Tom Harkin

Mr. HARKIN

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

Mr. HARKIN

Mr. HARKIN. Mr. President, I am pleased to join the Senator from Iowa, Mr. Grassley, as a cosponsor of his amendment. As we all know, the reason this is so critical is that the health care system in rural America is collapsing. For too long the Medicare reimbursements to urban centers have eclipsed those to rural communities at such a rate that cities, towns, and villages throughout rural America are in a real health care crisis. In our State of Iowa, low reimbursement rates mean we can't recruit and retain health care professionals. Every time a hospital in Iowa treats a Medicare patient, it loses money. That cost is shifted to small businesses, private insurance companies, private payers--in other words, Main Street, Iowa. This amendment takes a giant step forward in fixing this problem and getting us on the path to making sure we in rural States have the same kind of reimbursements that people do in more urban areas. It would give rural providers and hospitals, and the communities they serve, the support they need and deserve. I urge my colleagues to support its adoption.

Mr. HARKIN

Mr. HARKIN. Parliamentary inquiry, Madam President: In terms of the time, can this time be reserved?

Mr. HARKIN. I reserve the remainder of my time. I yield the floor.

Mr. HARKIN. Mr. President, I ask if the Senator can yield me 15 minutes.

Mr. HARKIN. I appreciate that. I will not take an hour. Parliamentary inquiry: The Senator asked that the amendments be set aside; right?

