Bob Graham

Mr. GRAHAM

Mr. GRAHAM. I would like to address the Chairman of the Subcommittee. Does the Chairman also agree to strike the language on page 15 and on page 25 of Senate Report 106-76 relating to funding for tobacco litigation?

Mr. GRAHAM. Mr. President, I am prepared to offer an amendment with my distinguished colleague Senator DeWine to the Commerce, State, Justice appropriations bill that will help law enforcement officers in their efforts to protect our citizens. We believe that after the Congress passed Public Law 103-411, it had unintended consequences that have imposed unnecessary costs on state and local governments. Under this law, aircraft belonging to law enforcement agencies are considered ``commercial'' if costs incurred from flying missions to support neighboring jurisdictions are reimbursed. Multiple governmental agencies have recognized this problem, with the support of the Federal Aviation Administration, they have jointly drafted corrective language for this problem. Before proceeding, however, I would like to inquire as to the plans for consideration of this issue by the Commerce Committee this year. I wonder if my distinguished colleagues from the state of Arizona and South Carolina--the Chairman and ranking member of the Senate Committee on Commerce, which has oversight on these matters--could engage Senator DeWine and me in a discussion regarding this matter.

Mr. GRAHAM. Will the Senators from Arizona and South Carolina agree to review this matter on the FAA reauthorization bill and by the end of year?

Mr. GRAHAM

Mr. GRAHAM. My amendment would require the Attorney General to conduct a study on crimes against older individuals no later than 180 days after the date of enactment of this legislation. The population aged 65 years or older numbered 34.1 million in 1997 and will continue to grow as the baby boomer generation ages. These individuals are particularly vulnerable to crime. Because they have made the determination that our large elderly population is susceptible to monetary scams and physical acts of intimidation, criminals defraud the elderly in areas ranging from telemarketing to health care fraud to securities and insurance. Federal prosecutors and law enforcement officials throughout Florida are spending more and more of their time in efforts against the cheats, fly-by-night operators, and other criminals who are targeting the elderly for financial profit. The losses suffered as a result of these crimes not only affect the elderly and their families but also squander resources for programs that provide services to millions of needy elderly Americans. Mr. President, we can and must do better. My amendment will require the Justice Department study to examine two vital issues: (1) whether an individual over 65 is more likely than the average individual to be the target of a crime; and (2) the extent of crimes committed against individuals over 65. This amendment gives the Senate the opportunity to express its determination to protect this important segment of American society from criminals. In his national bestseller, ``The Greatest Generation,'' NBC news anchor Tom Brokaw discusses the heroics of the World War II generation and how they saved the world from tyranny. It would be a shame if the generation that protected us in its youth was allowed to become victims of scam artists and violent criminals in its later years. Mr. President, this study will be a first step toward freeing older Americans from the threat of crime. I urge all of my colleagues to support this important measure. amendment no. 1326 (Purpose: To extend temporary protected status for certain nationals of Liberia) At the appropriate place in the bill, insert the following:

