Jim Jeffords

Mr. JEFFORDS

Mr. JEFFORDS. Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. JEFFORDS. Madam President, I am here today to discuss aspects of the budget. Today we continue the discussion on our 1999 budget, and I am generally pleased with the work that the committee has done. I am generally optimistic about our country as we progress, but today I wish to place an emphasis on education with a special emphasis on the congressional responsibility for the education of the children of the District of Columbia, the Nation's Capital. In 1995, when the Republicans took over the leadership role in Congress, I became chairman of the subcommittee responsible for education on the Labor and Human Resources Committee. I also, as No. 13 in seniority on the Appropriations Committee, became the subcommittee chairman on the DC Appropriations Subcommittee. Although I left the Appropriations Committee in 1997 to go to the Finance Committee, I vowed to continue my work for the schoolchildren of the District. I did so to follow through with the work I helped start in 1996, with the writing of the new education plan for the District. Also, when I became chairman of the Labor and Human Resources Committee, I believed I had a special obligation for education in the District of Columbia. The Constitution, through the District clause, confirmed by the Supreme Court, endows in Congress the same powers over the District of Columbia that a State has--not only powers but responsibilities. Thus, Congress is responsible under the Constitution for the District's education. We must not forget that. As Republicans, we believe strongly that State and local governments are the key players in establishing education policy. This conviction works beautifully for every State in the Nation except for the Nation's Capital. What an irony. We, as Republicans in leadership of this Congress, have not fully recognized that under the Constitution we must act as both the State entity for the District and the local governing entity for education. In 1996, Congress did recognize that the District's educational system was indeed in trouble; in fact, the whole city was in deep trouble. The control board was established to help the District's education crisis. The present DC education reform plan was written in the 1996 appropriations bill with assistance from Congressman Steve Gunderson, who had strong support from the Speaker, and also with the help of the then-Senate majority leader, Bob Dole. The implementation of this plan began in earnest under the leadership of General Becton and continues under Chief Academic Officer Arlene Ackerman. They recently gave a nationally known student achievement test to evaluate basic student performance in the District. It clearly established a severe problem. The Nation's Capital, for which we are constitutionally responsible, has the worst educational results in the country, including the worst student dropout rate of close to 40 percent. In addition, through decades of neglect, the District of Columbia has one of the worst school infrastructure problems in the Nation. GSA found that $2 billion of repairs and improvements are needed. When I took the chairmanship of the DC Appropriations Subcommittee in 1995, I immediately met with the superintendent, then-Superintendent Franklin Smith, who was a member of the DC school board. They all had great intentions and great plans. And, in fact, they had great plans and great intentions for many years, but evaluation results got worse, not better. This was true even though teachers were teaching to the same tests they had been using since 1978. They told them what the tests were going to be. It was obvious that the superintendent of the school board had no control over the system. The control board had been established realizing the dimension of the problem. This is back in 1996. They knew that the firm leadership with appropriate authority had to be established. In my mind, the board very wisely chose two generals to answer that challenge--General Williams as financial officer and General Becton as superintendent. In my opinion, the generals, with considerable personal sacrifice, performed admirably, and ably. We are indebted. In particular, General Becton is a unique individual. He is 70-plus, but looks 50, and has the energy of a 40-year-old. He is personable and tough. Although not primarily an educator, his accomplishments as president of Prairie View A&M University proved his ability in this field. He got the job done. They both got the job done. The generals had to kick a lot of butts. Friends are not made that way, wounded critics are. But they got results. Per-pupil costs are down to within the average in the Washington metropolitan region, a constant source of irritation with many Members who claim they add all this money. They do not anymore. Personnel numbers had been reduced. Many inefficient managers were replaced. The congressionally enacted school reforms are being implemented. Tough decisions, such as ending social promotion, have been made; and that is a tough one. This, of course, has created a great need for remedial help for tens of thousands of kids who must improve to warrant graduation. A most qualified chief academic officer, soon to be superintendent, Arlene Ackerman, has been hired. The challenges before her are daunting. The dimension of the remedial help required for ending social promotion, not only in Washington but nationwide, has not yet been fully appreciated. She will need our help. She must have our help. As mentioned above, the education infrastructure is in a shameful condition after decades of neglect, requiring $2 billion worth of improvements. Fortunately, Parents United had been formed some time ago and has brought a lawsuit to enforce corrective action. Unfortunately, after Generals Williams and Becton had initiated their plans for school repairs, and finally having funding available in a manner that would not have required any closing of the schools, the judge, in her frustration, ordered the schools closed anyway. This caused emergency actions in contracting to get the schools opened and raised the costs considerably. I was present with the control board education trustees the night this happened. They did what they had to do. In fairness to the judge, her frustration, expressed in her ruling, raised the public's awareness to the deplorable condition of the schools. But where will the $2 billion needed for repairs come from? Congress is responsible for making it available. This may require money from the budget, it may not, but it has to be found. Bonding is obvious, but how is it to be paid for? This January, I held hearings on the DC school situation. I have attached Professor Raskin's applicable testimony that the Constitution requires us to find the funds. At the beginning of 1997, I left the Appropriations Committee and went to the Finance Committee. I vowed