Tom Harkin

Mr. HARKIN

Mr. HARKIN. I ask unanimous consent that the pending amendment be set aside so I might offer another amendment.

Mr. HARKIN. Mr. President, is the pending amendment the Wellstone amendment?

Mr. HARKIN. Mr. President, I ask unanimous consent that it be set aside and I call up my amendment.

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

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

Mr. HARKIN. Will the Senator yield?

Mr. HARKIN

Mr. HARKIN. Mr. President, it is with mixed feelings that I stand in support of this amendment. I am a member of the conference committee on the Patients' Bill of Rights. When we began the conference, I had high and great hopes for this because my colleagues on the Republican side told us how committed they were to meaningful HMO reform. Let us look at the history and the record. This passed the Senate almost a year ago, in July of 1999. It passed the House in October. The first meeting we had was on March 2 of this year, and we conducted no business. Then there was another meeting on March 9 that lasted a little while. Not much was done. Then we had two more reduced meetings, not of the entire conference but just a few members of the conference behind closed doors in Senator Nickles' office off the floor. There were four meetings. We have heard about 400 hours and all this hard work. Four meetings? That is tough work. Maybe they have been talking with each other for 400 hours. I do not know. It reminds me of a story about a car stuck in a snowbank. The guy spends 10 hours in the car spinning the wheels going nowhere. Someone shows up and he says: I spent 10 hours trying to get my car out of the snowbank. He is sitting there gunning the gas pedal, spinning the wheels, and going nowhere. If he had just gotten out of the car with a shovel, he would have been out of there. That is what this conference committee is doing; it is spinning its wheels. Since we started meeting, we finalized agreement on two provisions--out of 22 in disagreement, 2 provisions. These were noncontroversial provisions to which both sides easily agreed. The first was on access to pediatric care. That took about 30 seconds to decide. The next issue was provider nondiscrimination. That was identical in both the House and the Senate bills. That is what we have agreed on. That is all we have to show for 400 hours? Four hundred hours, that is what we have to show for it? As I said, we are spinning our wheels. Slowly, over time, I have come to the reluctant conclusion that our Republican Senate colleagues are not serious. They do not truly want a Patients' Bill of Rights. But I believe it is critical that we pass meaningful, bipartisan legislation this year. They did it in the House, and they showed it can be done in a bipartisan fashion. Mr. President, 160 million of our family members, friends, neighbors, and children are paying good money for health care with no guarantee of proper and appropriate treatment. We all know too many stories about patients who cannot see their doctor in a timely manner, who cannot get access to the specialists they need, patients who could not get the coverage for the type of care they thought was covered under their plan. It is very simple: Insurance either fulfills its promises or it doesn't. We are hearing enough to know in too many cases it does not. Employers and patients pay good money for health care coverage, only to find that the expected coverage evaporates at the time they need it. So we have a choice to make here, a choice between real or illusory protections, a choice between ensuring care for millions of Americans or ensuring the profit margins of the managed care industry. The Norwood-Dingell bill, the amendment before us, passed on a bipartisan vote in the House. It is commonsense patient protections by which the managed care plans must abide. Over 300 organizations representing patients, consumers, doctors, nurses, women, children, people with disabilities, and small businesses support the Norwood- Dingell bill. Unfortunately, I cannot help but think that if Members of Congress-- Senators sitting right here in this room today--were in the same health care boat as the average American family, this bill not only would have been made law, it would have been made law years ago. We have all the protections that are in the Patients' Bill of Rights. It is good enough for us, but it is not good enough for the American people, according to my friends on the other side of the aisle. The Senate majority pretends their bill offers real protections. But when you read everything below the title, the bill offered by the Senate Republicans sounds more like an ``Insurers' Bill of Rights'' than a Patients' Bill of Rights. It is my hope that this amendment will spur our colleagues on the other side of the aisle to renew their commitment to this conference committee and to do it in a bipartisan fashion. Spinning your wheels for 400 hours is not getting the job done.

Mr. HARKIN

Mr. HARKIN. Mr. President, I yield myself on my time such time as I may consume. I thank the Senator from Montana for his strong support and input into this bill, as he said over a couple of years, trying to make sure we get a crop insurance bill that helps farmers manage risks. I appreciate his input and his kind words. Hopefully, we will adopt this conference reports this afternoon and farmers in Montana and Iowa, and all points in between, will at least have some assurance they can help manage their own risks.

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

Mr. HARKIN. We are not under any kind of a speaking order unanimous consent, is that correct?

