Michael Enzi

Mr. ENZI

Mr. ENZI. Yes.

Mr. ENZI. Yes.

Mr. ENZI. The Senator from Missouri is absolutely correct. They are required to carry multiple books.

Mr. ENZI. For the local companies, it would be $25 million to $30 million. We are talking about at least $300 million across the United States per year.

Mr. ENZI. They are, and we want them to be competitive without having to do all the mergers that were spoken of earlier.

Mr. ENZI. Absolutely, they have to be paid by consumers.

Mr. ENZI. I thank the Senator from Missouri for his comments. We have an opportunity to fix the system so it works the same for big companies and small companies so they all operate under generally accepted accounting principles, so the small rural guy is not doing all of the extra accounting that the big guys are not required to do.

Mr. ENZI. I ask for the yeas and nays.

Mr. ENZI. Will the Senator yield for a question?

Mr. ENZI. You would agree they all ought to be on the same accounting system?

Mr. ENZI. Mr. President, I ask for the yeas and nays on my amendment.

Mr. ENZI. Mr. President, in light of the last vote, I ask unanimous consent the yeas and nays be vitiated on the amendment.

Mr. ENZI. In light of the last vote, I ask unanimous consent the yeas and nays be vitiated on the amendment.

Mr. ENZI

Mr. ENZI. Mr. President, I rise to introduce a bill which will enable Devils Tower National Monument to retain its historic and traditional name. Wyoming is a state rich with heritage. We have cities and communities named after great explorers like John Charles Fremont, John Wessley Powell, and mountain man Jim Bridger. We have cities named after William F. ``Buffalo Bill'' Cody, Civil War Hero General Philip Sheridan and Army Fort Commander Caspar Collins. The state is also rich with names that recognize the contributions by Native Americans. Our state capital, Cheyenne, is joined with other areas named Shoshoni, Washakie, Arapahoe, Ten Sleep, Sundance and Shawnee. Wyoming also adopted many names that represent the unique geography that makes up our diverse state. For example, we have the Yellowstone, Riverton, Big Piney, Green River, Mountain View, Lonetree, and the Wind River Canyon. One such place, Devils Tower, was named in 1875 by a military survey team. You can imagine the impact on the group as it rode up to the tower more than 120 years ago. The gray volcanic tower sits on the plains of Northeastern Wyoming and shoots up, straight into the sky, for approximately one-quarter of a mile. Its rugged walls and round shape make it look something like a giant petrified tree stump. I live in the area and have visited the tower many times. I can attest that the name Devils Tower is clearly applicable. Along with Yellowstone National Park's Old Faithful, Devils Tower has become an icon of Wyoming and the West. This unique structure is known internationally as one of the premiere climbing locations in the world and therefore plays a vital role in the state's billion dollar tourism industry. I am, however, sensitive to the feelings of those Native Americans who would prefer to see the name of this natural wonder changed to something more acceptable to their cultural traditions. Many tribal members think of the monument as sacred. However, I believe little would be gained and much would be lost should Devils Tower be renamed. Any name change for Devils Tower would dredge up age-old conflicts and divisions between descendants of European settlers and the descendants of Native Americans and would place a heavy burden on the region's economic stability. My legislation will prevent such an impact and will embrace the least offensive option offered so far--the preservation of the traditional name of Devils Tower. I urge my colleagues to support this measure. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ENZI

