Chuck Grassley

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I am pleased to introduce the Medicare Rural Health Access Improvement Act of 2009. The purpose of this legislation is to continue ongoing efforts to ensure that Americans in rural areas have access to health care services. Much has been done in the past to improve access to rural providers such as hospitals and doctors. Much more still needs to be done. And it is even more important in light of the economic challenges we face. I hold town meetings in each of the 99 counties in the great state of Iowa every year. As many know, Iowa is largely a rural state, and a significant concern that I consistently hear during these meetings is the difficulty my constituents experience in accessing health care services. As the former Chairman and currently the Ranking Member of the Finance Committee, it has therefore been a priority for me to improve the availability of health care in rural areas. In Iowa, as in many rural areas across the country, hospitals are often not only the sole provider of health care in rural areas, but also employers and purchasers in the community. Moreover, the presence of a hospital is essential for purposes of economic development because businesses check to see if a hospital is in the community in which they might set up shop. As you can see, it is vital that these institutions are able to keep their doors open. In previous legislation, Congress has been able to improve the financial viability of rural hospitals. For instance, the creation and subsequent improvements to the Critical Access Hospital designation have greatly improved the financial health of certain small rural hospitals and ensured that community residents have access to health care. However, there are still a group of rural hospitals that need help. I am referring to what are known as ``tweener'' hospitals, which are too large to be Critical Access Hospitals, but too small to be financially viable under the Medicare hospital prospective payment systems. These facilities are struggling to stay afloat despite their tireless efforts. Like in many communities in across the country, the staff of tweener hospitals and their community residents take great pride in the quality of care at these facilities. I have heard countless stories of the exemplary work tweener hospitals in Iowa perform not only as providers of essential health care, but also as responsible members of their communities. It is for this reason that many provisions in this bill are intended to improve the financial health of tweener hospitals and ensure that people have access to health care. Most tweener hospitals are currently designated as Medicare Dependent Hospitals and Sole Community Hospitals under the Medicare program. There are provisions, both temporary and permanent, included in this bill that would improve Medicare payments for both types of hospitals. This includes improvements to the payment methodologies so that inpatient payments to Medicare Dependent Hospitals would better reflect the costs they incur in providing care. Improvements are also proposed in this bill to Medicare hospital outpatient payments for both Medicare Dependent Hospitals and Sole Community Hospitals so they would both share the benefit of hold harmless payments and add-on payments. Also, a major driver of the financial difficulties that tweener hospitals face is the fact that many have relatively low volumes of inpatient admissions. This bill would improve the existing low-volume add-on payment for hospitals so that more rural facilities with low volumes would receive the assistance they desperately need. Over the years, many have commented that it is simply unfair for many rural hospitals to receive only a limited amount of Medicare Disproportionate Share Hospital, or DSH, payments while many urban hospitals are not subject to such a cap. This bill would eliminate the cap for DSH payments for those rural hospitals for a two-year period. There are also other provisions that would continue to help rural hospitals. The rural flexibility program would be extended for an additional year. This essential program provides valuable resources for rural hospitals. This legislation also seeks to improve incentives for physicians located in rural areas and increase beneficiaries' access to rural health care providers. It includes provisions designed to reduce inequitable disparities in physician payment resulting from the Geographic Practice Cost Indices, or adjusters, known as GPCIs. Medicare payment for physician services varies from one area to another based on the geographic adjustments for a particular area. Geographic adjustments are intended to reflect cost differences in a given area compared to a national average of 1.0 so that an area with costs above the national average would have an index greater than 1.0, and an area below the national average would have an index less than 1.0. There are currently three geographic adjustments: for physician work, practice expense, and malpractice expense. Unfortunately, the existing geographic adjusters result in significant disparities in physician reimbursement which penalize, rather than equalize, physician payment in Iowa and other rural States. These geographic disparities in payment lead to rural states experiencing significant difficulties in recruiting and retaining physicians and other health care professionals due to their significantly lower reimbursement rates. These disparities have perverse effects when it comes to realigning Medicare payment to reward quality of care. Let me put that into context. Iowa is widely recognized as providing some of the highest quality health care in the country yet Iowa physicians receive some of the lowest Medicare reimbursement due to these inequitable geographic adjustments. Medicare reimbursement for some procedures is at least 30 percent lower in Iowa than payment for those very procedures in other parts of the country. That is a significant disincentive for Iowa physicians who are providing some of the best quality care in the country, and it is fundamentally unfair. Congress needs to reduce these disparities in payment and focus on rewarding physicians who provide high quality care. The inequitable geographic payment formulas have also exacerbated the problems that rural areas face in terms of access to health care. Rural America today has far fewer physicians per capita than urban areas. The GPCI formulas are a dismal failure in promoting an adequate supply of physicians in states like Iowa, and more severe physician shortages in rural areas are predicted in the future. The legislation I am introducing today makes changes in the GPCI formulas for work and practice expense to reverse this trend. It recognizes the equality of physician work in all geographic areas and establishes a national value of 1.0 for the physician work adjustment. It establishes a practice expense floor of 1.0 floor and revises the calculation of the practice expense formula to reduce payment differences and more accurately compensate physicians in rural areas for their true practice costs. These changes are needed to help rural states recruit and retain more physicians so that beneficiaries will continue to have access to needed health care. Last year Congress enacted a number of other provisions to improve Medicare payment for health care professionals and providers in rural areas that will expire at the end of 2009. This bill extends the existing payment arrangements which allow independent laboratories to bill Medicare directly for certain physician pathology services through 2010. It extends and improves the rural ambulance payments enacted in the Medicare Improvements for Providers and Patients Act of 2008 by increasing payments from three to five percent and extending them an additional year, through 2010. The bill also includes several new provisions to improve beneficiary access to health care services. It permanently increases the payment limits for rural health clinics. It also allows physician assistants to order post-hospital extended care services and to serve hospice patients. Finally, the bill would protect rural areas from being adversely affected by the new Medicare competitive bidding program for durable medical equipment. It would ensure that home medical equipment suppliers who provide equipment and services in rural areas and small metropolitan statistical areas, MSAs, with a population of 600,000 or less can continue to serve the Medicare program by exempting these areas from competitive bidding. We must ensure that rural areas continue to have medical equipment suppliers available to serve beneficiaries in these areas. As you can see, we still have much to do when it comes to ensuring access to health care in rural America. I look forward to working with my colleagues on this important matter.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I am pleased to introduce the Medicare Rural Health Access Improvement Act of 2009. The purpose of this legislation is to continue ongoing efforts to ensure that Americans in rural areas have access to health care services. Much has been done in the past to improve access to rural providers such as hospitals and doctors. Much more still needs to be done. And it is even more important in light of the economic challenges we face. I hold town meetings in each of the 99 counties in the great state of Iowa every year. As many know, Iowa is largely a rural state, and a significant concern that I consistently hear during these meetings is the difficulty my constituents experience in accessing health care services. As the former Chairman and currently the Ranking Member of the Finance Committee, it has therefore been a priority for me to improve the availability of health care in rural areas. In Iowa, as in many rural areas across the country, hospitals are often not only the sole provider of health care in rural areas, but also employers and purchasers in the community. Moreover, the presence of a hospital is essential for purposes of economic development because businesses check to see if a hospital is in the community in which they might set up shop. As you can see, it is vital that these institutions are able to keep their doors open. In previous legislation, Congress has been able to improve the financial viability of rural hospitals. For instance, the creation and subsequent improvements to the Critical Access Hospital designation have greatly improved the financial health of certain small rural hospitals and ensured that community residents have access to health care. However, there are still a group of rural hospitals that need help. I am referring to what are known as ``tweener'' hospitals, which are too large to be Critical Access Hospitals, but too small to be financially viable under the Medicare hospital prospective payment systems. These facilities are struggling to stay afloat despite their tireless efforts. Like in many communities in across the country, the staff of tweener hospitals and their community residents take great pride in the quality of care at these facilities. I have heard countless stories of the exemplary work tweener hospitals in Iowa perform not only as providers of essential health care, but also as responsible members of their communities. It is for this reason that many provisions in this bill are intended to improve the financial health of tweener hospitals and ensure that people have access to health care. Most tweener hospitals are currently designated as Medicare Dependent Hospitals and Sole Community Hospitals under the Medicare program. There are provisions, both temporary and permanent, included in this bill that would improve Medicare payments for both types of hospitals. This includes improvements to the payment methodologies so that