to continue to fight for funds for DC. During reconciliation, I nearly got an amendment for $1 billion passed in the committee. The Senate did provide $50 million for the repairs of the Washington, DC, schools--a small amount, relatively, to the $2 billion. In conference with the House, at the House's insistence, the $50 million was cut. But OMB Director Frank Raines agreed to work with me to find the money. He asked me to put together a working group. This has been done. To help prepare material for the working group, I held three days of hearings in January. Material from these hearings has been forwarded to the members of the working group. I have also outlined several options for the working group's consideration. Some require no Federal funds; others are completely Federally funded. Somewhere we have to find the answer. I hope we can furnish guidance soon. I have attached materials showing the need for congressional action, as the DC financial system under present circumstances cannot provide a sufficient revenue stream to pay for bonds. Let us end on a positive note. Progress is being made to improve the DC school system. I recently traveled to Chicago with General Becton. I also traveled to Long Beach, CA, with Arlene Ackerman. These school systems are examples of sound reform where corrective action is being taken. We learned a great deal on these trips. And work is starting here. First, we must make sure children can read and comprehend. Programs such as Everybody Wins!, a literacy-mentoring program I am deeply involved with, have been started, helping thousands of youngsters. Hundreds of our volunteers come from the Senate, and they have been doing a wonderful job in bringing the reading situation in that school under control, but thousands more are needed to help. The flow of nonreaders to upper grades must stop. Substantial growth here is expected by next year in these programs. There are two others called the President's Program for Reading and also another one called the Everybody Reads Program started by the District. To help the students ``in the pipeline,'' summer schools will be held. The second thing: A group to find remedial solutions through information technology has been formed. Much needs to be done. No. 3, legislation has been introduced, S. 1070--my bill--to form regional efforts in skill training, giving an opportunity for those young people to be able to get those $30,000 to $50,000 jobs, high- paying jobs, that are available and can be filled. No. 4, I also met with the presidents of regional universities and colleges to work together with the business community to form a cohesive, seamless educational system, for which the comprehensive framework should be established by the end of May. And that is critical. We have the resources in this region, we have the people in this region, but we must work together to all do what we can for the school system. No. 5, the critical needs for in-service training of teachers must be met. The Department of Education and the local teacher colleges are pledged to help. I just met with some from the Department of Education. The Higher Education Act soon will be out on the Senate floor, and that will help, also across the Nation, to assist us with respect to the serious problems we have with our schools not having the professional development necessary. Let me close by emphasizing that our problems in education will end only when the classrooms provide the appropriate education. This is a primary responsibility of the States and local school districts. Just remember, as for DC, under the Constitution, DC is our ``State.'' And we are responsible for our local schools, those in the Nation's Capital. Right now, we have the worst schools in the Nation. They must and they should be the best. Madam President, at this time I would like to turn to another education issue dealing with the budget also, and I just alert the Budget Committee as to what is being done. (The remarks of Mr. Jeffords pertaining to the introduction of S. 1882 are located in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, 2 months ago I informed the Senate about an ice storm that hit sections of the northeast in early January with such force and destruction it was named the ice storm of the century. I am pleased to support S.1768, the Emergency Supplemental Appropriations of 1998, to help bring much needed relief to citizens in not only the Northeast, but other areas of the country who have suffered from natural disaster. Mr. President, for two days straight, freezing rain, snow and sleet battered the Champlain Valley of Vermont, upstate New York, parts of New Hampshire and Maine and the Province of Quebec. Tens of thousands of trees buckled and shattered under the stress and weight of several inches of ice that coated their branches. Power lines were ripped down by falling branches and the weight of the ice--leaving hundreds of thousands of people without electricity for days and even weeks. Roads were covered with ice and rivers swelled and overflowed from heavy rain. The crippling ice storm brought activity in the area to a grinding halt. Just a few days after the storm, Senator Leahy and I visited the hardest hit areas of Vermont. The storm's damage was the worst I have ever seen. In the Burlington area twenty to twenty-five percent of the trees were toppled or must be chopped down. Another twenty-five percent were damaged. The storm also destroyed sugarbushes and dropped trees across hiking trails and snowmobile trails. Mr. President, local and State emergency officials acted quickly to help their fellow Vermonters and assess the damage. Vermonters rallied, with the help of the National Guard, to help themselves and their neighbors. As the temperatures dropped below zero, days after the storm, with thousands still without power, volunteer firefighters, police officers, national guard troops and every able bodied citizen came together working day and night to help feed, heat, and care for the people in their community. The organized and volunteer responses to this disaster were incredible. Stories of Vermonters helping Vermonters were commonly told throughout the disaster counties and state. Hardest hit were dairy farmers. Already struggling to make ends meet due to low milk prices, the ice storm left farms without power to milk their cows. During the first few days of the storm the majority of the milk had to be dumped. Milk became non-marketable because it could not be sufficiently cooled or it could not be transported to the processing plants. Farms without generators missed milkings all together or significantly altered the milking schedules. As a result, cows became infected with mastitis and reduced production. In addition, cows became infected with respiratory illnesses due to poor air circulation in the barns. Even farms with generators were affected. Since the power was out for such a long duration the