Tom Harkin

Mr. HARKIN

Mr. HARKIN. I thank the Chair. Mr. President, first, I rise on another topic, but I want to say to the Senator from North Dakota that I fully empathize and sympathize with him on his position. The flood about which my colleague from Illinois spoke a few minutes ago is the same flood that devastated Iowa in 1993. This Congress and the President came to the assistance of the people of Iowa in a very rapid measure. To this day, the people of Iowa talk about how rapidly the funds got out there, the Government was there to help. And the same thing should apply to any disaster anywhere. And it should apply in North Dakota also. I want to say to my colleague from North Dakota, he is right on the mark. This legislation ought to get through. The money ought to be sent out without all these other political ramifications. So I appreciate the Senator from North Dakota. Again, his position is the correct one. We ought to get the money through here. And we should not be loading it down with political considerations.

Mr. HARKIN. Mr. President, I understand under a previous order that I have 30 minutes under my control at this time.

Mr. HARKIN

Mr. HARKIN. Mr. President. Today, I am introducing, on behalf of myself, Senators Hutchinson, Reid, Bryan, and Rockefeller, the Social Security Consumer Protection Act. This is a simple, commonsense legislation that will arm consumers with the information they need to protect themselves from a growing type of consumer scam. Several years ago Congress took an important step toward stamping out frauds against older Americans. We passed a law making it illegal for companies to prey upon senior citizens and others by misrepresenting an affiliation with Social Security or Medicare. After some delay, the Social Security inspector general has begun to enforce this important new consumer protection law. However, we are finding that many scam artists are squirming through a loophole in the law that allows them to charge unwitting consumers for services that are available free of charge from Social Security or Medicare. A recent investigation by my staff found that unsuspecting consumers--from new parents to senior citizens--are falling prey to con artists charging them for services that are available free of charge from the Social Security Administration. Many of the schemes involve use of materials and names which mislead consumers into believing that the scam artists are affiliated with the federal government. Companies operating under official sounding names like Federal Document Services, Federal Record Service Corp., National Records Service, and U.S. Document Services are mailing information to thousands of unsuspecting Americans, including many Iowans. These companies are scaring people into remitting a fee to receive basic Social Security benefits and eligibility information such as a new Social Security number and card for a baby and changing names upon marriage or divorce. We began to look into this problem based on a number of complaints from Iowans who had received these deceptive mailings. One example was sent to me by Deb Conlee of Fort Dodge. She received a mailing from a company called Document Service. The official looking letter starts: ``Read Carefully: Important Facts about your Social Security Card. The response envelope is stamped ``SSA-7701'' giving the impression that it is connected with the Social Security Administration. The solicitation goes on to say that she is required to provide Social Security with any name change associated with her recent marriage and get a new Social Security card. It then urges her to send them $14.75 to do this. It says, ``We urge you to do this immediately to help avoid possible problems where your Social Security benefits or joint income taxes might be questioned.'' Ms. Conlee paid $60 to this company and was furious when she learned that she could have gotten the same services free of charge from Social Security. Last year I asked Social Security Commissioner Shirley Chater to investigate the complaints of Iowans and those of consumers like her. She responded that the services provided by Document Service ``are completely unnecessary. Not only do they fail to produce any savings of time or effort for the customer, they also tend to delay issuance of the new Social Security card.'' While it is now illegal for a company to imply any direct connection with Social Security or Medicare in mailings, it is not illegal to charge for the very same services that are available at no cost from the government. So while Congress has acted to try and stop scam artists from trying to fool people into thinking their business is somehow affiliated with Social Security, Medicare, or some other government agency, many are skirting around the edges of this law and are conning consumers into paying for services that they can get free of charge. Nowhere in any of the mailings from these outfits that I have reviewed is there any mention that the services they offer are in fact available to consumers at no cost from the government. The Social Security Consumer Protection Act would require that any such solicitation prominently display the following consumer alert: ``IMPORTANT PUBLIC DISCLOSURE: The product or service described here and assistance to obtain the product or service is available free of charge from the Social Security Administration or the Department of Health and Human Services.'' Armed with this information, consumers would be able to make informed decisions about where to obtain the service they need or want. Companies found to be in violation of this simple requirement would face fines. Our legislation would not stop the provision of services by private companies. Rather, it would simply make sure that consumers are fully informed, so that they can make an informed choice about where and how they prefer to receive certain services. These scams must be put to an end. A simple change in the law would go a long way toward stopping them. The bill we are introducing today would make such a change without imposing an undue burden on legitimate businesses or restricting consumer freedom of choice. Mr. President, this legislation has been endorsed by the National Committee to Preserve Social Security and Medicare. The National Committee is an effective and aggressive advocate of the rights of older Americans. I am pleased to have their endorsement and ask unanimous consent to include a copy of their letter of support be printed in the Record. I urge my colleagues to review this bill and to work with us to ensure its prompt approval.