Mr. HARKIN. Mr. President, I join with my distinguished chairman, thanking all the staff who worked so hard on this and hammered out all the agreements over a long period of time on both sides of the aisle. All the Members of our committee and their staffs did a great job. I join our distinguished chairman in thanking them. Let me also thank our chairman, our leader, Senator Lugar, for his persistence and doggedness in getting this bill through. I think it has been at least 1\1/2\ years, if I am not mistaken, since we started on this road. It has had a lot of twists and turns and ups and downs. Senator Lugar stayed in there. He knew how important this bill was to our farmers. It is a great bill. It is one that is really going to help our farmers manage their risks. I again compliment him and thank him for his leadership but also for being so kind and generous, to always work with me and be open and aboveboard. I have never had an instance where I thought in any way that my chairman was ever keeping anything hidden, going behind the door or anything such as that. It has been a great working relationship. I thank my friend and my chairman for having that kind of good working relationship with this side of the aisle.

Mr. HARKIN. I yield back my time.

Mr. HARKIN. Mr. President, I will yield the floor and let my colleagues make their statements. I vitiate that unanimous consent and yield the floor.

Mr. HARKIN. There are a lot of points in there, that is true. Mr. President, I express my support for the conference report to the Agriculture Risk Protection Act of 2000 which we conferenced yesterday. I thank Senator Lugar, our chairman, for his hard work and persistence, as I said, over a couple of years in crafting the crop insurance title in this conference report which will provide significant benefits to farmers across the country. This accomplishment is bipartisan, one of which we can be proud. I thank Senator Lugar again for his persistent and strong leadership. I thank both Senator Roberts and Senator Kerrey who really were the impetus for these changes in the Crop Insurance Program. I know the two of them worked long and hard to put together this bill. In the beginning stages, they worked with us on both sides of the aisle to meet the needs of various parts of our country. I especially thank Senator Roberts and Senator Kerrey. In this regard, Mr. President, this is probably the last agriculture bill we will have this year. There may be some bits and pieces that come along later. I think it is safe to say this may be the last, and probably will be the last, major ag bill this year. In that regard, I pay my respects and thank our departing colleague, Senator Kerrey from Nebraska. He has been an invaluable member of the Senate Agriculture Committee for all of these years. He has always given great input and great insight into our deliberations and discussions on all facets of American agriculture. He has been an invaluable member of our committee. I know I will miss him greatly on our side of the aisle. He has always worked in a bipartisan fashion to help move legislation. I take this time to thank my friend and colleague from across the Missouri River and to wish him well in the future and again thank him for his work in getting this legislation through. It is a fitting tribute to his work through the years in the Senate. His fingerprints are on this crop insurance bill we are passing today. The point of the bill is to help farmers obtain better crop insurance; that is, to help them buy up their coverage. The final structure of the premium subsidy schedule provides higher discounts at both lower and higher levels of buy-up coverage. The improvements at the highest levels, 80 and 100 and 85 and 100, will benefit Iowa farmers who typically face low risk of loss. The bill also provides equivalent subsidies to farmers buying revenue insurance policies such as CRC, which is the crop revenue coverage, a product which is very popular with Iowa farmers. This change spurred development of new insurance policies and products. In addition, the bill will offer reimbursement to private developers of new plans of insurance. Again, that will be good for our farmers. Another major provision maintained was the elimination of the area loss trigger for the program for noninsured crops, such as hay and forage crops or horticulture fruits and vegetables. This change is important to Members in the West and Northeast, one which we fought very hard to maintain in conference. The bill will also protect farmers by allowing them to maintain their insurable yields, despite significant crop loss, by limiting how much of a loss affects future insurance coverage. This feature could be very helpful to Iowa farmers, especially those facing potential drought this summer. At some point today we will be talking a little bit more about that drought. But this will also be very helpful, again, to other farmers, too, in the Dakotas and other places where they have had some very severe losses for 1 or 2 years in a row, which, if not balanced out, could unduly affect their rates and their coverage in future years. So we protected those farmers in those areas in those circumstances. I also want to note some other positive provisions in this bill, in the economic assistance package. First, there is $50 million for conservation, $10 million for the Farmland Protection Act, and $40 million for EQIP. I am disappointed, however, that an amendment that I had offered in the Senate, and which was adopted by the Senate, that would have linked conservation compliance to the provisions of crop insurance, was rejected by the House conferees. In every other Government farm programs, there is a provision that mandates that a farmer has to follow conservation compliance to be eligible for those programs. We had it for crop insurance until 