Bob Graham

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. At this stage we have two options in the conflict that has engulfed us in Iraq. We can continue to carry on unilaterally, which is the course we have taken, a course which, in my judgment, will be continued through this $87 billion supplemental appropriation; or, second, to the maximum degree possible, pursue a real internationalization of the occupation and reconstruction of Iraq, a sharing of the burden of blood and treasure and responsibility for decisionmaking while also including a central role for Iraqis in determining the future of their country. Of these two options, the second, the commitment to real internationalization, has significantly more potential to get us out of Iraq as honorably and as expeditiously as possible. If we do not change from our current unilateral course, we will continue to bear the unilateral burdens alone: One soldier killed per day, 10 soldiers maimed per day, an increasing cost of occupation. Last year the occupation cost $1 billion a week. Under the supplemental appropriation we have just voted, it will now be $1.3 billion a week. The total cost of reconstruction, including the funds we have just voted, through September 30 of next year will be almost $25 billion. This administration has avoided answering the question: How much will we spend before we exit Iraq? As a result, I am concerned that this $87 billion supplemental appropriation is in essence a blank check for the President's failed policy. It will remove a substantial portion of the pressure for real progress in the internationalization of the occupation and reconstruction efforts directed at Iraq. Passage of this supplemental spending bill will remove the incentive for this administration to negotiate. Mr. President, the reality is that it is only through significant international troops and money, only with significant decision sharing by the United States with those foreign countries that our Nation has any reasonable expectation of an honorable and expeditious exit from Iraq. This appropriation leads us in the opposite direction. We will do it alone. It will increase the risk to our brave soldiers. It will unnecessarily transfer reconstruction costs to the U.S. taxpayer, and it will lengthen the time when the United States can honorably and expeditiously leave Iraq. Mr. President, I suggest the absence of a quorum.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, I am very pleased to introduce the Medication Errors Reduction Act of 2003 with my friend and colleague Senator Olympia Snowe. In recent years we've heard much about the consequences of medication errors. What we haven't heard as much about are the root causes for the medication errors, or the solutions that are available to us to reduce errors, save lives, prevent injuries, and reduce costs. Simply put, our legislation is necessary because as a nation we face a serious patient- safety problem. The good news is that we have a solution to the problem: we have the technological ability to dramatically reduce medication errors and thus save lives. The bad news is that the start-up costs and a lack of awareness have to this point been preventing us from reaping the benefits of the new technologies. The solution is right in front of us, but has been just out of reach. The legislation we are introducing today would bring the solution within our reach. It would address the causes of medication errors-- which are systems breakdowns--and the solutions--use of clinical computerized information systems that can save lives. We are here today to lend a helping hand, not to point a finger. We all share the goal of improving patient safety, and our bill will do that in a very simple, straightforward manner. The legislation establishes a voluntary grant program to encourage hospitals and skilled nursing facilities to become the pioneers of new, life-saving technologies. It does that by assisting with the often prohibitive start-up costs associated with purchasing and implementing information systems--systems that are designed to reduce medication errors and improve patient safety. I want to stress the goal of this legislation: to help build a safer medication-delivery system. The great successes of our health care system are largely due to our highly committed and talented doctors, nurses, pharmacists, hospitals, nursing homes and other health care providers. The problem we are addressing today is not theirs, but is a problem with the system they rely on to provide inpatient care. The Institute of Medicine report that kicked off much of this discussion 4 years ago tells us that we must address the ``systems problems'' and design systems that will prevent errors--just as cars are designed so that drivers cannot start them while in reverse helps prevent automobile accidents. The systems we want to fund would improve the medication-delivery system at many stages. We leave it up to the hospitals and nursing homes to determine exactly what types of technology would best fit their institutions and their needs. The grants could be used to purchase or improve computer software and hardware, purchase or lease communications capabilities, or provide education and training staff on computer patient safety programs. The grants could be used to improve patient safety at every stage of the medication delivery process. For example, a hospital or nursing home could use the funds to implement 1. electronic prescribing systems that can intercept errors at the time medications are ordered, 2. electronic medical records to alert doctors to possible drug interactions and complications related to the patient's medical history, 3. automated pharmacy dispensing to make sure the nurse receives the correct medication in the correct dosage for the correct patient, and 4. bedside verification--using bar codes on patient wristbands and the medications to ensure that the right medication is administered to the right patient at the right time. We could only have dreamed about clinical computerized information systems when the Medicare program was implemented. Today, we have them at our disposal. The sooner we get them into our hospitals and nursing homes, the sooner we start saving lives. The Medication Errors Reduction Act is supported by the Florida Hospital Association, National Rural Health Association, National Association of Children's Hospitals, Healthcare Leadership Council, AFSCME, Federation of American Hospitals, Catholic Health Association of the United States, Association of American Medical Colleges, Premier, Inc., the American Society of Heath-System Pharmacists, McKesson Corporation, IBM, VHA, Inc., Vanderbilt University Medical Center, New York Presbyterian Hospital, Aetna, Siemens, AmerisourceBergen Corporation, American Health Packaging, AutoMed, Choice Systems, Inc., Pharmacy Healthcare Solutions, Telepharmacy Solutions, Verizon, Becton Dickinson, American Health Care Association, AFL-CIO, Cardinal Health, and the eHealth Initiative. I ask their letters of support to be included for the Record. With their help, this bill will become law and we will be well on our way to improving patient safety.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, I am very pleased to introduce the Medication Errors Reduction Act of 2003 with my friend and colleague Senator Olympia Snowe. In recent years we've heard much about the consequences of medication errors. What we haven't heard as much about are the root causes for the medication errors, or the solutions that are available to us to reduce errors, save lives, prevent injuries, and reduce costs. Simply put, our legislation is necessary because as a nation we face a serious patient- safety problem. The good news is that we have a solution to the problem: we have the technological ability to dramatically reduce medication errors and thus save lives. The bad news is that the start-up costs and a lack of awareness have to this point been preventing us from reaping the benefits of the new technologies. The solution is right in front of us, but has been just out of reach. The legislation we are introducing today would bring the solution within our reach. It would address the causes of medication errors-- which are systems breakdowns--and the solutions--use of clinical computerized information systems that can save lives. We are here today to lend a helping hand, not to point a finger. We all share the goal of improving patient safety, and our bill will do that in a very simple, straightforward manner. The legislation establishes a voluntary grant program to encourage hospitals and skilled nursing facilities to become the pioneers of new, life-saving technologies. It does that by assisting with the often prohibitive start-up costs associated with purchasing and implementing information systems--systems that are designed to reduce medication errors and improve patient safety. I want to stress the goal of this legislation: to help build a safer medication-delivery system. The great successes of our health care system are largely due to our highly committed and talented doctors, nurses, pharmacists, hospitals, nursing homes and other health care providers. The problem we are addressing today is not theirs, but is a problem with the system they rely on to provide inpatient care. The Institute of Medicine report that kicked off much of this discussion 4 years ago tells us that we must address the ``systems problems'' and design systems that will prevent errors--just as cars are designed so that drivers cannot start them while in reverse helps prevent automobile accidents. The systems we want to fund would improve the medication-delivery system at many stages. We leave it up to the hospitals and nursing homes to determine exactly what types of technology would best fit their institutions and their needs. The grants could be used to purchase or improve computer