Mr. GRAHAM

Mr. GRAHAM. The Post editorial describes the stark implications of rejecting the amendment. The Post states: It would be an amnesty for decades of misconduct and a retroactive taxpayer subsidy for that misconduct as well. My second main objection to this language is that on May 20 of this year, the Congress, through a conference committee on the emergency supplemental bill, enacted a provision that denied the Federal Government access to some $250 billion which the States have secured through their tobacco settlement. The original amendment, which was introduced by Senator Hutchison of Texas and myself, as well as Senator Bayh, Senator Voinovich, and other Members of the Senate, passed this Senate by a vote of 71-29. This body could not have spoken with more clarity: Uncle Sam, keep your hands off the States' money. But in taking that vote, while we said to the Federal Government, ``Hands off,'' I and many of my colleagues, including Senator Hollings and others, had argued that if the Federal Government wants its own money, then it should sue the tobacco industry for the recovery of funds spent for the treatment of tobacco-related illnesses in Federal programs, such as Medicare. If that sentiment was true just a few weeks ago, it is certainly true today. My third objection is that this report language would be an abdication of our Federal responsibility to deny the Justice Department its most fundamental responsibility. What is that responsibility? It is the responsibility to locate and to investigate areas where individuals, organizations, entire industries, may in fact be liable and responsible for harming the people of the United States of America. Evidence uncovered by the States in their successful legal efforts against the tobacco industry clearly implicates the tobacco industry in their complicity to cover up evidence of addiction and illness related to the product they produce and market. To allow the tobacco industry to escape responsibility for these practices and to not investigate it fully to determine whether the Federal Government can recoup funds-- funds that come from the taxpayers of America, funds that have been paid out to treat tobacco-related illnesses--would be totally irresponsible and a surrender of our fiduciary responsibility to the taxpayers. Finally, there are some parties to this litigation who have no alternative but to have the Federal Government litigate on their behalf. In this instance, I am speaking about Native Americans. I ask unanimous consent that the full text of this letter be printed in the Record at the conclusion of my remarks.

Mr. GRAHAM. Mr. President, the letter from the National Congress of American Indians signed by its president, Mr. W. Ron Allen, states: There are many Indian Nations, however, who do not possess the resources to bring individual suits and will, therefore, rely upon the DOJ to bring suit on their behalf. I do not believe we should tolerate a situation in which a large number of our Native Americans are precluded from having their legal rights represented. I urge my colleagues to vote to strike the offending report language. I urge my colleagues to allow the Justice Department to do its job, and to use its best professional judgment on how to proceed with its legal strategy against the tobacco industry. Rather than giving the Marlboro Man and rather than giving Joe Camel another victim, let us vote to hold the tobacco companies accountable by the simple action of allowing the Department of Justice to do its responsible job as the Nation's investigator and litigator. I ask unanimous consent that a letter from the Leadership Council of Aging Organizations, which represents organizations such as the AARP, the Historically Black Colleges and Universities, Families USA, National Senior Citizens Law Center, National Council on the Aging, the National Council of Senior Citizens, and many other organizations representing older Americans which also support this language--support it particularly because they recognize the possibility of strengthening the Medicare program through funds derived from a successful prosecution of this litigation--be printed in the Record.

Mr. GRAHAM. Mr. President, I ask unanimous consent that I be given 4 additional minutes to conclude my remarks.

Mr. GRAHAM. I ask unanimous consent for 4 minutes to complete my remarks.

Mr. GRAHAM. Mr. President, I offer this amendment on behalf of myself, Senator Durbin, and others, as a means of raising our strong objection to a provision that appeared in the report accompanying the Senate Commerce-State-Justice appropriations bill. That provision was on two pages. On page 15 of the report, the last sentence in the first paragraph reads: No funds are provided for tobacco litigation or the Joint Center for Strategic Environmental Enforcement. Then on page 25, in the lower half of the page, this sentence appears: No funds are provided for expert witnesses called to provide testimony in tobacco litigation. My objection is that those two sentences have with them a clear inference that it is the policy of the Senate that the Department of Justice, in a rare instance, should be denied the investigative and prosecutorial discretion to determine whether it is in the interest of the United States and its people for the Federal Government to bring litigation against the tobacco industry and pursue that litigation in an effective manner. Even more troubling is the sweeping nature of this language, which I believe could be reasonably interpreted to amount to a grant of immunity to the tobacco industry from Federal prosecution. Further, if the Senate fails to strike this offending report language which grants immunity to the tobacco industry, we will be reversing the intent of a sense-of-the-Senate amendment we adopted less than 4 months ago by a unanimous vote, on March 25. The Senate clearly articulated not only that it was supportive of the Federal litigation but determined that the use of settlement dollars should be primarily to add to the strength of the Medicare trust fund on the basis that it is the Medicare trust fund that has been primarily affected by these excessive health care costs. I will discuss that in a moment. While preparing a litigation strategy and while allowing the Department of Justice to exercise its traditional range of discretion, it is by no means a guarantee of success. Denying funds to the Department of Justice, tying their hands at the outset, precluding them from the ability to hire expert witnesses will only assure the failure of this important legal initiative. We all know the tobacco industry is responsible for tens of billions of dollars of tobacco-related illnesses that the Federal Government spends to care for and treat individuals with lung cancer, emphysema, heart disease, and every other illness associated with tobacco use. The most recent estimate for the costs incurred by the Federal Government for the treatment of tobacco-related illnesses totals $22.2 billion each year. This includes Medicare, $14.1 billion; Veterans' Administration, $4 billion; Federal Employees Health Benefit Program, $2.2 billion; Department of Defense, $1.6 billion; Indian Health Services, $300 million. Put simply, a vote that retains this restrictive report language would, in essence, grant the tobacco industry immunity against Federal litigation. I ask unanimous consent that a copy of an editorial from the Washington Post be printed in the Record immediately after my remarks. (See Exhibit 1.)

