Jim Jeffords

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I am pleased to note that the Foreign Relations Committee has included a very important provision on global climate change in S. 925, as reported. This provision, section 813, expresses the sense of Congress that the United States should take responsible action to ensure significant and meaningful reductions in emissions of greenhouse gases from all sectors. I strongly support this provision. Its inclusion in this legislation should be a signal to all the conferees on this bill and to the world that the Senate strongly supports such reductions. The findings preceding the articulation of the sense of Congress in section 813 are also very important. They clarify that it is Congress' position that evidence continues to demonstrate that increases in atmospheric concentrations of man-made greenhouse gases are contributing to global climate change. This assertion is supported by reports from the National Academy of Sciences, the International Panel on Climate Change, and testimony before various Senate committees, including the Senate Environment and Public Works Committee of which I am the ranking member. We have heard repeatedly that increasing greenhouse gas emissions increase the risks associated with global climate change and warming. I believe it is prudent and practicable to manage these risks now by reducing our emissions as swiftly as possible. Based on the work of many highly respected scientists, I believe we must endeavor to prevent a doubling of atmospheric concentrations of carbon. That means dramatic changes in the way we use, produce and consume fossil fuels in the next 10 to 15 years. Nearly every single climate expert and scientist believes that the facts require us to take prudent actions now to reduce emissions and thereby reduce the risks of climate change. In a December 2002 resolution, the American Geophysical Union said the following: ``AGU recommends the development and evaluation of strategies such as emissions reduction, carbon sequestration, and adaptation to the impacts of climate change. AGU believes that the present level of scientific uncertainty does not justify inaction in the mitigation of human-induced climate change and/or the adaptation to it.'' As much as some people would like to continue debating whether or not global warming is occurring and whether or not man-made emissions are contributing to that warming, there is not a real debate on this matter in the scientific community. They have moved on, as Congress and the Administration should, to trying to define the magnitude of the probable disruption to earth and human systems, and to designing emissions reductions and adaptation programs to avert the negative effects of that disruption to our quality of life, the environment, and the economy. I ask unanimous consent that four short documents be printed in the Record following my remarks.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, as we debate the Prescription Drug and Medicare Improvement Plan of 2003, I would like to take a few minutes today to speak in support of the overall bill, but I would also like to highlight several provisions in the bill that are of particular importance to me and my State of Vermont. Over the last several days, we have focused much of our discussion on the aspects of this bill related to prescription drugs and the Medicare Advantage Program. These are clearly among the most important provisions of this bill and these issues warrant the attention and debate they are receiving. I especially appreciate the close relationship this bill has to last year's tripartisan effort--which effectively is the parent of the current bill Last year, my friends-- Senators Grassley, Snowe, Hatch, and Breaux--and I set out to design a bill that provided a prescription drug benefit along with other improvements, what we called ``enhancements,'' to the basic operations of the Medicare Program. The tripartisan bill was good legislation-- something all of its original cosponsors were very proud to work on together. This year, I am pleased to say that the Grassley-Baucus bill is even better than our effort from last year, and I commend Chairman Grassley and Ranking Member Baucus for their leadership and initiative in bringing it to the Senate floor. One of the most important reasons that the Prescription Drug and Medicare Improvement Act is stronger than the tripartisan plan from last year is because it includes provisions that begin to resolve longstanding inequities in payments to rural doctors, hospitals, and other provisions. This problem can be stated simply. Rural health care providers are paid less than providers in more densely populated areas for the same exact services. Earlier this year, I joined with my colleagues, Senators Hatch, Grassley, Lincoln, and Bingaman, in introducing the legislation that addressed geographic inequities for physician services by changes to the physician reimbursement formulas. As many of our colleagues are aware, Senator Grassley fought to include these rural provisions in the recent tax bill that was signed by the President. And although I strongly disagreed with enacting further tax cuts, I was doubly disappointed to see the rural health provisions stripped out in the conference with the House. These unfair geographic differences in reimbursement rates have gone on far too long, and I am especially pleased to see reimbursement issues for rural providers getting the attention they deserve--including the commitment from the President to my friend from Iowa pledging his support for rural health relief as part of the effort we have underway. I am, therefore, very pleased to see that these provisions are included in the chairman's mark and are now part of this bill. I am also glad that Chairman Grassley and Ranking Member Baucus have worked with me to address another inequity in the system. Critical access hospitals provide care in the most remote regions of my State of Vermont and all other rural States. These hospitals are small, yet serve as critical resources to their communities. The managers have agreed to include a provision in their amendment that will make a technical correction to current law, allowing hospitals like the Mt. Ascutney Hospital in Windsor, VT, to expand access to psychiatric and rehabilitative services to the most vulnerable citizens in that community. I would also like to speak today in support of a provision in this bill that establishes Medicare demonstration programs to improve health care quality. I heard my friend from Montana speak yesterday about quality and geographic disparities, and I know how committed he is to improving the quality of services delivered under Medicare. Earlier in this Congress, I was pleased that Senators Frist, Beaux, and Gregg joined me in introducing S. 1148, the Medicare Quality Improvement Act. I want to thank Chairman Grassley and Ranking Member Baucus for including this provision in this bill. I became concerned about the issue of health care quality after reading the work of Dr. Jack Wennberg of Dartmouth, which has shown that higher levels of Medicare spending do not lead to better health outcomes. Let me repeat this finding. Higher levels of Medicine spending do not lead to better health outcomes. Instead, spending tends to vary by region--generally reflecting the availability of physicians and hospitals--rather than the health or needs of the population. I have followed Dr. Wennberg's work for a very long time. One of his early studies looked at rates of surgical procedures at Vermont hospitals. He found that communities in Vermont that had many more medical procedures were not necessarily healthier. I saw how this result led Vermont health care providers to join with the business community in achieving high quality, supportable outcomes. I also saw how our State government used this effort to improve health care across our State. Today, I am happy to say that Vermonters enjoy some of the highest quality health care in the United States, at a cost that is among the lowest in the country. As we prepare to vote for the bill before us, I think it is critically important for us to consider some of the lessons learned from Vermont. Some of my colleagues have expressed concern about the costs of the bill before us. Others have expressed concern that the bill does not go far enough. The quality demonstration program in this bill will give us some of the answers we need to these funding questions. The need for these demonstrations is critical. RAND Health published a study today in the New England Journal of Medicine that describes the problems with overuse and underuse of needed medical care services in the United States. The RAND study will make it clear that every American is at risk--not only for failing to receive needed medical care, but also for receiving care that is not needed and may even be harmful. This is a problem that belongs to each and every one of us, and we must find ways to fix it. The legislation before us closes a significant gap in the health benefit package available to our Nation's seniors. However, providing coverage for health care services is not enough. We must do a better job of ensuring that people are getting the care they need, and also that they need the care they get. In closing, I would like to urge my colleagues from both sides of the aisle to support this bill as we move forward. This bill will establish a drug benefit that is universal, comprehensive, affordable, and sustainable. This bill restores necessary and long-needed fairness to our physicians and providers in rural areas. And, the bill will improve the quality of care offered under Medicare.

