Tom Harkin

Mr. HARKIN

Mr. HARKIN. Mr. President, today, Senator Smith and I and others introduce the Money Follows the Person Act of 2003. This legislation is needed to truly bring people with disabilities and older Americans into the mainstream of society and provide equal opportunity for employment and community activities. In order to work or live in their own homes, Americans with Disabilities and older Americans need access to community-based services and supports. Unfortunately, under current Federal Medicaid policy, the deck is stacked in favor of living in an institution. The purpose of our bill is to level the playing field and give eligible individuals equal access to community-based services and supports. Under our legislation, the Medicaid money paid by States and the Federal Government would follow the person with a disability from an institution into the community. This legislation provides 100 percent Federal reimbursement for the community services that an individual needs during the first year that they move out of an institution or nursing home. By fully reimbursing the States, it gives them some additional resources to allow people with disabilities and older Americans to choose to live in the community. President Bush first proposed the Money Follows the Person Rebalancing Initiative in his FY '04 budget and indicated that the demonstration project would provide full Federal reimbursement for community services for the first year that an individual moves out of an institution or nursing home. As of this date, the administration has not suggested legislative language to Congress or provided specific details regarding the implementation of the proposal. Working with the disability community, we have drafted this legislation and look forward to working with the administration and our colleagues to enact the Money Follows the Person concept into law. We have a Medicaid system in this country that is spending 70 percent of its dollars on institutional care and only 30 percent on community services. This bill is an important step toward switching those numbers around. It is shameful that our Federal dollars are being spent to segregate people, not integrate them. It has been 13 years since we passed the Americans with Disabilities Act, which said no to segregation. But our Medicaid program says yes and we need to change it. This is the next civil rights battle. If we really meant what we said in the ADA in 1990, we should enact this legislation. The civil right of a person with a disability to be integrated into his or her community should not depend on his or her address. In Olmstead v. LC, the Supreme Court recognized that needless institutionalization is a form of discrimination under the Americans with Disabilities Act. We in Congress have a responsibility to help States meet their obligations under Olmstead. An individual should not be asked to move to another state in order to avoid needless segration. They also should not be moved away from family and friends because their only choice is an institution. For example, I know a young man in Iowa, Ken Kendall, who is currently living in a nursing home because he cannot access home and community based care. Ken was injured in a serious accident at the age of 17 and sustained a spinal chord injury. With the help of community based services covered by his insurance company, Ken could live in his home in Iowa City. Remaining independent made a tremendous difference in his life. However, several years ago, Ken lost his health insurance and after a time, he went onto Medicaid. As a Medicaid recipient, Ken was only given the option to live in a nursing home in Waterloo almost 2 hours from his friends and family in Iowa City. In the nursing home, Ken has become isolated. He is very far from his family and friends and does not have access to transportation. He had not been to a restaurant or a movie since he moved to the nursing home over 2 years ago. His life has dramatically changed from when he lived in his own apartment and hired his own attendants to care for him. Recently Ken wrote to me that he finally went to dinner and a movie for his 30th birthday. He said ``I was almost in tears. I felt like I had a real life again.'' This bill would give people like Ken a real life and not just on their birthdays. People like Ken should not have to continue waiting to be able to live in the community and enjoy the opportunities that other Americans take for granted. Federal Medicaid policy should reflect the consensus reached in the ADA that Americans with Disabilities should have equal opportunity to contribute to our communities and participate in our society as full citizens. That means no one has to sacrifice their full participation in society because they need help getting out of the house in the morning or assistance with personal care or some other basic service. This bill will open the door to full participation by people with disabilities and older Americans in our neighborhoods, our communities, our workplaces, and our American Dream, and I urge all my colleagues to support us on this issue. I want to thank Senator Smith for his commitment to improving access to home and community based services for people with disabilities. I would also like to thank Senators Kennedy, Lautenberg and Kerry for joining me in this important initiative. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. HARKIN

