Dianne Feinstein

Mrs. FEINSTEIN

Mrs. FEINSTEIN. Mr. President, I ask unanimous consent that amendment No. 2774 be set aside and that amendment No. 2721 be called up.

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mrs. FEINSTEIN. Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. Madam President, I particularly thank Chairman Reed for putting this provision in the bill. I am very grateful. I am also very grateful for his defense of it today. I thank my friend and colleague, Senator Boxer, for her help on the floor, for her support, and for her continuous advocacy on behalf of California. The bottom line is, would you sell the National Mall for profit? Would you sell Roosevelt Island for profit? Would you sell any part of the federal highway system for profit? Why would you take land that has been dedicated for veterans purposes and lease it out for profit when we know, as Senator Boxer said, we have thousands of homeless veterans, and right now there is a proposal moving forward to possibly build some homeless units for veterans on that facility? This land was deeded to the Federal Government, a huge amount of land, for the purpose of veterans, not for Fox movie studios, not for Enterprise, or whatever car rental agency, but for veterans in a city with the largest number of veterans in the United States, and over 322,000 veterans enrolled to use that facility, with a hospital of 1,000 beds on that facility. You are going to begin to lease out that land? I think it is terrible, just terrible. The next step would be the National Mall. We ought to resist this effort. There are a lot of ways to make money, but I think the worst way is to make money off veterans at this point in time. I very much resist this amendment. I join with my friend and colleague, Senator Boxer, in resisting the amendment. I join with the committee chairman in resisting this amendment. I join with the ranking member of the committee in resisting this amendment. I hope there will be a very strong vote. Madam President, I ask for the yeas and nays, and I move to table the amendment. Once again, I will withdraw my motion to table for the greater good of getting a unanimous consent agreement, I hope. I yield the floor and suggest the absence of a quorum.

Mrs. FEINSTEIN. Madam President, it is just an interesting note that the man who gave this land, the 300-plus acres, to veterans was a United States Senator at the time, John P. Jones. He actually was a Republican from the State of Nevada, and he served 30 years in the Senate, from 1873 to 1903. So he was a 50-percent owner of this land, and it was a wonderful gift to the veterans. I think it should not be destroyed. Thank you. I note the absence of a quorum.

Mrs. FEINSTEIN. Madam President, I move to table amendment No. 2642, the DeMint amendment. If I might correct that, it is 2686, the DeMint amendment. I move to table and I ask for the yeas and nays.

