Jim Jeffords

Mr. JEFFORDS

Mr. JEFFORDS. I was getting the amendment.

Mr. JEFFORDS. Mr. President, at this time I offer my amendment and ask unanimous consent that the pending amendment be set aside for the purposes of consideration of this amendment.

Mr. JEFFORDS. I ask unanimous consent that further reading of the amendment be dispensed with.

Mr. JEFFORDS. Mr. President, I want to thank the Senator from New Mexico for accommodating us. This will be an important amendment to help. And I am very pleased to accommodate the committee with our promptness.

Mr. JEFFORDS. Mr. President, if I may respond.

Mr. JEFFORDS. Yes, that is perfectly all right with me.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I will be very brief because I know we are about ready to vote. I did not want to let this time go by without expressing my strong support for the Ryan White Act, and I am proud to be an original cosponsor. As many of my colleagues have already pointed out, we need to pass this bill as written with an authorization for adequate funding. The statistics are clear. AIDS has become one of the most difficult and complicated public health threats in recent memory. The incidence of AIDS and the need for the Ryan White CARE, far from abating, are increasing. Some today have asked: Why AIDS? Why the Ryan White CARE Act? What is so important about this program? Well, it has already been said but it bears repeating, that AIDS is now the leading killer of men and women ages 25 to 44. This virus is challenging our health care system in ways it has not been challenged before as it moves through the population with terrifying speed and deadliness. It is estimated that over 1 million Americans are currently infected with HIV. A quarter of a million Americans have already died from this disease. Far from going away, this virus is spreading through geographic and demographic regions that we might previously have considered unaffected. When the Ryan White CARE Act was first passed with wide bipartisan support 5 years ago, we clearly recognized the need for addressing this emerging epidemic through a national health program. This bill is not about homosexuality. This bill is not about abstinence. This bill is about judgment. This bill is about providing health care to people who are suffering from a disease. We designed the CARE Act to do equally two important things: to provide help and health services to those already living with AIDS, as well as to take the pressure off our critical care units and emergency rooms by utilizing early intervention techniques with AIDS and HIV patients. It is cost effective. 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 a hospital than a person not receiving such care. This would indicate a cost savings of over $22,000 per person. I think it is important to outline what these funds do and do not do. Dollars from the CARE Act go to increasing the availability of critical outpatient primary care services, providing support services and improving the quality of life of those living with HIV. In Vermont the CARE Act money is primarily used 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, improving their quality of life, while saving the system money. When early interventions and primary care are used successfully, the health care system saves untold dollars in unused emergency health care services. From a purely fiscal perspective, we cannot afford not to fund these programs. The funding these community based organizations receive goes to care and services. It does not go to advertisements in the Washington Blade. It does not go to brochures about prevention. The dollars that we authorize in this bill help sick people, people from all walks of life, all demographic groups, to get the health care and other services that they need to live with this deadly disease. During our committee consideration it became clear that the AIDS epidemic is spreading. It is no longer confined to certain populations or certain geographic locations, but is now clearly affecting rural as well as urban areas, women and children as well as men. Any of us who previously felt confident and untouched by HIV because AIDS affected 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. David Curtis and I have known each other for over 30 years. David is a lawyer, around my age, in fact we clerked together. He's from a similar background to my own, and I would venture to guess, similar to that of many of my colleagues. David Curtis has AIDS. As a person living with AIDS he told our committee of the debilitation of this disease, how he can no longer drive over half an hour without stopping to rest, how he has been forced to sharply curtail his practice of law. As former chair of the largest AIDS service organization in Vermont he also told of the difficulties of providing services to people who live tens and sometimes hundreds of miles apart and how CARE Act funding helps make it possible for people to get access to health care, services, counseling, and pharmaceuticals that otherwise would not be available. The Ryan White CARE Act helps people like David, people living with HIV and AIDS, not only in Vermont, but all over the country, to get the help they need. The face of AIDS is changing, it is affecting the people I know and the people we all know. We must all remember during this debate that the disease could easily affect us or someone we care about. 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 the Ryan White CARE Act as reported out of the Labor Committee. Mr. President, I yield the floor.

