Jim Jeffords

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I am proud to be an original cosponsor of the Ryan White CARE Act; I am proud to have served on the conference committee for this very vital legislation; and I am proud to be here today to speak in support of the bill's final passage. As most of us are aware, AIDS has become one of the most difficult and complicated public health threats in recent memory. For this reason, the Ryan White CARE Act is important not only for to those already infected with HIV or suffering from AIDS--as a public health bill, this legislation is important for all of us. We've said it a number of times before, but it bears repeating: AIDS is now the leading killer of men and women ages 25 to 44. AIDS has killed over 300,000 people since the beginning of the epidemic in the early 1980's--but half of those people, 154,077, have died in the past 2 years. The Centers for Disease Control estimates that nearly 1 million people are now infected with HIV, the virus that leads to AIDS. Clearly, then, AIDS is challenging our health care system in ways it has not been challenged before. We discussed this bill at length nearly a year ago, so I want to take a few minutes to remind my colleagues of the valuable programs they will help to support today. As I've already mentioned, the bill provides health services to those already living with AIDS. It also relieves pressure from our critical care units and emergency rooms by utilizing early intervention techniques with AIDS and HIV patients. The programs we're reauthorizing today work at the local level, and they're cost-effective--two things we've tried hard to stay focused on in this Congress. The Ryan White CARE Act funds community based organizations to provide needed outpatient care at the local level in the most cost effective and efficient ways possible for the populations that need help the most. One study even indicated that a person receiving outpatient managed care spends 8 fewer days in the hospital than a person not receiving such care--resulting in a cost savings of over $22,000 per person. Dollars from the CARE Act increase the availability of critical outpatient primary care services; they provide support services; and they improve the quality of life of those living with HIV. In Vermont, CARE Act money is used primarily to provide pharmaceuticals to people with HIV and AIDS who need drugs, but cannot afford them. Successful outpatient care keeps people out of the hospital, improves their quality of life, and saves money for the system. When early interventions and primary care are used successfully, the health care system saves untold dollars in unused emergency health services. From a purely fiscal perspective, we cannot afford not to fund these programs. Finally, let me remind my colleagues that this is not a disease from which we can remove ourselves so easily as we might expect. Any of us who previously felt confident we could not be touched by HIV or AIDS because AIDS affects other people must now reexamine those assumptions. Soon we will all have friends whose lives have been touched by this disease. I had the honor of hosting one of my friends, David Curtis, at a Labor Committee hearing on this bill. The face of AIDS is changing, it is affecting the people I know and the people we all know. If we and our loved ones are affected, I know we will want adequate resources to be available to help with prescription drugs, health care and support services. The Ryan White CARE Act is an assurance that help will be available. So for my friend, David Curtis and the millions of other Americans affected by HIV, I hope my colleagues will join me in supporting final passage of the Ryan White CARE Act.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I would like to express my strong support for the Leahy-DeWine amendment, which preserves critical due process rights for refugees arriving in the United States after fleeing persecution in their countries of origin. While the United States must control its borders and ensure that its hospitality is never abused, it must also live up to its finest traditions as a land of freedom and refuge for the oppressed. Our country is built on the rule of law, and must preserve and protect that legacy for all. This amendment would ensure that those fleeing oppression have a fair opportunity to present their cases and have them studied and reviewed by appropriate officials. Many genuine refugees are forced to come to the United States with false documents and then apply for asylum. In fact, an argument could be made that the more dangerous their situation, the more urgent it is that they come to apply for asylum, and the more likely that they will not have access to government travel documents from the government which is persecuting them. It is just these most needy people who will suffer most directly from the summary exclusion measures which this amendment seeks to modify. With adoption of this amendment, the United States will remain able to ensure that those with valid, deserving cases for asylum will continue to be able to apply for asylum in the United States. I urge my colleagues to support this important amendment.