Mr. HARKIN

Mr. HARKIN. Mr. President. Today, I am introducing, on behalf of myself, Senators Hutchinson, Reid, Bryan, and Rockefeller, the Social Security Consumer Protection Act. This is a simple, commonsense legislation that will arm consumers with the information they need to protect themselves from a growing type of consumer scam. Several years ago Congress took an important step toward stamping out frauds against older Americans. We passed a law making it illegal for companies to prey upon senior citizens and others by misrepresenting an affiliation with Social Security or Medicare. After some delay, the Social Security inspector general has begun to enforce this important new consumer protection law. However, we are finding that many scam artists are squirming through a loophole in the law that allows them to charge unwitting consumers for services that are available free of charge from Social Security or Medicare. A recent investigation by my staff found that unsuspecting consumers--from new parents to senior citizens--are falling prey to con artists charging them for services that are available free of charge from the Social Security Administration. Many of the schemes involve use of materials and names which mislead consumers into believing that the scam artists are affiliated with the federal government. Companies operating under official sounding names like Federal Document Services, Federal Record Service Corp., National Records Service, and U.S. Document Services are mailing information to thousands of unsuspecting Americans, including many Iowans. These companies are scaring people into remitting a fee to receive basic Social Security benefits and eligibility information such as a new Social Security number and card for a baby and changing names upon marriage or divorce. We began to look into this problem based on a number of complaints from Iowans who had received these deceptive mailings. One example was sent to me by Deb Conlee of Fort Dodge. She received a mailing from a company called Document Service. The official looking letter starts: ``Read Carefully: Important Facts about your Social Security Card. The response envelope is stamped ``SSA-7701'' giving the impression that it is connected with the Social Security Administration. The solicitation goes on to say that she is required to provide Social Security with any name change associated with her recent marriage and get a new Social Security card. It then urges her to send them $14.75 to do this. It says, ``We urge you to do this immediately to help avoid possible problems where your Social Security benefits or joint income taxes might be questioned.'' Ms. Conlee paid $60 to this company and was furious when she learned that she could have gotten the same services free of charge from Social Security. Last year I asked Social Security Commissioner Shirley Chater to investigate the complaints of Iowans and those of consumers like her. She responded that the services provided by Document Service ``are completely unnecessary. Not only do they fail to produce any savings of time or effort for the customer, they also tend to delay issuance of the new Social Security card.'' While it is now illegal for a company to imply any direct connection with Social Security or Medicare in mailings, it is not illegal to charge for the very same services that are available at no cost from the government. So while Congress has acted to try and stop scam artists from trying to fool people into thinking their business is somehow affiliated with Social Security, Medicare, or some other government agency, many are skirting around the edges of this law and are conning consumers into paying for services that they can get free of charge. Nowhere in any of the mailings from these outfits that I have reviewed is there any mention that the services they offer are in fact available to consumers at no cost from the government. The Social Security Consumer Protection Act would require that any such solicitation prominently display the following consumer alert: ``IMPORTANT PUBLIC DISCLOSURE: The product or service described here and assistance to obtain the product or service is available free of charge from the Social Security Administration or the Department of Health and Human Services.'' Armed with this information, consumers would be able to make informed decisions about where to obtain the service they need or want. Companies found to be in violation of this simple requirement would face fines. Our legislation would not stop the provision of services by private companies. Rather, it would simply make sure that consumers are fully informed, so that they can make an informed choice about where and how they prefer to receive certain services. These scams must be put to an end. A simple change in the law would go a long way toward stopping them. The bill we are introducing today would make such a change without imposing an undue burden on legitimate businesses or restricting consumer freedom of choice. Mr. President, this legislation has been endorsed by the National Committee to Preserve Social Security and Medicare. The National Committee is an effective and aggressive advocate of the rights of older Americans. I am pleased to have their endorsement and ask unanimous consent to include a copy of their letter of support be printed in the Record. I urge my colleagues to review this bill and to work with us to ensure its prompt approval.