generators could not provide adequate wattage to precisely run the milking systems, resulting in mastitis and loss production. The major impact on dairy farms as a result of the ice storm was non- marketable milk and production loss. The loss of even one milk check for many of the farms will have an adverse impact on their business. Current milk prices are not sufficient to offset such losses. Mr. President, I am pleased that my colleagues on the Appropriations Committee have worked with me and others in the disaster areas to recognize and respond to the needs of the affected regions. The 1998 Emergency Supplemental Appropriations will bring much needed relief to Vermont's most severely affected areas. Dairy farmers will be compensated for production loss and loss of livestock. Maple producers will be helped by replacing taps and tubing. Land owners will be aided in clearing debris and replanting trees destroyed by the storm. Mr. President, the citizens and trees of Vermont, as well as upstate New York, Maine and New Hampshire have suffered from this storm. Local and State assistance will help communities and individuals get back on their feet, but Federal relief will ensure that the disaster areas are not overwhelmed by the recovery.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I want to speak first very briefly on the amendment offered by the Senator from Missouri that would help the disaster areas of the Northeast. First I want to commend the Senator from Missouri for helping the areas of the Northeast that were so punished by the recent problems with respect to the ice storms. Vermont suffered very significantly in the upper part of the State, but with the knowledge that we have with respect to what happened in New York and Maine which so far outpaced our problems, I can certainly commiserate with their need to have assistance, especially with respect to utilities, which have been greatly harmed by the weather problem.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, it is with great pleasure that I rise today, with my friend and colleague, Senator Edward Kennedy, to introduce the Work Incentives Improvement Act of 1998. This bill has developed over many months with the help of the disability community, the Social Security Administration, the Health Care Financing Administration and other Congressional offices to help the insurmountable health barriers to individuals who wish to work, but must remain dependent on the Social Security Disability system to continue to access needed health benefits provided by the Federal and State governments. Mr. President, the current system has had very limited success. 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. Currently, less than 5 percent of beneficiaries have taken advantage of this so called work incentive. Mr. President, I have worked for more than a year with Senator Kennedy to assess why so few SSI and SSDI beneficiaries return to work. We have found that the primary barrier is a lack of available health care coverage--this needed coverage is either unavailable or unaffordable in the private sector for those with disabilities. Specific barriers facing individuals with disabilities who want to work include an inability to obtain affordable health insurance through Medicare. After a period of time on the current SSDI work incentives program, the individual must pay full fare--more than $370 a month. We researched how many individuals take advantage of this and would you believe, Mr. President, that out of more than 3.5 million beneficiaries, only 114 have chosen to buy in to Medicare. People with disabilities simply cannot afford the coverage over more than a short period of time. Another barrier is that the critical services people with disabilities need are unavailable. Personal assistance services and drugs are available only through a state's Medicaid plan. SSDI beneficiaries do not have access to Medicaid unless they impoverish themselves to get it. When we looked into this we found that SSDI people who need Medicaid covered services, those so-called ``dual eligibles,'' are the fastest growing entitlement population in the government. For those SSI beneficiaries who have access to Medicaid, personal assistance services are covered in only half the states. Mr. President, our Work Incentive Improvement Act will provide incentives for persons with disabilities to return to work and still be able to access health insurance. It will ensure that an attempt to work, or an inability to remain working, does not penalize participants for future SSDI and SSI eligibility. Under our legislation, those SSDI applicants who want to return to work could access Medicare Part A for free. If their incomes rise above 250 percent of poverty they would buy-in based on 10 percent of earned income above 250 percent. Part B premium contributions would remain the same. They would also be able to access a new State Work Options Program that provides personal assistance services and prescription drugs to those states that chose to set one up. Long term disabled SSDI beneficiaries who have been receiving cash benefits for more than 24 months would be eligible for Medicare A&B for the same rates as described above, the State Work Options Program, and an expanded Impairment Related Work Expense to include the cost of automobiles in areas where accessible transportation is unavailable. Such an incentive would do much to keep an individuals income below SGA, and be more likely to keep their cash benefits. Persons with disabilities who are working under SSI's work incentive program would have access to the State Work Options Programs if they needed personal assistance services to begin working. The legislation also strengthens current State Medicaid Waiver projects that provide health services and supports to persons with disabilities who want to work. This legislation also supports the development of demonstration projects that gradually phase out the loss of cash benefits as a worker's income rises, instead of the current cash cut-off that so many disabled persons who return to work face today. Finally, this legislation will enable Congress to obtain the kind of information it needs to undertake more comprehensive reform of disability work incentive programs. Mr. President, no one in this body can disagree with the idea that work is a central part of the American dream. I am committed to ensuring this Congress that we pass legislation to provide cost- effective assistance to help disabled Americans pursue a career, and the American dream.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I would like to announce for the information of the Senate and the public that a hearing of the Senate Committee on Labor and Human Resources will be held on Tuesday, March 24, 1998, 10:00 a.m., in SD-430 of the Senate Dirksen Building. The subject of the hearing is Health Care Quality. committee on energy and natural resources