Mrs. FEINSTEIN. Madam President, I come to the floor to oppose the amendment just presented by Senator DeMint. I worked very hard to get a provision in the military construction bill regarding this major piece of veterans property in the center of Los Angeles. I want to begin by thanking Senator Reed and Senator Kay Bailey Hutchison for agreeing to put this legislation in the Military Construction bill. This is 388 acres--388 acres--in the middle of Los Angeles. It is bisected by Wilshire Boulevard. It is near Santa Monica Boulevard. It is a large piece of property, and on that property is a 1,000-bed veterans hospital. The property was deeded in 1888 following the Civil War by two families to the Federal Government to be used specifically and permanently as an Old Soldiers' Home for the use of veterans. As many Members know, California has the largest number of veterans in America--over 2 million--and over 300,000 veterans are enrolled to use the facilities in this State of which this facility is prime. At the time, as the population of disabled and elderly veterans grew following the end of the Civil War, the Government decided to respond by establishing a number of national homes throughout the United States. In March of 1888, Senator John P. Jones and Arcadia B. de Baker donated their Santa Monica ranch lands in southern California to establish the Pacific branch of the National Homes for Disabled Volunteer Soldiers. The deed reads very specifically: That whereas by an act of Congress approved March 2, 1887 to provide for the location and erection of a branch home for the disabled volunteer soldiers west of the Rocky Mountains, the Board of Managers of the National Home for Disabled Volunteer Soldiers were authorized, empowered, and directed to locate, establish, construct, and permanently maintain a branch of said National Home for Disabled Volunteer Soldiers. The sole purpose outlined in the original deed was affirmed in 2002 by then Veterans Affairs Secretary Anthony Principi when he visited the site and again when he issued a May 2004 decision regarding plans for the modernization of VA facilities elsewhere. What has happened is the administration sees this land dedicated to veterans and says: Aha, there is a higher and better use for this land. We can make $4 billion if we lease out the unbuilt-upon parts of this land. That is what they have done under the radar screen. They have leased out to an automobile rental agency. They have leased out to a Fox movie lot. This is veterans land. This is land that was deeded to veterans to be used by veterans, not to be used by Fox movies, not to be used by automobile rentals. The administration admits if they do this, they can raise $4 billion in commercial rentals from this land, thereby taking this hospital, now in its park-like setting, and encrusting it with high rise buildings along Wilshire Boulevard. Well, let me tell my colleagues what has happened. The veterans community has risen up in Los Angeles and said: We are the largest veterans community anywhere in the Nation. You are taking land deeded to us. You are going to lease it, rent it in any way you can for this higher and best use, which is high-rise construction, and they don't like it. The neighbors don't like it. The city doesn't like it. The Board of Supervisors doesn't like it. Yesterday, the L.A. Times editorialized against it. So this amendment is not an amendment just concocted out of my brain. This is an amendment that has been worked on for a long time, with Members of the House who represent this area and with the Military Construction Subcommittee of Appropriations. We want to preserve the integrity of the land that was originally granted for use as an Old Soldiers' Home for veterans purposes in this new modern-day era and do it in a way where we have access to the largest number of veterans anywhere in the United States. I find it shocking that the Department of Veterans Affairs went ahead and leased parts of this land. The VA continues to this day film production on the property. It recently allowed Fox Studios to construct a set storage building there. In 1996, a 65,000-seat NFL football stadium was proposed for the open space on the west L.A. VA until Congress stepped in and passed a resolution to prohibit the action. Once again, I have asked Congress to step in and prohibit the commercialization of this site. It should be used for veterans purposes. So when I was in Los Angeles in August, I met with former Mayor Dick Riordan and Eli Broad to discuss various options. No decisions were made, but they have a vision for this. The important thing is that it not be commercialized; that for the financial problems of the administration, they shouldn't commercialize this land. They shouldn't sell it to the highest bidder. They shouldn't go for the highest and best use. They shouldn't build high-rise construction. I will tell my colleagues, if it happens, there will be an uprising from the neighbors in the area because this land is right off of the 405 freeway, and congestion and difficulties will result. I find it rather a crass gesture to take veterans land that is dedicated to veterans, that has a large hospital, 1,000 beds in it, that serves tens of thousands of enrolled veterans--no other city serves so many veterans--and go ahead and commercialize this site. So what this does is stops that commercialization of the site. The California delegation is united, whether it is in the Senate or whether it is in the House. I can give my colleagues two pages--and I will give my colleagues some of them--of people supporting this legislation: the County of Los Angeles; the City of Los Angeles; Zev Yaroslavsky, chairman of the County Board of Supervisors; Mayor Antonio Villaraigosa; Representatives Henry Waxman, Berman, Harman, and Sherman; City Council members, every one of them; State Senator Kuehl; Assemblyman Feuer, Assemblywoman Bass, Assemblywoman Brownlee; Santa Monica mayor; Santa Monica council; AMVETS Post 2; AMVETS Post 116; American Legion Post 123; VFW Post 875; Vietnam Veterans of America Chapter 446; the Bel-Air Association; the Beverly Glen Association; Blair House; the Brentwood Community Council; and on and on--the Coalition for Veterans Land; the Federation of Hillside and Canyon Associations; Friends of Westwood; the Pacific Palisades. It is virtually all of west L.A. that is saying: Don't sell this land for commercial use. What the Department has announced is that they intend to make $4 billion by selling this land. You and I know what is going to go on this land: commercial, office, high-rises because that is what you get the money from. It would be a travesty. One of the things we now know is that traumatic brain injury is a major injury from this war. We need to build on veterans facilities, not take their land away. So I would say, Senator DeMint, take back this motion. It is the wrong thing to do. Administration, I know you have a statement saying you oppose the amendment, but the city of Los Angeles, the county of Los Angeles is united. So, Madam President, I move to table the amendment, and I suggest the absence of a quorum.

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

Mrs. FEINSTEIN. Madam President, I withdraw my motion to table at this time because I know Senator Boxer is coming to the floor and wishes to address this question, and Senator DeMint may wish to also respond, and I will remain and propose the motion at a later time.