inpatient payments to Medicare Dependent Hospitals would better reflect the costs they incur in providing care. Improvements are also proposed in this bill to Medicare hospital outpatient payments for both Medicare Dependent Hospitals and Sole Community Hospitals so they would both share the benefit of hold harmless payments and add-on payments. Also, a major driver of the financial difficulties that tweener hospitals face is the fact that many have relatively low volumes of inpatient admissions. This bill would improve the existing low-volume add-on payment for hospitals so that more rural facilities with low volumes would receive the assistance they desperately need. Over the years, many have commented that it is simply unfair for many rural hospitals to receive only a limited amount of Medicare Disproportionate Share Hospital, or DSH, payments while many urban hospitals are not subject to such a cap. This bill would eliminate the cap for DSH payments for those rural hospitals for a two-year period. There are also other provisions that would continue to help rural hospitals. The rural flexibility program would be extended for an additional year. This essential program provides valuable resources for rural hospitals. This legislation also seeks to improve incentives for physicians located in rural areas and increase beneficiaries' access to rural health care providers. It includes provisions designed to reduce inequitable disparities in physician payment resulting from the Geographic Practice Cost Indices, or adjusters, known as GPCIs. Medicare payment for physician services varies from one area to another based on the geographic adjustments for a particular area. Geographic adjustments are intended to reflect cost differences in a given area compared to a national average of 1.0 so that an area with costs above the national average would have an index greater than 1.0, and an area below the national average would have an index less than 1.0. There are currently three geographic adjustments: for physician work, practice expense, and malpractice expense. Unfortunately, the existing geographic adjusters result in significant disparities in physician reimbursement which penalize, rather than equalize, physician payment in Iowa and other rural States. These geographic disparities in payment lead to rural states experiencing significant difficulties in recruiting and retaining physicians and other health care professionals due to their significantly lower reimbursement rates. These disparities have perverse effects when it comes to realigning Medicare payment to reward quality of care. Let me put that into context. Iowa is widely recognized as providing some of the highest quality health care in the country yet Iowa physicians receive some of the lowest Medicare reimbursement due to these inequitable geographic adjustments. Medicare reimbursement for some procedures is at least 30 percent lower in Iowa than payment for those very procedures in other parts of the country. That is a significant disincentive for Iowa physicians who are providing some of the best quality care in the country, and it is fundamentally unfair. Congress needs to reduce these disparities in payment and focus on rewarding physicians who provide high quality care. The inequitable geographic payment formulas have also exacerbated the problems that rural areas face in terms of access to health care. Rural America today has far fewer physicians per capita than urban areas. The GPCI formulas are a dismal failure in promoting an adequate supply of physicians in states like Iowa, and more severe physician shortages in rural areas are predicted in the future. The legislation I am introducing today makes changes in the GPCI formulas for work and practice expense to reverse this trend. It recognizes the equality of physician work in all geographic areas and establishes a national value of 1.0 for the physician work adjustment. It establishes a practice expense floor of 1.0 floor and revises the calculation of the practice expense formula to reduce payment differences and more accurately compensate physicians in rural areas for their true practice costs. These changes are needed to help rural states recruit and retain more physicians so that beneficiaries will continue to have access to needed health care. Last year Congress enacted a number of other provisions to improve Medicare payment for health care professionals and providers in rural areas that will expire at the end of 2009. This bill extends the existing payment arrangements which allow independent laboratories to bill Medicare directly for certain physician pathology services through 2010. It extends and improves the rural ambulance payments enacted in the Medicare Improvements for Providers and Patients Act of 2008 by increasing payments from three to five percent and extending them an additional year, through 2010. The bill also includes several new provisions to improve beneficiary access to health care services. It permanently increases the payment limits for rural health clinics. It also allows physician assistants to order post-hospital extended care services and to serve hospice patients. Finally, the bill would protect rural areas from being adversely affected by the new Medicare competitive bidding program for durable medical equipment. It would ensure that home medical equipment suppliers who provide equipment and services in rural areas and small metropolitan statistical areas, MSAs, with a population of 600,000 or less can continue to serve the Medicare program by exempting these areas from competitive bidding. We must ensure that rural areas continue to have medical equipment suppliers available to serve beneficiaries in these areas. As you can see, we still have much to do when it comes to ensuring access to health care in rural America. I look forward to working with my colleagues on this important matter.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, let me first say, I adamantly oppose and abhor discrimination of any kind, whether it is based on gender, age, religion, disability or race. I am a father to two daughters. I have five granddaughters and two great-granddaughters. I want all of my granddaughters to know that their goals and achievements will only be limited by their own ambition rather than a despicable act of gender discrimination. There is no place for discrimination in our country, and all of my colleagues share this belief. No side in this debate is in favor of gender discrimination. The matter before the Senate is the Lilly Ledbetter Fair Pay Act. The Lilly Ledbetter Fair Pay Act seeks to overturn a Supreme Court decision that the sponsors contend has removed statutory protections against discrimination, in this case, pay discrimination. The Court's decision in Ledbetter v. Goodyear Tire held that a plaintiff alleging pay discrimination under title VII must file a claim within the statutory filing period of the alleged discrimination. It is unfair to individuals who were unknowingly discriminated against to have a strict statute of limitations that prevent them from bringing suit once they discover the discrimination. I could not agree more. An individual should not be precluded from seeking justice simply because they were not aware of the discrimination. This is the situation that the proponents of the Ledbetter bill seek to address. However, we must also ensure that the remedy to this injustice does not lead to allegations of discrimination that are years and, perhaps, decades old. A reasonable statute of limitations ensures that the discrimination is identified and reported and the employee receives a timely resolution if there is discrimination. Statutes of limitation have been part of our legal history for hundreds of years and further the interest of justice by ensuring claims are brought in a timely manner while evidence is still available. These limitations have long been recognized by courts as a way to balance the rights of plaintiffs against the rights of defendants. In the case of employment discrimination suits, the statute of limitations provides employers protection from having to defend allegations where records no longer exist or employees have moved on or passed away. Statutes of limitations have always stood in some tension, and it is our job as the elected representatives of plaintiffs and defendants across this country to strike the necessary balance. We need to ensure that law does not sanction hidden discrimination nor effectively eliminate the statute of limitations. The supporters of this bill have offered their version of a solution to this problem. The underlying bill would essentially reset the clock on the statute of limitations every time a new paycheck was received by an individual who was discriminated against in the past. They believe this is necessary regardless of how long in the past the claim of discrimination occurred. It would effectively eliminate the statute of limitations for discrimination claims. The underlying bill also goes far beyond the stated objective of providing justice to those who have been subject to concealed discrimination. Instead, it could have the exact opposite effect of hindering efforts to quickly resolve discrimination claims. By pushing claims off indefinitely into the future, the bill creates a separation between the discriminatory act and the filing of a claim making cases harder to prove and more costly to defend. Simply put, the bill offered by Senator Mikulski greatly expands the existing statute further than it was before the Supreme Court decided the Ledbetter case. While I believe the Mikulski bill goes too far, I do believe Congress should act to ensure discrimination claims are not simply ignored. As I said before, we need to find the right balance. I believe that balance is found with the alternative bill offered by my colleague, Senator Kay Bailey Hutchison. Her amendment essentially codifies a discretionary approach that courts and the Equal Employment Opportunity Commission have applied in these cases for years. The fact is, the Supreme Court and the EEOC have long recognized that statutes of limitation or charge-filing periods can be extended or ``tolled'' in circumstances where the discrimination is hidden or concealed. Simply put, defendants shouldn't be able to run out the clock just because they hide the discrimination or it is unknown to the victim. The Hutchison alternative simply codifies this doctrine of equitable tolling. The Hutchison amendment provides that the clock on the charge- filing deadline does not start running until an employee discovers the discrimination or should have discovered the discrimination. This thoughtful, balanced approach protects the rights of the employee if the discrimination was concealed, but also ensures that the claim can be resolved timely. The Hutchison amendment codifies the flexibility of the claim-filing deadline when the discrimination is concealed, rather than effectively eliminating the deadline outright. It is the type of balanced, measured approach we as legislators are elected to find. While it is my sincere hope that in this day and age no employer treats individuals differently based on gender, I am a cosponsor and strongly support the Hutchison amendment and believe it is the best possible way to ensure that the rights of all individuals are protected from discrimination. Unfortunately, this balanced amendment was rejected by the majority, as were a number of other thoughtful, balanced, and needed amendments offered by colleagues on my side of the aisle. Because those efforts to improve the bill and minimize unintended consequences were rejected, I must vote against the bill. I regret that the Senate was unable to work in a more bipartisan manner to address the serious issue of gender discrimination.

