Bill Frist

Mr. FRIST

Mr. FRIST. Mr. President, tomorrow we will have morning business. We will say more about that. Then at 11 o'clock, we will proceed to this conference report for up to 4 hours. I am not sure we will use that entire 4 hours, but there will be up to 4 hours equally divided on this very important bill, followed by a vote. On a separate issue we have been addressing all day--actually the last several weeks--the FSC/ETI or JOBS bill, we are making real progress. As mentioned shortly after the vote earlier this afternoon, we are working on a list of amendments, a finite list of amendments, that would be agreed to by both the Democratic side and the Republican side. We made real progress. I was very hopeful we would be able to, around this time, come back and say: This is the list; this is exactly how we are going to handle it. But we will continue to work over the next several hours and do want to announce that progress. We will have more to say either later tonight but more probably early first thing in the morning.

Mr. FRIST. Mr. President, I thank our colleague from Florida. He has been sitting patiently. I already interrupted another Senator, but this will be very brief. Mr. President, over the next few minutes, I want to outline what the plans will be over tonight and tomorrow, briefly. Unanimous Consent Agreement--H.R. 3108 First, Mr. President, I ask unanimous consent that at 11 a.m., on Thursday, April 8, the Senate proceed to the conference report to accompany H.R. 3108, the pension equity bill. I further ask consent that there then be 4 hours equally divided for debate between the two leaders or their designees. Finally, I ask unanimous consent that following the use or yielding back of time, the Senate proceed to vote on adoption of the conference report, with no intervening action or debate.

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. FRIST. I thank the Chair. (The remarks of Mr. Frist and Mr. Hatch pertaining to the introduction of S. 2290 are located in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the Judiciary Committee be discharged from further consideration of S. 1108, and the Senate proceed to its immediate consideration.

Mr. FRIST. Mr. President, I ask unanimous consent that the bill be read the third time, the motion to reconsider be laid upon the table, and that any statements relating to the bill be printed in the Record.

Mr. FRIST

Mr. FRIST. Madam President, I understand that S. 2290, which was introduced earlier today, is at the desk. I ask for its first reading.

Mr. FRIST. I now ask for its second reading and, in order to place the bill on the calendar under the provisions of rule XIV, object to further proceedings on this matter.

Mr. FRIST

Mr. FRIST. Mr. President, I see my colleague from Tennessee in the Chamber. I know shortly he will be addressing the issue under consideration, that of medical liability. In seeing him, I did want to, for a couple of minutes, talk about a very important event that will occur later this evening. The State of Tennessee, which both he and I represent, is once again at the height of March Madness. Congratulations to the University of Tennessee Lady Vols, who will play for their seventh NCAA title tonight against a familiar foe, the University of Connecticut Huskies. Coach Pat Summitt has maintained a championship basketball program at the University of Tennessee for three decades. This upcoming matchup, to be played in a few hours, will be the Tennessee native's 102nd NCAA tournament game. Coach Pat Summitt has led the team to an overall record of 851 wins and 166 losses in 30 seasons. Under the watchful eye of the winningest coach in women's basketball history, the Lady Vols have advanced to the NCAA Sweet 16 and the Elite Eight in 19 of the last 23 years. Tennessee is making its third straight Final Four appearance, setting a new NCAA record with 15 such appearances. The win over Stanford in the 2004 Midwest Regional final gave the Lady Vols their 14th 30-win season in Coach Pat Summitt's 30- year career at Tennessee. This is an especially big game for the Lady Vols seniors. During their 4-year stint at Tennessee, they have yet to clinch a national championship. They did garner a No. 1 seed for a nation leading 16th time in 2004. It is the seniors' outstanding play that has blazed the trail to the 2004 NCAA championship game. Senior Tasha Butts scored the winning basket at the buzzer in both games of the Midwest regional. Senior LaToya Davis scored with 1.6 seconds left in Sunday night's Final 4 matchup to keep Tennessee's national championship hopes alive. Butts, Davis, and fellow senior Ashley Robinson accounted for one- third of the team's total production in the 2004 NCAA Tournament. They have attributed 47 percent of Tennessee's points, 77 percent of its assists, and 39 percent of its three-pointers. Together these exceptional student athletes have produced 30 points, 21 rebounds, 10 assists, 4 steals, and 3 blocked shots per game. Tennessee, although a perennial powerhouse, has not won a national title since 1998. Under the tutelage of a basketball living legend, combined with the heart of the Lady Vols' seniors, Tennessee hopes to bring the glory of women's basketball back to Rocky Top. I wish both teams good luck tonight, and I hope to join the Tennessee Lady Vols at a White House victory celebration later this year. Go Vols. I yield the floor.

Mr. FRIST. Mr. President, I ask unanimous consent to speak as in morning business for up to 5 minutes.