Mr. ENZI. Mr. President, I rise to introduce a bill which will enable Devils Tower National Monument to retain its historic and traditional name. Wyoming is a state rich with heritage. We have cities and communities named after great explorers like John Charles Fremont, John Wessley Powell, and mountain man Jim Bridger. We have cities named after William F. ``Buffalo Bill'' Cody, Civil War Hero General Philip Sheridan and Army Fort Commander Caspar Collins. The state is also rich with names that recognize the contributions by Native Americans. Our state capital, Cheyenne, is joined with other areas named Shoshoni, Washakie, Arapahoe, Ten Sleep, Sundance and Shawnee. Wyoming also adopted many names that represent the unique geography that makes up our diverse state. For example, we have the Yellowstone, Riverton, Big Piney, Green River, Mountain View, Lonetree, and the Wind River Canyon. One such place, Devils Tower, was named in 1875 by a military survey team. You can imagine the impact on the group as it rode up to the tower more than 120 years ago. The gray volcanic tower sits on the plains of Northeastern Wyoming and shoots up, straight into the sky, for approximately one-quarter of a mile. Its rugged walls and round shape make it look something like a giant petrified tree stump. I live in the area and have visited the tower many times. I can attest that the name Devils Tower is clearly applicable. Along with Yellowstone National Park's Old Faithful, Devils Tower has become an icon of Wyoming and the West. This unique structure is known internationally as one of the premiere climbing locations in the world and therefore plays a vital role in the state's billion dollar tourism industry. I am, however, sensitive to the feelings of those Native Americans who would prefer to see the name of this natural wonder changed to something more acceptable to their cultural traditions. Many tribal members think of the monument as sacred. However, I believe little would be gained and much would be lost should Devils Tower be renamed. Any name change for Devils Tower would dredge up age-old conflicts and divisions between descendants of European settlers and the descendants of Native Americans and would place a heavy burden on the region's economic stability. My legislation will prevent such an impact and will embrace the least offensive option offered so far--the preservation of the traditional name of Devils Tower. I urge my colleagues to support this measure. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ENZI

Mr. ENZI. Mr. President, I yield myself such time as I might take for some additional views. During the Health, Education, Labor, and Pensions Committee consideration of S. 326, I asserted strong positions on several key components of the managed care reform debate. These additional views are intended to reiterate my support for S. 326, provide the committee with a cohesive explanation of my position on specific policy, and express my appreciation to the committee for reporting to the full Senate a good bill for health consumers. S. 326 offers a series of patient protections to consumers in Employee Retirement Income Security Act (ERISA) regulated health plans. 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 will provide consumers in self-funded plans the same protections being offered to state-regulated plans participants. Additionally, all ERISA regulated plans will be required to disclose extensive comparative information about coverage, networks and cost-sharing. This requirement is complemented by the establishment of a new binding, independent external appeals process, the lynchpin of any successful consumer protection effort. I believe the two most contentious elements of the managed care reform debate are addressed favorably for consumers in S. 326. The first is holding health plans accountable for medical versus coverage decisions; the second is ensuring that health plans cannot manipulate the definition of ``medical necessity'' to deny patient care. S. 236 does not expand the liability of ERISA plans by exposure to state tort laws, which has been proposed as a way to hold health plans accountable for medical decisions. Rather, S. 326 gets patients the medical treatment they need right away through a timely appeals process. Get the care; then worry about the problems. It doesn't require them to earn it through a lawsuit. I do understand the frustration expressed by physicians who are held liable for their medical decisions. It is for that very reason that the bill I support securely places the responsibility for medical decisions in the hands of independent medical experts. These decisions are binding on health plans, who run the risk of losing their accreditation, daily fines and, ultimately, their stake in the market. Likewise, the external appeals process in S. 326 prohibits plans from hiding behind an arbitrary definition of medical necessity to deny care. S. 326 expressly establishes a standard of review, including: the medial necessity and appropriateness, experimental or investigational nature of the coverage denial; and, any evidence-based decision making or clinical practice guidelines, including, but not limited to, those used by the health plan. This is in subtitle C. Sec. 503(e)(4). In other words, the independent external reviewer--required by the bill to have appropriate medical expertise--will have access to the patient's medical record, evidence offered by the treating physician and all other documents introduced during the internal review process. Additionally, the reviewer will consider expert consensus and peer- reviewed literature, thus incorporating standards of ``medical necessity'' clearly outside those prescribed by the plan. The bill also requires that, during the internal appeals process, the medical necessity determination is made by an independent physician with appropriate expertise--not by the plan. Since its inception in 1974, this is the first major reform effort of ERISA 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. The contention has been how to do this in the context of our health delivery system. I believe S. 326 is a responsible approach to protecting consumers in the managed care market. While bipartisanship was in short order during committee consideration of S. 326, it is my hope that through the balance of this process we will continue discussions among Members to advance needed patient protections without jeopardizing access to health care. While we have been unable to bridge some of the partisan barriers during floor consideration, I believe a better plan for health care consumers is being passed today. I suggest the absence of a quorum and ask unanimous consent that the time be charged to our side.

