Jim Jeffords

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, Vermont's home health agencies are a model of efficiency for the nation. For the past seven consecutive years, the average Medicare expenditure for home health care in Vermont has been the lowest in the nation. This efficiency was achieved by exclusive reliance on 13 nonprofit agencies which provide care without sacrificing quality, and which adhere strictly to Medicare requirements and guidelines. Today, I am cosponsoring The Medicare Home Health Equity Act of 1998, with my good friend Senator Collins, in order to preserve this high-quality, low-cost home health system from possible insolvency. At this moment, Vermont is facing an unprecedented crisis in its home health care system. This is not a crisis of their own making, and the home health agencies had little, if any, advance warning that disaster was imminent. The crisis that befalls Vermont's home health care agencies, and many others throughout the country, arose from the decision made by Congress, as a part of the Balanced Budget Act of 1997 (BBA), to adopt a Medicare prospective payment system for home health care. There is compelling rationale and general agreement for moving Medicare to a prospective payment system (PPS) in the home health care sector. Under a national, prospective payment system, low-cost agencies will fare well, as they have already learned how to manage their resources wisely. However, the interim system created by the BBA for the transition to a PPS is fundamentally flawed and rewards high-cost agencies. Under the Interim Payment System, reimbursement limits for home health care are heavily weighted toward an agency's historical costs. This means that until a prospective payment system can be designed and implemented, the lowest cost agencies will face the most significant caps on their Medicare payments. Where a prospective payment system aims to level the playing field for agencies that care for similarly situated patients, the interim system preserves and reinforces significant disparities across agencies. Although high-cost agencies will face reductions in payments under the interim system, these will be the agencies in the best position to make those cuts. Low-cost agencies with budgets that are already lean have no place to turn. It would be a national tragedy if those low-cost agencies cannot survive the transition to a prospective system. I commend the efforts of my good friend Senator Collins for bringing this bill forward. it was a difficult task to craft a remedy that allows committed and responsible home health agencies to survive and also maintain budget neutrality. The Medicare Home Health Equity Act of 1998 would alter the interim payment formula by basing payment caps on a blend of national and regional averages. In this way, we can move toward a more uniform level of reimbursement and allow home health care agencies in the same locale to operate under the same constraints. Furthermore, this legislation can be implemented quickly. This is important, because the regulations defining the interim payment system were not published until January of this year--nearly four months after the payment system was in force. The situation is serious. We must provide relief to home health agencies and peace of mind to the clients who are under their care. Last August, I voted in support of the Balanced Budget Act of 1997. I was proud of the changes we made to preserve Medicare benefits for the present and for future generations. Today, I urge my colleagues to enact The Medicare Home Health Equity Act of 1998 and correct the unintended consequences of the BBA's interim payment system reimbursement limits on low-cost home health agencies.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I would like to announce for information of the Senate and the public that a hearing of the Subcommittee on Public Health and Safety, Senate Committee on Labor and Human Resources will be held on Thursday, April 30, 1998, 11 a.m., in SD-430 of the Senate Dirksen Building. The subject of the hearing is Agency for Health Care Policy Research. For further information, please call the committee, 202/224-5375.

Mr. JEFFORDS. Mr. President, I would like to announce for information of the Senate and the public that a hearing of the Senate Committee on Labor and Human Resources will be held on Wednesday, April 29, 1998, 10 a.m., in SD-430 of the Senate Dirksen Building. The subject of the hearing is ``Assistive Technology Act.'' For further information, please call the committee, 202/224-5375.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today, April 23, as the United States Congress joins hands with the United States Holocaust Memorial Museum and conducts a Day of Remembrance ceremony in the Rotunda of the Capitol. This ceremony, and those in each of the 50 State capitols and in some 200 cities and towns throughout the nation, honors the memory of those 11 plus million Holocaust victims and the millions more who survived but found their pre-WWII lives in shambles and in all too many cases, irretrievable. This year's ceremony pays special tribute to the children, those innocent victims of the war and the Nazis' persecution. That they survived is remarkable. In some instances, they bear the physical markings of their plight. Others carry their wounds in their hearts and heads. That this great nation mandates a Day of Remembrance ceremony is an indication of its commitment to historical memory. But an equally important part of our effort to learn from the past is the presence of the United States Holocaust Memorial Museum. Its mission is to advance Holocaust memory, education and scholarship. This week marks its 5th anniversary. Five years ago, no one would have predicted the reaction of the United States to the opening of the Holocaust Museum. Estimates of visitation, even those most rosy, were low by a factor of more than two. Expecting 750,000 visitors under the highest estimate, the museum welcomed over 2 million in its first year and every year since. Just drive by the Holocaust Museum any morning and see the line stretching around the building. While I reflect on the Holocaust Museum, I feel it appropriate to mention the work of a distinguished Vermonter, Professor Raul Hilberg. Professor Hilberg spent many years educating students at the University of Vermont about the Holocaust, but few people know how instrumental he was in furthering Holocaust related research as a real serious enterprise. It wasn't until Raul Hilberg began his study of this important subject that historians began to take it seriously, and his research preceded the concept of the Holocaust Memorial Museum. Professor Hilberg was instrumental in furthering the Museum's research programs and many feel that he serves as a father figure to the institution. Americans care about the past and want the world they leave to their children to be a better and safer place. They have learned well the lessons from the fall of German democracy and the rise of Nazism. They look around the world today and see acts of genocide and crimes against humanity and rightly worry about our future. They come to the Holocaust Museum because it informs and educates. It makes disregarding the past and even contemporary acts of genocide and crimes against humanity more difficult. We as a nation benefit greatly from this institution which stands as a testament to the horrors of the past and guards against a reoccurrence in the future.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, today I am submitting an amendment to the resolution to ratify the accession of Poland, Hungary, and the Czech Republic to the North Atlantic Treaty Organization (NATO). This amendment addresses future new membership in the alliance. 