Mr. FRIST. Mr. President, I will take a few moments to comment on a bill that deserves to be debated on this floor and brought to this floor because, as the distinguished Senator from New Hampshire said, the patients--not the doctors and not the system; all of them are disadvantaged--but it is the patients who suffer. When people hear of patients, they say: That is somebody in a hospital somewhere who is suffering. No, it is you and your children, and everybody who is listening to me. Who knows? You could be driving home today from work, and you might have an accident and have to go to the emergency room or the trauma room. Or after you pick up your kids from school--or maybe they are taking the bus home from school today-- if they are struck by a car, or fall down and break a bone, they have to go to the emergency room. Or if you are one of the millions of women who anticipate the joy of having a baby in the near future, it is you who will suffer as you look for an obstetrician, as you look for an obstetrician who will be with you during that prenatal period or over the whole 9-month period. All of this comes down to a fundamental issue. Our medical litigation system is broken. It is failing. It is failing the American people. It is failing our communities. It is failing our hospitals. It is failing our doctors. It is failing our families. And, most importantly, it is failing our patients. The medical litigation system should be strong. Its purpose is to promote the common good, first and foremost; and, second, to improve health care for all Americans through the fair and efficient resolution of meritorious medical negligence claims. Indeed, those two purposes-- to promote the common good and to improve health care through the fair and efficient resolution of meritorious medical negligence claims--are noble goals. But instead of achieving these noble goals, our litigation system is out of control and patients are being hurt. Due to this broken system of medical justice, medical liability premiums today are unnecessarily skyrocketing. You will hear the words ``skyrocketing'' and ``runaway'' because that is what is happening. The ultimate victims are the patients--the potential patients, the future patients--and that means all of us, our families and future generations. The ultimate victims are patients who see their access to care--to that obstetrician, to that emergency room, to that trauma center-- threatened and, in some cases, totally disappearing. The American Medical Association now lists 19 States where access to care is threatened. The situation is a crisis that is getting worse day by day by day. That is why as majority leader, in terms of scheduling in the Senate, we are going to keep bringing this issue back because the crisis is getting worse. If we are not successful, we will come back again and again. While the crisis does affect all people who will need or who need appropriate access to care, it affects those who are seeking help from specialists in particular. When we say ``high-risk specialist physicians,'' they are the ones who are responding to a trauma accident or the neurosurgeon who has to be highly trained to respond to a brain injury, a contusion, a head injury. When we say ``high-risk medical specialist,'' we mean the cardiac surgeon, a high-risk specialty physician who is called in if trauma comes into an emergency room. These patients who seek the high-risk medical specialist indeed are among the most sick and the ones who most desperately need urgent attention. But our litigation system is increasingly forcing these medical specialists, such as neurosurgeons and obstetricians, to drop their services altogether and not do those higher risk responses; to limit those services maybe to certain hours to not provide those services; not to offer those services in the emergency setting but do them in a much more controlled environment. It is even causing these high-risk medical specialists to pick up their practices and move from one State, say, from cities such as Philadelphia, where premiums are skyrocketing, to a city in California that has done a much better job and that is not in crisis because they have legislated appropriately in terms of addressing what was 20 years ago a crisis in California in medical liability. It causes these neurosurgeons and obstetricians--the two areas we are addressing in part with the legislation we are doing our best to bring to the floor over the next 24 hours--to retire from the practice of medicine altogether. They are saying: It is too much, $400,000 as a neurosurgeon in some cities, just for liability premiums. I can't afford that. I am going to leave the whole practice of neurosurgery. It does not make sense for me anymore. That is the reality today. It is a reality that is getting worse. And when we say it is a crisis, it is a crisis getting worse. And that demands a response by this body. As the services these specialists provide become harder and harder to find, who is hurt? Everybody, yes, but the sickest and, indeed, the most vulnerable are the ones hurt the worst; again, demonstrating the perverse and unintended consequences of a failing medical litigation system. That is why this week we are bringing to the floor this medical liability reform. It is for the patients. The Pregnancy and Trauma Care Access Protection Act focuses liability reform on two areas: Emergency and trauma care, and obstetrical services, where the services are provided right before, during, and after the delivery of babies. It is these two critical areas that are literally under siege today because they rely on medical specialists who are suffering the most from this lawsuit abuse. Of course, the true victims are those who need to go to the emergency room, as the distinguished Senator from New Hampshire said. It is not the physicians themselves. It is the people who have to go to the emergency rooms and wait longer for a specialist to be called in because they are not in the hospital, or there is nobody in the region. It is the expectant mother who is having difficulty even finding an obstetrician. And it is the stories that are increasingly occurring of once you get an obstetrician, right after you become pregnant, that obstetrician leaves and moves and another obstetrician comes in, and maybe that obstetrician stays a few months and then another obstetrician. So we have a huge medical problem. It is our responsibility to respond. Before coming to the Senate, I spent 20 years both training and practicing as a thoracic surgeon, a chest surgeon, which is heart, lungs, trachea--really everything between the diaphragm and the neck. That is what I did. As a member of the thoracic surgical team at Vanderbilt University Medical Center, we handled all of the trauma to the chest, the lungs, the heart. That is what I did every day. At that level I trauma center, which covered throughout the middle section of Tennessee, if somebody came in with a knife wound to the chest, they would call Dr. Frist, and I would go down and repair the knife wound to the chest or to the heart, as a medical specialist. Based on that experience, I can tell you that emergency care and trauma care is an absolutely necessary and critical component of our overall health care system. Each year, there are 110 million visits to the emergency room, and 90 percent of these visits require urgent attention, emergency attention within 2 hours. These are emergencies. As I implied earlier, no one can predict when you are going to need that care. Driving home today, will you be in an accident, or will your child fall down and break a bone climbing a tree this afternoon? That is emergency care that you want a response to immediately. The Alliance of Specialty Medicine has documented the important details of this critical care. Approximately 28 million Americans visit the emergency room each year due to an accident. Ninety-nine percent will recover after receiving care; in many cases, lifesaving care. Over 3.5 million emergency room visits are related to bone fractures or to broken bones. Of these, 888,000 require hospitalization, and delays in treatment can result in loss of the use of that limb, amputation of that limb, or indeed permanent disability. Over 1.5 million people suffer traumatic head injury with damage to the brain itself. Neurosurgeons, a focus in the legislation we are debating, perform over 36,000 emergency brain operations on head-injured patients each year. They place little intracranial monitoring devices to control brain swelling in another 8,000 patients each year. Trauma frequently inflicts damage to the spinal cord which runs through the body. Indeed, over 70,000 Americans are hospitalized because of spinal injuries each year. Another 26,000 are hospitalized with acute or emergency or sudden neck injuries. And, as we all know, nerve tissue heels in a very slow, different way. You cut off blood supply to the spinal cord or to the brain and there is not an immediate response. That tissue pretty much dies forever; very slow recovery. Thus that time of response becomes critical. Delay in treating any sort of injuries to the spinal cord can cause paresthesia or tingling, paralysis, can cause permanent disability, and, of course, can cause death. My own specialty was the chest and was cardiothoracic, cardiovascular, the heart itself. When you look at emergencies coming in because of heart attack or cardiovascular disease or stroke, the blood vessel is huge. Sixty-five million Americans have some form of heart and blood vessel, or cardiovascular disease, which could lead to a heart attack or stroke; and each year over 1 million Americans suffer a myocardial infarction, or a heart attack. You want to take them to the emergency room because today, as cardiac surgeons, cardiologists, heart specialists--and it is very different today than 30 or 40 years ago--there are medicines you can give and procedures you can do that can open up the blood supply when you have a heart attack and get blood to the heart before the millions of cells die. Every moment counts. It is important to get that blood supply opened by heart specialists. Unfortunately, our broken litigation system is stretching those moments--if those specialists are not available to respond--into hours. It is stretching them longer and longer, and that causes death of that heart muscle. Of course, patients and most people listening today expect, if they have an emergency and are going to be rushed to the emergency room, that there will be people to treat them, including heart specialists who can rush down and open the blood vessels; or if they have a brain injury or a concussion or a contusion to the head, they expect there will be somebody there to respond appropriately. However, that assumption is getting to be less and less true, due in large part to our broken medical malpractice litigation system. Because of runaway medical malpractice costs, many medical specialists have been forced to stop treating patients in the emergency room--the neurosurgeons; the orthopedics, or bone surgeons; the heart and lung surgeons; the obstetricians; the cardiologists; and the list goes on in terms of specialists we