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

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, today I join Senator Simon in introducing the Simon-Jeffords International Peace Operations Support Act of 1995. The altogether natural and necessary focus in American politics on our domestic problems should not blind us to the monumental responsibilities of the United States as a leader of the world community. The very real dangers of the post-cold war world, as well as the equally real opportunities, are ignored only at our peril. When civil strife or naked aggression threaten the stability of countries or whole regions and threaten the lives of whole populations, it is clearly in the world community's interest to try to do something. This response could take many forms, and a U.S. contribution might appropriately consist of political support, logistics or intelligence assistance, or provision of equipment. But there surely will be times when it will be in the U.S. national interest to respond to acute peacekeeping and other humanitarian needs with a contribution of troops. We are severely hamstrung today in our ability to respond to these types of problems. With the most capable military establishment in the world, we find ourselves often unable to contribute troops to international peacekeeping efforts because of unclear political guidance to our military as to whether peacekeeping is part of its mission and a reluctance to train a designated cadre of troops to perform the tasks of peacekeeping, refugee assistance, and other humanitarian operations. Our legislation addresses this problem. It sharpens one of our tools of foreign and security policy by providing clearer guidelines for U.S. troop contributions to United Nations or other international peace activities. It specifically makes this activity a formal mission of the U.S. military in cases where U.S. national interests are served by a peacekeeping deployment. It also calls for the identification of a specific unit or units consisting of service personnel who have volunteered for such service and who would be given specialized training for the unique circumstances of such missions. The preeminent position of the United States in the world, and our far-flung commercial and security interests do not always dictate that we contribute troops to address particular problems, but they do dictate that we be prepared to do so if necessary. As in other areas of international endeavor, U.S. leadership means that our contributions leverage contributions by other states that follow our lead. Thus, greater U.S. contributions to U.N. peacekeeping might, as the result of a multiplier effect, prove to be the most cost-effective method of increasing worldwide peacekeeping capabilities. We are rightly proud of the dedication, skills, and bravery of our Armed Forces. They are the world's most effective fighting force, and their skills and dedication have successfully been applied to humanitarian activities in, for example, Operations Provide Comfort in Iraq and Restore Democracy in Haiti. Not all international crises will result in U.S. troop deployments. Indeed, our experience in Somalia has brought home quite clearly to us the limits of international action in the face of massive civil strife. But when the international community decides to act, and when we decide that it is appropriate to offer as our contribution the finest, most capable men and women in uniform in the world, we must be ready.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I introduce the Employer Group Purchasing Reform Act of 1995 for myself and my Democratic colleague Senator Nunn. Our bill amends the Employee Retirement Income Security Act of 1974 (ERISA) in three significant ways. First, we provide increased protection for approximately 46 million employees in self- funded employee benefit health plans. Second, we increase the purchasing power and affordability of health insurance for small employers by putting into place the States ability to crack down on the fraudulent and abusive practices used by unscrupulous multiple employer welfare arrangement (MEWA) operators that have left thousands of small businesses and their employees without health insurance. We then make the way for voluntary health plan purchasing coalitions to flourish. This bill complements S. 1028, the Health Insurance Reform Act of 1995, which is the bi-partisan bill that Senators Kassebaum and Kennedy introduced last week, of which I am proud to be an original co-sponsor. As I said last week, the foundation for incremental health reform is a well-functioning private market. The Kassebaum-Kennedy bill makes great strides in addressing many of the problems in the insured market and also begins to level the playing field in both the insured and self- insured markets by applying the same national rules to both segments of the marketplace. This Health Insurance Reform Act deals with one of the central concerns for all Americans, knowing their health insurance will be portable from job to job. Generally, portability means all people who have insurance today will be able to purchase affordable insurance tomorrow, even if they get sick, or change or lose their jobs. In order for this to occur, we have to convert the rules in today's insurance market, which reward excluding people, into rules where health plans must take all comers. The Health Insurance Reform Act takes a giant step toward this goal. S. 1028 provides much needed improvements at the national level, but at the same time allows States the flexibility they need to move ahead with their own reform efforts. Unfortunately, unless we make greater strides in leveling the playing field between the ERISA self-funded market and the insured market, the current trend of more and more businesses moving from the insured State regulated market to the self- insured federally regulated market, as documented in a soon to be released GAO report, will continue. You may ask what is self-insured or self-funded anyway, and why should I be concerned about this trend? Well, self-funding is merely a pay-as-you-go financing mechanism used by employers and unions to fund health benefits for employees. The term is used synonymously for any ERISA health plan--but--in actuality ERISA health plans can be either insured or self-funded. The irony is that the term self-funded is never used in ERISA and therefore has never been defined. This lack of clarity about how much risk an ERISA plan must assume to be self-funded has caused havoc in the insured marketplace regulated by the States. This fragmentation has caused prices in the insured marketplace to continue to rise because of the risk segmentation. In addition, it is the insured market that gets assessed for providing subsidies for State high risk pools. Employers choose to self-fund for basically two reasons. First, it provides greater flexibility and uniformity in benefit plan design and second, if you have a healthy workforce it costs less to provide your employees health benefits. Unfortunately, when some employers who self- fund experience an employee with a catastrophic illness they contain their costs by lowering life-time limits of health coverage. Our bill would prohibit this practice. Many employees who are in self-funded ERISA plans are not aware of this fact because many of the large insurance companies, like Cigna, administer the claims and the employees' insurance card will usually say Cigna on the front. If a problem occurs with the plan most people will file a complaint with a State insurance department only to find out there is nothing the State can do because the plan is under ERISA and lacks many of the protections afforded people with insured plans. When ERISA was passed, over 20 years ago, the many years