1996. It was taken out. I and others desired to put that back in this crop insurance bill. As I said, it was adopted on the Senate side, but the House conferees refused to go along with that. And in the interests of getting the crop insurance bill through, we acceded to the unanimous consent request to go ahead and remove that provision. I am hopeful to come back with that again at some point in the future on some other piece of agricultural legislation. But other than that, there is $50 million for conservation. That is good. Secondly, there is $15 million in this bill to assist farmer-owned cooperatives, and other farmer-owned ventures, to help develop the value-added crops and processing for our farmers. Third, there is $7 million in this bill to further fund vaccines for pseudo-rabbies eradication program for hogs. It is very important in our area of the country. Fourth, in the nutrition assistance programs, there is $110 million for school lunch commodity purchases. Again, we have a lot of surplus crops out there, a lot of surplus commodities. I think it is beneficial, both for the health of our children, and the school lunch program, the school breakfast program, and the summer feeding program, that we purchase these commodities and get them out to our young kids. Also, we have reformed the Child and Adult Care Food Program to guard more against fraud which has come up repeatedly. Also, there is a provision in this bill--that is also a small provision--but I think it is going to be very important, which is going to permit us to get more children into health insurance for low-income families. Right now, under the provisions in this bill, if you qualify for reduced-price school lunches, or free school lunches, a provision in the bill will then say the people in the school have to inform your families that since you qualify for free or reduced lunches, you will probably qualify for things such as the CHIP program, to make sure, through Medicaid, your children are in a health insurance program. That is another way of reaching low-income families to make sure that their children are indeed covered by health care. That is another good provision in this bill. Lastly, there is a biomass research and development title in this bill that Senator Lugar has worked on for a long time. He is a real champion of it. I have been a cosponsor of it, but it is Senator Lugar who has pushed this bill to help make more fuel and industrial raw materials from biomass. And this bill is part of this. Again, another good provision of this bill is the biomass research and development bill that has been championed by Senator Lugar. So there is much that is good in this bill. That is why I will support it. That is why I was reluctant in the conference committee to take any more time than we did yesterday, in just a few hours, to get this bill through. But I am compelled to speak for a little bit about what is in this bill that I think is detrimental to our family farm structure in America and to ensuring that we have a diversified and widely spread system of agriculture. The $7.1 billion in emergency assistance that is included in this report, I believe, is misapplied, misdirected, and in many cases will be misspent. It is clear that our farmers are going to need aid. There is no doubt about that. But how this final package looks, I think, does not really meet those needs. This is the third year in a row that we have had additional AMTA payments--payments to farmers based on emergency help in the farm economy. The farm economy is still in shambles. For 3 years in a row, it has been in shambles. Every year, we come back and do the same thing year, after year after year, after year. Someone once defined ``insanity'' as doing the same thing over and over and expecting a different result. Every year we keep doing the same thing over and over, and we expect some different result; and we do not get a different result. The only result we get is fewer and fewer family farmers, more stress in rural areas, and more and more of our money going to the larger concerns who are driving out our family farms. But I want to recite for the Record where this money is going, these billions of dollars that we are taking from taxpayers and putting out there. During the first 3 years of our Freedom to Farm bill--1996 to 1998-- the top 10 percent of payment recipients, or about 150,000 individuals, got 61 percent of the payments. Ten percent of the recipients got 61 percent of the money. Their annual payments from AMTA, the supplemental AMTAs, we passed every year, and the loan deficiency payments averaged $95,000. That is for the top 10 percent. The other 90 percent averaged only $7,000 in payments. I have a chart that illustrates this. It shows the average Government payments by farm size in 1997. The average was $7,378 for all farms. But those farms that had sales greater than $1 million averaged $33,699. For those farms that had sales of $250,000 to $500,000, they averaged $16,524--and on down. As you can see, the bigger you are, the more you got. And I daresay, it is usually those bigger farmers that were better able to protect themselves with insurance and other methods, who may not have needed that kind of assistance. It is the farmers down here in the lower end that needed the assistance and the help. But they were left stranded. On a State-by-State basis, the lopsided nature is even more striking. I will talk about Iowa, too, but the top 10 percent of recipients in Mississippi received 83 percent of the payments. In Alabama, the top 10 percent received 81 percent of the payments. In my own State of Iowa, lest anyone think that I am singling out other States other than my own, the top 12 percent, in terms of income, received 50 percent of the payments in my State of Iowa. I do not think that is fair. The inequities of the