Mr. HARKIN. Mr. President, today, Senator Smith and I and others introduce the Money Follows the Person Act of 2003. This legislation is needed to truly bring people with disabilities and older Americans into the mainstream of society and provide equal opportunity for employment and community activities. In order to work or live in their own homes, Americans with Disabilities and older Americans need access to community-based services and supports. Unfortunately, under current Federal Medicaid policy, the deck is stacked in favor of living in an institution. The purpose of our bill is to level the playing field and give eligible individuals equal access to community-based services and supports. Under our legislation, the Medicaid money paid by States and the Federal Government would follow the person with a disability from an institution into the community. This legislation provides 100 percent Federal reimbursement for the community services that an individual needs during the first year that they move out of an institution or nursing home. By fully reimbursing the States, it gives them some additional resources to allow people with disabilities and older Americans to choose to live in the community. President Bush first proposed the Money Follows the Person Rebalancing Initiative in his FY '04 budget and indicated that the demonstration project would provide full Federal reimbursement for community services for the first year that an individual moves out of an institution or nursing home. As of this date, the administration has not suggested legislative language to Congress or provided specific details regarding the implementation of the proposal. Working with the disability community, we have drafted this legislation and look forward to working with the administration and our colleagues to enact the Money Follows the Person concept into law. We have a Medicaid system in this country that is spending 70 percent of its dollars on institutional care and only 30 percent on community services. This bill is an important step toward switching those numbers around. It is shameful that our Federal dollars are being spent to segregate people, not integrate them. It has been 13 years since we passed the Americans with Disabilities Act, which said no to segregation. But our Medicaid program says yes and we need to change it. This is the next civil rights battle. If we really meant what we said in the ADA in 1990, we should enact this legislation. The civil right of a person with a disability to be integrated into his or her community should not depend on his or her address. In Olmstead v. LC, the Supreme Court recognized that needless institutionalization is a form of discrimination under the Americans with Disabilities Act. We in Congress have a responsibility to help States meet their obligations under Olmstead. An individual should not be asked to move to another state in order to avoid needless segration. They also should not be moved away from family and friends because their only choice is an institution. For example, I know a young man in Iowa, Ken Kendall, who is currently living in a nursing home because he cannot access home and community based care. Ken was injured in a serious accident at the age of 17 and sustained a spinal chord injury. With the help of community based services covered by his insurance company, Ken could live in his home in Iowa City. Remaining independent made a tremendous difference in his life. However, several years ago, Ken lost his health insurance and after a time, he went onto Medicaid. As a Medicaid recipient, Ken was only given the option to live in a nursing home in Waterloo almost 2 hours from his friends and family in Iowa City. In the nursing home, Ken has become isolated. He is very far from his family and friends and does not have access to transportation. He had not been to a restaurant or a movie since he moved to the nursing home over 2 years ago. His life has dramatically changed from when he lived in his own apartment and hired his own attendants to care for him. Recently Ken wrote to me that he finally went to dinner and a movie for his 30th birthday. He said ``I was almost in tears. I felt like I had a real life again.'' This bill would give people like Ken a real life and not just on their birthdays. People like Ken should not have to continue waiting to be able to live in the community and enjoy the opportunities that other Americans take for granted. Federal Medicaid policy should reflect the consensus reached in the ADA that Americans with Disabilities should have equal opportunity to contribute to our communities and participate in our society as full citizens. That means no one has to sacrifice their full participation in society because they need help getting out of the house in the morning or assistance with personal care or some other basic service. This bill will open the door to full participation by people with disabilities and older Americans in our neighborhoods, our communities, our workplaces, and our American Dream, and I urge all my colleagues to support us on this issue. I want to thank Senator Smith for his commitment to improving access to home and community based services for people with disabilities. I would also like to thank Senators Kennedy, Lautenberg and Kerry for joining me in this important initiative. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. HARKIN

Mr. HARKIN. I move to lay that motion on the table. The motion to lay on the table was agreed to. Amendments Nos. 1182, 1183, 1184, 1185, 1186, and 1187, en Bloc, to Amendment No. 1136

Mr. HARKIN. I thank the Senator for his kind words.

Mr. HARKIN. I notify my colleagues I plan to offer another amendment later today that will be dealing, again, with aspects of reconstruction in Iraq regarding people with disabilities having access to places being rebuilt. Finally, I compliment my friend and colleague from Virginia, again, for his untiring, unrelenting effort to make sure that victims of terrorism are awarded compensation. These are not people who just get the money; they have to go to court. They have to prove their case. If they are successful, then they will be awarded compensation from the countries that sponsor this State-sponsored terrorism. I am proud to join as a cosponsor.

Mr. HARKIN. Mr. President, I compliment and commend my friend and colleague from Virginia for his unrelenting efforts to make sure victims of terrorism and their families are duly compensated for the acts of terrorism done to them and to their families by various government entities abroad. Senator Allen has been in the forefront of this fight. I am proud to join him as a cosponsor of this amendment to again reinforce our commitment to the American victims of State- sponsored terrorism. We are united as Americans to meet the threat of terrorism. Even as we track down the terrorists and defend America, we must never forget that terrorists acts are ultimately stories of human tragedy. We must never forget the victims, victims such as Kathryn Koob from Waverly, IA, who sought to build cross-cultural ties between the Iranian people and the American people, only to be taken hostage in the U.S. Embassy in Tehran and held captive for 444 nightmarish days in Iran. This amendment by Senator Allen and myself and others will enable American victims of terrorism to receive compensation from blocked or frozen assets of foreign governments that sponsored the attacks upon them. Despite repeated provisions passed by Congress and enacted by the President most recently as part of the Terrorism Risk Insurance Act of 2002, again the amendment on which both Senator Allen and I had worked, American victims of terrorism continue to be denied court-awarded compensation. Last year, Congress passed this amendment that Senator Allen and I cosponsored 81 to 3 as part of the Terrorism Risk Insurance Act. This law required that compensation to American victims of Iran-sponsored terrorism be made from all blocked Iranian assets. Unfortunately, the State Department has decided to play semantics in order to get around the law, saying Iranian assets held by the United States are ``regulated,'' not ``blocked.'' This amendment offered today by Senator Allen and myself and others makes explicitly clear the meaning of ``blocked.'' Regulated, frozen, seized, held, licensed, restricted or anything of similar meaning, no matter by what specific legal authority Iranian funds are held by the U.S. Government. So this should clear it up. It is a matter of fairness to the victims. It is also a matter of fairness for the American taxpayer. The executive branch of the Government actively opposes the use of blocked or frozen assets to pay court-ordered compensation but calls, instead, for compensation to be paid with U.S. tax dollars. I believe this is backwards. State sponsors of international terrorism, not the American taxpayer, must be compelled to pay these costs first and foremost. I don't know how Congress can make itself more clear. But let's try to make it clear again that we will continue to speak on the Senate floor about this issue until all American victims of State-sponsored terrorism receive the compensation they were awarded from those who perpetrated the attacks upon them. I am honored to join Senator Allen and others today and to send a strong message to State sponsors of terrorism that they will pay for what they have done, and an equally strong message to American victims of terrorism that their country supports them. I ask unanimous consent I be added as a cosponsor to the Murray amendment.