28 countries in central Asia and eastern Europe that have applied for NATO membership or may aspire to join at a future date when they can meet NATO criteria. Today we are considering extending the NATO security umbrella to only three countries--Poland, Hungary, and the Czech Republic. It is important that we have a clear understanding that the expansion process may go much further than this initial round. In January 1994, the Administration adopted the Partnership for Peace program to provide a framework for NATO's evaluation of states that are considered to be candidates for alliance membership. In addition to the first three countries invited to join NATO, nine other Partnership for Peace countries have begun the formal application process for membership--Estonia, Latvia, Lithuania, Romania, Bulgaria, Albania, Slovakia, Slovenia, and the Former Yugoslavia Republic of Macedonia. Moreover, another 15 countries have expressed an interest in NATO by joining the Partnership for Peace. These countries include Armenia, Austria, Azerbaijan, Belarus, Finland, Georgia, Kazakstan, Kyrgystan, Moldova, Russia, Switzerland, Turkmenistan, Ukraine, and Uzbekistan. Although not associated with Partnership for Peace, Croatia has expressed hope that they too will be admitted some day. The extensive territory covered by these NATO hopefuls begs for more information on the nature and mission of the alliance in the future. My amendment would require an annual report to the Senate on United States Government discussions with the governments of each of these countries on their possible accession. The reports would include the expected timetable for those countries to meet the criteria for NATO membership and how the Administration believes the functioning of NATO would be altered if they were to become a member. Just how far are we willing to extend the NATO alliance? I am not questioning whether Poland, Hungary, and the Czech Republic deserve to become alliance members. All three have made remarkable gains since the end of the Cold War. But in the future, other of these 25 nations will meet the criteria to join NATO and may be no less deserving of membership. Now is the time for the Senate to begin thinking about the long-term indications of a decision to open NATOs doors to the East.

Mr. JEFFORDS

Mr. JEFFORDS. There is no excuse for our inability to fulfill our responsibility to make sure that these schools are brought up to code compliance and modern standards. I yield the floor.

Mr. JEFFORDS. I yield myself 15 minutes.

Mr. JEFFORDS. Mr. President, we just finished a vote on the controversial Moseley-Braun amendment related to school construction. There is no question about the tremendous school infrastructure needs throughout this Nation. Well over $180 billion are necessary to bring the schools up to some appropriate standard. However, as was very aptly pointed out, and no doubt was one reason that the amendment was defeated, it is States that have the primary responsibility for that construction. It is not a constitutional responsibility of this body. I just bring to the attention of the body a chart that was discussed earlier today. Quoting the words of the Clinton administration: The construction and renovation of school facilities has traditionally been the responsibility of state and local governments, financed primarily by local taxpayers. We are opposed to the creation of a new Federal grant program for school construction. I want people to keep that in mind when they consider what I have to say. Under the Constitution, the District of Columbia, the Capital of the United States, is, in the view of Congress, at least in the writings, are our responsibility as a state legislature is to a State. We, the Members of the Congress of the United States, are responsible for the infrastructure of this city and its school system. And we should be ashamed of our negligence in that regard. The neglect did not occur over a few years; it has occurred over decades. So, the deficit in the school infrastructure is the responsibility of all of those who have been in power, whether it was the local governments to whom we gave the power in the 1970s and 1980s or whether it was the Congress that was in power before that. Everyone has neglected the school infrastructure. There is no question that the Nation's Capital, for which Congress is responsible, has one of the worst school infrastructures in the Nation. Again, this fall, the DC schools did not open on time. How that happened is another story that could be discussed some other time. But the bottom line is that it was because of the dilapidated conditions of the schools. The students marched to make us all aware of what was happening. I now show you a chart that appeared as a photograph in the Washington Post on Wednesday, October 8th, in which the students say, ``Why should students suffer for adult incompetence?'' It should be ``For congressional incompetence,'' because we are responsible for those schools being closed. The question is, what should we do about it? I voted against the Moseley-Braun amendment because I felt that that money, which would be more than adequate to fix up the D.C. schools, should be utilized for that purpose. I am not pushing this issue right now for this reason: Last year, I raised the issue of funding the construction of the DC public schools to bring them up to standard. I almost got $1 billion in the Finance Committee. That effort failed by one vote. We did end up with $50 million coming out of the Senate. But in the reconciliation bill, even the $50 million was dropped. Why? Because it was said that there were better programs to be financed by the Federal Government to help the District of Columbia than to help the school system. I violently disagree with that. At the same time, the Director of OMB said that he would work with me this year to find the money for the schools, as did other members of the Finance Committee. The members of the conference committee also said that they would help. Thus I have formed a working group with the OMB Director, Frank Raines, and other Members of both the House and the Senate, and we will be working over the next month or two to be able to try to find out what we can do to make sure that these schools get brought up to proper standards. Congress is not meeting its obligation. The infrastructure repair requirements--just to bring schools up to modern standards--is $2 billion. That is with a ``b,'' $2 billion, to give the students in this city the necessary funds to fix up the schools. The District is the size of a small State--population-wise, about the size of Vermont. That we are not able to help these kids is a travesty. There is no excuse for that. Also, if you want to look at the DC schools compared to the rest of the country, we have a chart. The red bar is where D.C. is on critical areas in need of repairs, and the yellow is the national average. The national total is $180 billion necessary to bring schools up to proper standards--not very good. But if you compare the national average with the D.C. schools, my God, look at that. Exterior walls and windows, 72 percent of DC schools are inadequate. The national average is 27 percent. Sixty-seven percent of the roofs on the schools in this city are in bad need of repair, 65 percent of the heating and ventilation needs repair, and 65 percent of the plumbing needs repair. Electrical lighting, 53 percent. That is just not acceptable. We should be ashamed. It is our responsibility to make sure that those repairs are made. However, not only have we not done that, but in 1974 when we created home rule, we prohibited the District from raising its own money from the most