great cost. We are not talking hypothetical on the cost either. I am not going to pretend to be a constitutional lawyer because I am one of the few people here who is not a lawyer at all. But I was a Boy Scout. I am watching what is happening to the Boy Scouts in this country. Five times in the year 2000, this instance came up. I have to tell you, already this year, eight times. That is just ones that I was able to find, which means they are ones that made national press. It doesn't mean it is all the instances of it happening. The five last year and the eight this year are cases where it happened in school. I am not talking about all of the discrimination that there is out there against the Boy Scouts. I am just talking about in school. We cleared up the definitional problem that I think would have made that a near unanimous vote before. It should have made it a near unanimous vote before. Now we have an amendment that tries to eliminate anything that the Helms amendment could have done. Here is how it eliminates it. It does it in two ways. It eliminates the enforcement mechanism. There was not anything in the Helms amendment that automatically took money away from schools. There was a review process. If the review process said they discriminated, there was the possibility that they would lose their funds. Enforcement: There is no enforcement in this amendment. It may say what the Constitution says, but it doesn't provide enforcement. The amendment we agreed to before, that provides enforcement. The second problem is this one allows discrimination against the Boy Scouts. The wording in here does not preclude--this is a big problem with the school--does not preclude charging them exorbitant rates. They would still have equal access; they would have, depending on how you took it to court, a fair opportunity. But it would not be the same thing as in the Helms amendment where you could not be charged discriminatory fees to keep the Scouts out. Every one of those things would require another court action. I am not an attorney. I am told a lot, when I go back to Wyoming, that one of the problems in this country is we have too many attorneys. They talk about the old towns in the West where the first attorney came to town and he went broke. In other towns the first attorney came to town, he was accompanied by another attorney, and they both did very well. That is what is happening to the Boy Scouts. We have enough attorneys; they can all do very well at the expense of the Boy Scouts. The dollars being spent on litigation ought to be spent on good programs for youth. We have been talking throughout the education bill about the need to do things for youth, the need to have kids taken care of after school. This is an organization where you do not take care of the kids after school, the kids help take care of us after school. We are talking about a communitarianism group, a group focused on helping their community through their volunteer efforts. In order to get your Eagle award you have to do a community project-- not a personal project, not a family project. It has to be a community project. So these kids get to find out what voluntarism is. It is not voluntarism for them. It is that grand distinction; it is for other people, that chance to do something for other people. We need to make sure every time we can get a free program such as the Boy Scouts that will teach character and take care of the community, we do everything we can to promote it. We have taken care of this through the Helms amendment. We can destroy it through the Boxer amendment. I yield the floor.

Mr. ENZI

Mr. ENZI. I wanted to speak on the Helms amendment, as well.