Mr. HARKIN. That is fine.

Mr. HARKIN. Mr. President, I understand there are 5 minutes reserved for Senator Kennedy.

Mr. HARKIN. I am told by his staff that Senator Kennedy is unable to be in the Chamber due to other commitments. He has yielded his time to me on this amendment. I thank Senator Kennedy for yielding me this time. I ask to be recognized at this point for those 5 minutes.

Mr. HARKIN. Mr. President, Senator Kennedy has been a great leader on this issue. I know he wanted to speak on Senator Murray's amendment, but he could not be here at this time. We have been debating for the last few days the medical malpractice bill. We moved off it. But I think there is another, more pressing issue we need to address. It is what I call ``President Bush's economic malpractice.'' The victims are working Americans. As has been stated, unemployment has continued to climb; at 6.4 percent, it is the highest level since 1994. That is 9.4 million people looking for work who can't find any. Under President Bush's misguided leadership, we have lost 3.1 million private sector jobs. This is the first time since Herbert Hoover's administration we have had an administration with a net loss of jobs. What a record. Again, the numbers don't reflect the millions of workers who were laid off and had to take jobs that paid far less. In fact, the unemployment rate, in addition to the unemployed, would include part- time workers who want to work full time but can't find it and discouraged workers no longer seeking jobs. This rose to 10.3 percent in June. We are still losing jobs every month--33,000 last month alone. The economy is limping along. Our national deficit continues to balloon and will reach about $400 billion by the end of this year. Again, that is why I accuse this administration of ``economic malpractice.'' I don't think any illustration is better than this cartoon in the Pittsburgh Post Gazette. Here is a man holding a cup of coffee. He says: ``I tried to get angry with Bush for attempting to take away my overtime pay, but then I remembered I don't have a job.'' Later on, I am going to have an amendment also dealing with overtime pay because not only do we have people who are unemployed who need an extension, as Senator Murray says in her amendment, but now they want to take away overtime pay for those who are working. It is sort of a double hit on the workers of America. In May, after weeks of Democratic efforts, Congress extended the unemployment benefits for 2.5 million Americans who had been laid off. But our Republican colleagues refused to include assistance for the 1.1 million Americans hit the hardest by the economic crisis--those long- term unemployed who have already run out of their unemployment benefits. It is unconscionable to provide billions of dollars in tax breaks for the wealthiest of Americans and refuse to provide an average of $260 a week for the recession's first and hardest hit victims. That is what the Murray amendment does. This amendment provides up to a 13-week additional benefit for these 1.1 million long-suffering Americans. I might add that I looked at the figures. There are 9,800 in my State of Iowa alone. This would give them 13 weeks of additional benefits, and it would provide 7 additional weeks of benefits for those who have received the 26 weeks of benefits but who are out of it and who live in those States hardest hit by the recession. It occurred to me when I looked at the amendment offered by the Senator from Washington that it really is unconscionable that this Congress proposed these tax breaks for the wealthiest but won't come down and help those who are unemployed. I ask a rhetorical question: The tax breaks we provided for the wealthiest in our country, did we limit them to 26 weeks? Did we limit them to 13 weeks so they can get the tax breaks, but they are only for 26 weeks and once the 26 weeks are over, they snap back again and they have to pay the tax rate they paid before? No. It is unending. It goes on and on. From now on, they continue to get those tax breaks. But for hard-hit Americans out of work, our colleagues on the other side of the aisle are saying 26 weeks, that is enough; you are out. I don't believe that is fairness in our society. I commend and compliment my friend and colleague from Washington State for addressing this issue and for pointing out that these hardest hit Americans deserve and need to have this extension.

Mr. HARKIN. Reserving the right to object, what is the list?

Mr. HARKIN

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

Mr. HARKIN. Mr. President, this is a very simple, fully offset amendment that will restore a cut in title I funding to three States without harming or hurting any other State. The fiscal year 2003 Labor-HHS appropriations bill that Congress passed in February included a 13 percent increase for title I, the most important Federal program in the No Child Left Behind Act. At the time the Congressional Research Service projected every State would receive a sizable increase over the previous year. But 4 months after the bill was passed, new data from the 2000 census showed that three States would actually get less title I money in fiscal year 2003 than they did in fiscal year 2002. Those three States are Iowa, Maryland, and Michigan. Their total cut in title I funding is $4.4 million. The Congress did not intend for any State to get a cut in title I. I recently had a meeting with Secretary Paige about this matter. We had a full and frank discussion. He agreed to find an offset from Education Department funds that would otherwise lapse at the end of the fiscal year. Again, let me make it clear, none of the title I money in this amendment will come from any other State. It is fully offset by Education Department funds that will not otherwise be spent. Secretary Paige has signed off on the amendment. So has Senator Specter, chairman of the Labor-HHS Appropriations Subcommittee. I urge my colleagues to support it.