have to respond in the emergency room. They are simply saying: I will practice my specialty, but I am not going to do it in the emergency setting. I will not sign up for what we call ``on- call'' for the emergency room or for the trauma team because if I do, my own insurance premiums will skyrocket, or I cannot get the insurance at all. So fewer and fewer specialists are volunteering for this ``on- call'' in emergency rooms. Because of the high-risk operations they are called upon to perform in these emergency situations, neurosurgeons, the specialty of the brain and spine, have been particularly hit hard by the litigation process. According to the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, between the years 2000 and 2004, that 4-year period, the national average, of medical liability premiums for neurosurgeons increased 100 percent. It literally practically doubled, from $45,915 up to $91,848. As I mentioned a few minutes ago, in some States, neurosurgeons are now paying insurance premiums of almost $400,000 per year. That is not the cost of doing the medicine or delivering the care or of the practice or being in the operating room or paying the nurses to help you or the cost of the equipment or the cost of the drugs or the cost of your training; that is just a tax of $400,000 placed on top of all those expenses that the physicians pay to have the opportunity to treat you if you come into the emergency room. It doesn't make sense. It is a crisis. It is getting worse. It should be no surprise that this medical malpractice liability crisis is having a negative effect on the way these much needed specialists practice medicine. In fact, a recent survey--a fascinating survey--showed that 70 percent of neurosurgeons responding said they have had to make at least one of five practice changes. So if 100 responded, 70 said they have had to do one of these following things to narrow down or change their practice in response to the medical malpractice crisis: referred complex cases, closed their practice, moved to a different state, stopped providing patient care or retired. Runaway lawsuits are forcing neurosurgeons and other specialists to limit emergency services. Again, it is not the doctor who is being hurt, it is the patients who are being hurt, and it is future patients, and that means potentially everybody listening to me now. Many patients are rushed to these trauma centers. When I was on call at Vanderbilt Trauma Center as a thoracic surgeon, we had somebody actually in the hospital, or very close to the hospital, practically all the time. For heart disease, heart attacks, you need somebody there almost all the time. Why is that? Because you have a golden hour, especially for spinal disease and heart disease. Every second that goes by that you have the blood supply cut off, especially when you can open that blood supply up, the patient is being hurt. Unfortunately, patients are having to endure longer and longer waits as these precious lifesaving minutes tick by. If you have a broken bone, a gunshot wound, frequently you might be diverted from one facility to another because of the lack of availability of a specialist or the resources in one of the hospitals. Then you have this frantic search of finding a needed specialist for that broken bone, or that gunshot wound to the heart, or that stab wound. According to a recent study--because people say that could not be what is happening today, but it is what is happening--76 percent of emergency departments recently have diverted patients to another facility because of a lack of specialty physician coverage. Of these, over 33 percent diverted patients 6 or more times a month, and an additional 28 percent have diverted patients to other facilities 3 to 5 times a month. Over a quarter of hospitals report that the reason they have lost specialty coverage is because of medical liability concerns. These concerns simply discourage specialists from offering their services or volunteering their services for this on-call emergency coverage. The medical litigation crisis is affecting health care, patient care, all across the country. The consequences are obvious--the consequences of death. Here is an example. According to the Palm Beach Post, a Florida woman, Mildred McRoy, suffered a hemorrhagic stroke in February. That is where you actually bleed into the brain itself, and because the skull is a fixed cavity, when you bleed into the brain, it swells and it requires an emergency response. She was rushed to JFK Medical Center in Atlantis for treatment, but JFK stopped providing around-the-clock neurosurgical coverage in July because of the medical liability crisis. In fact, there wasn't a single neurosurgeon on call in all of Palm Beach County when this occurred. Again, that shows how pervasive the impact is if you don't have specialists signing up because of high medical liability premiums. Ms. McRoy was then transported 40 miles away to North Broward Medical Center. More than 8 hours later she was operated on by a neurosurgeon but died after being in a coma for several days. That is the story. That is why we must act. We know there is a problem, a crisis, and we know the crisis is getting worse. We know it is going to take action on this floor to reverse it. Florida is one of the 19 States the AMA considers in crisis. In a few cases, trauma centers and emergency rooms have been actually forced to shut down--as we saw on the chart that was behind me a while ago, which the Senator from New Hampshire had shown--because either the emergency department physicians or the on-call specialists could not obtain medical liability insurance at any price whatsoever. The most infamous example occurred in the summer of 2002 when Las Vegas lost its only level I trauma center. When I use that term, level I, that is the highest level. They can take anything that comes. Level I is the most sophisticated, most prepared, most responsive level of trauma center that we have. Las Vegas lost their level I trauma center which, by the way, was one of the 10 most busiest in the country for several days, forcing residents from that major city of Las Vegas to travel over 100 miles to seek urgent care. For me as a physician who has gone through 4 years of medical school and 8 years of medical training, what is sad and tragic is we are not getting rid of a few bad doctors. Right now we have highly qualified, highly committed physicians, women and men, who have chosen to dedicate their lives to helping their fellow man--really mankind, humanity broadly--through neurosurgery or obstetrics or heart surgery, and we are literally forcing them to leave the field they cherish, that they spent years working to become so they can help other people. These are people who are devoting their professional lives to healing others, and we are saying because of this medical litigation system, which is out of control: You are no longer going to be able to do that. They do not want to drop these specialized services. They do not want to make themselves unavailable for emergency care. Indeed, that is why they got into the business. Tragically, and all too often, the medical litigation system, with these skyrocketing, out-of-control costs simply leaves them no choice. In the end, our health care system suffers, but it is the patients who really suffer. The story is the same for obstetricians. Right now we know women are having a harder time finding an obstetrician. As I said earlier, one might have two or three obstetricians over one pregnancy period today because obstetricians are having to move. A few weeks ago, we brought the Healthy Mothers and Healthy Babies Access to Care Act to the floor of the Senate. That bill specifically addressed the medical liability challenges we have focusing on OB/GYNs and women and the babies they serve. We did that because all across the country, indeed in my home State of Tennessee, the current medical litigation system is forcing many OB/GYNs to simply stop delivering babies. Floor discussions at that time several weeks ago demonstrated the crisis. It showed the extent of the crisis. There is no reason at this juncture to restate all of the arguments, but the doctor drain has gotten so bad that it is clear that women are having a harder time finding doctors to give them prenatal care and to deliver their babies. What happened several weeks ago? Unfortunately, opponents to this needed medical liability reform filibustered the mere consideration of the bill on the floor of the Senate. We simply cannot allow people to keep their heads in the sand any longer. The crisis is real. It is time for us to act. The crisis is getting worse every day. As a physician and as a policymaker, as someone who has had the opportunity, a real blessing, to take care of patients in the setting of trauma, the emergency room, and responding to their needs, I am simply not, as majority leader, going to sit back and allow this crisis to continue to explode. The legislation itself we are considering, the Pregnancy and Trauma Care Access Protection Act, addresses these two areas--delivering babies and responding to emergency care. Why? Because these areas have been hit the hardest. It is common sense in medical litigation reform that will protect our patients, our families from medical negligence with fair compensation. If somebody has been negligently injured, they deserve just and fair compensation. If there are bad doctors, they need to be punished accordingly. The problem is the overall system is broken. The overall system has these frivolous lawsuits with these runaway costs. The legislation is based on sound models that have worked in States, that have a demonstrated track record, such as California. It is supported by numerous medical specialty societies and speciality groups. The American College of Obstetricians and Gynecologists, the American Association of Neurological Surgeons, the American Academy of Orthopedic Surgeons all support this legislation and, of course, the list goes on. I hope opponents of reform do not make excuses. They seem to put the blame of the crisis everywhere except where it belongs--our medical litigation system. It is time to face that simple fact that we need to reform our medical litigation system. It is in desperate need of reform. It is hurting all patients. It is hurting our vulnerable patients the most. In addition, I should add that all of this has a huge, unnecessary cost in the practice of defensive medicine, the reaction of our medical system to frivolous lawsuits. These are your health care dollars that are being wasted. These are your health care dollars that are taken from you and not being channeled back into better health care for you. Congress should act now. I am very hopeful we will be allowed to act now by putting patients first rather than the special interests who have been so vocal in obstructing this bill. For the sake of all Americans who will be forced to go to the emergency room this year and for the sake of all expectant mothers, I ask my colleagues to allow this debate to move forward tomorrow by voting to proceed to this critical medical litigation reform bill. Mr. President, I yield the floor.