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

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

Mrs. FEINSTEIN. I note the absence of a quorum.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. Mr. President, I wish to announce that the Committee on Rules and Administration will meet on Wednesday, September 12, 2007, at 10 a.m., to conduct a hearing on the Nomination of Robert C. Tapella of Virginia, to be Public Printer, Government Printing Office. For further information regarding this hearing, please contact Howard Gantman at the Rules and Administration Committee, 224-6352.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. I move to lay that motion on the table. The motion to lay on the table was agreed to. vote on s. 2011

Mrs. FEINSTEIN. Mr. President, I remember well the day I saw the letter from Admiral McConnell. I believe the day was July 24. That is not a long time ago. But it was a kind of wake-up call to us. Because what that letter says in essence is he believes the United States is vulnerable, and he believes we need to move quickly to change FISA. From an intelligence point of view, many of us believe the chatter is up. It is not necessarily well defined, but during the 9/11 period, this is clearly a period of heightened vulnerability. Therefore, what Admiral McConnell wants to do is be able to better collect foreign intelligence. I very much respect what has happened. I respect the bill that was put together on the Democratic side, and I respect the bill that was put together on the Republican side, which is the McConnell bill on that side. The Senator from Wisconsin might be interested to know that some of us just met with Admiral McConnell, particularly to discuss Senator Feingold's concern. There is a different point of view. A U.S. citizen in Europe is, in fact, covered. A U.S. citizen in Europe, the minimization under certain specific laws, not FISA, but precisely 12333 point something, which I cannot remember at the present time, comes into play. That U.S. citizen is subject to a warrant from the court. This is a temporary bill. It is to fill a gap. The court has done something which has said that what has existed for decades with respect to the collection of foreign intelligence now cannot exist under the present law, and we need to change that law. It is my intention to vote for both bills. The reason I will vote for both bills is to see that some bill acquires the 60 votes to get passed tonight. We are going out of session. There is no time. I think this is unfortunate. I received the Democratic bill about 20 minutes ago. I went into the leader's office, tried to sit down and get briefed. Up to this point I still don't understand it. I spent all afternoon on the McConnell bill. I am just beginning to understand the subtleties in it and the other laws that come into play. This is not going to be an easy vote for anyone. But what we have to think of right now is, on a temporary basis, how do we best protect the people of the United States against a terrible attack. I thank the Chair and yield the floor.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. Mr. President, how much time does our side have?

Mrs. FEINSTEIN. Thank you very much, Mr. President. I would like to say something in response. Basically, the earmark language is formed on the DeMint language that was in the Senate bill. What happened was that staff sat down with all of the Parliamentarians for several hours to determine the workability under Senate rules and procedures of the language. Amendments were made that would make the language workable. Now the Senator from South Carolina contends that the Parliamentarians should review the entire bill and rule on whether each and every earmark is listed by the Chair and vet that earmark. When our offices spoke with the Parliamentarian's office, we realized that this was not a workable situation and could lead to gridlock in the Senate. Now, maybe that is what the junior Senator from South Carolina wants, but I, for one, believe the American people want us to carry out their business. There is full disclosure. There is full transparency. The committee chairs must certify that the earmark list is complete. It must be published on the Internet 48 hours before it comes before the Senate. Disclosure and transparency is what earmark reform is all about. No more dark of night additions to bills, even when the conference committee is often closed. Once again, if the junior Senator from South Carolina had allowed a conference, Members would have been able to sit down in the full light of day and, Member to Member, House to Senate, discuss this. But instead, he alone--he alone--despite importation after importation to allow the conference to go ahead, would not allow it to go ahead. One Member. That effectively would have stopped the bill--stopped the bill. Instead, the majority leader and the Speaker of the House, after the bill passed the House by a wide margin, believed this was too important to let one Member--one Member--stop it. So they figured a way to bring a bill from the House, which is what is now before us. To me, this is all sour milk, spoiled milk. He would have stopped the bill dead if he could have his way. But it didn't happen that way. And you know, there is more than one Member of the Senate. There are more than 2, 3, 4 or 5; there are 100 Members. Members' views have to be taken into consideration. Yes, there was some change in the language, but there is nothing in the change of language that in any way, shape or form stops full disclosure or the certification of the committee chair or stops putting it on the Internet 48 hours before it comes to the board. It is real reform. I hope there will be the votes here for cloture. I urge the Senate of the United States to vote for cloture on what is the most significant ethics and lobbying reform bill since Watergate.