Mr. JEFFORDS. Mr. President, this bill is a landmark piece of legislation the most significant modernization of the Medicare Program since its inception in 1965. Its passage by the Senate is a major accomplishment on the path toward enacting a prescription drug benefit for our Nation's seniors. It is the result of years of bipartisan, I might even say tripartisan, effort and it puts in place many long- sought changes. It has many significant features for the citizens of my home State of Vermont. It provides a sustainable, universal, and comprehensive prescription drug benefit. It guarantees access to traditional Medicare for all beneficiaries. It allows Medicare beneficiaries to participate, if they choose, in new systems of care that better reflect today's dynamic health care environment. The bill recognizes the high cost of providing quality care in rural settings and closes the reimbursement gap between rural providers and their urban counterparts. Finally, it contains a provision that will allow us to better understand how to provide quality health care--not care driven by using more and more resources, but instead one based on ensuring quality patient outcomes. Over the past 2 weeks, I have applauded the work of my colleagues who have labored over this bill. Today, I have the pleasure of congratulating them on their success and thanking them for their efforts. I have worked for more than 3 years with my good friends, Chairman Grassley and Senators Snowe, Breaux, and Hatch. In many meetings over many months, we delved into the details of what came to be called the Tripartisan Bill. This has been one of the finest experiences of my many years in Congress. I am very proud to have been a part of that group and that our efforts led the way to our success today. I especially want to salute the efforts of Senator Baucus and Senator Kennedy without whose hard work and commitment to working through an agreement we would not have accomplished this remarkable victory, and they deserve our accolades. A bill such as this is the result of great effort on the part of many different people who are not elected to this body, but upon whom we all rely. I would like to recognize the staff members who have worked so hard on this bill and deserve much of the credit for its successful passage. On Senator Grassley's staff: Ted Tottman, Linda Fishman, Colin Roskey, Mark Hayes, Jennifer Bell, and Leah Kegler, and on Senator Baucus' staff Jeff Forbes, Liz Fowler, Jon Blum, Pat Bousliman, Kate Kirschgraber, and Andrea Cohen deserve considerable recognition for their tireless efforts. Catherine Finley, Tom Geier, and Carolyn Holmes from my friend Senator Snowe's staff; Patricia DeLoatche and Trecia Knight of Senator Hatch's office; and most especially Senator Breaux's legislative director Sarah Walters deserve enormous credit for this bill. Finally, we would not be claiming a victory today if it were not for the contributions of Senator Kennedy's staff, especially, David Nexon and Michael Meyers. On my own staff, I particularly want to recognize the contributions of Paul Harrington during the last Congress, and most especially the work of Sean Donohue who took up that effort on the tripartisan bill and who has continued to see it through to today's success, with the recent assistance of Daniel Crimmins, our Robert Wood Johnson Health Policy Fellow. Each and all have worked tirelessly to gather the input, analyze the issues, and build a consensus toward achieving this final product.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, will the Senator yield for a question?