Mr. FRIST

Mr. FRIST. Yesterday, I also mentioned the need to act on the pension equity conference report. We would like to lock in agreement for a short period of debate and a vote on the conference report prior to the end of this week. An important piece of legislation, the pension bill had gone to conference; it has come out of conference; it is ready for floor action. I know there are objections to this on the Democratic side at this time. However, I hope we will be able to reach a time agreement this week on this timely conference report as well. Mr. President, as we look at the medical malpractice and medical liability bill, as we look at FSC/ETI or the JOBS bill, as we look at the pension equity conference report, we have a lot to do over the next 4 days. We have a short amount of time to do it. It is important we stay focused on these important bills for the American people. I yield the floor.

Mr. FRIST. Mr. President, this morning there will be a period of morning business until 11 a.m. Following morning business, the Senate will then resume consideration of the motion to proceed to S. 2207, the Pregnancy and Trauma Care Access Protection Act of 2004. I remind my colleagues, on Friday of this past week I asked for consent to proceed to S. 2207 to allow us to begin debate on this important medical liability issue, an issue which addresses a crisis which affects us all. There was an objection from the other side and it was necessary to file a cloture motion on the motion to proceed to the pregnancy and trauma care bill. Under the order, that vote will occur at 2:15 tomorrow afternoon. Members will debate that motion and the merits of this underlying medical liability legislation throughout the day today. I do hope we are able to invoke cloture Wednesday afternoon so we may proceed to this very important measure. I also remind Senators yesterday it became necessary for me to file a second cloture motion with respect to the JOBS bill, the bill known as the FSC/ETI, or the Jumpstart JOBS bill. Consideration of this timely measure--timely because sanctions right now are in effect and the sanctions are affecting U.S. companies every day--consideration of this timely measure has been slowed because of unrelated amendments, amendments that have nothing to do with these manufacturing jobs and trade issues. I have had a number of discussions with the two managers of the bill in an effort to finish the bill in a reasonable amount of time with a reasonable number of amendments, but we have been unable to reach an agreement today. Due to the desire to offer these unrelated amendments not relevant to the bill, and with no end to the number of amendments in sight, it became necessary for this second cloture vote. I now ask consent that the vote on cloture on the motion to recommit occur tomorrow afternoon following the 2:15 vote, regardless of the provisions of rule XXII.