likely source to repair its schools. How did we do that? Well, the Senators from Virginia and Maryland very cleverly put a provision in the act that says the District cannot tax the income of nonresident workers. Every State in the Union that has a tax on income, taxes the income of nonresidents. Every city in a multistate area that has an income tax also taxes the income of nonresidents. So in prohibiting a commuter tax in DC, we have precluded District residents from generating the revenues to improve the physical infrastructure of the schools. The District has to have a revenue stream to be able to raise the bonds in order to pay for the school repairs. We in Congress have the responsibility to repair the schools, and we have prevented the local government from raising the money using the most logical source to fix those schools. What must we do? We have a number of options. I first point out that the closing of the schools this past fall demonstrates the necessity of funding the school repairs. In this regard, I want to clear up something for the record. A lot of blame has been heaped on General Becton, the school superintendent. Actually, what happened was that the citizen's group, Parents United, brought a lawsuit to ensure proper repairs while some repairs were already in process of being made. The work was planned so the schools wouldn't have to be closed, but the judge, who got fed up with city's inability to repair the schools, said, ``No, you are not going to open the schools until you complete the repairs.'' This then created a panic, because the school administrators had to search all of a sudden to find contractors to get the schools fixed to then get the schools re-opened. That process, as a subsequent GAO analysis showed, ended up adding expense to the renovation process. It is important for us to recognize that before we go home this year, before we fix schools in other areas, it is our responsibility to fix the schools of this city. We are constitutionally responsible. I am hopeful that in the days ahead, when our DC schools working group meets, our task will be to figure out how Congress is going to find the necessary $2 billion in the years ahead, either through some revenue stream created for the District or by utilization of Federal funds. We have to do that. We cannot allow this travesty to continue for the young people of D.C. when we have a constitutional responsibility to fix their schools. I am hopeful that as we go forward, we will be able to work together, both sides of the aisle, to find a solution to this inexcusable travesty for the young people of Washington. I want to make sure that my colleagues understand that what I have said is valid. First, we have a letter from Dr. Brimmer, the head of the control board, which indicates that it is impossible to create a revenue stream for the DC schools under the present fiscal situation of the city, nor does the school district have the authority to create a dedicated revenue source. Therefore, it would be necessary for Congress to do something to acquire the necessary money for construction and repairs of the school system. I ask unanimous consent that this letter be printed in the Record.

Mr. JEFFORDS. In addition, I ask unanimous consent to have printed in the Record the testimony of Professor Raskin from hearings I held in January. It addresses the constitutionality of Congress' responsibility for those schools. As a constitutional scholar, his testimony justifies what I think has become obvious from the debate, that the Congress has a responsibility to provide for the D.C. schools infrastructure.

Mr. JEFFORDS. Also, for those who have additional interest in this issue, I ask unanimous consent to have printed in the Record a list of all the States that have an income tax and whether or not those states tax the income of nonresidents. I also ask unanimous consent to have printed a list with similar information about cities that impose taxes on nonresidents. It shows that every city in a multistate area that has an income tax also taxes the income of nonresidents. Somebody may point out that Baltimore does not, but Baltimore, as you know, is flanked on two sides by water and on two other sides by the State of Maryland. It cannot therefore be construed as a city in a multistate area.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I would like to announce for information of the Senate and the public that a joint hearing of the Senate Committee on Labor and Human Resources and the House Committee on Education and the Workforce will be held on Wednesday, April 22, 1998, 10:30 a.m., in SD-106 of the Senate Dirksen Building. The subject of the hearing is ``Proposed Individuals With Disabilities Education Act Regulations.'' For further information, please call the committee, (202) 224-5375. committee on labor and human resources

Mr. JEFFORDS. Mr. President, I would like to announce for information of the Senate and the public that a joint hearing of the Subcommittee on Public Health and Safety, Senate Committee on Labor and Human Resources and Subcommittee on Health and Environment, House Committee on Commerce will be held on Thursday, April 23, 1998, 2:30 p.m., in SH- 216 of the Senate Hart Building. The subject of the hearing is The Gift of Life: Increasing Bone Marrow Donation and Transplantation. For further information, please call the committee, (202) 224-5375.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today with great pride and enthusiasm to submit a Senate Resolution Commemorating the 20th Anniversary of the founding of the Vietnam Veterans of America. This resolution has the cosponsorship of Senator Specter, Senator Akaka and Senator Leahy. The resolution also points out that April marks the 18th Anniversary of the founding of Vietnam Veterans of America's first local chapter in my home town of Rutland, Vermont. Mr. President, the VVA is a Congressionally chartered national veterans service organization exclusively dedicated to Vietnam-era veterans and their families. In the late 1970s, America had come through its longest and most divisive war. Many of the millions of veterans who served during that period felt that their concerns were not being addressed by the veterans community and by the federal government. In January, 1978, Bobby Muller and a small band of Vietnam veterans came to Washington, D.C. to create an advocacy organization to push for federal action to address the needs of this unique veteran population. The VVA, initially known as the Vietnam Veterans Coalition and then the Council of Vietnam Veterans, went to work focusing first on the dissemination of government information and coordination of relations between the federal government and the veteran. In time it became clear that, like many other organizations, this one could not survive simply by making a good case for its initiatives--it needed to build a strong membership base in order to wield political power. By the summer of 1979, the new Vietnam Veterans of America began to focus on building its membership. The growth of the organization was slow initially, but a breakthrough came following resolution of the American Hostage Crisis in Iran in January, 1981. It became clear to many Americans that if the hostages deserved a jubilant homecoming, so did the veterans of Vietnam. Vietnam veterans began to clamor for action in the form of programs that would place the last generation of wartime veterans on the same footing as veterans from previous wars. The strength of the organization grew with the increase in membership. The public also became more willing to deal with the neglected veterans issues unique to the Vietnam war. This culminated in the dedication of the Vietnam Veterans Memorial