Mr. HARKIN

Mr. HARKIN. I thank the Chair. I thank my colleague from Rhode Island again for continuing to be involved in this discussion, for his leadership in the House and now in the Senate on the total issue of arms control and especially on the issue of the test ban treaty. Mr. President, let me continue for a little bit to talk some more about the aspects of this treaty and why it is so important that we ratify it this year. Again, to recap, 34 years ago today, on June 10, 1963, President Kennedy made a historic speech at American University here in Washington, DC. He talked about the need for a test ban treaty to limit the number of nuclear weapons tests. Four months after that, President Kennedy negotiated with the Soviet Union, signed and secured ratification from the United States Senate for the limited test ban treaty that banned all atmospheric tests of nuclear weapons. So, since October 1963, the two nations have had no atmospheric tests of nuclear weapons. But President Kennedy's goal was not just atmospheric tests. His goal was to ban all nuclear weapons tests. As President Kennedy said on June 10, a comprehensive test ban treaty ``would check the spiraling arms race in one of its most dangerous areas. It would place the nuclear powers in a position to deal more effectively with one of the greatest hazards * * * the further spread of nuclear arms. It would increase our security; it would decrease the prospects of war.'' That is a quote from President Kennedy's speech at American University 34 years ago. Mr. President, completion of a global nuclear test ban treaty negotiations has been a central nuclear arms control objective for more than 40 years. This long-awaited goal was finally won just last September, September 24, 1996, when the United States and other countries signed the Comprehensive Test Ban Treaty, the CTBT as it is called, a treaty consistently supported by more than 80 percent of the American public. Now, we in the Senate must ensure that the Comprehensive Test Ban Treaty is ratified here in the Senate and by 43 other nuclear-capable countries so that it formally enters into force. The Comprehensive Test Ban Treaty is a major milestone in the effort to prevent the proliferation of nuclear weapons. It would establish a permanent ban on all nuclear explosions in all environments for any purpose. It's zero-yield prohibition on nuclear tests would help to halt the development and deployment of new nuclear weapons. The treaty would also establish a far-reaching verification program that includes a global network of sophisticated seismic, hydro-acoustic, radionuclide monitoring stations, as well as on-site inspection of test sites to deter and detect violations. I might just add here, Mr. President, one of the important reasons for getting this treaty ratified as soon as possible is that under this regime, newly emerging nations that may be wanting to develop a nuclear weapon will find it thousands of times more difficult to do so. I will not put myself in a position of saying it will be absolutely impossible, nothing is 100 percent perfect, but many of these smaller nations that may want to have a nuclear weapon are going to need a small nuclear weapon. They will need some of the latest technology in order to have it delivered in a vehicle that they have in their possession or that they might soon acquire. To do that would require testing. If they cannot do the testing, then they cannot acquire the latest technology in nuclear weapon design and construction. Mr. President, in 1991, the Soviet Union announced a unilateral nuclear weapons test moratorium. In 1992, the House and Senate passed legislation establishing a 9-month U.S. moratorium with restrictions on the number and purpose of any further U.S. tests and a prohibition on U.S. tests after September 30, 1996, unless another nation conducts a test. In 1993, President Clinton, with advice from the armed services, the nuclear weapons laboratories, and the Energy Department, determined that the U.S. nuclear arsenal was safe and reliable without further testing. On July 3 of that year, he announced he would extend the test moratorium and agree to begin multilateral test ban negotiations in January of 1994. The Comprehensive Test Ban Treaty was negotiated over more than 2 years at the 61-nation Conference on Disarmament in Geneva. A key turning point occurred in 1995, when our Nation's leading nuclear weapons scientific advisors concluded that our nuclear weapons stockpile is safe and reliable and that even low-yield weapons tests are unnecessary, even the so-called safety tests intended to guard against defects that could lead to accidental warhead detonations. Spurred by the independent JASON scientific group's report that the United States nuclear arsenal is safe and reliable without testing, and spurred further by the international outcry when the French resumed nuclear testing after a 3-year hiatus, the United States and France then adopted a zero-yield test ban position in the nuclear weapons test ban talks. So, by August 1996, the negotiations produced a final nuclear weapons test ban treaty text supported by all countries except one, all countries except India, and India sought to include in the treaty a timetable for eliminating all nuclear weapons and, again, India would find its own nuclear weapons development program limited by a ban on testing. So, to overcome one nation's opposition, Australia proposed-- and more than 100 other countries supported--a resolution endorsing the Comprehensive Test Ban Treaty, a zero-yield test ban, which was submitted to the U.N. General Assembly and passed by the overwhelming margin of 158-3 on September 10, 1996. Now, for the Comprehensive Test Ban Treaty to formally enter into force, it must be ratified by 44 named signatory nations, including the five declared nuclear weapons states and the three undeclared nuclear weapons states--India, Israel, and Pakistan. The U.S. ratification requires, of course, a two-thirds vote by the U.S. Senate. However, until the Comprehensive Test Ban Treaty does enter into force, all signatories, including the United States, are bound by article XVIII of the Vienna Convention on Treaties not to undertake any action that violates the purpose or intent of the treaty. In other words, the signatory nations shall not test nuclear weapons. That is sort of the recent history. Now, what is the next step? Well, several key steps must now be taken. Before the Comprehensive Test Ban Treaty can be considered by the Senate Foreign Relations Committee and the full Senate, the Clinton administration must submit the articles of ratification and must reach agreement with the Senate leadership to begin formal consideration of the treaty. The treaty must also become a priority for the administration and for the U.S. Senate. The Foreign Relations Committee of the Senate and the Senate in its whole must then proceed with a thorough examination of the treaty and to vote on it. In the end, I believe the Senate will agree that ratification of the treaty is in our country's national security interests just as President Kennedy said 34 years ago today. The Senator from Illinois mentioned that conservatively we are spending about $30 billion a year now to maintain our nuclear stockpile. I wondered how much we had spent over the intervening years. It turns out that from right after the end of World War II until now, the United States has spent more than $300 billion --that is billion with a ``b''--$300 billion, about a third of a trillion dollars, for nuclear weapons and nuclear weapons materials. That does not include the cost of all the delivery vehicles--that is, all of the missiles, the silos we build, the Minutemans and the Titans--and it does not include the cost of all the B-52 bombers, the B-47 bombers, the B-2 bombers, and the B-1 bombers. It does not include that. It does not include the cost of all the submarines, all the Polaris and later the Trident submarines. That probably would come to hundreds of billions more. I am talking just about nuclear weapons material alone, and the weapons themselves--$300 billion approximately that we have spent, and now about $30 billion a year. As I mentioned earlier, Mr. President, that is 2\1/2\ times what we are spending on all medical research in the National Institutes of Health. We are spending 2\1/2\ times every year to maintain the nuclear stockpile than we are spending on all biomedical research through the National Institutes of Health. That is not right, and that is why it is time to conclude the Comprehensive Test Ban Treaty. President Kennedy said 34 years ago today that the negotiations for a ban on above-ground nuclear tests were in sight, and he implored the Nation and the international community to bring that treaty to a conclusion. As I said, 4 months later, the agreement was reached and the atmospheric test ban treaty became a reality--in just 4 months at the height of the cold war. The Soviet Union no longer exists. We have relations with Russia, open relations. We visit their military establishments; they visit ours. We now have an agreement where they will be an adviser to NATO. Well, now it is time for us to conclude the Comprehensive Test Ban Treaty. It has been around a long time. Now we are at the point where we can bring it to its final conclusion. President Clinton must adopt the same attitude that President Kennedy adopted in 1963. He must insist on a quick closure, to make it a top priority of his administration to get the Comprehensive Test Ban Treaty ratified by the Senate this year. It is in our best interests. It would help secure our planet from nuclear threats. It would go a long way toward ensuring that newly emerging nations do not get their hands on the nuclear trigger and would begin the process of getting rid of, over a period of time, the nuclear stockpiles that we have and saving all of that money that we are now spending and, hopefully, putting that money into important endevors such as medical research. Well, the end is in sight. We soon can have in hand a comprehensive ban on all nuclear weapons tests. Mr. President, sometimes it boggles the mind to think of how many nuclear tests we have had in the past. Nuclear tests worldwide, underground tests, 1,517, with the United States doing 815, the old Soviet Union doing 496, France doing 160, Britain 24, China 22, and India 1. Atmospheric testing: 528 atmospheric tests prior to 1963, with the United States doing 215, the Soviet Union doing 219, France doing 50, Britain, 21, and China, 23. Total, all tests: 2,046. A sad, sad chapter in the history of humankind; a terrible toll that it has taken not only economically from America and other countries by what we have spent, but I think it has taken a terrible toll environmentally. Much of the money that we spend now through the Department of Energy for our nuclear weapons stockpile is spent on cleaning up the mess that was made, first, through the production of nuclear materials; second, through the refining of these nuclear materials, and the processing; third, through the storage; and, of course, fourth, through the underground testing. So we are spending today, and we will continue to spend in our lifetimes, billions of dollars just to clean up the mess that has been made. There is another mess that has been made that we are paying for dearly. All those atmospheric tests that I mentioned--528 of them--each and every one of those produced in the atmosphere large amounts of plutonium and other toxic materials. I have seen estimates that tons of plutonium were released during all of these tests into the atmosphere, in the food chain, and in sea life. The half-life of plutonium is tens of thousands of years. And, yet, we know it is one of the most carcinogenic materials known to mankind. One microscopic piece of plutonium can cause cancer. Who knows how much plutonium is embedded into the ground and into the soils from the underground tests, how much of that plutonium may find itself to underground aquifers later on in the evolution of our planet? We are paying a terrible price for this sad chapter of our history. We shouldn't pay the price any longer. Now is the time to end testing once and for all and close the books on it. I call upon President Clinton to make this a priority of his administration this year. I call upon the majority leader of the Senate and the minority leader of the Senate to make it a priority for the U.S. Senate this year that we debate and vote on the comprehensive test ban treaty. I call upon the chairman and the vice chair of the Senate Foreign Relations Committee, as soon as the President sends this down, to take it up, to investigate it, to debate it fully, and to vote on it and report it to the floor of the Senate. This must be a priority. We must do it this year. Let's make this 34th anniversary of President Kennedy's speech at American University the last anniversary before we have a completion of what he called a ban on all nuclear testing.