Mr. ENZI

Mr. ENZI. Mr. President, we are debating education, and we are debating a new direction in education. That is what the overall difference is that I address in the amendment. The new direction we are talking about is increased flexibility so that the schools can use the money to the best advantage possible. I am really pleased to see a lot of funds come to Wyoming. But there was a small amount that we could not use. By the time we wanted to hire the required administrator, there was no money left in the program. Now we will be able to combine those programs and have fewer administrators and, hopefully, less paperwork. To listen to the debate, it grows more and more to sound as if the Federal Government should fund all of education. The States fund 93 to 94 percent of education. What we are trying to do is to allow them to use the money--that little bit of money they get from the Federal Government--as effectively as possible. I had an intern who worked for me. He had been a principal at a school and he got a leave of absence. He came to Washington and did a little checking to see what happened to the paperwork he had to fill out for years and years. He was delighted to find that every piece of paper he sent back to Washington was well read. It was examined to make sure every t was crossed and every i was dotted. It was examined to make sure every blank was filled in, and that it was filled in properly. What he was disappointed to find out was that that was the end of the road for that piece of paper. We provide 6 to 7 percent of the money, depending on whose figures you use, and we force over 50 percent of the paperwork. How do we do that? We build a huge bureaucracy in Washington. Every time we do a new program or add more funding to a program, we hire more bureaucrats in Washington; the money does not get to the classroom. Throughout the debate, you will hear that we do not provide the money for--fill in the blank--or we do not provide enough money for--fill in the blank. Remember, what the Federal Government is doing is providing about 6 to 7 percent of the local funds. It is a State responsibility to provide education. They have been doing it. They have had the main role in doing it. In Wyoming, we have a provision in our State constitution that says all children will have an equal opportunity for education. We have had court cases over the years that have determined the money has to go to the State and the State has to distribute it on an equal basis, so that all kids get an equal education. That is a difficult thing to do. We have a lot of rural communities. When you have rural communities, they have different needs and different capabilities than a city. A big high school in a city might be able to provide a wide range of courses. A small rural area might only be able to offer the basic courses. Is that an equal education? It is very difficult to determine. But it sounds to me, from a lot of the discussion, that it is time we press the States to make sure they are providing an equal education. It has not been our fault that some schools get a lot more funding and some schools get a lot less funding. There are some exceptions, and we try to take care of those exceptions. But I do not think we are placing nearly enough pressure on the States to do the job of having equality that would solve a lot of the problems we are talking about in this Chamber. But today I mainly want to talk about the issue of technology. Senator Dorgan brought that up early this morning. He and I have an amendment on which we have been working. Senator Cantwell and I have been working on another amendment. Mr. President, as a former computer programmer and someone who is very interested in technology and all its applications, I am glad to know that increasing access to technology has been receiving national attention. While technology can never replace a caring, qualified teacher or involved parents, it can open a child's eyes to worlds they might otherwise never have a chance to experience. I firmly believe that the educational opportunities afforded by technology can and should be harnessed in a child's pursuit of academic success. There is also evidence that the need for skilled workers is rising and technology is becoming an increasingly valuable asset as students move from the classroom into the job market. I have been disappointed to see that over the past few years the Federal Government has tried to support educational technology through a fragmented set of programs with money flowing through multiple bureaucratic agencies. This kind of disorganized Federal funding has generated tremendous amount of bureaucratic redtape that has not helped States and local school districts ensure that all children have access to technology. The legislation that we are debating today, the overall bill, S. 1, the Better Education for Students and Teachers Act, changes all this. It consolidates current technology programs authorized through the Elementary and secondary Education Act to create a targeted State formula program geared towards improving the use of technology in the classroom. This change in the structure of Federal technology programs is a great thing for small or predominantly rural States such as Wyoming, which may not receive enough money from a particular categorical program, as I mentioned earlier, to effectively achieve the goal of increasing technology. When this legislation passes, Wyoming will have the ability to use Federal funds to implement the technology programs they believe will be most useful to students. This legislation also makes it easier for States that may not have the resources to hire a professional grant writer and are therefore at a disadvantage when it comes to applying for the competitive grants that have traditionally been used to allocate technology funding. Under this new formula, States will have the flexibility to implement technology to support and expand school reform efforts with a focus on improving student achievement and academic performance, provide ongoing professional development to help integrate technology into school curriculum, acquire hardware and software, and repair and maintain school technology equipment. The Better Education for Students and Teachers Act supports a comprehensive system to effectively use technology in elementary and secondary schools to improve academic achievement and student performance. Specifically, the goal of title II, part C of this legislation is to assist every student in crossing the digital divide by ensuring that every child is technologically literate by the time they finish the eighth grade. I am pleased to report that Senator Dorgan and I have completed work on an amendment that will help to give rural schools comprehensive assistance to make sure that our children have the technological background they will need to be successful in the 21st century. Senator Cantwell and I have also drafted an amendment that will help ensure that the findings of the Web-based Education Commission, of which I was a member, are used to allow States and local school districts to effectively implement technology in a variety of areas. With the increasing national focus on technology, I am pleased to report the State of Wyoming has determined that technology is so critical to their educational success that they have put considerable time and effort into the development, ongoing implementation, and revision