Mr. FRIST

Mr. FRIST. I now send a first-degree amendment to the instructions to the desk and ask for its consideration.

Mr. FRIST. Mr. President, I ask for the regular order with respect to S. 1637.

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

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

Mr. FRIST. Mr. President, I send a second-degree amendment to the desk.

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

Mr. FRIST

Mr. FRIST. Mr. President, first, in terms of jobs and job training, this morning the President of the United States unveiled a proposal to double the number of Americans who would receive job training assistance from the Federal Government. The initiative reflects the President's commitment to help people get the training they need, they require to find new jobs and better jobs. It builds upon an earlier proposal by the President of the United States announced in his State of the Union Message in January to help community colleges train an additional 100,000 workers for industries that are creating jobs in this country, to bring these job training programs to people who need the education and the job training, and to use our community colleges, expanding on the tremendous resource they provide today. As we all know, our economy is changing and changing fast. It is being transformed in so many ways. That is a great source of strength and adaptability, that flexibility to changing times both here in this country and around the world. Yet, at the same time, as we increasingly realize, this transformation, this adaptability, this flexibility in our economy--these changes in our economy--almost by definition result in a dislocation, a loss of jobs for some individual workers. That leaves us with a responsibility that we on the floor of the Senate must address, and we have addressed in part, but we have not fully addressed. We must make a strong commitment to effective--I underscore that word ``effective''--job training programs that will help American workers adapt to that changing economy, to give them the tools they need to fill those new jobs that are being created. The Department of Labor, as we all know by now, announced last Friday that more than a half a million new jobs have thus far been created this year. That is good news. It is great news. We need to keep working to ensure that more jobs are created, and that workers are being trained to fill those new jobs that are being created. We need to respond now as well as in the months ahead. We hear about the Workforce Investment Act, the WIA. We hear about it, and we hear that it is being obstructed, that we have acted in the Senate, that the House has acted, but it cannot make it to conference. Yes, this is one of a whole series of bills that we have worked on, that we have passed, and then we have this obstruction in getting to conference. Although my colleagues know, others who are listening may not: No matter how much work you do on the Senate floor, and the House floor, and you pass things, until you get it to conference and work through it and bring it back to the floor, it does not become law of the land. That is exactly where we are with this Workforce Investment Act. People ask, what is the Workforce Investment Act? Right now, our Federal Government sends about $4 billion--actually, more than $4 billion--a year to State governments and local governments through this Workforce Investment Act. However, last year, only 200,000 people-- 200,000 workers--received job training through these programs. President Bush, as he outlined today, has set a goal to double the number of workers receiving job training through Workforce Investment Act programs. So we have fewer than 200,000 workers, and that would mean doubling it to 400,000 workers a year. He set out--and appropriately, I believe, and as reflected in our underlying bill--he wants to do this by maximizing the Federal dollars that are sent, by maximizing those Federal dollars directly to the workers themselves-- getting it right down to the workers themselves, No. 1, and, No. 2, eliminating the bureaucracy, the overlap, the duplication, the overhead cost, where we know there are going to be additional savings. So we have a problem, but it is a problem that we know can be fixed. Right now, the Federal Government spends $23 billion a year on more than 30 job training programs, spread across nine different Departments and agencies. The result of that is a confusing patchwork of programs that result in overlapping, inefficiencies, confusion, and chaos. This overlap of all of these programs results in bureaucratic redtape. You put all that together, it means fewer of the dollars that are allocated, that are spent actually get down to that individual worker or person who is to receive job training. I applaud the President for his focus on creating jobs, on training workers for jobs today and the future, but we in the Congress have to step up as well. The fact is the Workforce Investment Act has expired. It needs to be reauthorized. Mr. Enzi, the Senator from Wyoming, who is chairman of the Subcommittee on Employment Safety and Training of the Committee on Health, Education, Labor, and Pensions, has done a tremendous job in working with his colleagues in a bipartisan way to develop a bill. That bill has passed in the Senate. A companion bill has passed in the House. But because of objections from the other side of the aisle, we have been unable to go to conference, to pull those two bills together on this important JOBS legislation. I do hope that the other side of the aisle will reconsider their objections to go to conference so that we indeed can get important legislation to the President and get workers back to work, get people back to work who may have lost their jobs with the appropriate training. That is our responsibility. The President has laid out the vision, laid out the agenda. We have written the legislation. We passed the legislation. Now it is time to marry that legislation with the House in conference. Thus I ask my colleagues on the other side of the aisle to reconsider and allow us to go to conference. It is in our workers' best interest. Indeed, it is in America's best interest.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that morning business be closed.