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 Tuesday, March 17, 1998, 10 a.m., in SD-430 of the Senate Dirksen Building. The subject of the hearing is retirement security. 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 Executive Session of the Senate Committee on Labor and Human Resources, will be held on Wednesday, March 18, 1998, 9:30 a.m., in SD-106 of the Senate Dirksen Building. The Committee will consider S. 1648, Preventing Addiction to Smoking among Teens (PAST) Act. 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 Executive Session of the Senate Committee on Labor and Human Resources, will be held on Thursday, March 19, 1998, 10:00 a.m., in SD-430 of the Senate Dirksen Building. The subject of the hearing is Health Insurance Portability and Accountability Act of 1996: First Year Implementation Concerns. For further information, please call the committee, 202/224-5375. subcommitte on national Parks, historic preservation and recreation

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, today, I am pleased to announce my co- sponsorship of ``The Health Professions Education Partnerships Act of 1998.'' My colleague Senator Frist, the Chair of the Labor and Human Resources Committee's Subcommittee on Public Health and Safety, has drafted this legislation reauthorizing the important programs contained in Titles VII and VIII of the Public Health Service Act. This legislation provides comprehensive, flexible, and effective authority for the support of health professions training programs and the related community-based educational partnerships. The enactment of this Act will improve health workforce quality, diversity, and the distribution of funds while requiring greater accountability of both the grant recipients of federal funds and the agency that administers them. Titles VII and VIII of the Public Health Service Act have provided programs of support to health professions schools and their students, for the past thirty-five years. As these programs have evolved, there has been a continuing need to address the specific concerns of rural and inner- city communities that experience shortages of health professionals and a lack of primary care providers. This reauthorization will allow the Title VII and VIII programs to set improved goals and outcomes measures and it also provides them with greater flexibility in establishing priorities to target emerging workforce issues. In my own State of Vermont, the students of the University of Vermont's College of Medicine have benefited from a number of these programs and scholarships, including those relating to family medicine, professional nurse and nurse practitioner training. The newest Title VII program in Vermont is the Area Health Education Center (AHEC) which opened its first site in April 1997 in the Northeast Kingdom of Vermont. The AHEC will decentralize health professions education by having portions of the training provided in primary medical personnel shortage areas and by improving the coordination and use of existing health resources. Over the next two years, two additional sites are planned in other underserved areas of the state. These efforts have contributed to making Vermont a better place to obtain health care services and improved the quality of life for its residents. Again, I want to thank Senator Frist and his excellent staff for their dedication and hard work in drafting the ``Health Professions Education Partnership Act of 1998.'' Enactment of this legislation will improve health professions training programs across America and, as the Chair of the Labor and Human Resources Committee, I intend to make its passage one of our highest priorities.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, today, I am pleased to announce my co- sponsorship of ``The Health Professions Education Partnerships Act of 1998.'' My colleague Senator Frist, the Chair of the Labor and Human Resources Committee's Subcommittee on Public Health and Safety, has drafted this legislation reauthorizing the important programs contained in Titles VII and VIII of the Public Health Service Act. This legislation provides comprehensive, flexible, and effective authority for the support of health professions training programs and the related community-based educational partnerships. The enactment of this Act will improve health workforce quality, diversity, and the distribution of funds while requiring greater accountability of both the grant recipients of federal funds and the agency that administers them. Titles VII and VIII of the Public Health Service Act have provided programs of support to health professions schools and their students, for the past thirty-five years. As these programs have evolved, there has been a continuing need to address the specific concerns of rural and inner- city communities that experience shortages of health professionals and a lack of primary care providers. This reauthorization will allow the Title VII and VIII programs to set improved goals and outcomes measures and it also provides them with greater flexibility in establishing priorities to target emerging workforce issues. In my own State of Vermont, the students of the University of Vermont's College of Medicine have benefited from a number of these programs and scholarships, including those relating to family medicine, professional nurse and nurse practitioner training. The newest Title VII program in Vermont is the Area Health Education Center (AHEC) which opened its first site in April 1997 in the Northeast Kingdom of Vermont. The AHEC will decentralize health professions education by having portions of the training provided in primary medical personnel shortage areas and by improving the coordination and use of existing health resources. Over the next two years, two additional sites are planned in other underserved areas of the state. These efforts have contributed to making Vermont a better place to obtain health care services and improved the quality of life for its residents. Again, I want to thank Senator Frist and his excellent staff for their dedication and hard work in drafting the ``Health Professions Education Partnership Act of 1998.'' Enactment of this legislation will improve health professions training programs across America and, as the Chair of the Labor and Human Resources Committee, I intend to make its passage one of our highest priorities.

Mr. JEFFORDS

Mr. JEFFORDS. Madam President, I ask unanimous consent that the statements of Senators Bingaman, Hutchinson, Murray, Collins, Reed and Warner be considered as a part of the proceedings in this morning's executive session of the Committee on Labor and Human Resources.

Mr. JEFFORDS. I yield the floor.

Mr. JEFFORDS

Mr. JEFFORDS. Madam President, I have a modification to the amendment at the desk, and I ask that it be accepted.

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

Mr. JEFFORDS. Madam President, I have an amendment at the desk, No. 1716.