Mr. HARKIN. Mr. President, I will speak to my amendment in a moment. Before I do, I wish to make preliminary comments about the tax bill before us which the President and the Republicans have called a jobs and growth package and they say it is to grow the economy. I certainly agree that the economy is in dire straits and we are in desperate need of taking action. That is true. Since President Bush took office, the United States has lost 2.6 million jobs, more than 36,000 of those in my State of Iowa. Unemployment rates, including long-term unemployment rates, continue to rise. That is a fact. The economy is in a shambles. Unemployment continues to go up. This is not just some academic process. It is causing real hardship for millions of Americans and families who are without a job and without health care coverage. Senator Specter and I had a hearing in our appropriations subcommittee talking about the lack of access and affordability of health care. You can read the story of the man who testified, Mr. Kurilko. He was referred to in the Wall Street Journal. He is 57 years old, worked 37 years on a job. He now has a heart problem, diabetes. He is out of a job. He and his wife now face the prospect of losing their life savings because his health care costs, just for insurance, are over $2,000 a month. This is a man who worked in a blue-collar job, a steel mill, all of his life. That is what is happening in America today. Families without work, and the high cost of health care, go without coverage, and they see their life savings vanishing before their eyes. We see it affecting other areas of our economy, our families, and our States. The tuition fees in Iowa have increased sharply at our public universities. However, the tuition does not make up for the shortfall in the loss of State funding. We are seeing cuts to critical public health initiatives, including those that help indigent dialysis patients, and a program that helps immunize low-income kids. Public schools in Iowa have cut 350 teachers statewide. Schools are forced to share nurses and counselors and eliminate programs such as music and art and enrichment classes entirely from their schools. In our hearing this morning, we had a teacher from a small school in Iowa testify. The cost just in her school district for health care coverage went up 61.5 percent over the last year. As he said, they are now approaching the point where their health care costs are going to equal the salary of a first-year teacher. So this is the real America that is happening in my State, in every State, to people who have worked all their lives and now do not have any health care coverage. Our schools are being cut. Our infrastructure is deteriorating in this country, as well as our bridges, roads, sewer, and water systems. What is the answer before us for growth and jobs in our economy? An enormous tax cut, in large part for the wealthy in our country. That is the answer. If I believed this tax bill before us would help the economy, create the jobs we need, and help provide health care coverage, I would be all for it. But the fact is, we have tried this before. In 1981, under President Reagan, we had a supposedly big supply side cut in taxes. We lost 1.3 million jobs in the two years after the passage of that bill. Then OMB Director David Stockman called it a riverboat gamble. Guess what. Working Americans all over this country lost that gamble. In 1982, part of that measure was reversed and the Federal Reserve sharply dropped interest rates allowing for things to start to get better. After much hard work in the 1990s, we passed a bill in 1993 that put us on the path towards a balanced budget, restored confidence and creating 22 million jobs. Productivity went up. It was a bill with a policy totally out of line with the supply side philosophy of the 1981 bill. Almost every Republican senator predicted that the economy would be severely hurt. The economy grew, and 6.5 million jobs were created in just the first two years after that bill passed. The United States enjoyed 40 consecutive months of unemployment below 5 percent. Twenty years after 1981, we had another supply side riverboat gamble in front of us. President Bush assured the country in 2001 that We can proceed with tax relief without fear of budget deficits, even if the economy softens. And on another occasion, he said A tax cut now will stimulate the economy and create jobs. Yet what we are now facing, almost two years after the passage of that measure is a loss of another 1.8 million jobs to our economy. The President, and the Republicans, passed a $1.3 billion tax cut like the one we are considering today. It was targeted to the wealthiest. Unfortunately, the President's predictions were dead wrong. I want to get this chart back up. Two years after the 1981 bill, we lost 1.3 million jobs. Since the 2001 tax bill was passed 20 years later, we have lost 1.8 million jobs in almost 2 years. Now, 22 years after the first try, we are going to try it again. It is not enough that the riverboat gamble failed in 1981. It is not enough that it failed in 2001. By gosh, we are going to try it again, folks--another riverboat gamble. One would think history would teach us something. If history does not, then how about some of the economists and what they are saying. Federal Reserve Chairman Alan Greenspan said: There is no question that as deficits go up, contrary to what some have said, it does affect long-term interest rates. It does have a negative impact on the economy . . . He twice testified before Congress in opposition to the tax cut plan, warning that these deficits would stunt long-term growth. Ten Nobel laureates and 400 other economists disagree with the President's approach. In a statement made February 10 of this year, they wrote: Regardless of how one views the specifics of the Bush plan, there is wide agreement that its purpose is a permanent change in the tax structure and not the creation of jobs and growth in the near term. The economists also said that: Passing these tax cuts will worsen the long-term budget outlook, adding to the nation's projected chronic deficits. This fiscal deterioration will reduce the capacity of the government to finance Social Security and Medicare benefits, as well as investments in schools, health, infrastructure, and basic research. Moreover, the proposed tax cuts will generate further inequities in after-tax income. That is what these 400 economists said. What we are talking about is fairness. We want fairness in the Tax Code. We want fairness to the working families of America in how they are taxed and who pays the burden in this country. Every time we talk about fairness, President Bush says, class warfare. Why is fairness class warfare? Why is it in President Bush's head that if we try to have fairness in the Tax Code, he thinks it is class warfare? That is what this is about. It is about basic fairness. We have tried it before. It failed horribly, and yet I guess we are going to do it again. Why should we do this? Why should we go against the advice of some of the most renowned economists and why should we go against what we know from history? Why take a risky gamble when people's lives are at stake? Why take a risky gamble when 9 million Americans cannot find jobs? If I were out of work, I would want my representatives in Washington to do what has been proven to grow the economy, proven to create jobs, not what has twice proven to fail. In fact, the more I think about this tax bill before us, I think of Bill Bennett. It is like a gambling addiction, putting $500 in the slot machine and pulling the handle. That is what this tax bill is like. It is like putting $500 in and pulling the handle and hoping he hits it. Now we know that Mr. Bennett did not hit it. He lost millions of dollars over several years of gambling. That is what this bill is like. It is a riverboat gamble, like David Stockman called it in the 1980s. I am getting to my amendment now, and there is an interesting comparison I wanted to make on Medicare. How much does the plan before us cost? Well, when we throw out figures of billions of dollars, eyes sort of glaze over. No one can understand exactly how much money that is. So I thought I might compare it. The President's plan if made permanent costs more than the entire 75- year shortfall in both Social Security and Medicare, about 1.8 percent of GDP. The Bush tax cuts made permanent over a 75-year period will amount to 2.3 percent to 2.7 percent of GDP. We hear all the talk about the shortfall we are going to have in Social Security and Medicare when the baby-boomers retire, and that we have to do something about it. Here is your answer: The Bush plan will cost more than the shortfall in Social Security and Medicare. Think about it. Are we going to have this riverboat gamble, a tax cut that basically benefits the wealthiest in our society, when we could be using this to secure Social Security and Medicare for 75 years? But maybe that is what this is all about. It was Newt Gingrich, after all, who said that they--the Republicans--wanted to have Medicare ``wither on the vine.'' Maybe that is what this is all about. Pass this tax cut, reward the wealthiest in our society, and when it comes time to do something about Social Security and Medicare, we will not have enough money. Maybe that is what it is all about. That is not what we should be about. We should be about a jobs and growth bill that helps the working families of America. We ought to be about a bill to help secure Medicare and Social Security for the baby boomers. One of the ways we can do this is by making sure we have equity in the Medicare system. The amendment I sent to the desk will help do that by making sure we have better equity in the Social Security system and Medicare system. I tried to listen as my colleague from Iowa offered his amendment. I did not receive a copy of it earlier, so I did not have a chance to look at it. I heard some of the things that my colleague from Iowa was talking about in terms of helping right some of the wrongs in Medicare to provide for less disparity under Medicare. Most of what I heard I agree with. I think a number of the provisions in Senator Grassley's Medicare amendment are similar to provisions in my amendment. I commend him for that. However, his amendment uses a different offset. I don't know exactly what that is. I plan to analyze it overnight. It may have some merit, I don't know. Both are trying to help rural hospitals and providers. I hope we can work together to get that done sometime this year. Basically, what my amendment would do is, say, if the Congress does not pass legislation by December 31, 2003 then the Secretary of Health and Human Services would promulgate regulations by December 31, 2004. We would have to enact additional legislation. If none passed, the Secretary would have to act by the end of 2004. Those regulation changes would have to have the following parts: One, to equalize urban and rural base payment rate. This increases the rate for all hospitals in cities below one million people. Two, improve the Medicare incentive payment program to ensure that bonus payments are made on behalf of all eligible physicians; three, my amendment would eliminate the Medicare DSH cap. The current cap disproportionately hurts rural states; four, it would establish a Medicare inpatient hospital bonus payment for hospitals with low Medicare patient volumes; five, it would adjust the Medicare inpatient hospital prospective wage index to revise the labor-related share of such index to account for 62 percent of such index. Currently, payments are 71 percent based on labor costs. I heard Senator Grassley's amendment did the same thing; next, reinstate a bonus payment to home health care providers in rural areas. A 10 percent bonus has expired and this would reinstate it. Next adjust the work GPCI to no less than 1 for physicians; lastly, this amendment I am offering would say we would have a hold harmless clause that whatever we do could not result in the lower level of reimbursement for a health care provider under title XVIII, that such provider would have received but for the enactment or these of this amendment or these regulations. The offset I used would be to limit, to put a cap on any tax deductions for dividend income not to exceed $500. In other words, you could get an exclusion of up to $500 on dividends in terms of a tax benefit, but no more than that. That offset would fully pay to make sure our hospitals in Iowa or Washington State--I know Washington is very low on the payment schedule--Montana, other States, make sure that we have an equalization so the Medicare payments in those States are not so skewed as they are right now. We can get this done simply by capping at $500 the tax benefits under the present bill before the Senate on dividends. It seems to me that would be a small price for the wealthiest in our country to pay to make sure we had a working Medicare system that was fair to all. In closing, regarding the tax bill, do we take a risky gamble as we have before, sort of a Bill Bennett gamble, as I have said, pull the handle on the slot machine and hope something comes up? Or do we go with proven methods to grow the economy and create jobs? Do we break the bank on tax cuts for the wealthy or do we invest in education? Do we break the bank on dividend tax breaks or do we cap them and use that offset as a way of helping equalize Medicare payments in our States? Do we break the bank on tax cuts for the rich or help families afford college tuition? Do we break the bank on tax cuts for the rich or do we help families afford health care coverage? Do we break the bank on tax cuts for the rich or do we keep Social Security secure? Do we break the bank on tax cuts for the rich or do we keep Medicare benefits intact? Do we break the bank on tax cuts for the rich or do we start to work on having smaller deficits? These are our choices. The choice is clear. This bill needs some serious amendments. There will be a number of amendments offered and, quite frankly, if some of the amendments are accepted, maybe the bill would be worthy of support. As the bill sits right now, the bill must be opposed, unless we can adopt some of these amendments that I think would make it, A, more fair and equitable, and B, to make sure we invest in the long-term security of Social Security and Medicare. How much time do I have remaining?