Mr. JEFFORDS

Mr. JEFFORDS. I thank the Senator very much, my good friend from Rhode Island. I am pleased to be here again this morning to talk about the importance of adopting a balanced budget in this Congress. As the speakers before me have outlined, it is extremely serious, and this may be the only opportunity we have now that we have a group of moderates who believe very strongly that there is a solution and that if we all sit down together and reason, we can have a balanced budget. I believe that very strongly. The last time I spoke here, I spoke as a member of the Appropriations Committee and of the dire need with respect to the ability to appropriate to bring the entitlements under control. I suggested at that time that we had some difficult decisions to make in that regard. In particular, we have to look at the CPI and also we have to look at entitlements, especially those in the area of Medicaid and Medicare, to find ways to better handle them so that we do not continue the rapid increase we have in expenditures, which has made it imperative that we get together on a balanced budget. Today I would like to speak to you as the chairman of the Senate Education Committee. Those of us who depend upon discretionary funds to accomplish those goals which we have set out look at the future and realize that with the increasing needs we have because of international competition in the area of education, there is no way we can reach those by depending upon our State and local governments to raise those funds, especially if you take a look at what the present trends show would be necessary to cut back on discretionary spending, especially the nonmilitary discretionary spending. Let me briefly outline to you some of the dire consequences with respect to education. On the one hand, we have recognized now for over a decade the incredible need we have to improve our educational system, in particular to meet the demands of international competition. Study after study has shown that if we do not change and improve our educational system, then in the next century the United States will no longer be an economic power but will be a second-rate power. What is the rationale and what are some of the reasons for that conclusion? First of all, international studies comparing our young people with those of other nations have shown that this country, which has been proud of its educational system, ranks dead last when it comes to the ability of our young people with respect to mathematics, with China, a growing economic power, being by far the leader with respect to education of its students in mathematics. In addition, even a more horrible situation is the fact of the so- called forgotten half. The forgotten half are those individuals who are not college bound. We have not paid much attention to that group. In fact, studies that have been done by those who measure literacy found that half of our students who graduate from high school are functionally illiterate. That has to be turned around. That is not even taking into consideration the fact that in some cases up to 30 percent of the students have already dropped out of high school. If you add those percentages together, you can see that this Nation's might with respect to education capacity is not there. What do we do to change that? I am not one who would be up there to disagree with those who say you just cannot throw money at and improve education. That is a fact. What you cannot do is say you must cut back on education. Now we have suddenly gotten the message, at least from the people as well as from those who are discussing it, that cutting education is the poorest thing we can do. But, again, I wish to point out that if we do not do something about balancing the budget, the impact upon discretionary spending is going to be so dramatic we cannot escape the fact we may have to start cutting back on education. That would put this Nation in dire peril. The public agrees with this; 86 percent say do not cut education, and 80 percent of those who said balance the budget said, yes, but do not cut education. Congress heard that message this time, and we were able to escape. Due to the efforts of the Senator from Maine and others, we were able to stop, for instance, the tendency to seriously cut back on funding with respect to higher education. We were able to stop that and to keep it steady rather than having the dramatic cuts that were suggested by the other body. In addition to that, the work of the senior Senator from Pennsylvania was very dramatic in the final analysis on the need not to cut back on education, and we finally recognized that we could not and we did not this time cut education. But the pressures in the future are going to be very dramatic. Let me conclude by pointing out again there are dramatic needs in education that must be fulfilled. For instance, if we were to match what other countries do with respect to days spent in education--China spends 250 days a year in education; we spend 180, and all of the other nations, our international competition in Asia and Europe, average about 220 days--we would have to appropriate, in order to get even with the average, some $76 billion to spread over the States. That is just one example. I could go on. Let me just stop and say we have an opportunity here through the leadership of Senator Chafee and Senator Breaux to be able to bring into check the decrease in the spending of the discretionary funds which will be necessary if we do not adopt a plan such as theirs. I commend them for their effort. I intend to work as hard as I can in order to bring the spending under control so that we do not have to have the negative impact upon education which we will have to have if we do not do so. I yield the floor. Mr. CHAFEE addressed the Chair.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to speak on one of the most critical issues of this Congress--balancing our Federal budget. I support the effort to balance the budget over the next 7 years. It is a task that is long overdue, one that we should have tackled long before the Federal debt began to escalate in the early 1980's. Our carelessness in financial planning is a terrible legacy to leave our children and grandchildren. First, I want to commend the two Johns, Senator John Chafee and Senator John Breaux. The ability to develop a budget structure agreeable to enough Senators in the middle to become a model for passage is a daunting task. It has taken hundreds of hours. It has a real chance to be the model to end the balance the budget deadlock. It is probably unrealistic to expect we can get the 1996 reconciliation package revised, but there is a real chance it can be used for the soon arriving 1997 budget. When I voted in the House in 1986 against the balanced budget constitutional amendment I stated at the time we could not wait the number of years required to get it approved by the States. However 10 years later the situation has become much worse. Now I also realize that it is imperative we move forward without the amendment. Any further delay will greatly increase the damage to national economic stability. The basic problem is the increasing cost of entitlement programs. These are programs outside of the appropriations process. They have increased well beyond the growth of revenues and population. In addition it appears through generosity or otherwise they have increased at a rate greater than the actual cost of living created by inflation. Our proposal recognizes this for the future. This will make additional cuts in discretionary programs such as education less necessary. But it does so in a way which may actually protect from a greater decrease which will be recommended this June by a panel of experts. The entitlements that have provided the greater problems are in the area of health care. The increasing projected costs in Medicaid and Medicare represent about one-half of the increasing cost problem. We cannot continue to run a Federal-fee-for service system. Trying to control costs without controlling utilization has not worked. There are too many ways that costs can be shifted to these programs. Progress in this area will be controlled by more State responsibility. But those of us on committees of relevant jurisdiction must work to move to a Federal capitated system combined with utilization of private insurance methodologies and Federal guidelines to get these costs under control. It is interesting to note that in 1954 the Eisenhower administration introduced legislation along these lines when it recognized some Federal system was required. This was H.R. 8356. The purpose of the bill was ``to encourage and stimulate private initiative in making good and comprehensive services generally accessible on reasonable terms through adequate health prepayment plans, to the maximum number of people * * * (b) by making a form of reinsurance available for voluntary health service prepayment plans where such reinsurance is needed in order to stimulate the establishment and maintenance of adequate prepayment plans in areas, and with respect to services and classes of persons, for which they are needed.'' I believe this gives us a possible route implemented through individual choice to get us out of our