of thought and architecture that went into the pension provisions that gave employees real security regarding their retirement were not duplicated in the health arena. As a matter of fact, the broadly drafted language of the preemption clause actually took protection away from employees who were not in an insured health plan. A major reason the drafters did not take the same precision in the health benefit area was the certainty that this was not necessary because national health reform was just right around the corner. Well, here we are in 1995 still talking about health reform. As a matter of fact the talk has moved from the national front of last year toward looking to the States to move forward with reform. But the States are only able to reform the insured market. It is up to Congress to address the problems ERISA preemption has caused in the private market. If we do not figure out a way to level the regulatory playing field in the market we are never going to have a solid foundation for market based health reform. The Employer Group Purchasing Reform Act levels the playing field in some significant ways. First, we define self-funding to make it clear that employers must assume substantial financial responsibility if they are to be afforded preemption from State insurance laws. Second, it emulates the portability protection individuals have when a group health plan disbands. Americans who purchase health insurance have the protection of State guarantee funds in the event a health insurer goes belly-up. Individuals who are in self-funded plans will now be assured a 3 month conversion policy in the event their employer goes out of business. Employees will no longer face a double whammy of losing a job and also their health insurance. Rather than have the Federal Government regulate and determine the appropriate solvency requirements for self-funded plans this bill has the market set the standards. Our bill will require self-funded plans to purchase involuntary plan termination insurance in the event of bankruptcy. As I mentioned when the Kassebaum-Kennedy bill was introduced last week, I was most grateful for the inclusion of the health plan purchasing coalition section of S. 1028. I believe that the key to making health insurance more affordable for individuals and small employers is properly designed voluntary group purchasing arrangements. The health plan purchasing coalitions in our bill are very similar to those in S. 1028 except that we allow the coalition more flexibility in the design of the benefits offered through the multiple health plans in the coalition. Employer group purchasing is not a new 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 MEWA's under ERISA. A MEWA is an arrangement where two or more employers group together to purchase health benefits. This definition, added to ERISA by the 1982 Erlenborn amendment, is very broad and encompassed all types of insurance-like arrangements that involve more than one employer, regardless of their corporate structure, insurance status, or status as an employee welfare benefit plan. Categorizing the various types of MEWA's is difficult primarily because different people use different terms to refer to the same entity. While a number of MEWA's fill an important gap in our present health benefits system, some MEWA administrators have taken advantage of the confusion as to who bears the responsibility for regulatory oversight, the Feds or the States. They have been able to create and run ``Ponzi'' schemes designed to take premium payments with no intention of covering any major health claims. It has taken the States over 10 years to finally get the Federal courts to interpret that self-funded MEWA's were intended to be regulated by the States. Unfortunately, not all courts are in agreement. My esteemed cosponsor of this legislation, Senator Nunn, led the effort to uncover the corruption in the operation of fraudulent MEWA's when he chaired the Senate Permanent Subcommittee on Investigations. He was instrumental in drafting the section of the bill that addresses MEWA reform. Simply put, we make it clear once and for all that the States are responsible for regulating all MEWA's. Therefore, the numbers 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 the regulators. Hopefully, we have now paved the way for other States to do the same. The Employer Group Purchasing Reform Act gives clear authority for State's to shut down fraudulent MEWA's and clear authority to certify the well designed and defined health plan purchasing coalitions which do not assume risk and are membership driven. At this time, I'd like to take this opportunity to congratulate my colleague in the House, Congressman Fawell, for leading efforts in the House to address the MEWA problems. Although we have taken different approaches to resolving this problem, I look forward to working with him and the cosponsors of his bill in finding the best way for small businesses to group together and finally get the same purchasing power in the market that has previously only been afforded to the large employers. I won't take the time now to go over the rest of this bill but would ask unanimous consent to include a section-by-section analysis of he bill in the Record. I am very excited about the bipartisan approach taken by both the Health Insurance Reform Act and the Employer Group Purchasing Reform Act. I am looking forward to working with my colleagues on the Labor Committee to make improvements in these bills and then take the best of these bills and report a bipartisan bill out of committee that we all can be proud to bring to the floor of the Senate this year.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise to say that I am pleased we are making, I think, constructive progress on this bill. I have watched the bill as it has progressed, and I have not supported cloture up to this point, because I felt it was necessary to keep pressure on to make sure that constructive progress was made. I have seen things with respect to cost benefit, to net benefit and matters of change relative to judicial review and substantial other improvements. There are also other amendments pending which I believe can improve this bill. Whether they will improve this bill to the point that I could vote for it, I am not at all sure. But I will watch the progress as we go along. The filibuster should not be used purely to prevent passage of bills, but it should be used in a meaningful way to ensure that an opportunity is made for constructive change and constructive passage of a piece of legislation. So although I have not supported cloture in the past, it is my view that it is time to allow us to continue, recognizing that by granting cloture does not mean the debate closes, but rather that we will have amendments which are already filed and are relevant to be taken up. So I look forward to seeing what kind of progress we have made, what the bill looks like and, therefore, it is my intention to vote for cloture this time, whereas I have withheld my vote in the past two attempts.