Mr. GRAHAM. Mr. President, I ask unanimous consent that the pending amendment be temporarily laid aside.

Mr. GRAHAM. Mr. President, this amendment will restore $30 million in funding for the National Endowment for Democracy. I understand that the State Department accounts are severely underfunded and there is no easy way to fund these programs, and I will work to ensure that all the State Department accounts are funded by the time this bill emerges from conference. In spite of the unfortunate position we now find ourselves, it is nevertheless critical that we restore the funding for the National Endowment for Democracy. Today we will debate the merits of the NED and the importance of its mission. This will be the seventh time in the last seven years that the Senate debates NED funding. The last time this debate took place, in 1997, an effort to eliminate NED funding was reversed by a vote of 72-27. I am hopeful that this current debate will reach a similar conclusion. But this debate is really about much more than the National Endowment for Democracy. What we are debating here today goes to the very fundamental nature of our democracy. Are we to continue to be the beacon of freedom to which oppressed peoples around the world look to for guidance and support in their struggles to attain the same liberties and freedoms that we hold so dear? Or are we going to shrink from that responsibility and abandon those who seek to change the fundamental character of their nations so that their people may enjoy the benefits of freedom? Around the world, the NED is a vibrant and effective advocate for the ideals for which our fore fathers risked their lives and sacred honors. It is our ambassador to the oppressed people of the world who are fighting and risking their lives for freedom. But you don't need to take my word for this. Let me tell you about some others who believe that the NED is as important as I do. In 1995, seven former Secretaries of State sent a letter to the congressional leadership that stated: During this period of international change and uncertainty, the work of the NED continues to be an important bi-partisan but non-governmental contributor to democratic reform and freedom. Four Former National Security Advisors, Allen, Brzezinski, Carlucci, and Scowcroft, wrote that ``the endowment remains a critical and cost- effective investment in a more secure America, and we support its work.'' Just this week, the New York Times editorialized on the importance of the NED, and the Wall Street Journal printed a piece by former President Carter and Paul Wolfowitz, an official in the Reagan and Bush administrations, that did the same. So many as champions of democracy have recognized the important contribution of NED to their own work. These include Harry Wu, the Chinese human rights activist, His Holiness the Dalai Lama, Elena Bonner, the chairman of the Andrei Sakharov Foundation, and Vaclav Havel. To some here in Congress, the NED is a target to undermine and defund. But to those struggling to overcome oppression in some 80 or 90 countries around the world, NED is a helping hand in their fight for democracy. I ask my colleagues to stand with freedom and democracy, to stand with those who have led democratic transitions, and to stand with those who continue to pursue the dream of democracy around the world. I ask my colleagues to stand with the NED.

Mr. GRAHAM. Mr. President, I send an amendment to the desk and ask for its immediate consideration.

Mr. GRAHAM. Mr. President, I ask that the amendment I had offered relative to prohibition on tobacco litigation be withdrawn.