preset health care cost mess. We must find the way to control uncontrolled cost shifts and to spread the cost of the sick over the widest base. Hopefully the Finance Committee and the Labor and Human Resource Committee will join in achieving this goal. Mr. President, like my colleagues in this bipartisan coalition, I want a Federal budget that is balanced in an equitable manner. In reaching a balanced budget we must be careful not to cut those programs which could be counterproductive to balancing the budget. In other words, cuts in one program can result in increased costs in other programs, thus making it more difficult to balance the budget. The bipartisan budget proposal accomplishes this goal by making the tough decisions necessary to balance within 7 years and still maintain a strong commitment to discretionary and mandatory spending. Unlike other budget proposals, this plan provides for cuts to the overall discretionary spending that are both achievable and modest. If we are successful in getting health care costs under control it should be possible to actually make needed increases in such accounts. Mr. President, there are many important programs within the discretionary accounts that need to be maintained. The centrist group realizing the importance of discretionary spending provided modest cuts to the discretionary account. I would like to highlight just a few examples of the importance of maintaining the discretionary accounts. One example can be seen in Federal health research spending. We are nearing discoveries and new treatments to the causes of many illnesses and diseases, such as Alzheimer's and Parkinson's. The centrist coalition provides the flexibility to maintain spending on medical research. It is well known that for every dollar spent on health research, several dollars are saved by the Federal Government. This spending on health research could allow for the potential to eliminate tens of billions of dollars in Federal health care costs over the next decade or more. Another example of this group's commitment is in providing adequate education funding. As a group we understand that this Nation faces a crisis--a crisis which is costing us hundreds of billions of dollars in lost revenues, decreased economic productivity, and increased social costs, such as welfare, crime, and health care. Mr. President, business leaders warn us that unless improvements are made in our educational system, our future will be even bleaker. The rising costs of higher education combined with the lower income levels of middle-income families is causing thousands not to finish college, and fewer to attend graduate school in critical areas such as math, science, and engineering. As chairman of the Education Subcommittee, I am particularly concerned about maintaining funding for education, and I have worked with my colleagues in this centrist group to ensure that adequate funding will be protected within education programs. Finally, in order to help solve the deficit problem, and as importantly, to prevent unnecessary hardship to individuals, this group's plan protects the Federal commitment to education, health research and many other discretionary spending areas by providing the least amount of cuts of any plan yet offered. Mr. President, I am committed to balancing this budget, but not on the backs of the poor, the elderly and our children. This budget proposal is the only plan that protects the neediest Americans while balancing the budget.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, this conference agreement includes the final conference agreement on the District of Columbia appropriations for fiscal year 1996. Like each of the other appropriations bills contained in this omnibus agreement, the District's bill has endured a long and arduous course to enactment today. The District of Columbia portion is not all that we would want, but it is the best we can do. A key feature of this bill is the education reform that it contains. It would have been better and more effective if we could have included the $15 million in additional assistance that our original conference agreement included to begin these reforms. But that was not possible. However, legislative language is included on many of the reforms and I will work with the Superintendent, the Board of Education, other city officials and the control board to make sure that these reforms are implemented. The children of this city can not, and now will not, wait another day. The District is in a fiscal crisis. Research by the General Accounting Office and the Congressional Research Service of cities who have faced similar crises tells us that if we are to restore the economic vitality, an essential ingredient to restoring fiscal health, we must reform the schools. We must provide quality public schools to retain and attract a tax base. That pursuit within Congress begins with this bill. One of the important reforms in the bill is the creation of a Consensus Commission on Education Reform. This group of citizens will cast a watchful eye over the reform process in the District and, if there are impediments or a failure to act on the required reform plan, it will recommend and request the control board to take the required steps to make reform a reality. I am determined that we will no longer have wonderful plans or insightful reports that go unimplemented. This time the intentions of the reformers will be realized. The agreement does not include additional funds to carry out these reforms in 1996, but it does authorize funds for fiscal year 1997 and beyond. I can assure city officials and my colleagues that I intend to do everything that I can to see that these funds are appropriated next year and in the future so that the changes envisioned are achieved. Mr. President, in closing I want to thank the Senator from Oregon for his tenacious and tireless work on this bill and his invaluable help in the regular D.C. conference. His help and guidance made an agreement possible. Many others contributed to the D.C. bill and the Omnibus bill's success, especially the Senator from West Virginia who helped craft the agreement we are considering today. I also need to thank our subcommittee's distinguished ranking member, the Senator from Wisconsin, Senator Kohl, for his cooperation and support during the consideration of this bill. Finally, Mr. President, our counterparts in the House, Representative Jim Walsh and Representative Julian Dixon, who worked with us in a partnership to find common ground and bring this bill to this point today. Mr. President, I urge Senators to support this agreement, we need to get on with the task of reforming public education in the District and restoring fiscal sense to it's budget process. This bill sets that course. I yield the floor.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I am submitting for myself and several of my colleagues a concurrent resolution recognizing the people of the Republic of Sierra Leone for their recent elections and democratic transition. The elections held this February and March were the first multiparty democratic elections in Sierra Leone in almost 30 years. They marked what could well be the key turning point in the civil war which has tormented Sierra Leone since 1991. In the face of ongoing civil war and violence, Sierra Leoneans--SEE-AIR-AH LEE-OH-NEE- UNS--turned out in impressive numbers to vote, literally putting their lives on the line for democracy. They clearly believed that the ballot is more powerful than the bullet, and voted to end military rule and the rule of the gun. Their courage and resolve remind us of the blessings of democracy and liberty which we so often take for granted in the United States. This example is particularly timely for us in this year of American elections. As well as helping move Sierra Leone toward a peaceful resolution of its own civil conflict, this successful transition from military rule to democracy can serve as a positive example for the region. Sierra Leone's potential role in the region was underlined last week during the tragic events in Liberia. The new government of Sierra Leone allowed the United States to use the airport in Freetown as a transit point for the evacuation of Americans and third country nationals from Liberia. We are grateful for this assistance. I also wish to take this opportunity to recognize the important contribution of the various Americans involved in Sierra Leone's transition, notably the United States Embassy in Freetown led by Ambassador John Hirsch, and the African-American Institute, which sent a nonpartisan election observation group to monitor the elections throughout Sierra Leone and train local monitors for this and future democratic elections there. I have long believed that there are many positive developments in Africa, and that they often are overshadowed by the problems and crises. It is my pleasure today to be able to recognize one such positive development, and in that spirit, I hope that my colleagues in the Senate and in the House will join me and my colleagues to pass this resolution congratulating the Republic of Sierra Leone on its democratic transition.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I ask for the yeas and nays.