current system have been exacerbated during the current economic crisis in agriculture. The last 2 years have shown that when prices are low, regular AMTA payments do nothing to keep an ad hoc disaster package under control. More importantly, they are not an effective mechanism in targeting aid to those who need it. We have had the AMTA payments. We come along every year, and we have a disaster program. They are a very poor method of response to our current farm crisis. While it is important to get needed aid out to producers, it is imperative that we get it out to help mostly family farmers who are really hurting, not to help the bigger farms bury the smaller ones. The data indicates just the opposite is happening. The lion's share of this additional aid will go to the largest producers, while small producers receive almost nothing. Under the current scheme, a recipient at the high end of the spectrum may qualify for as much as $240,000 in AMTA payments this fiscal year. Under the current law, a person ``may be eligible'' to receive the payment maximum of $40,000 for each round of AMTA payments, the original payment plus the supplemental payment we have in this bill. That adds up, of course. Then they already received the supplemental payment that is in the fiscal year 2000 appropriations bill. So that is $120,000. If they structure their operations to fit under the three-entity rule, each person can receive payments from three entities. That, in effect, doubles that $120,000 up to $240,000. And that is not the end of it. As much as $300,000 in loan deficiency payments and marketing loan gains can go to that farmer. One farmer in this country this year can get up to $540,000 of taxpayers' money. I don't believe that is right; I don't believe that is fair. I was going to offer a provision in the conference committee. I didn't. The reason I didn't is that I thought it was important to get the crop insurance bill through. As I said in the conference committee yesterday, we should have a crop insurance bill before us. The budget resolution that was passed here, that allowed us to have additional spending this year for supplemental payments to farmers, provided for the authorizing committee to authorize it by June 29, which means we had until the end of June to have a debate in our committee to talk about the policy implications of what we have been doing the last couple years and whether or not we want this policy structure to continue. Do we want to really continue to put our AMTA payments out like this? Well, we did not have that debate, so here we are confronted with this on a crop insurance bill, which should not be. This should be a separate bill from the Agriculture Committee on the floor where we could debate this. Maybe it would be the will of the majority of the Senate to continue to give large payments to large farmers, to continue the three-entity rule to allow some farmers to get hundreds of thousands of dollars. That could have been the outcome. But at least we should have been debating it. It should be here in a manner in which it would be debatable and amendable. We don't have that. I was going to offer an amendment to limit to $100,000 the most anyone could get through the AMTA system. I heard all kinds of talk from different people saying this would be terrible. That would have affected five-tenths of 1 percent of all the recipients; 6,700 farmers would have been affected by that if we would have capped it at $100,000. I have always thought I was here to fight for the vast majority of the family farmers who are out there, not just the top one-half of 1 percent who, by and large, have the economic wherewithal to protect themselves. Many of our smaller farmers simply don't. Again, the data indicates that it is those at the top of the spectrum who are getting the most money. I have another chart. This chart illustrates how we are going in the wrong direction. As we continue down this pathway of AMTA payments, supplemental AMTA payments, loan deficiency payments built on each other year after year, without addressing the underlying provisions of the Freedom to Farm bill, what is happening is we are creating a bigger gap between the big farmers and the smaller farmers in our country. This chart illustrates that. As one can see by Government payments here on the left side, $20,000, $40,000, $60,000, $80,000, $100,000, and producers who receive those payments, if they look at this block, they will see that those producers who received about $50,000 or more in payments in the last 3 years almost doubled the amount of money they were getting from the Government--almost doubled it. Look here at our smaller, family-sized farmers, who only got maybe $2,000 or $3,000 in payments. They just went up a very small amount. These doubled in size, doubled in payment; these hardly went up at all. What kind of policy are we pursuing here? I am not talking about farmers just getting big on their own and making more money. If these big farmers are more efficient and can do a better job and get this money in the marketplace, God bless them. We are talking about taxpayers' money going from here to these farmers. The big ones almost doubled in the amount of money they are getting from the Government; the smaller ones barely got any increase at all. I wish someone would explain to me how this is sound public policy. I have the figures right here. Recipients who averaged $50,000 or more in Government payments from 1996 to 1998 received $42,337 more in 1998 than in 1996. In contrast, if you were at the bottom of the payment spectrum, these little ones down here at the bottom, you averaged between $5,000 and $10,000 per year, which is the bulk of the farmers in my State; you received a mere $740 more in 1998 than you did in 1997. I will repeat that. In my State--just talking about my State; I don't want