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

Mr. GRAHAM

Mr. GRAHAM. Mr. President, thirty years ago today human beings first set foot the surface of the Moon. The Apollo 11 landing was an unprecedented accomplishment, one that marked the culmination of a national commitment to space exploration initiated by President Kennedy. As many of my colleagues will remember, our country's space program was a child of the Cold War. In many ways, our rivalry with the Soviet Union in space was the primary impetus for the Apollo Program. The Soviets launched the first artificial satellite. They put the first man in space. They achieved the first space walk. Thirty years ago, we were intent on responding to those milestones by putting the first man on the Moon. As then Senate Majority Leader Lyndon Johnson said, ``I, for one, don't intend to go to sleep by the light of a Communist moon.'' Today there is no Cold War, no unifying theme around which to rally our space program. Yet our exploration of space remains as important today as it was three decades ago. History tells us that those nations which developed the frontier prospered. Space is the latest frontier. Mr. President, if I am not mistaken, the Chinese character for ``crisis'' is the same as that for ``opportunity.'' As our nation recalls the triumph of Apollo, we face both crisis and opportunity in our space program. On May 25th, the Cox Commission reported multiple instances of sensitive American nuclear and missile technology falling into the hands of the People's Republic of China. It identified the lack of a sufficient United States commercial space launch capacity--a problem that has sent launch business to nations like China--as one of the reasons for this transfer of information. The numbers tell an alarming story. Though nearly 70% of the world's commercial satellites are assembled in the United States, less than 45 percent are launched from our shores. Because more than 60 U.S. satellites have been approved for export to launch from Russia, the Ukraine, and China since 1995, U.S. rocket manufacturers and their vast supplier network have lost approximately $2.4 billion in direct revenues--a figure that doesn't include American satellite launches by the powerful European Arainespace Consortium. Why are we losing out to other nations? One reason is cost. As scientist and author Gregg Easterbrook pointed out in the June 2, 1998 edition of the New York Times, companies that launch satellites aboard American space vehicles can expect to pay between $10,000 and $12,000 per pound. Nations like China--where government partially subsidizes the cost of satellite launches--can offer the same services for half the cost. A second reason for our nation's declining share of commercial space launches is the relatively small number of available launch vehicles in the United States. From 1977 to 1986, the space shuttle was the only spacecraft authorized to carry satellites into orbit. That nearly ten- year hiatus in American rocket development gave a huge advantage to nations that used that time to build and improve the Russian Proton, European Ariane, and Chinese Long March rockets. Last fall, I joined Senator Connie Mack (R-FL), U.S. Representative Dave Weldon (R-FL), members of the House Science and Senate Commerce Committees, and a broad, bipartisan coalition in tackling these problems through the enactment of the Commercial Space Act. That legislation took steps to create a stable business environment for the U.S. commercial space industry, while simultaneously making the government's use of space technology more efficient and saving taxpayers millions of dollars. Even better, it did not add new federal regulations or raise taxes by so much as a penny. President Clinton signed it into law on October 28, 1998. The Commercial Space Act will help to address the cost and capacity problems that have plagued our nation's commercial space industry. For example, it breaks the federal government's monopoly on space travel and