Mr. GRASSLEY. I thank the Chair. (The remarks of Mr. Grassley pertaining to the introduction of S. 301 are printed in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Mr. GRASSLEY. I thank the Chair for the time, and I yield the floor.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I rise to introduce a bill today. Over the past several years, I have worked to establish greater transparency in the financial relationships and financial disclosure requirements between physicians and manufacturers of drugs, of biologics, and medical devices. In the last Congress, the 110th, Senator Herb Kohl of Wisconsin and I introduced what is entitled the Physician Payments Sunshine Act, which is intended to bring some much-needed transparency to these relationships between physicians and manufacturers. To explain why this bill is so important, let me point to a number of investigations I have conducted in the depth and scope of these relationships between physicians on the one hand, and manufacturers of drugs, biologics, and medical devices on the other hand. My findings to date are troubling and reveal significant undisclosed financial ties between physicians and industry. Some examples: These relationships, at times, resulted in annual incomes of over $1 million to individual physicians from just one company. Another example. My investigations determined that several prominent physicians at major universities had failed to disclose large sums of money to their research institutions. That was despite institutional as well as Federal requirements that these reportings take place. This was also despite these physicians' involvement with Federal research study products made by the various drugmakers with whom they have financial relationships. This Federal research has involved billions of dollars in taxpayers' money to fund this research. My oversight has confirmed the need for a consistent, easy-to- understand national system of disclosure, as opposed to a patchwork of disclosure requirements at State and institutional levels, although I compliment States that have such laws on the books. Today I am here to introduce, along with Senator Kohl, the Physician Payment Sunshine Act of 2009. The Physician Payment Sunshine Act would require that manufacturers of drugs, biologics, and medical devices disclose, on an annual basis, any financial relationships that they have with physicians. That information would be posted online by the Secretary of Health and Human Services in a format that is searchable, that would be clear and easy for the public to understand. Whether the relationship is as simple as buying a doctor's dinner or as complex as a multimillion-dollar consulting arrangement, these relationships may affect prescribing practices and may influence research. More importantly, they can obscure the most important issue existing between doctors and patients, and that is a question every doctor and patient has to consider: What is best for the patient? This legislation Senator Kohl and I are introducing today closely parallels the version I circulated last year and follows some recent MedPAC recommendations. MedPAC recommended a lower annual reporting threshold of $100--in the previous bill, it was higher--no de minimis exceptions for payments and a tighter preemption provision. MedPAC will publish their final recommendations in their March report to Congress. I will take those recommendations into consideration and intend to continue pursuing policies that go beyond the transparency in health care than even the existing bill does. There is a greater need for this legislation, and that greater need is demonstrated by a witness testifying at the Finance Committee hearing on health reform last year that industry and physician relationships are pervasive. Drug and device companies spend billions and billions every year on marketing, product development, and research, and much of this money goes directly to doctors. Last year, the Des Moines Register wrote: Your doctor's hand may be in the till of a drug company. So how can you know whether the prescription he or she writes is in your interest or the best interest of a drug company? That is a pretty good question that we all ought to be looking at. Many of these relationships are beneficial and appropriate. That is why we don't outlaw any of these relationships. What we do is make them be reported. And some of these should be reported on a more regular basis than they are even without this legislation. Physicians play important roles in inventing and refining new devices or in conducting medical research. They are hired to educate other doctors. We don't do anything in this legislation to end those professional relationships. But as is often the case, a few bad apples can spoil the whole barrel. It is clear Congress needs to act now to pass disclosure legislation. Currently, drug and device makers have to comply with a number of State requirements, each State giving its own definition and own rules. Patients as well as other doctors have no way to learn about these important relationships. This information should not only be available to those few Americans lucky enough to live in a State already requiring some level of disclosure. Even in the States currently requiring disclosure, most do not apply that law to medical device companies. Some States do not even make public the information they collect, which is of little value to patients who might want to know if their doctors have a relationship with a drug company or a medical device company about which they ought to know. Now, this bill isn't adding new burdens to the industry. By creating a central reporting system, the legislation actually relieves burdens. In addition, I am hopeful that this bill will enjoy the same wide- ranging support as the prior legislation that Senator Kohl and I put in during the 110th Congress. I want to be clear--and this is the second time I am being clear on this point--this legislation does not regulate the business of drug and device companies. Let the people in industry do their business since they have the training and the skills to get the job done. But keep the American people apprised of the business you are doing and how you are doing it. After all, what is at risk isn't merely private interest but the health and well-being of all Americans who depend upon the drugs and medical devices to sustain and to improve their lives. In this process of what we call transparency, in this process that we call sunshine legislation, I often quote from an opinion of Justice Brandeis, I think in 1914, where he said: ``Sunlight is the best disinfectant.'' And that is what Senator Kohl and I are aiming to accomplish with this Physician Payment Sunshine Act, just a little sunlight so the public is better informed.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I rise to introduce a bill today. Over the past several years, I have worked to establish greater transparency in the financial relationships and financial disclosure requirements between physicians and manufacturers of drugs, of biologics, and medical devices. In the last Congress, the 110th, Senator Herb Kohl of Wisconsin and I introduced what is entitled the Physician Payments Sunshine Act, which is intended to bring some much-needed transparency to these relationships between physicians and manufacturers. To explain why this bill is so important, let me point to a number of investigations I have conducted in the depth and scope of these relationships between physicians on the one hand, and manufacturers of drugs, biologics, and medical devices on the other hand. My findings to date are troubling and reveal significant undisclosed financial ties between physicians and industry. Some examples: These relationships, at times, resulted in annual incomes of over $1 million to individual physicians from just one company. Another example. My investigations determined that several prominent physicians at major universities had failed to disclose large sums of money to their research institutions. That was despite institutional as well as Federal requirements that these reportings take place. This was also despite these physicians' involvement with Federal research study products made by the various drugmakers with whom they have financial relationships. This Federal research has involved billions of dollars in taxpayers' money to fund this research. My oversight has confirmed the need for a consistent, easy-to- understand national system of disclosure, as opposed to a patchwork of disclosure requirements at State and institutional levels, although I compliment States that have such laws on the books. Today I am here to introduce, along with Senator Kohl, the Physician Payment Sunshine Act of 2009. The Physician Payment Sunshine Act would require that manufacturers of drugs, biologics, and medical devices disclose, on an annual basis, any financial relationships that they have with physicians. That information would be posted online by the Secretary of Health and Human Services in a format that is searchable, that would be clear and easy for the public to understand. Whether the relationship is as simple as buying a doctor's dinner or as complex as a multimillion-dollar consulting arrangement, these relationships may affect prescribing practices and may influence research. More importantly, they can obscure the most important issue existing between doctors and patients, and that is a question every doctor and patient has to consider: What is best for the patient? This legislation Senator Kohl and I are introducing today closely parallels the version I circulated last year and follows some recent MedPAC recommendations. MedPAC recommended a lower annual reporting threshold of $100--in the previous bill, it was higher--no de minimis exceptions for payments and a tighter preemption provision. MedPAC will publish their final recommendations in their March report to Congress. I will take those recommendations into consideration and intend to continue pursuing policies that go beyond the transparency in health care than even the existing bill does. There is a greater need for this legislation, and that greater need is demonstrated by a witness testifying at the Finance Committee hearing on health reform last year that industry and physician relationships are pervasive. Drug and device companies spend billions and billions every year on marketing, product development, and research, and much of this money goes directly to doctors. Last year, the Des Moines Register wrote: Your doctor's hand may be in the till of a drug company. So how can you know whether the prescription he or she writes is in your interest or the best interest of a drug company? That is a pretty good question that we all ought to be looking at. Many of these relationships are beneficial and appropriate. That is why we don't outlaw any of these relationships. What we do is make them be reported. And some of these should be reported on a more regular basis than they are even without this legislation. Physicians play important roles in inventing and refining new devices or in conducting medical research. They are hired to educate other doctors. We don't do anything in this legislation to end those professional relationships. But as is often the case, a few bad apples can spoil the whole barrel. It is clear Congress needs to act now to pass disclosure legislation. Currently, drug and device makers have to comply with a number of State requirements, each State giving its own definition and own rules. Patients as well as other doctors have no way to learn about these important relationships. This information should not only be available to those few Americans lucky enough to live in a State already requiring some level of disclosure. Even in the States currently requiring disclosure, most do not apply that law to medical device companies. Some States do not even make public the information they collect, which is of little value to patients who might want to know if their doctors have a relationship with a drug company or a medical device company about which they ought to know. Now, this bill isn't adding new burdens to the industry. By creating a central reporting system, the legislation actually relieves burdens. In addition, I am hopeful that this bill will enjoy the same wide- ranging support as the prior legislation that Senator Kohl and I put in during the 110th Congress. I want to be clear--and this is the second time I am being clear on this point--this legislation does not regulate the business of drug and device companies. Let the people in industry do their business since they have the training and the skills to get the job done. But keep the American people apprised of the business you are doing and how you are doing it. After all, what is at risk isn't merely private interest but the health and well-being of all Americans who depend upon the drugs and medical devices to sustain and to improve their lives. In this process of what we call transparency, in this process that we call sunshine legislation, I often quote from an opinion of Justice Brandeis, I think in 1914, where he said: ``Sunlight is the best disinfectant.'' And that is what Senator Kohl and I are aiming to accomplish with this Physician Payment Sunshine Act, just a little sunlight so the public is better informed.