Mr. ENZI. Mr. President, I rise in support of the amendment. I want to particularly congratulate the Senator from Maine for her care and concern over the 2 years she has been involved in drafting this bill. I want to particularly express my pleasure at the improvement to the continuity of care provision she put into this bill. From our base bill, we further extend our continuity of care for terminally ill patients through the end of life. While the language in our committee bill followed the recommendations of the President's Quality Commission and the National Committee on Quality Assurance, both of which recommended ninety days for transition for all chronically ill patients, we feel very strongly that terminally ill patients and their families deserve to remain with their providers. Extremely important is the other piece of the continuity of care provision. It would require the Agency for Health Care Policy Research, the Medicare Payment Advisory Commission and the Institute of Medicine to conduct a multi-pronged study into the appropriate thresholds, cost and quality implications of moving away from the current narrow definition of ``terminally ill'' towards identifying those with ``serious and complex'' illness. This study was suggested by the groups who advocate for patients suffering with terminal illness. Unfortunately, many patients are not captured by current efforts to address the coordination and care needs of those who have several years, rather than several months, to live. This is because ``terminally ill'' is a narrowly construed concept. These patients may be better captured as ``serious and complex.'' This study is designed to help shape those parameters and seeks to improve the care for all patients with terminal illnesses. Again, I commend the Senator from Maine's leadership on this important matter. I yield the floor and reserve the remainder of my time.