of a comprehensive education technology plan. This plan does a great job of identifying Wyoming's needs, defining our infrastructure requirements, articulating goals for educational technology, and proposing strategies for achieving these goals. It was complied by teachers, school boards, communities, libraries, State agencies, businesses, and other interested citizens from around the State. Wyoming outlined some ambitious objectives in their technology plan, such as establishing educational partnerships among public and private entities, implementing improved professional development geared towards technology, integrating technology into instructional delivery systems, providing equal access to interactive information resources for all students, and creating an evaluation process to determine if their plan is working. As Federal legislators we must clear away any obstacles and unnecessary redtape that would slow or stop the implementation of the goals that so many people in Wyoming have worked so hard to develop. I would also like to stress that the appropriate use of technology in education can and should go beyond the classroom. For example, Wyoming has also done a great job of utilizing Federal technology funds in an innovative way by establishing a website--that is, www.wyoming.edgate.org_that provides services for students, teachers and parents. If you want to know how your child's school is doing, you can go to the web site and find out. This website also allows teachers to access innovative curriculum ideas, gain information about professional development options, or access the latest information on teaching techniques. Students can get help on their homework. They can view notes from their teachers, or even research a science project. Parents have the ability to check on their child's homework assignments, gain information on options for paying for college, get ideas about how to talk to their kids about drugs, or even check their school's test scores to ensure instant accountability. While Wyoming was able to use Federal funds for this program, current law required the State to expend valuable time and resources to get a waiver from the Federal Government. I am also very pleased with Wyoming's efforts to develop a distance education system that will allow kids in any high school across the State to participate in courses such as advanced placement English and calculus, Japanese, Russian, art history, sociology, anthropology, and on and on. It has made selection of classes in the very rural schools much greater than it was before. Considering the rural and sometimes geographically isolated nature of some of Wyoming's communities, it is a tremendous asset. This type of distance learning will allow an unprecedented level of educational equity in my State, where students in small schools that serve 20 students or less will be able to receive the same diversity in course offerings as students in the much larger schools. It will also allow areas that have difficulty recruiting and retaining teachers to share in the teaching expertise of other areas of the State without traveling the miles and miles and miles. The same distance learning system also provides Wyoming with great opportunities for providing continuity in our professional development programs. Teachers from around the State will now have the chance to participate in proven and effective professional development that will improve the educational opportunities for all of our students. Speaking of professional development efforts that incorporate technology, I have been very impressed by the work of project WYO.BEST. This pilot program in Platte County School District No. 1 in Wheatland, WY, has been working to help teachers improve their ability to teach in a standards-based, technology-enriched environment geared towards improving student learning and achievement, and they have been doing this since 1997. Over 100 teachers in southeast Wyoming have received sustained training and mentoring in student-centered instructional approaches, in standards-based instruction, and in technology integration. All of this has been done under the guidance of their director of instruction, Roger Clark. I take this opportunity to commend him for his efforts. The progress that has been made by the State of Wyoming is impressive, but we are certainly not alone. States across the country have been making tremendous progress not only in incorporating effective uses of technology in the classroom but in preparing students to pursue technical careers after graduation. A good example of this is the PPEP TECH High School in Tucson, AZ, which I recently had a chance to visit. This school is part of a publicly financed statewide system that provides an alternative educational program for students age 15 through 21 in grades 9-12. The school's primary focus is on providing high academic standards and technological training for the children of migrant and seasonal farm workers in rural Arizona and for at-risk students, high school dropouts, or students who work. Each student is actively engaged in an individualized educational program that helps them obtain a high school diploma, improve their job skills, and continue on the postsecondary education. Laptop computers and 1-800 numbers allow the children of migrant workers to move frequently and still work with the same teachers. They submit their homework; they get their grades by using the Internet. Here is an effort to make sure that no child is left behind. I have also been very impressed with the efforts of an organization called the JASON Project. This organization offers students and teachers in grades 4-9 a comprehensive multimedia approach to enhanced teaching and learning in science, technology, math, geography, and associated disciplines. Included in the project's components are State- aligned curricula, video programming, satellite transmissions, on-line activities, and professional development training. Hands-on learning is provided for the visual learners, while sounds help oral learners to achieve. I am pleased to report that 35 teachers in Freemont County, WY, are currently preparing to receive training that will enable them to participate in this program. The JASON Project provides a new program topic each year. For example, the 2001-2002 school topic of ``Frozen Worlds'' will take students and teachers on a virtual adventure of some of the colder regions of our planet and solar system, such as Alaska and the polar regions. Students will then examine research questions such as what are the dynamic systems of earth and space; how do these systems affect life on earth; what technologies do we use to study these systems; and why. As you can see, there are many options that allow teachers and students to integrate technology into the classroom. Our first responsibility as Federal legislators is making sure States and local school districts have the ability to implement the programs they feel are most effective. Once again, I commend my colleagues on the Health, Education, Labor and Pensions Committee on their hard work on this legislation. I intend to support S. 1 and any other legislation that helps States such as Wyoming by giving them the flexibility they need to determine the best way they can help their own students gain access to technology. I encourage my colleagues to do the same. Mr. President, I yield the floor and reserve the remainder of my time.