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I would like to take a moment today to recognize the 75th anniversary of Hostelling International USA. Since 1934, Hostelling International USA has helped facilitate travel within the United States by the world's youth and promoted intercultural understanding. As part of the international hostelling movement, this organization has helped Americans to experience different parts of their own country and helped international travelers to better understand our unique and proud history, people, and way of life. The sharing of cultures that naturally occurs in a hostel helps people to better understand and identify with others of various backgrounds. Instead of retreating to a hotel room every night, travelers in a hostel are literally living beside and interacting with fellow travelers from other countries. Several of my staff have stayed in hostels while traveling, and I know their experiences have helped shape their ability to appreciate different cultures and points of view. In this respect, it is the small, everyday human interactions that can have the biggest impact, like encountering someone who may not speak English and learning to communicate or sharing favorite foods among an international group of travelers. In my home State of Iowa, the Northeast Iowa Council of Hostelling International USA has provided activities for youth and adults alike in Postville and surrounding communities since 1975. I am glad that Iowans have the benefit of this programming to give a greater understanding of the world and its people to residents who may not have had a chance to travel widely. I am also glad that Hostelling International USA continues to provide the opportunity for people from around the world, and especially young people, to see the real America firsthand and meet the American people. This is the best way to build good will across the globe, and I congratulate Hostelling International USA for its 75 years of service.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I am pleased to join my colleague, Senator Feinstein, in reintroducing the Saving Kids from Dangerous Drugs Act. I believe we have an ongoing moral obligation in this country to ensure our young people have every opportunity to grow up without being accosted by drug pushers at every turn, whether on TV, in the movies, or on the way to school. This bipartisan legislation comes in response to the recent warnings issued by the Drug Enforcement Administration, DEA, and the White House's Office of National Drug Control Policy about highly addictive and dangerous drugs being colored, packaged, and flavored in ways that appear to be designed to attract use by children. As cochairman of the Senate Caucus on International Narcotics Control, I can tell you that the most at-risk population for drug abuse is our young people. Research has shown time and again that if you can keep a child drug free until they turn 20, chances are very slim that they will ever try or become addicted to drugs. Unfortunately, unscrupulous drug dealers are all too aware of statistics like these and have developed new techniques and marketing gimmicks to lure in younger users. As a parent and now grandparent, this is extremely troubling. These drug dealers are flavoring drugs with additives to make them taste like candy. For instance, some drugs that have been recovered by the DEA and local law enforcement have been flavored to taste like strawberry and are known as ``Strawberry Quick.'' Other flavors, such as lemon, coconut, cinnamon and chocolate are clearly being used to make highly addictive drugs like meth and cocaine seem less harmful and more appealing. These flavored drugs are also being marketed in smaller amounts, making them cheaper and more accessible to children. According to an article in USA Today, at least eight States have reported instances involving candy flavored drugs, and many law enforcement officials are expecting these deadly substances to infiltrate their States in the near future. The DEA recently arrested three men in an undercover operation in California where candy flavored cocaine was being distributed. The DEA seized at least four different flavors of cocaine along with other dangerous substances. The estimated street value of the flavored cocaine seized in this operation was $272,400. The DEA also arrested 12 people in connection to a marijuana-laced candy and soft drink operation in 2006. The marijuana-laced candy that was seized in this operation was packaged to look like well known brand name candy bars. These drug busts further illustrate the fact that drug dealers will stop at nothing to hook a new generation on these deadly substances. Currently, Federal law enhances the criminal penalties that apply when a person sells drugs to anyone under the age of 21. When this occurs, the Federal penalties are doubled--or tripled for a repeat offense--and a mandatory minimum of at least 1 year must also apply. However, this penalty applies only to someone who actually sells drugs to someone under 21. The Saving Kids from Dangerous Drugs Act would expand the circumstances under which these enhanced penalties apply to cover the entire operation. Under our bill, the enhanced penalties that already exist would also apply to anyone who knowingly or intentionally manufactures, creates, distributes, dispenses or possesses with the intent to distribute a controlled substance that has been flavored, colored, packaged or otherwise altered in a way that is designed to make it more appealing to a person under 21 years of age. The DEA busts are prime examples of why we need this bipartisan bill to keep drug dealers from peddling their poison to our children. I am pleased that the National Narcotics Officers Association Coalition is strongly supporting this measure. This organization represents 69,000 law enforcement officers who encounter these terrible substances on a daily basis and work endlessly to keep our children and communities safe. The fight against deadly drugs is an ongoing struggle. We must do all we can to protect the most vulnerable among us. We must send a clear message to those wishing to prey on our youth that you risk serious prison time when you target our future. Although this bill was passed out of the Judiciary Committee unanimously last year, the Senate never passed the bill in the 110th Congress. I ask that my colleagues join us in support of this important legislation and pass the Saving Kids from Dangerous Drugs Act.

Mr. GRASSLEY

Mr. GRASSLEY. Madam President, many Senators, including this one, reluctantly supported the Troubled Asset Relief Program last year because we were told by the so-called experts that our financial markets were on the verge of collapse. We were told that we had to deal with the toxic mortgages that were clogging up our financial markets by having the government purchase them at an auction and hold them until the markets stabilized. The theory was to get these troubled assets off the banks' balance sheets and provide them with additional funds to lend to credit worthy borrowers. I had serious doubts about the original plan, but it has never been implemented. Instead, the money has been used to invest directly in select financial institutions. Essentially, it has become a slush fund for the Secretary of Treasury to engage in an erratic industrial policy of picking winners and losers among any company directly, or indirectly, connected to our financial markets. I am deeply troubled by this outcome. I believe Congress was mislead with respect to the financial crisis as well and the intended use of the funds. Moreover, the administration's decision to use funds to provide assistance to the U.S. auto industry was contrary to congressional intent. The ever-changing nature of the TARP program has introduced a new level of uncertainty into our financial markets. Market participants no longer know when or where the Federal Government will intervene. This unpredictability has a chilling effect on investors and undermines the ability to raise capital and make new loans. The outgoing administration has misused these funds and failed to provide adequate accountability. But, the vote today is about the use of the remaining funds by the incoming administration. Unfortunately, they have expressed a desire to pursue an even more vigorous policy of picking winners and losers, with an extra dose of micro-management thrown in for good measure. The efficient allocation of credit is vital to the successful operation of our economy. Without saving and investment, there can be no long-term economic growth. Banks and other financial institutions serve a critical role in bringing savers and investors together and allocating credit to its most productive use. To operate successfully, credit markets need transparency and accountability. Transparency is achieved through the reporting and disclosure of assets and liabilities. Accountability is achieved through the proper alignment of risk and reward. Those who accept risk should profit from their success and pay for their losses. Unfortunately, we have allowed ourselves to undermine the very foundation of our credit markets through a series of well-meaning, but ultimately misguided actions. The continuation of the Troubled Asset Relief Program will not address these fundamental problems. We need a new approach. I'm hopeful Congress will be able to work with the new Administration in the coming months to improve our financial markets and revitalize our economy.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I would like to briefly explain my vote against final passage of S. 22, the Omnibus Public Land Management Act of 2009. I would like to be clear that I do not oppose every aspect of this bill, nor do I oppose the notion that our Nation's most unique and precious natural features should be protected for the use and enjoyment of future generations. As with many large omnibus bills, there are a number of provisions that enjoy strong support in the Senate. However, taken as a whole, this bill represents an enormous commitment of federal resources in perpetuity that we simply cannot afford at this time. For years, our existing national parks, wildlife refuges, and other public lands have been faced with a backlog of much-needed maintenance projects because we have not had the resources to do everything that needs to be done along with competing budget priorities. Now, in the midst of an economic downturn and on the eve of considering an historically large economic stimulus package, the strain on Federal budgets has rarely been greater. In light of this fact, it is intellectually dishonest to promise to the American people that the Federal Government will protect and maintain additional Federal lands when we know that we are not even able to fully keep our current commitments. For that reason, I felt it necessary to vote no on this bill at this time.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I would like to pay tribute to Edythe Salzberger, who passed away at the age of 99 last month. Edythe devoted her life to the belief that the creative process is both healing and life enhancing. An interest in art created by psychiatric patients led her to the Hillcrest Children's Center, a home for emotionally disturbed children, where she began her years of service to the disabled and distressed. A pioneer in the field of art therapy, Mrs. Salzberger wrote numerous articles, trained clinicians and other mental health professionals, established an art therapy program at Chaim Sheba Medical Center in Israel, and helped found the Washington chapter of what later became the American Art Therapy Association. Art therapy is based on the belief that the creative process involved in artistic self-expression helps people solve problems, develop interpersonal and conflict resolution skills, manage behavior, reduce stress, increase self-esteem and self-awareness, and achieve insight. It is used to treat patients of all ages dealing with a host of problems related to emotional and mental disorders, substance abuse, trauma, loss, neurological injuries, and psychosocial difficulties resulting from medical illness. A life-long painter, Edythe Salzberger combined her desire to create with her desire to help. She will be missed not only by friends and family but by all the patients and practitioners of the field she helped pioneer and the respected professional association she helped create. I ask unanimous consent to have the obituary of Edythe Salzberger from the December 15, 2008, edition of the Washington Post printed in the Record.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I would like to speak for less than 10 minutes as in morning business.

Mr. GRASSLEY. I thank the Chair.