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise in support of the Dole-Lieberman substitute amendment to S. 21, the Bosnia and Herzegovina Self Defense Act of 1995. The events of the last week in Bosnia are appalling. Not only does the tragedy continue, but the latest attack on so-called safe areas has resulted in a new level of violence aimed at civilians, a new wave of ethnic cleansing and the creation of a whole new refugee population. The position of the United Nations in Bosnia is increasingly untenable: its role in delivering humanitarian aid is marginal, its role in protecting ``safe areas'' is dominated by spectacular and deadly failures. The fact that the United Nations chief role in Bosnia increasingly is offering hostage targets to the Bosnian Serbs would be laughable if it were not so sad. Not only are our allies' brave and dedicated soldiers being put at risk, but their role as hostage targets has virtually guaranteed inaction by NATO air power no matter how brutal and blatant Bosnian Serb aggression becomes--whether it is aimed at Bosnian Government forces, at civilians, or even at the U.N. peacekeepers themselves. The United Nations must strengthen its position in Bosnia or get out. At a minimum, it must reconfigure its troops into stronger and more easily defended units. I am inclined to support efforts by the administration and our European allies to do this, if it can contribute to offering real protection to the currently misnamed ``safe areas.'' In the end, however, if the resulting UN forces have no viable mission to carry out they should be withdrawn. U.S. and NATO assistance in this effort would be appropriate. I do not support the use of U.S. ground troops to take sides in this war, or simply to assist a feckless U.N. force. But NATO air power can contribute to protection of Bosnian ``safe areas'' or at least deter further Bosnian Serb aggression. It should be used. We have a moral responsibility to allow the Bosnians to defend themselves and to try to end the one-sided slaughter. And our broader security interests will be seriously damaged if we allow this aggression to go unchallenged, and to spread to Kosovo, Croatia, and eventually Albania, Macedonia, and beyond. Failure to act carries grave risks. I am under no illusion that solutions to the problems in Bosnia are simple. Some problems defy attempts from the outside to solve them, and this may be a tragedy the United States cannot end, as much as we would like to. But, there are things we can do, and the people of Bosnia have suffered too long. At a minimum, and as an immediate step, we can and should end the unjust arms embargo against Bosnia. Mr. President, I have been involved and interested in this situation for several years now. I would like to try to put it in some sort of perspective that perhaps all of us can understand where the morality is and where we ought to be. I was, in August 1992, at a conference in Austria with several European members of Parliament. At that time, I had also just come from visiting Croatia, and had been to the front and visited with refugees that had streamed out, with those that had been victims, and with those that had witnessed the terrible situation with respect to the raping of women, and the deaths of many males which had occurred as a result of the Serb intrusion into the villages and homes of the Bosnian Moslems and Croats. When I was at that conference, the Chancellor of Austria was present. And I asked the Chancellor--I said, ``Why is it not imperative, and certainly rational, for the European Community to step in and stop the fighting in some way?'' He looked at me and he said, ``Well, we cannot get involved because they are both our friends.'' I started to think about that at that conference. It seemed to me that the time you really want to get involved between two of your friends who are fighting is when one of your friends is there handcuffed to a post and the other friend is there beating him with a lead pipe. It seems even more imperative that you ought to get involved and stop the fighting, especially when you consider that the size of those that are standing around watching the fight are more than capable of walking in and resoling the situation. That seems to me the situation we have right now. Also, at that conference I asked a question of the group there. Well, would it not be right under this situation, if you are not ready to go in and separate your friends from fighting, that perhaps at least you ought to take the handcuffs off the individual that is at the post and perhaps give that individual a weapon or the weapons necessary to be on equal terms with his opponent? No, they said. The answer to that is, well, more people might get hurt that way--with the conclusion, therefore, that it would be better to allow your friend to be beaten to death than to come in and try to separate them because somebody might get hurt. Take a look at the U.N. situation. There is a way you can look at it and, I think, using that same scenario, understand what has happened there. First of all, in the two opponents, the Serbs and the Bosnian Serbs on the one hand against the Moslems, Bosnian Moslems and Croats on the other, we have a situation where one side is heavily armed and the other is not. The Bosnian Serbs inherited the arms which came from Yugoslavia--howitzers, the tanks, and the airplanes--whereas those weapons are not available to the other side. That is the situation we have now. It seems to me that again those forces that are standing outside, that have the ability to come in and settle it, are faced with a couple of options, again very similar to the scenario I laid out, and that is we can walk in with force, and we can do it. But then that may put some of our people and others in harm's way. The other thing we could do is to say, all right, we are going to level the fighting field. In fact, we will not only do that, but if we arm the Bosnians, their forces outnumber the Serb forces. Well, if I am standing there as a Serb force and recognize that, whereas I now have the upper hand because of the weapons I possess, if the United States suddenly enters and changes its policy and says, OK, that is enough, we are now going to arm the other side so they have the same kind of arms you do, all of a sudden I am not in a position of superiority but instead in a position of inferiority. So that is why I support this amendment, because what we will be doing is aiming a huge weapon at the Serbs instead of their pointing weapons in the other direction, and that leverage alone, in my mind, will bring the Serbs to the conclusion that they have to come to heel and to reach some political accomodation. The other way, which is represented by our current policy, is to come in and say we will hold a shield up and prevent one side from beating the other. And then, of course, when that got troublesome and we began to get hurt, we let the shield down, and the beating began again with impunity. If we just go in there now and try to strengthen those forces but we still do not raise the shield to protect, we are not going to make any headway at all. I am a strong believer that if you get involved in these things and you have overwhelming force, the best way to resolve the situation is to make sure that force is available and ready, whether it is the United Nations or ours. Alternatively, as this amendment would provide, we can say, if you do not come in and work out a peace here, we will arm the other side so they have the superiority. Continuation of this policy which relies on an ineffectual peace force and hamstrings real efforts to assist the war's victim is a very destructive policy with respect to the United Nations. This event could well make the difference as to whether the United Nations is going to be an effective body to prevent war in the future or not. We are at that point where we have to do what is necessary to ensure that we can preserve the ability of the United Nations to make a difference, and, [[Page S 10292]] hopefully, we will have the courage to do that. So I again reflect back upon a year and a half ago or so or 3 years ago now when we were starting to take a look at this, and I have come to the same conclusion again that I came to then, that if we do not as a United Nations intervene in a responsible way, we will cause the United Nations to become an ineffective and unusable organization with respect to this kind of conflict. I yield the floor. Mr. PELL addressed the Chair.