software and hardware, purchase or lease communications capabilities, or provide education and training staff on computer patient safety programs. The grants could be used to improve patient safety at every stage of the medication delivery process. For example, a hospital or nursing home could use the funds to implement 1. electronic prescribing systems that can intercept errors at the time medications are ordered, 2. electronic medical records to alert doctors to possible drug interactions and complications related to the patient's medical history, 3. automated pharmacy dispensing to make sure the nurse receives the correct medication in the correct dosage for the correct patient, and 4. bedside verification--using bar codes on patient wristbands and the medications to ensure that the right medication is administered to the right patient at the right time. We could only have dreamed about clinical computerized information systems when the Medicare program was implemented. Today, we have them at our disposal. The sooner we get them into our hospitals and nursing homes, the sooner we start saving lives. The Medication Errors Reduction Act is supported by the Florida Hospital Association, National Rural Health Association, National Association of Children's Hospitals, Healthcare Leadership Council, AFSCME, Federation of American Hospitals, Catholic Health Association of the United States, Association of American Medical Colleges, Premier, Inc., the American Society of Heath-System Pharmacists, McKesson Corporation, IBM, VHA, Inc., Vanderbilt University Medical Center, New York Presbyterian Hospital, Aetna, Siemens, AmerisourceBergen Corporation, American Health Packaging, AutoMed, Choice Systems, Inc., Pharmacy Healthcare Solutions, Telepharmacy Solutions, Verizon, Becton Dickinson, American Health Care Association, AFL-CIO, Cardinal Health, and the eHealth Initiative. I ask their letters of support to be included for the Record. With their help, this bill will become law and we will be well on our way to improving patient safety.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, today I commend the Senate for addressing and correcting an unfortunate hardship placed on Native American veterans. For the past decade, VA's Native American Housing Loan Program has provided direct loans to eligible Native American veterans who wish to purchase, construct, or improve a home on trust lands--lands held by the federal government for the benefit of Native Americans. A problem arose this year due to a provision included in the fiscal year 2003 Omnibus Appropriations bill, which set a spending cap for the program at $5 million. That figure was deemed reasonable by the administration and appropriators because it was taken from previous years' spending amounts. However, due to historically low interest rates over the past year, VA and borrowers have worked together to refinance many loans, loans that were counted toward the $5 million cap. The combined costs of refinanced loans and new loans led VA to exceed the newly-implemented cap. Consequently, last June, VA was forced to cease providing further funds for the year. This left many Native American veterans in despair as their housing projects sat awaiting completion. With the cessation of the program, veterans have been unable to complete construction on homes that were already in progress, refinance existing loans, or pay contractors. The Native American Housing Loan Program originally began as a 5-year pilot project in 1993. Congress, recognizing its value, has re- authorized it twice and extended it through 2005. A recent GAO report noted a primary motivating force behind the bill was the fact that the home ownership rate among Native Americans is one of the lowest in the United States, finding that ``while over 67 percent of Americans own their homes, fewer than 33 percent of Native Americans own homes.'' In the report accompanying a reauthorization of the program in 1998, the Senate Committee on Veterans' Affairs stated that direct loans to these Native American veterans are necessary since--even with traditional VA guarantees--commercial lenders will not make mortgage loans to finance the purchase or construction of housing on Native American lands. They decline to do so because Federal law would prohibit a lender, in the event of default, from taking possession of native trust lands. Recent estimates indicate there are approximately 190,000 Native American military veterans. Many expert demographers recognize that, historically, Native Americans have the highest record of service per capita when compared to other ethnic groups. Congress realized that they should be allowed to receive the benefits they have earned through their service--such as VA home loans--no matter where they choose to live in the United States. The Native American Housing Loan Program alleviates some of the problems faced by Native American veterans in a couple of ways. First, the bill lowers barriers for these heroic veterans by encouraging them to participate in the privileges and benefits of home ownership in America. Secondly, the program provides economic incentives to develop thriving and long-lasting Native American communities. According to VA's Annual Report to Congress for fiscal year 2002, VA closed 62 loans during 2002 for a total of 289 loans made under the program from its inception through September 30, 2002. Mr. President, as ranking member on the Veterans' Affairs Committee, I applaud the Congress for working to alleviate this problem in a timely manner. I am proud to support a provision in the Department of Defense appropriations bill that will eliminate the spending cap completely. The legislation ensures that stalled housing projects can be continued without stifling future home ownership opportunities for Native American veterans. I am glad that we have been able to work in a bipartisan manner and I know the Native American veteran community is thankful of our efforts.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Hard-working, law-abiding farmers and growers also suffer under the current system. They continue to be at legal risk for hiring undocumented workers who frequently present fraudulent documents that appear to be credible. The current agricultural guest worker program also fails to provide for unforeseen labor shortages. The bill before us provides an essential balance. It establishes a legal system that ensures basic rights and protections for workers who make significant contributions to our nation's economy. It also ensures the development of an efficient agricultural guest worker program that improves farmer and grower access to legal agricultural workers. Agricultural workers do extremely grueling work, work that puts fruits, vegetables and flowers on the tables of many American households. Dedicated, experienced farm workers deserve the dignity, empowerment and improved quality of life that come with earning legal status. Farmers that play by the rules should have a modern, streamlined program that provides easier access to legal agricultural workers. Congress has not focused on farm worker issues since the mid-1980s. Reform of our agricultural guest worker program is long overdue, and I am hopeful that we will move beyond our status quo and address this important issue this year.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Hard-working, law-abiding farmers and growers also suffer under the current system. They continue to be at legal risk for hiring undocumented workers who frequently present fraudulent documents that appear to be credible. The current agricultural guest worker program also fails to provide for unforeseen labor shortages. The bill before us provides an essential balance. It establishes a legal system that ensures basic rights and protections for workers who make significant contributions to our nation's economy. It also ensures the development of an efficient agricultural guest worker program that improves farmer and grower access to legal agricultural workers. Agricultural workers do extremely grueling work, work that puts fruits, vegetables and flowers on the tables of many American households. Dedicated, experienced farm workers deserve the dignity, empowerment and improved quality of life that come with earning legal status. Farmers that play by the rules should have a modern, streamlined program that provides easier access to legal agricultural workers. Congress has not focused on farm worker issues since the mid-1980s. Reform of our agricultural guest worker program is long overdue, and I am hopeful that we will move beyond our status quo and address this important issue this year.