Daniel Inouye

Mr. INOUYE

Mr. INOUYE. Mr. President, today I rise to introduce the Clinical Social Workers' Recognition Act of 1999 to correct an outstanding problem in the Federal Employees Compensation Act. This bill will also provide clinical social workers the recognition they deserve as independent providers of quality mental health care services. Clinical social workers are authorized to independently diagnose and treat mental illnesses through public and private health insurance plans across the Nation. However, Title V, United States Code, does not permit the use of mental health evaluations conducted by clinical social workers for use as evidence in determining workers' compensation claims brought by Federal employees. The bill I am introducing corrects this problem. It is a sad irony that Federal employees may select a clinical social worker through their health plans to provide mental health services, but may not go to this professional for workers' compensation evaluations. The failure to recognize the validity of evaluations provided by clinical social workers unnecessarily limits Federal employees' selection of a provider to conduct the workers' compensation mental health evaluation and may well impose an undue burden on Federal employees where clinical social workers are the only available providers of mental health care. Mr. President, I ask unanimous consent that the text of this bill be printed in the Record.

Mr. INOUYE. Mr. President, I rise today to introduce legislation to enable former prisoners of war who have been separated honorably from their respective services and who have been rated to have at least a 30 percent service-connected disability to have the use of both military commissary and post exchange privileges. While I realize it is impossible to adequately compensate one who has endured long periods of incarceration at the hands of our nation's enemies, I do feel that this gesture is both meaningful and important to those concerned. It also serves as a reminder that our nation has not forgotten their sacrifices. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. INOUYE

Mr. INOUYE. Mr. President, I rise today in support of the Coast Guard Authorization Act. Since 1790 the U.S. Coast Guard and its predecessor services have done a truly outstanding job of protecting America's coasts and maritime interests. Today, the Coast Guard is recognized as the ``Premier Maritime Service in the World'' and a model of efficiency within the federal government. Despite drastic reductions in resources and personnel over the last several years, the result of government downsizing and shrinking budgets, the Coast Guard has admirably maintained a high level of service. The Coast Guard has met the challenges of a growing number of missions while continuously improving performance in its existing mission areas of law enforcement, maritime safety, marine environmental protection, and national security. With personal strength at the lowest level since 1967, and the smallest fleet of aircraft and seagoing cutters since 1989, the men and women of the Coast Guard continue to provide outstanding service to our nation. Since 1992, the number of fisheries boarding conducted by Coast Guard personnel has increased by 62%. Since 1983, the number of undocumented migrants interdicted by the Coast Guard has grown by 635%. Last year, arrests of cocaine traffickers were up 1000%, and cocaine seizures were triple the previous year. Through these incredible interdiction efforts, the Coast Guard kept more than 468 million cocaine ``hits'' and 100 million marijuana ``joints'' off American streets last year. The estimated street value of these seizures is more than $4.2 billion--$1 billion more than the Coast Guard's entire 1997 discretionary budget. The return on investment provided to the American taxpayer by the Coast Guard is not unique to its drug enforcement mission. In the area of Search and Rescue alone, the Coast Guard provided the American public with a 4-to-1 return on investment last year represented by 5,000 lives saved and 65,000 persons assisted. Further, Coast Guard prevention efforts have contributed to a 50% reduction in major oil spills over the past 10 years and a 43% decline in recreational boating deaths since 1970. Mr. President, many in this country have no knowledge of the U.S. Coast Guard. Many do not realize the Coast Guard operates throughout the world and, in addition to its many other missions, is this nation's fifth armed service. Many do not realize that the U.S. Coast Guard participated extensively in the Persian Gulf War and, in fact, still has personnel in the Persian Gulf enforcing the embargo against Iraq, as well as in other ``hot spots'' around the world. Coast Guard cutters, aircraft and personnel routinely deploy throughout the world in support of Coast Guard missions ranging from search and rescue, law enforcement, and environmental protection to ice breaking, port security, and vessel safety. Mr. President, the U.S. Coast Guard is an agency in which the U.S. should invest, not divest. This bill authorizes adequate funding and includes other provisions to allow the Coast Guard to continue to carry out its important work. For these reasons, I urge the passage of this important measure.