Mr. ENZI. Mr. President, I rise in opposition to the amendment. I have sat here and listened to the arguments from the other side. There is part of this amendment the Democrats didn't even talk about. The problem is that this part of the amendment will make things worse, and not just for doctors and nurses. It will put patients at risk by allowing providers to release the intimate details of a patient's treatment without having to worry about being accurate or even truthful. Here is how. Under the Democrat amendment, any provider could disclose any information about a patient at any time for any reason. This fact is so important that I want to say it again: under the Democrat amendment, any provider could disclose any information about a patient at any time for any reason. And as bad and unbelievable as that is, that's not even the worst of it. This amendment allows a provider to do the worst of all things--not only to give out information about a patient, but even lie about it--and not be held accountable. How can that be possible, you ask? Isn't that against the law? Not if this amendment passes, it's not. If this amendment passes, that possibility is a reality, and your private health records will be held hostage by a provider who can make an unchecked decision to disclose them without asking your permission and who can't be penalized for doing so. But that is not all. There is no requirement in the Democrat amendment that when a provider exposes your confidential records, that the provider make disclosures only within his area of expertise. So if an anesthesiologist wants to reveal something about the way your ear exam was performed, the Democrat amendment says that is okay. There is nothing saying that the person disclosing your information has to know anything about either the procedure or your case before revealing everything about it--in fact, he doesn't even have to witness the treatment or ever have met you--and there's nothing saying he will be held accountable if he's mistaken or just flat out wrong. Adding insult to injury, the Democrat amendment doesn't even say that the disclosure has to relate to safety and health. All the amendment says is that the disclosure must be based on squishy terms that aren't even defined. For example, the amendment says that the disclosure must be based on information, and I'm quoting here, that the provider ``reasonably believes * * * to be true.'' It is unbelievable to think that this flies under the Democrat amendment. It is unbelievable that the amendment would allow a patient's health information, records, and private treatment details to be jeopardized and publicized without his consent, based on something that a total stranger ``reasonably believes to be true'' and is not even related to the patient's own safety. Exposing patients to such a high degree of risk without tying disclosures to patient safety, expertise or even accuracy is not only unacceptable, it's just plain wrong. What the Democrat amendment completely ignores is that procedures specifically related to the health care industry are in place for reporting problems with patient safety and health right now. The amendment also completely ignores and steam rolls all the state law in this area. I find it fascinating that the other side has said over and over and over again in this debate that their bill will not shift decisionmaking from the state capitals to Washington bureaucrats, and then they propose an amendment like this. I want to talk about what this does to state law, and then talk about the procedures that are in place now. On the first day of this debate, I heard no less than four Senators on the other side of the aisle characterize our ``states rights'' argument as being ``tired'' and ``old.'' Well, while I might take issue with it being ``tired,'' I certainly agree that it is ``old.'' In fact, it's as old as the Constitution. And if you are tired of hearing about it, think about this: How many times have you been to Wyoming? What do you know about the folks there? I can tell you that it's true they need access to good health care, and I can also tell you that folks there don't want the Federal government to step in and trump what the Wyoming Legislature has done to protect them. They don't want one standard that applies to everyone regardless of who they are, where they're from, and how they live. And if those on the other side of the aisle think that the people I represent in Wyoming are exactly like New Yorkers or Californians, then I suggest you head back to Cheyenne with me this weekend and see if you change your mind. One size fits all doesn't fit when we are talking about giving providers ways to report patient safety problems and protecting them when they make disclosures. Over 25 states have their own language prohibiting employers from retaliating against providers who disclose information relating to patient safety within a recognized framework. That's over 25 states with different laws and different reporting procedures; 25 states that offer different rights and responsibilities. I cannot underscore the importance of this enough. To a Democrat caucus that has repeatedly said that their bill will not shift the decisionmaking from the state capitals to Washington bureaucrats, I challenge you to tell me how such a statement jives with an amendment such as this one that fully wipes out state law. Not only that, I challenge you to tell me how this flawed amendment is better than the law that exists on the state books. More on this in a minute. Bottom line, this amendment allows providers to file complaints disclosing confidential patient information without permission. These complaints don't need to relate to safety and health. The provider does not need to know anything about who or what they are disclosing-- whether it be the specific patient treatment or the patient himself. And finally--and most ridiculously--the provider doesn't need to be accurate because he can't be penalized for inaccurate statements, misleading information or even downright lies about the patient or other health care providers. How in heaven's name could any state law anywhere be worse, or more destructive, than this? Indeed, having no law whatsoever would be vastly better. But you do not have to take my word for it. Just take a look at some of the State laws. In California, for example, providers cannot disclose information that violates the confidentiality of the physician-patient privilege. An important provision. Is it anywhere to be found in the democrat amendment? No. The amendment ignores it entirely. What about a Rhode Island law that eliminates any protection for providers who participate or cause the problem being reported, or who provide false information? That one is pretty important, too. Also nowhere to be found in the Democrat amendment. The body of state law that it would destroy is incredibly vital whether we're talking about ERISA plans or not, because the courts have definitively held that where quality of care is concerned, state law trumps ERISA. As the Supreme Court has held, ``the historic powers of the State include the regulation of matters of health and safety.'' Another seminal third circuit case has held in citing the Supreme Court that, while the quality control of health care benefits might indirectly affect the sorts of benefits