Mr. FRIST

Mr. FRIST. Mr. President, today the Senate will be in a period of morning business for Senators to make statements and to introduce legislation. There will be no rollcall votes during today's session, and tomorrow the Senate will resume debate on the motion to proceed to S. 2207, the Pregnancy and Trauma Care Access Prevention Act of 2004. Last week I filed a cloture motion on that motion to proceed, and that vote will occur at 2:15 on Wednesday. That cloture vote will be the first rollcall vote during this week. I had hoped to reach agreement for us to begin this medical liability bill, but there was an objection from the other side of the aisle which has made this cloture necessary. I know Chairman Gregg and others will want to speak to the issue tomorrow, and I encourage all Members to listen closely to the debate. The whole issue of medical malpractice reform and medical liability has reached crisis proportions in this country, as will be discussed tomorrow. You can't go to any community that is not affected by the unnecessary and frivolous lawsuits that have been filed, which results in a poor quality of care, with less access, with physicians moving from communities--in fact, some physicians leaving their specialty or leaving the practice of medicine altogether. This week we will also try to finish the bill that has to do with manufacturing and jobs and taxation, a bill called the JOBS bill or a bill that is known as the FSC/ETI legislation. This is a very important bill that is directed at putting in sync our trade policy with what is actually carried out today in trade. We continue to have discussions on how to finish this legislation. Unfortunately, there are an inordinate number of amendments that keep coming from the other side of the aisle. Given the importance of this bill and the timeliness of it, it is imperative we find a way to complete the measure as quickly as we possibly can without having to consider an additional 30 or 40 amendments. Today I will offer a second cloture motion so we can have a vote this week to determine if Members are prepared to bring this bill to a conclusion. The House passed the conference report to accompany the Pension Funding Equity Act. That conference report should be arriving today, and we must act on that conference report. I will be talking to the Democratic leader about scheduling the pension bill this week. I understand there is a payment deadline on April 15 and, therefore, there is urgency for us to act quickly and to act this week before we will be on our recess next week. Again, there is a payment deadline of April 15, and thus I want to act on this pension bill this week. On yet another subject, the Commerce Committee is to file the legislation which is known as the indecency legislation. The House has acted, and we would like to expedite consideration of this bill as soon as we possibly can. Lastly, I remind everyone we have been working for some time on asbestos litigation. We will be bringing that bill to the floor after the Easter recess. I hope Senators will allow us to proceed to that measure and debate the underlying bill, an important bill that recognizes the asbestos litigation system is out of control today and people who should be compensated are not receiving their just compensation because of a lack of reform. It is an issue we have talked a lot about, an issue that has been addressed in committee, and an issue we should address and will address in the Senate. In a few moments I will be addressing issues surrounding health care security for our seniors.