Mr. GRASSLEY. I have been fighting against SILO/LILO tax shelters for a long time, as has Senator Baucus. In October 2003, the Finance Committee held hearings on the status of abusive tax shelter activities. During that hearing, we received anonymous testimony from a leasing industry executive that used the name Mr. Janet. He described how U.S. corporations were able to take tax deductions for such things as the Paris, France, sewer lines and the New York subway system. Major corporations were claiming tax deductions on taxpayer-funded infrastructure located in the United States and overseas. Imagine our surprise when we learned that U.S. taxpayers were subsidizing the cost of electric transmission lines in the Australian outback. I find it hard to believe that a corporation was actually taking a tax deduction for the New York City transit car pictured here. However, that is exactly what greedy corporations were doing. Just like the greedy tax shelter promoters who were handing out U.S. taxpayer money to greedy corporations by selling these shady tax shelters to them, the House voted last night to put U.S. taxpayer dollars on the line to bail out tax shelter participants and perpetuate these abusive tax shelters. If we look at all the key congressional players on this deal, we will find that, perhaps not by coincidence, nearly all of them represent areas where these transit shelter deals were done. These tend to be the biggest cities. They tend to be the areas where the shops that hired the sharpies that manufacture these tax shelters do business. Most of these key congressional players for years, especially when Republicans were in the majority, railed against tax shelters. Now we find that for these key congressional players, the imperatives of the transit lobby decisively outweigh the importance of cracking down on a tax shelter that a Federal judge rightly described as ``rotten to the core.'' This reminds me of the Joker from the 1989 version of ``Batman,'' who says: ``I'm giving out free money.'' You know the Joker, as shown on this chart. You have seen him. ``I'm giving out free money.'' As we all know, money is not free. Unfortunately, the joke here has been--and will again be if we do not do something about it--on the American taxpayer. Literally, the guarantee continues the cruel tax shelter joke on the American taxpayers' dime. I urge my colleagues in the Senate to not allow this cruel joke to be played on the American taxpayers. I have fought against these tax shelters in the past, and I will continue to fight against them in the future. This provision puts taxpayers' dollars on the line and perpetuates an abusive tax shelter. In fact, it puts the U.S. Government in the position of guaranteeing tax benefits that corporations, including foreign corporations--again, I want to emphasize--hope to reap from engaging in these tax shelters. So as Senator Baucus has just done--and I thank him for his leadership--I urge my colleagues to vote against this bill which contains a bailout for tax shelter participants. I yield the floor.

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

Mr. GRASSLEY. I ask unanimous consent to speak for 15 minutes.

Mr. GRASSLEY. Madam President, I come to the floor to back up the chairman of the committee, Senator Baucus, who has spoken on the very same issue. We have had a close working relationship for 8 years as either chairman and ranking member, and those changed from time to time. Part of our effort of working together has been to close down abusive tax shelters. So I am here to support what he said and to say, in my own words, my reasons for wanting this provision out of the bill. The bottom line of what I am saying is the bottom line of what Senator Baucus has already said. This tax provision has no business being in this bill. There is a provision in this auto bailout bill that deals with a number of transit agencies that assisted corporations in tax shelters. This provision in the auto bailout bill has nothing to do with automakers. It would prop up a tax shelter that Senator Baucus and I shut down in the year 2004. Shutting down that tax shelter saved American taxpayers $26.56 billion, according to the nonpartisan Joint Committee on Taxation. That is real money. So we should be very protective of making sure money that by subterfuge was not going to come into the Federal Treasury comes back to the Federal Treasury and is not used in the future. This tax shelter is commonly referred to as sale-in, lease-out, or by the acronym SILO, or another program lease- in, lease-out that we refer to by the acronym LILO. This tax shelter bailout within the automaker bailout bill would have the Federal Government guarantee obligations that public transit agencies now face because they entered into shady deals with corporations, including foreign corporations, where they sold things such as the transit agencies' own train cars and then magically leased them back from these corporations to do what they were doing all the time anyway, hauling people. This was not done to change the way the transit agency operated but, instead, to collect a fee for assisting the tax shelter, where the corporations could take advantage of the tax deduction for depreciation of things such as these train cars. As chairman of the Senate Finance Committee in 2004, I worked hard to shut down these tax shelters as a matter of tax fairness, and Senator Baucus was there working closely with me to do that. The Internal Revenue Service has been working to recover money from these deals. If this tax shelter bailout were to pass, it would interfere with the working of the IRS in these efforts to collect money that should never have been deducted in the first place. This tax shelter bailout can change the cost-benefit analysis for those tax shelter corporations that are considering settling their disputes with the IRS over the SILO/LILO tax shelters. It is wrong for the auto bailout bill to bail out transit agencies from participating in these shady tax shelters. The Federal Government should not guarantee the transit agencies' obligations to corporations, including foreign corporations, when doing so allows the tax shelter to continue as it did before 2004, and these corporations, including foreign corporations, to continue taking tax shelter deductions for things such as transit agencies' train cars. If the Federal Government is called upon to pay the guarantees of the transit agencies' obligations to these tax shelter corporations, including foreign tax shelter corporations, then the hardworking U.S. taxpayer will be sending money directly to these foreign corporations and others. I don't know how many, but we know foreign corporations are very much involved. These tax shelters were, in fact, set up so corporations were able to take large depreciation deductions. However, the tax shelter needed a nontaxpaying entity that had large amounts of assets that could be depreciated. So that is where the transit agencies come in. The transit agencies were paid millions of dollars to do nothing, simply sign papers and go about business as usual of transiting people within cities or between cities, as they were doing before this tax shelter was ever thought up. The transit agencies are called accommodation parties in tax shelter lingo. They are called this because, in exchange for their fee, they helped make tax shelters work for corporations that were bilking the U.S. taxpayers out of billions of dollars, and those billions of dollars were lost revenue to the Federal Treasury. This auto bailout bill proposes to bail out the transit agencies from the consequences of their bad judgment of entering into tax shelters. I say ``bad judgment'' because they ought to know this doesn't make sense. Some lawyer might tell you: We can get by with this because we found this loophole in the tax laws. But, in fact, lawyers can find anything. The English language is not so perfect that we write perfect pieces of legislation that somebody who is wise can't find a way around. That is what happened prior to 2004, before Senator Baucus and I shut it down. As the transit agencies have found out--and that is why they are coming to the bailout bill for some help--when you lie down with dogs, you get fleas. Now that the transit agencies have fleas due to their participation in this tax shelter scheme, they want the Federal Government to be their flea remover. If this provision is enacted and if the Federal Government guarantees the transit agencies' tax shelter obligations, it will actually help these shady tax shelter deals stay alive longer and, who knows, encourage more of this in the future. We are trying to shut down a business I consider illicit, people going through the Tax Code and seeing where they can find a tax loophole and writing a program and go out and sell it. They go out and sell it to somebody else, then flee to the woods, and some corporation or individual has to defend it themselves, and they can't. They get stuck with the tax bill from the IRS. We want to shut down the tax shelter-writing business. I will not help the transit agencies avoid the consequences of their participation in these tax shelters. I do not want to put U.S. taxpayer money on the line to support tax shelters that have been stealing from these same taxpayers. I am aware that as early as February 2000, we had a Federal initiative from the executive branch. In the year 2000, the Federal Transit Administration, under the Clinton administration, used to advocate these tax shelter deals to transit agencies as innovative financing. The Federal Transit Administration's promotion of these tax shelters was shameful, and it gave a legitimacy to it. I suppose it even encouraged further tax shelter people to write. But in 2004, Senator Baucus and I said: Enough is enough. That is why the legislation was passed in 2004, shutting down these and saving the taxpayers that $25 billion the Joint Committee on Taxation said could be saved; in other words, paid into the Federal Treasury, instead of some sharp lawyer finding a way to keep it out of the Federal Treasury. Going back to when these were first being instituted by the Federal agency or encouraged by the Federal agency, we did have the IRS responding to that. So you had one agency promoting something. You had the IRS issue a revenue ruling that came out against these tax shelters. But between that 1999 March 1 date and the time Senator Baucus and I finally concluded this needed to stop in 2004, we still had a bunch of these deals consummated. Even if the transit agencies were not aware of the IRS's position, the transit agencies should have realized that getting money for essentially doing nothing ought to be too good to be true. If it sounds too good to be true, it probably is not the right thing to do. That is common advocacy to any consumer in America met by some snake oil salesman who comes along to sell a product. If it sounds too good to be true, you ought to raise questions about it. We even have a situation where every court that has considered these transactions has ruled they are abusive tax shelters and has not allowed the tax breaks claimed by the corporation that engaged in the tax shelters. Three of these court cases are BB&T Corporation, the Fifth Third Bancorp, and AWG Leasing Trust. In a recent court opinion involving John Hancock Life Insurance Company, Chief Judge David Hamilton of the U.S. District Court for the Southern District of Indiana wrote that the SILO deal at issue was ``pure, abusive tax shelter,'' was ``rotten to the core'' and was ``a sham without economic substance.'' Additionally, in February 2004, Senator Baucus and this Senator sent letters to Washington, DC, New York City, and Chicago transit agencies asking for their assistance in an investigation of these abusive tax shelters. I ask unanimous consent that these three letters be printed in the Record.