Mr. INOUYE

Mr. INOUYE. Mr. President, since taking my oath of office in January of 1963, I have had the high privilege of serving with 323 senators. Among them were some of the giants we read about in history books, Richard Russell of Georgia, Everett Dirksen of Illinois, Mike Mansfield of Montana, and John Stennis of Mississippi. I have served with men and women of great moral strength and high intellect, but, of the 323 senators, I shall always look upon one person as my ``best friend''--Senator Wendell Ford. How does one become a best friend of a stranger? I had some knowledge of Wendell before he was elected, because I was then a member of the Senate Campaign Committee and serving as the Secretary of the Democratic Caucus. I knew that he was a former State Senator, Lieutenant Governor, and the 49th Governor of the Commonwealth of Kentucky before he was elected to the Senate. I also knew that he was one of the most popular Presidents of the U.S. Junior Chamber of Commerce. When I first met Wendell in early 1974, I immediately liked what I saw. I could see that he was ``truth in packaging'' personified. There were no fancy frills, or bells, or ribbons around him. He was down to earth. He obviously loved his constituents and without question, understood them. Immediately, I concluded that he was a ``man of the people.'' Soon, I found myself serving with him on two important Committees--the Senate Committee on Commerce, Science, and Transportation and the Committee on Rules and Administration. Whenever he stood and raised his voice to defend, advocate, oppose, or support a measure, you knew that it related to people. Therefore, I was not surprised when he became the prime mover of the National Voter Registration Act which would ensure that every American who was of age, qualified and wanted to vote was given the opportunity to do so. He took away all of the obstacles that stood in their path. He also made certain that when a worker's spouse was ill at home, he or she was given the right to be with their loved ones in their time of great need. He knew what it was to be a husband and a father. And he knew what it meant to comfort wives and children in time of need. When Wendell became the Chairman of the Aviation Subcommittee, first and foremost on his agenda was passenger safety. He was always ready to carry the banner for the working man and woman. And during the recent tobacco legislation debates, Wendell's voice was one of the very few that spoke out for the tobacco farmer. His concern was not for the wealthy Chief Executive Officers. His concern was for the poor farmer who had to struggle, day in and day out, to eke out a livelihood. Wendell also spoke out for the miners who worked in the deep coal mines, and for those who had been discriminated against in employment because of their age. He was a ``work horse,'' never a ``show horse.'' When others would give eloquent speeches on cutting the cost of government, he did something about it. He led the movement to adopt a two-year budget, thereby saving millions of dollars by streamlining our budgetary process. He introduced the measure that is responsible now for using recycled printing paper by the federal government, thus saving millions of dollars. After all, the paperwork of the federal government today, with all the technological advances, still uses more than 480,000 tons of paper annually. However, before Wendell Ford got into the act, it was nearly double that amount. As a politician, he wanted to make certian that campains were carried out without corruption and without impediments. He streamlined voter registration procedures, and did everything to increase voter participation in federal elections. Wendell Ford's departure from the Senate will leave a huge void in the committee rooms and in the Senate Chamber. It is difficult for me to imagine that next year we will not hear his voice rising to defend the working man and woman. We will not hear his voice to insist upon safety for our traveling public. And we will not hear his voice for good and clean government. I hope that the people of Kentucky will someday come to the realization that they and the people of this nation were blessed with the service of Wendell Ford. Winston Churchill just prior to his retirement from active government service said, ``Service to the community is the rent we pay for living on this earth.'' Wendell Ford has been paying his rent throughout his life. It will be difficult for me to say goodbye to my good friend. It will be difficult no matter how good a person his successor may be, to fill his ``huge boots.'' But most importantly, I agree with my wife, Maggie, that what makes Wendell a good husband, a good father, and decent human being is the fact that he had the good sense to marry his beloved Jean. Without Jean, Kentucky and our nation would have been denied the great service of Wendell H. Ford. Wendell and Jean, you have my best wishes for continued happiness and fulfillment in the bright years ahead. We shall miss you immensely.

Mr. INOUYE

Mr. INOUYE. Mr. President, I rise today to bring my colleagues' attention to a very exciting expedition. Last month, Mr. Michael ``Mick'' Bird completed the second leg of an unprecedented 24,000 mile voyage around the world. On August 19, 1997, Mick Bird started rowing out to sea from Fort Bragg, California in his vessel Reach. After 66 days of rowing, on October 23, 1997, Mick arrived in Hilo Bay on the Big Island of Hawaii. After putting the Reach in drydock in Hawaii, Mick returned to his home base in California to raise support and prepare for the next leg of his historic journey. Mick returned to Hawaii this Summer and put to sea in Reach on July 18, 1998 rowing for the Gilbert Islands, about 2,500 miles southwest of Hawaii and the halfway point between Hawaii and Australia. On September 22, 1998, 66 days and more than 2,200 miles from Hawaii, Mick made land fall on Majuro in the Marshall Islands, a bit north of his intended destination in the Gilberts. Mick is now happily home in California with his family preparing for his next leg to the north central coast of Australia; another 2,500 mile row. Mick Bird, a former U.S. Air Force officer, is of Pacific Island descent and has family ties to the State of Hawaii. His voyage is more formally known as Trans-Oceanic, which is the name of the non-profit organization sponsoring this attempt at the world's first solo circumnavigation of the globe by a rowing vessel. The goals of this expedition are, among others, to explore the limits of the human spirit, to raise awareness about ocean ecosystems, to be an example of individual achievement as well as teamwork, and to generate support for The National Tuberous Sclerosis Association. The expedition is also using its World Wide Web sites (www.naau.com and www.goals.com/ transrow) to create a direct link between Mick's vessel Reach and educators and students to share experiences and practical applications of math, science and geography. I would like to congratulate Mr. Bird on his very impressive accomplishments to this point, and to express my good wishes for the safety and success of the rest of this voyage around the world. I also wish to commend him and Trans-Oceanic for enhancing public awareness and education. I encourage my colleagues to have a look at Trans- Oceanic's web sites and share them with educators at home to follow along with this amazing journey.

Mr. INOUYE

Mr. INOUYE. Mr. President. I would like to add my expression of support in this area to that articulated by the junior Senator from Alaska. I was pleased to work with my colleagues in the conference committee to shape this important provision. I look forward to reviewing this report from the Department of Defense early next year. I, too, believe that it is particularly important to focus on the qualitative balance now in 1998 as compared to that which existed in 1979, when Congress enacted the Taiwan Relations Act, with its Section 3 provisions regarding continued military sales to the Republic of China on Taiwan.

Mr. INOUYE. Mr. President, I, too, would like to thank the Senator from Massachusetts for his remarks. I have also supported funding for photonics research in the past. In the future, most of our weapons systems will depend on photonics for their effectiveness. If we are to maintain our competitive advantage, we must maintain an advantage in photonics research. I would also agree with the Senator from Alaska and his explanation of our Committee's legislative intent in providing additional funding for the Photonics Research Center.

Mr. INOUYE. I yield back the remainder of my time.