Mr. FRIST

Mr. FRIST. Mr. President, last night, I called my mother-in-law in Fort Worth, TX, just to get her perspective on Medicare and health care security for seniors, and to ask her what she, a long way from Washington, DC, understood in terms of the important Medicare legislation we passed on this floor in a bipartisan way--a Medicare bill that was signed by the President of the United States on December 8, 4 months ago. We had a good conversation. I asked a little bit in a personal way about her own experience with buying prescription drugs. She, like most seniors who are having to buy prescription drugs on their own--because, remember, until December of this past year, 4 months ago, prescription drugs were outside of Medicare. So many seniors are dependent on prescription drugs for a whole range of illnesses, or to prevent illnesses, whether it is arthritis, diabetes, heart disease, or cancer. Those prescription drugs have been out of reach, or at least must be obtained outside of the Medicare system but indeed no longer. It was clear to me that there is a lot of confusion by what people see in the press, what people see on television, comments that are made by opponents to that legislation. So I want to take a few minutes to comment on the importance of this legislation, but equally important, on what this legislation is doing and can do and will do for individuals with disabilities and seniors. I am speaking about 40 million people who will potentially be touched by this legislation we passed 4 months ago. The first point. Already, seniors are benefiting. The legislation was signed December 8, and already seniors are benefiting because of the new bill and the reforms in that bill. Health care plans are getting an extra boost. As a result, seniors who are enrolled in Medicare health plans, Medicare private health plans, are already receiving better benefits at lower, what we call out-of-pocket costs. Already, these seniors are receiving more benefits at lower out-of-pocket costs. In fact, the Centers for Medicare and Medicaid Services--when you hear CMMS, that means Centers for Medicare and Medicaid Services, which is the Government organization, or entity, the center in charge of managing and administering Medicare. They report that 3.7 million seniors are already receiving increased benefits, just 4 months after signing the bill, and 2 million have received lower cost sharing. That means when they actually have a benefit delivered, they pay less for that benefit; 1.9 million have seen their premiums go down; and it is less than 4 months after the President signed the bill. That is, the monthly premium seniors are paying has already gone down for 1.9 million seniors. Let me share with you just one specific example. Aetna has eliminated copayments for a whole broad range of preventive services. That includes routine physical examinations. It is interesting; until this Medicare legislation, routine physical examinations were not part of Medicare. They eliminated copayments for routine physical exams; they eliminated copayments for bone mass measurements; they eliminated copayments for colorectal screening exams, prostate screening exams, mammograms, pelvic exams, and for routine hearing and vision exams for seniors enrolled in their Medicare Advantage plans. Aetna has also slashed copayments for inpatient hospitalizations-- that is when you are admitted to the hospital--by 50 percent. They added coverage for generic drugs in every market and for brand-name drugs in many of its larger markets. In less than a month from now, seniors are going to also be able to take advantage of a new Medicare-endorsed prescription drug discount card. In less than 2 months, all Medicare beneficiaries, whether they are enrolled in private plans or whether they are enrolled in the traditional Medicare Program, are going to be able to use these discount cards, endorsed by Medicare, in order to get a 10- to 25- percent discount off the cost of their prescription drugs. These cards, in 2 months, are going to be available. You will be able to take them in, and however you are getting prescription drugs today, you will be able to get an additional 10- to 25-percent discount. There is even better news for those 8 million lower income seniors-- those who have the hardest time affording prescription drugs, or additional costs of health care. They will be eligible for an additional $600 in subsidies and assistance on top of the discount they are going to get, that 10- to 25-percent discount. That is, again, 8 million lower income seniors who will have the discount card, 10- to 25-percent discount, but in addition will get $600 in value, subsidies, to purchase prescription drugs. That is $600 in assistance they didn't have before the President signed that bill on December 8 of last year. At the end of April, in about 3, 3\1/2\ weeks, all Medicare beneficiaries will be receiving a letter from the Secretary of Health and Human Services, Tommy Thompson. In that letter, there will be a four-page guide with information on this discount card. When I talked to my mother-in-law last night, she said she faintly heard about this card but didn't have too much information on that. I told her in a few weeks this information will come to you in a letter. Read that four-page guide. More detailed information will be available from the Department of Health and Human Services. It will placed on the Department of Health and Human Services Web site and, as most people are beginning to hear, you can call 1-800-medicare and obtain even further information. If you call that number, they will also send you a 32-page booklet called Guide to Choosing a Medicare-Approved Drug Discount Card. I mention all this now because people say they don't know very much about the card, but I point out that information will be made available on a timely basis so you will be able to understand what these cards provide, what they don't provide, and also what is the best card for you to choose given what drugs you may be on. In fact, the Health and Human Services Web site will contain a fantastic new analysis, or Web page, that is easy to use called Price Compare. It is a price-compare tool that will allow seniors to choose the drug card that is best for them and their individual needs by offering a comparison of the cards available in that area for them. It will be specific, where you can put on that Web page what drugs you are on, and there will be a comparative analysis that is placed on the Web site where you can say this card looks like it would benefit me better than the other card, as well as a listing of all the cards available in your area. This site will be live and up and running at the end of this month, on April 29. It will have information as to how individuals with their individual needs will be able to benefit. Actually, an individual or specific pharmacies in one's community will be listed as well. So I am looking forward to that site. It will be a fantastic new Web site. Right now, seniors and their families can go to a Web site, if you want to, www.medicare.gov. On the Web site you would look for a site called ``Prescription Drugs and Other Assistance Programs.'' There is a section on that Web site. There you can enter your ZIP Code, where you live, and you can enter your income and your current medications to find out which cards will be available in your area. This is a wonderful and easy way to get prepared once the final Web site comes out, and those benefits are made available. Again, we will keep you posted on when the benefits specifically become available. It is clear that seniors and individuals with disabilities need and deserve relief from these high costs of prescription drugs. Seniors need and deserve a Medicare Program that provides them with what they want, and that is health care security. In the event one needs medicine to prevent a disease or illness, or when one is a senior or an individual with a disability and an illness strikes, they will have access to appropriate treatment. When I say health care security, that is what I mean. Now that prescription drugs are brought into Medicare, we can say seniors will have affordable access with this legislation, much better than in the past. I do want to tell the seniors of America that the President of the United States has heard them in that it is difficult to receive and purchase these skyrocketing prescription drugs because of the cost. The leadership in Congress has responded with this bipartisan plan and, indeed, help is on the way, and more help will be on the way in the coming weeks. That is the positive side. I also want to take this opportunity to comment on the fact that despite this landmark and new commitment--and, yes, it does mean more Government resources are directed at seniors who need those resources in terms of help obtaining prescription drugs--hardly a day goes by that opponents to this legislation do not level a new attack or a new accusation or seek a new investigation trying to tear apart this tremendous accomplishment for our seniors and for our individuals with disabilities. I want to thank and commend Secretary Tommy Thompson for initiating an investigation that is being conducted by the inspector general of the Department of Health and Human Services in response to some of these accusations. I look forward to the inspector general's findings. If a law has in any way been broken, or if information was inappropriately withheld from Congress, clearly appropriate actions ought to and will be taken. However, the number of the attacks and the vehemence of the attacks coming from the other side, from those people who opposed this landmark legislation for seniors, suggests there is a lot more at work and a lot more is going on than just wanting strong congressional oversight or good government. Unfortunately, what we are seeing is an orchestrated scheme to discredit the progress that has been made to date to get prescription drugs to seniors in an affordable way; to dismantle the prescription drug coverage that for the first time in history we have put into the Medicare system. The opponents to the original legislation seem to want to dismantle that. It is political gamesmanship. Part of it is driven by the success of passage of this wonderful legislation. Part of it is the fact that it is a political year and we have 7 months or so going into these elections, and people say this Medicare legislation, which is a success for the President of the United States and a success for this body, needs to be discredited in some way, I would argue, for political purposes. We know for a fact that attacking Medicare is in part an aspect of the opponents' game plan for the elections. Why do I say that? Because we can actually find it in writing in a memo written earlier this year to