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, today I rise to celebrate 30 years of the VA cemetery system. ``Celebrate'' may seem a strange word to use in reference to something so closely tied with mourning, but it is appropriate that we do just that. VA's national cemetery system is one of its most precious resources, providing our veterans the final respect and honor they have earned. VA's operation of the National Cemetery Administration dates from September 1, 1973, when Congress transferred control of the national cemeteries from the Department of Army to what was then the Veterans Administration. Those cemeteries joined the ones already operated by VA, and the National Cemetery System--now the National Cemetery Administration--was created. America's history of providing a final resting place to our veterans extends back before 1973, when the Civil War left hundreds of thousands of soldiers dead. In the spirit of Abraham Lincoln's words that the Nation must ``care for him who shall have borne the battle, and for his widow and his orphan,'' Congress established national cemeteries in order to fulfill that commitment. Today, the National Cemetery Administration ensures that our veterans have a proper burial and maintains the national cemeteries as shrines to their memory. Since taking over the national cemetery system, VA has seen an increase in annual burials from 36,400 to a record 89,300 in 2002. More and more veterans are choosing to be laid to rest in national cemeteries than ever before. This choice is a testament to the devotion that the employees of the VA's National Cemetery Administration show in performing their duties. In noting the importance of the National Cemetery Administration and in honoring its extensive history, I must also point to the need to ensure its future. Nearly 655,000 veteran are expected to die this year, and even more will die in each of the next 5 years. By the end of 2004, only 64 of the 124 veterans national cemeteries will be available for both casketed and cremated remains. As cemetery capacity decreases, veterans in areas near those closing cemeteries lose access to burial options. In order to ensure that proper funeral honors are provided for veterans and their family members, we must develop new cemeteries and expand existing cemeteries. In such cities as Birmingham, AL; Bakersfield, CA; Columbia/Greenville, SC; Philadelphia, PA; and, in my own State, Sarasota and Jacksonville, FL, more than 175,000 veterans in each of these areas are currently without full burial options. We must ensure that their sacrifice is honored. One of the most difficult things we do is cope with the death of someone we love. By guaranteeing a burial that befits the sacrifice of our Nation's soldiers, the National Cemetery Administration mitigates some of that pain and commemorates the service and lives of our veterans.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, I rise today to pay tribute to the memory of an extraordinary Floridian who was also an American treasure--Chesterfield Harvey Smith. On Wednesday, July 16, 2003, we lost this resounding voice of conscience to cardiopulmonary complications at Doctor's Hospital in Coral Gables, FL. He was 85. Chesterfield Smith often called himself a ``country lawyer,'' but he was a pillar of this Nation's legal community. After graduating from the University of Florida's law school in 1948, he joined a law firm that he led through mergers and acquisitions to become one of the country's largest, Holland & Knight. He served as president of the Florida Bar Association in 1964, and then became president of the American Bar Association in 1973. While ABA president, Mr. Smith condemned President Richard Nixon following the firings of an attorney general and others in the so- called ``Saturday Night Massacre'' during the Watergate scandal. Mr. Smith's comment--``no man is above the law''--has been described as a turning point in public opinion. Smith urged that an independent special prosecutor be employed to investigate the President. ``The justice system was being torn down by Nixon's actions,'' Mr. Smith recalled in an interview with The Associated Press in 1999. Mr. Smith challenged members of the legal profession to provide quality, affordable legal services for all persons in need, insisting that law firms fill in where government funding came short. Always a visionary, he proposed testing of lawyers to weed out incompetents and was an early advocate of equal rights for women and minorities. Among his many honors, in 1969, the Florida State Chamber of Commerce named Chesterfield Smith the first ``Distinguished Floridian of the Year,'' and he was subsequently honored as a ``Great Floridian'' by Governor Lawton Chiles and the Florida Cabinet. In 2002, Supreme Court Justice Ruth Bader Ginsburg presented Mr. Smith with an award in recognition of his lifelong commitment to pro bono service. Born in the small town of Arcadia in southwest Florida, Chesterfield served from 1934 to 1938 with the Florida National Guard. He joined the Army in 1940, prior to Pearl Harbor, where he quickly achieved the rank of Technical Sergeant and was recommended for Officer Candidate School. After attending OCS and being commissioned as a Field Artillery Officer, he served during World War II combat as the Commander of B Battery with the 390th Field Artillery Battalion, 94th Infantry Division, that participated in the Northern France, Rhineland, Ardennes-Alsace and Central Europe Campaigns. His bravery in these campaigns resulted in his being awarded the Bronze Star Medal. He was also awarded the American Defense Service Medal, American Campaign Service Medal, European Middle Eastern Campaign Medal with four Bronze Service Stars and the World War II Victory Medal. Chesterfield was discharged from the Army, having attained the rank of Captain, in December 1945. He served 6 more years in the Army Reserve, retiring in 1951 with the rank of Major. After the war, he returned to Florida and graduated from law school at the University of Florida. He joined the firm of Holland, Bevis & McRae in Bartow and quickly made partner. Later, under Smith's leadership, the firm merged with the Tampa firm Knight, Jones, Whitaker and Germany in 1968, and the new firm became Holland & Knight. Smith served as the firm's managing partner for 18 years. Today, Holland & Knight is our nation's eighth largest firm and sets the standard for public service. In short, this son of Florida bravely served his Nation as a member of the armed services and as a civilian. He truly was worthy of what was his most cherished title: ``Citizen Smith.'' I urge my colleagues to join me in expressing heartfelt condolences to Chesterfield's widow, Jacqueline Allee Smith of Coral Gables, FL and in expressing our appreciation for this great man's lasting legacy.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, I rise today to urge my colleagues to support an expansion of an existing Department of Veterans Affairs assisted living pilot program. Currently, 35 percent of veterans are 65 or older, which translates into 8.75 million people. Of that, about 640,000 are 85 and older-- those most in need of long-term care. VA estimates that the numbers will more than double to about 1.3 million in 2012. The assisted living pilot program is designed to help this massive group of men and women who either need long-term care now or potentially will need it in the future. The pilot program was first established through The Veterans Millennium Health Care and Benefits Act, which gave VA clear authority to furnish an assisted living service, including to the spouses of veterans. For my colleagues who do not know--and I doubt there can be many-- assisted living is a form of institutional care for those who need help caring for themselves but who do not need to be in a nursing home. By giving them the option of assisted living in an assistive facility, we allow our elderly veterans to retain their independence. The existing pilot has also provided VA a way to offer long-term care without having to house the program within its hospitals, reducing some of the burden to increase its number of beds. The Veterans Millennium Health Care and Benefits Act allowed for only one pilot program. After an extensive application process, on January 9, 2001, the Northwest Veterans Integrated Service Network (VISN 20) was selected as the pilot site. Though the panel which selected the winner felt that other applicants, including the second place proposal from Florida's VISN 8, warranted funding, they were tied by the law's limit of one program. Since its inception, the VA assisted living pilot program in VISN 20 has placed a total of 181 veterans in assisted living facilities. The average veteran selected for the pilot is a 69-year-old unmarried male who was referred from an inpatient hospital setting. The average veteran enrolled in the pilot also typically shows significant functional impairment and a wide variety of physical and mental health conditions. Initial findings show the average cost of the program is comparable to that of private assisted living--even costing less than some offered in Boise and Portland, two cities that are hosting the program. The average contract facility used for the pilot has 25 rooms. Another valuable facet of the program is its use of a computerized database that makes it extremely efficient for components such as recruitment, processing of payments, high quality data collection, and data analysis for ongoing management feedback and evaluation. Clearly, VA needs to do more in the area of long-term care. On May 22 of this year, at the request of the Senate and House Committees on Veterans Affairs, the General Accounting Office (GAO) issued the report VA Long-Term Care: Service Gaps and Facility Restrictions Limit Veterans' Access to Noninstitutional Care. GAO found that ``VA's lack of emphasis on increasing access to noninstitutional long-term care services has contributed to service gaps and individual facility restrictions that limit access to care.'' The report made several recommendations to VA, including that they ``refine current performance measures to help ensure that all VA facilities provide veterans with access to required noninstitutional services.'' In fiscal year 2002, VA served about 36 percent of its long-term care workload in non-institutional settings, yet, that same year, non- institutional care accounted for just 9 percent of VA's long-term care expenditures. Clearly a move from traditional institutional care is wise. The assisted living pilot program goes far in helping VA address these problems and meet the goals set out for them by GAO. While the assisted living pilot in VISN 20 does not expire until October 2004, I am convinced that veterans in that part of the country are benefitting from the approach. The legislation I introduce today would expand the pilot program to three additional networks, for three additional years. Why should the rest of the Nation be prevented from reaping the benefits of such a practical, cost-effective program? Both veterans and VA employees affiliated with the program have praised what it has to offer. They believe that it fills an important gap for those who require care but do not need nor want to go to a nursing home. We must expand this program that provides such deserved care to our Nation's veterans, allowing them to maintain both their health and their self-respect. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, I rise today to urge my colleagues to support an expansion of an existing Department of Veterans Affairs assisted living pilot program. Currently, 35 percent of veterans are 65 or older, which translates into 8.75 million people. Of that, about 640,000 are 85 and older-- those most in need of long-term care. VA estimates that the numbers will more than double to about 1.3 million in 2012. The assisted living pilot program is designed to help this massive group of men and women who either need long-term care now or potentially will need it in the future. The pilot program was first established through The Veterans Millennium Health Care and Benefits Act, which gave VA clear authority to furnish an assisted living service, including to the spouses of veterans. For my colleagues who do not know--and I doubt there can be many-- assisted living is a form of institutional care for those who need help caring for themselves but who do not need to be in a nursing home. By giving them the option of assisted living in an assistive facility, we allow our elderly veterans to retain their independence. The existing pilot has also provided VA a way to offer long-term care without having to house the program within its hospitals, reducing some of the burden to increase its number of beds. The Veterans Millennium Health Care and Benefits Act allowed for only one pilot program. After an extensive application process, on January 9, 2001, the Northwest Veterans Integrated Service Network (VISN 20) was selected as the pilot site. Though the panel which selected the winner felt that other applicants, including the second place proposal from Florida's VISN 8, warranted funding, they were tied by the law's limit of one program. Since its inception, the VA assisted living pilot program in VISN 20 has placed a total of 181 veterans in assisted living facilities. The average veteran selected for the pilot is a 69-year-old unmarried male who was referred from an inpatient hospital setting. The average veteran enrolled in the pilot also typically shows significant functional impairment and a wide variety of physical and mental health conditions. Initial findings show the average cost of the program is comparable to that of private assisted living--even costing less than some offered in Boise and Portland, two cities that are hosting the program. The average contract facility used for the pilot has 25 rooms. Another valuable facet of the program is its use of a computerized database that makes it extremely efficient for components such as recruitment, processing of payments, high quality data collection, and data analysis for ongoing management feedback and evaluation. Clearly, VA needs to do more in the area of long-term care. On May 22 of this year, at the request of the Senate and House Committees on Veterans Affairs, the General Accounting Office (GAO) issued the report VA Long-Term Care: Service Gaps and Facility Restrictions Limit Veterans' Access to Noninstitutional Care. GAO found that ``VA's lack of emphasis on increasing access to noninstitutional long-term care services has contributed to service gaps and individual facility restrictions that limit access to care.'' The report made several recommendations to VA, including that they ``refine current performance measures to help ensure that all VA facilities provide veterans with access to required noninstitutional services.'' In fiscal year 2002, VA served about 36 percent of its long-term care workload in non-institutional settings, yet, that same year, non- institutional care accounted for just 9 percent of VA's long-term care expenditures. Clearly a move from traditional institutional care is wise. The assisted living pilot program goes far in helping VA address these problems and meet the goals set out for them by GAO. While the assisted living pilot in VISN 20 does not expire until October 2004, I am convinced that veterans in that part of the country are benefitting from the approach. The legislation I introduce today would expand the pilot program to three additional networks, for three additional years. Why should the rest of the Nation be prevented from reaping the benefits of such a practical, cost-effective program? Both veterans and VA employees affiliated with the program have praised what it has to offer. They believe that it fills an important gap for those who require care but do not need nor want to go to a nursing home. We must expand this program that provides such deserved care to our Nation's veterans, allowing them to maintain both their health and their self-respect. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, I ask unanimous consent that the attached article from the Gainesville Sun be printed in the Record.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, earlier this afternoon a declassified version of the report of the House and Senate Intelligence Committees on the events of September 11, 2001, were released to the public. I will take a few minutes to recognize those who performed a great public service in producing this report and to commend it to my colleagues and those who are watching. The public version of this report is available at the Web site of the Government Printing Office, www.access.gpo.gov. This report fulfills the commitment that was made to the American people and particularly to the families of those who perished in this tragedy. The commitment was to conduct a thorough search for the truth about what our intelligence agencies knew or should have known about al-Qaida and its intentions prior to September 11. It was then to apply the lessons learned from that experience to reform the intelligence community in such a way as to mitigate the likelihood of a repetition of September 11. This was a historic first-of-a-kind effort. For the first time in the history of the Congress, two standing committees, the House and the Senate, joined together to conduct a special inquiry with its own staff. That staff was led by the very capable Ms. Eleanor Hill. The staff reviewed nearly 1 million documents and conducted some 500 interviews. The joint inquiry committee held 22 hearings last year, 9 of which were open to the public. The result of this effort was released today. This document includes both findings of fact and 19 recommendations for reform. I am extremely proud of the commitment that the Members of the House and Senate Intelligence Committee have given to this review. I would especially like to recognize the vice chairman of the Senate committee, Senator Shelby, and the chairman and vice chairman of the House Intelligence Committee, Congressman Porter Goss and Congresswoman Nancy Pelosi. The report's findings are grouped in 24 subject areas, but they have a single bottom line: The attacks of September 11 could have been prevented if the right combination of skill, coordination, creativity, and some good luck had been brought to the task. There is an abundance of important information in this report that suggests, for example, institutional resistance to making counterterrorism a high national priority prior to September 11. This resistance took many forms. It included a lack of information sharing among key agencies. It included budget cuts at the Department of Justice for the FBI's counterterrorism program. Simply put, those problems contributed to the Government's inability to successfully launch an offensive against al-Qaida. As an example of this difficulty, a previously classified finding, No. 14 in the report, states that senior military officials were reluctant to use military assets to conduct offensive counterterrorism efforts in Afghanistan or to support or participate in CIA operations directly towards al-Qaida prior to September 11. In part, this reluctance was driven by the military's view that the intelligence community was unable to provide the intelligence necessary to support military operations. For example, the report confirms that between 1999 and 2001, U.S. Navy ships and submarines armed with cruise missiles were positioned in the north Arabian Sea. Their mission was to attack Osama bin Laden, but it was a mission frustrated because they were not able to get the actionable intelligence which only could have come by our ability to place spies close enough to al-Qaida to tell us what that organization would be doing and where Osama bin Laden might be on any given day. The report makes it clear we should have known that potential terrorists were living among us. Indeed, two of the terrorist-turned- hijackers lived with an FBI informant in San Diego, CA, for 6 months or more in the year 2001. A resourceful FBI agent in Phoenix wanted to follow up on suspicions about foreign-born students who were honing their skills at American flight schools. Officials at FBI central headquarters shut him down. To assure the American people that we take such actions seriously, we included a recommendation, No. 16, that calls for the Director of Central Intelligence to implement new accountability standards throughout the intelligence community. These standards would identify poor performance and affix responsibility for it. It would also set a standard to recognize and reward excellent performance. Had such standards been in place 2 years ago, we might have been able to hold those whose performance fell short of what our country deserves accountable for their errors, omissions and commissions, particularly in the critical period immediately before September 11. Had these standards been implemented last year, it is possible