Mr. HARKIN. Mr. President, I call up amendment No. 1200 and send a modification to the desk.

Mr. HARKIN

Mr. HARKIN. Madam President, no one can doubt that kids today face tremendous obstacles to eating right and making healthy choices. Every day, they are bombarded with dozens of advertisements enticing them to eat more and more unhealthy foods. Tens of billions of dollars are spent each year to convince our kids to buy the products. In the face of this advertising and marketing power, our efforts to help kids eat healthier are more important than ever. This is no less the case in our schools than elsewhere in society. Even in our schools, it's getting harder and harder to ensure that kids get healthy food. The sale of soda pop, candy, foods high in fat and low in nutritional value, commonly called junk food, has become an accepted, but still unacceptable, reality in American schools. Ballooning sales of soft drinks and candy in our schools undercut the $15 billion dollar investment our nation makes in child nutrition every year. I still believe that, given the chance, our kids can and will make good choices about the foods they eat. We just don't give them these choices. To test this hypothesis that, given the opportunity, kids would make good choices about the food they eat, I proposed and got adopted in the Farm Security and Rural Investment Act of 2002 a pilot program that provides grants to schools for the simple purpose of allowing them to use the money to purchase fresh fruits and vegetables for their students. Some schools use the grants to deliver bins of fruits and vegetables to their classrooms every day. Others set up kiosks in the halls. A few schools even put free fruits and vegetables in their vending machines. Not long ago the Department of Agriculture released its assessment of the pilot program. Not surprisingly, it received high marks. Schools reported that 98 percent of students were interested in the program. Schools also reported that, over the course of the program, 71 percent of students grew more, not less, interested in the program. Most importantly, students told program evaluators that the pilot made them much more conscious about the junk food that they eat. Over the course of the year my staff and I visited numerous schools in Iowa that participated in the pilot program. These visits simply confirmed what USDA reported in its report on the pilot program. The enthusiasm was incredible. Students loved it. Teachers loved it. Administrators loved it. Parents loved it. When I visited Harding Middle School in Des Moines at the end of May, just as the pilot program was coming to an end, they gave me one message loud and clear-- ``keep the fruits and vegetables coming.'' Today I am introducing legislation, S. 1392, to do just that and to expand the program to all 50 States. Under this legislation, the pilot program would expand from its current 4 states and tribal schools and 60,000 students to 50 states and over 1 million children. It would also expand the pilot to ensure that additional Indian tribal schools are able to participate in the program. It would do this at a reasonable price tag--only $75 dollars per student per year. This means that at a cost of just over $75 million per year, we can make fresh fruits and vegetables a constant presence in the life of over 1 million American schoolchildren. It is difficult for me to imagine a more effective use of taxpayer dollars. Today I am also introducing companion legislation, S. 1393, to the fruit and vegetable pilot program expansion. The first piece of legislation seeks to provide kids with healthier food, and the second complements that by improving the overall nutritional environment of American schools. It seeks to give kids more choices and the ability to choose healthy foods. Despite the fact that we invest over $15 billion annually in child nutrition, our nation's children still too often do not get good nutrition at their schools. Meals provided through the National School Lunch Program and the School Breakfast Program must meet nutritional standards. But there is far too much competition and interference with these balanced meals. Vending machines, school snack bars, and a la carte sales routinely provide kids with a wide variety of less healthy choices. A recent GAO report found that 43 percent of elementary schools, 74 percent of middle schools, and 98 percent of high schools have vending machines, snack bars, canteens, and other places where students can readily obtain foods that defeat the sound and balanced nutrition that children and adolescents need. We talk about the importance of giving our kids lots of choices, but as junk foods become the norm and displace more nutritious choices, are we giving kids more choices or less? I believe we should always provide kids with good tasting and healthy alternatives to the foods that provide almost no nutritional benefits. The bills that I'm introducing today provide schools and students with more choices, not less. I want to make sure that the kids in Iowa schools and other schools across the country will be able to choose foods that both taste great and are great for their health and nutrition. The omnipresence of junk food is one of the reasons that our society is confronting a lethal threat--obesity. Obesity is even more pronounced among our children. According to the Centers for Disease Control, in the year 2000, 64 percent of all Americans were classified as either overweight or obese. Of