in November, 1982. The activities around the Memorial rekindled a sense of camaraderie among the veterans and the feeling of a shared experience too significant to ignore. Since then, the VVA has made great strides in the kinds of services it provides to its membership, including the founding of the Vietnam Veterans of America Legal Services that provides assistance to veterans seeking benefits and services from the government. VVA has also published critical information around benefits for Post-Traumatic Stress Disorder and Agent Orange illnesses. I can personally vouch for the incredible efforts of people like Albert and Mary Trombley, Jake Jacobsen, Dennis Ross, Clark Howland, and of course the late Mike Dodge and Don Bodette to establish and foster the growth of grassroots organizations like Chapter 1 in Rutland, Vermont. This individual leadership has ensured a steady growth in VVA's size, stature, and prestige. The legislative accomplishments of the VVA through its high-profile presence on Capitol Hill have been impressive. Organizations like Vietnam-era Veterans in Congress, which now boasts 70 members, have served the overall membership well by supporting the pragmatic agenda of the VVA and sticking to its founding principle that ``Never again will one generation of veterans abandon another.'' Today, the VVA has a national membership of 51,000 with more than 500 chapters. VVA state councils in 43 states coordinate the activities and programs of its national organization, ensuring that grassroots input to Congress continues to ensure that the federal government meets its obligations to its Vietnam veterans. Mr. President, this Resolution expresses the Senate's gratitude to the organization for its advocacy for its members and wishes it continued success in the years to come. Resolved,

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I urge my colleagues to vote in favor of this amendment. It originally was a second-degree amendment to the Kennedy amendment. I understand that the Senator from Massachusetts agrees with our amendment. I appreciate that. But I point out that what we are doing now is trying to make sure that our health care system does what we want it to do, trying to make sure that it is fair to patients and trying to make sure that we provide what is necessary for us to improve the system that is now having some problems. I urge my colleagues to vote in favor of this amendment. An important and necessary role for the Federal Government is to foster a competitive marketplace by ensuring that efficient and similar information about the product is available to consumers. Consumers can make their choices according to their own personal beliefs. Another role is to ensure fairness, and this amendment provides that. I urge Members to vote for it. Mr. KENNEDY addressed the Chair.

Mr. JEFFORDS. Mr. President, I rise today to commend Majority Leader Lott, Chairman Domenici and the members of the Budget Committee for putting together a balanced fiscal blueprint for the Federal Government. The federal budget consists of more than 1,060 spending accounts that fund an estimated 113,000 programs, projects, and activities. The federal budget and a Congressional budget collapse these accounts into twenty budget functions. It was not too long ago that we talked about the ever-increasing deficit and the need to for fiscal restraint of these functions. Under this resolution, the budget would be balanced three years earlier than the Fiscal Year 2002 deadline set out in the Balanced Budget Agreement of 1997. The budget we will be voting on provides for the first surplus in a generation. After reaching a peak of $290 billion in 1992, the unified budget deficit has declined to where the Congressional Budget Office projects a surplus in the current fiscal year of nearly $8 billion. Current laws and policies left unchanged, and real economic growth averaging 2.2 percent annually, the unified budget surplus is projected to grow to $67 billion by 2002. The budget achieves this surplus while also increasing spending by 3.6 percent over last year. Even though the budget calls for increased spending, it maintains the principles of the Balanced Budget Agreement of 1997. This budget we have before us today embraces a bipartisan approach of protecting federal programs while preserving the principles of fiscal discipline. Mr. President, Chairman Domenici has increased funding in some of the programs that are important to me as Chairman of the Labor and Human Resources Committee. The budget provides an additional $15 billion for the National Institute of Health, $5 billion for the IDEA educational programs, and $5 billion for Child Care Block Grants. The budget provides funding for the $214 billion Intermodal Surface Transportation Efficiency Act that the Senate passed on March 12, 1998. The State of Vermont would average $118 million a year in highway money and $2.5 million for mass transit projects through 2003. Vermont will be able to use funds to reconstruct aging rail lines, repair bridges, and improve major roads throughout the state. Mass transit funding will go to small-town bus systems and minibuses for disabled and handicapped people in rural areas. Mr. President, even though this budget provides additional funding on programs that are very important to me, we still have many challenges ahead. The Federal Government still has a $5.5 trillion debt. In Fiscal Year 1998, the Federal Government will spend about $250 billion on interest on the national debt. One out of every seven dollars in taxes goes simply to pay off the bondholders. This money gets diverted from important programs that the Federal Government provides. The Clinton Administration said that without enactment of any budget agreement, debt would have approached $7 trillion by 2002. Mr. President, there is $14 trillion in unfunded obligations for the retirement and health care benefits of the Baby-boomer generation. That generation is now just ten years away from starting to impose its unprecedented burdens on its children and grandchildren. We as a nation need to begin to agree on a way to ensure the health care and retirement security of the Baby-boomer generation retirees. The economy of the United States is booming and inflation has all but vanished. Unemployment is low and federal budget will be balanced for the first time in 30 years. This budget provides the building blocks to meet the challenges that lie ahead. I call upon my colleagues to build upon the work over the last decade at both ends of Pennsylvania Avenue and support this budget resolution.