the Nation could have avoided the embarrassment and damage to our Government's credibility that has occurred because of the use of discredited intelligence information in the President's State of the Union Address. So far, we have seen no one suffer more than the indignity of a newspaper headline in either incident. With the release of the joint inquiry report, it is time to look ahead and continue to implement the important reforms of the intelligence community that are necessary and to enhance the Federal Government's partnership with State and local law enforcement and other first responders. If the recommendations in this report are heeded by the White House, by the agencies, and by this Congress, we should be able to make great strides in improving the security of the American people. It is my intention to introduce legislation soon, with cosponsorship of members of the joint inquiry, that would implement the reforms which require legislative action. I hope it will move expeditiously to passage with the full support of the administration. I will also begin that effort with a sense of outrage because we have lost valuable time. It took 7 months, almost as long as it took to conduct the inquiry, for the intelligence agencies to declassify the portions of the report that we are releasing today. What are the consequences of that 7 months' delay? One is that the momentum for reform, which was at a high tide in the weeks and months immediately after 9/11, has begun to diminish despite the scope of the tragedy. We will learn shortly whether we can reinvigorate that reform movement. This Senate will face the test of its will to do so. I, for one, am committed to see this report is not forgotten or overlooked. In my view, the delay reflects the excessive secrecy with which this administration appears to be obsessed and which is keeping important findings of our work from the American people. Such censorship also saps the urgency of reform and precludes the American peoples' ability to hold its leaders accountable. The most serious omission, in my view, is part 4 of the report which is entitled ``Finding, Discussion and Narrative Regarding Certain Sensitive National Security Matters.'' That section of the report contained 27 pages between pages 396 through 422. Those 27 pages have almost been entirely censured. This is the equivalent of ripping out a chapter in the middle of a history book before giving it to your child or grandchild and then telling her ``good luck on the test.'' The declassified version of this finding tells the American people that our investigation developed ``information suggesting specific sources of foreign support for some of the September 11 hijackers while they were in the United States.'' In other words, officials of a foreign government are alleged to have aided and abetted the terrorist attacks on our country on September 11 which took over 3,000 lives. I would like to be able to identify for you the specific sources of that foreign support but that information is contained in the censured portions of this report which are being denied to the American people. What are the consequences of this? It significantly reduces the information available to the public about some of the Government's most important actions, or more accurately, inactions prior to September 11. Second, it precludes the American people from asking their Government legitimate questions such as, How was the information that our Government might have had prior to September 11 utilized after September 11 to enhance the security of our homeland and American interests abroad? Third, almost 2 years after the tragedy of September 11, the administration and the Congress, in the main, have not initiated reforms which would reduce the chances of another September 11. For example, we are allowed to report that the estimates of the CIA's counterterrorism center is that between 70,000 and 120,000 recruits went through al-Qaida's training camps in Afghanistan before those troops were attacked in late 2001. The important questions as to the significance of that statement, to the security of the American people, are not available. This obsession with excessive secrecy is deeply troubling. The recognition of the evils of secrecy in a free society date back to the beginnings of our Nation. Patrick Henry declared: The liberties of a people never were, nor ever will be, secure when the transactions of their rulers may be concealed from them. President John F. Kennedy observed in the first year of his Presidency: ``the very word secret is repugnant in a free and open society, and we are, as people, inherently and historically opposed to secret societies, to secret oaths, and to secret proceedings. We decided long ago that the dangers of excessive and unwarranted concealment of pertinent facts far outweighed the dangers, which are cited to justify.'' These are traditional American values that are being trampled. So the joint committee included our report with this recommendation, recommendation No. 15. ``The President should review and consider amendments to the Executive Orders, policies, and procedures that govern the national security classification of intelligence information in an effort to expand access to relevant information for Federal agencies outside the intelligence community and for State and local authorities which are critical to the fight against terrorism and for the American public''. In addition, the President and heads of Federal agencies should assure that the policies and procedures to protect against unauthorized disclosure of classified intelligence information are well understood, fully implemented, and vigorously enforced. It is my observation that because classification is used so excessively, the corollary is only a minimal effort to enforce classification of materials that truly do deserve to be classified. Again, I remind my colleagues that these recommendations were written late in 2002 before the current crisis developed over the use and possible misuse of intelligence leading us to war in Iraq. But that crisis has given this recommendation even greater urgency for the Government's credibility with the American people and our credibility with the rest of the world. These qualities have been severely eroded in large part because of excessive secrecy. To regain the people's trust we must bring new transparency to our decisionmakers. We must bring new transparency to our decisionmaking. We must move decisions and governmental information into the sunshine. We owe that and much more to the 3,000 victims of September 11.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, I rise today to point out the accomplishments of the Department of Veterans Affairs National Center for Post-Traumatic Stress Disorder for fiscal year 2002. As spelled out in its 13th annual report, the Center for PTSD has made significant strides in the treatment of this trauma--steps that became particularly meaningful following September 11, 2001. Born during a time of crisis, the Center was created just months before the Loma Prieta, CA, earthquake in 1989. That event's aftermath became the Center's first real emergency-response experience. Since then, the Center has been called in time and time again to treat the mental trauma resulting from disasters, including the crisis brought on in my own state of Florida following Hurricane Andrew. Though the Center's primary focus has always been and continues to be theis country's veterans, the knowledge and expertise gained through work in the VA system has proved to be invaluable in all areas related to disaster mental health. This became all too clear in the weeks and months following September 11, 2001. The Center for PTSD's fiscal year actually began on October 1, 2001, just weeks after the events of 9/11. The year that followed proved to be the Center's greatest test of its 13-year history, calling into play all three of the Center's main areas of endeavor: research, education, and consultation. In 2001, the Center took leadership of a 3-year project to develop best-practice guidelines for emergency mental health interventions, taking into account both criminal and natural disasters. By the time 9/ 11 had taken place, staff were one year into the project, enabling them use the wealth of research and analysis already accumulated. During the recovery efforts, the Center's education materials, especially those on the website, proved very helpful in educating relief workers, victims, families and bystanders about PTSD and how to cope with it. In addition, Center staff were called upon to consult for several agencies. Its researchers used the recovery process as an opportunity to gather data and conduct long-term research studies on the effects of 9/11, including a major study involving the entire Fire Department of New York. In the end, this report proves mostly to be a living history of the events of September 11 and the way our Nation coped with those tragedies. As documented in the report's pages, the lessons of that day will remain invaluable to the future treatment of PTSD, for both our Nation's veterans as well as the rest of the country. As Ranking Member of the Committee on Veterans' Affairs, I am proud of the accomplishments the Center for PTSD has made in treating disaster-related mental health. The hard work and dedication of its staff proved invaluable to all those affected by September 11, 2001, regardless of whether they witnessed firsthand the attacks in New York City and Washington, DC, or simply watched the events of that terrible day unfold on their television.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. I ask Senator Cochran and Senator Byrd are you aware of the Multi-State Anti-Terrorism Information Exchange Program, or the MATRIX program, which is a powerful new tool used by our law enforcement officers to combat terrorism and domestic crime?