Mr. HARKIN. I thank my colleague from Illinois for his very eloquent remarks and for reminding us of just how much we are spending. Even yet today, to maintain this nuclear stockpile, the United States spends roughly $30 billion a year. That is just about three times the amount that we are spending on all medical research at the National Institutes of Health, to find the causes and cures of things like heart disease, cancer, and Alzheimer's, diabetes, Parkinson's disease. Three times what we are spending on this arsenal than all medical research. We are trying to come up with money for NIH. We had a sense-of-the-Senate resolution last week--98 to 0--to support a doubling of funding for NIH. That would bring it up to about $25 billion a year, not even up to this level. Yet we do not have the money to even get about a 4 or 5 percent increase at NIH. I thank the Senator from Illinois for his eloquent comments. I want to also yield to the Senator from Rhode Island for his comments on this topic and thank him for being involved in this discussion on the floor of the Senate. This is an important anniversary. It must be noted. And we must mark it as hopefully the last anniversary in this long journey to get a Comprehensive Test Ban Treaty. I just say to my friend from Rhode Island and my friend from Illinois, that President Kennedy during that famous speech, 34 years ago today, at American University, called for an end to nuclear testing, and then proceeded to negotiate with the then-Soviet Union and others for a ban on atmospheric testing. Four months later this Senate ratified a ban on all atmospheric testing--4 months. And then here we have been 34 years to get to a comprehensive test ban. So if they could do that in 4 months, I would think now, certainly before the end of this year, we could bring this to a closure. I yield to my friend and my colleague from Rhode Island.

Mr. HARKIN. Mr. President, I take the floor today with a couple of my colleagues to note a very important anniversary. Mr. President, 34 years ago today, on June 10, 1963, President John F. Kennedy delivered a historic address at American University here in Washington, DC, regarding the need for the vigorous pursuit of peace. He declared that the United States has a critical interest in limiting the testing of nuclear weapons. We wanted to mark that occasion today by talking about the need to continue that progress and to bring to completion President Kennedy's dream and goal of the Comprehensive Test Ban Treaty. I yield at this time to my colleague from Illinois for his unanimous- consent request and for any comments he wants to make. I reserve the balance of my time.

Mr. HARKIN. I thank my colleague. Mr. President, how much time do I have?

Mr. HARKIN

Mr. HARKIN. Mr. President, I rise today to introduce the Rural Health Care Protection and Improvement Act of 1997. This legislation is critical to the survival of the fragile health care systems and infrastructure in rural areas and small towns across America. Rural Americans are more often poor, more often uninsured, and more often without access to health care than other Americans. The health care system in many small towns in Iowa is on the critical list--we have too few doctors, nurses, and other health care professionals and many of our rural hospitals are barely making it. Iowa ranks first in the percentage of citizens over age 85 and third nationally in the percentage of the population over age 65. Because of our demographics our health care providers in Iowa depend heavily on Medicare payments. And many of them are struggling. One reason they are struggling is because of the gross inequities between rural and urban Medicare payment rates. In fact, the House Ways and Means Committee recently published a report estimating that Iowa loses $0.7 billion a year because of current Medicare payment policies. The higher cost of living in areas such as New York City and Miami in no way justifies the huge disparity in payment rates. The current system rewards waste and inefficiency and penalizes States like Iowa whose health care providers practice a conservative, cost-effective approach to health care. The legislation I am introducing today would correct this wrong- headed system. This bill would make Medicare payments to managed care plans fairer for rural areas by readjusting the AAPCC so that rates are more equitable between rural and urban areas. But even more importantly, this bill corrects the inequities in the regular fee-for-service Medicare Program. AAPCC rates are unfair because they are tied directly to Medicare fee-for-service payments, and fee-for-service payments are very low in rural areas. Even with a correction in managed care payments, over two-thirds of Iowa seniors will likely continue to receive care under the standard fee-for-service system. This bill corrects fee-for-service rates, so that seniors in rural areas will at last be able to receive the quality and access to health care they deserve. Mr. President, my legislation would also reauthorize and extend the Rural Health Transition Grant Program. This grant program helps small rural hospitals and their communities adapt to the changing health care marketplace. Specifically, the grants help hospitals adjust to reductions in the need for inpatient services and increased demand for outpatient and emergency services and help rural hospitals meet the increasingly difficult task of recruiting staff. Rural hospitals use these funds for a variety of programs. For example, Marengo Memorial Hospital, Mitchell County Hospital, Franklin General in Hampton, and Kossuth County Hospital as well as other hospitals used funds to help develop rural health care networks. Pochahontas Community Hospital and Community Memorial Hospital in Sumner used funds to recruit health professionals and Holy Family Hospital in Estherville used funds to improve emergency services. These grants are provided over 3 years. They represent a small but vital source of revenue for hospitals struggling to adjust to a new health care environment. Unfortunately, these grants were not reauthorized last year, and there are many hospitals that were promised transition grant funds but for whom the money is no longer available. This legislation would help ensure that these few hospitals are able to finish out their grants and meet the changing needs of their patients and communities. Mr. President, the health care system is undergoing tremendous change and our rural hospitals must adjust to this new environment. The Transition Grant Program helps hospitals modify the type and extent of services so they can better serve rural communities. Mr. President, the legislation I am introducing will help improve access and enhance the quality of health care in rural areas. And it will help shore up the fragile health care infrastructure in our rural communities and small towns.