Mr. INOUYE. Mr. President, I rise to speak in strong support of this conference agreement. Chairman Stevens has once again done an extraordinary job in moving this bill forward while protecting the interests of the Senate, and supporting our Nation's defense. Quite often when we talk about defense we highlight the investment items such as tanks and missiles and ships and fighting aircraft. Mr. President, while these are all important, and in fact critical to ensuring a strong defense, whenever you meet commanders in the field, each one will tell you that the most important element of our defense is the men and women who are willing to serve us. There are 1,396,000 men and women in the Active Forces and another 877,000 in our National Guard and Reserve. This represents less than 1 percent of our population. And they are the ones who are willing to sacrifice everything to stand in harm's way to defend all the rest of us. Mr. President, we should be very grateful for their willingness to serve and, most important, we should demonstrate our gratitude by ensuring that they receive adequate compensation, good housing and quality medical care. In this bill, we have made some progress on each of these fronts. First, the bill provides for a 3.6 percent pay raise, one-half percent higher than requested by the administration. Second, the conferees have added $505 million to cover real property maintenance needs for barracks and housing for our military personnel and their families. Third, the bill has added $500 million for supporting our bases to make sure that there is enough money to adequately operate the bases. Finally, we have fully funded the Defense Health Program. Mr. President, many of us have a real concern that our military no longer believes that we are doing enough to respond to their needs. Last May, our chairman led a delegation to the Persian Gulf. It was very clear from the men and women with whom we spoke that there is growing dissatisfaction in our military with their working and living conditions, and pay. We have tried to address these within the funding constraints that we face, but we believe more needs to be done. We know we do not have all the answers on the best approach to fix this problem. Therefore, the conferees have directed the Defense Department to review all aspects of its compensation package, from recruiting incentives to retirement, including all quality of life programs. It is the intent of the managers that the Defense Department conduct this review in the next 3 months and provide the Congress with its recommendations in conjunction with its budget submission for fiscal year 2000. Mr. President, this is a good package. The bill provides more money in title II for operation and maintenance than was requested by the President. It does a great deal to help our men and women in uniform, not as much as we would like, but more than DOD requested. Considering the tough financial climate that we are living in, I must commend our chairman for forging this agreement and thank his staff too for their great assistance. Mr. President, this is a good package, I recommend it to all of my colleagues. Mr. President, I understand there is some concern regarding section 8115 in this conference report. It was my understanding that the provision regarded the deployment of additional ground troops to Yugoslavia, Albania, and Macedonia. We hope that those responsible for interpreting this legislation will understand this when they respond to this provision. Mr. President, before I close, may I add my commendation to the extraordinary work of our staff, led by Steve Cortese and Charlie Houy.

Mr. INOUYE

Mr. INOUYE. Mr. President, I rise today to pay tribute to the late Mrs. Minal Kumar, who throughout her exceptional career dedicated herself to public service. Mrs. Kumar's extraordinary humanitarian efforts and outstanding contributions have improved the lives of women, children and infants in Hawaii. As the sole nutritionist on the Island of Kauai for the State of Hawaii Department of Health's Women, Infants and Children program, Mrs. Kumar nearly tripled the program's caseload in six years. She opened clinics in the outlying areas of the underserved communities of Hanalei, Kilauea and Waimea, and was the first nutritionist to serve the Island of Niihau. The central theme of her work was encouraging and supporting mothers to breast feed their children, the infant feeding method recommended to improve the health of infants. In remembrance of her many accomplishments, her co-workers have built a garden at the Hawaii Department of Health's Kauai District office and a memorial fund in her name has been established by Hawaii Mothers' Milk, Inc. I ask my colleagues to join me in paying tribute to the late Minal Kumar for all she has done for the people of Hawaii.

Mr. INOUYE

Mr. INOUYE. Mr. President, the U.S.-Asia Institute, a non- profit organization, recently completed its 40th Congressional Staff Delegation to China and Hong Kong in cooperation with the Chinese People's Institute of Foreign Affairs (CPIFA). I am pleased to bring this milestone to the attention of the Senate. The Institute's commitment to promoting friendship and understanding between countries in Asia and the U.S. government goes back almost 20 years. Founded in 1979 by Esther Kee, Norman Lau Kee, and Joji Konoshima, the U.S.-Asia Institute has been steadily working to achieve its goal through international conferences, seminars, student exchange programs, and Congressional staff trips to Asia. Among its numerous activities in support of cultural understanding, the U.S.-Asia Institute's Congressional staff trip program to China and Hong Kong is unrivaled. Since its inception in 1985, the China program has hosted more than 320 Congressional staff members in numerous places throughout China--from Heihe in the North on the Russian border to Hainan in the South; from the dynamic coastal cities of Shanghai and Guangzhou to the remote city of Urumqi, an oasis on the ancient Silk Road; and to the capital, Beijing. Over 150 Congressional offices have benefited from the intense, hectic, fact finding programs that provide Congressional staff members a unique opportunity to observe this dynamic nation first-hand and to further their understanding of complex Sino-U.S. relations. This program has survived the sometimes tumultuous relationship between the two countries thanks to the steadfast commitment of the U.S.-Asia Institute and the CPIFA to promote dialog on issues of mutual interest to our two great nations. I congratulate the U.S.-Asia Institute and CPIFA for their remarkable achievements and hope their longstanding partnership will continue into the 21st century.