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, today, I join with my good friend Senator Christopher Dodd, in announcing the introduction of the Health Care Personal Information Nondisclosure Act of 1998--The Health Care PIN Act. This legislation will establish necessary national standards to protect the confidentiality of each American's medical records. Information technology presents our nation with the difficult challenge of ensuring that we reap its benefits without sacrificing one of our most important values: the right to individual privacy. In order to maintain control over our personal medical information, Congress must pass health care confidentiality legislation--as quickly as possible. The time is ripe for action. There have been major technological advances in health care's administrative, delivery, and payment systems. These advances have the potential to improve the quality of patient care. For example, electronic pharmaceutical records make it possible for pharmacists to identify potential drug interactions before filling a prescription. However, we must also have guarantees that our personal health care information is not being used inappropriately. Congress has made repeated attempts to enact a comprehensive federal privacy law but has, to date, been unsuccessful. The loose web of protections at the federal and state levels that has evolved in the absence of a comprehensive law leaves many aspects of health information unprotected. The Health Care PIN Act represents a synthesis of recommendations from many sources. It draws heavily from the discussion draft that I worked on with Senator Bennett and the ``Medical Information Privacy and Security Act,'' introduced by Senator Leahy and Senator Kennedy. The Labor and Human Resources Committee has held three hearings on the confidentiality of health care information, and the testimony and comments provided at each of those hearings has been invaluable-- especially, the administration's recommendations presented by Secretary Shalala in September. Under the terms of the Kassebaum/Kennedy legislation, if Congress fails to enact federal privacy legislation by August 1999, the Secretary of Health and Human Services is required to promulgate regulations establishing electronic privacy standards in the year 2000. This is too important a matter of public policy to be done outside of the legislative process and it is another reason why I intend to make this task one of the highest priorities of the Labor and Human Resources Committee. Other nations have taken steps to protect patient privacy. In 1995, the European Union enacted the Data Privacy Directive. The EU Directive requires that individuals have rights of consent, access, correction, and remedies for failure to protect confidential personal information. This Directive requires that by October 1998, if countries trading with any of the 15 European Union member states do not introduce similar rules, data cannot be transmitted between these countries. If we do not act promptly, this initiative raises the concern that the European Union could limit the flow of health care data between our countries for research and restrict the ability of American companies to compete overseas. The Health Care PIN Act would preempt state laws relating to medical records confidentiality--with the important exception of public health issues and those areas having a history of discrimination, such as mental health and HIV-AIDS. Since most health plans exchange health care information over the borders of many states, we need one privacy standard in this county--rather than 50 different ones--in order to achieve the greatest benefits from information technology and also ensure that all Americans have a uniform standard of privacy protection. The Act requires that individually identifiable health care information not be released unless authorized by patient consent. With very few exceptions, individually identifiable health care information should be disclosed for health purposes only, which includes the provision and payment of care and plan operations. Under the legislation, patients would have the right to copy and correct their medical records. In order to achieve accountability, the Health Care PIN Act provides that civil and criminal penalties would be imposed on individuals who use information improperly through unauthorized disclosure. Our individual right to privacy at times must be balanced against the need to protect the health of others. The Health Care PIN Act allows for the disclosure of health information without patient consent for the release of information to public health authorities for disease reporting. In addition, patient consent would not be required to disclose information needed for legitimate law enforcement purposes, including purposes required by state law such as the reporting of gunshot victims. Quality care requires more than the free flow of information between providers, payers, and other users of health information. It requires trust between a patient and a care giver. For our health care system to be effective, as well as efficient, patients must feel comfortable sharing sensitive information with health professionals. Technology has provided the tools to allow the ease of access to health care information. Now, the Health Care PIN Act is needed to ensure the confidentiality of this personal health information. It is my intent to work closely with the other members of the Labor and Human Resources Committee, and Senators Bennett and Leahy, to enact legislation this year that will establish national standards to protect medical information and enhance quality of health care for all Americans.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to congratulate the Vermont State Housing Authority on its 20th Anniversary of providing Vermonters with access to affordable housing. On March 23, 1968, the Vermont State Housing Authority (VSHA), the nation's first statewide housing authority, was established to ensure that Vermonters have access to affordable housing. Over many years of initiative, dedication, and innovation, the VSHA has aggressively and compassionately pursued opportunities to make housing more accessible and affordable for Vermont's neediest families. I celebrate and extend my congratulations to VSHA. As a Senator, my highest priorities focus on the essentials for each citizen--economic security, quality education, health care, and meaningful work. We all know that a home is a critical foundation for a successful journey through life. Every year VSHA helps Vermonters build this foundation by providing housing services that reach more than 5,300 families. From mobile home park residents to senior citizens, VSHA serves a wide range of clients. Over the years, VSHA has emphasized neighborhood reinvestment initiatives that provide essential supports needed to shape healthy, safe communities so its residents can thrive. The professionalism, reliability, and accomplishments of the staff at VSHA are unsurpassed. Aware of the needs and hopes of Vermonters, the VSHA staff work tirelessly to preserve and create hopeful environments for Vermonters. Mr. President, I commend the Vermont State Housing Authority for its outstanding contribution and dedication to improving the quality of life for Vermonters. I am both proud and honored to represent such an accomplished group of individuals here in Washington as they are a national model for how to provide affordable, quality housing opportunities for those in need. I express my sincerest thanks for VSHA's 20 years of commitment to Vermont and her people. Their continued leadership and drive will continue to ensure that every Vermonter has a place to call home.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, Vermont has a long-standing reputation of having the most valiant regiments to be dispatched to the Union Army during the Civil War. Vermonters not only fought bravely for the preservation of the Union and for an end to slavery, they made vital contributions to many important battles. The Union Army was at a great advantage when they were lucky enough to have Vermonters fighting by their side. Mr. President, I rise today to pay tribute to Howard Coffin, a Vermonter who has lead the fight for the preservation of this country's hallowed grounds. I am pleased and honored that Howard Coffin will receive the Vermont Civil War Council's ``Full Duty" award for his dedication and accomplishments in preserving and understanding of our nation's most cherished and sacred lands. Preserving our nation's battlefields is very important to me and a subject very close to Howard's heart. Several years ago I had the privilege to travel with Howard, who is well known as the most prominent Civil War tour guide in Vermont, from battlefield to battlefield. We relived Jackson's battles of the 1862 campaign and retraced the Union