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

Mr. JEFFORDS. Mr. President, I yield to the Senator from Arkansas.

Mr. JEFFORDS. Mr. President, I have an amendment at the desk.

Mr. JEFFORDS. I want to preclude that objection from being registered, so, Mr. President, I have an amendment to my amendment.

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

Mr. JEFFORDS. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with or we will be here the rest of the evening.

Mr. JEFFORDS. Mr. President, it is an amendment to the amendment. I will ask to have it reported.

Mr. JEFFORDS. That, of course, is the Senator's option. I cannot stand here representing 100 groups who support this amendment and taking into consideration the tremendous effort that Christopher Reeves has put into this personally to try and convince this body to do this reasonable thing, and not, unfortunately, from the Senator's perspective, ask for a recorded vote. I do not mean to embarrass the Members on this, but I just remind them that I was told I could come to the floor and offer it, and I am being precluded. But I understand that all got changed as we went along the way, and I do not hold any grudges against anybody. I understand you have to stand by that no amendment outside of the Finance Committee. I just would suggest to my colleagues that they are not bound by any such thing and would urge them to vote in favor of the amendment. Incidentally, I have now heard something which occurs when you get people nervous here, that there has been a rush to find a new cost from CBO, and apparently they are ready to rush over and claim I do not have enough money. Well, I am always ready for those circumstances, and we are rushing over with an amendment which will put a sufficient amount of money in it so I do not get into a budget problem. If they are not around, if we can just get the yeas and nays without going through the necessity of me amending the amendment, that is fine, too.