Mr. INOUYE

Mr. INOUYE. Mr. President, it is with great pleasure that today, along with Mr. Akaka, Mr. Stevens, Mr. Hatch, Mr. Byrd, Mr. Thomas, Mr. Hollings, Mr. Roth, Mr. Ford, Mrs. Boxer, Mr. Murkowski and Mr. Sessions to submit the Pacific Island Summit Resolution. Since the end of World War II, the U.S. has lacked a strong diplomatic policy and presence in the Pacific Region. This has become more prevalent in recent years. Often characterized as a policy of ``benign neglect,'' the current situation is insufficient to continue the role of the U.S. as the leading world power as we enter the new millennium. The Pacific region covers an immense area of the Earth, approximately three times that of the contiguous United States. Increasing enforcement of treaties demarcating exclusive economic zones are revealing Pacific Island countries that wield control over vast tracts of the ocean, marine fisheries and undersea minerals; resources that will play a major role in the future of the global economy. As natural resources around the world dwindle, access to the relatively untapped resources in this region of the world will become increasingly important. The U.S., as the leading world power, should seek to maintain strong ties to this region. By cultivating diplomatic relationships with these leaders today, we foster strong economic ties tomorrow. In October 1997, then-Prime Minister Hashimoto held a summit meeting in Tokyo, Japan with various Pacific Island heads of state. Clearly, Japan is aware of the unlimited potential of this region, its valuable resources, and the importance of gaining access to them. It is economically and strategically important that we not stand idly by while other countries step into the vacuum created by the present U.S. policy. This resolution, Mr. President, encompasses all of these ideas in expressing the sense of the United States Senate that a summit meeting between the President and leaders from the Pacific region would be an excellent opportunity for the U.S. to strengthen its position economically and strategically. These Pacific Islands in return will be provided the rare opportunity to share their interests, visions for the future, and concerns with the leader of the world's most powerful democracy. It is my sincere belief that this summit will rebuild a foundation neglected since the end of World War II and be the beginning of a mutually beneficial relationship between the U.S. and this great region. Congressman Eni Faleomavaega introduced similar legislation in the House of Representatives, which speaks to the importance of developing and maintaining close diplomatic and economic ties with the Pacific and that a Pacific Island Summit would aid the U.S. considerably in attaining this goal. It is my hope that this legislation will be considered and approved in both chambers expeditiously.