Mr. HARKIN. Mr. President, I send an amendment to the desk.

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

Mr. HARKIN

Mr. HARKIN. Mr. President, I rise today to congratulate the people of Grundy Center, Iowa for their hard work and success in developing one of the Nation's best-all around physical education programs, in their schools and in the entire community. As a result of their leadership and dedication to physical fitness, Grundy Center has been selected to receive the PE4LIFE Community Achievement Award. In addition, the community will now serve other Iowans and the rest of the Nation as the second PE4LIFE Institute. This is a great achievement, thanks in large part to Beth Kirkpatrick and Rick Schupbach, who for 15 years have served this community and dedicated themselves to building an innovative physical education program. The PE4LIFE program effectively reaches and inspires every student, regardless of athletic ability or experience, to become physically active for a lifetime. It is the kind of inclusive approach that will make a difference in Iowa and throughout the country. The need for what Rick and Beth will do as codirectors of the new PE4LIFE Institute has never been greater. Obesity has become our Nation's fastest rising public health threat. The number of overweight and obese Americans has more than doubled in the last 30 years. The problem is especially serious for children; the number of overweight children is growing at a rate faster than the number of adults. If we don't do something to halt and reverse the trend, we will face a significant health care crisis. If we don't do something, our children, as they grow into adults, will face greater threats from diabetes, heart disease and other serious maladies related to being out of shape and overweight. It is now estimated that the annual cost of treating obesity related diseases is over $100 billion per year. Unfortunately, the solution is getting away from us. Physical education in our Nation's schools has declined. In 1991, only 42 percent of our Nation's students had daily physical education. Today that number is around 29 percent. Physical education and daily physical activity go a long way to improving the overall health of our children. We need to improve on cardiovascular endurance, muscle strength, flexibility, help with weight regulation, bone development and posture. Teaching active lifestyle habits to children will go a long way to helping our children grow up to be active and healthy adults. An active lifestyle also promotes the constructive use of leisure time. Improving physical education in our schools is a sure way to influence these behavior patterns in our children. Our kids are not in shape. They spend too much time in front of the TV, playing video games or working on their computers. The best way to get them back on their feet is to improve the physical education they receive while they are in school. Programs like the new PE4LIFE Institute in Grundy Center are critically important to tackling this problem. Before he was inaugurated, President-elect John F. Kennedy wrote an article for Sports Illustrated entitled, ``The Soft American.'' He wrote: For physical fitness is not only one of the most important keys to a healthy body: it is the basis of dynamic and creative intellectual activity. The relationship between the soundness of the body and the activities of the mind is subtle and complex. Much is not yet understood. But we do know what the Greeks know: that intelligence and skill can only function at the peak of their capacity when the body is healthy and strong: that hardy spirits and tough minds usually inhabit sound bodies. President Kennedy would have been impressed by the people of Grundy Center. We are proud of their accomplishments, and we look forward to working with them in the future as they help Iowa and the rest of the Nation become more physically fit.