an ERISA plan can afford, they have traditionally been left to the states, and there is no indication in ERISA that Congress chose to displace general health care regulation by the states. It's clear: the courts have deferred to the states when it comes to quality of care. I think that the democrats should take a lesson from this. I have heard it said, however, that we need not worry about the overhaul of state law that occurs under the Democrat approach to health care because their bill will merely set a ``floor'' upon which States can build. Such a statement is questionable given an amendment such as this that is so flawed that it actually protects those who publicize confidential patient information and lie about it without giving the patient or other accused providers an opportunity to object. As a former state legislator, I say respectfully, ``thanks, but no thanks.'' The only floor this sets for the States is the one they will stomp on when they take one look at this bill. So who should investigate claims of wrongdoing and retaliation? I have mentioned that lots of other procedures are in place that allow for reporting and are specific to the health care industry. One of the biggest and most far-reaching of these is the reporting mechanism in place at the Joint Commission on Accreditation of Healthcare Organizations. The Joint Commission covers over 80 percent of the approximately 6,200 hospitals in this country that receive Medicare payments. These charts I have next to me are blow-ups of information taken directly off of the Joint Commission's website and show not only how reports and concerns about patient care can be disclosed, but also what followup occurs in response. Here is how the process works. If a provider wants to report an alleged problem, that provider has several choices under the Joint Commission. He can e-mail a complaint, fax a complaint, mail a complaint, or call the Joint Commission directly using their toll free number. And there are a couple of points I want to make about why this process is so much better, more related to the health care industry, and has much stronger teeth than this amendment. First, using the Joint Commissions' toll free number, reporting concerns can be immediate and confidential. Not only that, communications with the Joint Commission can be made in English or in Spanish. Second--and this one's really important, too--all complaints must relate to quality of care issues and patient safety unlike the democrat amendment which can relate to anything. Third--and perhaps most important of all--where serious concerns have been raised about patient safety, the Joint Commission will, and I emphasize ``will'' conduct an unannounced, on site investigation. Period. And with the Joint Commission, there will never be any concern over who's investigating problems. The Joint Commission's standards are recognized as representing a contemporary national consensus on quality patient care, and these standards are continuously reviewed to reflect changing health care practices. This is a real solution that combines a proactive reporting method to make sure that patient quality is not compromised, with an appropriate and strong follow up with mandatory, unannounced, on site inspections by an organization that knows the health care industry as well as anyone. In addition to all the State laws setting up reporting procedures and protections for providers, and in addition to the practices in place such as the Joint Commission, there are other controls. Hospitals that receive Medicare payments and that are not accredited by the Joint Commission are certified by the states. All these hospitals are required to provide patients with a document that explains their rights including a phone number where they can call a state agency to make a complaint about quality of care issues. These rights must also be posted. Yet another control is that patients--and even providers--can anonymously complain to the Medicare Program's Peer Review Organization on quality of care matters. Providers may also complain to HCFA's regional offices, state survey agencies and professional licensing boards. I have heard the stories about providers who have disclosed information and then were retaliated against. What I don't know is why the state laws, the Joint Commission's reporting process, state reporting processes, Medicare reporting processes, HCFA's reporting processes, and the professional licensing board--among other protections--are not working. I have in my hand a copy of the HELP Committee's report on the Patients' Bill of Rights and all of the amendments introduced to the bill. You may remember that an amendment similar to the democrat amendment introduced here today was introduced during the markup of this bill. I happened to remember that amendment, too, and so I picked up a copy of the committee report and began to leaf through the minority comments to find their explanation of the amendment. I was looking for some reason--other than pure politics-- about why an amendment like this is needed, about what isn't working in the system that must be fixed, and about why current laws, practices and procedures aren't enough. This is what the committee report is for, right? So I looked, and I looked. Out of the report's main body of 108 pages, 99 pages were written by the majority to explain and to support our bill. Only nine pages were written by the minority--nine. So out of nine pages, you would not think it would take too long to find some information--any information--about one of the minority's major amendments. I did not think so either, but I was wrong. I did finally find the minority's reference to the amendment, though. It was three sentences long. Three sentences out of nine pages on a major amendment. Let me read them to you: ``Doctors and other providers must be able to give every patient their best possible advice, without fear of retaliation or financial penalties.'' So far, so good. ``Out plan bans abusive insurance industry practices that undermine the integrity of the doctor-patient relationship. The committee legislation does not.'' So I kept reading. I scanned the page. What abusive industry insurance practices? I wanted to know. Why do providers fear retaliation? Why are current law, current practices, and current procedures not working? Nothing. Wouldn't you think that if the majority was able to spend its time writing 99 pages supporting its position, the minority might have been able to spend just a little more time adding even one paragraph to its nine pages on this? Not even one paragraph on an amendment that the democrats say is so vital. It just doesn't make any sense. I have heard time and again that Republicans are weeping ``crocodile tears'' about our bill. In fact, out of those mere nine pages in the minority's committee report, an entire sentence was wasted making this statement. But it seems to me that when you lay down amendments and don't share information about why we should trump state law in support of an amendment that protects providers who disclose misleading and confidential patient information unrelated to the patient's safety, then I think it is the democrats who are the ones crying crocodile tears when people like me are baffled by their empty allegations and outlandish solutions. Mr. President, I yield the floor.