Mr. JEFFORDS. Madam President, this amendment gives the States the tools necessary to preserve our Nation's historic covered bridges. These picturesque relics of past industrial genius continue to serve many important functions. However, covered bridges are quickly disappearing due to arson, floods, decay and simple neglect. Without proper and consistent maintenance, these engineering masterpieces will slowly fade into history. Today I am proposing that the Federal Government assist towns and counties across the Nation in restoring and protecting historic covered bridges. Together with States, local communities and committed preservationists, we can curb the decay of these treasures and protect them for generations to come. This country once boasted 12,000 covered bridges. Today, less than 800 remain. Not too long ago transportation officials started tearing down these old landmarks by the bunches in favor of more modern and accessible bridges. Arsonists have been a highly visible threat. Weather has taken its toll. Many old bridges have been carried off by floods or collapsed under the weight of heavy snows. Of course, weather would not be so destructive if it were not for the most dangerous and imminent risk--neglect. Without proper and consistent maintenance, covered bridges slowly decay and eventually fall to harsh weather or flooding. Behind me are two pictures of covered bridges in Vermont. Many of our Nation's historic wooden bridges are in this shape. Others are suffering, but some are being preserved as this picture shows. With proper care and maintenance, covered bridges can be preserved, as this one is, so they might be enjoyed throughout the years. A majority of these wooden structures still perform their original duties but still carry more traffic and weight than their designers anticipated, often leading to weight-related collapse. The cost to properly rehabilitate a working covered bridge comes close to $500,000. Some bridges are far more expensive. Many of these bridges are on town roads, off the National Highway System, and tend not to be a priority. But these bridges must not be lost. This amendment will direct the Secretary of Transportation to fund the efforts to inventory, repair and maintain our Nation's covered bridges. Moneys provided by the measure give the States the ability to fully restore their covered bridges ensuring the safety of travelers without compromising the bridges' historical integrity. This amendment calls for proper research, construction and maintenance techniques. The proposal will provide funds for fire, arson and vandalism prevention. These grants to States will prove vital to ensuring the covered bridges survive into the next century, into the next millennium. These covered bridges stand as a reminder of our heritage and contribute immensely to making our Nation the beautiful place it is today. I urge my colleagues to adopt this amendment. I commend the authors of this legislation, Senators Chafee, Warner, and Baucus, for completing action on this measure. Mr. GRASSLEY. Madam President, I am pleased to join with my friend and colleague Senator Jeffords, to help spotlight and preserve an important part of America's and Iowa's heritage--covered bridges. This amendment will help our states to do the rehabilitation and preservation work necessary to maintain these icons of the open road. I urge the adoption of this amendment. There is a romance concerning our Nation's covered bridges. They bring forth pictures of a different time in American history. It was a time when life moved more slowly, both on and off the road. It was time when travelers could take the time to enjoy the scenery as they unhurriedly passed by. Now it seems that most of us are in a hurry to get to our next destination, with little or no time to observe and enjoy the passing scene. Today, I am happy to say, these bridges are drawing tourists. In Iowa this is in no small part due to a very popular book which was made into a movie. ``The Bridges of Madison County'' has greatly helped to focus attention on covered bridges. For Iowa, the book and movie have helped to increase our tourism industry. For our Nation, the book and movie have helped to bring into full view of the public a unique part of our transportation and cultural heritage. This attention for the covered bridges is well deserved. Maintenace and protection of these bridges is expensive. It is well that we take steps at the federal level to help the states preserve and protect these structures of beauty and grace. They are truly a national enhancement, a vital part of our history, and deserving of our special attention.

Mr. JEFFORDS

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, March 11, 1998, 9:30 a.m., in SD-106 of the Senate Dirksen Building. The following is the committee's agenda. 1. S. 1648, Preventing Addiction to Smoking among Teens (PAST) Act. 2. Presidential Nominations. For further information, please call the committee, 202/224-5375. subcommittee on public health and safety

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, March 12, 1998, 9:30 a.m., in SD- 430 of the Senate Dirksen Building. The subject of the hearing is Assessment of New Health Care Technologies Role of AHCPR. For further information, please call the committee, 202/224-5375. committee on agriculture, nutrition, and forestry