Mr. HARKIN

Mr. HARKIN. Mr. President, I am pleased to be joined by Senators Specter and Kennedy today in re-introducing legislation that will give new hope to Americans with paralysis. Recent news reports about the medical miracle Christopher Reeve has experienced over the two past years is an inspiration for every American living with paralysis as a result of a spinal cord injury. When it was announced that, for the first time since his accident in 1995, Chris regained sensation and movement in parts of his body, providing inspiration for some of the two million Americans with paralysis. Most recently, Chris has started weaning himself from a ventilator, breathing on his own for the first time since his accident. Today, through the Christopher Reeve Paralysis Act of 2003, we seek to achieve two primary goals. First, to further advance the science needed to promote spinal regeneration. And second, to build quality of life programs throughout the country that will further advance full participation, independent living, self-sufficiency and equality of opportunity for individuals with paralysis and other physical disabilities. Chris' recovery and recent scientific evidence show that progress is possible. At research centers in the United States, Europe and Japan, techniques of rigorous exercise have helped numerous persons with paraplegia with limited sensations in their lower bodies walk for short distances, unassisted or using walkers. While the results of these new methods are quite promising, the limits of what physical exercise can do for patients remains grossly understudied. While each person and each injury is unique, and some people recover spontaneously, an estimated 250,000 Americans are living with spinal cord injuries that have not improved. Which therapy or combination of therapies will work for each person is unknown. Today two million Americans are living with paralysis, including spinal cord injury, stroke, cerebral palsy, multiple sclerosis, ALS and spina bifida. We need research to see how these new interventions work on the entire population of individuals with paralysis. What we do know is the ordinary repetitive motions used in most rehabilitation centers, like squeezing a ball, are almost certainly not enough to appropriately address neurological injuries. Patients are usually told that after one year, two at the most, they will never make further progress in their abilities to move or feel sensation. Yet eight years after his accident, through a rigorous exercise plan, Chris is finally seeing results. Due to efforts led by the National Institutes of Health and the Christopher Reeve Paralysis Foundation, our Nation stands on the brink of amazing breakthroughs in science for those with paralysis. However, the biotech and pharmaceutical industries have not invested in paralysis research because they believe the market does not support the private investment. There is an urgent need for the Federal Government to further step up its commitment in this area. The Christopher Reeve Paralysis Act would do just that. By establishing Paralysis Research Consortia at the National Institute of Neurological Disorders and Stroke, we can substantially increase our ability to capitalize on research advances in paralysis. These consortia would be formed to explore unique scientific expertise and focus across the existing research centers at NINDS in an effort to further advance treatments, therapies and developments on one or more forms of paralysis that result from central nervous system trauma and stroke. Additional breakthroughs are underway in rehabilitation research on paralysis. Federal funding for rehabilitation research at the National Center for Medical Rehabilitation Research at NIH is showing real potential to improve functional mobility; prevent secondary complications like bladder and urinary tract infections and ulcers; and to develop improved assistive technology. These rehabilitation interventions have the potential to greatly reduce pain and other complications for people with neurological disorders and stroke and, at the same time, save millions in health care costs. Over the past 20 years, overall days in the hospital and rehabilitation center for those with paralysis have been cut in half. Those with paralysis face astronomical medical costs, and our best estimates tell us that only one-third of those individuals remain employed after paralysis. At least one-third of those with paralysis have incomes of $15,000 or less. To date, there are no State-based programs at CDC that address paralysis and other physical disability with the goal of improving health outcomes and prevent secondary complications. This bill will, for the first time, ensure that individuals with paralysis get the information they need; have access to public health programs; and support in their communities to navigate services. Ultimately these programs will help remove the barriers to community participation and help improve quality of life. The bill also establishes hospital-based registries on paralysis to collect needed data on the true numbers of individuals with these conditions, and it invests in population-based research to see how various therapies impact different people. We are on the brink of major breakthroughs for individuals with neurological disorders and stroke that result in paralysis. This bill will ensure that the federal government does its part to help more than 2 million Americans. When Christopher Reeve was injured, he put a face on an issue that has been neglected for too long. Since then, his tireless efforts to walk again, coupled with his passion and commitment to improve quality of life for others with paralysis, make him an inspiration to all Americans. It is a pleasure and an honor to lead a bipartisan group of Senators, along with the support of a number of disability groups, including the American Stroke Association, the American Heart Association, the Christopher Reeve Paralysis Foundation, the National Family Caregivers Association, the National Spinal Cord Injury Association, Paralyzed Veterans of America and Easter Paralyzed Veterans, in introducing this bill.