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

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today in support of the Health Insurance Reform Act of 1995, which is being introduced today by Senators Kassebaum, Kennedy, Frist, Dodd, Gorton, Mikulski, Gregg, Pell, Simon, Wellstone, Chafee, Hatch, Lieberman, and myself. I applaud Senator Kassebaum and Senator Kennedy for their commitment in developing, what I believe to be the first truly bipartisan insurance reform bill introduced this Congress. As I have stated many times in the past few years, health care reform cannot be successful unless Republicans and Democrats work together. I am proud to be an original cosponsor of a piece of legislation that has been developed in one of the most inclusive processes that I have been privileged to be a part. This legislation makes great strides in laying a foundation for a well functioning private market, which is critical if we are to be successful in creating a solid health care system for all Americans. This bill puts into place minimum national insurance reform standards, which transforms the current exclusionary insurance system into one which moves closer to accepting all comers, yet the bill allows States a great amount of flexibility to move ahead at a faster pace if they choose. This bill, assures that if any individual has insurance today even if they get sick, or change or lose their job, they will be able to purchase insurance tomorrow. This bill encourages a variety of health plans to compete in the marketplace. Individuals will have choices between managed care plans which focus on preventative care, as well as, catastrophic plans with medical savings accounts. This bill fixes certain glitches in COBRA so that individuals with disabilities will no longer have to experience a gap in health insurance between the transition from employer to Medicare coverage. Mr. President, I am most grateful for the inclusion of the health plan purchasing coalition section of this legislation. I will be introducing legislation next week called the Employer Group Purchasing Reform Act of 1995, in which health plan purchasing coalitions are the center piece. I believe very strongly that voluntary private market group purchasing arrangements, for employers and individuals, is the key to making health insurance not only more accessible but also more affordable for all Americans. My legislation will also address the fraud and abuse in employer group purchasing arrangements called multiple employer welfare arrangements [MEWA's] under the Employee Retirement Income Security Act of 1974 [ERISA]. Senators Nunn and Cohen have both held hearings over the past few years which have uncovered ponzi schemes that have left millions of small business owners and their employees sick and without insurance. The legislation will give clear authority to the States to shut down group purchasing arrangements that are fraudulent and clear authority to certify health plan purchasing coalitions. In addition, the legislation also begins to level the playing field between insured and self-funded health plans in the market by amending ERISA. I look forward to the same bipartisan support of this bill as has been achieved by Senators Kassebaum and Kennedy. Mr. President, I am very eager to work with Senator Kassebaum, chairman of the Labor and Human Resources Committee, in the next couple of months, to report a market reform bill out of committee that can be brought to the Senate floor this session. We must begin to address Americans concern about portability and affordability of health insurance this year and I believe that the Health Insurance Reform Act of 1995 is an excellent place to start.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to speak on the budget resolution. Like many of my colleagues I am concerned with some of the choices made during the budget conference, and would like to take a few moments to express some constructive comments about the conference report. Mr. President, in reaching a balanced budget we must be careful not 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. One example of this dilemma is in cuts in health research. We are nearing discoveries and new treatments to the causes of many illnesses and diseases such as Alzheimers and Parkinsons. To reduce spending on this research now could mean a continuation of tens of billions of dollars in health care costs needlessly spent, only to save a few million dollars in the short-term. Internationally we are seeing deadlier viruses emerging, we can not afford to weaken our commitment to investigating, identifying and eventually eradicating these diseases. Another example is in cutting nutrition programs. For instance, cuts in WIC benefits for pregnant women, studies have shown, would increase health care costs by over $3 for every one dollar cut. Further, our food stamp program provides necessary stability for low-income families at the most essential level--putting food on the table. This Nation's future id dependent upon how well we prepare our children for adulthood. Hungry children can not learn. In addition, in the area of cutting education. 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 in causing thousands not 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 will work with my colleagues during the appropriation and reconciliation process to ensure that education programs receive adequate funding. Mr. President, thus in order to help solve the deficit problem, as importantly, to prevent the unnecessary hardship to individuals I wish to put the leadership on notice, I will find it difficult to support a reconciliation bill or appropriation bills that could produce counterproductive budget results and needless hardship for millions of Americans, as outlined above. Mr. President, I recognize that the budget resolution is not a law and is advisory in nature. Therefore, I will vote for the budget resolution, since I am committed to balancing the federal budget. Mr. President, I can not make it any clearer that I remain firm in my commitment to not see the budget process be used to make counterproductive cuts, just to pay for a tax cut. I am committed to balancing this budget, but not on the basks of the poor, the elderly and our children to simply provide a tax cut. In closing, action needs to be taken now by Congress to balance the budget [[Page S 9393]] for the sake of our children and grandchildren. Mr. President, I voted for the balanced budget amendment, and I supported the budget agreement that came out of the Senate Budget Committee after it was amended. However, when it traveled over to the House and was conferenced, substantial and unfortunate changes were made, resulting in what I believe to be counterproductive cuts. Therefore, I reluctantly support this budget resolution. I do this, since I believe that it is critical for this Nation to balance the federal budget to give our children a future. But, I will still do all I can to change the cuts that were made in health care, the NIH, nutrition, and in education, in particular. I join speakers today-- Senators Cohen, Kassebaum and Snowe--and will join them in their efforts to accomplish that same purpose. Notwithstanding the huge votes that the NIH and the education amendments had--85-14 for NIH, 67-32 for education--they came back with additional cuts. I understand that during conference negotiations, everyone needs to take some additional cuts to create a compromise. But these changes are counterproductive. I stand today to highlight some of these concerns. When you are in a budget situation, there are programs you can cut that will help reduce the budget, but there are also some programs within the federal budget that by decreasing them it will increase your costs in other programs. That is the potential here. With respect to NIH research, we are on the verge of many breakthroughs in curing illnesses and diseases, such as Alzheimer's and Parkinsons. By cutting back their research funds by just 1 to 3 percent per year, we hamper that possibility in the near future for finding answers. If these answers can be found in the next few years, the result could be tens of billions of dollars in federal savings. In addition, I point to education spending, because that is where I have a role to play as chairman of the Senate Education Subcommittee. I point out that, in this particular matter, what we may be cutting over the next 7 years could be counterproductive to our Nation. Reduced education expenditures could lead to reduced incomes, reduced revenues and increased social costs. As for the $10 billion in mandatory cuts that the Labor Committee is instructed to find, let me quickly talk about some of my concerns. Mr. President, let us look at education generally. Education is the key to the success of this Nation. It is the key to our growth. It has been the key to our growth over the past 60 years. From 1929 to 1990, 45 percent of the growth was due to improved education--45 percent. The amount of economic income that resulted from this growth is surely in the trillions of dollars. But what are we going to do about it? We must be careful in how we reduce federal education spending over the next 7 years to ensure that we will not make these problems worse. Mr. President, that is my goal as chairman of the Education Subcommittee. Let me highlight what this chart shows; this indicates what the annual taxes by family were in 1991. As you can see, those who do well in this Nation, who pay our taxes, are those who made it not only through college but through graduate school. High school graduates and those that do not make it through high school do very poorly. If we can increase those educational levels--and we are not doing well with education right now on all these levels, we can increase federal revenues and decrease federal costs on social programs. But let us talk about higher education because that is where my concerns are greatest. Let us look at the next chart we have. This shows the average annual earnings by profession and educational level, again, indicating the revenues we lose by not allowing our kids to be sufficiently educated. Right now, if you do not finish high school, the yearly earnings are $12,000, and for graduate school graduates, it is up to $74,000. The key to us continuing increasing our revenue is our education, as well as increasing our national productivity. This next chart shows the difference between high school dropouts and college graduates. This is what has happened over the last 20 years. The high school dropout has seen a decrease in his or her income of 35 percent--family income. The only ones that have shown a real increase are those that are postgraduates, the ones we are picking on first. College graduates stayed about even. Some others have gone down. If we do not improve the educational levels of this Nation, we are going to continue to see a drop in our revenues. The next chart is helpful in letting us understand what is happening. This indicates where my state of Vermont is on education. This shows what has happened in our State over the last 8 years, as to what debt a college student has to hold through the 4 years. It has gone from $8,000 in 1990 to $21,000, and it is going up off the chart in the future. Mr. President, we need to work hard at improving educational costs for students. The other charts that I have here will indicate how serious it is. I will highlight these charts at a later time. Now let us take a look at this. Now, on top of these figures, consider the proposal to eliminate the in-school interest subsidy for graduate and professional students. I will work my colleagues over the summer to find the best ways to maintain educational spending. We need to work on ways to keep the cost to students that borrow to a minimum. For instance, if a student is using a subsidized Stafford loan, as an undergraduate that student may borrow up to $23,000. Upon graduation, this student decides to earn an advanced degree in math or science and begins to think about the cost. With the interest subsidy in place, he could borrow an additional $8,500 per year through the subsidized Stafford Loan Program. Assuming a 4-year graduate program, now that student would owe $57,000 upon graduation. My job over the next few months is to find appropriate cuts within the Labor Committee's instructions to protect the interest subsidy and keep that same student from owing almost $65,000. Mr. President, as chairman of the Education Subcommittee that is my job. It is not one that I relish, but one that needs to be done. Mr. President, since I am committed to balancing the Federal budget to ensure the future of our children, I will vote most reluctantly for this budget resolution, but I am committed to working with my distinguished chairman of the Budget Committee to improving on these counterproductive cuts in education, health, and nutrition.