Mr. JEFFORDS. I was obviously on this issue with the Senator from North Dakota. We were forced into providing an ``out'' for them so we could get the bill to the floor that said the Secretary would have the authority to be able to set the bill aside and prevent this coming in. I don't think they would be required to make any rationalization. But, obviously, it was something we had to accept at the time in order to get the bill voted on. And then what happened?

Mr. JEFFORDS. I thank the Senator.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, as Senators, we are accustomed to the glare of the public spotlight and there are even some members of Congress who crave such attention. In general though, we are here because we share a deep desire to serve our country and to help ensure that our government and its laws are true to the spirit of America. We sometimes forget that we are also part of a Senate community filled with people who believe in that same kind of public service. Though they do not share the spotlight with us, we could not do our jobs without them and the nation would suffer. So, I want to recognize the contributions made by all staff, and in particular the experts in the Office of Senate Legislative Counsel that help keep us true to the law, its structure and its functioning. They help put our ideas into real form and maintain the integrity of the code. That is why it is very very difficult today to note the passing of Janine Johnson, Assistant Counsel in Office of Legislative Counsel. She was an integral and crucial part of that office. Her professionalism, her deft grasp of complicated statutes, her work ethic, and above all, her pleasant manner and bearing, will be sorely missed by that office, but also by me, my office and in particular, my Environment and Public Works Committee staff. Many of my staff have worked with Janine for a decade or more and have been uniformly impressed by her unparalleled skill and commitment to her job. Janine had a knack for taking even the most complicated concepts and proposals and breaking them down into manageable parts. Then, she found ways to integrate them into existing statutes. To many staff, she was a legislative magician. One did not need to know Janine for very long to see that she shone with a pure and intense inner light that made the way clearer and easier for others. But, the memory of her kindness and delicate humor will live on and inspire those who follow her. Janine was a talented woman and a lawyer's lawyer. She had a green thumb and many days brought one of her prized amaryllis plants in to brighten the front office. She also spoke many languages, including beginning Russian which I believe she started in Middlebury, VT. The Senate has suffered a great loss with the passing of Janine Louise Johnson. I wish her family and friends all the best in coping with the pain. However, I want to note that her significant contributions to the Senate and to the nation will not be forgotten and that she should serve as a model for us all.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I ask unanimous consent to allow floor privileges for Daniel Crimmins, a Robert Woods Johnson health policy fellow in my office during deliberations on this measure.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, it is not hyperbole to start by saying that we are engaging in a truly historic Medicare debate--one that has the potential to rival the 1965 creation of the Medicare Program. Over the next 2 weeks, we will have the opportunity to consider and enact the most significant Medicare modernization in 37 years. We have the chance to do more for the health care and well-being of our Nation's elderly than has been accomplished through any recent Medicare legislation. I commend Senator Grassley and Senator Baucus for their work in bringing this measure to the Senate floor. The Prescription Drug and Medicare Improvement Act is a landmark improvement to the Medicare Program and our colleagues deserve a great deal of credit for reaching this bipartisan agreement--I would say tripartisan. This is a large and complex bill--measuring over 600 pages. It is not at all unusual for a proposal of that size to have issues remaining and I know there are some of our colleagues for whom these issues need to be debated and addressed. So we should not be Pollyanna about the outcome. Work remains to be done. But I have been listening to our colleagues as they have come to the floor to discuss this bill and I am encouraged by the largely positive tone of their remarks. I am encouraged because this year I sense a cautious optimism among our colleagues that this Congress--this year-- we will be successful. As our colleagues know, I have been working on various efforts to modernize Medicare and to provide a prescription drug relief for our elders for many years. Most recently, I had the pleasure and honor to work with several of our colleagues on what came to be known as the tripartisan bill. I joined with Senator Grassley, Senator Breaux, Senator Snowe, and Senator Hatch in a 2-year effort at drafting a compromise measure that we felt could gain a majority of votes in the Senate. It was a true pleasure working with my friends in the tripartisan group and although we were not ultimately successful last year, I am convinced that much of our effort then has contributed to the bill we are debating now. So it is with a great deal of satisfaction that I am here to speak in favor of S. 1, the Grassley-Baucus, Prescription Drug and Medicare Improvement Act of 2003. S. 1 provides for a comprehensive, universal and affordable prescription drug benefit under Medicare. It also pioneers new arrangements with private sector-based health plans that promise to integrate traditional medical care with innovations in the areas of disease prevention and chronic disease management. The drug benefit, in particular though, meets four principles that have guided me throughout this effort. First, this program provides a universal benefit; it is available to all Medicare beneficiaries. While I believe it is critical to provide a benefit to the poor and those with catastrophic costs, all seniors, regardless of income, will benefit from this plan. Second, this program is comprehensive. Beneficiaries will have access to the best medicines, and will not be limited to only the cheapest ones for the sake of saving money. Third, this Medicare drug benefit is affordable--for both beneficiaries and the Government. Finally, for a drug benefit to be truly successful it must be sustainable. It will do little good to repeat the catastrophic failure of years past by beginning a program that we cannot carry on. This program, which combines seniors' contributions with a Government guarantee, will have the best chance of enduring into the future. I believe this bill meets these four standards. It is universal, comprehensive, affordable, and sustainable. Could it be improved? Probably. And that is why we will debate and possibly amend it this week. But this approach is a good compromise. It offers a respectable and responsible plan within the budget limitations we face. It is a good compromise. I support this bill and urge the Members here to support it as well. In closing, I also thank several of our other colleagues who contributed so much to this effort. I think again, that the work of our tripartisan group from last year did much to pave the way to today's bill--so I thank my colleagues for letting me join with them in seeking a tripartisan solution. Again, I thank Senators Grassley, my friend of over 28 years. We have worked on this issue and many others in the past. I think this will be one of our proudest achievements. Also, this bill would not have the balance that it does without the contributions of other members including Senators Baucus, Daschle, Graham, and Rockefeller of the Finance Committee and of Senator Kennedy's efforts to bridge the divides where they existed. As I close for today, I would like to mention that the measure we are debating this week contains many more significant provisions than just those related to prescription drugs. So I will look forward to returning to the Senate floor at a later time to discuss those provisions with our colleagues. Mr. President, I yield the floor.