Mr. HARKIN

Mr. HARKIN. Mr. President, today I come to the floor to pay tribute to a great person, a long-time friend and a true pioneer, Dr. Robert C. Atkins. Dr. Atkins, cardiologist, physician, and author, among many other endeavors, passed away tragically on April 17 from injuries suffered in a fall in New York City. A leader in both natural medicine and nutritional pharmacology, Dr. Atkins majored in pre-med at the University of Michigan and then went on to receive his medical degree from the Cornell University Medical School in 1955. He was the founder of The Atkins Center for Complementary Medicine, Atkins Nutritionals, Inc, and cofounder and past president of the Foundation for the Advancement of Innovative Medicine. But as accomplished as he was a physician and researcher, Dr. Atkins was best known for his controlled carbohydrate approach to weight management known as the ``Atkins Diet.'' In addition to researching and developing what has become one of the leading weight control methods, Dr. Atkins also wrote 13 books, including ``Dr. Atkins' New Diet Revolution'' and ``Atkins for Life,'' both of which have been and remain on The New York Times bestseller list. His commitment to revolutionizing medicine and nutrition and determination to stand by his research led People magazine to name him one of the ``25 Most Intriguing People,'' and Time magazine to add him to their list of ``People Who Matter''. Dr. Atkins invested millions of his own money in the Dr. Robert C. Atkins Foundation, endowing institutions with the necessary funding for research and education. I knew Bob Atkins for many years. He was a good friend and we saw eye to eye on many important issues including dietary supplements, alternative medicine, and medical research. As the lead proponent in the formation the National Center for Complementary and Alternative Medicine, I was always grateful with Dr. Atkins tireless effort to educate law and policymakers. Dr. Atkins helped to bring national attention and credibility to complementary medicine as a serious and effective medical approach. Dr. Atkins will always be remembered for having the courage and foresight to challenge conventional wisdom on nutrition. His tireless efforts to point out ways to lose weight and prevent and manage diabetes and heart disease in ways conventional medicine had ignored or were unaware are irreplaceable and have forever changed how Americans, and the world, view nutrition, weight loss and diet. During his life he treated thousands of patients, including Members of Congress and their families. My condolences go out to his wife Veronica and mother Norma, and all the people who had the pleasure to work for and with him. His legacy and lifetime achievements will continue to guide policy makers and doctors around the world. Bob Atkins not only left a legacy of nutrition and health, but set an example for everyone to believe in themselves and to question establishment policies. Bob, we thank you and we miss you.