encourages launch options that might lower costs. Until the passage of this legislation, the space shuttle was the only American craft authorized to both leave and re-enter our planet's atmosphere. Commercial companies that have an interest in providing repeat services to their customers might benefit from the same principle of reusability that powers Columbia, Discovery, Atlantis, and Endeavor. In addition, our legislation helps to mitigate the United States' dearth of launch vehicles by allowing the conversion of excess ballistic missiles into space transportation carriers. International arms control agreements have rendered these missiles useless for national defense, and the hundreds in storage eat up close to $10 million a year. Replacing their nuclear warheads with scientific and educational payloads will give the United States a practical, low-cost method for putting satellites into orbit. But more and less expensive rockets will do little to erase other nations' competitive advantage if the United States does not have the infrastructure needed to launch them. That's why a similar bipartisan coalition recently introduced the Spaceport Investment Act. This legislation would make the financing of spaceport construction and renovation 100% tax-free--an innovation that could spur private investment in the important task of building and modernizing our nation's space launch facilities. While airports, high speed rail, seaports, mass transit, and other transportation projects can raise money through tax-exempt bonds, spaceports do not currently enjoy such favorable tax treatment. This amounts to a glaring omission in federal policy. Airlines, cruise, and shipping lines could not exist without airports and seaports. In the same fashion, state-administered spaceports provide vital incentives for space-related economic growth by supplementing the launch infrastructure already provided by the federal government. My home state offers tangible proof of spaceports' value to the commercial space industry. Since its creation in 1989, Spaceport Florida has facilitated more than $100 million in space-related construction and investment projects. This includes the modification and conversion of Launch Complex 46 from a military to a commercial space facility. Virginia, Alaska, and California also host spaceports, and ten other states--Idaho, Louisiana, Mississippi, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Texas, and Utah--are considering their establishment. We must take advantage of this opportunity to make the public and private sectors partners in the effort to build badly needed launch sites around the nation. The Commercial Space Act and Spaceport Investment Act will boost the effort to recapture space business in the United States. But these legislative initiatives must be part of a larger solution. In the coming months, I will be exploring the idea of a National Space Summit that brings together lawmakers, federal and state space administrators, business leaders, and academic representatives with the goal of launching a united effort to revitalize our commercial space industry and reverse our rapidly declining share of space launches. Mr. President, while we recognize the historical significance of today's date, we must not let the accomplishments of the past dilute our focus on the future. My proposal is an innovative and efficient method for encouraging private and public cooperation in the important goal of revitalizing our national reach for the stars. I urge my colleagues in the Senate to join us in this important effort to repave our pathways to outer space. This would be a fitting tribute to the brave pioneers who landed on the Moon thirty years ago today. Those early explorers sacrificed much for our nation's commitment to space exploration. Just yesterday, one of these pioneers, Apollo 12 Commander Pete Conrad, was buried in Arlington National Cemetary. Let us produce a lasting memorial to these astronaut heroes by rededicating ourselves to their cause.