Mrs. FEINSTEIN. I ask unanimous consent to have printed in the Record a section-by-section analysis of the bill we are about to vote on, including legislative history endorsed by the three principal Senate authors of the legislation: myself, Chairman Lieberman and Majority Leader Reid.

Mrs. FEINSTEIN. Mr. President, quickly, before I begin, I also wish to send my very deep condolences to those families who will have lost their loved ones in this very tragic bridge collapse. I heard the mayor on the television this morning, and it brought me back to my days as mayor. I know what this kind of difficulty--whether it is an earthquake or a bridge collapse-- brings for a city. I wish to extend my thanks to the wonderful efforts made by the emergency forces and the medical team of the city of Minneapolis. I think it was very special. I saw many acts of heroism. I very much agree with what the majority leader said about our deteriorating infrastructure. My thoughts went to the great Golden Gate Bridge. I think we need to pay more attention to our homefront and to those items. But at this point I send my very deep condolences to those who will have lost family members and loved ones. Mr. President, if I may, I wish to present a unanimous consent agreement regarding speakers on our side directly following my remarks: Senator Lieberman, for 10 minutes; Senator Obama, for 10 minutes; Senator Feingold, for 10 minutes; Senator Durbin, for 10 minutes; and Senator Reid, for 10 minutes of leader time, I believe.

Mrs. FEINSTEIN. Yes, there is.