campaign of 1864. From that day on I have shared Howard's passion and interest in this country's sacred past. Fortunately for me and this country, Howard took the lead as a member of my staff to find out all we could about the battlefields and what was needed to safeguard this nation's Civil War heritage. It quickly became apparent that the Civil War battlefields were in need of protection. Howard was instrumental in drafting and helping pass important legislation which led to eventual passage of the Shenandoah Valley Battlefields Commission and the Civil War Sites Advisory Commission. A leader in the effort to preserve Civil War battlefields, Howard has served on the boards of the Association for the Preservation of Civil War Sites and Protect Historic America and served as member of the Civil War Sites Advisory Commission. He has published several books on the Civil War, including ``Full Duty'' and his most recent, ``Nine Months to Gettysburg,'' which tells the story of the Second Vermont Brigade. He also organized the first ever fundraiser for battlefield preservation in Vermont generating over $10,000 for the protection of the battlefield of the 3rd Winchester where Vermonters fought and died so valiantly. Mr. President, the American Civil War is thought by many historians to be the fundamental event shaping the character of the United States. However, battlefield sites that are vital to understanding and appreciating our nation's history are in grave danger. This country is lucky to have Howard Coffin on its side, because he will not rest until every field, hill, dam, valley, and woods in this country that has been saturated with the blood of soldiers who fought so bravely are protected and recognized. I am grateful for the foresight and dedication of Howard Coffin and congratulate him on his acceptance of the ``Full Duty'' award.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to pay tribute to David Murray, a well known and certainly well regarded patient advocate at the Veterans' Administration (VA) in White River Junction who is leaving the great state of Vermont to relocate to the state of Washington. Although I question why anyone would willingly opt to move from the most beautiful state in the union, I must concede that Washington state is probably a close second in terms of beauty and quality of life. I certainly wish Dave well as he embarks on this exciting venture, though life at the Veterans' Administration hospital will never be quite the same without him. Each day he goes beyond the call of duty in his never-wavering advocacy for veterans. He provides veterans and their families with their crucial link to understanding and moving through the system. Dave is probably the most sought after person at the VA and I would venture a guess that he receives more ``pages'' in one hour than most VA doctors receive in an entire day. Service is a word that Dave knows well. He served honorably in the Marine Corps during the Vietnam War, continued his federal service for the next 20 plus years culminating in his current job as Patient Advocate at the VA hospital in White River Junction. He is a member of the Disabled American Veterans, the Veterans of Foreign Wars and the American Legion and involved himself in his community as a boy scout leader. It is my understanding that Dave, when he's not working or wearing one of his many service hats, actually enjoys camping, canoeing and gardening. Mr. President, I would like to publicly recognize Dave's outstanding contribution to his fellow veterans and wish him and his wife Diane the very best in their change of venue. I would ask them to remember that if they ever decide to come home to Vermont, we will leave the light on.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to pay tribute to the Goodrich Memorial Library in Newport, Vermont as it recalls 100 years of community service. On May 2, 1998 the Goodrich Memorial Library will kick off a year-long celebration with a wide array of activities for people young and old. Converse and Alvira Goodrich donated their entire estate so that Newport Village could construct and maintain a new town library. Architect George Story's vision became reality when the doors were opened and a ceremony held to dedicate the new library on September 1, 1898. An extremely ornate Victorian building, the Goodrich Memorial Library houses a wealth of information for those interested in Vermont history. In one of its rooms, the library maintains an archive of local newspapers dating back to the 1800s and early 1900s. The Goodrich Memorial Library not only serves as a resource for information, but also as a critical bond in the community. It brings people together for cultural events and as a shared experience it provides a link between generations. It is a reminder of the town's long and proud history, one that I hope will continue for years to come. Once again, I would like to congratulate the Goodrich Memorial Library on its centennial anniversary and wish them the best of luck in the next century of service.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, today, I join with my good friend Senator Christopher Dodd, in announcing the introduction of the Health Care Personal Information Nondisclosure Act of 1998--The Health Care PIN Act. This legislation will establish necessary national standards to protect the confidentiality of each American's medical records. Information technology presents our nation with the difficult challenge of ensuring that we reap its benefits without sacrificing one of our most important values: the right to individual privacy. In order to maintain control over our personal medical information, Congress must pass health care confidentiality legislation--as quickly as possible. The time is ripe for action. There have been major technological advances in health care's administrative, delivery, and payment systems. These advances have the potential to improve the quality of patient care. For example, electronic pharmaceutical records make it possible for pharmacists to identify potential drug interactions before filling a prescription. However, we must also have guarantees that our personal health care information is not being used inappropriately. Congress has made repeated attempts to enact a comprehensive federal privacy law but has, to date, been unsuccessful. The loose web of protections at the federal and state levels that has evolved in the absence of a comprehensive law leaves many aspects of health information unprotected. The Health Care PIN Act represents a synthesis of recommendations from many sources. It draws heavily from the discussion draft that I worked on with Senator Bennett and the ``Medical Information Privacy and Security Act,'' introduced by Senator Leahy and Senator Kennedy. The Labor and Human Resources Committee has held three hearings on the confidentiality of health care information, and the testimony and comments provided at each of those hearings has been invaluable-- especially, the administration's recommendations presented by Secretary Shalala in September. Under the terms of the Kassebaum/Kennedy legislation, if Congress fails to enact federal privacy legislation by August 1999, the Secretary of Health and Human Services is required to promulgate regulations establishing electronic privacy standards in the year 2000. This is too important a matter of public policy to be done outside of the legislative process and it is another reason why I intend to make this task one of the highest priorities of the Labor and Human Resources Committee. Other nations have taken steps to protect patient privacy. In 1995, the European Union enacted the Data Privacy Directive. The EU Directive requires that individuals have