Mr. ENZI

Mr. ENZI. Mr. President, for the information of all Senators, the Senate will convene at 9:30 a.m. and be in a period for morning business until 10 a.m. Following morning business, the Senate will immediately resume consideration of S. 1344, the Patients' Bill of Rights legislation. Senator Nickles, or his designee, will then be recognized to offer a second-degree amendment to the Collins amendment No. 1243. By previous consent, this legislation will be completed on Thursday. Therefore, Senators can expect additional amendments and votes throughout tomorrow's session of the Senate.

Mr. ENZI

Mr. ENZI. Mr. President, I ask unanimous consent that I not be interrupted.

Mr. ENZI. Mr. President, I ask unanimous consent that Patrick Thompson, my HELP subcommittee staff person, and Mark Battalini, my legislative fellow, be granted floor privileges during debate on S. 1344, the Patients' Bill of Rights.

Mr. ENZI. Mr. President. I rise in opposite to this amendment. 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. This is a principle which has been recognized--and respected--for more than 50 year. In 1945, Congress passed the McCarran-Ferguson Act, a clear acknowledgement 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 enforces of consumer protections. And, as if we need to re-learn this lesson yet again, it is usually for the best when we let each state respond to the needs of its own consumers. State legislatures are watching, wondering how far we are going to dip into their authority. As recently as this year, this matter of fact was re-affirmed 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. But, despite our elevation, we don't need the mandate regarding skin cancer that Florida has on the hooks. 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's about a mandate that I voted for and still support today. You see, unlike in 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. So, we passed an any willing provider law that requires health plans to contract with any provider in Wyoming who's 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. But I know it's not the right thing to do for Massachusetts or California, so I wouldn't dream of asking time to shoulder that kind of mandate for our sake when we can simply, responsibly, apply it within our borders. An extra, unnecessary layer of mandates, whether they be for certain kinds of coverage or for a protection that not everybody needs or wants, are so-called ``protections'' we simply shouldn't force people to pay for. If we were all paying for skin cancer screenings that only a few of us need or want, or if we were all paying for any willing provider mandates that only some of us need to assure access, then we'd all be one of two things--either over-charged, not-so-savvy consumers, or we'd be uninsured. 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. It is being suggested that all of our local needs will be magically met by stomping on the good work of the states through the imposition of an expanded, unenforceable federal bureaucracy--kind of a one-size-fits- all plan. It was complicated before. This is an overlay of how the plan will work under the Democratic plan. It is considerably more complex and considerably tougher to deal with. It is being suggested that our local needs would be magically met by stomping on the good ground of the States that have kept it simple and have the bureaucracy already in place. It is being suggested the American consumers would prefer to dial a 1-800 number to nowhere versus calling their State insurance commissioner, real people who can be talked to each time you call. You don't have to repeat the same ground to bring them up to speed on where the problem is, and chances are because they know you they will get it solved right away. They are the people you meet in the grocery store after church on Sundays. As for the uninsured population in this country, carelessly slapping down a massive new bureaucracy on our states does nothing more than squelch their efforts to create innovative and flexible ways to get more people insured. We should be doing everything we can to encourage and support these efforts by states. We certainly shouldn't be throwing up roadblocks. And how about enforcement of the minority's proposal? One of the findings of the amendment reads as follows, ``It would be inappropriate to set federal health insurance standards that not only duplicate the responsibility of the 50 State insurance departments but that also would have to be