Mr. HARKIN

Mr. HARKIN. Mr. President, I am pleased to be joined by Senators Specter and Kennedy today in re-introducing legislation that will give new hope to Americans with paralysis. Recent news reports about the medical miracle Christopher Reeve has experienced over the two past years is an inspiration for every American living with paralysis as a result of a spinal cord injury. When it was announced that, for the first time since his accident in 1995, Chris regained sensation and movement in parts of his body, providing inspiration for some of the two million Americans with paralysis. Most recently, Chris has started weaning himself from a ventilator, breathing on his own for the first time since his accident. Today, through the Christopher Reeve Paralysis Act of 2003, we seek to achieve two primary goals. First, to further advance the science needed to promote spinal regeneration. And second, to build quality of life programs throughout the country that will further advance full participation, independent living, self-sufficiency and equality of opportunity for individuals with paralysis and other physical disabilities. Chris' recovery and recent scientific evidence show that progress is possible. At research centers in the United States, Europe and Japan, techniques of rigorous exercise have helped numerous persons with paraplegia with limited sensations in their lower bodies walk for short distances, unassisted or using walkers. While the results of these new methods are quite promising, the limits of what physical exercise can do for patients remains grossly understudied. While each person and each injury is unique, and some people recover spontaneously, an estimated 250,000 Americans are living with spinal cord injuries that have not improved. Which therapy or combination of therapies will work for each person is unknown. Today two million Americans are living with paralysis, including spinal cord injury, stroke, cerebral palsy, multiple sclerosis, ALS and spina bifida. We need research to see how these new interventions work on the entire population of individuals with paralysis. What we do know is the ordinary repetitive motions used in most rehabilitation centers, like squeezing a ball, are almost certainly not enough to appropriately address neurological injuries. Patients are usually told that after one year, two at the most, they will never make further progress in their abilities to move or feel sensation. Yet eight years after his accident, through a rigorous exercise plan, Chris is finally seeing results. Due to efforts led by the National Institutes of Health and the Christopher Reeve Paralysis Foundation, our Nation stands on the brink of amazing breakthroughs in science for those with paralysis. However, the biotech and pharmaceutical industries have not invested in paralysis research because they believe the market does not support the private investment. There is an urgent need for the Federal Government to further step up its commitment in this area. The Christopher Reeve Paralysis Act would do just that. By establishing Paralysis Research Consortia at the National Institute of Neurological Disorders and Stroke, we can substantially increase our ability to capitalize on research advances in paralysis. These consortia would be formed to explore unique scientific expertise and focus across the existing research centers at NINDS in an effort to further advance treatments, therapies and developments on one or more forms of paralysis that result from central nervous system trauma and stroke. Additional breakthroughs are underway in rehabilitation research on paralysis. Federal funding for rehabilitation research at the National Center for Medical Rehabilitation Research at NIH is showing real potential to improve functional mobility; prevent secondary complications like bladder and urinary tract infections and ulcers; and to develop improved assistive technology. These rehabilitation interventions have the potential to greatly reduce pain and other complications for people with neurological disorders and stroke and, at the same time, save millions in health care costs. Over the past 20 years, overall days in the hospital and rehabilitation center for those with paralysis have been cut in half. Those with paralysis face astronomical medical costs, and our best estimates tell us that only one-third of those individuals remain employed after paralysis. At least one-third of those with paralysis have incomes of $15,000 or less. To date, there are no State-based programs at CDC that address paralysis and other physical disability with the goal of improving health outcomes and prevent secondary complications. This bill will, for the first time, ensure that individuals with paralysis get the information they need; have access to public health programs; and support in their communities to navigate services. Ultimately these programs will help remove the barriers to community participation and help improve quality of life. The bill also establishes hospital-based registries on paralysis to collect needed data on the true numbers of individuals with these conditions, and it invests in population-based research to see how various therapies impact different people. We are on the brink of major breakthroughs for individuals with neurological disorders and stroke that result in paralysis. This bill will ensure that the federal government does its part to help more than 2 million Americans. When Christopher Reeve was injured, he put a face on an issue that has been neglected for too long. Since then, his tireless efforts to walk again, coupled with his passion and commitment to improve quality of life for others with paralysis, make him an inspiration to all Americans. It is a pleasure and an honor to lead a bipartisan group of Senators, along with the support of a number of disability groups, including the American Stroke Association, the American Heart Association, the Christopher Reeve Paralysis Foundation, the National Family Caregivers Association, the National Spinal Cord Injury Association, Paralyzed Veterans of America and Easter Paralyzed Veterans, in introducing this bill.