Mr. JEFFORDS. What this does, Mr. President, is take an amount of money which has been verified by CBO, which has yet to be utilized and also verified by OMB, that will cover any conceivable cost of this bill, to make sure someone does not come back and say I failed to cover any cost of that. I understand there will be maybe a motion to table. Let me just urge my colleagues to please remember what we are trying to do here. You have 100 disability groups of people who are in favor of this amendment. You have estimates which indicate that we have eliminated all the small businesses 25 or under. We have not pulled lifetime caps. We have gone to $10 million, which is exactly the value of what they were many years ago when the million dollar cap was in fashion. What we are trying to do is prevent people going into bankruptcy in order to qualify for Medicaid in order to take care of their sick ones. It also improves this bill because this bill would allow an insurance company--although they are forced to take somebody on the policy, they can lower the lifetime caps and chop them off after a year again, and then they are back out on the street looking for care and back onto Medicaid. With that, I would suffer the indulgence of a tabling motion at this time.

Mr. JEFFORDS. All right.

Mr. JEFFORDS. Mr. President, I know that we have had a difficult day today. We are having a difficult time trying to face the facts of life that the bill we are amending is a very important one, one which I have been an original cosponsor and one which part of the bill is mine. It is something that I worked very hard on. I believe it is an excellent job. However, I also believe that it has a very serious flaw in it. Thus, at the time the committee was meeting--and I want to point out that we have already made an exception today--the Finance Committee came and said, ``Hey, we have a bunch of amendments.'' Most of them have been accepted. So we have already made several exceptions to the nonamendment rule. I want to remind people of that. Now, I submitted this amendment, which I have before this body, at the committee. I am a member of the committee, ranking Republican on the committee. At that time it was said, ``Hey, we want to get out of here a unanimous bill. We may have problems.'' So I said, ``OK, I will wait until the floor.'' So I come to the floor to offer an amendment, which I think about everybody agrees ought to be on it, and they said, ``No. No amendments--except for the Finance Committee amendments.'' I understand that the ranking Republican and the chairman of the committee are bound by their commitment to no amendments, but nobody else is. Nobody else is in this body. So I hope Members would say he deserves to be heard. He has told me I could raise this amendment on the floor, and here it is. Now we will talk about what the amendment is and why we are here. The bill is one which provides, if a person is working for a business and changing jobs, or whatever else, has a health problem, that they are guaranteed an issuance of a policy or a continuance of a policy, notwithstanding the fact that they are sick. That is very important. This is an important breakthrough. That is why I supported the bill. However, what we were not aware of at the time and I brought to the committee's attention, but perhaps there was too little time to consider it, is the fact that there is no requirement now under the Federal law for any kind of a certain level of cap. Now, what could happen to us is, OK, we require the insurance company to take a sick person, but then the insurance company has the right to change its benefits, or it can say, ``OK, we will lower the lifetime cap. So when we take you on, as soon as we pay whatever level of funds we reduce the limit to, you are gone, finished, you have no more coverage.'' Well, this amendment would rectify that and say we have to put--as a nationwide standard, with the exception, we admit it could cause some problems with small businesses, so we exempt 25 and under. We say you have to have $10 million of coverage. Why the $10 million? The $10 million lifetime cap is because the standard for the industry for many years was a million dollars. But that was 20 years ago. That million dollars is worth about $100,000 now. So we say, let us go back to the standard of 20 years ago and put on that cap. I want to point out that when we do this, we are obviously going to cause some costs. I will explain that later. But let us take a look at who we are talking about when we are talking about those covered under this provision. We are talking about those that are working for businesses, as I say, that get sick. All of a sudden they have some pretty big bills. Remember, some of the lifetime caps out there on these insurance plans are $50,000. That is one day in a hospital sometimes. So you go in there sick, and all of a sudden you have no coverage. We are trying to correct that. Now, let me point out to you, again, what we are talking about from a national policy perspective. What happens now to that sick person? That person is sick. They have been allowed to be covered and then chopped off because they have reached the lifetime limit of, say, $50,000. What happens? Under the law right now, in order for them to qualify for Medicaid, they cannot have resources beyond a certain level. So what we are talking about--and I will give some examples in a minute--is middle income people, or even higher income people, who suddenly are placed in a position where the only way they can get care for their loved one is to get rid of all of their assets and then they will qualify for Medicaid. So the household has to go through that--getting rid of its assets--and then they qualify for Medicaid. Should our policy in this Nation do that? I say no, and I am sure you will, too. This is not good policy. Let me talk a little about some of the people involved. I think all of you have probably heard the ads of Christopher Reeve, or watched them on television, or read the editorials in the newspapers and the stories that have covered this. If you want an example as to whether or not it could happen to you, here is ``Superman,'' who was involved in a very serious accident. He was thrown off his horse and he becomes a C- 2, which is a broken neck. He has lost the functions below the neck level, without some assistance. He has a cap of $1.2 million, and it is costing him $400,000 a year. In 3 years, he will be past that cap. Let us take Jim Brady, who is another one--not an example of the lifetime cap, because he is on worker's compensation, but he had a head injury caused by a bullet when he was with President Reagan. He would be far beyond a million-dollar cap, to say nothing of a $50,000 cap at this time. Let me talk about some of the people that do not have the resources of a Christopher Reeve, or the protection of the law with respect to worker's comp, like Jim Brady. Let me go through some of these so that you understand better what kind of people we are talking about. This story is about Donelle and Kyle Meniketti, from the Washington Post. For 4 years, Donelle Meniketti waged a tremendous fight to save her son Kyle from suffering death or severe brain damage as a result of a rare breathing disorder that struck when he was 18 days old. It says: When he sleeps, said the Livermore, CA, woman, his airway collapses and his brain does not tell him to breathe. He needs a breathing machine at night and an oxygen monitor. When he sleeps, he must have someone there all the time to make sure he is breathing. Home nursing care costs alone can be $10,000 a month, and even though Mrs. Meniketti has spent sleepless nights watching over her son rather than pay for a nurse, his medical care is making constant claims on the health insurance plan of her husband Keith. As these claims mounted, they face the terrible prospect of the child's expenses soon reaching the million-dollar cap. He is 4 years old. So far he has escaped it. But they will be forced into Medicaid if this amendment does not succeed. Then there is Heather Fraser. I wish you would have seen her. She appeared at our press conference the other day. She is 23 years old and suffers from cystic fibrosis. She has suffered already many times. She does not know from one day to the next whether she is going to have one of these respiratory infections. She has had chronic problems of all different kinds and will continue to do so. She graduated from college, is 23, and is looking forward to the future. What is going to happen? The average cost per year to treat a moderate case of cystic fibrosis is $46,000. More severe cases cost roughly $79,000. To date, Heather's medical expenses have exceeded $800,000. Research is going on, but right now she will be beyond the cap and on Medicaid. Another one is Lauren Yandell of Williston, VT. Her policy has a cap of $1 million. Lauren has a son who has suffered from a chronic and very rare neurological disease since birth. Because of medications and frequent surgery and personal care, his medical expenses are extremely high--last year alone, over $70,000. He is only 5 years old. At this rate, Lauren believes her son will exhaust the limit within 10 years. Barbara Church, in Shelburne, VT--these are Vermonters, but there are people like this all over the Nation. Barbara has a 12-year-old son who was in a car accident 3 years ago. He has a very similar condition to Christopher Reeve. Since the accident, medical expenses have ranged from $20,000 to $50,000 annually. Her policy through her employer does not have a cap, and she is wary because if she loses her job, as it is under this law now, and she tries to go somewhere, she will not have the cap, or it may be only $50,000. There is no protection for her. These are the kinds of real-life situations. Is it appropriate for us to say that the way these people should get their continuous care is to get rid of all their assets and live in poverty for the rest of their lives, as long as their child survives? No, that is not what the policy of this Nation ought to be. This amendment would make sure that those occurrences do not occur. I hope that people will take into consideration that this is an amendment which will correct the deficiencies in the bill before us by saying that there will be a cap out there, which will be sufficient to take care of the expenses of these people to whom we are saying, ``You have a good deal because you can continue your coverage.'' Right now, the expectations are not there, and they can be changed at any moment. So I want to urge you to consider that this is something that is important to the bill before us. It is an amendment to the bill before us. It is to correct the serious problem in the bill before us. What we are talking about here, as far as the impact, is, obviously, if somebody is paying some money, somebody is going to have to shell out some money somewhere else. If they are being paid to have their health taken care of--first of all, let me review for a moment the kinds of costs involved with these actions. Look at this chart. It will show you about children with hemophilia. There are about 7,000 children with hemophilia, not many in terms of 250 million. The average cost per year per person is $100,000. Life expectancy is 40 years. Lifetime cost per person for hemophilia is $4 million. Do you want to put them all under Medicaid? Cystic fibrosis, the case I talked about earlier; the prevalence is about 4,000 in this country. That is not many relative to the huge population. It is easy to spread around the cost. The average cost per person per year is $18,000, and the average life expectancy is 30 years; $2.5 million. This is the kind of situation which we are talking about. Let us take a look. There are other examples. Spinal injury and head trauma, you can also see where the costs are--around $5 million for a lifetime situation. Now let us review the question of why this is going to be a reasonable cost with respect to the existing situation. Again, insurance--the main purpose of insurance is to spread costs over a larger population so that the cost is small to the employer and to the employee with the insurance policy. But because of the huge number for which we spread it, it makes it reasonable for a family to afford. Let me remind all of my colleagues that we all have no lifetime cap. None of the Federal employees have anything to worry about. We are all covered, whatever the costs are. In addition to that, as this chart shows, we are one of the 20 percent in this country that have no limits whatsoever. There are those that have more than $1 million, about 6 percent. The biggest group is that one that has been carrying the $1 million forward for the last 20 years as long they have been in business. That is 46 percent. So already we are at over 70 percent. Then we go on down. I will be candid with you. The lower, of course, your lifetime caps, especially when you get to the really low levels, you obviously start covering more things than normally, and you end up with more cost. But the thing I am trying to make sure you understand is the cost that is spread around is not that high. Let us take a look at what some of the people say about what those costs would be. First of all, let me run through some of these that have given us some costs. The American Academy of Actuaries, for instance, has given us a cost analysis which demonstrates what we are talking about. Let me go to Price Waterhouse first. Price Waterhouse is a noted accounting firm, which we often look to give us accurate information, estimates that the Jeffords amendment would save $7 billion in Medicaid costs--$7 billion--over 7 years. And more importantly, the cost to businesses would be somewhere in the area of--especially those in the larger areas--would be somewhere around 1 percent of their premiums. Let us go to another one. We have several on this. Also the National Taxpayers Union; let me tell the people on my side of the aisle what the National Taxpayers Union says. They are supporting it. They say it will be scored as a direct spending reduction in the Medicaid Program by approximately $2.8 billion over a 5-year period. In addition, $2.1 billion may be saved through State and local Medicaid Programs. How can you say that this is not something that should be done when we know what it is going to do to help us address the budget problems which we have? Do you know what that amount of money means? That is going to be replaced by the insurance premiums? But it does not even cover the money that is drained out of all those families that went out for expenditures on health care. The Consumers Union, the other side of the aisle usually looks forward to the lifetime cap amendment which would significantly benefit consumers. The Consumers Union agrees that, if health insurance policies have lifetime caps, it would be no lower than $10 million to the people exposed. They say it is important and essential. Then, of course, we have to look to the Congressional Budget Office and we have CBO's estimates. This came to us today. The Congressional Budget Office says the amendment would increase the Federal deficit. They are the only ones who say it is a cost after you balance out the deductions for taxes--$120 million. So by the worst-case scenario we have an offset for this. You could have a tiny, itty-bitty negative impact of $120 million over 5 years. So it is almost a no-brainer. It is hard to find out why anybody is against it. This is the Congressional Budget Office again. The proposal would initially raise private insurance premiums by 0.4 percent. You want to keep in mind that, if you are an employer, you have options. You can increase your premiums, or you can increase your deductibles. So it may not even cost the businessman anything. So again, the Congressional Budget Office says that we have something here which either costs nothing or something which is going to save the Treasury billions of dollars over 7 years. So it is just hard for me to figure out why there can be any opposition to do this. Not only that. But Senator Kennedy, and I think Senator Kassebaum, have suggested that this is a great amendment and that it ought to be on some other bill. What other bill? Why not the one it is most relevant to? Why not on the one with which we are trying to make sure is helping people with their transfer from job to job? I understand the complexity of trying to get a bill through without any amendments on it. But I remind everyone that we have already granted exceptions to the Finance Committee, and I asked the committee that be one of those exemptions because I offered it at the committee level, and they said, ``No way. Take it to the floor.'' I come to the floor. They say, ``Sorry. No amendments even though it is relevant to the bill.'' It will save the middle-income people billions of dollars. It will not cost employers hardly anything, and it will establish for the first time a good policy in this situation so that we do not drive people through poverty to qualify for Medicaid. Mr. President, I yield the floor. Mr. SIMON addressed the Chair.