Mr. JEFFORDS. I thank the chairman for his comments.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise in strong support of cloture, as I believe it is the right of the President to have an opportunity to have a vote up or down on a very fine man who is willing to dedicate his time to public service, who has an unblemished career of dedication to those people who need help, those who are economically disadvantaged, and those who have not seen the advantages that have been brought to so many others. It is unfortunate that we find ourselves in this situation because there is no question that this man was picked because he would not ``Raise the specter of abortion,'' because his record, first of all, of being an ob/gyn doctor who only performed 39, 40, if you want to count another, abortions in 38 years is certainly not of one who is out seeking to make a career of abortions, by any stretch of the imagination. In addition to that, by serving the poor and starting his program I Have a Future, he set an example we must replicate around this country of how we can get the young people in our schools to look towards the future with hope, to understand that teenage pregnancy is a bad situation and that he had all those kinds of rules that he followed in respect to that, teaching abstinence, of teaching parental guidance when possible, things that I do not think anyone disagrees with. It is true that the study was marred by utilization of statistics, but that does not in any way diminish the importance of the message he was giving to those young people. Mr. President, I want to remind my colleagues what this vote is about. We are here to consider whether or not we will limit debate on this nomination, whether we not allow a minority of this Chamber to take this nominee hostage. We are going to vote now, not on whether Dr. Henry Foster is qualified for the job of Surgeon General--which I believe he is--but on whether we will allow the President's nominee the courtesy, the due process, of an up or down vote on his nomination. What reason could we possibly have not to vote? Whose interests are served by allowing a minority of Senators to deny a presidential nominee a confirmation vote? The charges against Dr. Foster that we heard yesterday and today are just that--charges. They are allegations, not fact. During the committee process I spent hours and hours familiarizing myself with Dr. Foster's record and the specifics of his critics' charges. I became convinced of several facts: Henry Foster did not learn of the Tuskegee experiments in 1969 at the [[Page S 8872]] briefing given by public health officials. Not only is he documented as attending at a complicated Caesarean section birth shortly after the meeting started, but I believe the doctors who were at that meeting were not given the full story. Foster did not know anything about the denial of treatment for these men. In fact, no one did, because even the doctors at the meeting were not told about it. According to the FBI, the public health officials were already covering their tracks and when they briefed these six or eight doctors they did not tell them the truth about the experiment. How could they have? Certainly someone given the facts would have spoken out publicly and halted the 40-year-long project. Foster did not know because nobody knew. Decades later, we cannot prove the content of the meeting because the minutes, trip report and file have long ago disappeared from the CDC archives as the officials tried to cover their tracks. Dr. Foster has had a distinguished medical career, treating patients within the medical norms of his time and even advancing new and better treatments in many cases. I hope my colleagues will resist the temptation to judge treatments given decades ago--like the sterilizations of severely mentally impaired women--by the medicine of today. Then as well as now, Dr. Foster has enjoyed the admiration and acclamation of his peers, and he has been supported in this nomination by every medical group that I can think of, ranging from the AMA, not known for its liberalism, to the American College of OB/GYNs to the American Association of Medical Colleges. It is undeniably true that the administration did not serve Henry Foster's nomination well in its characterization of his record on abortion. Ever since they misinformed Senator Kassebaum's office about the number of procedures he had performed back in January, there has been confusion in the numbers game. But after he had the opportunity to review his patients' medical records, Dr. Foster gave us a number; he is the physician of record for 39 surgical procedures since 1973. That number has not changed. I can understand why he did not know off the top of his head, because I would be hard pressed to give an accurate count of the votes I have taken on a particular issue over the past 20 years. I might volunteer an estimate, but I would certainly have to do research to verify the number. Some have implied that we should not vote on Henry Foster's nomination because he was once--once in a 30-year career--charged with medical malpractice. The charges were dropped. The case was not adjudicated. Yes, the allegation of improper conduct was made, but it was not substantiated. I would suggest to my colleagues that we have a similar situation here and now with this nomination. There is no substance to the charges against this good man, this talented and hard-working doctor. Let us not let ideology and politics get in the way of fairness. We have a collective responsibility to vote, even on controversial nominees. I do hope my colleagues will join me in supporting Dr. Foster's nomination, but at the very least I believe he deserves an up or down vote. Let us not deny him that. Please join me in voting for cloture.