Mr. JEFFORDS

Mr. JEFFORDS. I rise in support of the amendment offered by Senator Bingaman. His amendment does not go as far as I would wish, because it does not fully preserve the integrity of NEPA or the Endangered Species Act. These two Federal statutes, which are under the jurisdiction of the Environment and Public Works Committee, have been cornerstones for the protection of environmental quality for decades. Section 2604 of the bill negates or weakens application of these laws to most energy development on tribal lands. Section 2604 would allow tribes to grant leases or rights-of-way for mineral development, electric generation, transmission or distribution facilities or facilities to process energy resources of any sort on tribal lands. The tribes could do this without the approval of the Secretary of the Interior. This would effectively remove the current legislative authority of the Department of the Interior over these matters. Under existing law, the oversight of the Secretary of the Interior over energy development on tribal lands triggers a variety of Federal permitting requirements which will ensure that NEPA, section 7 of the Endangered Species Act, and a variety of other Federal laws will apply to these activities. Removal of the Secretary's approval authority over many of these actions would have a number of consequences. First, it would mean that Federal NEPA laws would no longer apply. It would also mean that the section 7 Federal consultation provisions of the Endangered Species Act would cease to apply. This is particularly significant in that tribal lands are often adjacent to some of the most protected and pristine Federal lands, including wildlife refuges, wilderness areas, and National Parks. Wholesale changes in the application of the Federal mineral leasing and development laws--and potentially a host of environmental laws--to tribal lands, could have significant impacts on adjacent sensitive lands, air quality, water quality and wildlife. Because of their sovereign immunity and special trust status, tribes are also generally exempt from many State environmental and other laws, to which private lands are subject. Section 2604 represents a sweeping reversal of years and years of established environmental and energy laws, many of which are within the jurisdiction of the Senate Environment and Public Works Committee. Our committee has never held hearings on this, nor had the opportunity to examine the extent to which this language would weaken or amend Federal environmental laws, or laws relating to the development of commercial nuclear power. My preference would be to insert language which I filed yesterday, which would clarify that Federal environmental and nuclear laws would continue to apply to these tribal lands, regardless of removing the approval of the Secretary of the Interior under the Indian Mineral Development Act. However, because I think that the language offered by Senator Bingaman has a greater chance for success, I will vote in favor of his amendment. At a minimum, his amendment would remove any implicit waiver of Federal environmental laws and would create an environmental review process to be conducted by tribes to ensure at lease some modicum of public involvement in what could possibly be massive energy development on tribal lands. Section 2604 creates an unprecedented lack of Federal oversight for development with potentially massive environmental impacts, and I urge my colleagues to adopt Senator Bingaman's amendment.