Mr. JEFFORDS. I would like to amend my amendment first to have plenty of money in there so nobody can----

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, first, I ask unanimous consent that Theresa Stathas, a fellow in my office, be granted the privilege of the floor for the duration of the consideration of S. 1028.

Mr. JEFFORDS. Because the employer frequently pays a significant portion of the premium, a large majority of the eligible employee--both young and old, sick and healthy--choose to enroll in an employer- sponsored plan. Since so many people participate in group plans, the average per employee price of coverage stays relatively low and remains affordable for each employee, since the insurance risk is spread over a large pool of people. The individual market, on the other hand, contrasts in many ways from the group market. For instance, those who buy individual health insurance pay the entire premium out of their own pockets, whereas, in most cases, a business picks up most of the tab. If an individual buys it, it is out of his own pocket. Not only do the people receive no subsidy from the employer, they also do not receive the same tax advantages afforded to employer-sponsored health plans. This is a critical difference. Therefore, costs to the individual is a major concern. When individuals leave a group coverage situation and decide not to purchase in the individual market, it is because they cannot afford it or because they are healthy and have decided they do not need the coverage and do not want to pay the amount of money they would have to pay. The individual market is so price sensitive, as prices go up, healthy and less costly people leave the market, causing the prices to continue to spiral upward. This vicious cycle makes it inevitable that individual coverage will become less affordable for hundreds of thousands, if not millions, of Americans. What is the solution? We must encourage purchasing cooperatives in the individual and small group market. Group purchasing is the first tool to bring down costs of individuals. The key concern regarding ERISA is the risk of segmentation. I was very pleased when Senators Kassebaum and Kennedy included in the health plan purchasing coalition section my own bill which I offered with Senator Nunn, S. 1062. I believe that the key to making health insurance more affordable for individuals and small employers is properly designed voluntary group purchasing arrangements. Employer group purchasing is not in the concept. Many employers have been pooling funds and contracting with entrepreneurs to offer health benefits to their employees at reduced rates for many years through something defined as multiple employer welfare arrangements, referred to as MEWA's, under ERISA. A MEWA is an arrangement where two or more employers group together to purchase health benefits. The more that group together, the lower the per employee cost or employer cost. While a number of MEWA's form important gaps in our health care system, some MEWA administrators have taken advantage of the confusion as to who bears responsibility for regulatory oversight, the Feds or the States. It is very, very confusing. They have been able to create and run ponzi schemes, designed to take premium payments with no intention of covering any major health claims. My esteemed cosponsor of S. 1062, Senator Nunn, led the effort to uncover the corruption of fraudulent MEWA's when he chaired the Senate Permanent Committee on Investigations. He was instrumental in drafting the section of the bill that addresses MEWA reform. It is important. I bring it up, also, as I will mention later, because of what is in the House bill. The bill Senator Nunn and I introduced makes clear, once and for all, that the States are responsible for regulating all MEWA's. Therefore, the number of States that have moved forward in this area will no longer have to be involved in costly litigation, using precious State resources, to prove they are regulated. I must say, I am very concerned about the way the House bill handles the group purchasing in the small group market. First, continuing to segment the market by creating different rules for insured and self- insured MEWA's is a mistake. Second, giving the Department of Labor the additional responsibility of now being the insurance regulator for all self-insured MEWA's takes away a current State responsibility and hands it over to the Federal Government. This seems totally inconsistent with the philosophy and fiscal reality of less Federal Government and more responsibility for the States. I think we should be careful when we are looking at this in the conference committee. Requiring purchasing cooperatives to offer only fully insured products, as in the case of S. 1028, is a much better solution. Although the group purchasing section of the Kassebaum-Kennedy bill is good, I hope we will be able to improve upon it in conference with the House. I hope we can take the lead from Governor Whitman accomplished in New Jersey. She saw the need to look at the impact overburdened State-mandated benefits laws can have in a small group market and developed a variety of distinct benefit packages that small employers can choose to purchase for their employees. This strikes me as a critical step at expanding health care coverage. Fixing what is broken in our current health insurance system should be what is accomplished in this year of incremental reform. Although I believe the Kassebaum-Kennedy bill is a good bill, I believe it can be a great one. That is the main reason Senator Simon and I plan to offer an amendment that would raise lifetime limits, caps, to $10 million. We want to ensure that this bill lives up to its basic promise. What good does it do to pass a law that prevents insurers from excluding individuals with preexisting conditions if you let employers set lifetime caps at $50,000--which is probably 1 day or 1 week for those people--to meet the needs of those conditions? It is critically important, in my mind, that we make sure that we make this remain a good bill and that we pass a good bill. I will mention that I offered this amendment in committee, and they said at that time that we wanted to come out with a 16 to 0 bill. This was the step that people have to understand--that I would not offer this in committee, but I said I would offer it on the floor. There was some concern raised about having amendments to this bill. But I point out that this is important to the bill in order to make it work. This is not an extraneous amendment, unrelated to the purpose of the bill. If we do not prevent insurers from reducing lifetime caps, then we have the very likely situation where they will reduce the caps if they have to take sick people in. If we do that, we will have lost the great benefit of what we are trying to do today. Let me talk about the lifetime cap amendment. In a letter I received from the American Academy of Actuaries addressing my amendment, they stated: . . . this amendment is unlike State mandates that require coverage of specific medical services. This is a Federal mandate that appears to greatly increase the security provided plan participants by raising their potential benefits to $10 million. This is also important. CBO has estimated that premiums would only increase by 0.16 of a percent, while at the same time reducing Federal and State expenditures in the Medicaid Program. So what we would do is to prevent the horrendous situation we have now. How do you take care of the sick people in this country that have an insurance policy that has a lifetime cap? What happens? You reach the cap and then you have to, under the present situation, drain all your resources until you are poor. And then you apply for Medicaid, and you are eligible for Medicaid. I want to point out that I think that is a terrible way to handle things. I also point out that other information that we have received from reputable organizations has backed us up in the fact that this is a de minimus cost to most employers, and it is a huge benefit to the Federal budget. The National Taxpayers Union has said that the net savings could be as much as $2 billion in Federal savings and $3 billion in State and local savings by just passing this amendment, at a very minimal cost to employers. As U.S. Senators, we have the peace of mind in knowing that our health insurance will be there if a catastrophic illness or injury strikes one of our families. In our plan, there is no cap. Anything can be covered. In a large number of HMO's, there are no lifetime caps, and in some other group policies there are no lifetime caps. So I want to focus your attention on that. Hopefully, in the time before I offer the amendment, you will learn more about this and agree with us. For now, I would like to, once again, commend both Senators Kassebaum and Kennedy for bringing this bill to the floor of the Senate. I urge my colleagues to vote for its passage. I am hopeful that when we finally do get to my amendment, you will keep in mind that what we will do will be almost an unmentionable expense to most employers, but will save people from incredible experiences of having to go through bankruptcy in order to get health care coverage, and also will allow us to reduce the cost of Medicaid to State, local, and Federal Government. Mr. President, I yield the floor. Mr. KERREY addressed the Chair.