Mr. HARKIN

Mr. HARKIN. Mr. President, today Senator Specter and I and others introduce the Medicaid Community-Based Attendant Services and Supports Act of 2003, MICASSA. This legislation is needed to truly bring people with disabilities 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. The Medicaid Community Attendant Services and Supports Act accomplishes four goals. First, the bill amends Title XIX of the Social Security Act to provide a new Medicaid plan benefit that would give individuals who are currently eligible for nursing home services or an intermediate care facility for the mentally retarded equal access to community-based attendant services and supports. Second, for a limited time, States would have the opportunity to receive additional funds to support community attendant services and supports and for certain administrative activities. Each State currently gets Federal money for their Medicaid program based on a set percentage. This percentage is the Medicaid match rate. This bill would increase that percentage to provide some additional funding to States to help them reform their long term care systems. Third, the bill provides States with financial assistance to support ``real choice systems change initiatives'' that include specific action steps to increase the provision of home and community based services. Finally, the bill establishes a demonstration project to evaluate service coordination and cost sharing approaches with respect to the provision of services and supports for individuals with disabilities under the age of 65 who are dually eligible for Medicaid and Medicare. Some States have already recognized the benefits of home and community based services. Every State offers certain services under home and community based waiver programs, which serve a capped number of individuals with an array of home and community based services to meet their needs and avoid institutionalization. Some States also are now providing the personal care optional benefit through their Medicaid program. However, despite this market progress, home and community based services are unevenly distributed within and across states and only reach a small percentage of eligible individuals. Those left behind are often needlessly institutionalize because they cannot access community alternatives. A person with a disability's civil right 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. This MICASSA legislation is designed to do just that and make the promise of the ADA a reality. It will help rebalance the current Medicaid long term care system, which spends a disproportionate amount on institutional services. For example, in 2000, 49.5 billion dollars were spent on institutional care, compared to 18.2 billion on community based care. In the same year, only 3 States spent 50 percent or more of their long term care funds under the Medicaid program on home and community based care. And that means that individuals do not have equal access to community based care throughout this country. An individual should not be asked to move to another state in order to avoid needless segregation. 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 two 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 has not been to a restaurant or a movie since he moved to the nursing home over two years ago. His life has dramatically changed from when he lived in his own apartment and hired his own attendants to care for him. MICASSA would give him that choice again--the choice to control his own life and live a full and meaningful life in his home community surrounded by his friends and family. 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. I am very pleased that the administration has included the Real Choice Systems Change grants in its budget this year at $40 million dollars. Senator Specter and I have supported these grants for several years now. I also applaud the administration's commitment to The President's New Freedom Initiative for People with Disabilities and believe that this legislation helps promote the goals of that initiative. Community based attendant services and supports allow people with disabilities to lead independent lives, have jobs, and participate in the community. Some will become taxpayers, some will get an education, and some will participate in recreational and civic activities. But all will experience a chance to make their own choices and govern their own lives. This bill will open the door to full participation by people with disabilities in our workplaces, our economy, and our American Dream, and I urge all my colleagues to support us on this issue. I want to thank Senator Specter for his leadership on this issue and his commitment to improving access to home and community based services for people with disabilities. I would also like to thank Senators Kennedy, Cochran, Biden, Landrieu, Kerry, Corzine, Schumer, and Clinton 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 Specter and I and others introduce the Medicaid Community-Based Attendant Services and Supports Act of 2003, MICASSA. This legislation is needed to truly bring people with disabilities 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. The Medicaid Community Attendant Services and Supports Act accomplishes four goals. First, the bill amends Title XIX of the Social Security Act to provide a new Medicaid plan benefit that would give individuals who are currently eligible for nursing home services or an intermediate care facility for the mentally retarded equal access to community-based attendant services and supports. Second, for a limited time, States would have the opportunity to receive additional funds to support community attendant services and supports and for certain administrative activities. Each State currently gets Federal money for their Medicaid program based on a set percentage. This percentage is the Medicaid match rate. This bill would increase that percentage to provide some additional funding to States to help them reform their long term care systems. Third, the bill provides States with financial assistance to support ``real choice systems change initiatives'' that include specific action steps to increase the provision of home and community based services. Finally, the bill establishes a demonstration project to evaluate service coordination and cost sharing approaches with respect to the provision of services and supports for individuals with disabilities under the age of 65 who are dually eligible for Medicaid and Medicare. Some States have already recognized the benefits of home and community based services. Every State offers certain services under home and community based waiver programs, which serve a capped number of individuals with an array of home and community based services to meet their needs and avoid institutionalization. Some States also are now providing the personal care optional benefit through their Medicaid program. However, despite this market progress, home and community based services are unevenly distributed within and across states and only reach a small percentage of eligible individuals. Those left behind are often needlessly institutionalize because they cannot access community alternatives. A person with a disability's civil right 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. This MICASSA legislation is designed to do just that and make the promise of the ADA a reality. It will help rebalance the current Medicaid long term care system, which spends a disproportionate amount on institutional services. For example, in 2000, 49.5 billion dollars were spent on institutional care, compared to 18.2 billion on community based care. In the same year, only 3 States spent 50 percent or more of their long term care funds under the Medicaid program on home and community based care. And that means that individuals do not have equal access to community based care throughout this country. An individual should not be asked to move to another state in order to avoid needless segregation. 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 two 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 has not been to a restaurant or a movie since he moved to the nursing home over two years ago. His life has dramatically changed from when he lived in his own apartment and hired his own attendants to care for him. MICASSA would give him that choice again--the choice to control his own life and live a full and meaningful life in his home community surrounded by his friends and family. 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. I am very pleased that the administration has included the Real Choice Systems Change grants in its budget this year at $40 million dollars. Senator Specter and I have supported these grants for several years now. I also applaud the administration's commitment to The President's New Freedom Initiative for People with Disabilities and believe that this legislation helps promote the goals of that initiative. Community based attendant services and supports allow people with disabilities to lead independent lives, have jobs, and participate in the community. Some will become taxpayers, some will get an education, and some will participate in recreational and civic activities. But all will experience a chance to make their own choices and govern their own lives. This bill will open the door to full participation by people with disabilities in our workplaces, our economy, and our American Dream, and I urge all my colleagues to support us on this issue. I want to thank Senator Specter for his leadership on this issue and his commitment to improving access to home and community based services for people with disabilities. I would also like to thank Senators Kennedy, Cochran, Biden, Landrieu, Kerry, Corzine, Schumer, and Clinton 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. Under the previous order, how much time was the Senator from New York given?