Mr. JEFFORDS

Mr. JEFFORDS. Madam President, I rise today to introduce the ``Marine Turtle Conservation Act of 2003''. Marine turtles were once abundant, but now they are in serious trouble. Six of the seven recognized species are listed as threatened or endangered under the Endangered Species Act, and all seven species have been included in Appendix I of the Convention on International Trade in Endangered Species of Wild Flora and Fauna, CITES. Because marine turtles are long-lived, late-maturing, and highly migratory, they are particularly vulnerable to the impacts of human exploitation and habitat loss. In addition, for some species, illegal trade seriously threatens wild populations. Because of the immense challenges facing marine turtles, the resources available to date have not been sufficient to cope with the continued loss of nesting habitat due to human activities and the resulting diminution of marine turtle populations. The Marine Turtle Conservation Act of 2003 is modeled after the successful Asian Elephant Conservation Act, the African Elephant Conservation Act, and the Rhinoceros and Tiger Conservation Act. These acts have established programs within the Department of the Interior to assist in the conservation and preservation of these species around the world. More than 300 projects have been funded and generated millions of dollars in private matching funds from sponsors representing a diverse group of conservation organizations. The projects range from purchasing anti-poaching equipment for wildlife rangers to implementing elephant conservation plans to aerial monitoring of the Northern white rhinoceros. The Marine Turtle Conservation Act of 2003 will assist in the recovery and protection of marine turtles by supporting and providing financial resources for projects to conserve nesting habitats of marine turtles in foreign countries and marine turtles while they are found in such habitats, to prevent illegal trade in marine turtle parts and products, and to address other threats to the survival of marine turtles. The bill authorizes $5 million annually to implement the program. This legislation will help to preserve this ancient and distinctive part of the world's biological diversity. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I want to state my opposition to the Federal Communications Commission's scheduled June 2nd vote to overhaul current broadcast media ownership rules of newspapers, television ,and radio stations. I am disappointed that FCC Chairman Michael Powell has refused to hold a single public hearing regarding the proposed changes to these rules, or to entertain further public comment on what is turning out to become a historic rulemaking. The public needs to be heard from, and the public needs to know what will happen if the changes that Chairman Powell has proposed become reality. The biennial review required by the 1996 Telecommunications Act requires the FCC to review its rules every 2 years, but this review should not be used as an excuse to radically alter the way our constituents receive their news from the media. Not only am I disappointed at how this situation has come to pass, but I am also dismayed at what the FCC proposes. There are a number of changes that I disagree with--and this is just from what we have learned last week. For instance, we have learned that the FCC is considering to allow the major broadcast networks to purchase more television stations and strip them of local control. The FCC is also proposing to ease ``cross- ownership'' rules and allow a media company to own a newspaper and television company in the same community. I urge everyone to reflect on this and how this will impact communities throughout this country. In my State of Vermont, we have a very proud tradition of grassroots activism. Our local Vermont media knows this and reports the day's events with a Vermont audience in mind. If more Vermont media companies are controlled by out-of-state, or out-of-country owners, I fear a significant deterioration in the coverage of local news. The Vermont Press Association and the Vermont State Legislature have concerns similar to mine. The Vermont Press Association has written a letter to the FCC explaining its position, and the Vermont State Legislature passed unanimously a joint resolution regarding this matter. I ask unanimous consent that both documents be printed in the Record.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I am very pleased to introduce the Champlain Valley National Heritage Act of 2003. I am joined by Senator Leahy and Senators Schumer and Clinton of New York. This bill will establish a National Heritage Partnership within the Champlain Valley. Passage of this bill will culminate a process to enhance the incredible cultural resources of the Champlain Valley. The Champlain Valley of Vermont and New York has one of the richest and most intact collections of historic resources in the United States. Fort Ticonderoga still stands where it has for centuries, at the scene of numerous battles critical to the birth of our Nation. Revolutionary gunboats have recently been found fully intact on the bottom of Lake Champlain. Our cemeteries are the permanent resting place for great explorers, soldiers and sailors. The United States and Canada would not exist today but for events that occurred in this region. We in Vermont and New York take great pride in our history. We preserve it, honor it and show it off to visitors from around the world. These visitors are also very important to our economy. Tourism is among the most important industries in this region and has much potential for growth. The Champlain Valley Heritage Partnership will bring together more than one hundred local groups working to preserve and promote our heritage. Up to $2 million a year will be made available from the National Park Service through the Lake Champlain Basin Program to support local efforts to preserve and interpret our heritage and present it to the world. Most of the funding will be given to small communities to help preserve their heritage and develop economic opportunities. This project has taken many years for me to bring to the point of introducing legislation. This has been time well spent working at the grass-roots level to develop a framework to direct federal resources to where it will do the most good. I am confident that we have found the best model. This will be a true partnership that supports each member but does not impose any new federal requirements. The Champlain Valley National Heritage Partnership will preserve our historic resources, interpret and teach about the events that shaped our nation and will be an engine for economic growth. I am hopeful that this bill, which was considered by the Senate last year, will become law during this Congress. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. JEFFORDS. Mr. President, I am pleased to join with my colleagues Senators Hatch, Grassley, Lincoln, and Bingaman in introducing the Medicare Physician Payment Equity Act of 2003. This bill corrects a longstanding inequity in the Medicare Part B reimbursement methodology that pays rural physicians less than what is received by physicians for more densely populated areas who provide the same exact service. I am pleased that we are able to offer a legislative solution to this payment inequity. Establishing Medicare reimbursement for physician services is a complex process and many factors go into setting rates. Without going into all of the intricacies of how fees are set, let me note that, for any specific service, the physician fee schedule has three components-- physician work, practice expenses, and the cost of malpractice insurance. Each of these components is further subjected to a geographic adjustment, which is lower for rural areas than for urban areas. In my own State of Vermont, we face a chronic shortage of doctors in our rural areas. Yet, when we need to find a physician for a rural clinic, we compete in a national market to find providers. The inequities in payments these physicians receive, however, makes it all the more difficult to recruit and retain physicians. Rural physicians have the same training, spend the same time with patients, and manage the same office pressures as their urban counterparts. Their work should be valued equally, and that is what this bill accomplishes. I've heard from many people in Vermont about this issue. Tim Thompson, M.D., President of the Vermont Medical Society, expressed his concern that while Vermonters pay the same premiums as other Americans to support the Medicare program, our doctors are paid less. This occurs without regard to the quality or efficiency of health care services they provide. In fact, according to the Center for Medicare Services, Vermont physicians provide the second highest quality care in the country, but the State is ranked forty-fourth in payments per Medicare beneficiary. We should do more to reward quality health care regardless of whether it is provided in an urban or rural setting. The Vermont Medical Society has told me that they strongly support the Medicare Physician Payment Equity Act of 2003 as an important first step in reducing the existing inequities in payment levels. I look forward to working with my colleagues to pass the Medicare Physician Payment Equity Act of 2003.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I am very pleased to introduce the Champlain Valley National Heritage Act of 2003. I am joined by Senator Leahy and Senators Schumer and Clinton of New York. This bill will establish a National Heritage Partnership within the Champlain Valley. Passage of this bill will culminate a process to enhance the incredible cultural resources of the Champlain Valley. The Champlain Valley of Vermont and New York has one of the richest and most intact collections of historic resources in the United States. Fort Ticonderoga still stands where it has for centuries, at the scene of numerous battles critical to the birth of our Nation. Revolutionary gunboats have recently been found fully intact on the bottom of Lake Champlain. Our cemeteries are the permanent resting place for great explorers, soldiers and sailors. The United States and Canada would not exist today but for events that occurred in this region. We in Vermont and New York take great pride in our history. We preserve it, honor it and show it off to visitors from around the world. These visitors are also very important to our economy. Tourism is among the most important industries in this region and has much potential for growth. The Champlain Valley Heritage Partnership will bring together more than one hundred local groups working to preserve and promote our heritage. Up to $2 million a year will be made available from the National Park Service through the Lake Champlain Basin Program to support local efforts to preserve and interpret our heritage and present it to the world. Most of the funding will be given to small communities to help preserve their heritage and develop economic opportunities. This project has taken many years for me to bring to the point of introducing legislation. This has been time well spent working at the grass-roots level to develop a framework to direct federal resources to where it will do the most good. I am confident that we have found the best model. This will be a true partnership that supports each member but does not impose any new federal requirements. The Champlain Valley National Heritage Partnership will preserve our historic resources, interpret and teach about the events that shaped our nation and will be an engine for economic growth. I am hopeful that this bill, which was considered by the Senate last year, will become law during this Congress. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I am pleased to join with my colleagues Senators Hatch, Grassley, Lincoln, and Bingaman in introducing the Medicare Physician Payment Equity Act of 2003. This bill corrects a longstanding inequity in the Medicare Part B reimbursement methodology that pays rural physicians less than what is received by physicians for more densely populated areas who provide the same exact service. I am pleased that we are able to offer a legislative solution to this payment inequity. Establishing Medicare reimbursement for physician services is a complex process and many factors go into setting rates. Without going into all of the intricacies of how fees are set, let me note that, for any specific service, the physician fee schedule has three components-- physician work, practice expenses, and the cost of malpractice insurance. Each of these components is further subjected to a geographic adjustment, which is lower for rural areas than for urban areas. In my own State of Vermont, we face a chronic shortage of doctors in our rural areas. Yet, when we need to find a physician for a rural clinic, we compete in a national market to find providers. The inequities in payments these physicians receive, however, makes it all the more difficult to recruit and retain physicians. Rural physicians have the same training, spend the same time with patients, and manage the same office pressures as their urban counterparts. Their work should be valued equally, and that is what this bill accomplishes. I've heard from many people in Vermont about this issue. Tim Thompson, M.D., President of the Vermont Medical Society, expressed his concern that while Vermonters pay the same premiums as other Americans to support the Medicare program, our doctors are paid less. This occurs without regard to the quality or efficiency of health care services they provide. In fact, according to the Center for Medicare Services, Vermont physicians provide the second highest quality care in the country, but the State is ranked forty-fourth in payments per Medicare beneficiary. We should do more to reward quality health care regardless of whether it is provided in an urban or rural setting. The Vermont Medical Society has told me that they strongly support the Medicare Physician Payment Equity Act of 2003 as an important first step in reducing the existing inequities in payment levels. I look forward to working with my colleagues to pass the Medicare Physician Payment Equity Act of 2003.