Mr. GRAHAM of Florida. I can attest to the success the MATRIX program has had in our home State of Florida. Time is critical in preventing acts of terrorism. Our law enforcement officials in Florida tell me that, with the advantages of the MATRIX system, they have seen significant improvements in cases involving kidnapping, identity theft, drug trafficking and terrorism, just to name a few. MATRIX has been a resounding success, with the program set to expand to 12 additional States in the near future, including Kentucky, Pennsylvania and Texas.

Mr. GRAHAM of Florida. Yes, for the first time, States will be able to share information through this integrated database system, providing law enforcement officers with the information they need to investigate threatened acts of terrorism or domestic crimes. The same results would have required many hours to accomplish. Those hours can now be compressed, freeing up limited law enforcement resources to focus on critical priorities, such as responding to terrorist threats.

Mr. GRAHAM of Florida. My colleague from the State of Florida and I encourage the Department of Homeland Security to identify additional funds for the MATRIX program, as it is clear the existing information systems and networks upon which our first responders rely need to be upgraded to fight the global war on terror. And I thank the chairman and ranking member for their comments. fort gordon, georgia

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, when Congress enacted the Tax Reform Act of 1986, it was heralded for its simplicity, efficiency and fairness. Yet the legislation was not fair to states such as Florida that choose not to finance the government through the imposition of an income tax. Residents from these States are forced to pay a higher Federal income tax liability than comparable citizens of other States. This results from the 1986 Act's elimination of the Federal income tax deduction for State sales taxes. Today, Senators Nelson of Florida, Daschle, Johnson and I are introducing the Sales Tax Equity act to remedy this inequity and lift our constituents from second-class status. The bill allows taxpayers to elect a deduct State and local sales taxes in lieu of a deduction for State and local income taxes. Although the election is available to residents of all States, the practical effect of the bill is to make the deduction for State taxes available to residents of States with no State income tax. Residents from these States should not be forced to pay higher Federal tax bills simply because their State government's funding does not derive from an income tax. To avoid burdensome record-keeping requirements, the deduction for State and local sales taxes would be determined by tables produced by Treasury. Those tables will take into consideration the sales tax rates in the various States and average consumption. The Joint Committee on Taxation estimates the cost of restoring this fairness to the citizens of non-income tax States at $26 billion over ten years. Under most circumstances it should not be incumbent upon those of us who are trying to restore equity in our Federal tax laws to find offsets for this cost. The problem we face, however, is that last week the Office of Management and Budget announced that the deficit for this year would be 455 billion dollars--165 billion dollars greater than the previous record deficit. The fiscal hole in which we now find ourselves--primarily as a result of the fiscal mismanagement of the Bush Administration--places an extra burden on us. The responsible approach to fixing this problem, therefore, requires us to put together a proposal that will not exacerbate the deficit. Fortunately, offsets exist that will fully offset the cost of the restored sales tax deduction and improve the Nation's tax laws by making it tougher for taxpayers to avoid paying their fair share. In his last report to the IRS Oversight Board, former Commissioner Rossotti identified corporate tax shelters as one of the top problems facing the IRS. To combat this growing problem, the bill includes measures to crack down on the proliferation of tax shelters. The purpose of these provisions is to reinforce the Treasury department's administrative enforcement regime. A key element of the Service's enforcement regime is their ability to detect potentially abusive transactions. Thus, the bill promotes disclosure of such transactions through a framework of increased penalties and limited defenses in the event of nondisclosure. The legislation also clarifies the judicially created doctrine of economic substance and imposes a new 40 percent strict-liability penalty for those transactions that fail this new requirement. Clarification of the economic substance doctrine requires that the taxpayer establish that (1) The transaction changes in a meaningful way, apart from the Federal income tax consequences, the taxpayer's economic position, (2) the taxpayer has a substantial non-tax purpose of entering into the transaction, and (3) the transaction is a reasonable means of accomplishing such non-tax purpose. In addition to cracking down on potentially abusive transactions, our bill will shut down known abusive transactions. Last year, at the request of the Chairman and Ranking Members of the Senate Committee on Finance, the Joint Committee on Taxation investigated Enron's tax returns. One of the areas on which the Joint Committee focused was the tax shelter arrangements, offshore entities, and special purposes entities that Enron used to reduce its tax liability. The Joint Committee issued its report on this investigation on February 13, 2003 and included recommendations for shutting down some of the tax shelters used by the company. This legislation includes those recommendations. The legislation also eliminates incentives in our tax code that encourage individuals and corporations to renounce their U.S. citizenship to avoid paying U.S. tax. For individuals, the legislation generally subjects U.S. citizens who relinquish their U.S. citizenship and certain long-term U.S. residents who terminate their U.S. residence to tax on the net unrealized gain in their property as if such property were sold at fair market value on the day before the expatriation or residency termination. Only a gain in excess of $600,000, $1.2 million for a married couple, is subject to tax. The legislation also establishes new rules to thwart efforts by some U.S. corporations to reincorporate in a foreign country in order to avoid paying U.S. tax. These proposals are identical to legislation passed previously by the Senate. There is one additional, and crucial, benefit of our legislation. It will not slow down the current conference negotiations on legislations extending the child credit expansion to low-income families. As my colleagues know, legislation resolving this matter has passed both the House and Senate and the differences between the two bills must be reconciled. It is important for that legislation to get resolved as soon as possible so that the IRS has ample time to send checks out to these families this summer. Some have suggested that resolution of the sales tax issue--a matter not included in either the House or Senate bill--be attached to the child credit bill. I fear that such an attempt would further complicate resolution of that important legislation. I hope our colleagues will look upon this legislation in the spirit with which it is offered. It is fundamentally unfair that for the past seventeen years the residents of our States have faced higher Federal income tax liabilities than their fellow citizens living in other States. We feel that we have structured our legislation in a manner that corrects this inequity without jeopardizing the tax benefits available to residents of other States. Furthermore, the bill is fiscally responsible and improves the tax system by making it more difficult for those who would use tax shelters and other devices to lower their taxes.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, when Congress enacted the Tax Reform Act of 1986, it was heralded for its simplicity, efficiency and fairness. Yet the legislation was not fair to states such as Florida that choose not to finance the government through the imposition of an income tax. Residents from these States are forced to pay a higher Federal income tax liability than comparable citizens of other States. This results from the 1986 Act's elimination of the Federal income tax deduction for State sales taxes. Today, Senators Nelson of Florida, Daschle, Johnson and I are introducing the Sales Tax Equity act to remedy this inequity and lift our constituents from second-class status. The bill allows taxpayers to elect a deduct State and local sales taxes in lieu of a deduction for State and local income taxes. Although the election is available to residents of all States, the practical effect of the bill is to make the deduction for State taxes available to residents of States with no State income tax. Residents from these States should not be forced to pay higher Federal tax bills simply because their State government's funding does not derive from an income tax. To avoid burdensome record-keeping requirements, the deduction for State and local sales taxes would be determined by tables produced by Treasury. Those tables will take into consideration the sales tax rates in the various States and average consumption. The Joint Committee on Taxation estimates the cost of restoring this fairness to the citizens of non-income tax States at $26 billion over ten years. Under most circumstances