Mr. HARKIN. Mr. President, I was informed that I may reserve time for the end of the debate also.

Mr. HARKIN. I will. I just hope Senators will go by and, rather than saying they are going to vote for Sutton, will strike another blow for civil rights in this country and tell the assembled people with disabilities out here in this reception room that we are going to say no to Mr. Sutton and we are going to set a higher standard for our Federal judges. Let's defeat this nominee, not on a personal basis, but let's have judges who will understand that upholding people's civil rights against States rights is not a zero sum game. When we win on our civil rights, we all win. I am glad to yield to my friend from Nevada.

Mr. HARKIN. The order was entered into and Mr. Schumer is not here.

Mr. HARKIN. Mr. President, parliamentary inquiry: Since the other side is not speaking, does their time run?

Mr. HARKIN. That is true.

Mr. HARKIN. Therefore, if time is running, it runs off of the other side.

Mr. HARKIN. Mr. President, a lot of times these debates, especially when they involve a court nominee such as Mr. Sutton, tend to get personal, and they should not. I hope no one here interprets anything I have said as being any kind of personal thing against Mr. Sutton. I said at the beginning I found him to be a pleasant, intellectual individual with whom I spent an hour and a half. I do not know him personally, of course. That is not the point. It is just like my good friend from Utah, Senator Hatch. Senator Hatch was very helpful when we passed the Americans with Disabilities Act. I have told him that many times. He happens to be a good friend of mine on a whole host of issues on which we have worked together. I have no doubt that perhaps Mr. Sutton has compassion toward people with disabilities, but that also raises a problem with me. It has been said many times Mr. Sutton's father had a school for kids with cerebral palsy. When Mr. Sutton was in my office, I asked him if that was a segregated school and he said, no, it was not. But he thought I meant male and female. What it was, was kids with cerebral palsy only went to this school. Well, I commend Mr. Sutton's father for his compassion, for having a school for kids with cerebral palsy, but that is what we are trying to get over with the Americans with Disabilities Act. That is what we are trying to get beyond. We are trying to get beyond segregation. I spoke about my brother Frank when he was sent half way across the State to the school for the deaf--segregation because he was disabled. So, again, to have that mindset that somehow people have to be put in an institution, like the Olmstead case--fortunately, Mr. Sutton did not win that one, but if his view had prevailed, the two women in that case would still be in an institution. Now they are living by themselves, out free to shop, free to make their own meals, free to travel, not being stuck in an institution. This vote we are about to have has nothing to do with Jeffrey Sutton as a person, but it has a lot to do with him as a potential judge and how he views his role and how he views Congress's role. He said that the Americans with Disabilities Act was not needed. On National Public Radio he said that, ``disability discrimination in a constitutional sense is really very difficult to show.'' Then, later on, Mr. Sutton said that in this context it is a zero sum game; that if civil rights wins, the States lose. It is not a zero sum game at all. Yes, like my friend from Utah, I believe in federalism. I believe in the Federal/State system on which our country is set up, on which our constitutional framework is established. I think it is the best system ever devised on the face of the Earth. But I do not believe in the kind of federalism that Mr. Sutton espouses, that it is a zero sum game; that if we expand civil rights somehow a State loses, or that somehow Congress does not have the authority, constitutionally, to address the kinds of social ills and social wrongs perpetrated so long in our country on minorities and on people with disabilities. That is why 400 civil rights groups have come out opposed to Mr. Sutton. We here in the Congress did our job. We worked long and hard over many, many years, Republicans and Democrats, to pass the Americans with Disabilities Act. Mr. Sutton says that discrimination against people with disabilities is very difficult to show. Is that the mindset we want on the Federal bench? I ask my fellow Senators, send a strong message that we are going to stand behind the Americans with Disabilities Act, that we are not going to let it be chiseled away by a Federal judge such as Mr. Sutton. I ask for a ``no'' vote to send that message. Mr. President, I ask unanimous consent to have printed the Record a list of letters the Committee has received in opposition to the confirmation of Jeffrey Sutton to the Sixth Circuit Court of Appeals, and three of these letters which come from large coalitions of civil rights, women's rights and disability rights organizations. First, a letter from the Leadership Conference on Civil Rights and the Alliance for Justice, dated April 28, 2003. Second, a letter from 25 women's groups, dated April 28, 2003. Third, a letter from ADA WATCH, a coalition of disability rights organizations, dated May 14, 2003.

Mr. HARKIN. How much time do we have remaining?

Mr. HARKIN. Five more minutes.