Mr. ENZI

Mr. ENZI. I suggest the absence of a quorum.

Mr. ENZI. I thank the Chair. (The remarks of Mr. Enzi pertaining to the introduction of S. 984 are located in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

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

Mr. ENZI

Mr. ENZI. Madam President I rise today to introduce the Veterans Road to Health Care Act 2001. This legislation would raise the travel reimbursement rate for veterans who must travel to Veterans Administration hospitals for treatment. The current reimbursement for veterans is 11 cents per mile. This bill would raise that figure to match the Federal employees travel reimbursement rate which is 34.5 cents per mile. The average price for gas in Wyoming right now is $1.63 per gallon. I know it varies across the Nation. The current rate of 11 cents per miles barely makes a dent in the expenses incurred by veterans who have no choice but travel by automobile for health care. I have received numerous letters from veterans in Wyoming describing how difficult it is to work into their budget the money necessary to travel between their hometown and the VA hospital. Being able to access health care is vital, it should not be a choice between driving to receive needed treatment or being able to afford other necessities. In Wyoming, we have two VA hospitals, one in Cheyenne and one in Sheridan. Veterans have to travel to one of these facilities to be treated for health conditions and be covered by the health care plan that the military provides for them. This poses a serious problem in terms of travel expense, especially with the rise in gasoline prices. It was a problem before; it is a bigger problem now. Some of the largest towns in Wyoming like Evanston and Cody are over 300 miles away from the nearest VA facility. A veteran living in Evanston has to drive 360 miles to reach the nearest VA hospital, and from Cody it is about 300 miles to the nearest facility. This bill addresses the healthcare of veterans who have special needs. It would allow veterans who have been referred to a special care center by their VA physician to be reimbursed under the Travel Beneficiary Program for their travel to the specialized facility. This applies only to those veterans who cannot receive adequate care at their VA facility and who have a nonservice connected disability. This legislation is important to all veterans, but it is especially significant to those veterans who live in rural States, like my home State of Wyoming. Rural States are less populated, there is greater distance between towns and far fewer options for transportation. Wyoming has miles and miles of miles and miles. Cars are the main mode of transportation. In urban areas, there are more readily available health care facilities and more transportation options for accessing those facilities. There are subways and bus systems and the towns and cities and VA hospitals are closer together. I believe that the Government has a duty to compensate our service men and women for the sacrifices they made defending the freedoms of this country. With our current recruitment and retention problems in the military, I think it is our Nation's responsibility to give veterans the kind of access to healthcare they have earned through their service to our country. The rising cost of gasoline should not be the driving factor for a veteran to go untreated at veterans clinics. I strongly urge my colleagues to support this important bill. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ENZI