to pick on anybody else's State--in my own State of Iowa, if you received an average of $50,000 or more in Government agricultural payments from 1996 to 1998, in 1 year you got more than a $28,000 increase, from 1997 to 1998. You got $42,000 more over the 2 years. That is if you were at the top of the heap. If you were at the bottom and you only got $5,000 to $10,000 in Government payments, you got $740 more. Someone please tell me how this is good public policy, that we give Government money out like this to the biggest, those who can protect themselves. Do you know what they are doing with that money? They are buying more land. They are getting bigger, because our smaller farmers are going out of production and the bigger farmers are buying their land. Again, if this were a free market approach, I would say fine, but it is Government payments going out to large farmers who are providing for the extinction of our family farmers--Government policies, right now, allowing these bigger farmers to get these massive Government payments, squeezing the smaller producers, and the bigger producers are buying up the land and getting bigger and bigger and bigger. It isn't because of any free market approach, it is because of governmental policies. Again, the disparities are not just size related, they are based on planting history. When I opened my remarks earlier today, I said someone please explain to me how it is good public policy that we pay farmers AMTA payments, Government payments, this year based on what they did 20 years ago. That is right. I try to explain this to people, and I get blank stares. It is a fact. If you have two farmers out there, one who has a 20-year history of planting and the other who maybe only has a 5-year history of planting, the one who has the 20-year history of planting may be planting nothing this year, but guess what, you are going to get money. Yet if you were a farmer out there planting for the last 3, 4, or 5 years, you don't have that 20-year history, you won't get anything. Again, please explain to me how this is good policy. It is not tied to what farmers are producing today. It is tied to what they produced 20 years ago. Two farmers in Iowa, with half their production in corn and half their production in soybeans, can be paid markedly different levels because of past planting history. When you figure the AMTA payment level, the farmer with a 50-percent corn base and a 50-percent soybean base will be paid half as much in AMTA payments as the farmer who has a 100-percent corn base. What sense does this make? It makes no sense. Farmers all over my State recognize that. Now, as if all I have said isn't bad enough, the prospects for drought this year will even cause this program to be worse than it is. If a drought of the proportions that is predicted actually occurs, the disparity between the haves and the have-nots will grow even more. Why is that? Because let's say we have a drought--and it looks as if we are going to have pretty severe droughts in some parts of the country and other parts of the country will not--that means that the price, say, of corn is going to go up. But you, who are in a drought area, may only get a certain portion--you may get an AMTA payment, but you won't get anything out of the market because you won't have a crop. If, however, you are in an area where you haven't had a drought, you are going to get high prices for your crop and an AMTA payment. Those who have no crop to sell will have their incomes plummet; they will get no adjustment in their AMTA payment to address those losses. They will get absolutely no more than the farmer who has a huge crop because they were not in the drought area. Again, these payments will exacerbate again this disparity between the large farmers and the small farmers in America. Again, I think that is bad public policy. Now, maybe if we have a big drought, we will come rushing in here with some kind of a disaster package. But, again, I wonder who is going to get the benefits of that. So throughout all of this, the mantra has been that there is no other viable mechanism, that AMTA payments are our best means of getting aid to our producers. Well, if this is the best we can do, I would hate to see what the worst is. There is a better way. I believe both sides should come together to figure out a better way of getting payments out to farmers. This idea of giving more and more to the biggest is not right, not good for our country; it is not good public policy. I have urged the Senate to have a frank and open discussion about the failures of the current system and on ways to improve it. We have not been afforded that opportunity in a meaningful way. As I said, this is in no way disparaging of my friend and the chairman of the Agriculture Committee. I know he was more than willing to have this discussion and this debate. But the powers that be insisted that we have this AMTA payment provision on the crop insurance bill. So here we are with it, without any provision for our authorizing committee to discuss and debate, and perhaps modify. As I said, I don't know if the will of the majority would have been there to do that, but at least we could have had an open and frank discussion about whether or not we wanted to go in that direction. Hopefully, we will have that opportunity in the future. So, again, I hope we will have this type of debate. I think our farmers and our taxpayers deserve that type of debate. In the meantime, I have no problems with the underlying bill. It is a good bill. The crop insurance bill is a good bill. It is going to go a long way toward helping our farmers manage the risk. As I said, there are other good provisions attached onto it. I am just sorry we had to attach on the payment provisions to this bill without having the committee do its job. Mr. President, I yield the floor.