Mr. HARKIN

Mr. HARKIN. Mr. President, I rise today to introduce the Rural Health Care Protection and Improvement Act of 1997. This legislation is critical to the survival of the fragile health care systems and infrastructure in rural areas and small towns across America. Rural Americans are more often poor, more often uninsured, and more often without access to health care than other Americans. The health care system in many small towns in Iowa is on the critical list--we have too few doctors, nurses, and other health care professionals and many of our rural hospitals are barely making it. Iowa ranks first in the percentage of citizens over age 85 and third nationally in the percentage of the population over age 65. Because of our demographics our health care providers in Iowa depend heavily on Medicare payments. And many of them are struggling. One reason they are struggling is because of the gross inequities between rural and urban Medicare payment rates. In fact, the House Ways and Means Committee recently published a report estimating that Iowa loses $0.7 billion a year because of current Medicare payment policies. The higher cost of living in areas such as New York City and Miami in no way justifies the huge disparity in payment rates. The current system rewards waste and inefficiency and penalizes States like Iowa whose health care providers practice a conservative, cost-effective approach to health care. The legislation I am introducing today would correct this wrong- headed system. This bill would make Medicare payments to managed care plans fairer for rural areas by readjusting the AAPCC so that rates are more equitable between rural and urban areas. But even more importantly, this bill corrects the inequities in the regular fee-for-service Medicare Program. AAPCC rates are unfair because they are tied directly to Medicare fee-for-service payments, and fee-for-service payments are very low in rural areas. Even with a correction in managed care payments, over two-thirds of Iowa seniors will likely continue to receive care under the standard fee-for-service system. This bill corrects fee-for-service rates, so that seniors in rural areas will at last be able to receive the quality and access to health care they deserve. Mr. President, my legislation would also reauthorize and extend the Rural Health Transition Grant Program. This grant program helps small rural hospitals and their communities adapt to the changing health care marketplace. Specifically, the grants help hospitals adjust to reductions in the need for inpatient services and increased demand for outpatient and emergency services and help rural hospitals meet the increasingly difficult task of recruiting staff. Rural hospitals use these funds for a variety of programs. For example, Marengo Memorial Hospital, Mitchell County Hospital, Franklin General in Hampton, and Kossuth County Hospital as well as other hospitals used funds to help develop rural health care networks. Pochahontas Community Hospital and Community Memorial Hospital in Sumner used funds to recruit health professionals and Holy Family Hospital in Estherville used funds to improve emergency services. These grants are provided over 3 years. They represent a small but vital source of revenue for hospitals struggling to adjust to a new health care environment. Unfortunately, these grants were not reauthorized last year, and there are many hospitals that were promised transition grant funds but for whom the money is no longer available. This legislation would help ensure that these few hospitals are able to finish out their grants and meet the changing needs of their patients and communities. Mr. President, the health care system is undergoing tremendous change and our rural hospitals must adjust to this new environment. The Transition Grant Program helps hospitals modify the type and extent of services so they can better serve rural communities. Mr. President, the legislation I am introducing will help improve access and enhance the quality of health care in rural areas. And it will help shore up the fragile health care infrastructure in our rural communities and small towns.

Mr. HARKIN

Mr. HARKIN. Mr. President, today I am pleased to be joined by my distinguished colleague from Rhode Island, Senator Reed, in introducing an important women's health initiative. The DES Research and Education Amendments of 1997 would extend and expand our effort to assist the over 5 million Americans who have been exposed to the drug, DES. Representative Louise Slaughter, a long-time leader on this issue, is introducing companion legislation today in the other body. Between 1938 and 1971, some 5 million American women were given the synthetic drug, diethylstilbestrol, commonly known as DES. Women were given the drug during pregnancy in the mistaken belief it would help prevent miscarriage. The drug was pulled from the market based on studies that found that it was ineffective and might result in damage to children born to the women who had been given it. Since the 1970's, studies have shown that DES does damage the reproductive systems of those exposed in utero and increases these individuals' risk for cancer, infertility, and a wide range of other serious reproductive tract disorders. The women exposed in utero to DES are five times more likely to have an ectopic pregnancy and three times more likely to miscarry when they in turn try to have children. Studies also show that one of every thousand women exposed to DES in utero will develop clear cell cancer. Women who took DES have also been found to face a higher risk for breast cancer. In 1992, while there had been a number of research studies on DES exposure and its effects, much more research was necessary. That year, President Bush signed legislation introduced by myself and Representative Slaughter, that mandated a significant increase in DES research supported by the National Institutes of Health [NIH]. Our legislation also required NIH to support long-term studies of Americans impacted by this drug. Those studies are now underway and must be continued. The legislation we are introducing today will ensure that this critical medical research continues. In addition, there is now preliminary evidence that the grandkids of women who took DES may also be at higher risk for certain health problems, and this legislation would help ensure that further research into this is supported. Another major problem in this area is that millions of Americans don't know the risks they face because of their exposure to DES. Many health professionals who see these people also lack sufficient information about DES exposure and the appropriate steps that should be taken to identify and assist their patients. As a result, many people do not seek or get the appropriate preventive care or take appropriate preventive measures to reduce their risks of adverse affects. For example, women exposed to DES in utero and therefore at higher risk of miscarriage may be able to reduce their risks with appropriate precautionary steps. In an initial attempt to address this need for better information, our 1992 legislation required NIH to test ways to educate the public and health professionals about how to deal with DES exposure. The legislation we are introducing today would give people across the Nation access to the information developed through these pilot programs by requiring a national consumer and health professional education effort. Mr. President, we took a very important step in 1992 to begin to address the significant problem presented by DES exposure. And we did it with strong bipartisan cooperation between a Democratic Congress and a Republican President. That legislation expires this year. We need to make sure that the progress we've made is continued. The 5 million Americans whose health is at risk are depending on us to work together to make sure that happens. I urge my colleagues to join me in support of that effort. I ask unanimous consent that a copy of the legislation be included in the Record.