Mr. JEFFORDS

Mr. JEFFORDS. I thank the Senator from Rhode Island. Change of Vote

Mr. JEFFORDS. Mr. President, I would like to engage my colleague from Rhode Island in a colloquy on Federal oversight of the design of projects in Vermont that are on noninterstate portions of the National Highway System [NHS]. First, Mr. President, I would like to acknowledge the hard work that committee staff, my staff, the U.S. Department of Transportation and the Vermont Agency of Transportation have put in on the NHS-design issue. All the parties have acknowledged that Vermont's mountainous terrain and historic villages present a unique challenge when designing highway and rural road improvements. It has been the goal of the parties to come up with solutions that do not adversely affect Vermont's small communities and rural landscape. Mr. President, the 1991 Intermodal Surface Transportation Efficiency Act placed control for the design of highway improvements off the NHS in the hands of the individual States. It has been our experience in Vermont that this has improved communications with local citizens on highway projects and lowered project costs. it is the Vermont Agency of Transportation's desire to assume primary responsibility for the management of its transportation system, including those non-interstate roads proposed for the National Highway System. Representatives of the U.S. Department of Transportation have assured Vermont transportation officials that such control and flexibility can be provided for the non-interstate NHS roads through existing provisions of the United States Code, title 23.

Mr. JEFFORDS. To ensure that a common understanding exists on the above matters between the U.S. Department of Transportation and Vermont transportation officials, Vermont has been assured by the Federal Highway Administration's Deputy Administrator Jane Garvey and other high-level Federal highway officials that she and these officials will visit Vermont in the near future to discuss these matters. Following this visit and drawing on the provisions of section 117 of the United States Code, title 23, Vermont has been assured that an agreement will be executed that will grant Vermont the authority required to assume primary responsibility for the management of its transpiration system, including the non-interstate roads on the NHS.

Mr. JEFFORDS. Vermont has been assured by the U.S. Department of Transportation that under section 117, United States Code title 23, the Vermont Agency of Transportation can be granted the authority to provide design exceptions at its discretion on non-interstate NHS roads. Further, Vermont has been assured that it may determine the scope of non-interstate NHS projects. These projects include simple road and bridge resurfacing, while more comprehensive improvements undergo the necessary planning and design process.