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, as Chairman of the Labor and Human Resources Committee, I have closely monitored the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) over the past year to ensure its successful implementation and consistency with legislative intent. On February 11, 1997, the Committee held its first oversight hearing on proposed HIPAA regulations relating to minimum standards for the access, portability, and renewability of health coverage for both fully insured and self-funded plans. Today, I am releasing a new GAO Report, entitled ``Health Insurance Standards: New Federal Law Creates Challenges for Consumers, Insurers, Regulators (GAO/HEHS 98-67),'' that examines the HIPAA first year implementation issues and challenges that consumers, issuers of health coverage, state insurance regulators, and federal regulators have faced since HIPAA's passage. The findings of this report will be the focus of a second Labor Committee HIPAA oversight hearing that is scheduled for March 19, 1998. One of HIPAA's most important features is that it provides people who lose their group insurance coverage with guaranteed access to coverage in the individual market--regardless of their health status. However, the GAO found that the complex nature of the law, as well as, insurance carrier practices, and insurance product pricing have hindered many consumers from benefiting from this provision. Some insurance carriers have charged rates that are 140 to 600 percent of the standard premium to people who lose group coverage, and, thus, effectively discouraging them from obtaining the needed individual health insurance coverage. In addition, HIPAA guarantees access to coverage only if certain eligibility criteria have been met. These criteria include having a minimum of 18 months of prior coverage, the exhaustion of all residual employer coverage, and the application for individual coverage within 63 days of the termination of group coverage. Many consumers are not aware of these requirements and are at risk of forfeiting their right to coverage in the individual market. Another GAO finding relates to HIPAA's certificate of coverage requirement. Health coverage providers, including employers and insurance carriers, believe that certain HIPAA regulatory provisions create an administrative burden, unanticipated consequences, and the potential for consumer abuse. Although most insurance issuers comply with the Act by providing the mandated certificate of coverage to individuals terminating their insurance, most believe that the process is costly and unnecessary. They feel it would be more efficient to issue the certificates of coverage only to those who request them. The GAO also examined the guaranteed renewal provision and its relationship to other programs such as Medicare. Once eligible for Medicare, HIPAA does not permit issuers to cancel individual coverage. As a consequence, consumers could be left with more expensive, redundant coverage. In addition, the GAO found that the special enrollment periods for group plan enrollees may create opportunities for consumer abuse. Individuals could switch from plans with large deductibles to those with ``first dollar'' low deductibles in anticipation of medical expenses. Insurance issuers fear such practices will raise overall costs. The GAO found that implementing and enforcing HIPAA has been challenging for state insurance regulators due to certain unclear provisions. The provisions cited by the GAO that may need further clarification include those relating to risk-spreading, preexisting conditions, nondiscrimination, and the late enrollee requirements in the group market. The process of clarifying these regulations by the three federal agencies involved in implementing HIPAA (DHHS, DOL and IRS) is ongoing. The report also confirms that federal regulators have faced an overwhelming, new role under HIPAA. In the five states that have failed to pass the legislation required by HIPAA (CA, MA, MI, RI and MO), the Department of Health and Human Services is now required to act as insurance regulator for certain provisions. The department may also have to play a regulatory role in the District of Columbia and some U.S. territories. Meeting these new state regulatory duties has put a financial burden on the agency. As a result, DHHS has requested an additional $15.5 million to fund 65 new full time equivalent staff and contractor support for HIPAA related enforcement activities in fiscal year 1999. Mr. President, this new GAO report updates the progress in implementing the Health Insurance Portability and Accountability Act of 1996 and highlights important areas for additional oversight. Consumers leaving their group coverage are facing barriers to individual coverage. Some issuers of health coverage are concerned about the additional administrative burden of HIPAA and its possible unintended consequences. And there are areas of the law that need further clarification for state regulators. The Department of Health and Human Services' new role implementing and enforcing HIPAA may also require additional resources. In addition to this report, another GAO report on the extent to which large employers have access to health insurance will be completed by the end of May. These two GAO reports and their findings will help Congress in our quest to ensure a successful implementation of the Health Insurance Portability and Accountability Act of 1996. Mr. President, I ask that the executive summary of the report be printed in the Record. The executive summary follows: results in brief Although HIPAA provides people losing group coverage the right to guaranteed access to coverage in the individual market regardless of health status, consumers attempting to exercise their right have been hindered by carrier practices and pricing and by their own misunderstanding of this complex law. Among the 13 states where this provision first took effect, many consumers who had lost group coverage experienced difficulty obtaining individual market coverage with guaranteed access rights, or they paid significantly higher rates for such coverage. Some carriers have discouraged individuals from applying for the coverage or charged them rates 140 to 600 percent of the standard premium. Carriers charge higher rates because they believe individuals who attempt to exercise HIPAA's individual market access guarantee will, on average, be in poorer health than others in the individual market. In addition, many consumers do not realize that the access guarantee applies only to those leaving group coverage who meet other eligibility criteria. For example, individuals must have previously had at least 18 months of coverage, exhausted any residual employer coverage available, and applied for individual coverage within 63 days of group coverage termination. Consumers who misunderstand these restrictions are at risk of losing their right to coverage. Issuers of health coverage believe certain HIPAA regulatory provisions result in (1) an excessive administrative burden, (2) unanticipated consequences, and (3) the potential for consumer abuse. Although issuers appear to be generally complying with the requirement to provide a certificate of coverage to all individuals terminating coverage, some issuers continue to suggest that the process is burdensome and costly and that many of these certificates may not be needed. These issuers, as well as many state regulators, believe that issuing the certificates only to consumers who request them would serve the purpose of the law for less cost. Also, issuers fear that HIPAA's guaranteed renewal provision may create several unanticipated consequences for those eligible for Medicare or holding policies designed for certain targeted populations. For example, HIPAA does not permit issuers to cancel coverage of individuals once they become eligible for Medicare. Consequently, some individuals could pay more for redundant coverage. Likewise, for individuals enrolled in subsidized insurance programs for low-income persons, HIPAA may require that such coverage be renewed after these individuals' income exceeds program eligibility limits. Finally, certain protections for group plan enrollees may create the opportunity for consumer abuse. HIPAA's establishment of special enrollment periods may give employees an incentive to forgo coverage until they become ill, and guarantees of credit for prior coverage in the group market could provide enrollees an incentive to switch from low-cost, high-deductible coverage to low-deductible (``first-dollar'') coverage when medical care becomes necessary. Some issuers fear that the overall cost of coverage could increase if such abuses became widespread. State insurance regulators have encountered difficulties in their attempts to implement and enforce HIPAA provisions where they found federal guidance to lack sufficient clarity or detail. For example, regulators say unclear risk-spreading requirements contribute to the high costs faced by certain eligible