Mr. JEFFORDS

Mr. JEFFORDS. Like many of my colleagues, I am a veteran. I have the greatest respect for those who serve this Nation. I served the Naval Reserves for 30 years and was on active duty in the Navy in the 1950s. My ship, the McNair, was the first U.S. military ship to navigate the Suez Canal after the Egyptians took control of the canal in 1955. I am a member of the Veterans of Foreign Wars, the VFW. Like every Senator, I am concerned about our troops on our military bases in the States and throughout the world. I want them to have every advantage as they prepare for and engage in military conflict. However, sweeping changes to environmental laws, even with changes that are proposed during the time our country is at war, should be considered by the Environment and Public Works Committee. Our committee is charged with understanding the implications of change in these laws as well as the need for change and to weigh the consequences to public health and the environment. As our distinguished colleague who chairs the Armed Services Committee observed in a recent hearing in our Committee, these laws have taken years to put in place. However, Section 322 of S. 1050, the National Defense Authorization Act for Fiscal Year 2004 contains a provision that would change how critical habitat is designated under the Endangered Species Act, a law within the jurisdiction of the Environment and Public works Committee. Section 322 prohibits the Secretary of the Interior from designating critical habitat on any Department of Defense lands that have an integrated natural resources management plan, known as INRMP, prepared under the Sikes Act, if the Secretary determines that the plan addresses special management consideration, or protection. The INRMP provisions of the Sikes Act were never intended to be a substitute for the Endangered Species Act, but rather a complement to it. As a complementary conservation measure, INRMP is not subject to the same rigorous implementation requirements as conservation measures taken under the Endangered Species Act, such as being based on the ``best available science.'' INRMPs are often substandard compared to the ESA, and the required INRMP components under the Sikes Act cannot be universally relied upon to accomplish species conservation goals. In addition, Section 7(j) of the Endangered Species Act already allows the law's requirements to be waived, at the request of the Secretary of Defense, when national security concerns outweigh those of species conservation. To date, no Secretary of Defense has ever utilized this flexibility in the Act. Granting a blanket exemption to the ESA removes the ability for decisions to be made on a case by case basis when national security concerns are real. After hearings in the Environment and Public Works Committee both last year and this year, on this issue and the other DOD proposals within the jurisdiction of the EPW Committee, I do not believe the case has been made to warrant these changes to existing law. However, the bill before us contains a provision that would substantially change the way critical habitat is protected on Department of Defense lands. The amendment offered by myself and Senators Lautenberg and Akaka will help to ensure that important protections underlying the Endangered Species Act will not be lost under the integrated natural resource management plans developed under the Sikes Act and this Defense Authorization bill. The amendment would require that the Secretary of the Interior determine in writing that the Integrated Natural Resources Management Plan will effectively conserve the threatened and endangered species covered by the plan and assure that adequate funding is provided for the management activities. This means that if land is needed for a species and military training, the Secretary of the Interior will review the Defense Department's plan for managing the lands and funding the management activities to make sure that species will be adequately protected. The Department of Defense and the Department of the Interior have been working together to balance needs of the military for training with the needs of endangered species for survival. This amendment affirms that balance. It is my hope that the two agencies will continue to work cooperatively and I urge my colleagues to support this amendment. I yield the floor.