these, 30 percent were actually obese. Among kids, the problem of obesity is exploding. In the last 20 years, the number of overweight kids tripled. This is nothing short of a public health crisis. It's past time to get serious about fighting obesity and we must fight obesity first at its root--childhood--where children learn habits that stay with them for life. A recent article in the journal Health Affairs estimated the cost of obesity to our nation at $93 billion annually. That is nearly a tenth of annual health care spending. Incredibly, obesity costs our society about as much as smoking. In response to the health threats our kids face at schools, many schools across the country are taking matters into their own hands. Some are providing healthier choices in their vending machines, school snack bars, and a la carte sales. In Iowa, with support from the milk industry, selected schools are working to replace soft drinks with milk. The results are encouraging. Schools report that students are enthusiastic about these changes. It just goes to show that not only are students willing to accept healthier choices like fresh fruit and vegetables and milk, but that they actively want them. We also know that schools have benefited financially and nutritionally from expanding the choices available to their children. Faced with alarming statistics about childhood overweight and obesity rates, North Community High School in Minneapolis reevaluated the school's beverage vending practices. With the support of the administrative team, the principal contacted the district's Coca-Cola representative, who was willing to work with North to provide healthier choices. As a result, the school increased the number of machines from four to 16, stocked 13 machines with water or 100 percent fruit/ vegetable juice, stocked two machines with sports drinks, and limited soda to one machine with limited hours of sale. They also instituted a competitive pricing system, selling water for $.75, sports drinks and 100 percent fruit/vegetable juices for $1.00, and soda and fruit drinks, e.g., Fruitopia, for $1.25. The water machines are strategically placed in high traffic areas and students are now allowed to drink water in the classroom. Soda sales are down, but vending profits increased by almost $4,000 and the total number of cases of beverages has more than doubled from the previous school year, with water being the best seller. These are the kinds of efforts and innovations that we need to encourage and support. That is why the second bill that I am introducing today creates a competitive incentive grant program to schools to improve the overall nutritional atmosphere in schools. Under this program, the Secretary of Agriculture makes competitive grants to schools so that they can provide healthier vending alternatives, improve the nutritional quality of their school meals, promote the consumption of fruits and vegetables, and provide nutrition education. With this support, other schools can follow in the footsteps of schools like North Community High School and institute practices that are good for the school and good for the students. Because we know that success in this area requires the leadership and commitment of a broad range of stakeholders, this bill gives a preference to schools that can demonstrate a multi-sectoral approach and engage the efforts of parents, businesses, and anyone else with a vested interest in the nutrition and educational success of our students. It also gives priority to applications that include a plan for continued success once their federal grant money has been expended. Finally, the legislation uses sound science, not special interests, to determine what kinds of nutritional standards our elementary, middle schools, and secondary schools should institute. To achieve this, my legislation directs the Secretary of Agriculture to enter into an agreement with the Institute of Medicine at the National Academy of Sciences, one of the premier scientific institutions in this country. The Institute of Medicine is directed to study the issue of children's nutritional needs at school and to make recommendations to the Secretary of Agriculture regarding appropriate standards for the sale of all foods in our schools. Based upon the recommendations of the Institute of Medicine, the Secretary is directed to promulgate regulations that will provide appropriate and adequate safeguards for the nutrition of our children at school. Taken together, the two pieces of legislation that I am introducing today represent a new chapter in our nation's efforts to provide for the health and safety of our kids. This body has a long history of bipartisan efforts on child nutrition and, with our child nutrition programs up for reauthorization this year, I have every reason to believe that these efforts will continue this year. Having served on the Senate Committee on Agriculture, Nutrition, and Forestry, I know that the issue of child nutrition knows no partisan boundaries. Democrats and Republicans alike have joined together over the years. I invite my colleagues on both sides of the aisle to join me in cosponsoring this legislation to give kids the healthy choices they want and deserve and to safeguard the nutrition of our nation's children. If ever our children have been in greater need of this support, I cannot remember it, and so I invite my colleagues to join me in this effort. I ask unanimous consent that the bills be printed in the Record.