Mr. HARKIN

Mr. HARKIN. Mr. President, today I am pleased to be joined by my distinguished colleague from Rhode Island, Senator Reed, in introducing an important women's health initiative. The DES Research and Education Amendments of 1997 would extend and expand our effort to assist the over 5 million Americans who have been exposed to the drug, DES. Representative Louise Slaughter, a long-time leader on this issue, is introducing companion legislation today in the other body. Between 1938 and 1971, some 5 million American women were given the synthetic drug, diethylstilbestrol, commonly known as DES. Women were given the drug during pregnancy in the mistaken belief it would help prevent miscarriage. The drug was pulled from the market based on studies that found that it was ineffective and might result in damage to children born to the women who had been given it. Since the 1970's, studies have shown that DES does damage the reproductive systems of those exposed in utero and increases these individuals' risk for cancer, infertility, and a wide range of other serious reproductive tract disorders. The women exposed in utero to DES are five times more likely to have an ectopic pregnancy and three times more likely to miscarry when they in turn try to have children. Studies also show that one of every thousand women exposed to DES in utero will develop clear cell cancer. Women who took DES have also been found to face a higher risk for breast cancer. In 1992, while there had been a number of research studies on DES exposure and its effects, much more research was necessary. That year, President Bush signed legislation introduced by myself and Representative Slaughter, that mandated a significant increase in DES research supported by the National Institutes of Health [NIH]. Our legislation also required NIH to support long-term studies of Americans impacted by this drug. Those studies are now underway and must be continued. The legislation we are introducing today will ensure that this critical medical research continues. In addition, there is now preliminary evidence that the grandkids of women who took DES may also be at higher risk for certain health problems, and this legislation would help ensure that further research into this is supported. Another major problem in this area is that millions of Americans don't know the risks they face because of their exposure to DES. Many health professionals who see these people also lack sufficient information about DES exposure and the appropriate steps that should be taken to identify and assist their patients. As a result, many people do not seek or get the appropriate preventive care or take appropriate preventive measures to reduce their risks of adverse affects. For example, women exposed to DES in utero and therefore at higher risk of miscarriage may be able to reduce their risks with appropriate precautionary steps. In an initial attempt to address this need for better information, our 1992 legislation required NIH to test ways to educate the public and health professionals about how to deal with DES exposure. The legislation we are introducing today would give people across the Nation access to the information developed through these pilot programs by requiring a national consumer and health professional education effort. Mr. President, we took a very important step in 1992 to begin to address the significant problem presented by DES exposure. And we did it with strong bipartisan cooperation between a Democratic Congress and a Republican President. That legislation expires this year. We need to make sure that the progress we've made is continued. The 5 million Americans whose health is at risk are depending on us to work together to make sure that happens. I urge my colleagues to join me in support of that effort. I ask unanimous consent that a copy of the legislation be included in the Record.

Mr. HARKIN

Mr. HARKIN. Mr. President, I associate myself with the remarks of the chairman of the Agriculture Committee.

Mr. HARKIN

Mr. HARKIN. Mr. President, it is a privilege for me to speak today in behalf of Robert Pratt, to serve on the U.S. District Court for the Southern District of Iowa. I have known Bob and his wonderful family for almost 25 years. I met him when we were both fresh out of law school. We landed jobs at the Polk County Legal Aid Society. And it was this experience that made a permanent impression on me. Since that time, Bob has dedicated his life to using the law to improve people's lives, their communities and their future. He is currently in private practice in Des Moines and continues to devote his practice to the legal needs of lower income and economically disadvantaged Iowans. Bob Pratt is, quite simply, one of the best public interest lawyers in the country. And his respect for the rule of the law and his faith in our country's system of justice is truly inspiring. I believe that Bob possesses all of the qualifications necessary to assume the very serious responsibilities carried out by any Federal judge. He has the temperament, the intellectual rigor, the compassion, and the ability to be fair and impartial. I am also proud to say that Bob enjoys bipartisan support from the Iowa legal community. Robert Downer, former President of the Iowa State Bar Association, and a Republican, states: ``It has been my privilege to be acquainted with Mr. Pratt for some time, and I regard him very highly both personally and professionally. With the heavy caseload in the Southern District of Iowa it will be of great benefit to litigants in that court if he can be confirmed without delay.'' Mr. President, I am proud to continue Iowa's fine tradition of judicial selection based upon merit. I believe Bob Pratt reflects very proudly on all of us who have chosen to be public servants. And I have no doubt that he will make an excellent U.S. District judge for the Southern District of Iowa. statements on the nomination

Mr. HARKIN

Mr. HARKIN. In 1 year?

Mr. HARKIN. Sure.

Mr. HARKIN. I will try not to take more than a minute. The Senator from Texas said, if I heard him correctly, that we can double in 1 year the funding for NIH if we would just set our priorities straight.

Mr. HARKIN. I ask if the Senator from Texas would amend his statement in the Record and provide us with a table. If the Senator from Texas says we can quadruple spending for NIH, please tell us how. Please put in the Record for all to see what the Senator from Texas would like to cut in order to increase that kind of funding for NIH. If he does not, well, then the words are just words; they do not mean anything. So I challenge the Senator from Texas to back up his words with examples of where we are going to get the money to quadruple in 1 year funding for NIH. Lastly, let me just say, again for the record, there has been some talk we put the money there, but we don't know where it is going to go. We offer the amendment as chairman and ranking member of the subcommittee as cosponsors. We have the votes on his side and our side to make sure that is where the money goes, to NIH. There should be no doubt in anyone's mind that that is where this money is going to go. I thank the chairman for taking the lead on this.

Mr. HARKIN. I thought it was double. We are spending about $13 billion a year at NIH.

Mr. HARKIN. May I have 10 minutes?