Mr. INOUYE

Mr. INOUYE. Mr. President, I rise today, as I have in prior years, to oppose the amendment proposed by my colleague, the Senator from Wyoming, Senator Enzi. Mr. President, I have had the privilege of serving on the Committee on Indian Affairs for over 20 years. And I believe that in order to fully appreciate and understand the matter before us, a brief review of the history of our relationship with Indian country might help, because over the course of those 20 years, I have learned a bit about the state of Indian country and the pervasive poverty which is both the remnant and result of too many years of failed Federal policies. Mr. President, there was a time in our history when the native people of this land thrived. They lived in a state of optimum health. They took from the land and the water only those resources that were necessary to sustain their well-being. They were the first stewards of the environment. And those who came later found this continent in pristine condition because of their wise stewardship. Even after the advent of European contact, most tribal groups continued their subsistence way of life. Their culture and their religions sustained them. And, Mr. President, they had very sophisticated forms of government, so sophisticated and so clearly efficient and effective over many centuries that our Founding Fathers could find no other better form of government upon which to structure the government of a new nation, the United States of America. So our Founding Fathers--Benjamin Franklin, Thomas Jefferson--adopted the framework of the Iroquois Confederacy, a true democracy, and it is upon that foundation that we have built this great Nation. But, unfortunately, there came a time in our history when those in power decided that the native people were an obstacle, an obstruction to the new American way of life and later to the westward expansion of the United States. So our Nation embarked upon a course of terminating the Indians by exterminating them through war and the distribution of blankets infected with smallpox. We nearly succeeded in wiping them out. Anthropologists and historians estimate that there were anywhere from 10 million to 50 million indigenous people occupying this continent at the time of the European contact. By 1849, when the United States finally declared an end to the era known as the Indian wars, we had managed to so efficiently decimate the Indian population that there were a mere 250,000 native people remaining in the lower 48. Having failed in that undertaking, we next proceeded to round up those who survived, forcibly marched them away from their traditional lands, and across the country. Not surprisingly, these forced marches-- and there were many of these trails of tears--further reduced the Indian population because many died along the way. Later, we found the most inhospitable areas in the country on which to relocate the native people and expected them to scratch out a living there. Of course, we made some promises along the way; that in exchange for tribal lands in the millions of acres we would provide them with education--at least we promised them education--health care and shelter. We told them, often in solemn treaties, that these new lands would be theirs in perpetuity. There are many wonderful treaties in our archives, some that begin with phrases: As long as the sun rises in the East and sets in the West, and waters flow from the mountain tops to the sea, this land is yours. We promised them that their traditional way of life would be protected from encroachment by non-Indians and that we would recognize their inherent right as sovereigns to retain all powers of government not relinquished. Their rights to hunt, fish, gather food, to use the waters that were necessary to sustain life, were also recognized as preserved in perpetuity for their use. But over the years, these promises and others were broken by our National Government, and our vacillations in policies, of which there were many, left most reservation communities in economic ruin. It grieves me to repeat this, but there were 800 treaties solemnly entered into by the Government of the United States and the leaders of Indian country--800. It was the responsibility of this body, the U.S. Senate, to ratify these treaties. Mr. President, 430 of them were ignored. They lie in our files at this moment; 370 were ratified by the U.S. Senate. And of the 370, we proceeded to violate every single one of them. The cumulative effects of our treatment of the native people of this land have proven to be nearly fatal to them. Poverty in Indian country is unequal anywhere else in the United States. The desperation and despair that inevitably accompanies the economic devastation that is found today in Indian country accounts for the astronomically high rates of suicide and mortality from diseases. For Indian youth between the ages of 18 and 25, the rate of suicide is 14 times the national norm of the United States. Within this context, along came an opportunity for some tribal governments to explore the economic potential of gaming. It didn't prove to be a panacea, but it began to bring in revenues that tribal communities didn't have before. Then the State of California entered this picture by bringing a legal action against the Cabazon Band of Mission Indians, a case that ultimately made its way to the Supreme Court. Consistent with 150 years of Federal law and constitutional principles, the Supreme Court ruled that the State of California could not exercise its jurisdiction on Indian lands to regulate gaming activities. This was in May of 1987. In the aftermath of the Supreme Court's ruling, we got into the act, the Congress of the United States. During the 100th session of the Congress, I found myself serving as the primary sponsor of what is now known as the Indian Gaming Regulatory Act of 1988. There were many, many hearings and many, many drafts leading up to the formulation of the bill that was ultimately signed into law. Initially, our inclination was to follow the well-established and time-honored model of Federal Indian law which was to provide for an exclusively Federal presence in the regulation of gaming activities on Indian lands. The Constitution and the laws of our land say the relationship will be between the Federal Government and the Indian government. Such a framework would have been consistent with constitutional principles, with the majority of our Federal statutes addressing Indian country, and would have reflected the fact that as a general proposition, it is Federal law, along with tribal law, that governs most all of what may transpire in Indian country. But State government officials--Governors, attorneys general--came to the Congress, demanding that a role in the regulation of Indian gaming be shared with them. Ultimately, we acquiesced to those demands. After much thought, many hearings, much debate, the Congress of the United States selected a mechanism that has become customary in dealings amongst sovereign governments. This mechanism, a compact between a State government and a tribal government, would be recognized by the Federal Government as the agreement between two sovereigns as to how the conduct of gaming on Indian lands would proceed. The Federal participation in the agreement would be accomplished when the Secretary of the Interior approved the tribal-State compact as part of the law. In an effort to ensure that the parties would come to the table and negotiate a compact in good faith, and in order to provide for the possibility that the parties might not reach agreement, we also provided a means by which the parties could seek the involvement of the Federal district court, and if ordered by the court, could avail themselves of a mediation process. It is not for the Indian leaders to determine whether the process is being carried out in good or bad faith. The court will decide that, and the court is not an Indian court. It is the district court of the United States of America. That judicial remedy and the potential for mediated solution when the parties find themselves at an impasse has subsequently been frustrated by the ruling of the Supreme Court upholding the 11th amendment, the amendment that provides immunity to the several States of the Union. Thus, while there are some who have consistently maintained that sovereign immunity is an anachronism in contemporary times, in this area at least, the States still jealously guard their sovereign immunity to suit in the courts of another sovereign. In so doing, the States have presented us with a clear conflict, which we have been trying to resolve for several years. Although 24 of the 28 States that have Indian reservations within their boundaries have now entered into 159 tribal-state compacts with 148 tribal governments, there are a few States in which tribal-state compacts have not been reached. And the conflict we are challenged with resolving is how to accommodate the desire of these States to be involved in the regulation of Indian gaming and their equally strong desire to avoid any process which might enable the parties to overcome an impasse in their negotiations. The Secretary of the Interior is to be commended in his efforts to achieve what the Congress has been unable to accomplish in the past few years. Following the Supreme Court's 11th amendment ruling, the Secretary took a reasonable course of action. He published a notice of proposed rulemaking, inviting comments on his authority to promulgate regulations for an alternative process to the tribal-state compacting process established in the Indian Gaming Regulatory Act. Thereafter, he followed the next appropriate steps under the Administrative Procedures Act, inviting the input of all interested parties in the promulgation of regulations. When the Senate acted to prohibit him from proceeding in this time- honored fashion, he brought together representatives of the National Governors Association, the National Association of Attorneys General, and the Tribal Governments, to explore whether a consensus could be reached on these and other matters. In fact, a working group of those interests will be meeting this week in Denver to pursue the Secretary's initiative. In the meantime, my colleagues propose an amendment that would not only prohibit the Secretary from proceeding with the regulatory process, but which would prevent those State and tribal governments that desire to enter into a compact from securing the necessary Federal approval. By the latter formulation, my colleagues would federally pre-empt what is otherwise the prerogatives of sovereign governments--namely the State and tribal governments--to pursue that which is their right under Federal law and their right as sovereigns. Once again, there have been no hearings on this proposal--no public consideration of this formulation--no input from the governments involved and directly affected by this proposal. Last year, the Secretary of the Department of the Interior made clear his intention to recommend a veto of the Interior appropriations bill should this provision be adopted by the Senate, and approved in House- Senate Conference. I would suggest that it is unlikely that the Secretary's position has changed in any material respect--particularly in light of all that he has undertaken to accomplish, including frank discussion amongst the State and tribal governments. As one who initiated a similar discussion process several years ago, I am more than a little familiar with the issues that require resolution. However, in the intervening years, court rulings have clarified and put to rest many of the issues that were in contention in that earlier process. I have continued to talk to Governors and attorneys general and tribal government leaders on a weekly if not daily basis, and I believe, as the Secretary does, that the potential is there for the State and tribal governments to come to some mutually-acceptable resolution of the matters that remain outstanding between them. I believe the Secretary's process should be allowed to proceed. I also believe that pre-empting that process through an amendment to this bill could well serve as the death knell for what is ultimately the only viable way to accomplish a final resolution. The alternative is to proceed in this piecemeal fashion each year--an amendment each year to prohibit the Secretary from taking any action that would bridge the gap in the Indian Gaming Regulatory Act that was created by the Court's ruling and which will inevitably discourage the State and tribal governments from fashioning solutions. This is not the way to do the business of the people. There are those in this body who are opposed to gaming. As many of my colleagues know, I count myself in their numbers. I am opposed to gaming. Hawaii and Utah are the only two States in our union that criminally prohibit all forms of gaming, and I support that prohibition in my State. We don't have bingo or poker. Mr. President, like many of my colleagues, I have walked many miles in Indian country, and I have seen the poverty, and the desperation and despair in the eyes of many Indian parents and their children. I have looked into the eyes of the elders--eyes that express great sadness. I have met young Indian people who are now dead because they saw no hope for the future. I have seen what gaming has enabled tribal governments to do, for the first time--to build hospitals and clinics, to repair and construct safe schools, to provide jobs for the adults and educational opportunities for the youth--and perhaps most importantly, to engender a real optimism that there can be and will be--the prospects for a brighter future. It is for these reasons, and because of their rights as sovereigns to pursue activities that hold the potential for making their tribal economies become both viable and stable over the long term, that I support Indian gaming. If our country--this great Nation--had followed the provisions in our treaties and abided with our promises, then there would be no need for me to be supporting Indian gaming. Mr. President, it is for these reasons, that I must, again this year, strongly oppose the efforts of my colleagues to take from Indian country, what unfortunately has become the single ray of hope for the future that native people have had for a very long time.