rights of consent, access, correction, and remedies for failure to protect confidential personal information. This Directive requires that by October 1998, if countries trading with any of the 15 European Union member states do not introduce similar rules, data cannot be transmitted between these countries. If we do not act promptly, this initiative raises the concern that the European Union could limit the flow of health care data between our countries for research and restrict the ability of American companies to compete overseas. The Health Care PIN Act would preempt state laws relating to medical records confidentiality--with the important exception of public health issues and those areas having a history of discrimination, such as mental health and HIV-AIDS. Since most health plans exchange health care information over the borders of many states, we need one privacy standard in this county--rather than 50 different ones--in order to achieve the greatest benefits from information technology and also ensure that all Americans have a uniform standard of privacy protection. The Act requires that individually identifiable health care information not be released unless authorized by patient consent. With very few exceptions, individually identifiable health care information should be disclosed for health purposes only, which includes the provision and payment of care and plan operations. Under the legislation, patients would have the right to copy and correct their medical records. In order to achieve accountability, the Health Care PIN Act provides that civil and criminal penalties would be imposed on individuals who use information improperly through unauthorized disclosure. Our individual right to privacy at times must be balanced against the need to protect the health of others. The Health Care PIN Act allows for the disclosure of health information without patient consent for the release of information to public health authorities for disease reporting. In addition, patient consent would not be required to disclose information needed for legitimate law enforcement purposes, including purposes required by state law such as the reporting of gunshot victims. Quality care requires more than the free flow of information between providers, payers, and other users of health information. It requires trust between a patient and a care giver. For our health care system to be effective, as well as efficient, patients must feel comfortable sharing sensitive information with health professionals. Technology has provided the tools to allow the ease of access to health care information. Now, the Health Care PIN Act is needed to ensure the confidentiality of this personal health information. It is my intent to work closely with the other members of the Labor and Human Resources Committee, and Senators Bennett and Leahy, to enact legislation this year that will establish national standards to protect medical information and enhance quality of health care for all Americans.

Mr. JEFFORDS

Mr. JEFFORDS. Finally, I will talk to another matter which will have an impact upon the budget also. Hopefully, CBO comes up with figures you like; these figures are so small in terms of what the good is we should find no cause for alarm here. I rise to discuss an issue that is critically important to this Nation. Today there are millions of people with disabilities who want to work but just cannot. Why? Because the day they start work they lose access to affordable health insurance. These bright, intelligent, and very willing individuals are denied the right that every other citizen in this Nation has--the right to work. We have the responsibility to reverse this desperate situation and grant people with disabilities the right to become productive, taxpaying workers. Last week, I introduced legislation with Senator Kennedy and Senator Harkin entitled the Work Incentives Improvement Act. This bill will reform Social Security's work incentive programs and remove employment barriers for people with a disability. This legislation was developed over many months with the help of the disability community, the Social Security Administration, the Health Care Financing Administration and other congressional offices. This bill will end the insurmountable health barriers to individuals who wish to work. Our friends with disabilities do not need an incentive to work. They want to work. In fact, they are so desperate to obtain gainful employment that they are pushing this Congress to complete action on this legislation this year. And we must. These citizens are trapped by a system that penalizes their attempts to be productive. Social Security's current work incentive system has had limited success. Out of 7.5 million people who are social security disability beneficiaries, less than one percent can take advantage of these work incentives and actually are employed. The benefits offered are too expensive, time limited, and offer too few health care services for the many persons with disabilities who wish to work. For many years I have assessed why so few disabled social security beneficiaries return to work. The primary barriers relate to their inability to obtain or keep adequate and affordable health care coverage. For example, disabled social security beneficiaries who return to work are covered through Medicare, but after 39 months they must pay full fare for their health benefits--more than $370 every month. I seriously doubt that even a well-off person can afford to pay this rate every month over the course of their working life. In fact, out of more than 3.5 million beneficiaries, only 114 have chosen to take advantage of this Medicare coverage, preferring the alternative-- staying at home and receiving it for free. I don't know whether they prefer it; that is probably not right. Another barrier to work is the inability to get coverage for certain medical services. These services are usually unavailable in the private markets. If they are available, they are unaffordable. Necessities like personal assistance services and prescription drug coverage are offered through some state Medicaid plans, but disabled social security beneficiaries who need access to these Medicaid services must impoverish themselves to get them. Many are doing just that. These disabled social security individuals who have coverage for low-income Medicaid, called ``dual eligibles,'' are the fastest growing entitlement population in the government. The Work Incentives Improvement Act will provide access to appropriate health insurance for those persons with disabilities who wish to return to work. Many of these beneficiaries will be eligible for affordable Medicare. Beneficiaries will have access to limited Medicaid services through State Work Options Programs. They will be able to access critical services like Personal Assistance and prescription drugs in states that chose to offer them. Such incentives will allow people to return to work, confident in the knowledge that they will both keep their health care and get coverage for other needed services. No one in this body can disagree with the idea that work is a central part of the American dream. This budget resolution should provide funding for these and other initiatives designed to allow people with disabilities to work. Providing cost-effective assistance for people to work is both fiscally responsible and morally right. Those who work will become fully contributing members of society by paying for their own insurance coverage, and as taxpaying citizens of our nation, paying for these government programs as a whole. Inaction by this body will ensure that our Government continues to deny a person's dream to get back to work to help himself, to help herself, to pay taxes, to be able to participate in our society in a meaningful way. I hope the Senate will move ahead to resolve this problem and help persons with disabilities realize their dream to work. I wish everyone had a chance to be at the press conference we held with former leader Bob Dole and Justin Dart and other leaders in this field to see the expression on their faces and the joy that came when we announced what we would do to help those who were assembled to be able to participate in the workplace. I can assure Members that this bill--we have had CBO estimates much lower than previous estimates. It is hard to conceive why it costs money because all you are doing is allowing people benefits to work and to start paying taxes and to contribute to the cost. It is very difficult for me to see how there is any cost whatever. I yield the floor.