Mr. HARKIN

Mr. HARKIN. Madam President, no one can doubt that kids today face tremendous obstacles to eating right and making healthy choices. Every day, they are bombarded with dozens of advertisements enticing them to eat more and more unhealthy foods. Tens of billions of dollars are spent each year to convince our kids to buy the products. In the face of this advertising and marketing power, our efforts to help kids eat healthier are more important than ever. This is no less the case in our schools than elsewhere in society. Even in our schools, it's getting harder and harder to ensure that kids get healthy food. The sale of soda pop, candy, foods high in fat and low in nutritional value, commonly called junk food, has become an accepted, but still unacceptable, reality in American schools. Ballooning sales of soft drinks and candy in our schools undercut the $15 billion dollar investment our nation makes in child nutrition every year. I still believe that, given the chance, our kids can and will make good choices about the foods they eat. We just don't give them these choices. To test this hypothesis that, given the opportunity, kids would make good choices about the food they eat, I proposed and got adopted in the Farm Security and Rural Investment Act of 2002 a pilot program that provides grants to schools for the simple purpose of allowing them to use the money to purchase fresh fruits and vegetables for their students. Some schools use the grants to deliver bins of fruits and vegetables to their classrooms every day. Others set up kiosks in the halls. A few schools even put free fruits and vegetables in their vending machines. Not long ago the Department of Agriculture released its assessment of the pilot program. Not surprisingly, it received high marks. Schools reported that 98 percent of students were interested in the program. Schools also reported that, over the course of the program, 71 percent of students grew more, not less, interested in the program. Most importantly, students told program evaluators that the pilot made them much more conscious about the junk food that they eat. Over the course of the year my staff and I visited numerous schools in Iowa that participated in the pilot program. These visits simply confirmed what USDA reported in its report on the pilot program. The enthusiasm was incredible. Students loved it. Teachers loved it. Administrators loved it. Parents loved it. When I visited Harding Middle School in Des Moines at the end of May, just as the pilot program was coming to an end, they gave me one message loud and clear-- ``keep the fruits and vegetables coming.'' Today I am introducing legislation, S. 1392, to do just that and to expand the program to all 50 States. Under this legislation, the pilot program would expand from its current 4 states and tribal schools and 60,000 students to 50 states and over 1 million children. It would also expand the pilot to ensure that additional Indian tribal schools are able to participate in the program. It would do this at a reasonable price tag--only $75 dollars per student per year. This means that at a cost of just over $75 million per year, we can make fresh fruits and vegetables a constant presence in the life of over 1 million American schoolchildren. It is difficult for me to imagine a more effective use of taxpayer dollars. Today I am also introducing companion legislation, S. 1393, to the fruit and vegetable pilot program expansion. The first piece of legislation seeks to provide kids with healthier food, and the second complements that by improving the overall nutritional environment of American schools. It seeks to give kids more choices and the ability to choose healthy foods. Despite the fact that we invest over $15 billion annually in child nutrition, our nation's children still too often do not get good nutrition at their schools. Meals provided through the National School Lunch Program and the School Breakfast Program must meet nutritional standards. But there is far too much competition and interference with these balanced meals. Vending machines, school snack bars, and a la carte sales routinely provide kids with a wide variety of less healthy choices. A recent GAO report found that 43 percent of elementary schools, 74 percent of middle schools, and 98 percent of high schools have vending machines, snack bars, canteens, and other places where students can readily obtain foods that defeat the sound and balanced nutrition that children and adolescents need. We talk about the importance of giving our kids lots of choices, but as junk foods become the norm and displace more nutritious choices, are we giving kids more choices or less? I believe we should always provide kids with good tasting and healthy alternatives to the foods that provide almost no nutritional benefits. The bills that I'm introducing today provide schools and students with more choices, not less. I want to make sure that the kids in Iowa schools and other schools across the country will be able to choose foods that both taste great and are great for their health and nutrition. The omnipresence of junk food is one of the reasons that our society is confronting a lethal threat--obesity. Obesity is even more pronounced among our children. According to the Centers for Disease Control, in the year 2000, 64 percent of all Americans were classified as either overweight or obese. Of these, 30 percent were actually obese. Among kids, the problem of obesity is exploding. In the last 20 years, the number of overweight kids tripled. This is nothing short of a public health crisis. It's past time to get serious about fighting obesity and we must fight obesity first at its root--childhood--where children learn habits that stay with them for life. A recent article in the journal Health Affairs estimated the cost of obesity to our nation at $93 billion annually. That is nearly a tenth of annual health care spending. Incredibly, obesity costs our society about as much as smoking. In response to the health threats our kids face at schools, many schools across the country are taking matters into their own hands. Some are providing healthier choices in their vending machines, school snack bars, and a la carte sales. In Iowa, with support from the milk industry, selected schools are working to replace soft drinks with milk. The results are encouraging. Schools report that students are enthusiastic about these changes. It just goes to show that not only are students willing to accept healthier choices like fresh fruit and vegetables and milk, but that they actively want them. We also know that schools have benefited financially and nutritionally from expanding the choices available to their children. Faced with alarming statistics about childhood overweight and obesity rates, North Community High School in Minneapolis reevaluated the school's beverage vending practices. With the support of the administrative team, the principal contacted the district's Coca-Cola representative, who was willing to work with North to provide healthier choices. As a result, the school increased the number of machines from four to 16, stocked 13 machines with water or 100 percent fruit/ vegetable juice, stocked two machines with sports drinks, and limited soda to one machine with limited hours of sale. They also instituted a competitive pricing system, selling water for $.75, sports drinks and 100 percent fruit/vegetable juices for $1.00, and soda and fruit drinks, e.g., Fruitopia, for $1.25. The water machines are strategically placed in high traffic areas and students are now allowed to drink water in the classroom. Soda sales are down, but vending profits increased by almost $4,000 and the total number of cases of beverages has more than doubled from the previous school year, with water being the best seller. These are the kinds of efforts and innovations that we need to encourage and support. That is why the second bill that I am introducing today creates a competitive incentive grant program to schools to improve the overall nutritional atmosphere in schools. Under this program, the Secretary of Agriculture makes competitive grants to schools so that they can provide healthier vending alternatives, improve the nutritional quality of their school meals, promote the consumption of fruits and vegetables, and provide nutrition education. With this support, other schools can follow in the footsteps of schools like North Community High School and institute practices that are good for the school and good for the students. Because we know that success in this area requires the leadership and commitment of a broad range of stakeholders, this bill gives a preference to schools that can demonstrate a multi-sectoral approach and engage the efforts of parents, businesses, and anyone else with a vested interest in the nutrition and educational success of our students. It also gives priority to applications that include a plan for continued success once their federal grant money has been expended. Finally, the legislation uses sound science, not special interests, to determine what kinds of nutritional standards our elementary, middle schools, and secondary schools should institute. To achieve this, my legislation directs the Secretary of Agriculture to enter into an agreement with the Institute of Medicine at the National Academy of Sciences, one of the premier scientific institutions in this country. The Institute of Medicine is directed to study the issue of children's nutritional needs at school and to make recommendations to the Secretary of Agriculture regarding appropriate standards for the sale of all foods in our schools. Based upon the recommendations of the Institute of Medicine, the Secretary is directed to promulgate regulations that will provide appropriate and adequate safeguards for the nutrition of our children at school. Taken together, the two pieces of legislation that I am introducing today represent a new chapter in our nation's efforts to provide for the health and safety of our kids. This body has a long history of bipartisan efforts on child nutrition and, with our child nutrition programs up for reauthorization this year, I have every reason to believe that these efforts will continue this year. Having served on the Senate Committee on Agriculture, Nutrition, and Forestry, I know that the issue of child nutrition knows no partisan boundaries. Democrats and Republicans alike have joined together over the years. I invite my colleagues on both sides of the aisle to join me in cosponsoring this legislation to give kids the healthy choices they want and deserve and to safeguard the nutrition of our nation's children. If ever our children have been in greater need of this support, I cannot remember it, and so I invite my colleagues to join me in this effort. I ask unanimous consent that the bills be printed in the Record.