Mr. JEFFORDS. Mr. President, I want to comment briefly on the comments of the Senator from Nebraska about my amendment. I point out that, unlike all of the other amendments, this one is very relevant to this bill and will improve the bill. It is not extraneous to it. If we do not keep track of what the lifetime caps are, then this bill will be a mockery because, if we require the insurers to take sick people on, one way of getting out of that is to reduce the lifetime caps so that as soon as they come in they are out the other end. It was offered in committee with the understanding that it would be brought forward at this time. I just wanted to bring that to the Senator's attention and hope that I will make an exception to his decision in that regard. Mr. President, I yield to the Senator from Iowa. Mr. GRASSLEY addressed the Chair.

Mr. JEFFORDS. Mr. President, I rise today in support of the Kassebaum-Kennedy bill. Before I do that, I want to express my deep appreciation for the efforts that were put in, in 1994, by Senator Chafee, in trying to reach a consensus on what we can do to move health care forward. We worked long and hard, many of us, and the issues which we are involved with today in S. 1028 were some of those which gave us the greatest concern. I also want to thank Senator Bennett for his work with the Republican task force on health care. His work has been invaluable to us as we move forward to try and find, again, the kind of consensus that is necessary to get us good health care reform. What a refreshing experience it is to have Senator Frist with us, who has given us the invaluable knowledge of a practicing physician, who kept us from going too far astray in our efforts. It is wonderful that we have this kind of a coalition. Senator Rockefeller, who I have worked with, also, is so helpful in the health care reform area. I am beginning to feel confident that we will do something constructive here in health care reform, and hopefully it will happen in the next few days. Of course, my chairman and my ranking member, Senator Kennedy, who both have shown outstanding leadership in getting our committee to come out 16 to 0 on a bill, this is a miracle in itself. I am deeply appreciative of all their efforts. I rise in support of the Kassebaum-Kennedy Health Insurance Reform Act. If we send this legislation to the President, the 104th Congress will be remembered in history for taking the first steps toward real market-based health care reform. Market reform is not as easy as it may sound, for the simple reason you must take into consideration the State's responsibility for regulating insurance versus the Federal responsibility for regulating ERISA, employee benefit plans. That word, ERISA, is one that troubles many. The reason it troubles people is because there is not much there. We have the authority and the responsibility to provide good health care conditions for the self- funded plans, but we have exempted the self-funded plans from State regulations. That is why we are here today and why this is an important move forward. Finding the right balance between insurance regulation and employee benefits, while trying to incrementally reform the market, is something like mastering the Rubic's cube. Just when you think you have all the sides lined up, you find out one square is out of place. Last August, the Labor and Human Resources Committee lined up that Rubic's cube and it all seemed right with the world. As I mentioned, in a unanimous 16 to 0 vote, the committee voted favorably on S. 1028, the Health Insurance Reform Act of 1995. I must commend the chairman and the ranking member for that incredible feat. It is not an easy task putting together a health care reform bill that every member of the committee can vote for, but it happened. The Health Insurance Reform Act makes great strides in addressing many of the problems in the insured market and also begins to level the playing field in the self-funded ERISA market by apply the same national rules to both segments of the marketplace. Chairman Kassebaum's approach from the beginning was to build a bill around two areas of consensus--portability and elimination of discriminatory treatment of preexisting condition rules. The Kassebaum- Kennedy bill provides Americans the security of knowing that their health insurance will be portable from job to job and that all people who have insurance today will be able to purchase affordable insurance tomorrow even if they get sick. That is a critical phrase--even if they get sick, or change or lose their jobs. This is accomplished by converting the rules in today's insurance market which reward excluding people into rules where health plans can take all comers. There is a tendency to want to exclude sick people, naturally. You make more money if that happens. This will step in and say, ``Hey, no.'' S. 1028 provides much-needed improvements at the national level, but at the same time allows States the flexibility they need to move ahead in their own reform efforts. As we attempt to make coverage more widely available, we must also not lose sight of affordability, particularly in a market where employers and individuals are not mandated to purchase insurance. We must be very careful as we reform the insurance market, because if we are not, reforms that we hope will reduce costs and improve access may do just the opposite. How is this possible? Today, over 92 percent of the people who have private health coverage are part of a group--92 percent are part of a group. Most of these people get it through their employer under an ERISA health benefit plan. The key concern regarding ERISA is the risk segmentation that occurs in the private market due to the preemption clause. ERISA preemption effectively blocks States from regulating most employer-based health plans. ERISA preempts States from being in this area. Although many employers still purchase health coverage from a State- regulated health insurer that is subject to State insurance regulation, employer plans that cover 44 million people have elected to self-fund and avoid the State insurance laws. These laws deal with financial solvency, market conduct, benefit coverage, and premium taxes. States impose taxes on insurers for general revenues, as well as for financing specific programs like State guaranty funds and high-risk pools. Preemption made a lot of sense 20 years ago when the multistate employers and unions were looking for a way to offer uniform benefits to employees throughout the country. Most of the plans were offered through insurers. Most of the plans were offered through insurers. As States started to weigh down the insured market with mandated benefits, employers saw self-funding as a means of flexibility and plan design. These are two reasons why employers have left the insured marketplace. In a preliminary report I just received from GAO, the estimated additional costs of these mandated benefits range from a high in Maryland of 22 percent additional cost and low in Iowa of 5 percent. Mr. President, I ask unanimous consent that excerpts of the GAO preliminary estimate be printed in the Record.