it should not be incumbent upon those of us who are trying to restore equity in our Federal tax laws to find offsets for this cost. The problem we face, however, is that last week the Office of Management and Budget announced that the deficit for this year would be 455 billion dollars--165 billion dollars greater than the previous record deficit. The fiscal hole in which we now find ourselves--primarily as a result of the fiscal mismanagement of the Bush Administration--places an extra burden on us. The responsible approach to fixing this problem, therefore, requires us to put together a proposal that will not exacerbate the deficit. Fortunately, offsets exist that will fully offset the cost of the restored sales tax deduction and improve the Nation's tax laws by making it tougher for taxpayers to avoid paying their fair share. In his last report to the IRS Oversight Board, former Commissioner Rossotti identified corporate tax shelters as one of the top problems facing the IRS. To combat this growing problem, the bill includes measures to crack down on the proliferation of tax shelters. The purpose of these provisions is to reinforce the Treasury department's administrative enforcement regime. A key element of the Service's enforcement regime is their ability to detect potentially abusive transactions. Thus, the bill promotes disclosure of such transactions through a framework of increased penalties and limited defenses in the event of nondisclosure. The legislation also clarifies the judicially created doctrine of economic substance and imposes a new 40 percent strict-liability penalty for those transactions that fail this new requirement. Clarification of the economic substance doctrine requires that the taxpayer establish that (1) The transaction changes in a meaningful way, apart from the Federal income tax consequences, the taxpayer's economic position, (2) the taxpayer has a substantial non-tax purpose of entering into the transaction, and (3) the transaction is a reasonable means of accomplishing such non-tax purpose. In addition to cracking down on potentially abusive transactions, our bill will shut down known abusive transactions. Last year, at the request of the Chairman and Ranking Members of the Senate Committee on Finance, the Joint Committee on Taxation investigated Enron's tax returns. One of the areas on which the Joint Committee focused was the tax shelter arrangements, offshore entities, and special purposes entities that Enron used to reduce its tax liability. The Joint Committee issued its report on this investigation on February 13, 2003 and included recommendations for shutting down some of the tax shelters used by the company. This legislation includes those recommendations. The legislation also eliminates incentives in our tax code that encourage individuals and corporations to renounce their U.S. citizenship to avoid paying U.S. tax. For individuals, the legislation generally subjects U.S. citizens who relinquish their U.S. citizenship and certain long-term U.S. residents who terminate their U.S. residence to tax on the net unrealized gain in their property as if such property were sold at fair market value on the day before the expatriation or residency termination. Only a gain in excess of $600,000, $1.2 million for a married couple, is subject to tax. The legislation also establishes new rules to thwart efforts by some U.S. corporations to reincorporate in a foreign country in order to avoid paying U.S. tax. These proposals are identical to legislation passed previously by the Senate. There is one additional, and crucial, benefit of our legislation. It will not slow down the current conference negotiations on legislations extending the child credit expansion to low-income families. As my colleagues know, legislation resolving this matter has passed both the House and Senate and the differences between the two bills must be reconciled. It is important for that legislation to get resolved as soon as possible so that the IRS has ample time to send checks out to these families this summer. Some have suggested that resolution of the sales tax issue--a matter not included in either the House or Senate bill--be attached to the child credit bill. I fear that such an attempt would further complicate resolution of that important legislation. I hope our colleagues will look upon this legislation in the spirit with which it is offered. It is fundamentally unfair that for the past seventeen years the residents of our States have faced higher Federal income tax liabilities than their fellow citizens living in other States. We feel that we have structured our legislation in a manner that corrects this inequity without jeopardizing the tax benefits available to residents of other States. Furthermore, the bill is fiscally responsible and improves the tax system by making it more difficult for those who would use tax shelters and other devices to lower their taxes.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. I move to lay that motion on the table. The motion to lay on the table was agreed to. Amendment 975, as Modified

Mr. GRAHAM of Florida. Mr. President, this is a sad evening for me. I rise to oppose the prescription drug bill that we will be voting on shortly. No issue that we have debated over recent years has held so much promise, the promise that we could fundamentally reform Medicare from a program which today requires you to be sick enough to go to the doctor or the hospital in order to get services to one that would have its focus on wellness, including the opportunity to participate in a voluntary, comprehensive, universal, and affordable plan of prescription drugs. Prescription drugs are, in today's health care system, a fundamental part of maintaining good health. I have spent the better part of the last 5 years, as have so many of my colleagues--and in the case of Senator Byrd, many more than 5 years--attempting to deliver a meaningful drug benefit for our Nation's seniors. I have learned some things during this period. Unfortunately, what I have learned convinces me that the bill before us tonight is not worthy of America's seniors. Because what we are about to deliver is a hollow promise and little else. Why do I believe this? Why have I come to the conclusion that this proposal is not worthy of using all of the years of enthusiasm and commitment of America's seniors and many of those such as myself who represent a substantial number of those seniors? Why do we feel that this path is not acceptable? First, there are gaps in the benefit which are too large to overcome. I could not go home to Florida or to any other place in America and tell people that this legislation is a good deal. This is especially the case for those with large out-of-pocket expenses. How do we tell a senior who halfway through the first year in which this will be available, 2006, their drug costs will double but they will continue to pay the monthly premiums? That would be analogous to car insurance which says: You will be covered in case you have an accident from January to August but if you have one from September to December it is out of your pocket. Who would buy that automobile coverage? The worst thing is that millions of seniors will never realize they have bought in to such an inadequate policy until it is too late. Second, this bill does not provide a universal drug benefit. Under this plan, for instance, if you are a Medicare beneficiary but you are also poor, you will not get the prescription drug benefits for Medicare. That is right. Seniors at 74 percent or below the poverty level would be excluded from the Medicare benefit. They would get their prescription drugs through Medicaid. This is a clear effort for the Federal Government to unload a substantial part of its prescription drug expenses on the States, States which are already struggling with serious financial problems. It is for that reason that the National Governors Association has opposed this design saying: It is not good health policy. It is not good precedent. The argument is made that this is all we can do. We cannot do better because we do not have the resources to do better. This is analogous to the child who just has shot his mother and his father and now throws himself on the mercy of the court claiming to be an orphan. We have made the decision to be in the financial status that we are, and the consequence of that decision, as we debated a few weeks ago when we adopted the Senate's budget for the year, is that we are going to have to have an unnecessarily and unacceptably low level of financial support for a meaningful prescription drug benefit. Third, this plan will cost many seniors more than they can afford. From repeated surveys, seniors have stated that they need a plan with no deductible so that coverage starts from the first prescription. And they need a premium of no more than $25 a month. Yet the sponsors of this bill suggest a $275 deductible and an average premium of $35 per month, an average premium which could actually be higher because the private insurance companies will determine the level of the premium. You can look through the over 600 pages of this bill and not find the number $35. That is a hope number but the actual number will be determined by the private insurance carriers. Fourth, this bill would subject millions of America's seniors to a giant experiment, a giant experiment in delivering prescription drugs through an untested delivery system, a system which is unheard of in the private markets. It is stated that this system will be justified because it will be efficient and