Mr. GRAHAM

Mr. GRAHAM. Will the Senator from Louisiana yield for purposes of a unanimous consent request?

Mr. GRAHAM. I ask unanimous consent immediately after completion of the time controlled by the Senator from Louisiana, that I be given 10 minutes as in morning business.

Mr. GRAHAM

Mr. GRAHAM. We have not found anybody who was aware of it except some diligent soul who actually got to page 252 of the bill sometime late last night or this morning and discovered this. I might say, it is very difficult to even get copies of this amendment. We have known for several years that the HMO industry did not want competitive bidding. They like the socialized formula system that exists today. They are attempting in any way they can, including this stealth attack late last night on page 252, to kill competitive bidding. Unfortunately, just as with the issue of the HMO bill we have been debating, on the issue of patients versus the bottom line of the HMOs, the HMOs won in the Patients' Bill of Rights, and they have won again by killing competitive bidding. I say they have won. I think it is a Pyrrhic victory. I think the Senator from North Dakota might recall an event that, as Yogi Berra said, it is deja vu all over again. I think it was just about 3 years ago, in a similar stealth maneuver, that we discovered there was embedded in a large bill a provision that would have given the tobacco industry a $50 billion tax break. Once that issue surfaced, it could not stand the light of day. It slowly withered, died, and has not been resurrected. I suggest the light of day will be shed on what the HMO industry has done by inserting this amendment on page 252 of a technical amendment, the fact they are using this as a means of avoiding the rigors of the marketplace, they are using this to avoid a rationalization of the compensation that HMOs receive from their patients so that we don't continue this pattern of 32,700 people being dropped. I can tell my colleagues, most of these people are people who come from rural areas. They come from small towns where they don't have high fee-for-service medicine. The HMOs want to skim off those areas that have high fee-for- service, where they can get a formula that results in a very rushed reimbursement level. They don't want to provide services, and they don't even want to have a competitive bidding process that can arrive at what the marketplace says they should be paying for those HMO beneficiaries in smaller communities of America. What we are seeing, again, is the bottom line winning out over the rights, the interests, and the health of patients. We are watching as Medicare patients are dumped on the street. Is that the HMO industry's idea of reform? It is my idea of a travesty, and it is one that we need to bring to the attention of America. And we, as the Senate, need to expunge this dark page, page 252, and its companion, page 253, from our records. I hope we will, at the first opportunity, do so. I thank the Chair. Exhibit 1 [From the Washington Post, July 16, 1999] HMOs Will Drop 327,000 Medicare Beneficiaries Next Year (By David S. Hilzenrath) About 327,000 of the 6.2 million Medicare beneficiaries nationwide who belong to HMOs will be abandoned by their health plans next year, the government said yesterday. Of those, 79,000 will be unable to enroll in another health maintenance organization as 41 health plans withdraw from the federal health insurance program for the elderly and disabled and another 58 stop serving Medicare beneficiaries in particular areas, according to the agency that runs Medicare. Medicare beneficiaries who lose their HMO coverage have two or three alternatives: They can choose another HMO, if one is available; they can revert to standard fee-for-service Medicare coverage; and they can buy ``Medigap'' policies to supplement the standard benefits. But there is no guarantee that they can find a Medigap policy with prescription drug coverage, which is one of the main reasons some Medicare beneficiaries choose HMOs. In Maryland and Virginia, 33,000 beneficiaries--26.9 percent of those with HMO coveage--will lose their current coverage, and 27,000 will be unable to replace it with another HMO. An HMO industry group recently predicted that more than 250,000 beneficiaries would be affected by the changes, but the Department of Health and Human Services released the final tally based on notices HMOs were required to submit by July 1. This year, a larger number of beneficiaries--407,000--were abandoned by their HMOs, but a smaller number--51,000--were left without an HMO option. The managed-care industry says HMOs are pulling out of Medicare because the government isn't paying them enough, but the government says the HMOs' actions reflect broader industry trends.

Mr. GRAHAM. I ask unanimous consent for an additional 5 minutes.

Mr. GRAHAM. It states: ``HMOs Will Drop 327,000 Medicare Beneficiaries Next Year.'' We have just spent 4 days of debate on trying to avoid having people dropped from their HMOs, and we now have an announcement that just in the Medicare program alone--the Medicare program has 39 million participants, and approximately 4 million of those are in HMOs--out of that relatively small number of HMO beneficiaries, 327,000 are being dropped. What does it say? It says that of those who are being dropped, 79,000 will be unable to enroll in another HMO because there are no other HMOs in their area. When the industry was asked, why is this happening, their answer was: The managed care industry says HMOs are pulling out of Medicare because the Government isn't paying them enough. You would think the industry would therefore want to have an alternative system that would provide adequate reimbursement, but not excessive reimbursement, and that the place to achieve that is the marketplace. We heard a lot of talk this week about how we ought to have deference to the marketplace. I think what the HMOs want is to have free enterprise when it relates to service to the patients, and they want to have socialism when it relates to how much revenue they get paid. So in 1997, in the face of all of these factors, the Congress, by a very strong vote--I think it was 76 votes in the Senate--passed the Balanced Budget Act which contained a provision that would actually start HMOs toward a competitive bidding process--the same process, incidentally, used by many other large HMO users, State and local governments, and in the private sector. It was started very modestly, with a demonstration plan so that we could learn about what was involved in competitive bidding for HMOs. I, frankly, thought that was excessive caution, that we could have taken advantage of the experience that was already available by many other large users, but the thought was, let's go slow, let's do a demonstration project. So since 1997, HCFA, the Federal agency with responsibility for managing Medicare, has been organizing this demonstration project. They selected Kansas City and Phoenix as the two sites for the demonstration project. They are about to start, and all of a sudden, on the 252nd page of what is supposed to be a corrective manager's amendment, we not only bar the demonstration projects that are about to commence but bar any other demonstration projects that may be suggested. Yet we started with a finding that we support competitive bidding. Boy, I tell you, if this is the way they support the principle, you do not want them to be your parents and say they are going to give you good care.