Mrs. FEINSTEIN. Objection.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. Mr. President, I rise today to address an important development in the way our votes our counted. Last November, California elected a new chief election officer--Secretary of State Debra Bowen. Secretary Bowen served in the California Legislature, where she had a reputation as a dedicated advocate for greater protections of our voting systems. Upon becoming secretary of state, she called for a ``top-to-bottom'' review of all voting systems used in California. This was a dynamic and appropriate step, given the heartburn that electronic voting systems have caused voters nationwide. The problems with paperless voting systems are clear. Computers are no substitute for a paper record. We want to know where our most important documents are--and we don't leave them on the computer. Votes should be no different. Many events over the last few years have raised great concerns about paperless voting systems. In a congressional race in Sarasota, FL, about 18,000 ballots had no recorded vote. The final vote count divided the candidates by only 300-odd votes. So-called ``under-votes'' occur in every election. But the rate in Florida's 13th Congressional District was unusually high. And because there was no verified paper record, we may never know who really won that election. Some say paper ballots can malfunction or be manipulated just as easily as these computers. I strongly disagree. When paper records fail, we can see that they have failed. If paper records are stolen, or disappear, we will notice their absence. But when malfunctions or security gaps occur in paperless voting systems, there is no easy way for voters or election officials to know that something has gone wrong. It is for this reason I support optical scan paper systems--or, at minimum, voting systems that produce a paper record verified by the voter. So it is entirely appropriate that Secretary Bowen performed this test. Californians go to the polls in 6 months to cast their votes in the presidential primary. They must have confidence in their voting systems. With the cooperation of several voting system vendors, the University of California assembled several teams to review the systems. The teams examined the systems' source code, their physical and software defenses, and the ability of people with disabilities to use these systems. The systems fell short in all three tests. In a short span of time, computer scientists identified a number of major vulnerabilities with the voting systems. And these experts were able to hack the vote in less than 5 weeks. It is important to note that many election officials employ security measures to protect their systems from these kinds of attacks. In this test, the focus was on the voting system's defenses alone--no external protections were employed. Even without such protections, the results of this examination clearly indicate we need to improve these systems. A few examples of what the University of California experts were able to do: First, researchers were able to gain access to the internal computer system by breaking or bypassing the locks in the voting systems. In the case of one voting system, ordinary office objects were used to gain access. Second, researchers were able replace existing software with a new, corrupt virus that fed incorrect election data to the system. This attack used a program that appeared to change the text, but instead replaced the original software with corrupted code. Many small jurisdictions may lack the technical ability to identify and protect against these attacks. Third, while election officials can test these systems, experts noted that software distinguishes between election mode and testing mode. This could allow a virus to instruct the system to run properly during a test--but allow it to be corrupted during an election. Even counties that test their systems often could be vulnerable. Finally, the team was able to develop a device that would allow unauthorized access--and allow someone wishing to corrupt the ballot box to change the system's vote count. What does all this mean for elections in the United States? It means we should to follow the lead of Secretary Bowen, and take a very careful look at our voting systems. It means the argument for paper as an essential part of voting systems is becoming more and more convincing. It means we should watch and carefully assess the new standards for testing voting systems that will be employed for the first time in December. I hope these standards have a significant impact, that they catch the vulnerabilities of these systems. I believe the bill I introduced in May will lead to great improvements in the technology and the processes of elections. The Ballot Integrity Act would immediately prohibit new purchases of paperless voting systems. By 2010, it would require a voter-verified paper record to be produced by all voting systems used in federal elections. It would ensure that laboratories that test voting systems would not be hand-picked by vendors. And it would bar wireless and internet components in voting systems. In addition, States would have to document which individuals have access to voting systems, and they would have to agree on ways to train poll workers on how to operate machinery. This approach deals with all elements of the voting process--and recognizes that good voting equipment cannot be secure without good procedures to protect the integrity of the vote. While the debate rages over how California should respond to this new report, it is important to stick to the basics. Vote verification is the new consensus. More than half the States use paper records to preserve the vote count. I know Americans are passionate about ensuring that their votes are counted. California has taken an important step--and uncovered some disturbing information. The Senate should support improving Federal elections by passing the Ballot Integrity Act.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. Mr. President, today I recognize the 50 years of great work by the League to Save Lake Tahoe. The League to Save Lake Tahoe has a long history of fighting to protect what I consider to be the crown jewel of the Sierra. The league was founded in 1957 as the Tahoe Improvement and Conservation Association to fight runaway development in one of our Nation's most beautiful regions. Since then, its membership has grown to 4,500 people, but its mission remains the same: to protect Lake Tahoe's famously clear waters and the surrounding area's natural beauty. Protecting Lake Tahoe is an issue very dear to my heart. My love for Tahoe goes back to my childhood, when I attended camp and rode horses through its beautiful forests. Today however, the lake's health is threatened. Water clarity has declined from 102 feet in 1968 to 68 feet today, and the forests are more susceptible to catastrophic wildfires. The League to Save Lake Tahoe was influential in developing the Environmental Improvement Program that identified actions that needed to be taken to help restore Lake Tahoe and instrumental in organizing the 1997 Presidential Forum. The league has continued to display an unwavering commitment to protecting the irreplaceable natural resources the Lake Tahoe Basin is blessed with. I would like to congratulate the League to Save Lake Tahoe on a half century of outstanding environmental stewardship and wish them the best of luck in their continuing mission to Keep Tahoe Blue.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. Mr. President, I rise to introduce legislation to correct a longstanding flaw in the Medicare Geographic Practice Cost Index, GPCI, system that negatively impacts physicians in California and several other states. This legislation will allow counties that are underpaid by at least 5 percent to be reclassified into a payment locality that reflects their own geographic costs. It holds harmless the counties, predominately rural ones, whose locality average would otherwise drop as other counties are reclassified. Finally, this legislation is fully offset by requiring that independent diagnostic laboratories comply with state and federal regulations. This will allow the Centers for Medicare and Medicaid services, CMS, to take action against unscrupulous operators, predominately in California, that seek Medicare reimbursements for inaccurate and unnecessary diagnostic testing. This legislation would benefit physicians who are currently underpaid in 10 States: California, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, Missouri, Texas, and Washington. Congressman Sam Farr has introduced companion legislation, H.R. 2484, in the House of Representatives, which now has 12 cosponsors. The Medicare Geographic Practice Cost Index measures the cost of providing a Medicare covered service in a geographic area. Medicare payments are supposed to reflect the varying costs of rent, malpractice insurance, and other expenses necessary to operate a medical process. Counties are assigned to ``payment localities'' that are supposed to accurately capture these costs. Here is the problem: some of these payment localities have not changed since 1997. Others have been in place since 1966. Many areas that were rural even 10 years have experienced significant population growth, as metropolitan areas and suburbs have spread. Many counties now find themselves in payment localities that do not accurately reflect their true practice costs. These payment discrepancies have a real and serious impact on physicians and the Medicare beneficiaries they are unable to serve. My home State of California has been hit particularly hard. San Diego County physicians are underpaid by 5.5 percent. A number of physicians have left the county and 60 percent of remaining San Diego physicians report that they cannot recruit new doctors to their practices. Santa Cruz County receives a 10.2 percent underpayment, and as a result, no physicians are accepting new Medicare patients. Instead, they are moving to neighboring Santa Clara, which has similar practice cost expense, but is reimbursed at a rate that is at least 22 percent higher. This means that seniors often need to travel at least 20 miles to see a physician. Sacramento County, a major metropolitan area, is underpaid by 4.6 percent. The county's population has grown by 9.6 percent, while the number of physicians has declined by 11 percent. Sonoma County physicians are paid at least 8 percent less than their geographic practice costs. They have experienced at 10 percent decline in specialists and a 9 percent decline in primary care physicians. Seniors' Medicare cards are of no value if physicians in their community cannot afford to provide them with health care. The underpayment problem grows more severe every year, and the longer we wait to address it, the more drastic the solution will need to be. This legislation provides a common sense solution, increasing payment for those facing the most drastic underpayments, while protecting other counties from cuts in the process. This is an issue of equity. It costs more to provide health care in expensive areas, and physicians serving our seniors must be fairly compensated. I urge my colleagues to support this legislation. I ask unanimous consent that the text of the bill be printed in the Record.