Mr. ENZI. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. ENZI. Mr. President, I rise in support of S. 896, the Restoring Earnings to Lift Individuals and Empower Families, or RELIEF Act of 2001. It is time we ease the tax burden on all American taxpayers and return part of the surplus to the people who created it. The legislation before us will benefit American taxpayers and improve our Nation's economy. The provisions of the RELIEF Act of 2001 include across-the-board rate reductions for all Americans, repeal of the death tax, reduction of the marriage penalty, doubling of the child credit, and increased incentives for retirement savings and education. This legislation incorporates some good principles of tax policy, such as encouraging investment, strengthening families, and rewarding savings. It takes an important step in the right direction toward a tax policy more worthy of a great nation. The RELIEF Act of 2001 will encourage economic growth and productivity by strengthening America's small businesses. Small businesses are the backbone of the American economy. They represent over 99 percent of all employers in America and employ half of America's private workforce. Small business creates 80 percent of all new jobs in America and accounts for bout 38 percent of the gross domestic product and half of the gross business product. Because of their ability to adapt quickly to changing market conditions, small businesses are nearly the sole source of job growth during times of economic recession. In short, if we want to provide a stimulus to the present economy, we should do all we can as soon as we can to help America's small businesses. The legislation before us will greatly help small businesses. First, it kills the death tax. It should come as no surprise to anyone that the death tax is one of the most destructive taxes to small businesses. In one foul swoop, this tax can demolish the work of several generations of entrepreneurs. The death tax rewards savings and investment with crippling tax rates that all too often force families to sell off their businesses just to pay their bill to the IRS. The death tax is a punitive tax on families by penalizing them for trying to pass on their life's labor to their children. I am pleased that this legislation axes the death tax and sends it to its grave where it belongs. Secondly, the RELIEF Act of 2001 will help stimulate the economy by empowering small businesses in their effort to provide more jobs, invest in their physical facilities, and develop new products that will benefit American consumers and our Nation as a whole. it is important for everyone to understand that most small business owners file their taxes as individuals. Most do not file as traditional C-corporations, but rather organize as sole proprietorships, partnerships, S- corporations or some other structure that allows them to file their taxes using the tax rates for individuals. Each and every one of these ``flow through'' businesses that has positive income will benefit from the tax relief before us. I would like to give my colleagues and the American people an idea of the number of small-business owners who would benefit under the rate reductions in the legislation before us. There are nearly 17\1/2\ million individuals who had income from sole proprietorships in 1999, the last year for which we have complete data. Each one of these 17\1/2\ million people will receive tax relief under this legislation. These might be retailers, dentists, general contractors, accountants, or people employed in any other number of occupations that provide the goods and services that we use every day. I should mention that these numbers only include taxpayers who had income from non-farm sole proprietorships and does not include business owners who may organize using other business entities, such as partnerships or S-Corporations. If we added in the people who file the schedule F for farm income and those who file schedule E for partnership income, the total would probably be in the neighborhood of 24 million. Since we don't have that data broken down by States, we will consider those small business owners who file as sole proprietorships. Keep in mind that the 17\1/2\ million is really the floor rather than the ceiling of small business owners who will benefit from the rate reductions in this bill. To give people an idea of how this tax bill will benefit their constituents, I would like to share some of the numbers from individual States. In my home State of Wyoming, there were 38,000 people with small business income in 1999. By passing this tax relief, each and every one of these business owners would have more money to put into their businesses and benefit the economy as a whole. Here is how this often works in the real world. Many of these businesses have a profit on paper which effectively puts these business owners into the highest tax bracket for any given year. If they didn't have to pay 40 percent of their income to the Federal Government, they would use this invest this money into their business by buying more inventory, building, remodeling, or re-tooling their physical facilities. Many of these businesses would use this money for testing, research and development of new products and technology which would in time greatly benefit the economy as a whole. In my home State of Wyoming, each of our 38,000 business owners are making a great contribution to our local communities and it is time we let them keep a little more of their own money so they can grow their businesses rather than grow the pork in the Federal budget. If you look at the other States, you will find that they also have significant number of small business owners who will benefit under the tax relief before us. Montana has 76,000 business owners who would benefit from this tax relief. Like Wyoming, many of these are Main Street businesses which form the backbone of the economy in our small towns and help perpetuate the western way of life. Colorado has 329,000 business owners who would benefit from this tax relief. Nebraska has 117,000 small business owners who would see their incomes rise from this tax relief. When you include the number of small business owners who operate farms, I expect this number would be considerable higher. Similarly, 486,000 small business owners in Georgia would find more money in their pockets if we pass the RELIEF Act of 2001. I have heard the criticism from some on the other side of the aisle that this tax cut is too tilted toward the rich. Some have said that the President's proposal would give millionaires the money to buy a new Lexus while it would only allow middle income people money to buy a new muffler. I really don't know what world they are living in, but I find it interesting that most of the people who are making these claims don't have any experience owning or operating a small business. I have heard a number of my colleagues on the other side of the aisle express great concern about the number of mega-mergers between multinational corporations over the past several years. They have argued that these businesses continue to swallow up their smaller competitors in many of our communities and all too often have the effect of eliminating any real local competition. As a former small business owner, I am very sympathetic to these concerns. My experience has taught me that the small, locally owned family businesses are much more likely to be active in their community. These are the businesses that constantly donate their goods and services to local charities, schools, and civic organizations in an effort to make their towns better places to live. Small business owners live in the same communities where they sell their products or offer their services and this is generally not true of the large, multinational corporations. Since most small businesses pay taxes under the individual rates, this legislation takes an important step in leveling the playing field with their large competitors. In short, if members of the U.S. Senate want to take one action this year that can greatly aid in the survival of America's more than 17\1/ 2\ million small businesses, they should vote for this tax relief legislation. Members will not have a better opportunity this year to register their support for America's Main Street business owners than the RELIEF Act of 2001. It is important to understand that we need to lower all the marginal rates to benefit our small businesses. According to treasury data, nearly two-thirds of the taxpayers who would benefit from lowering the top income tax rate are small business owners and entrepreneurs. Contrary to the stereotypes too often painted by the far left, most of the taxpayers in the top income tax bracket are not the idle rich. Now I have a little experience in owning and operating a small business. I owned operated a Main Street shoe store in Gillette, WY, for 26 years with my wife and our three children. Let me tell you, when I got a tax cut, I did not go out and buy a Lexus. I would take that money and make improvements to my store so that my business would be more successful in the future and I would be better able to provide the services and products that would benefit my family and my community. I wonder how these 17\1/2\ million small-business owners would feel if we told them ``you can't have a tax cut, because we don't trust you to spend your own money. You might just waste that tax cut on a luxury car. You better let us keep that money in Washington so we can continue to increase the size and scope of the Federal Government and have a little more control over every aspect of your lives.'' I don't know who my colleagues are talking with, but I trust the more than 38,000 small- business owners in my State to use their own money as they see fit. America's taxpayers are long overdue for a return of their surplus. Americans are shouldering the highest peacetime tax burden in our Nation's history. Both the level of taxation and our underlying tax policy are unjust and in desperate need of reform. For too long, we have punished marriage and savings, discouraged innovation and job growth, and punished the same small business owners that deserve much of the credit for our economic success over the past decade. It is time we listen to the more than 17\1/2\ million small business owners spread throughout our States, and our communities. It is they who will benefit from the RELIEF Act of 2001, and they in turn will help us by providing many of the goods and services that we will use every day. The RELIEF Act of 2001, will benefit every American taxpayer by allowing them to keep some of their own money. It will stimulate the American economy by rewarding entrepreneurship and job creation. It respects marriage and the family. It encourages savings and investment. It gives Americans greater freedom over their incomes and their futures. I applaud Chairman Grassley and Senator Baucus for their hard work in writing this legislation and bringing it before the Senate today. We should enact this legislation with all deliberate speed. I urge my colleagues to join me in supporting the RELIEF Act of 2001.