Mr. HARKIN

Mr. HARKIN. The offset we use is also an offset supported by the administration. I have a letter Senators can look at--I put it in the Record last night--from the Department of Justice, supporting the offset we use to pay for this to ensure that we can get people in community-based settings and out of institutions. I yield the floor.

Mr. HARKIN. I ask unanimous consent for an additional 30 seconds.

Mr. HARKIN. The amendment before us is the one where the money follows the purse. It is $350 million a year for 5 years whereby States can use this money to get out of institutions, out of nursing homes, people with disabilities and get them into community, home-based living. Thirteen years ago, this Congress and the President signed a bill called the Americans With Disabilities Act. One of the premises of that was we no longer wanted to segregate people with disabilities in our society. We wanted to integrate people with disabilities in education, work, travel, jobs, everything. However, under the Medicaid system, it is still segregation. Seventy percent of our Medicaid money goes to institutional care, only 30 percent to community-based care. What this amendment says is that for the first year, the Federal Government will pick up the full share of the State so the State can take people out of institutions and put them into community-based living. This was proposed by President Bush in his budget proposal for next year. It is exactly what the President proposed.

Mr. HARKIN

Mr. HARKIN. Mr. President, as I said earlier in response to the questions asked by my friend from Illinois, it is clear S. 1, the 654 pages, is a sham, a ruse, a bewildering, complex bill that is going to cause a lot of consternation for a lot of our elderly. Again, to the Senator from Illinois, I say, our Government, instead of using our power and influence to negotiate for better drug prices and better drug coverage on behalf of American seniors, is choosing to nurture special interest groups and big campaign donors. Why is it other industrialized nations are spending between 30 and 50 percent less on drugs than the United States? To me it is a matter of priorities. I end my comments by saying again, before this bill came, the Republicans took care of their friends, giving the wealthiest in this country nearly $1 trillion in tax breaks. Not only did we find the money to give every millionaire $93,000 in tax cuts, we made these tax cuts retroactive to January 1 of this year. Less than a month later, here we are, and the Republicans tell us we do not have enough money to get seniors on a fixed income real help with their prescription drug costs. Instead, next year they get a card. If you are low income, you get a $600 debit card. And then 2 years from now--actually 3 years from now in 2006--we start this class business. Some are in this class, some in another class, and some in another class. Try to figure it out. Our job in Congress should be to use our votes to provide security for seniors, not hand out profitable favors for special interest groups. If we are going to live up to our promise to seniors--our promise to seniors--I ask, how many Senators in this body in the last couple of years have signed pledges not to privatize Medicare, not to privatize Social Security? Our senior citizens, I know in my State and I am sure around the country, have asked us to sign those pledges. I wonder how many here have signed them not to privatize Medicare and not to privatize Social Security. If we are going to live up to those promises we made and those documents we signed and put their interests ahead of the special interests, the only vote on this bill is a resounding no, unless this Senate, in its wisdom, adopts the amendment offered by the Senator from Illinois, Mr. Durbin, because the Durbin amendment will work. The Senator from Illinois has developed a comprehensive and thoughtful alternative that truly gives what our seniors want and need: comprehensive coverage with the option of staying in Medicare. Let's take a look at the key differences between S. 1 and the Durbin amendment. Under S. 1, seniors have to pay a $275 deductible every year. Under the Durbin amendment, there is no deductible. Under S. 1, the bill before us, seniors pay a premium not set by law but set by insurance companies, which can be raised at any time. Under the Durbin amendment, seniors will know what premium they will pay because it will be set by law. Under the bill before us, even after the deductible, seniors will still have to pay 50 percent of their drug costs, the result of which means more than one-third of seniors will actually lose money if they participate. I have a chart that illustrates the so-called savings for seniors under the proposed drug benefit. Let's say you are a senior citizen and you are making over $14,369 a year--let's say you make $15,000 a year. Your total drug costs are $500. Your monthly drug costs about $42. Your share is $389.50. Your premium is $420. Your total out-of-pocket expenses for that year are $809.50. That means you lose $310 on your drugs. You pay in but you lose. Let's say your total costs are $1,000 a year. Your out-of-pocket expenses are $1,057.52. You lose $58. It is not until you reach just about $1,200 a year in drug costs that you break even. If your drug costs are less than that, you lose. Try telling that to senior citizens in your State. Let's face it, if you have an income of $15,000 a year and you live up in some of our northern States and you have a high heating bill in the wintertime, maybe you have other extraneous expenses, maybe you have to rent a place, you are not a homeowner and you have to pay rent, you have to eat, you have to buy clothes, and you are paying $500 a year in drug costs, and yet you are going to lose money? Wait until that hits the