Mrs. FEINSTEIN

Mrs. FEINSTEIN. Mr. President, I rise to introduce legislation to correct a longstanding flaw in the Medicare Geographic Practice Cost Index, GPCI, system that negatively impacts physicians in California and several other states. This legislation will allow counties that are underpaid by at least 5 percent to be reclassified into a payment locality that reflects their own geographic costs. It holds harmless the counties, predominately rural ones, whose locality average would otherwise drop as other counties are reclassified. Finally, this legislation is fully offset by requiring that independent diagnostic laboratories comply with state and federal regulations. This will allow the Centers for Medicare and Medicaid services, CMS, to take action against unscrupulous operators, predominately in California, that seek Medicare reimbursements for inaccurate and unnecessary diagnostic testing. This legislation would benefit physicians who are currently underpaid in 10 States: California, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, Missouri, Texas, and Washington. Congressman Sam Farr has introduced companion legislation, H.R. 2484, in the House of Representatives, which now has 12 cosponsors. The Medicare Geographic Practice Cost Index measures the cost of providing a Medicare covered service in a geographic area. Medicare payments are supposed to reflect the varying costs of rent, malpractice insurance, and other expenses necessary to operate a medical process. Counties are assigned to ``payment localities'' that are supposed to accurately capture these costs. Here is the problem: some of these payment localities have not changed since 1997. Others have been in place since 1966. Many areas that were rural even 10 years have experienced significant population growth, as metropolitan areas and suburbs have spread. Many counties now find themselves in payment localities that do not accurately reflect their true practice costs. These payment discrepancies have a real and serious impact on physicians and the Medicare beneficiaries they are unable to serve. My home State of California has been hit particularly hard. San Diego County physicians are underpaid by 5.5 percent. A number of physicians have left the county and 60 percent of remaining San Diego physicians report that they cannot recruit new doctors to their practices. Santa Cruz County receives a 10.2 percent underpayment, and as a result, no physicians are accepting new Medicare patients. Instead, they are moving to neighboring Santa Clara, which has similar practice cost expense, but is reimbursed at a rate that is at least 22 percent higher. This means that seniors often need to travel at least 20 miles to see a physician. Sacramento County, a major metropolitan area, is underpaid by 4.6 percent. The county's population has grown by 9.6 percent, while the number of physicians has declined by 11 percent. Sonoma County physicians are paid at least 8 percent less than their geographic practice costs. They have experienced at 10 percent decline in specialists and a 9 percent decline in primary care physicians. Seniors' Medicare cards are of no value if physicians in their community cannot afford to provide them with health care. The underpayment problem grows more severe every year, and the longer we wait to address it, the more drastic the solution will need to be. This legislation provides a common sense solution, increasing payment for those facing the most drastic underpayments, while protecting other counties from cuts in the process. This is an issue of equity. It costs more to provide health care in expensive areas, and physicians serving our seniors must be fairly compensated. I urge my colleagues to support this legislation. I ask unanimous consent that the text of the bill be printed in the Record.