Mr. HARKIN. Mr. President, I am pleased to join my colleague, the chairman, Senator Specter, to support this important amendment. Yesterday the Senate went on record in support of doubling research at NIH with the adoption of the Mack sense-of-the-Senate amendment, a unanimous vote last time. This amendment that Senator Spector is offering is a modest first step toward making good on that commitment. Senator Specter said the amendment would add $1.1 billion to the health account to restore, first of all, the $100 million cut contained in the resolution and additional moneys to enable our subcommittee to provide adequate funding for NIH and other health programs. Without our amendment, it will be virtually impossible to provide even an inflation adjustment for medical research in the year 1998. Mr. President, the resolution before us, despite the other merits, is, to put it kindly, extremely shortsighted when it comes to support for finding cures and more cost-effective treatment and prevention for the many diseases and disabilities that affect us. In so doing, it shortchanges our future, shortchanges Americans' health, and shortchanges efforts to control health care costs and keep Medicare solvent in the long run. At the same time we are shortchanging basic investments in health care, the Pentagon gets another multibillion- dollar increase. Here is a chart right here that will show you. Here is the shifting priorities. This is our budget agreement versus last year's spending. Defense gets $3.2 billion more; health gets $100 million cut. Wrong priorities. Another way of looking at it is to see what is happening with our spending on discretionary health funding. The President's budget had $25.3 billion; the 1997 budget was $25 billion; the budget agreement is $24.9 billion. That is where that missing $100 million is. We are going in the wrong direction in spending for basic research in this country. Let me just give a couple of examples to show the folly of what we are doing. Last year, the federally supported research on Alzheimer's disease totaled about $300 million. Yet it is estimated that we spend about $90 billion annually caring for people with Alzheimer's. In other words, for every $100 we spend caring for people with Alzheimer's we are spending about 3 pennies on research for Alzheimer's. Supported research on diabetes is about $290 million a year, yet it is estimated we spend over $25 billion on diabetes care. Mental health, research is about $613 million a year, estimated $130 billion a year spent annually on mental health care. So, these penny-wise and pound-foolish statistics are even more illogical today. We are at a time of great promise. Just about every day we read about new discoveries and new breakthroughs, new therapies and new treatment strategies. We are making progress. But, while we aren't suffering from a shortfall of ideas, we are suffering from a shortfall of resources. I have often made this analogy, when it comes to medical research. It is like we have 10 doors and they are all closed. We want to find out what is behind those doors. If you look behind one door, the odds are 10 to 1 you are not going to find what you are looking for. Right now, we are funding less than 25 percent of the peer reviewed, accepted grant proposals at NIH. That means we may be looking behind door No. 1, but doors 2, 3, and 4 are still closed. That is the odds. They are not good odds we are going to find the right treatments, strategies, cures, interventions. ``Let's Make A Deal'' had better odds than that. Maybe there is a cure for breast cancer behind door 3, or Alzheimer's behind door No. 4, or Parkinson's behind door No. 2, but we don't know because we aren't committing the resources to unlock those doors. There is another impact that lack of medical research funding has. Young people, maybe looking ahead, thinking about pursuing a career in medical research, yet they see the resources are not there to let them do long-term research. So the doors are locked to the cures but so are the doors to careers. Our lack of investment in research is discouraging people from pursuing careers in medical research. Here is a figure. The number of people under the age of 36 applying for NIH grants dropped by 54 percent between 1985 and 1993. I know there are a lot of factors, but we believe that the lower success rate among all applicants is making biomedical research less and less attractive to young people. This amendment, by Senator Specter, provides a very modest downpayment on what is needed. It begins to put us on the right path, the path that we committed to last night unanimously by adopting the Mack amendment. This amendment today will have a real impact on efforts to support medical research. But let me be clear, even with adoption of this amendment we can't get the job done. The budget resolution before us makes it clear that the only way we can devote the resources we need to help research, to help health research and stop robbing Peter to pay Paul is by going outside of the regular discretionary spending process. This resolution calls for $24.2 billion in discretionary health spending by the year 2002. That includes NIH, CDC, Community Health Centers, Older Americans Act, health professional training, maternal and child health care, and on and on. To double funding for NIH, as this body committed to do last night, would cost over $26 billion by the year 2002. That is $2 billion more than the entire health function is allotted by the year 2002. So even if you eliminated all funding for breast cancer screening, Meals on Wheels for seniors, drug treatment, Older Americans Act, community health centers, and on and on, if you eliminated all of that, this budget resolution would still not enable us to meet the goal that we said last night by a vote of 98 to 0 that we wanted to meet by the year 2002, which is to double NIH funding. The only way we are going to get this is through another mechanism. I believe the best other mechanism is called for in S. 441, National Fund for Health Research Act, that Senator Specter and I introduced. Basically, what this trust fund says is, look, we spend about $650 billion a year in health plans--Blue Cross/Blue Shield, Aetna, HMO's, on and on. All we are asking is that 1 percent, 1 penny out of every dollar that we spend on health care in this country, be remitted to a trust fund, just like a highway trust fund. Every time you buy a gallon of gas, you put money into the highway trust fund. It is like an airline ticket tax; you put money in to keep the airports going. What we are saying is, it is unconscionable that we spend all this money in health care in America and we put nothing from that health care budget into research. The bill Senator Specter and I have introduced, S. 441, will do that. It will take 1 penny out of $1 to put into a research trust fund, because if we do not do it, then all we did last night were just words, so much hot air. Ninety-eight Senators last night said they want to double funding for NIH by the year 2002. Let's put our resources where our mouths are. The first step toward that is adopting the Specter amendment to at least meet the needs next year to make sure that we do not have this $100 million cut in health spending, and to make sure that we have higher-than-inflation-spending resources for the National Institutes of Health. Mr. President, expanding our commitment to research will promote health care, control health costs, create jobs and strengthen our economy and competitive position in the global marketplace. This amendment is an investment in our future. I urge the adoption of the Specter amendment so that we can meet-- start to meet--what we said we were going to do last night when we adopted the Mack resolution. I yield back whatever time I have remaining.

Mr. HARKIN. And the proud cosponsor of your amendment, I might add. How much time do we have?