enforced by the Health Care Financing Administration (HCFA) if a State fails to enact the standard.'' That is a name you hear thrown around a lot because HCFA has some problems. HCFA is as much as 10 years late in sending out some notices which they need to send. They are already overburdened. If you don't believe me, talk to the people who are working with home health care, another area of health that is very important. They will tell you how HCFA is able to solve their problem. They are going out of business because of HCFA. In other words, not only is it being suggested that we trample the traditional, overwhelmingly appropriate authority of the states with a three-fold expansion of the federal reach into our nation's health care, they want HCFA to be in charge. HCFA, the agency that leaves patients screaming, has doctors quitting Medicare, and, lest we not forget, is the agency in charge as the Medicare Program plunges towards bankruptcy. And you want to give them all of this now, too? I could go on at length about the very real dangers of empowering HCFA to swoop into the private market with its embarrassing record of patient protection and enforcement of quality standards. For example, it took ten years for HCFA to implement a 1987 law establishing new nursing home standards intended to improve the quality of care for some of our most vulnerable patients. According to the General Accounting Office, HCFA missed 25 percent of its implementation deadlines for the consumer and quality improvements to the Medicare Program which were required under the Balanced Budget Act of 1997. Even more alarming is that HCFA is still using health and safety standards for the treatment of end-stage kidney disease that are 23 years old. Equally astonishing is that HCFA has yet to update its 1985 fire safety standards for hospitals. HCFA is a federal bureaucracy at its worst, making it the last place to which we want our consumer protection responsibilities to revert--let alone complicating it such as this. To me, the message is pretty clear. Expanding the role of the Federal Government well beyond its lawful authority would be a big mistake. The scope of Federal authority under the Employment Retirement Income Security Act, ERISA, with regard to the regulation of health care, is well understood. Duplicating, complicating, and ultimately unraveling 50 years of State experience and subsequent action makes no sense. For those of my colleagues who think no one is bothered by that, I and 117 million Americans currently protected by State health insurance beg to differ. Our Federal responsibility lies with those 48 million consumers who fall outside the jurisdiction of the State regulation. That is our scope. That is our charge. That is what the States are politely reminding Members of now. If we go through with this, they may remind us less politely. In March of this year, the National Association of Insurance Commissioners implored Members to not make a mess of what they have done for health care consumers, saying: The states have already adopted statutory and regulatory protections for consumers in fully insured plans and have tailored these protections to fit the needs of their states' consumers and health care marketplaces. In addition, many states are supplementing their existing protections during the current legislative session based upon particular circumstances within their own states. We do not want states to be preempted by Congressional or administrative actions. I am stunned that their pleas is so easy for some to ignore. I yield the floor.

Mr. ENZI

Mr. ENZI. Mr. President, I ask unanimous consent that when the Senate completes its business today, it stand in adjournment until the hour of 9:30 a.m. on Thursday, July 15. I further ask unanimous consent that on Thursday, immediately following the prayer, the Journal of proceedings be approved to date, the morning hour be deemed to have expired, the time for the two leaders be reserved for their use later in the day, and the Senate stand in a period for morning business until 10 a.m., with Senators allowed to speak for up to 5 minutes each, with the following exceptions: Senator Specter, 15 minutes, and Senator Byrd, 15 minutes.

Mr. ENZI. Further, I ask unanimous consent that Senator Nickles, or his designee, be recognized at 10 a.m. to offer an amendment.

Mr. ENZI

Mr. ENZI. Mr. President, if there is no further business to come before the Senate, I now ask unanimous consent that the Senate stand in adjournment under the previous order.