Mr. JEFFORDS

Mr. JEFFORDS. First of all, I commend the chairman of the Committee on Agriculture, along with the ranking member, for the incredible work that they have put into this bill. I believe it is an excellent piece of legislation that provides stability, enhances markets, streamlines outdated programs, creates incentives to protect the environment, and benefits all farmers from all regions of the country. Having worked on several farm conferences in my period in the House, I know how difficult and how hard it is to come through with a consensus. Not only do you have to worry about all the farm interests but also you have to worry about all of those who are affected by farm policy. It is a tremendous piece of work which they have accomplished. I also thank the Members in the House with whom I worked for many years, for their support at the critical time on the conference committee. Without their help this could not have come about. I am especially pleased that the conference reached a comprehensive dairy title that reflects the interests of all regions of the country. I was most keenly concerned about the Senate farm bill's inability to give our dairy farmers at least a fair deal. It was this concern that motivated me to vote against the bill for the first time in my 20 years in Congress. Fortunately, through the help of our chairman and ranking member from my good State of Vermont, the conference committee, after hours of intense consideration produced a dairy title that provides stability for our farmers and true reform in the dairy program. The dairy title eliminates the 10-cent-per-hundredweight assessment paid by dairy producers, returning $150 million annually to dairy producers throughout the country at this difficult time for them. It reforms and consolidates the Federal milk marketing order system, consolidating the orders from 34 to between 10 and 14 will help bring more uniformity in prices throughout the country. It continues price support purchases from December 31, 1999, followed by a recourse loan program for butter, nonfat dry milk and cheese beginning on January 1, 2000, giving the industry the means to compete in world markets and enhancing the future of a strong, renewed dairy industry. Most significantly for the farmers of New England, the bill grants consent to the Northeast Interstate Dairy Compact. Mr. President, in March of last year, I introduced the Northeast Interstate Dairy Compact along with the entire New England delegation. The dairy compact is intended to help give farmers and consumers fair and stable milk prices in New England. It will establish an interstate commission consisting of one delegation from each of the six New England States. The commission will have the authority to hold public hearings on the fluid class 1 milk market in New England. The dairy compact originated in the Vermont legislature over 7 years ago. It has universal support among Vermonters and throughout New England and is critical to the maintenance of the region's dairy industry, if not its survival, offering both income stability and income enhancement. The compact has been overwhelmingly approved by the legislatures of all six New England States and simply needed the consent of Congress. What the State legislatures offered was not at all a novel idea. The widespread support for and central importance of the dairy compact to New England has been throughly emphasized by the regions Governors, legislatures, consumers, farmers, and local processors. The single most overwhelming fact about the economics of dairying in New England is that the price to the consumer continues to increase at the same time the price to the farmer continues to go down. In fact, current farm milk prices are, as low as they were over 10 years ago while the price to consumers is substantially higher. The hard working dairy farmers of New England have seen federally set minimum prices return less money than it costs them to produce their milk. The result, during the 1980's, 40 percent of the New England farms ceased to operate. In my own State of Vermont, where agriculture is such an important part of our economy and way of life, nearly 50 percent of the farms have been lost in past 10 years. The inclusion of the dairy compact in the conference report is a tribute to the hard-working dairy farmers of New England, who are such a vital part of the region's heritage. The compact ensures that family farms from St. Albans to Pawlet, to those in the Northeast Kingdom and all across New England will have the ability to survive and remain economically viable into the next century. Mr. President, milk processing plants, feed and equipment dealerships, veterinarians, banks, and many others suffer when farms in their communities go out of business. Not surprisingly, the dairy processors' lobby fought hard to prevent Congress from approving the compact. After all, they have benefited for a long time on both ends of their business from cheaper farm milk and higher consumer prices. Several of my colleagues have heard from large milk processors in their States about how this compact could hurt the national dairy industry or the farmers in their own State. Such claims are false. The compact would in no way prevent milk from coming into the region or affect the price of milk in any other region of the country. Despite the claims of the processors' lobby, the fact remains that the compact is very similar to existing State over-order programs currently in place. Like those programs, the compact would not conflict with or alter the Federal milk marketing order system, but only complement its operation. In short, New England States are working cooperatively as a region only to maintain a healthy dairy industry in New England, without adverse effect on the rest of the country. The compact has been carefully crafted so that it will not affect the national dairy industry. Nonetheless, in order to address any concerns that the conference committee may of had of how the compact will work in practice several additions were included. The compact limits the ability of other States to join; allows farmers outside New England who sell milk within the region to benefit from the compact; restricts the interstate commission to regulate class I milk only, and will terminate concurrent with the Secretary's implementation of the dairy pricing and Federal milk marketing order consolidation and reforms. Mr. President, I am also pleased that this bill takes great strides at addressing conservation practices. USDA conservation programs have traditionally addressed the problems faced by producers growing row crops. The technical and financial assistance that livestock producers need have not been well addressed by our current set of conservation programs. This bill creates a new Environmental Quality Incentives Program to help farmers with conservation projects, creating new incentives for farmers to protect and enhance the use their land. In addition, the bill includes a $35 million initiative to buy easements on farmland threatened by development and $50 million wildlife habitat program. These provisions, along with several others will help farmers from throughout the country deal with water quality, erosion and other conservation challenges. Mr. President, the hard work and partnership with both the House and Senate has produced a comprehensive bill that reflects accountable reform, important market stability, and environmental responsibility. I encourage my colleagues to support this important piece of legislation.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I believe the Senator from Arkansas has yielded me time.