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I would like to discuss Eric Holder's nomination to be the U.S. Attorney General. While Mr. Holder appears to have the appropriate credentials and work experience, it is important that the Judiciary Committee be able to fully and carefully vet the candidate for this important position because this is the Nation's top law enforcement officer. I was surprised to hear that the chairman of the Judiciary Committee noticed Mr. Holder's confirmation hearing for January 8, 2009. Mr. Holder was only formally announced as the prospective Attorney General nominee on December 1 of this year. I understand the Judiciary Committee has a large number of boxes of archived documents relating to his employment at the Justice Department, and those materials need to be reviewed. We have not even gotten Mr. Holder's questionnaire, nomination materials, or FBI background investigation yet. Judiciary Committee members just sent a letter to the Justice Department and the Clinton Library requesting documents relating to issues that Mr. Holder was involved in during his tenure in the Clinton Justice Department. Once we get these materials and once these documents come to us, it will take some time for committee members to review them. While it is not unprecedented for the Judiciary Committee to hold a hearing prior to the inauguration of a President, such as the one held for former Attorney General John Ashcroft, there are significant differences. First, the Ashcroft nomination hearing was held from January 16 to January 19, 2001, obviously giving committee members more breathing room to review his record. Moreover, Attorney General Ashcroft was a well-known quantity to us because he served as our colleague in the U.S. Senate and he was a prominent member of the Judiciary Committee. Of course, this was all prior to his nomination for Attorney General. Even then, my colleagues on the other side of the aisle insisted on 2 days of testimony from the nominee and 2 days of testimony from 23 other outside witnesses, for a total of 4 days of hearings. The bottom line is that the proposed January 8 hearing timetable doesn't give members a full and fair chance to consider Mr. Holder's background as thoroughly as we should. We must have time to comprehensively examine all of Mr. Holder's information, materials, and documents, most of which we haven't even received yet. There is no need to jump the gun and undermine our oversight responsibilities. This is all the more important because Mr. Holder is not a nominee free and clear of issues. The fact is Mr. Holder played a very key role in some very controversial matters, and since his nomination, a number of newspapers, including the New York Times, the Washington Post, and the Wall Street Journal, have all published articles reminding the public of those controversies and raising serious questions about Mr. Holder's role in them. These issues need to be fully considered by members of the Judiciary Committee and eventually by the full Senate. For example, red flags about Mr. Holder's judgment and independence include his role in securing pardons or clemency for an unrepentant billionaire fugitive tax cheat such as Marc Rich or terrorists such as members of the FALN and Weather Underground. A lot of people--including this Senator--have found these facts to be troubling. As I previously mentioned, a number of editorials have been written asking questions about how those facts impact Mr. Holder's ability to serve as U.S. Attorney General. I expect to question Mr. Holder at his confirmation hearing about these and other controversial matters he has been involved with. In addition, Mr. Holder has been in private practice since he left the Clinton Justice Department over 8 years ago. It is important that we know what Mr. Holder has been doing in those 8 years, which cases he has been involved with, and who his clients are, what speeches he has made, and so forth. For example, public reports have emerged that in 2004, the Governor of Illinois hired or sought to hire Mr. Holder. We certainly need time to learn what that is all about. Mr. Holder has not provided the committee with all of this information yet. Again, it is not unreasonable for members of the Judiciary Committee to want to receive all of these materials and have ample opportunity to study them before holding the nomination hearings. As such, I, then--this Senator, then--is in support of Senator Specter's request that Chairman Leahy move the hearing to a later date in January so committee members can do their duty and review Mr. Holder's nomination in a responsible manner. I yield the floor.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, seven weeks ago Congress faced an extremely difficult decision of whether or not to pass an unprecedented $700 billion economic stabilization bill to help our Nation's economy and financial markets. The Emergency Economic Stabilization Act, the Act, passed by Congress and signed into law by the President, was designed to provide new, expanded authority to the Department of the Treasury to take immediate action to stabilize our financial markets by purchasing troubled assets through a program called the Troubled Asset Relief Program or TARP. This new authority was designed to stop the continued declines in the financial services industry and the credit markets. Like many of the thousands of constituents from Iowa I've heard from, I shared their concerns that the stabilization plan put hundreds of billions of taxpayer dollars at risk. During the debate on this legislation I made it clear that I would only support this package if it included significant checks on the spending through various oversight mechanisms. I wanted to make sure the legislation wasn't a blank check for Government bureaucrats to spend taxpayer dollars with impunity. I'm glad that Congress listened to my concerns and I'm glad that specific oversight reforms I recommended were included in the final package. For instance, the creation of a Special Inspector General for the Troubled Assets Relief Program (Inspector General) was something I worked to include in the final legislation to ensure that an independent watchdog would be looking out for taxpayer funds allocated to the TARP. The legislation also has a number of additional oversight provisions such as the creation of a Financial Stability Oversight Board that is responsible for reviewing the exercise of the program to ensure the Treasury is operating as envisioned. Additionally, the legislation included provisions requiring regular reports from the Treasury to Congress, Tranche reports outlining any assets Treasury chooses to purchase, and reports from the Comptroller General at the Government Accountability Office. The Act also places controls on executive compensation and corporate governance at participating entities. Taken together, these provisions were aimed to provide a sturdy foundation for ensuring the program is properly overseen. However, despite these controls, many of these oversight provisions have been slowly implemented or outright ignored until recently. To date, the Senate has only held hearings on the nomination for the Special Inspector General and it is unclear when the nomination will be approved. Until then, the Inspector General at the Department of the Treasury has devoted some resources to overseeing the TARP, but we need to act expeditiously to approve the Special Inspector General to ensure someone is watching over all these taxpayer funds. I do believe once we confirm a nominee to be the Special Inspector General that this office will face an uphill battle to work quickly to hire staff and to get operations moving to find out where all the billions of dollars are and how they were spent. This isn't an impossible task, but it is one that will take serious effort and great leadership to accomplish. One concern I have with the Special Inspector General is the lack of authority that office will have to oversee the TARP and new, evolving programs under the TARP such as the Capital Purchase Plan, or CPP. The Secretary of the Treasury has indicated publicly that he intends to continue utilizing his authority under the Act to use the TARP and the CPP to continue to provide taxpayer funds via equity injections and stock warrant purchases to banks, financial institutions, and other entities, as opposed to purchasing distressed assets as the TARP was originally envisioned. While the Secretary is acting within his authority, this change was not necessarily envisioned from the oversight perspective when the Special Inspector General authorization was drafted. Instead, the current Act could be construed to only give the Special Inspector General the authority to review purchases of distressed assets and not the purchases and equity injections currently ongoing under the CPP. As a result, the Special Inspector General could be limited in authority to review the TARP before he takes office. To rectify this, Senator McCaskill and I are here today to introduce a simple legislative fix to this provision that would amend the Act to allow the Special Inspector General to review all actions taken under the TARP, including those of the CPP. This is a straight forward solution to ensure that the Special Inspector General has all the authority necessary to oversee the taxpayer dollars that are being used to stabilize the financial industry. This legislation makes one other change to the Act that will help the Special Inspector General hit the ground running once the Senate confirms the nomination. Looking back to the last Special Inspector General Congress created, the Special Inspector General for Iraq Reconstruction, SIGIR, we noted that Congress provided SIGIR the authority to utilize special hiring authority to fill these important jobs quickly and not have them tied up in bureaucratic red tape. This section of our bill simply states that the Special Inspector General may utilize special expedited hiring authority authorized under 5 U.S.C. Sec. 3161 for the first six months after the date of enactment to get the office up and running. Further, the section also removes statutory limits for how long these special appointments may serve because we do not want to limit the length of time these employees can work for the Special Inspector General given we don't know how long they will be needed to oversee this program. Taken together, these two simple provisions are necessary to ensure that the Special Inspector General is the aggressive, independent watchdog we envisioned when we passed the Act and not just a paper tiger. As a long time supporter of Inspectors General, I believe this legislation is necessary to ensure the success of the Special Inspector General. I urge my colleagues to support this urgent legislative fix to help ensure that American taxpayer dollars are not lost to fraud, waste, or abuse because of a simple oversight in the drafting of the original legislation.