Mr. HARKIN. Mr. President, I concur with what the Senator from Minnesota said. I defy anyone to explain in any rational context whatsoever, any kind of rational terms, why we make payments to farmers based on what they did 20 years ago. There is absolutely no rational basis for that. I will talk about that in my comments a little bit later. I understand there is a unanimous consent request we are operating under, is that right?

Mr. HARKIN. I yield the time.

Mr. HARKIN

Mr. HARKIN. Mr. President, I am pleased to join Senator Frist today to introduce the ``WISEWOMAN Expansion Act.'' This bill will help thousands of women have access to basic preventive health care they may otherwise not receive. The legislation builds on a successful demonstration program and expands screening services and preventive care for uninsured and low-income women across the nation. Beginning in 1990, I worked as Chairman of the Labor, Health and Human Services and Education Appropriations Subcommittee to provide the funding for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), run through the Centers for Disease Control and Prevention. In Iowa alone, the program has successfully served 8694 women through 618 provider-based breast and cervical cancer screening sites. Today, the Centers for Disease Control and Prevention currently run the WISEWOMAN (Well-Integrated Screening and Evaluation for Women in Massachusetts, Arizona and North Carolina) program through the NBCCEDP as a demonstration project. The program has successfully built upon the framework of the NBCCEDP to target other chronic diseases among women, including heart disease, the leading cause of death among women, and osteoporosis. The programs address risk factors such as elevated cholesterol, high blood pressure, obesity and smoking and provide important additional intervention services. This demonstration project has been successful. It is now time to expand the program to additional states, and eventually make it nationwide. As the brother of two sisters lost to breast cancer and the father of two daughters, I know first hand the importance of making women's health initiatives a top priority. The first step to fighting a chronic disease like cancer, heart disease or osteoporosis is early detection. All woman deserve to benefit from the early detection and prevention made possible by the latest advances in medicine. This bill ensures a place for lower-income woman at the health care table. Mr. President, the majority of Americans associate cardiovascular disease with men, but the American Heart Association estimates that nearly one in two women will die of heart disease or stroke. In fact, cardiovascular diseases kills nearly 50,000 more women each year than men. In my own state of Iowa, cardiovascular disease accounts for 44 percent of all dealths in Iowa. Close to 7,000 women die annually in Iowa from cardiovascular disease. Each year, nearly half a million women lose their lives as a result of heart disease and stroke. Sadly, with appropriate screening and interventions, many of these deaths could have been prevented. Osteoporosis is also a preventable disease and affects 1 out of every 2 women over the age of 50. Fortunately, some of the preventive measures women can take to reduce their risk for cardiovascular diseases, such as eating more nutritious foods and exercising, can also reduce their risk for osteoporosis. Mr. President, our bill would do the following: Expand the current WISEWOMAN demonstration project to additional states; Add flexibility to program language that would allow screenings and other preventive measures for diseases in addition to cardiovascular diseases; Allow flexibility for the WISEWOMAN program to grow and adapt with the changing needs of individual states and our better understanding of new preventive strategies; and Ensures continued full collaboration of the WISEWOMAN program with the NBCCEDP; Authorizes the CDC to make competitive grants to states to carry out additional preventive health services to the breast and cervical cancer screenings at NBCCEDP programs, such as: screenings for blood pressure, cholesterol, and osteoporosis; health education and counseling; lifestyle interventions to change behavioral risk factors such as smoking, lack of exercise, poor nutrition, and sedentary lifestyle; and appropriate referrals for medical treatment and follow-up services. In order to be eligible for this program, states are required to already participate in the NBCCEDP and to agree to operate their WISEWOMAN program in collaboration with the NBCCEDP. Mr. President, this bipartisan legislation has the support of the National Osteoporosis Foundation, the American Cancer Society and the Komen Foundation, among others. I urge my colleagues to join us in supporting this critical legislation.

Mr. HARKIN

Mr. HARKIN. Mr. President, I am pleased to be joined today by my colleagues, Senator Thomas, Senator Craig and Senator Feingold, to introduce the ``Medicare Fairness in Reimbursement Act of 2000.'' This legislation addresses the terrible unfairness that exists today in Medicare payment policy. According to the latest Medicare figures, Medicare payments per beneficiary by state of residence ranged from slightly more than $3000 to well in excess of $6500. For example, in Iowa, the average Medicare payment was $3456, nearly a third less than the national average of $5,034. In Wyoming the situation is worse, with an average payment of approximately $3200. This payment inequity is unfair to seniors in Iowa and Wyoming, and it is unfair to rural beneficiaries everywhere. The citizens of my home state pay the same Medicare payroll taxes required of every American taxpayer. Yet they get dramatically less in return. Ironically, rural citizens are not penalized by the Medicare program because they practice inefficient, high cost medicine. The opposite is true. The low payment rates received in rural areas are in large part a result of their historic conservative practice of health care. In the early 1980's rural states' lower-than-average costs were used to justify lower payment rates, and Medicare's payment policies since that time have only widened the gap between low- and high-cost states. Mr. President, late last year I wrote to the Health Care Financing Administration (HCFA) and I asked them a simple question. I asked their actuaries to estimate for me the impact on Medicare's Trust Funds, which at that time were scheduled to go bankrupt in 2015, if average Medicare payments to all states were the same as Iowa's. I've always thought Iowa's reimbursement level was low. But HCFA's answer suprised even me. The actuaries found that if all states were reimbursed at the same rate as Iowa, Medicare would be solvent for at least 75 years, 60 years beyond their projections. I'm not suggesting that all states should be brought down to Iowa's level. But there is no question that the long-term solvency of the Medicare program is of serious national concern. And as Congress considers ways to strengthen and modernize the Medicare program, the issue of unfair payment rates needs to be on the table. The bill we are introducing today, the ``Medicare Fairness in Reimbursement Act of 2000'' sends a clear signal. These historic wrongs must be righted. Before any Medicare reform bill passes Congress, I intend to make sure that rural beneficiaries are guaranteed access to the same quality health care services of their urban counterparts. Mr. President, our legislation does the following: Requires HCFA to improve the fairness of payments under the original Medicare fee-for-services system by adjusting payments for items and services so that no state is greater than 105% above the national average, and no state is below 95% of the national average. An estimated 30 states would benefit under these adjustments, based on 1998 data from the Ways and Means Green Book. Requires improvements in the collection and use of hospital wage data by occupational category. Experts agree the current system of collecting hospital data ``lowballs'' the payment received by rural hospitals. Large urban hospitals are overcompensated today because they have a much higher number of highly-paid specialists and sub- specialists on their staff, while small rural hospitals tend to have more generalists, who aren't as highly paid. Ensures that beneficiaries are held harmless in both payments and services. Ensures budget neutrality. Automatically results in adjustment of Medicare managed care payments to reflect increased equity between rural and urban areas. This legislation simply ensures basic fairness in our Medicare payment policy. I urge my Senate colleagues, no matter what state you're from, to consider our bill and join us in supporting this common sense Medicare reform. Thank you. Mr. President, I ask unanimous consent that the text of our bill be printed in the Record.