Mr. INOUYE

Mr. INOUYE. Mr. President, I wish to thank Chairman McConnell and Senator Leahy for their work in putting together a foreign operations funding bill that provides for our national security interests while doing so under tough fiscal constraints. I would also like to commend the Chairman and Ranking Member on their recognition of the important role Tunisia has played in the Middle East Peace Process for the past several years. Tunisia has been a long-time friend of the United States. Tunisia has, since the beginning of the Peace Process, fully committed itself to this process, which is viewed as the only way to restore peace in the Middle East. They launched the first U.S.-PLO dialogue as well as the first preparatory talks between Israeli and Palestinian leadership in Tunis. Tunisia was the first Arab country to host meetings within the framework of the Peace Process. Furthermore, a trilateral meeting was held in Washington in October 1995 bringing together the three Foreign Ministers of the United States, Israel and Tunisia, followed soon afterwards by another trilateral meeting, in January 1996, in Washington, D.C. A decision was then announced to open, both in Tunis and in Tel Aviv, interest sections in order to encourage the process of normalization between Arab States and Israel. The Tunisian's have undertaken these diplomatic initiatives at some level of security risk. Tunisia's next door neighbor is Libya. Nevertheless the Tunisians have refused to engage in an arms race. In 1997, they participated in 20 joint military exercises with the U.S. and the European Command. I believe it is time that we demonstrate our appreciation and support for this country through funding commitments. I also encourage the Administration to begin exploring additional funding initiatives in fiscal year 2000.

Mr. INOUYE

Mr. INOUYE. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. INOUYE. No objection.

Mr. INOUYE. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. INOUYE. No, we are prepared to go to third reading.

Mr. INOUYE. I agree that the Navy must give more consideration to ensuring worker and environmental safety to prevent the problems we have had in the past.

Mr. INOUYE. Mr. President, I thank Senator Daschle. I share the concern expressed by the two Senators from South Dakota that taxpayers are not getting their money's worth out of the Centennial Housing Project. You can be assured that I will assist you in your efforts to find a timely solution to this matter that will result in the repair of the housing units and the return of military personnel to the homes. Encouraging Greater Use of Distance Learning by the Department of Defense

Mr. INOUYE. That is correct. We have attempted to encourage such initiatives wherever we could, and wherever such initiatives made sense.

Mr. INOUYE. I am aware of the Carl Vinson project. It is certainly a promising concept, but are we providing any educational opportunities for service personnel nearing retirement or leaving the military due to the draw down of the military?

Mr. INOUYE. I agree with the Senator from Georgia. He makes a good point, and I hope the Department of Defense will take a look at such initiatives in the future.

Mr. INOUYE

Mr. INOUYE. Mr. President, I suggest the absence of a quorum.