Mr. HARKIN

Mr. HARKIN. Mr. President, as the Bible says, ``To every thing there is a season, a time to break down and a time to build up.'' The unfortunate truth is that too many of our Nation's schools have broken down. It is long past the time for us to build our schools back up--literally. You have heard my colleague from Illinois cite some of the details-- $112 billion is needed across this country to rebuild, repair and renovate schools. Some 14 million children attend school daily in facilities that are unsafe and inadequate. To put this in some perspective, this is almost five times the population of the entire State of Iowa. This as a national problem and needs a national response. A Federal program to assist needy communities in rebuilding schools will not and should not circumvent the primary local and State control of education. However, I firmly believe the Federal Government needs to become a better partner for States and local communities with respect to education, in general, and construction of school facilities, in particular. Senator Mosely-Braun has done a good job talking about the need nationally. I want to take a few moments to talk about the state of school facilities in my State. Iowans take great pride in education. Our State has a long tradition of placing a high value on education. In fact, Iowa students often lead the Nation in performance on national and even international assessments. This is a tribute to the teachers, families, school boards, administrators, and State policymakers who have made education a top priority for decades. I applaud the commitment that Iowa has made to education. However, we still have much to do. The General Accounting Office report found that 79 percent of Iowa schools report a need to repair or upgrade buildings to bring them up to overall good condition. Like many of my colleagues, I frequently visit schools in my State. I am often struck by the fact that many schools have not changed much since I was a student. We won't talk about how long ago that was. However, our homes, offices, shopping centers, cars and just about every thing else has changed radically. However, reinvestment and renovations have not been made to our Nation's schools. As a result, we are trying to prepare our children for the 21st century in facilities that hardly make the grade in the last one. We can certainly do better than that. In 1994, Senator Mosely-Braun secured legislation to authorize funding for school infrastructure. At that time, I served as chairman of the education appropriations subcommittee and provided $100 million for new school infrastructure. I was very disappointed when that modest downpayment was rescinded the following year. A problem that was a critical need then, has gotten even worse. In 1995, Iowa State University conducted a comprehensive survey about the condition of school buildings in the state and estimated that $3.4 billion is needed to repair and rebuild these facilities. This survey was updated a few months ago and the tab has risen to $4 billion. This is a problem that gets worse by the day and the impact on high quality learning is significant. It is long past time for the Federal Government to step up to the plate and help remedy this problem. The amendment I am offering with the Senator from Illinois is a very important response to this urgent national concern. We believe that children in a nation as rich as ours should not have to attend schools that look more like they belong in the third world. We implore our colleagues to help us provide a modest sum to rebuild our crumbling schools. Mr. President, I am fully aware that many of my colleagues will say that this problem is just too big for the Federal Government to handle. Our critics will point out that the need is enormous--$112 billion and we are proposing a $5 billion solution. However, this plan will generate $20 billion in newschool construction. To provide this additional funding we simply call for closing additional tax loopholes. Our amendment continues to build on the positive aspects of this budget. The underlying legislation increases funding for activities related to education and training by 13 percent over the next 5 years by calling for expanded access to Head Start and increased funding for Pell grants. In addition, the budget makes changes to the Tax Code to help Americans pay for college by providing tuition tax credits and deductions for postsecondary education. These investments are vital to the future of the United States and our ability to remain competitive in the international marketplace. The problems facing school facilities across our Nation are enormous and will not be solved overnight. However, as they say, Rome wasn't built in a day. Further, if we had that attitude in the 1950's we would not have built the Interstate Highway system or put a man on the Moon in 1969. As we know, every journey begins with one step. This is a very important step for us to take. One that will help provide safe, sound learning environments for millions of children. I urge my colleagues to support the amendment.

Mr. HARKIN

Mr. HARKIN. Mr. President, I rise today in strong support of the Lewis and Clark Water System Act of 1997. This legislation will authorize the construction of Lewis and Clark, along with a federal commitment of assistance for construction. Lewis and Clark is designed to be a treated, bulk water delivery system for 22 communities and rural water systems located in northwest Iowa, southeast South Dakota, and southwest Minnesota. Within this tri-state area, over 200,000 persons will be assured of clean and safe drinking water from Lewis and Clark. Lewis and Clark is necessary to address poor water quality sources, inadequate water supplies, population growth, and increasing federal regulations that the member water systems are trying to deal with. In many cases the drinking water currently delivered by Lewis and Clark's membership exceeds secondary drinking water standards for iron, manganese, sulfate, and total dissolved solids. Water of this quality is very difficult and expensive to treat. In Iowa, most of the involved drinking water systems are at, or near, their capacity, and have serious water quality problems. An engineering feasibility study completed by the Bureau of Reclamation in September 1993 concluded the project is technically feasible. However, this project will not be economically viable without federal assistance. Because many rural areas and small communities are involved with the project, the necessary financial resources do not exist to bring Lewis and Clark to completion. Through the Bureau of Reclamation study, each utility member determined that Lewis and Clark was the most feasible and least costly alternative for meeting future drinking water needs. It is estimated that this project will provide quality water at a reasonable cost, an estimated 75 cents per 1,000 gallons. Mr. President, this project represents a unique opportunity to bring safe, clean, and affordable drinking water to hundreds of thousands of persons in a tri-state area. It is not often Congress has the opportunity to assist in a project that has the joint cooperation of persons from three states, and twenty-two communities and local water systems. In an era when we see states and communities fighting for water resources, Lewis and Clark represents a grass-roots effort of concerned citizens, businesses, and government officials. Lastly, I would like to add that this is a project that clearly fits the characteristics of projects traditionally funded by the Bureau of Reclamation. Given its broad support, critical needs, and clear merits, I urge the passage of this important legislation.

Mr. HARKIN

Mr. HARKIN. Mr. President, I rise today in strong support of the Lewis and Clark Water System Act of 1997. This legislation will authorize the construction of Lewis and Clark, along with a federal commitment of assistance for construction. Lewis and Clark is designed to be a treated, bulk water delivery system for 22 communities and rural water systems located in northwest Iowa, southeast South Dakota, and southwest Minnesota. Within this tri-state area, over 200,000 persons will be assured of clean and safe drinking water from Lewis and Clark. Lewis and Clark is necessary to address poor water quality sources, inadequate water supplies, population growth, and increasing federal regulations that the member water systems are trying to deal with. In many cases the drinking water currently delivered by Lewis and Clark's membership exceeds secondary drinking water standards for iron, manganese, sulfate, and total dissolved solids. Water of this quality is very difficult and expensive to treat. In Iowa, most of the involved drinking water systems are at, or near, their capacity, and have serious water quality problems. An engineering feasibility study completed by the Bureau of Reclamation in September 1993 concluded the project is technically feasible. However, this project will not be economically viable without federal assistance. Because many rural areas and small communities are involved with the project, the necessary financial resources do not exist to bring Lewis and Clark to completion. Through the Bureau of Reclamation study, each utility member determined that Lewis and Clark was the most feasible and least costly alternative for meeting future drinking water needs. It is estimated that this project will provide quality water at a reasonable cost, an estimated 75 cents per 1,000 gallons. Mr. President, this project represents a unique opportunity to bring safe, clean, and affordable drinking water to hundreds of thousands of persons in a tri-state area. It is not often Congress has the opportunity to assist in a project that has the joint cooperation of persons from three states, and twenty-two communities and local water systems. In an era when we see states and communities fighting for water resources, Lewis and Clark represents a grass-roots effort of concerned citizens, businesses, and government officials. Lastly, I would like to add that this is a project that clearly fits the characteristics of projects traditionally funded by the Bureau of Reclamation. Given its broad support, critical needs, and clear merits, I urge the passage of this important legislation.