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I will be introducing a bill today in relation to the changes that we have worked on with members, of course, of both parties in our committee with respect to the higher educational programs. There is nothing more important to this Nation than maintaining our international superiority as the country with the best higher education. That is the reason this Nation is where it is today. And if we allow that to sink, as we have allowed our k-12 to sink, then, Mr. President, we will be sliding down, in the next century, to a position of lesser importance. I am introducing the bill today--with Senators Kennedy, Coats, and Dodd--the Higher Education Amendments of 1998. This legislation is a product of work begun by the Committee on Labor and Human Resources over a year ago. The Higher Education Act is among the most significant statutes under the jurisdiction of the committee. Since its inception in 1965, the act has been focused on enhancing the opportunities of students to pursue postsecondary education. The grant, loan, and work-study assistance made available by this act has made the difference for the countless millions in pursuing their dreams for a better life. At the start of the reauthorization process, we set out to achieve a number of important goals designed to strengthen these programs. I am pleased to say that this legislation achieves the five major objectives identified at the beginning of our efforts. First, the bill preserves the focus on students, who are the prime reason we have a Higher Education Act in the first place. Students now in school will be assured of receiving a lower interest rate on their loans and will see less of their own earnings penalized with respect to the Pell grant awards they receive. Students now in high school who aspire to a college education will continue to benefit from early intervention programs, including the National Early Intervention Scholarship Program--NEISP--and TRIO. Students who have graduated and are faced with exceptionally high loan burdens will be able to take advantage of extended repayment options under the Guaranteed Student Loan Program. Second, the bill takes a two-pronged approach to helping our Nation's elementary and secondary school teachers. They will be thoroughly prepared to offer the quality of instruction needed to assure that students achieve the standards we need and expect. Working at both the State level to promote system-wide reforms and at the local level to develop partnerships to enhance the quality of teacher training, the bill offers a comprehensive and systematic approach to this pressing national need. No longer will the Higher Education Act contain a collection of small, unfunded teacher training programs. Rather, the good ideas represented in these proposals--along with the many useful suggestions made by members of the committee--have been shaped into a broad approach. It is an approach which I hope will command the attention and support of Congress when we turn to the appropriations bill. Third, the bill reflects a strong commitment to the maintenance of two viable loan programs--the guaranteed or Federal Family Education Loan Program, known as FFELP, and the Direct Loan Program. To the extent possible within budgetary constraints, the bill levels the playing field to assure the continuation of fair and healthy competition between the two programs. Fourth, the bill takes important steps to improve the delivery of student assistance programs. In cooperation with the administration, we have developed a performance-based organization--a PBO--designed to strengthen the management of key systems with the Department of Education. A number of provisions in the legislation also pave the way toward taking advantage of efficiencies made possible through electronic processing and other technological advances. Finally, we have made every attempt to streamline programs, including the streamlining of the act itself. This bill takes nearly 50 programs off the books--off the books--and cuts in half the number of titles in the act. We have also attempted to relieve the regulatory burden on program participants while protecting the strong and effective integrity provisions included in the 1992 reauthorization. Perhaps one of the most difficult issues to resolve has been the change in the student loan interest rate scheduled to take effect on July 1 of this year. This has, of course, been a strong concern of the Budget Committee. This legislation adopts the proposal approved a few weeks ago by the House Committee on Education and the Workforce. For several months, Members of the House and the Senate have grappled with the issue. The dilemma has been to balance the desire to offer students the lowest possible interest rate while assuring an uninterrupted flow of loan capital so that borrowing will be possible. All analysts have concluded that allowing the scheduled rate to go into effect will mean the demise of the FFEL program. That outcome is unacceptable, given the substantial likelihood of program disruption. The Direct Loan Program, which now handles only 30 percent of total loan volume, simply is not in a position to pick up the slack. To do anything to interrupt the ability of our young people to participate in the FFEL program would be a disaster at this time. The solution offered by the House committee included in the bill is by no means perfect. Like Winston Churchill's comments about democracy, however, I say: This proposal is the worst possible option, except for all others. I am extremely appreciative of the hard work which my colleagues on the committee put into the development of this bipartisan bill. The committee will be considering this measure on Wednesday, and I hope that the full Senate will have the opportunity to debate it in the near future. Mr. President, I ask unanimous consent that a summary of the bill be printed in the Record.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I would like to announce for information of the Senate and the public that a hearing of the Senate Committee on Labor and Human Resources will be held on Thursday, April 2, 1998, 10:00 a.m., in SD-430 of the Senate Dirksen Building. The subject of the hearing is Metered Dose Inhalers. For further information, please call the committee, 202/224-5375.

Mr. JEFFORDS. Mr. President, I would like to announce for information of the Senate and the public that an executive session of the Senate Committee on Labor and Human Resources will be held on Wednesday, April 1, 1998, 1:30 p.m., in SD-430 of the Senate Dirksen Building. The following is the committee's agenda. 1. S. 1882, Higher Education Act Amendments of 1998. 2. S. 1754, the Health Professions Education Partnerships Act of 1998. 3. Presidential nominations. For further information, please call the committee, 202/224-5375. committee on indian affairs