Mr. INOUYE

Mr. INOUYE. Mr. President, I rise today to speak on an health issue of great importance now and in future years. As our population continues to increase, our elderly live longer, and healthcare technology advances, the need for access to care will undoubtedly also increase. Because of these monumental increases in the need for healthcare access for many Americans, I wish to take a few minutes to discuss the need for support of nursing school administered primary care centers. Nursing centers are university or nonprofit entity primary care centers developed (primarily) in collaboration with university schools of nursing and the communities they serve. These centers are staffed by faculty and staff who are public health nurses and nurse practitioners. Students supplement patient care while receiving preceptorships provided by colleges of nursing faculty and primary care physicians, often associated with academic institutions, who serve as collaborators with nurse practitioners. Nurse practitioners, and public health nurses, in particular, are educated through programs which offer advanced academic and clinical experiences, with a strong emphasis on primary and preventive health care. In fact, schools of nursing that have established these primary health care centers blend service and education goals, resulting in considerable benefit to the community at large. Nursing centers are rooted in health care models established in the early part of the 20th century. Lillian Wald in the Henry Street Settlement and Margaret Sanger, who opened the first birth control clinic, provided the earliest models of service. Since the late 1970's, in conjunction with the development of educational programs for nurse practitioners, college of nursing faculties have established nursing centers. There are currently 250 centers nationwide, affiliated with universities and colleges of nursing in Arizona, Utah, Pennsylvania, South Carolina, Tennessee, Texas, Hawaii, Virginia, and New York. The Regional Nursing Centers Consortium, an association of eighteen nursing centers in New Jersey, Pennsylvania and Delaware, was established in 1996 to foster greater recognition of, and support for, nursing centers in their pursuit of providing quality care to underserved populations. Nursing centers tend to be located in or near areas with a shortage of health professionals or areas that are medically underserved. The beneficiaries of their services have traditionally been the underserved and those least likely to engage in ongoing health care services for themselves or their family members. In the 1970's, I sponsored legislation that would give nurses the right to reimbursement for independent nursing services, under various federal healthcare programs. At the same time, one of the first academic nursing centers was delivering primary care services in Arizona. As the Vice Chairman of the Committee on Indian Affairs, I am pleased to note that the University of South Carolina College of Nursing has established a Primary Care Tribal Practice Clinic, under contract with the Catawba Indian nation, which provides primary and preventive services to those populations. The University also has a Women's Health Clinic and Student Health Clinic, which are both managed by nurse practitioners. Another prime example of services provided by nurse practitioners is the Utah Wendover Clinic. This clinic, in existence since 1994, provides interdisciplinary rural primary health services to more than 10,000 patients annually. The clinic now has telehealth capabilities that provide interactive links from the clinic to the university hospital, 120 miles away. This technology allows practitioners direct access to medical support for primary care, pediatrics, mental health, potential abuse, and emergency trauma treatment. To date, nursing centers have demonstrated quality outcomes which, when compared to conventional primary health care, indicate that their comprehensive models of care have resulted in significantly fewer emergency room visits, fewer hospital inpatient days, and less use of specialists. The Lasalle Neighborhood Nursing Center, for example, reported for 1997 that fewer than 0.02 percent of their primary care clients reported hospitalization for asthma; fewer than 4 percent of expectant mothers who enrolled delivered low birth rate infants; 90 percent of infants and young children were immunized on time; 50 percent fewer emergency room visits; and the clinic achieved a 97 percent patient satisfaction rate. What makes the concept of nurse managed practices exciting and promising for the 21st century is their ability to provide care in a ``spirit of serving'' to underserved people in desperate need of health care services. Interestingly, nurse practitioners have consistently provided Medicaid sponsored primary care in urban and rural communities for a number of years, and have consistently demonstrated their commitment to these underserved areas. The 1997 Balanced Budget Act (P.L. 105-33) included a provision that for the first time ever allowed for direct Medicare reimbursement of all nurse practitioners and clinical nurse specialists, regardless of the setting in which services were performed. This provision built upon previous legislation that allowed direct reimbursement to individual nurse practitioners for services provided in rural health clinics throughout America. The law effectively paved the way for an array of clinical practice arrangements for these providers; however, per visit payments to nurse run centers, as opposed to individual practitioners, was not formally included in the law. Federal law now also mandates independent reimbursement for nurse practitioners under the Civilian Health and Medical Programs of Uniformed Services (CHAMPUS), the Federal Employee Health Benefits Plan (FEHBP) and in Department of Defense Medical Treatment Facilities. As the Ranking Member of the Defense Appropriations Subcommittee, my distinguished colleagues and I have listened to the testimonies of the three Service Chief Nurses each year, during the Defense Medical hearings. I am proud to report that the military services have taken the lead in ensuring the advancement of the profession of nursing. Military advanced practice nurses provide care to service members and their families at all of the treatment facilities. The Graduate School of Nursing at the Uniformed University of the Health Sciences (USUHS), which has a very successful nurse practitioner program, was recently recognized in the top 100 graduate schools in the United States. The Commanding General at Tripler Army Medical Center, a two star position, is a nurse. This is a first ever accomplishment for nurses in the military. I hope to see more nurse officers in these leadership roles, even at the three star level. At the beginning of this session of Congress, I proposed legislation to amend Title XIX of the Social Security Act to expressly provide for coverage of services by nursing school administered centers under state Medicaid programs, similiar to payments provided to rural health clinics. Today, as we debate a number of health care issues, I urge us to consider creative avenues for expanding health care access for all Americans, particularly the poor and underserved. Nursing centers, as new models of health care providers, offer quality services for lower payments. In closing, I would like to reiterate that nurse practitioners provide cost effective, preventive care in underserved areas across America. Their educational programs emphasize the provision of care to patients with limited resources, financial and otherwise. A recent article in U.S. News and World Report showcased the successful Columbia Advanced Practice Nurse Associates (CAPNA), a nurse run primary care clinic in New York City. Dr. Mary Mundinger, the Dean of the Columbia School of Nursing and a Robert Wood Johnson Health Policy Fellow in 1984, was the catalyst for the center, which she envisions as a ``prototype of a new branch of primary care.'' Nurse practitioners have proven themselves to be well trained providers of high quality, cost effective care. Nursing school administered centers offer viable alternatives to health care access for the poor and underserved, and allow Americans more choices in their selection of cost effective, quality care services. The issues surrounding quality, access and the provision of patient care services are, Mr. President, at the crux of our current debates over health care reform. We owe it to each and every American to provide the very best options for quality health care available. Mr. President, I thank you for the opportunity to address my colleagues on this most important topic. I ask that an article on this subject be printed in the Record. The article follows: [From the U.S. News & World Report, July 27, 1998] For nurses, a