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, seven weeks ago Congress faced an extremely difficult decision of whether or not to pass an unprecedented $700 billion economic stabilization bill to help our Nation's economy and financial markets. The Emergency Economic Stabilization Act, the Act, passed by Congress and signed into law by the President, was designed to provide new, expanded authority to the Department of the Treasury to take immediate action to stabilize our financial markets by purchasing troubled assets through a program called the Troubled Asset Relief Program or TARP. This new authority was designed to stop the continued declines in the financial services industry and the credit markets. Like many of the thousands of constituents from Iowa I've heard from, I shared their concerns that the stabilization plan put hundreds of billions of taxpayer dollars at risk. During the debate on this legislation I made it clear that I would only support this package if it included significant checks on the spending through various oversight mechanisms. I wanted to make sure the legislation wasn't a blank check for Government bureaucrats to spend taxpayer dollars with impunity. I'm glad that Congress listened to my concerns and I'm glad that specific oversight reforms I recommended were included in the final package. For instance, the creation of a Special Inspector General for the Troubled Assets Relief Program (Inspector General) was something I worked to include in the final legislation to ensure that an independent watchdog would be looking out for taxpayer funds allocated to the TARP. The legislation also has a number of additional oversight provisions such as the creation of a Financial Stability Oversight Board that is responsible for reviewing the exercise of the program to ensure the Treasury is operating as envisioned. Additionally, the legislation included provisions requiring regular reports from the Treasury to Congress, Tranche reports outlining any assets Treasury chooses to purchase, and reports from the Comptroller General at the Government Accountability Office. The Act also places controls on executive compensation and corporate governance at participating entities. Taken together, these provisions were aimed to provide a sturdy foundation for ensuring the program is properly overseen. However, despite these controls, many of these oversight provisions have been slowly implemented or outright ignored until recently. To date, the Senate has only held hearings on the nomination for the Special Inspector General and it is unclear when the nomination will be approved. Until then, the Inspector General at the Department of the Treasury has devoted some resources to overseeing the TARP, but we need to act expeditiously to approve the Special Inspector General to ensure someone is watching over all these taxpayer funds. I do believe once we confirm a nominee to be the Special Inspector General that this office will face an uphill battle to work quickly to hire staff and to get operations moving to find out where all the billions of dollars are and how they were spent. This isn't an impossible task, but it is one that will take serious effort and great leadership to accomplish. One concern I have with the Special Inspector General is the lack of authority that office will have to oversee the TARP and new, evolving programs under the TARP such as the Capital Purchase Plan, or CPP. The Secretary of the Treasury has indicated publicly that he intends to continue utilizing his authority under the Act to use the TARP and the CPP to continue to provide taxpayer funds via equity injections and stock warrant purchases to banks, financial institutions, and other entities, as opposed to purchasing distressed assets as the TARP was originally envisioned. While the Secretary is acting within his authority, this change was not necessarily envisioned from the oversight perspective when the Special Inspector General authorization was drafted. Instead, the current Act could be construed to only give the Special Inspector General the authority to review purchases of distressed assets and not the purchases and equity injections currently ongoing under the CPP. As a result, the Special Inspector General could be limited in authority to review the TARP before he takes office. To rectify this, Senator McCaskill and I are here today to introduce a simple legislative fix to this provision that would amend the Act to allow the Special Inspector General to review all actions taken under the TARP, including those of the CPP. This is a straight forward solution to ensure that the Special Inspector General has all the authority necessary to oversee the taxpayer dollars that are being used to stabilize the financial industry. This legislation makes one other change to the Act that will help the Special Inspector General hit the ground running once the Senate confirms the nomination. Looking back to the last Special Inspector General Congress created, the Special Inspector General for Iraq Reconstruction, SIGIR, we noted that Congress provided SIGIR the authority to utilize special hiring authority to fill these important jobs quickly and not have them tied up in bureaucratic red tape. This section of our bill simply states that the Special Inspector General may utilize special expedited hiring authority authorized under 5 U.S.C. Sec. 3161 for the first six months after the date of enactment to get the office up and running. Further, the section also removes statutory limits for how long these special appointments may serve because we do not want to limit the length of time these employees can work for the Special Inspector General given we don't know how long they will be needed to oversee this program. Taken together, these two simple provisions are necessary to ensure that the Special Inspector General is the aggressive, independent watchdog we envisioned when we passed the Act and not just a paper tiger. As a long time supporter of Inspectors General, I believe this legislation is necessary to ensure the success of the Special Inspector General. I urge my colleagues to support this urgent legislative fix to help ensure that American taxpayer dollars are not lost to fraud, waste, or abuse because of a simple oversight in the drafting of the original legislation.

Mr. GRASSLEY

Mr. GRASSLEY. Madam President, I reserve the right to object.

Mr. GRASSLEY. Madam President, throughout the years, the Committee on Finance has worked to safeguard and improve the programs under its jurisdiction, including the Medicare and Medicaid Programs. The Finance Committee has a unique expertise on these programs and is the only committee in a position to assess the possible effects of individual changes on all Social Security programs as a whole. Accordingly, it is essential that any legislative proposals impacting these programs be considered by the full Senate only after the Finance Committee conducts a thorough analysis of the issues involved and the potential solutions. I would like to bring up one example of how this bill needs scrutiny. There is a provision buried in here that would allow California to escape its responsibilities to ensure that illegal aliens are not getting Medicaid benefits to which they are not entitled. Do the American people support giving Medicaid to illegal aliens? I don't think so. Simply bypassing the committee process with legislation on complex issues runs contrary to how this body should function. In fact, as my friend from New York is aware, Congress already had extensive debate and enacted a Medicare bill already earlier this year. That bill was authored by the chairman of the Finance Committee. So the Senate and the full Congress have already had extensive Medicare debate this year. The Senator from New York, as a member of the Finance Committee, had ample opportunity to raise the issues earlier this year that he now raises in a bill he wants to bring up right now. So regardless of the merits of the Senator's proposal, I believe that ship has set sail. I have a more extensive statement on the provisions themselves. Some of them, I want the Senator from New York to understand, I actually support, and I oppose some, obviously. Perhaps we can work together on some of these issues where we agree, if the Senator is interested. Today, however, I am forced to object to the Senator's consent request. Notwithstanding the significant jurisdictional and process issues I just raised, I would also like to note that there are several provisions in the bill I strongly support. However, there are several provisions in this bill that I oppose at this time and do not believe the Finance Committee has given proper consideration through hearings and investigations. One of the provisions in S. 3656 that I support would delay implementing provisions of a proposed CMS rule that would change conditions of participation for rural health clinics and decertify rural health clinics that are no longer in nonurbanized areas. It would also delay proposed changes to the existing payment methodology for rural health clinics and federally qualified health centers. While I am very concerned about the proposed CMS rule and its impact on rural health centers, RHCs, unfortunately I cannot support this legislation which is within the jurisdiction of the Finance Committee but which has not been given any consideration by the committee. The CMS proposed rule would impose new location requirements for RHCs and require that clinics be located in a nonurbanized area, as defined by the U.S. Census Bureau, as well as meet shortage area designation requirements. Only new RHCs applying for the program are currently required to meet these criteria but the CMS proposal would extend these requirements to already certified RHCs. According to CMS, about 500 of the approximately 3,700 RHCs operating today may not meet these requirements. Iowa is currently in the throes of a growing shortage of physicians, especially in the more rural areas of the State, due to inequitable geographic adjustments in physician payment that result in Iowa physicians receiving some of the lowest Medicare reimbursement in the country even though they provide some of the highest quality care. These geographic payment disparities, which discriminate against rural areas, have further exacerbated the problems of rural access to care. The CMS proposed rule could have a severe adverse impact on a number of rural health clinics in Iowa, including many located in counties that have been declared disaster areas from the severe flooding Iowa suffered earlier this year. Rural clinics in Iowa also could be severely impacted by the CMS proposed payment changes since RHC costs in Iowa and other States are already higher than the existing Medicare reimbursement cap. If the CMS rule is finalized as proposed, rural health clinics in Iowa and elsewhere may be forced to close their doors, even though they have served rural populations very well for many years, leaving Iowa with fewer physicians and some patients with little access to primary care and other critical medical services. This bill would prevent the application of a CMS policy to phase-out a payment adjustment for indirect medical education, IME, under the Medicare capital Inpatient Prospective Payment System, IPPS. Currently, teaching hospitals receive this upward payment adjustment under the capital IPPS. CMS announced in the fiscal year 2008, Medicare Hospital IPPS Final Rule that they would begin to phase out the IME adjustment for capital IPPS in fiscal year 2009. As the former chair and currently the ranking member of the Senate Finance Committee, it has long been one of my priorities to ensure Medicare payments are both accurate and equitable. I question whether this bill would further this goal, which many of us share. The appropriateness of the IME capital IPPS adjustment has been analyzed not only by CMS, but also the Medicare Payment Advisory Commission, MedPAC, which advises Congress on Medicare payment issues. CMS has documented relatively high and continued positive margins for teaching hospitals under the capital IPPS compared to nonteaching hospitals. In fact, from 1998 through 2006, teaching hospitals had an aggregate capital IPPS margin of 11.2 percent while nonteaching hospitals had an aggregate capital IPPS margin of -0.8 percent. Based on these figures, many, including myself, question the appropriateness of this payment adjustment. This is a case in point of why legislative proposals such as this must first go through the committee process. S. 3656 puts a moratorium on a CMS rule regarding Medicaid payments for hospital outpatient services. Early this year, Congress placed moratoriums on six other CMS Medicaid regulations. Just as I opposed those moratoriums, I strongly oppose this one as well. The Finance Committee has not held the first hearing as to why this action is necessary. We have not considered whether payments currently being made are not consistent with the statute. Medicaid is a critical program for children, pregnant women, the disabled, and the elderly. We have a responsibility to the people who depend on the program to make sure that funds are being appropriately spent. This moratorium is not consistent with that responsibility. This bill also intervenes in a dispute by CMS and the State of California. The State of California has been seeking approval of an extension of their family planning waiver for 6 years. For 6 years, CMS has been pushing California to improve their collection of Social Security numbers and citizenship documentation for women enrolled in the program. This bill essentially requires CMS to approve of the extension of California's waiver without requiring California to do anything further to improve their process of ensuring people who receive benefits are actually eligible for those benefits. I would also like to point out that a comprehensive Medicare bill written by the Chairman of the Finance Committee was passed by the Senate this summer. One can presume that the proposals in this bill were considered and rejected for inclusion in that Medicare bill. I understand that legislation is often the art of compromise. We can't always get everything we want in every bill and keep everything we dislike out. It is a balance. However, I think both in terms of process and policy, this bill does not sufficiently achieve a balance I think is necessary and I must, therefore, object to its consideration.