Democratic leaders. Party pollsters outlined a game plan for discrediting this landmark Medicare Modernization Act. The pollsters' advice in the memo was unequivocal that Democrats were in danger of surrendering the Medicare issue unless they were willing to totally discredit the legislation by defining it as, and I draw upon their words, ``unacceptable.'' We are seeing results. This poll-driven political game is being followed. For some, voting against the legislation was not enough. They have also tried to prevent seniors from learning about the new benefits to which they are entitled, some of which I just outlined. They have leveled charges intended to frighten seniors and to undermine the legislation itself. We simply will not let it happen. We cannot let it happen. I want seniors to know we will not turn back the clock on the progress we have made, under the leadership of the President of the United States and this body. We will make sure seniors and individuals with disabilities get these new benefits they need and deserve. When this law is fully implemented, the bottom line is that seniors will have better access to more affordable medicines and prescription drugs they need. There are several examples. Sixteen million lower income seniors-- there are 40 million seniors today and 16 million lower income seniors are going to be paying little or no monthly premium, and no more than $5 for each prescription. That is a huge benefit to those people who are most vulnerable to not being able to obtain prescription drugs. If we look at the 40 million seniors today, there will be 10 million seniors who have no current prescription drug coverage who will get relief from the high cost of prescription drugs by this legislation. All 40 million seniors today, and the 80 million baby boomers who will be coming through the system over the next 30 years, will have access to more preventive care because of this legislation. By that I mean simple things such as cholesterol screenings that were not a part of Medicare but are a part of Medicare today. I mentioned baseline physical examinations. For the first time in Medicare--and it is through those baseline physical examinations that the diagnosis of hypertension or possibly diabetes is made. For the first time, these baseline physical examinations will be a part of Medicare. The purpose is to diagnose the potential for having a stroke by figuring out whether or not one has hypertension, or one is at a risk for heart disease, diabetes, or cancer. We talk about chronic care coordination and disease management. Those are terms that are misunderstood, but they are very important. As a physician, it is important because with an aging population we see more chronic disease. As people live longer and we are able to treat acute and chronic disease such as heart disease, rheumatoid arthritis, or other debilitating arthritis, diabetes, or stroke, after one has had a stroke, it is very important. Couple that with diseases such as Alzheimer's or Parkinson's disease, how those chronic diseases are managed, especially when there is one, two, or three of the diseases with overlapping care, it is absolutely critical. Our system historically has not been set up very well. Especially in Medicare it has not been set up at all until recently, until this bill, to manage this complex overlap of diabetes with heart disease, with arthritis, with Parkinson's disease. For the first time in this Medicare bill there is an appropriate system set up for disease management and chronic disease coordination. Physicians will be able to continue treating Medicare patients because in the new law there was $7 billion included to help safeguard medical services to seniors. Seniors in rural areas will benefit from the legislation's historic $25 billion investment in improving health care in rural America, to provide services that may not be there today, to set up a system that will attract or keep nurses and physicians in rural areas, $25 billion injected into the system to better accomplish taking care of and managing the care of seniors in rural America. For the whole category of retirees today who get health coverage from their former employer, the cost of this bill will be more secure, thanks to the bill's $89 billion in increased Government assistance to retirees. I mentioned last night that my conversation with my mother-in-law very quickly came to the cost of a particular medicine she was taking and how, over the last three billing periods, I think she said, each time the cost of that one medicine has gone up. Was it addressed in the Medicare bill? As a first step, it was addressed. We still have a lot more to do. This Medicare bill was never intended to solve all of the challenges we have in Medicare today, but we did take a first step in controlling those prescription drug costs. Drug costs will be held more firmly in check for all Americans, not just seniors but for all Americans. That is because the Medicare bill had a whole part which speeds the cheaper generic drugs that are just as good, with just as much what we call efficacy--they are equal in efficacy, but it speeds those generic drugs to market, and by market I mean consumers; by consumers I mean patients; by patients I mean people such as my relatives, my mother-in-law, seniors who are out there today. Also, the Medicare bill helps close many of those loopholes in our Nation's patent laws that prevented prescription drug price competition. Again, it is a first step. It doesn't attempt to solve all of the prescription costs, the skyrocketing costs we see for prescription drugs, but takes a very definite first step. There is a lot of confusion about what health savings accounts are, but when you look at the Medicare bill, for the first time we have offered a health savings account or medical savings account that an individual can own. It does not apply just to seniors; it can start with a 20-year-old or 25- or 30- or 35- or 40-year-old. But it is an account that you yourself pay into, tax free. For health benefits that you want to pay for, you take it out tax free. So it is a tax favored savings account that you own and you can take with you through life. If you pay into it when you are 25 years of age or 30 years of age or 35 years of age, but say you have a high deductible insurance policy, and you don't have any health expenses that year, the money that you put in or that your employer put in or somebody from your family put in, rolls over to the next year and grows. If you don't need it the next year, it grows again. If you don't need it when you are 33, it grows again, or 35 or 40 or 45. You take it. You draw down on it, but you take it with you. When you get to be a senior, you can use it to pay for some of those copayments for a prescription drug or you can use it to pay for your long-term care if you need long-term care. It is a fantastic new entity that gives the individual real ownership--control over health care decisionmaking, control over that health care dollar. It is called a health savings account. It will be coming on line very soon. It was part of this Medicare bill signed by the President 4 months ago. In closing, this Medicare Modernization Act is helping millions of seniors in countless ways. Millions are being helped right now because of the passage of this bill. We are getting results. It is a major first step. I say it is a first step, a major first step, because, although it is a big bill, an important bill, a significant piece of legislation, because clearly there are things we will have to do about the cost of health care, affordability to our seniors, access to health care, addressing the issues of the trust fund itself, addressing the doubling of the number of seniors who will come into the system over the next 30 years with a diminishing number of the workforce actually paying into the system. These are all issues we will have to address. But this bill is a major first step that is to the benefit of every senior listening to me today and those 78 million people who will be new seniors over the next 30 years. We worked hard on this in this body, the Senate. We worked with the House. We worked in a bipartisan way to provide these benefits to America's seniors. We have worked hard to give seniors today the coverage they need and to give them the Medicare coverage they deserve. We simply cannot, we will not let election politics get in the way of health care for millions of America's seniors. I will close and review again very quickly those benefits on the chart next to me that outline how important this particular bill is that was not law on December 1 but on December 8 was signed by the President of the United States. Those benefits include a drug card with 10-25 percent immediate prescription drug discounts and additional relief for 8 million low-income seniors. That is now a reality. Comprehensive prescription drug coverage for 16 million low-income seniors is now a reality. Protection against high--catastrophic prescription drug costs, something that all seniors fear, not knowing what might happen to them 5 years from now or 10 years from now. There are new preventive benefits, including that annual physical examination where, for the first time, when that blood pressure cuff may be put around your arm and the diagnosis of high blood pressure is made, for the first time in the cost of the Medicare bill you can get help getting a drug, through Medicare, to prevent that hypertension causing a heart attack which otherwise would put you into the hospital--very expensive--or cause a stroke--very expensive. Now that can be preventative. There is $7 billion in improved physician payments which physicians deserve; $25 billion in rural health improvements in order that our rural communities will be able to access the appropriate health care they need today; $26 billion in State Medicaid relief and affordable health care through tax deductible health savings accounts. All of it is a first step, a start. I wish to comment this has been accomplished in a bipartisan way. We need to continue working in a bipartisan way. I look forward to doing that. I look forward to working with both sides of the aisle to the benefit of America's seniors. I yield the floor.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of H. Con. Res. 404, the adjournment resolution, the concurrent resolution be agreed to, and the motion to reconsider be laid upon the table.

Mr. FRIST

Mr. FRIST. Mr. President, I have a couple very brief statements to make; the first on the issue surrounding jobs, and the second on the issue of asbestos. Both of these issues are issues that we, on the floor of the Senate, have a real responsibility to address. I have specific suggestions as to how we might address both of these issues in the coming days and coming weeks.