barrier broken--It's a test insurers are backing: Can primary care work without doctors? (By James Lardner) Seems like everybody's been trying to take a bite out of doctors' paychecks lately--the federal government, employers, insurers, and now, of all people, nurses. In New York City, Medicare and eight private health plans have given their enrollees permission to get primary care from a group of nurse practitioners or NPs, who diagnose, treat, prescribe, refer, and bill very much as if they were M.D.'s. About 250 New Yorkers have signed up with the 10-month-old practice, known as CAPNA (for Columbia Advanced Practice Nurse Associates), and though it's still a tiny operation-- just four NPs--business is growing by six or seven new patients a week. Supporters think the idea of a nurse-run form of primary care has a lot of potential. Many doctors are dubious. The New York State Medical Society's chief lobbyist, Anthony Santomauro, sees a threat to the well-being of physicians as well as of patients. ``Your action,'' Santomauro warned his colleagues recently, ``could decide whether nurse practitioners . . . continue to serve under your direction and supervision or . . . become independent practitioners in direct competition.'' To Robert Graham, executive vice president of the American Academy of Family Physicians, what the nurses are doing ``comes very close to practicing medicine, which of course, requires a medical degree and a license.'' The law aside, critics argue that primary care entails subtle diagnostic decisions that physicians are uniquely qualified to make. ``The four years in medical school and three years in residency training and many hours of continuing education that physicians receive are very different from the 500 to 700 hours of training that most nurse-practitioner programs call for,'' says Nancy Dickey, a Texas physician who recently became president of the American Medical Association. (There are roughly 140,000 nurses with advanced degrees in the United States; as a rule, NPs have master's degrees that entail two years of classroom and clinical training.) While physicians stress the possibility of confusion about who is or isn't an M.D., they may be up against a bigger problem: a widespread longing for a slower-paced, more personal form of health care than many people feel they can get from physicians these days. ``If you spend 10 minutes with a doctor in New York City, you're doing well,'' says Doris Ward, a 77-year-old former nonprofit executive. Ward came to CAPNA's offices on East 60th Street seeking treatment for high cholesterol and anxious to find ``someone who would sit down and talk to me for a little while.'' Her NP, Marlene McHugh, devoted an hour to the initial appointment and recommended a dietary rather than a medical approach to her problem. Thomas Becker, a 36-year-old marketing manager, was confused about whom he was seeing. He didn't know that Edwidge Thomas was not a doctor when he picked her from a list supplied by his health plan; in fact, he didn't realize his mistake until his first visit. But Thomas asked such insightful questions that ``it didn't really matter to me,'' Becker says. After three appointments, two for sports-related injuries and one for flu, he rates CAPNA ``absolutely excellent.'' Bedside manner. Mary O'Neil Mundinger, dean of the Columbia University School of Nursing and the driving force behind CAPNA, sees it as the prototype of a new branch of primary care. She spent 17 years as a bedside nurse before getting a doctorate in public health, and she dismisses the suggestion that nurses are likely to overlook symptoms or botch diagnoses (``We don't miss things,'' she says crisply). But physicians, she argues, overemphasize diagnosing and prescribing, and tend to consider their work over once they have recommended a program of treatment; nurses, she says, are better at getting patients to follow the program. Two studies seem to bolster her case. Nurse practitioners have long provided primary care to those who might otherwise have gone unserved, such as residents of rural areas, and a 1986 study by the Office of Technology Assessment concluded that the care they provided was equivalent to that offered by physicians. When it came to communication and prevention, the OTA found NPs more adept. In addition, a 1993 analysis of studies comparing care offered by physicians with that provided by NPs found that nurses spent about 25 minutes with a patient; doctors spent 17. The two groups were about equal in their rates of prescribing drugs, but the nurses provided more patient education and stressed exercise more often than the doctors. While the debate may seem to pit nurses against doctors, the more important division exposed by CAPNA may be between two types of physician, primary-care providers and specialists. Critics of the CAPNA model fear that NPs, because they have less training than physicians, will rely too much on specialists. Many specialists respond that in the age of managed care, overreferral by nurses is far less of a danger than underreferral by doctors, who are torn between the interests of patients and, as Eric Rose, the chief of surgery at Columbia-Presbyterian Medical Center, puts it, ``the care of their bankbooks and the HMOs' bankbooks.'' (CAPNA has been referring surgery cases to Columbia- Presbyterian.) CAPNA's acceptance by insurers as a legitimate primary-care alternative to a practice run by physicians is clearly a breakthrough for nurses, who were long defined as hospital workers who existed to do the bidding of physicians. As recently as the 1970s, nursing-school curricula included elaborate protocols of respect (surrendering one's chair, for example) that a nurse was supposed to follow when a physician entered a room. The power of physicians is also under attack from market- oriented critics, who see them as attempting to carve out a monopoly at the consumer's expense. In the past, physicians' organizations have used their clout to beat back proposals to give quasi-medical powers to nonphysicians. But CAPNA was created with no change in the law; Mundinger reasoned that the kind of health care she hoped to offer affluent patients in midtown Manhattan was already the norm in much of rural and inner-city America. New York itself allowed NPs to write prescriptions--otherwise, health care in many areas of the state would have ground to a halt. ``As long as it was just poor folks, nobody was paying any attention,'' Mundinger says. The groundwork was laid in 1993, when Columbia-Presbyterian sought the nursing school's help in expanding health care services in two poor, upper-Manhattan neighborhoods. Spotting an opportunity, Mundinger asked in return for something that earlier partnerships of nurse practitioners had lacked: hospital admitting privileges--the ability to get patients into Columbia-Presbyterian and supervise their care there. Two new primary-care practices were created, one with doctors and nurse practitioners working as equals, the other run entirely by NPs. Mundinger's next brainstorm was to see if the concept would work in an affluent neighborhood. This time, in a move with widespread implications for health care, she went after managed-care plans for the right of reimbursement. Equal treatment. For the HMOs--under constant pressure from employers to cut costs--a nurse-run practice had obvious appeal if it meant lower payments for the same services. But Mundinger rejected support that was conditioned on reduced reimbursement, insisting that would open the HMOs to the charge of chiseling and cast her practice as a cheap substitute for real medicine. After months of discussions, Oxford Health Plans agreed to go along. Seven more health plans followed suit, all giving the nurses the same fee-for- service rates as doctors. Mundinger's admirers say she has not only created a significant new model of health care but, in doing so, has called the medical profession's bluff. Say Uwe Reinhardt, a health economist who teaches at Princeton University, ``Doctors always say the are rugged individualists, for free enterprise and such, and now at the first sight of a nurse they run to the government and say, `Please use your coercive powers to protect us!' '' Even some supporters, however, fear that Mundinger's model, for all its noble objectives, will appeal to the basest motives of insurers and employers, leaving patients, in the end, with less-trained people who are in just as much of a hurry. There is some reason for doubting this: A study in the April Nurse Practitioner, for example, found NPs more consistent than gynecologists in adhering to medical standards in evaluating cervical dysplasia, a precursor to cervical cancer. And as Robert Brook, a Rand analyst who is conducting an internal assessment for CAPNA, puts it: ``It's not like we started out with a perfect system.''