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, several years ago, I started looking at the financial relationships between physicians and drug companies. I am doing this because I am concerned that there is very little transparency on this issue. I have also learned that the little transparency that does exist is not being enforced or is being enforced inconsistently. For instance, the National Institutes of Health requires researchers to report outside payments to their institution if they receive a grant from the NIH. But I have learned that some researchers are failing to properly report this money. Recently, I examined payments from pharmaceutical companies to a professor of psychiatry at the University of Cincinnati. I found out that she was not reporting tens of thousand of dollars in outside income. I then looked at a group of the world's most prominent child psychiatrists, in particular, three researchers at Harvard who have taken millions of dollars from the drug companies. These doctors are funded by several NIH grants, but they were not reporting all of their money from the drug companies as required by NIH regulations. I then discovered a department chairman at Stanford who founded a company that was seeking approval from the Food and Drug Administration to market a drug for depression. The NIH is funding some research on this drug which was being led by this same Stanford scientist. Because there were some obvious conflicts with this situation, the NIH recently forced Stanford to pull this professor off the grant. I also sent letters to the University of Texas and Emory University about researchers at their institutions. I would now like to discuss another troubling aspect about the lack of financial transparency in medicine. ``The Infinite Mind'' is a radio show that is independently produced but runs on over 300 public radio stations. It is possibly the most authoritative program on psychology and neuroscience in America. This show has won over 60 journalism awards. According to a biography of the show's host, it has an audience of over half a million people. Back in my home State of Iowa, ``The Infinite Mind'' is broadcast on most Sundays, early in the evening. My guess is that thousands of Iowans tune in. According to its own website, ``The Infinite Mind'' prides itself on its ``independence.'' But there may be some problems with their financial transparency. Last May, a couple of reporters for a news site called ``Slate'' wrote about an episode of ``The Infinite Mind'' called Prozac Nation: Revisited. During this episode, three guests on the show discussed problems with antidepressants. After listening to a recording of the show, it appeared to me that the real effect of this particular episode was to undercut any criticism that antidepressants might be linked to an increased risk of suicide. This is an issue I tackled a few years back. Maybe these three guests felt that there really is no problem with antidepressants. But a large number of experts believe that antidepressants may be associated with an increased risk of suicide, particularly in kids. In fact, last March, two months before this show aired, Britain's Medicines and Healthcare Regulatory Authority MHRA, concluded a 4 year investigation of the antidepressant, Paxil. That report found that GSK had been aware since 1998 that Paxil was associated with a higher risk of suicidal behavior in adolescents. Now don't get me wrong, experts on public radio have a right to express their own opinions. However, I am concerned that the host of ``The Infinite Mind'' never pointed out that all three of the show's guests had strong financial ties to the pharmaceutical industry. That is right. Every one of them. And this was never mentioned during the program or by the guests who appeared. What listeners also never learned is that the host of ``The Infinite Mind'' has his own ties to drugmakers. When a show runs on National Public Radio, NPR, doesn't the public have a right to know where the show's host gets his money? The host of ``The Infinite Mind'' is Dr. Frederick Goodwin, who I am told, is one of our country's leading experts on bipolar disorder. In fact, he has written the definitive textbook on bipolar disorder. He is now an adjunct professor at George Washington University Medical Center and was formerly the director of the National Institute of Mental Health. But what you would never know about Dr. Goodwin is that he is also a paid spokesman for several drug companies. Now, I don't know how much money Dr. Goodwin actually receives from all the drug companies, but based on documents my office has received from GlaxoSmithKline, I do know that GlaxoSmithKline pays him around $2500 for every talk his gives on treatments for bipolar disorder and depression. These talks concerned several drugs such as Wellbutrin, Eskalith, and Lamictal. Based on documents that my office received from GlaxoSmithKline, Dr. Goodwin gives these talks to doctor groups around the country. So far this year, Glaxo reports that the company paid Dr. Goodwin over $130,000 for over 50 different talks. Of course, Dr. Goodwin may be making more money from other drug companies, but I only asked GlaxoSmithKline for their information. I do know from a scientific paper that Dr. Goodwin published that he has also given talks on behalf of Pfizer, Solvay, Janssen, Eli Lilly, Astra Zeneca and Bristol Myers Squibb. And he has served as a consultant for many of these companies, as well. In fact, Dr. Goodwin was very busy the week that the episode of Prozac Nation: Revisited started airing last March 26. GlaxoSmithKline's records show that the company paid Dr. Goodwin for several talks he gave that week on bipolar disorder and Lamictal. In fact, records show that he gave around eight talks at $2500 each, bringing him around $20,000 in payments. Several of the talks were done by teleconference, but Dr. Goodwin also spoke about Lamictal at Fleming's Prime Steakhouse in Birmingham, Michigan and the Rosebud Steak House in Schaumburg, IL. Based upon the information provided to my staff, Dr. Goodwin was also very active on behalf of Glaxo in 2005. That year, Glaxo paid Dr. Goodwin over $300,000 in speaking fees and around $25,000 in expenses to discuss their products. And this was the same year that he hosted an episode for ``The Infinite Mind'' on bipolar disorder in kids. Again there was no disclosure on the show about Dr. Goodwin's financial ties to GlaxoSmithKline or other drug companies. Let's take this one step further. When an episode on bipolar disorder first aired on September 20, 2005, Dr. Goodwin was once again on the road for the Glaxo. Glaxo's records show that the company paid him $2500 for a talk he gave that day on drug therapy for bipolar disorder. The talk was at Lemonia, a Tuscan restaurant located at the Ritz Carlton Golf Resort in Naples, FL. I don't think it takes a journalism or ethics professor to figure out that listeners of a national radio show should be told about the host's financial interests. It just seems obvious. This type of information should be out in the open and transparent. People should know that since 2000, GlaxoSmithKline has paid the host of a radio program on psychiatry over $1.2 million in speaking fees and over $100,000 in expenses. People should know that, based on information from Glaxo, most of these fees were paid to Dr. Goodwin through Best Practice, a pharmaceutical consulting firm that he helped establish in the late nineties. Among the many services that have been offered by Best Practice are marketing consultation, and the ``dissemination of new off label information.'' Now, I have already pointed out that this independently produced radio show runs on over 300 public radio stations. But it also runs on NPR's satellite station. This got the attention of Margaret Low Smith, a vice president at NPR. She has stated that any show that runs on NPR's satellite station, and I quote, ``must live up to NPR standards .'' So I would like to go over some of those standards as found on NPR's own website. According to NPR's own policies, and I quote, ``confidence in us as independent and fair means avoiding actual and apparent conflicts of interest or engaging in outside activities, public comment or writing that calls into question our ability to report fairly on a subject.'' The policy also states that an individual covered under this code ``has the responsibility to disclose potential conflicts of interest.'' I think these are very fair standards on transparency, and I hope that shows running on NPR will try to live up to them in the future. It is not my job as a Senator to screen newspapers, the evening news or national radio for my constituents. But it is my job to watch out for taxpayers' money. According to its website and promotional comments made during many of the show's episodes, ``The Infinite Mind'' has been made possible, at times, by major underwriting from the National Science Foundation and the National Institutes of Health. And that is why I am sending out two letters one to the National Institutes of Health and another to the National Science Foundation. The recently departed director of NIH has already acknowledged that they have problems with their policies when it comes to researchers not reporting outside income. I commend him for recognizing this fact. I also know that the NIH plans on changing its regulations to tighten up disclosure requirements. But I am not certain about the disclosure requirements when the NIH helps to fund a show like ``The Infinite Mind.'' I am going to ask the NIH to see if they require ``The Infinite Mind'' to disclose the money that drug companies pay to the show's host. And I am asking the NSF to explain their policies on financial disclosure to see if they might need some changes as well. I ask unanimous consent to have my letters to the National Institutes of Health and the National Science Foundation printed in the Record. I would also like to commend GlaxoSmithKline for their cooperation with the Committee and their commitment to transparency. It is greatly appreciated.

Mr. GRASSLEY

Mr. GRASSLEY. I agree with the chairman of the Finance Committee. I support the timber tax provisions and believe they should be made permanent or at least extended. I also agree with Senator Baucus that we have time to consider the matter early next year, and I will work with him to pass a timely extension.