individuals attempting to exercise their right to guaranteed access in the individual market. Lacking sufficient detail, for example, was guidance to implement nondiscrimination and late enrollee requirements in the group market. Federal regulators face an unexpectedly large regulatory role under HIPAA that could strain HHS' resources and impair its oversight effectiveness. In five states that reported they had not passed legislation to implement HIPAA provisions by the end of 1997, HHS, as required, has begun performing functions similar to a state insurance regulator, such as approving insurance products and responding to consumer complaints. In addition, HHS may be required to play a regulatory role in some of the other states, the District of Columbia, and the U.S. territories that have yet to pass legislation to implement certain HIPAA provisions. Consequently, the full extent of HHS' regulatory role under HIPAA is not yet known. Partly in response to health insurance issuers' and state regulators' concerns, federal agencies issued further regulatory guidance on December 29, 1997, intended to clarify current HIPAA regulations such as those related to nondiscrimination and late enrollment in group health plans. Agencies expect to continue supplementing and clarifying the interim regulations in other areas where problems may arise. To address its resource constraints, HHS has reprogrammed resources and requested additional resources as part of its fiscal year 1999 appropriations.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise to recognize Senator Frist for taking an important step that brings together a number of Government programs of research, treatment and disease prevention for women. Over the past several years, Congress and the Nation have become increasingly concerned about women's health. I appreciate the leadership and the expertise that Dr. Frist brings to Congress about these issues. We have much to learn about recognizing and treating the medical needs of women. In the first session of the 105th Congress, at least 21 bills relating to women's health were introduced and referred to the Senate Labor and Human Resources Committee. At our committee hearing on women's health last July, we heard about important advances being made in research. We also heard about significant gaps of knowledge which need to be filled. More importantly, we recognize how important it is to get information about scientific advances to the public and their health care providers. Thus, I am pleased the provisions of this bill provide for research and for public and professional education. We know that once the information is out to the public and health care professionals, we need screening programs, closely followed by access to treatment. The bill provides for important patient services. Finally, once common conditions are well recognized, detected and treated, we need data to track our progress in disease prevention and to alert us to new help in illness trends. This bill provides for these functions through the support for cancer registries, information systems, and program evaluation. It is my hope that having women's issues collected together in one bill will focus the attention of Congress and the Nation on vigorous support of the woman's health initiative. I am pleased to join Senator Frist in sponsoring this legislation.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise to recognize Senator Frist for taking an important step that brings together a number of Government programs of research, treatment and disease prevention for women. Over the past several years, Congress and the Nation have become increasingly concerned about women's health. I appreciate the leadership and the expertise that Dr. Frist brings to Congress about these issues. We have much to learn about recognizing and treating the medical needs of women. In the first session of the 105th Congress, at least 21 bills relating to women's health were introduced and referred to the Senate Labor and Human Resources Committee. At our committee hearing on women's health last July, we heard about important advances being made in research. We also heard about significant gaps of knowledge which need to be filled. More importantly, we recognize how important it is to get information about scientific advances to the public and their health care providers. Thus, I am pleased the provisions of this bill provide for research and for public and professional education. We know that once the information is out to the public and health care professionals, we need screening programs, closely followed by access to treatment. The bill provides for important patient services. Finally, once common conditions are well recognized, detected and treated, we need data to track our progress in disease prevention and to alert us to new help in illness trends. This bill provides for these functions through the support for cancer registries, information systems, and program evaluation. It is my hope that having women's issues collected together in one bill will focus the attention of Congress and the Nation on vigorous support of the woman's health initiative. I am pleased to join Senator Frist in sponsoring this legislation.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, today, I join with my good friend Senator Lieberman to introduce the Health Care Quality, Education, Security, and Trust Act--``The Health Care QUEST Act''--in order to improve the quality of our nation's health care system and provide necessary consumer protections without adding significant new costs; increasing litigation; or micro managing health plans. Over the past decade across the country, an extraordinary change has taken place in the delivery of health care. In 1996, over 67% of Americans received their health care through managed care--almost double the percentage that existed in 1990. However, this transition has not been problem-free. Many consumers worry that the quality of their health care is being sacrificed to cut costs. While the traditional fee-for-service health care system was guilty of over utilization and runaway costs, consumers did feel that they would get the necessary services, treatment, and information to recover from a serious illness or manage a chronic health problem. People are now worried that managed care only manages costs and, in effect, rations care. One consequence of this transformation is that Americans are losing confidence in the quality of care they receive from our health system. The American Association of Health Plans' voluntary initiative to respond to these concerns, ``Putting Patients First,'' is an important step and I urge that they continue to expand this effort. Businesses, such as General Motors and GTE, have also initiated programs to improve the quality of the health care received by their employees. In addition, a number of states have already passed legislative initiatives to address many of the problems consumers have experienced with their health plans. However, I believe that Federal legislation is necessary because the Employee Retirement Income Security Act of 1974 (ERISA) prevents states from enforcing health care quality standards that relate to the employer-sponsored health benefits that 148 million Americans receive. The Health Care QUEST Act addresses these concerns through four provisions. First, it creates a Health Quality Council to set national goals for improving health and serve as a resource for Congress and the President regarding health care quality. Second, it expands the duties and responsibilities of the Agency for Health Care Policy and Research (AHCPR) in order to develop the tools needed to measure and report health care quality. The Act also requires that employers and health plans provide enrollees with health plan information such as measures of consumer satisfaction and their right to access speciality health services. Finally, the Act calls for the establishment of the ``prudent layperson'' standard of access to emergency room care, the right to use an impartial independent external appeals process and the guarantee that a patient's health care professional is able to recommend the best treatment options and to serve as their advocate. These provisions will help to restore consumers confidence in the quality of our nation's health care system and provide a level playing field--so that managed care plan compete on the basis of quality as well as cost. Based on an analysis by the Lewin Group, the added costs for information disclosure and external appeals requirements are extremely low. The estimated monthly cost per person for comparative information and for external appeals with a three year phase-in is only $0.88. This cost estimate doesn't take into account the improved market efficiency and increased competition that the Lewin Group indicates will be achieved with these requirements. Much of the debate over this issue to date in Washington has been conducted from two very divergent viewpoints. Many House members, and some in the