will use the power of competition to suppress cost. If this was such a good system, why don't we provide it for all Federal employees so they can get, we as Federal employees can get, the benefit of this greater efficiency and cost savings? The reason is because insuring drugs only is not an actuarially sustainable risk. It has been analogized to buying a fire insurance policy just to cover the kitchen. No insurance company is going to sell you a policy for the most vulnerable area of your house to actually experience a fire. That is why no private insurance plan is available today which will provide you a prescription-only coverage. That is the equivalent of the kitchen in terms of its intensity and potential for explosion of cost within health care. Yet we are about to say that some 40 million of the most vulnerable and frail Americans are going to be the experiment for this ideology. I have said it before and I will say it again: There is simply no reason to subject our Nation's seniors to this grand experiment, particularly when we already know what works. There is no reason to pump extra dollars into private insurance plans. A few hours ago we adopted an amendment which will pump in $6 billion for additional benefits to HMOs. Those $6 billion could have been used to reduce the monthly premium, to close part of the gap of coverage. But what did we decide to do? We are going to give it to the HMOs so the Federal Government will be assuming more of the risk of coverage as opposed to these plans whose reason for being is to assume the risk and, therefore, have the incentive to provide the most efficient plans. We are begging these HMOs to participate in the Medicare Program for the sake of a private sector veneer, for the sake of an ideology untested. We actually tried a version of this before. Guess what. It didn't work. I speak from experience. Medicare HMOs have dumped hundreds of thousands of Floridians from their rolls as they have in virtually every other State, and more are being dumped each day. But this Congress, rather than look to the reality of past experience, has determined to embark on this collision course at the expense of seniors and at the expense of common sense. Fifth, I fear that we will have difficulty in convincing healthier seniors to sign up for this prescription drug benefit. As it is with virtually all insurance plans, it is critical that there be a mixture of those who have the greater likelihood of experiencing the risk with those who have the lesser likelihood in order to create an actuarially sound balance. One-third of our seniors would not break even under this legislation. That is, one-third of seniors with drug spending of less than $1,135 per year would get no benefit should they voluntarily sign up for this plan. Therefore, how do we induce them to do so? One of the ways that we had induced them in the past was to have a meaningful catastrophic care provision, so that seniors who, today, are relatively healthy are insuring themselves against the risk that they might have a disease or an accident that would put them into much higher prescription drug costs. Last year we determined that the level necessary to induce a large enough number of healthy seniors to participate was $4,000 in an annual drug expenditure, and if their previous employer made a contribution, that would be counted toward that $4,000. This bill increases the level at which a person would be eligible for catastrophic care to $5,800, and employer contributions would be excluded. This new level is significantly less of an inducement for healthy seniors to participate, and the effect is likely to be disappointing levels of participation. Mr. President, I ask unanimous consent that a copy of today's front page article ``For Struggling Seniors, Medicare Drug Plan's Proof Is in the Purse'' from the Washington Post be printed in the Record following my remarks.

Mr. GRAHAM of Florida. The reporter interviewed active, healthy seniors at centers in Cleveland, OH, and they were skeptical of the cost of the benefits that would be offered under this bill. Sixth, the fact that this bill doesn't take effect until 2006 is another brutal hoax on seniors, truly an abusive, shameful, misleading ploy. The fact is, many of those who most need prescription drug coverage today simply will not live long enough to get any benefits under this plan. As much as I have wanted to vote for a drug bill, for those reasons, I simply cannot vote for the one before us this evening. We have lost our focus. The focus should be on the Medicare Program in reform and how to help our 40 million seniors and disabled persons. Instead, the focus is everywhere else--insurance companies, drug companies, and hiding the flaws which ought to be exposed. This focus is often presented as the issue of choice. Choice has different meanings. For the idealog, choice means a choice among delivery systems. But for seniors, choice means doctors, hospitals, and, hopefully, prescription drugs. Yes, this gives seniors a choice among delivery systems. For instance, if you are one of the 89 percent of seniors in a fee-for-service Medicare Program, you will get a choice of between two or more prescription drug plans. If that fails, you will then drop back into traditional Medicare. The Stabenow amendment, which was defeated earlier in the debate, would have given seniors at least real choice between a prescription drug delivery system and fee-for-service Medicare as the delivery system. The tragedy is that we know what we ought to be doing. What we ought to be doing is building on the strengths of our current Medicare system--one of the most popular health care programs in this Nation's history. We also ought to be seeing that we have a plan that is affordable and comprehensive. I think the dye is cast and this bill is likely to pass the Senate. I will be hopeful that in conference it will improve but I think there is every likelihood to suspect that it will get worse. It will be my intention to introduce legislation that will correct the flaws of this legislation which, among other things, will provide for a patients' bill of rights, so that as we herd more seniors into HMOs, at least they will know the standards by which they will be asked to operate within that. We are beginning to hear the first rumblings of dissent. Today's Miami Herald looked at the legislation before the two Houses and this is what they had to say: House and Senate bills attempting to offer prescription drug cost relief to Medicare seniors can be summed up with the movie title, Dumb and Dumber. Both bills promise dubious benefits without providing the security that seniors want and have, with traditional Medicare health coverage. I ask unanimous consent that a copy of that editorial be printed in the Record after my remarks.

Mr. GRAHAM of Florida

Mr. GRAHAM of Florida. Mr. President, I rise to speak on an issue that will come before the Senate shortly. That is an amendment to strike the language from this legislation which is found in section 605, the legal immigrant child health provision. Let me give the background on section 605. What this legislation would do would be to allow States on a State option basis to elect to provide health care for pregnant women for the period of their pregnancy, plus 60 days thereafter, and immigrant children. In both categories we are talking about legal immigrants, not people who have arrived outside the system and undocumented. These are individuals who have come to the United States under all of the procedures that allow for legal immigration, with the most prominent category being for family reunification. The restoration of this has already been considered by the Senate Finance Committee, first in 2001, then in June of 2002, and most recently in the consideration of this legislation. This provision was sustained in the chairman's mark, as it had been placed by Senator Grassley and Senator Baucus, by a vote of 13 to 8. There has been both consideration and approval of this provision by the Finance Committee. It has been alleged that the provision of these services to legal immigrants will encourage illegal immigration. We are talking exclusively about pregnant women and children who have entered the United States on a legal basis. Prior to 1996, there was no restriction on health care benefits for legal immigrants. We are now carving out from the current exclusion for health care two categories, which are both humane and very much in the public interest, that pregnant women have adequate access to health care and that children grow up with adequate health care. It has been alleged that there are a number of benefits which have also been made available to legal immigrants, including emergency medical services, Head Start programs, foster care, school lunches, and food stamps. Those can be debated on their own merits but they are no substitute for providing to legal immigrants, children, and pregnant women a place to get appropriate health care. It has also been stated that this should be a responsibility of the sponsor.

Mr. GRAHAM of Florida. May I have 30 seconds to close?

Mr. GRAHAM of Florida. The Immigration and Naturalization Service under the current law has limited the kinds of public benefits that are relevant to the so-called public charge finding. INS officers place no weight on the receipt of noncash public benefits when determining whether an immigrant will be a public charge on society. This provision, section 605, is consistent with current national immigration policy. Therefore, I urge the defeat of this amendment.