streets. Under the Durbin amendment, seniors will pay only 30 percent of their drug costs, getting much closer to what I pay now--25 percent to 30 percent. That is it. They will know in advance they are only going to pay 30 percent. Under the bill before us, seniors will actually lose coverage for a period of time, even while they continue to pay their premium. That is that donut. When the drug costs reach $4,500, seniors stop getting any benefits until they reach $5,800. That is $1,300 they pay out of pocket, but they continue to pay their premiums. Under the Durbin amendment, there is no donut hole, no coverage gap. Most importantly, the bill before us will create mass confusion for seniors who stay in traditional Medicare because for the first time they will have to negotiate private plans and deal with the possibility, if not the likelihood, that plans will come into and pull out of States year after year. The result of this volatility will be a completely unpredictable system, where seniors not only will not know what plan they will be in from year to year, but they may have to switch drugs every year as plans with different formularies come in and out of the system. Think about the confusion that is going to cause. The Durbin amendment opens Medicare to private competition, but it includes a real and dependable prescription drug benefit delivered by Medicare. Basically, they have stated we will let them compete with Medicare and we will provide those choices to the elderly, but the Durbin amendment is real and dependable. The Durbin amendment makes other improvements on the underlying bill, but the bottom line for seniors is simple. The Durbin amendment delivers what the bill does not, a meaningful, dependable, reliable prescription drug benefit to all seniors in all States at all times. Now, some might say, yes, but the Durbin amendment sunsets at the end of 2009. Well, before any of my Republican colleagues start screaming bloody murder and start casting aspersions about how this may be a gimmick and a hoax, let's remember this is exactly the same thing they did, with the support of the President, to shoehorn almost a trillion dollars in tax cuts for the wealthy into a $350 billion price tag. I always say if it is good enough for the wealthy, it ought to be good enough for our seniors, too. Let them have the same deal. Again this is about priorities. Earlier this year the President and the Republican Congress made it clear their top priority was tax breaks to those least deserving and least in need. That is the result of their first effort. I am sure there will be more before the year is out. I already hear them over in the House talking about it. It netted each millionaire in this country a $93,000 tax cut this year. What the Durbin amendment says to our seniors is they are also our priority. Instead of bleeding our Treasury dry by giving every tax receipt back to the richest in the Nation, the Durbin amendment says before we get too far ahead of ourselves on tax breaks for the wealthy or anything else, we are going to get seniors the help they need. Some will come and argue his plan is too expensive, that it is not sustainable. All I can say is, this plan has roughly the same short- and long-term costs as the tax breaks we passed. All I ask is, what are the priorities of my colleagues? As luck would have it, both the tax breaks for the wealthy and under the Durbin amendment would sunset at roughly the same time. So in the not too distant future, the new Congress and new President can again set their priorities and decide which should be continued. Should we continue the tax breaks for the wealthy or should we continue a reliable prescription drug benefit under Medicare for the elderly? That is a choice a future Congress could make. We should not foist upon our elderly a misguided, complex, befuddling, bewildering--and these are not my words; these are words used by others--system of prescription drug coverage that will not meet their needs, that will cost them more money, that will actually cost some of them more than what they get out of it. That is what we are doing. That is what we are going to foist upon the elderly of this country, unless we adopt the Durbin amendment. If we do, then this Senator can wholeheartedly support this bill and vote for it. If not, then I will not be a part of a sham, of a ruse, to tell our elderly they are going to get something when they are not, to hold out a false hope when in fact they are not going to get the benefits they have asked us to give to them. This Senator's priority is with the elderly. Let's deal with them first. Let's meet their needs first. Then if we have something left over, let's think about tax breaks for the wealthy. Let's not do it the other way around. I yield the floor.

Mr. HARKIN. I may not be that long. I think I can wrap up in a half an hour.

Mr. HARKIN. I do not think I will be much more than a half an hour.

Mr. HARKIN. That is right.

Mr. HARKIN. I yield for a question.

Mr. HARKIN. I thank the Senator again for a very insightful question. I asked my staff--and I have good staff, and they do a lot of work on health care--to look at this 654-page bill. I said: What in there will help keep the cost of drugs down? Anything at all? Nothing. Zero. There is nothing in the bill that is going to help keep the cost of drugs down. In fact, I say to the Senator, I think just the opposite is going to be true because this bill will allow plans to increase premiums any time they want. So you signed up for a plan, and your premium is $35 a month. The plan is not making much money. The drug company jacks up the price of the drugs a little bit. That means the plan is not making much money, but the plan can increase the premium. The drug companies are always left harmless. They can just keep jacking up the prices.