Senate, believe we should regulate health care very closely, on a disease-by-disease or procedure-by-procedure basis. Another sizable camp believes that there is nothing wrong with the health care marketplace that can't be be sorted out by its own operation. Obviously, I disagree. And Congress, too, disagreed when it confronted many of these issues in the Medicare program last year. Much of what I propose in the Health Care QUEST Act is contained in the ``Balanced Budget Act of 1997'' and applies to plans that enroll Medicare beneficiaries. Extending the same standards to the private sector will ensure that all Americans have the same rights and protections. The states have developed comprehensive approaches that provide regulation for those components of the health care system under their jurisdiction. The challenge for the federal government is to define regulatory solutions for those sectors under federal control that advance the consumer choice health care market while recognizing the voluntary nature of our private system. These regulatory solutions, in my opinion, should not determine medical necessity, establish hospital lengths-of-stay, or impede private sector initiatives. Furthermore, we must not set into statute standards that would preclude efforts for continued quality improvement or fail to recognize the evolutionary nature of medical practice. The McCarran-Ferguson Act of 1945 granted states the authority to regulate the business of insurance. However, ERISA preempted state law with regard to the regulation of employee benefit plans. While ERISA provides detailed standards for employer provided pensions, it provides only minimal standards for health plans. Currently about 41 percent of those who receive their health coverage through employer-sponsored plans are in self-insured health plans. The Health Care Quest Act follows the framework established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) by setting national standards for employer sponsored plans under ERISA and a federal floor for insurance companies to follow that states can build upon. The Health Care QUEST Act will help to restore consumer confidence in our health care system and also promote market efficiency and accountability. I look forward to working with other Senators to enact legislation this year that establishes necessary consumer protections and sets national standards to guide our nation's market based health care reform efforts.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, today, I join with my good friend Senator Lieberman to introduce the Health Care Quality, Education, Security, and Trust Act--``The Health Care QUEST Act''--in order to improve the quality of our nation's health care system and provide necessary consumer protections without adding significant new costs; increasing litigation; or micro managing health plans. Over the past decade across the country, an extraordinary change has taken place in the delivery of health care. In 1996, over 67% of Americans received their health care through managed care--almost double the percentage that existed in 1990. However, this transition has not been problem-free. Many consumers worry that the quality of their health care is being sacrificed to cut costs. While the traditional fee-for-service health care system was guilty of over utilization and runaway costs, consumers did feel that they would get the necessary services, treatment, and information to recover from a serious illness or manage a chronic health problem. People are now worried that managed care only manages costs and, in effect, rations care. One consequence of this transformation is that Americans are losing confidence in the quality of care they receive from our health system. The American Association of Health Plans' voluntary initiative to respond to these concerns, ``Putting Patients First,'' is an important step and I urge that they continue to expand this effort. Businesses, such as General Motors and GTE, have also initiated programs to improve the quality of the health care received by their employees. In addition, a number of states have already passed legislative initiatives to address many of the problems consumers have experienced with their health plans. However, I believe that Federal legislation is necessary because the Employee Retirement Income Security Act of 1974 (ERISA) prevents states from enforcing health care quality standards that relate to the employer-sponsored health benefits that 148 million Americans receive. The Health Care QUEST Act addresses these concerns through four provisions. First, it creates a Health Quality Council to set national goals for improving health and serve as a resource for Congress and the President regarding health care quality. Second, it expands the duties and responsibilities of the Agency for Health Care Policy and Research (AHCPR) in order to develop the tools needed to measure and report health care quality. The Act also requires that employers and health plans provide enrollees with health plan information such as measures of consumer satisfaction and their right to access speciality health services. Finally, the Act calls for the establishment of the ``prudent layperson'' standard of access to emergency room care, the right to use an impartial independent external appeals process and the guarantee that a patient's health care professional is able to recommend the best treatment options and to serve as their advocate. These provisions will help to restore consumers confidence in the quality of our nation's health care system and provide a level playing field--so that managed care plan compete on the basis of quality as well as cost. Based on an analysis by the Lewin Group, the added costs for information disclosure and external appeals requirements are extremely low. The estimated monthly cost per person for comparative information and for external appeals with a three year phase-in is only $0.88. This cost estimate doesn't take into account the improved market efficiency and increased competition that the Lewin Group indicates will be achieved with these requirements. Much of the debate over this issue to date in Washington has been conducted from two very divergent viewpoints. Many House members, and some in the Senate, believe we should regulate health care very closely, on a disease-by-disease or procedure-by-procedure basis. Another sizable camp believes that there is nothing wrong with the health care marketplace that can't be be sorted out by its own operation. Obviously, I disagree. And Congress, too, disagreed when it confronted many of these issues in the Medicare program last year. Much of what I propose in the Health Care QUEST Act is contained in the ``Balanced Budget Act of 1997'' and applies to plans that enroll Medicare beneficiaries. Extending the same standards to the private sector will ensure that all Americans have the same rights and protections. The states have developed comprehensive approaches that provide regulation for those components of the health care system under their jurisdiction. The challenge for the federal government is to define regulatory solutions for those sectors under federal control that advance the consumer choice health care market while recognizing the voluntary nature of our private system. These regulatory solutions, in my opinion, should not determine medical necessity, establish hospital lengths-of-stay, or impede private sector initiatives. Furthermore, we must not set into statute standards that would preclude efforts for continued quality improvement or fail to recognize the evolutionary nature of medical practice. The McCarran-Ferguson Act of 1945 granted states the authority to regulate the business of insurance. However, ERISA preempted state law with regard to the regulation of employee benefit plans. While ERISA provides detailed standards for employer provided pensions, it provides only minimal standards for health plans. Currently about 41 percent of those who receive their health coverage through employer-sponsored plans are in self-insured health plans. The Health Care Quest Act follows the framework established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) by setting national standards for employer sponsored plans under ERISA and a federal floor for insurance companies to follow that states can build upon. The Health Care QUEST Act will help to restore consumer confidence in our health care system and also promote market efficiency and accountability. I look forward to working with other Senators to enact legislation this year that establishes necessary consumer protections and sets national standards to guide our nation's market based health care reform efforts.

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 Tuesday, March 3, 1998, 9:30 a.m., in SD-430 of the Senate Dirksen Building. The subject of the hearing is Global Health: United States Response to Infectious Diseases. For further information, please call the committee, 202/224-5375. committee on labor and human resources