Mr. JEFFORDS. Mr. President, I strongly urge my colleagues to support this important amendment. The Roth amendment will grant States the flexibility to use highway funds to maintain and revitalize intercity passenger rail service. At a time when we are shifting responsibility from Washington to the States, we should also allow individual States to chose how they would allocate Federal transportation funds and select transportation systems that best meet their needs for the future. Mr. President, my own State of Vermont spent the winter working to preserve our link to the national passenger rail system. In December, Amtrak announced that all passenger rail service to Vermont would be terminated. But in April, after extensive negotiations, the State of Vermont and Amtrak announced the establishment of the Vermonter, a new day train traveling from Washington, DC, to St. Albans, VT. The key to preserving this rail service was that the State of Vermont was willing to pay, out of general funds, the operating costs of this train. This is how important rail service is to Vermont. Earlier in this debate a number of Senators referred to a letter in support of this amendment from four Governors, including Governor Dean of Vermont. The letter clearly illustrates that States want the flexibility to use Federal transportation funds as they chose. Vermont would use these funds to support the Vermonter and possibly other passenger rail in the State, including a proposed route from White Hall, NY, through Rutland to Burlington, VT. Clearly, Vermont and other States should have this option. I commend Senator Roth for his dedication to this issue and I urge my colleagues to vote for this important amendment.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise in support of a vote for cloture. I believe this would probably be the first time in history if cloture is not granted for a nominee that has come out from a committee with a positive recommendation to be denied an up-or-down vote. I also recognize from listening to those who have opposed granting cloture, that it is critical that we have debate on Dr. Foster, because there is so much information out here which is incorrect. I sat through the hearings, and I have gone through thousands of pages of documentation, and I came to the conclusion that a President has the right to have people around him who he wants to have, and he has that right here. There is nothing that should stand in the way. First of all, there is no evidence whatsoever that this man is not competent to handle the job. Second, there is no credible evidence that there is any flaw in character or any reason why this person should be denied the job. To deny Dr. Foster the ability to have his nomination debated is indefensible, in my mind. I am not going to go into all the issues, but there are a couple I would like to straighten out. First of all, the Tuskegee situation. All of the argument has been about who knew what when. When did it occur? Was he there? Was he not? What we do not know is whether at that meeting which the CDC held in Tuskegee in the late 1960's, with the doctors of Macon County that they were told anything about the fact that there was a group of black men being denied treatment in order to see the difference between treating people with syphilis versus not treating them. That did not come out until the 1970's, and all hell broke loose, and everyone said what a shocking thing. Whether Dr. Foster was there--the evidence was clear he was not--but even if he had been there, he would not have learned anything. All of the information that has clouded that, strike it out of your mind, and remember that nobody at that time other than CDC knew the experiment was being conducted. Whether he was there or not is irrelevant. Second, another issue where there is confusion, as the previous speaker from my side of the aisle got into, there were two situations with respect to a sterilization situation which occurred in this country at a time when the decision was, and it was sort of ethical and considered wise in many respects, to sterilize seriously mentally deficient people. That had nothing to do with Tuskegee. The previous speaker got that confused. Make a judgment, but it was not unethical or improper at that time. Later on it was discarded as a methodology. Third, the abortion issue. Yes, there was changing information, confusing information, things hard to follow. That was not the doctor's fault. He was very clear. He searched his records and found out, over 30 years, performed 39 abortions, or was responsible for them. Thirty years--that is not a doctor who is working in abortion clinics. He is an ob-gyn. Obviously, he is going to have a number of abortions during that period of time, to save the life of the mother or whatever. The abortion issue is one that has been made to be a key issue, when it should not be here at all. I would ask Members to try and remove from your minds all the discussion we have had, and ask the simple question: Is this person deserving of the right to have a vote of up or down? That is the crux of it. We are having this cloture vote, because there are at least 51 votes that will support Dr. Foster to be the next Surgeon General of the United States. This is an attempt to use the cloture--and some of these issues which the information is, at best, misunderstood--to try and prevent or even avoid having that opportunity to vote. I urge my colleagues to seriously recognize and understand, first, the facts are very clear that the doctor ought to be recommended. The committee recommended him. More importantly, that he ought to be entitled to an up-or-down vote on the issue. We will discuss it and spend a day or so discussing these things so we can clear this up in everyone's mind. I spent days on this, and I am confident there is no reason this doctor should not be confirmed. He certainly should be allowed to have a vote up or down on whether or not he should be confirmed to be the next Surgeon General of the United States. I yield the floor. [[Page S 8740]]

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, this amendment is a technical correction to the current law regarding highways in Economic Growth Centers [EGC]. The amendment simply allows programs already approved for EGC funding to continue to receive this level of support. The EGC program was authorized by title 23, United States Code [USC], section 143, for projects on the Federal-aid systems other than the Interstate System. Under 23 USC 120(k), the Federal share for EGC projects financed with regular Federal-aid funds were 95 percent. However, in 1991, Congress passed the Intermodal Surface Transportation Efficiency Act [ISTEA], which eliminated the Federal-aid systems and replaced it with National Highway System, which we are debating today. In [[Page S 8657]] addition, ISTEA eliminated 23 USC 120(K). During debate over the Department of Transportation's Appropriations Act of 1993 my amendment to restore the 95 percent Federal funding ratio for previously approved EGC projects was accepted. However, because of the change ISTEA made in referring to Federal-aid systems, the amendment, as interpreted by the Department of Transportation, did not apply. The amendment I am offering today will grandfather those EGC projects that have already been approved for EGC ratio funding. My understanding is that there are roughly 19 projects in the State of Vermont, all located in the Barre/Montpelier area or in Burlington. In discussions with the Department of Transportation, we have been assured that this language will guarantee 95 percent Federal funding for these few EGC projects in Vermont.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, today I am pleased to introduce the Employment Non-Discrimination Act of 1995. I am joined in doing so by nearly one-third of the Members of the Senate. In my view, Mr. President, this bill is perhaps the most important civil rights legislation to come before Congress this year. I am honored to be a principal sponsor of the legislation in the Senate. The legislation extends to sexual orientation the same federal employment discrimination protections established for race, religion, gender, national origin, age, and disability. The time has come to extend this type of protection to the only group--millions of Americans--still subjected to legal discrimination on the job. The principles of equality and opportunity must apply to all Americans. [[Page S8502]] Success at work should be directly related to one's ability to do the job, period. People who work hard and perform well should not be kept from leading productive and responsible lives-- from paying their taxes, meeting their mortgage payments and otherwise contributing to the economic life of the nation--because of irrational, non-work-related prejudice. Mr. President: As a 61-year-old white male who grew up in a rural area, I fully understand how one could feel prejudice. I was not immune to it myself. However, through education and understanding, we must overcome such prejudice, as individuals and as a nation. When this issue has been raised in the states, the debate has often turned on the phrase ``special rights.'' This bill does not create any ``special rights.'' Rather, it simply protects a right that should belong to every American, the right to be free from discrimination at work because of personal characteristics unrelated to successful performance on the job. I'm proud to say that my home state of Vermont is one of several states that have enacted sexual orientation discrimination laws. It is no surprise, Mr. President, that the sky has not fallen. I am not aware of a single complaint from Vermont employers about the enforcement of the state law. However, I do know that thousands of Vermonters no longer need to live and work in the shadows. My little state of Vermont was the first to abolish slavery, the first to answer Lincoln's call to arms, and the only state I know of with the audacity to declare war on Germany before Pearl Harbor. Once again, I think it is time for the federal government to follow the lead of Vermont, and the other states and cities across the country that have declared war on this, the final front of discrimination. The bill we introduce today takes important steps in that direction. I look forward to the day when we can see it signed into law. Mr. President, I ask unanimous consent that a summary of the bill be printed in the Record.