Mr. HARKIN

Mr. HARKIN. Mr. President, I am pleased to be joined today by my colleagues, Senator Thomas, Senator Craig and Senator Feingold, to introduce the ``Medicare Fairness in Reimbursement Act of 2000.'' This legislation addresses the terrible unfairness that exists today in Medicare payment policy. According to the latest Medicare figures, Medicare payments per beneficiary by state of residence ranged from slightly more than $3000 to well in excess of $6500. For example, in Iowa, the average Medicare payment was $3456, nearly a third less than the national average of $5,034. In Wyoming the situation is worse, with an average payment of approximately $3200. This payment inequity is unfair to seniors in Iowa and Wyoming, and it is unfair to rural beneficiaries everywhere. The citizens of my home state pay the same Medicare payroll taxes required of every American taxpayer. Yet they get dramatically less in return. Ironically, rural citizens are not penalized by the Medicare program because they practice inefficient, high cost medicine. The opposite is true. The low payment rates received in rural areas are in large part a result of their historic conservative practice of health care. In the early 1980's rural states' lower-than-average costs were used to justify lower payment rates, and Medicare's payment policies since that time have only widened the gap between low- and high-cost states. Mr. President, late last year I wrote to the Health Care Financing Administration (HCFA) and I asked them a simple question. I asked their actuaries to estimate for me the impact on Medicare's Trust Funds, which at that time were scheduled to go bankrupt in 2015, if average Medicare payments to all states were the same as Iowa's. I've always thought Iowa's reimbursement level was low. But HCFA's answer suprised even me. The actuaries found that if all states were reimbursed at the same rate as Iowa, Medicare would be solvent for at least 75 years, 60 years beyond their projections. I'm not suggesting that all states should be brought down to Iowa's level. But there is no question that the long-term solvency of the Medicare program is of serious national concern. And as Congress considers ways to strengthen and modernize the Medicare program, the issue of unfair payment rates needs to be on the table. The bill we are introducing today, the ``Medicare Fairness in Reimbursement Act of 2000'' sends a clear signal. These historic wrongs must be righted. Before any Medicare reform bill passes Congress, I intend to make sure that rural beneficiaries are guaranteed access to the same quality health care services of their urban counterparts. Mr. President, our legislation does the following: Requires HCFA to improve the fairness of payments under the original Medicare fee-for-services system by adjusting payments for items and services so that no state is greater than 105% above the national average, and no state is below 95% of the national average. An estimated 30 states would benefit under these adjustments, based on 1998 data from the Ways and Means Green Book. Requires improvements in the collection and use of hospital wage data by occupational category. Experts agree the current system of collecting hospital data ``lowballs'' the payment received by rural hospitals. Large urban hospitals are overcompensated today because they have a much higher number of highly-paid specialists and sub- specialists on their staff, while small rural hospitals tend to have more generalists, who aren't as highly paid. Ensures that beneficiaries are held harmless in both payments and services. Ensures budget neutrality. Automatically results in adjustment of Medicare managed care payments to reflect increased equity between rural and urban areas. This legislation simply ensures basic fairness in our Medicare payment policy. I urge my Senate colleagues, no matter what state you're from, to consider our bill and join us in supporting this common sense Medicare reform. Thank you. Mr. President, I ask unanimous consent that the text of our bill be printed in the Record.

Mr. HARKIN

Mr. HARKIN. I ask for 30 seconds.