Mr. JEFFORDS. Madam President, I would like to talk just a minute about the need for available space for training. I was in the Navy. I was on board a destroyer. I was a gunnery officer. We were involved in wartime activity in Lebanon. Our training and all was for shore-fire bombardment. I understand what is needed and what is necessary, and I know this bill is carefully crafted to ensure there will be adequate space for the types of operations I participated in. I know our military is pretty efficient and there are areas that are designated that they cannot hit. There is always a chance they might, but they can rearrange things to make sure those areas are not in their gun sights. It is not anything that is of great difficulty to do. These are huge areas. So I think the arrangement we have under this amendment is very reasonable and, from my own experience, quite possible to keep everybody happy. So I disagree with the comments of my chairman. I yield the floor.

Mr. JEFFORDS. Madam President, I yield back the remainder of my time.

Mr. JEFFORDS. Madam President, I have no further requests for time. I see my chairman standing. I yield the floor.

Mr. JEFFORDS. About 5 minutes.

Mr. JEFFORDS. Madam President, I would like to reiterate that there is plenty of room for the training. All we ask is to make sure before that training is conducted there are studies done to make sure endangered species can be saved and they can reorient where the training is to accommodate them. The GAO found the military has presented no evidence that the Endangered Species Act has impaired training. If the DOD needs an exemption from the Endangered Species Act, sections 7(j) and 4(b)(2) provide relief from the designation of critical habitat. The DOD has never sought an exemption under 7(j). How can we say the law needs to be changed when the relief under current law has never been used? I refer the attention of my colleagues to this quote: The President has said that he wants the Federal Government to be held to the same standards of environmental cleanup as the private sector . . . so, we've [EPA] said you have got to meet the same standards as the private sector. That was Christine Todd Whitman on the Dianne Rehm show on May 21, 2003. And quoting again: I don't believe that there is a training mission anywhere in the country that is being held up or not taking place because of the environmental protection regulations. That is EPA Administrator Christine Todd Whitman's testimony before the Senate Committee on Environment and Public Works on February 26, 2003. This is a perfectly reasonable amendment. It will protect and not interfere at all with the training requirements of our Nation. I seriously counter the remarks made recently. I yield the floor.

Mr. JEFFORDS. I yield to the ranking member of the committee.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, this amendment accelerates the marriage penalty relief for low-income married couples who claim the earned- income tax credit. This marriage penalty relief was included in the 2001 tax bill but does not become fully effective until 2008. Other marriage penalty relief for the 2001 bill is accelerated as part of the bill under consideration today, but not the EITC marriage penalty relief. A copy of the Washington Post editorial of today on this issue is on your desk. The pending Senate bill accelerates the child tax credit for some in this group. But like the House version, it would provide no marriage penalty relief for EITC recipients who can face a particularly deep dip. Considering that in this situation, and two single parents each with one child, each earning $10,000, if they remain single, each receives about $2,500. If they marry, their total tax benefit falls by more than $1,000.

Mr. JEFFORDS. I urge you to look at the editorial at your desk.