Mr. GRAHAM. Mr. President, I come to the floor to voice my strong objection to hidden provisions which were inserted in the so-called last amendment during the consideration of the HMO Patients' Bill of Rights. Last night, at approximately 8 o'clock, an amendment was offered which had over 250 pages. It had been represented throughout the debate that this amendment would be of a corrective, technical nature. There were several statements made on the floor that alterations, which had been agreed to verbally, would be incorporated in that final amendment. What we find is that quite a different thing has occurred. First, I have found that several of the areas in which I had clear representations that refinements would be made were not made. In the area, for instance, of the emergency room, one of the key issues we spent considerable time debating had to do with poststabilization coverage. It was my understanding we had arrived at an agreement as to how to correct the language which all parties had appeared to agree would be an undue restriction on the rights of patients to receive proper care in an emergency room. I am sad to have to report that those changes were not incorporated in the final version of the legislation. I am even more offended by the fact that while the changes we thought would be there were, at least in this instance, not obtained, but more so there were extraneous issues inserted, issues that had never been considered on the floor, never considered by a committee, never debated and unknown until they were unearthed, in the case of the issue I was to raise on page 252 and 253 of the so-called manager's amendment. What is the provision I am so concerned about? It is section 901, ``Medicare Competitive Pricing Demonstration Project.'' If you want to get the full flavor of this, let me just quote: (a) Finding.--The Senate finds that implementing competitive pricing in the medicare program . . . of the Social Security Act is an important goal. I could not agree more with that statement. So that would cause your heart to beat, your level of anticipation to be excited as you want to go on to what is the next paragraph that will implement that goal. What is the next paragraph? It says: Notwithstanding what has been said above, the Secretary of Health and Human Services may not implement the Medicare demonstration project on competitive bidding; and, furthermore, notwithstanding any other provision, the Secretary of Health and Human Services may not implement any other competitive pricing project before January 1, 2001. An absolute outrage. Let me give you a little history of this. When the Medicare program began to move beyond fee for service and to accept modern ways of health care, it did so in a rather cumbersome way. It said that we will reimburse a health maintenance organization on a formula; and the formula is 95 percent of the fee for service payments to Medicare beneficiaries within that community. That may have some superficial rationale, but let me tell you what really happens. First, if you happen to be in a community that has, for instance, a large teaching hospital or other complex medical center that serves a larger region, you are going to have high fee-for-service payments because of the nature of the health care that is delivered in that community. I would imagine that Rochester, MN, is a community that has relatively high fee for service because it has that great Mayo Clinic. I can tell you that Miami, FL, has high fee-for-service charges because it has a number of tertiary care hospitals. So because of that aberration that has nothing to do with what an HMO should be reimbursed, HMOs in those communities get 95 percent of fee for service. There were some modifications made of that in the 1997 Balanced Budget Act, but the basic principle of a formula-based reimbursement which relates back to fee for service is still largely in place. There is a second sequence of that in that we have very erratic fee levels for HMOs. The community that is immediately adjacent to the high fee-for-service community can have very low fee-for-service medicine delivered there, and therefore the HMOs get a much lower fee. In my State, the differential from the highest to the lowest community is probably on the order of at least 100 percent from the highest to the lowest community that has an HMO program. What is the consequence of that? The consequence of that is reported in today's Washington Post on page A-2. I ask unanimous consent to have that article printed in the Record immediately following my remarks.

Mr. GRAHAM. Mr. President, I ask unanimous consent for an additional 5 minutes.

Mr. GRAHAM

Mr. GRAHAM. Mr. President, I yield 2 minutes to the Senator from Rhode Island.

Mr. GRAHAM. I yield 1 minute to the Senator from Arkansas.

Mr. GRAHAM. Mr. President, I yield 1 minute to the Senator from Connecticut.