Mr. HARKIN. Mr. President, first of all, I take a back seat to no one in being a legitimate hunter. I hunt every year. I have hunted since I have been a kid. I will take on anyone over there in trap shooting. That is not what this is about. It is not about law-abiding people who like to hunt and own guns to hunt with, or somebody who needs one for self-protection in their home. That is not what this is about. That's why I have to take issue with those who are always misinterpreting the Constitution of the United States--misinterpreting it. When you look at the Lott amendment before us, the first thing he says is the second amendment to the U.S. Constitution protects the right of each law-abiding U.S. citizen to own a firearm for any legitimate purpose, including self-defense or recreation. Please tell me where in the second amendment and the Constitution it says that. You can go out to the NRA building, and on the side it says, ```The right of the people to keep and bear arms shall not be infringed,' the second amendment to the Constitution.'' Anybody can take anything out of context, Mr. President. You can prove there is no God by reading the Bible. All I ask you is to open the Bible to Psalms 14:1. Guess what it says; ``. . .there is no God.'' I ask my friend from Idaho if he has ever read Psalms 14:1. It says there is no God, in the Bible. But what does it say right before that? ``The fool said in his heart there is no God.'' What relation does that have to the second amendment to the Constitution? Everybody has this book in their desk. It is not that big a deal to read this. It says: A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed. So what do they do? They take it out of context. I suppose somebody could take the Bible out of context, too. You have to put it into contextual framework. The framers of the Constitution knew they didn't want a standing army. They wanted a militia, like the National Guard, for people in their homes to keep arms for protection. Read your history books. These people out here who want to reinterpret the Constitution for their own ends are doing our people a great disservice. Now, take another look at the Lott amendment. The Lott amendment has a finding in the end. Here is the sense of the Senate that--get this: The right of each law-abiding United States citizen to own a firearm for any legitimate purpose, including self-defense or recreation, should not be infringed. The right of each law-abiding United States citizen. It doesn't have an age limit. Does that mean a kid 13 years old can have an Uzi for recreational purposes? It doesn't say that there. There is no age limit on it. It could be a 5-year-old kid or a 10-year-old kid. I will say one other thing. ``For any legitimate purpose,'' it says. Does that mean--

Mr. HARKIN. I thank the Senator. Read the language of the Lott amendment. ``The right of each law-abiding United States citizen.'' No age limit; 10-year-old kids or 14-year-old kids can own any amount of guns they want. ``For any legitimate purpose, including recreation.'' Does that mean if I want to own 50 Uzis, the Government can't have anything to say about it? Maybe that is my recreation and I want to blow down a lot of things in my backyard. This doesn't make any sense. The sense-of-the- Senate resolution makes no sense. It misinterprets the Constitution. Secondly, it opens the door wider than we have ever seen it before. Keep in mind, when you vote on the Lott substitute, what you are saying is that anyone in the United States who is a citizen--no age limit--can own any amount of guns that person wants. There are no restrictions. Is that what we want in this country? If so, have the guts to stand up and say so. Stand up and say that you want 10-year-old kids owning Uzis and machine guns. Go ahead and say it if that is what you want because that is what the language of the Lott amendment says. All you have to do is read the language of what is in front of us. Look at this chart. This says what we ought to do is ``start them young; there is no time like the present'' for a little kid like that on this chart. This is an ad. Under the Lott amendment, that kid could be carrying 10 Uzis. Keep that in mind when you vote for it. Mr. President, I do support Senator Daschle's resolution. We had one million mothers, their families and friends on Mother's Day demanding their elected lawmakers take final action on the Juvenile Justice bill and the gun measures that bill included. For ten months since we first passed the bill--despite numerous gun tragedies at schools, workplaces and even places of worship all across America--the Republican leadership has refused to move forward on these common sense provisions. What is almost as senseless as these tragedies is the fact that Congress refuses to act on this legislation that would prevent many of these shootings. What are the so-called controversial measures we're talking about? Measures--ironically--that would not affect law-abiding citizens who want to own a gun. Let me take a moment to list them: Requiring gun manufacturers to provide child safety locks with their guns, giving the owners the option to install them. Closing the gun show loophole that allows sales at gun shows without background checks. Right now, 40 percent of all gun show sales go without a background check. Under this provision, all potential buyers at gun shows will use the Instant Check computer system--which normally takes a few minutes. For the small percentage of potential buyers--less than 5 percent--they may have to wait up to three days so records can be checked manually on the closest business day. And the bill would ban juvenile possession of semi-automatic weapons and high-capacity ammunition clips. These are reasonable measures. But, I also believe we need to do a better job at enforcing current laws. I support the Administration's budget request for new funding to hire more ATF agents and prosecutors. I also support their request for research funding to develop ``smart-gun'' technology which could limit a gun's use to its owner and authorized users to help prevent accidental shootings. Opponents of common sense gun safety laws set up a false choice between prevention and enforcement. Any successful policy will have to have both of these elements.

Mr. HARKIN

Mr. HARKIN. I want to ask the Senator another question. The decisions they make today are behind closed doors. Does the Senator know how long it will be before we will be able to look at the detailed books to find out why they made those decisions? I will answer it. It will be 5 years before we will fully know why they made the decisions. Maybe if we knew tomorrow, or next week, or next month why they made the decision, we might want to make some changes around here in the way we operate. They make the decisions, and we will not know the full picture for 5 years why they did it.

Mr. HARKIN. I thank the Senator for yielding. I thank him for bringing us back to this point about the Fed behind closed doors. When they raise the rates, this is really a hidden tax, is it not, I ask the Senator.

Mr. HARKIN. No representation for the American people.