Mr. ENZI

Mr. ENZI. Mr. President, I will be making a motion on the germaneness of the amendment. First, this amendment is not quite as simple as the Senator from New Hampshire says. If a State has a sales tax, the cities, towns, and counties are desperately interested in this. They will not think it is appropriate to adopt a second-degree amendment that will preclude them from having any opportunity to continue the revenue on which they are counting for their schools and other forms of government. The retailers in our States will not be very happy with that simple change of policy allowing that tax to be destroyed. If a colleague is from a State that does not have a sales tax, he or she would want to vote against this amendment. The reason they would want to vote against it is because they would not want the other 44 States to take an opportunity later to take away a major source of their revenue. This needs a lot of work. There has been a bipartisan group of us working on this issue for almost a year. We have been working with the retailers, direct marketers, and all levels of government. The pending amendment is not germane to the provisions of the reconciliation measure. I, therefore, raise a point of order against the amendment under section 305(b)(2) of the Budget Act.

Mr. ENZI

Mr. ENZI. Mr. President, today the Senate will resume consideration of the reconciliation bill with 8 hours remaining for debate. Senator Gregg will be recognized momentarily to debate his amendment and will be followed by Senator Wellstone. Under the order, there will be up to 1 hour for debate on first-degree amendments and 30 minutes for debate on second-degree amendments. Votes on all amendments and final passage will begin at 6 p.m. Senators are encouraged to remain in the Chamber during votes in an effort to complete all action on the bill in a timely manner. I thank my colleagues for their attention. I yield the floor.